Xie Xiaoyu, Gao Rui, Chen Hai, Zhang Xueying, Cai Xingwei, Zhang Changteng, Liu Changliang, Zhu Tao, Chen Chan
Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University and the Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China.
Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
Front Aging Neurosci. 2022 Jun 30;14:939848. doi: 10.3389/fnagi.2022.939848. eCollection 2022.
Postoperative neurocognitive disorders (PNDs) is common among surgical patients, however, the effect of glucocorticoids for preventing PNDs is not clear. This review aims to evaluate the effect of glucocorticoids on the incidence of PNDs in adult patients undergoing surgery.
The databases of PubMed/Medline, Embase, the Cochrane Library, and Web of science were searched for all available randomized controlled trials (RCTs) from inception to April 30, 2022. RCTs comparing the effect of glucocorticoids with placebo on the incidence of PNDs in adult surgical patients (≥18 years old) were eligible. Subgroup analyses and meta-regressions were performed to evaluate sources of clinical heterogeneity. The level of certainty for main outcomes were assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.
Eleven trials with a total of 10,703 patients were identified. Compared with the control group, glucocorticoids did not reduce the incidence of PNDs (RR: 0.84, 95% CI: 0.67 to 1.06, = 0.13, GRADE = moderate). Secondary analyses for primary outcome did not change the result. In addition, the length of ICU stay was decreased in glucocorticoids group (RR: -13.58, 95% CI: -26.37 to -0.80, = 0.04, GRADE = low). However, there were no significant differences between groups with regards to the incidence of postoperative infection (RR: 0.94, 95% CI: 0.84 to 1.06, = 0.30, GRADE = moderate), blood glucose level (RR: 1.05, 95% CI: -0.09 to 2.19, = 0.07, GRADE = low), duration of mechanical ventilation (RR: -2.44, 95% CI: -5.47 to 0.59, = 0.14, GRADE = low), length of hospital stay (RR: -0.09, 95% CI: -0.27 to 0.09, = 0.33, GRADE = moderate) and 30-day mortality (RR: 0.86, 95% CI: 0.70 to 1.06, = 0.16, GRADE = moderate).
This meta-analysis suggests that perioperative administration of glucocorticoids may not reduce the incidence of PNDs after surgery. The effect of glucocorticoids on decreased length of ICU stay needs further researches. Future high-quality trials using acknowledged criteria and validated diagnostic tools are needed to determine the influence of glucocorticoids on long-term PNDs.
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022302262, identifier: CRD42022302262.
术后神经认知障碍（PNDs）在外科手术患者中很常见，然而，糖皮质激素预防PNDs的效果尚不清楚。本综述旨在评估糖皮质激素对成年手术患者PNDs发生率的影响。
检索了PubMed/Medline、Embase、Cochrane图书馆和Web of science数据库，以查找从数据库建立到2022年4月30日所有可用的随机对照试验（RCT）。比较糖皮质激素与安慰剂对成年手术患者（≥18岁）PNDs发生率影响的RCT符合纳入标准。进行亚组分析和meta回归以评估临床异质性的来源。主要结局的确定性水平采用推荐分级评估、制定和评价（GRADE）方法进行评估。
共纳入11项试验，总计10703例患者。与对照组相比，糖皮质激素并未降低PNDs的发生率（风险比：0.84，95%置信区间：0.67至1.06，P = 0.13，GRADE = 中等）。对主要结局的二次分析未改变结果。此外，糖皮质激素组的重症监护病房（ICU）住院时间缩短（风险比：-13.58，95%置信区间：-26.37至-0.80，P = 0.04，GRADE = 低）。然而，两组在术后感染发生率（风险比：0.94，95%置信区间：0.84至1.06，P = 0.30，GRADE = 中等）、血糖水平（风险比：1.05，95%置信区间：-0.09至2.19，P = 0.07，GRADE = 低）、机械通气时间（风险比：-2.44，95%置信区间：-5.47至0.59，P = 0.14，GRADE = 低）、住院时间（风险比：-0.09，95%置信区间：-0.27至0.09，P = 0.33，GRADE = 中等）和30天死亡率（风险比：0.86，95%置信区间：0.70至1.06，P = 0.16，GRADE = 中等）方面无显著差异。
本meta分析表明，围手术期使用糖皮质激素可能不会降低术后PNDs的发生率。糖皮质激素对缩短ICU住院时间的作用需要进一步研究。未来需要采用公认标准和经过验证的诊断工具进行高质量试验，以确定糖皮质激素对长期PNDs的影响。
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022302262，标识符：CRD42022302262
