The Presence of Diffuse Alveolar Damage on Open Lung Biopsy Is Associated With Mortality in Patients With Acute Respiratory Distress Syndrome A Systematic Review and Meta-Analysis
The Presence of Diffuse Alveolar Damage on Open Lung Biopsy Is Associated With Mortality in Patients With Acute Respiratory Distress Syndrome A Systematic Review and Meta-Analysis
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DOI：
10.1016/j.chest.2016.02.635
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发表时间：
2016-05-01
期刊：
影响因子：
9.6
通讯作者：
Thompson, B. Taylor
中科院分区：
文献类型：
--
作者：
Cardinal-Fernandez, Pablo;Bajwa, Ednan K.;Thompson, B. Taylor
目的：弥漫性肺泡损伤（DAD）被认为是ARDS的组织学标志，尽管大约一半的ARDS患者不存在DAD。与其他组织学类型相比，DAD合并ARDS综合征的临床意义尚不清楚。为了解决这个问题，我们进行了一项荟萃分析的肺活检系列患者的ARDS.METHODS：研究确定使用MEDLINE，EMBASE，科克伦注册对照试验，LILACS，和引文审查从1967年1月1日至2015年9月1日。如果研究包括以下所有内容，则纳入研究：ARDS诊断后进行的开放性肺活检（OLB）; ARDS和DAD的明确定义; OLB的组织学结果表明是否存在DAD;以及DAD和非DAD组报告的死亡率。我们排除了仅对特定组织学亚组（如DAD）进行的研究和少于5例患者的研究。结果：8篇文献中，4篇为高质量文献（n = 228），4篇为中等质量文献（n = 122）。各组之间DAD的Meta比例为0.45（95%CI，0.35-0.56; Q检验，21.1; I2，66.8%; P
OBJECTIVE: Diffuse alveolar damage (DAD) is considered the histologic hallmark of ARDS although DAD is absent in approximately half of patients with ARDS. The clinical implications of having the syndrome of ARDS with DAD vs other histologic patterns is unknown. To address this question, we conducted a meta-analysis of lung biopsy series for patients with ARDS.METHODS: Studies were identified using MEDLINE, EMBASE, Cochrane Register of Controlled Trials, LILACS, and citation review from January 1, 1967, to September 1, 2015. Studies were included if they included all of the following: open lung biopsies (OLB) performed after ARDS diagnosis; a clear definition of ARDS and DAD; histologic results of the OLB indicated the presence or absence of DAD; and mortality reported for the DAD and non-DAD groups. We excluded studies conducted solely on a specific histology subgroup (eg, DAD) and studies with fewer than 5 patients. Two authors independently selected studies for inclusion, and there were no language restrictions.RESULTS: Of 8 included studies, 4 were high-quality (n = 228) and 4 were middle-quality trials (n = 122). The meta proportion of DAD between all the groups was 0.45 (95% CI, 0.35-0.56; Q test, 21.1; I2, 66.8%; P