Department of Cardiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400025, China.
BMC Cardiovasc Disord. 2023 Jan 12;23(1):16. doi: 10.1186/s12872-022-03001-0.
Postoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery, and its occurrence is closely related to inflammation. This paper intends to apply meta-analysis to investigate the effect of glucocorticoids on POAF.
PubMed, Embase, Web of Science, and Cochrane Library were searched using the internationally recognized systematic evaluation and retrieval strategy. Two review authors independently selected relevant studies and extracted data based on the Cochrane handbook for systematic reviews of interventions approach. Stata 17 was used for data analysis. In the subgroup analysis, we grouped the participant data according to differences in glucocorticoids dose and type of surgery. At the same time, we also conducted a meta-analysis on the possible infection and gastrointestinal injury caused by glucocorticoids use.
27 studies and 14,442 patients were finally included. Results from the random-effects model indicated that the incidence of POAF was lower in glucocorticoid group (RR 0.80, 95% CI 0.71-0.92, P = 0.001). According to the subgroup analysis result, low doses of glucocorticoids reduced the incidence of POAF (RR 0.81, 95% CI 0.71-0.92, P = 0.001). The effect of high doses glucocorticoids on the POAF was not statistically significant (RR 0.81, 95% CI 0.56-1.19, P = 0.286). In the coronary artery bypass grafting (CABG) subgroup, the glucocorticoids reduced the incidence of POAF (RR 0.71, 95% CI 0.58-0.87, P = 0.001). In the CABG OR Valvular Surgery group, the effect of glucocorticoids on POAF was not statistically significant (RR 0.88, 95% CI 0.75-1.03, P = 0.108). 15 studies documented postoperative complications of infection, two studies were excluded from the system because the end point event was 0, and meta-analysis showed no increased risk of infection from glucocorticoid use (RR 0.85, 95% CI 0.68-1.06, P = 0.158). Eight studies documented the effects of glucocorticoids on gastrointestinal diseases, and meta-analysis showed no differences between the two groups (RR 1.12, 95% CI 0.83-1.50, P = 0.450).
The use of glucocorticoids can reduce the incidence of POAF. The subgroup analysis result showed that low-dose glucocorticoids were more effective than high-dose glucocorticoids in inhibiting POAF. The use of glucocorticoids in CABG alone can better inhibit the occurrence of POAF. The effects of glucocorticoids on infection and gastrointestinal injury were not statistically significant.
PROSPERO, CRD42022304521.
术后心房颤动（POAF）是心脏手术后最常见的心律失常，其发生与炎症密切相关。本文旨在应用荟萃分析研究糖皮质激素对 POAF 的影响。
使用国际公认的系统评价和检索策略，在 PubMed、Embase、Web of Science 和 Cochrane Library 中进行检索。两位综述作者独立选择相关研究，并根据 Cochrane 干预系统评价手册提取数据。使用 Stata 17 进行数据分析。在亚组分析中，我们根据糖皮质激素剂量和手术类型的差异对参与者数据进行分组。同时，我们还对糖皮质激素使用可能引起的感染和胃肠道损伤进行了荟萃分析。
最终纳入 27 项研究和 14442 名患者。随机效应模型的结果表明，糖皮质激素组 POAF 的发生率较低（RR 0.80，95%CI 0.71-0.92，P=0.001）。根据亚组分析结果，低剂量糖皮质激素可降低 POAF 的发生率（RR 0.81，95%CI 0.71-0.92，P=0.001）。高剂量糖皮质激素对 POAF 的影响无统计学意义（RR 0.81，95%CI 0.56-1.19，P=0.286）。在冠状动脉旁路移植术（CABG）亚组中，糖皮质激素降低了 POAF 的发生率（RR 0.71，95%CI 0.58-0.87，P=0.001）。在 CABG 或瓣膜手术亚组中，糖皮质激素对 POAF 的影响无统计学意义（RR 0.88，95%CI 0.75-1.03，P=0.108）。15 项研究记录了感染的术后并发症，由于终点事件为 0，有 2 项研究被排除在系统之外，荟萃分析显示糖皮质激素的使用并未增加感染的风险（RR 0.85，95%CI 0.68-1.06，P=0.158）。8 项研究记录了糖皮质激素对胃肠道疾病的影响，荟萃分析显示两组间无差异（RR 1.12，95%CI 0.83-1.50，P=0.450）。
糖皮质激素的使用可以降低 POAF 的发生率。亚组分析结果表明，与高剂量糖皮质激素相比，低剂量糖皮质激素在抑制 POAF 方面更有效。单独使用糖皮质激素进行 CABG 可更好地抑制 POAF 的发生。糖皮质激素对感染和胃肠道损伤的影响无统计学意义。
PROSPERO，CRD42022304521。
