Charkviani Mariam, Truong Hong Hieu, Nikravangolsefid Nasrin, Ninan Jacob, Prokop Larry J, Reddy Swetha, Kashani Kianoush B, Domecq Garces Juan Pablo
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Crit Care Explor. 2024 Feb 12;6(2):e1054. doi: 10.1097/CCE.0000000000001054. eCollection 2024 Feb.
Conduct a systematic review and meta-analysis to assess prevalence and timing of acute kidney injury (AKI) development after acute respiratory distress syndrome (ARDS) and its association with mortality.
Ovid MEDLINE(R), Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, Ovid PsycINFO database, Scopus, and Web of Science thought April 2023.
Titles and abstracts were screened independently and in duplicate to identify eligible studies. Randomized controlled trials and prospective or retrospective cohort studies reporting the development of AKI following ARDS were included.
Two reviewers independently extracted data using a pre piloted abstraction form. We used Review Manager 5.4 software (Cochrane Library, Oxford, United Kingdom) and Open Meta software (Brown University, Providence, RI) for statistical analyses.
Among the 3646 studies identified and screened, 17 studies comprising 9359 ARDS patients met the eligibility criteria and were included in the meta-analysis. AKI developed in 3287 patients (40%) after the diagnosis of ARDS. The incidence of AKI at least 48 hours after ARDS diagnosis was 20% (95% CI, 0.18-0.21%). The pooled risk ratio (RR) for the hospital (or 30-d) mortality among ARDS patients who developed AKI was 1.93 (95% CI, 1.71-2.18). AKI development after ARDS was identified as an independent risk factor for mortality in ARDS patients, with a pooled odds ratio from multivariable analysis of 3.69 (95% CI, 2.24-6.09). Furthermore, two studies comparing mortality between patients with late vs. early AKI initiation after ARDS revealed higher mortality in late AKI patients with RR of 1.46 (95% CI, 1.19-1.8). However, the certainty of evidence for most outcomes was low to very low.
While our findings highlight a significant association between ARDS and subsequent development of AKI, the low to very low certainty of evidence underscores the need for cautious interpretation. This systematic review identified a significant knowledge gap, necessitating further research to establish a more definitive understanding of this relationship and its clinical implications.
进行系统评价和荟萃分析，以评估急性呼吸窘迫综合征（ARDS）后急性肾损伤（AKI）的发生率、发生时间及其与死亡率的关联。
截至2023年4月的Ovid MEDLINE（R）、Ovid Embase、Ovid Cochrane对照试验中心注册库、Ovid Cochrane系统评价数据库、Ovid PsycINFO数据库、Scopus和Web of Science。
对标题和摘要进行独立的双人筛选，以确定符合条件的研究。纳入报告ARDS后发生AKI的随机对照试验以及前瞻性或回顾性队列研究。
两名研究者使用预先试点的提取表独立提取数据。我们使用Review Manager 5.4软件（英国牛津Cochrane图书馆）和Open Meta软件（美国罗德岛普罗维登斯布朗大学）进行统计分析。
在识别和筛选出的3646项研究中，17项研究（共9359例ARDS患者）符合纳入标准并被纳入荟萃分析。3287例患者（40%）在ARDS诊断后发生AKI。ARDS诊断后至少48小时发生AKI的发生率为20%（95%CI，0.18 - 0.21%）。发生AKI的ARDS患者的住院（或30天）死亡率的合并风险比（RR）为1.93（95%CI，1.71 - 2.18）。ARDS后发生AKI被确定为ARDS患者死亡的独立危险因素，多变量分析的合并比值比为3.69（95%CI，2.24 - 6.09）。此外，两项比较ARDS后晚期与早期发生AKI患者死亡率的研究显示，晚期AKI患者的死亡率更高，RR为1.46（95%CI，1.19 - 1.8）。然而，大多数结果的证据确定性为低至极低。
虽然我们的研究结果突出了ARDS与随后发生AKI之间的显著关联，但证据确定性低至极低强调了谨慎解读的必要性。这项系统评价发现了一个重大的知识空白，需要进一步研究以更明确地了解这种关系及其临床意义。
