Kim Do Wan, Yoo Hee Seon, Kang Wu Seong
Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju 61469, Republic of Korea.
Department of Surgery, Cheju Halla General Hospital, Jeju 63127, Republic of Korea.
Diagnostics (Basel). 2022 Nov 28;12(12):2972. doi: 10.3390/diagnostics12122972.
Hypovolemia may be underestimated due to compensatory mechanisms. In this systematic review and meta-analysis, we investigated the diagnostic accuracy of a flat inferior vena cava (IVC) on computed tomography (CT) for predicting the development of shock and mortality in trauma patients. Relevant studies were obtained by searching PubMed, EMBASE, and Cochrane databases (articles up to 16 September 2022). The number of 2-by-2 contingency tables for the index test were collected. We adopted the Bayesian bivariate random-effects meta-analysis model. Twelve studies comprising a total of 1706 patients were included. The flat IVC on CT showed 0.46 pooled sensitivity (95% credible interval [CrI] 0.32-0.63), 0.87 pooled specificity (95% CrI 0.78-0.94), and 0.78 pooled AUC (95% CrI 0.58-0.93) for the development of shock. The flat IVC for mortality showed 0.48 pooled sensitivity (95% CrI 0.21-0.94), 0.70 pooled specificity (95% CrI 0.47-0.88), and 0.60 pooled AUC (95% CrI 0.26-0.89). Regarding the development of shock, flat IVC provided acceptable accuracy with high specificity. Regarding in-hospital mortality, the flat IVC showed poor accuracy. However, these results should be interpreted with caution due to the high risk of bias and substantial heterogeneity in some included studies.
由于代偿机制，低血容量可能被低估。在这项系统评价和荟萃分析中，我们研究了计算机断层扫描（CT）上的下腔静脉（IVC）变平对预测创伤患者休克发生和死亡率的诊断准确性。通过检索PubMed、EMBASE和Cochrane数据库（截至2022年9月16日的文章）获得相关研究。收集索引测试的2×2列联表数量。我们采用贝叶斯双变量随机效应荟萃分析模型。纳入了12项研究，共1706例患者。CT上的IVC变平对休克发生的合并敏感度为0.46（95%可信区间[CrI]0.32 - 0.63），合并特异度为0.87（95%CrI 0.78 - 0.94），合并AUC为0.78（95%CrI 0.58 - 0.93）。IVC变平对死亡率的合并敏感度为0.48（95%CrI 0.21 - 0.94），合并特异度为0.70（95%CrI 0.47 - 0.88），合并AUC为0.60（95%CrI 0.26 - 0.89）。关于休克的发生，IVC变平具有较高的特异度，准确性尚可。关于院内死亡率，IVC变平显示准确性较差。然而，由于一些纳入研究存在高偏倚风险和显著异质性，这些结果应谨慎解释。
