Wang Mengqin, Tong Mengqi, Tian Zhaoxing
National Institution Office of Clinical Trials, Beijing Jishuitan (JST) Hospital, Capital Medical University, Beijing 100035, China.
Intensive Care Unit, Jishuitan (JST) Hospital, Capital Medical University, Beijing 100035, China.
Am J Emerg Med. 2024 May;79:127-135. doi: 10.1016/j.ajem.2024.01.041. Epub 2024 Feb 3.
Prolonged capillary refill time (CRT) is an indicator of poor peripheral perfusion. The aim of the systematic review and meta-analysis was to evaluate the association of prolonged CRT and mortality of critically ill patients.
To achieve the objective of this meta-analysis, we conducted a thorough search of PubMed, Embase, Cochrane Library, and the Web of Science to identify relevant observational studies with longitudinal follow-up. The Cochrane Q test was utilized to assess between-study heterogeneity, and the I statistic was calculated to estimate the degree of heterogeneity. We employed random-effects models to combine the outcomes, considering the potential influence of heterogeneity.
Eleven studies, encompassing 11,659 critically ill patients were included. During follow-up durations within hospitalization to 3 months, 1247 (10.7%) patients died. The pooled results indicated that a prolonged CRT at early phase of admission was significantly associated with an increased risk of all-cause mortality (risk ratio [RR]: 1.73, 95% confidence interval [CI]: 1.39 to 2.16, p < 0.001; I = 60%). Subgroup analyses showed that the association was not significantly modified by study design (prospective or retrospective), etiology of diseases (infection, non-infection, or mixed), or cutoff of CRT (>3 s, 3.5 s, or 4 s). The association between CRT and mortality was weaker in studies with multivariate analysis (RR: 1.43, 95% CI: 1.27 to 1.60, p < 0.001; I = 0%) as compared to that derived from studies of univariate analysis (RR: 6.27, 95% CI: 3.29 to 11.97, p < 0.001; I = 0%).
Prolonged CRT at admission may be a predictor of increased short-term mortality of critically ill patients.
毛细血管再充盈时间（CRT）延长是外周灌注不良的一个指标。本系统评价和荟萃分析的目的是评估CRT延长与危重症患者死亡率之间的关联。
为实现本荟萃分析的目标，我们全面检索了PubMed、Embase、Cochrane图书馆和科学网，以识别有纵向随访的相关观察性研究。采用Cochrane Q检验评估研究间的异质性，并计算I统计量以估计异质性程度。考虑到异质性的潜在影响，我们采用随机效应模型合并结果。
纳入了11项研究，共11659例危重症患者。在住院至3个月的随访期间，1247例（10.7%）患者死亡。汇总结果表明，入院早期CRT延长与全因死亡率增加显著相关（风险比[RR]：1.73，95%置信区间[CI]：1.39至2.16，p<0.001；I=60%）。亚组分析表明，研究设计（前瞻性或回顾性）、疾病病因（感染、非感染或混合）或CRT的截断值（>3秒、3.5秒或4秒）对该关联无显著影响。与单变量分析的研究结果（RR：6.27，95%CI：3.29至11.97，p<0.001；I=0%）相比，多变量分析的研究中CRT与死亡率之间的关联较弱（RR：1.43，95%CI：1.27至1.60，p<0.00一；I=0%）。
入院时CRT延长可能是危重症患者短期死亡率增加的一个预测指标。
