The prognostic importance of a small acute decrement in kidney function in hospitalized patients: A systematic review and meta-analysis
The prognostic importance of a small acute decrement in kidney function in hospitalized patients: A systematic review and meta-analysis
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DOI：
10.1053/j.ajkd.2007.07.018
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发表时间：
2007-11-01
影响因子：
13.2
通讯作者：
Parikh, Chirag R.
中科院分区：
文献类型：
--
作者：
Coca, Steven G.;Peixoto, Aldo J.;Parikh, Chirag R.
背景资料：最近，急性肾损伤（定义为血清肌酐水平的微小变化）与更差的短期结果相关;然而，这种相关性的精确性和可变性还没有完全探讨。研究设计：系统综述和荟萃分析。设置和参与者：住院患者。研究选择标准：在MEDLINE和EMBASE数据库中检索1990年至2007年2月发表的观察性队列研究和随机对照试验，血清肌酐水平的微小变化。预测因子：血清肌酐水平的绝对值和血清肌酐水平变化的百分比的微小急性变化（血清肌酐增加< 0.5 mg/dL或< 25%的较低阈值）。结果：与对照组相比，肌酐水平升高10%至24%的患者的死亡相对风险（FIR）为1.8（95%置信区间[CI]，1.3至2.5）。相比之下，肌酐水平急性变化25%-49%的受试者死亡FIR为3.0（95% CI，1.6 - 5.8），变化最大（>= 50%）的受试者死亡RR最高（RR，6.9; 95% CI，2.0 - 24.5）。结果是相似的，当肌酐水平的绝对变化被认为是调整后的RR汇总估计used.Limitations：个别患者的数据不可用，因此，只有组水平的数据汇总荟萃分析。结果表明，一个显着程度的统计异质性，只有部分改善了分离的研究，根据临床setting.Conclusions的子集：短期死亡率和急性肾功能下降相关的分级关系，即使是轻微的变化，血清肌酐水平预示着更糟糕的结果在各种临床环境和患者类型。
Background: Recently, acute kidney injury defined by small changes in serum creatinine levels was associated with worse short-term outcomes; however, the precision and variability of this association was not fully explored.Study Design: Systematic review and meta-analysis.Setting & Participants: Hospitalized patients.Selection Criteria for Studies: MEDLINE and EMBASE databases were searched for observational cohort studies and randomized controlled trials published from 1990 through February 2007 that provided information for small changes in serum creatinine levels.Predictor: Small acute changes in serum creatinine levels by absolute and percentage of changes in serum creatinine levels (lower threshold for increase in serum creatinine < 0.5 mg/dL or < 25%).Outcome: Short-term mortality (:! 30 days).Results: Compared with controls, patients with a 10% to 24% increase in creatinine levels had a relative risk (FIR) of death of 1.8 (95% confidence interval [CI], 1.3 to 2.5). By comparison, subjects with a 25% to 49% acute change in creatinine levels had an FIR of death of 3.0 (95% Cl, 1.6 to 5.8), and those with the largest change (>= 50%) had the greatest RR of death (RR, 6.9; 95% Cl, 2.0 to 24.5). Results were similar when absolute changes in creatinine levels were considered and when pooled estimates of adjusted RR were used.Limitations: Individual patient data were unavailable; thus, only group-level data were pooled for meta-analysis. Results showed a significant degree of statistical heterogeneity that was only partially ameliorated by separating studies into subsets based on clinical setting.Conclusions: Short-term mortality and acute decreases in renal function are associated through a graded relationship such that even mild changes in serum creatinine levels portend worse outcome in a variety of clinical settings and patient-types.