GI bleeding in patients with continuous-flow left ventricular assist devices: a systematic review and meta-analysis
GI bleeding in patients with continuous-flow left ventricular assist devices: a systematic review and meta-analysis
复制标题
DOI：
10.1016/j.gie.2014.03.040
复制
发表时间：
2014-09-01
影响因子：
7.7
通讯作者：
Gerson, Lauren B.
中科院分区：
文献类型：
--
作者：
Draper, Karen V.;Huang, Robert J.;Gerson, Lauren B.
背景资料：左心室辅助装置（LVADs）的患者是在增加风险的胃肠道出血（GIB），主要是从胃肠道血管发育不良病变（GIAD）。目的：进行荟萃分析的医学文献，以确定患病率和危险因素GIB.Design：进行文献检索，以确定研究报告GIB在LVAD患者。我们从每项研究中提取了患病率、再出血率和总死亡率。计算合并事件发生率和比值比（OR）及其95%置信区间（CI）。设置：荟萃分析17例病例对照和队列研究。患者：共1839例LVAD患者，其中1697例（92%）采用连续流LVADs.Results：LVAD患者GIB的合并患病率为23%（95%CI，20.5%-27%）。亚组分析表明，年龄较大（平均值标准差（SDm），0.69; 95% CI，0.23-1.15）和肌酐升高（SDm，0.65; 95% CI，0.12-1.18，P = 0.02）与GIB相关。与GIB无关的风险因素包括LVAD作为目标治疗（OR 1.85; 95% CI，0.8-4.3）、GIB既往史（OR 2.22; 95% CI，0.83-5.96）、高血压（OR 1.6; 95% CI，0.87-2.97）和/或存在连续流LVAD（OR 4.5; 95% CI，2.1-9.5）。GIB复发率为9.3%（95%CI，7%-12%），GIB死亡率为23%（95%CI，16%-32%）。上GIB、下GIB和小肠出血的汇总事件发生率分别为48%（95% CI，39%-57%）、22%（95% CI，16%-31%）和15%（95% CI，8%-25%）。GIAD在近端胃肠道是最常见的原因GIB（29%）。局限性：缺乏有关内镜治疗和后续的信息在大多数study.Conclusions：GIB的患病率增加的患者连续流LVADs，主要继发于GIAD的存在。
Background: Patients with left ventricular assist devices (LVADs) are at increased risk of GI bleeding (GIB), primarily from GI angiodysplastic lesions (GIAD).Objective: To perform meta-analysis of the medical literature in order to determine prevalence and risk factors for GIB.Design: A literature search was performed to identify studies reporting GIB in LVAD patients. We extracted rates of prevalence, rebleeding, and overall mortality from each study. Pooled event rates and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.Setting: Meta-analysis of 17 case-control and cohort studies.Patients: A total of 1839 LVAD patients of whom 1697 (92%) had continuous-flow LVADs.Results: The pooled prevalence of GIB in LVAD patients was 23% (95% CI, 20.5%-27%). Subgroup analysis demonstrated that older age (standard difference in means (SDm), 0.69; 95% CI, 0.23-1.15), and elevated creatinine (SDm, 0.65; 95% CI, 0.12-1.18, P = .02) were associated with GIB. Risk factors not associated with GIB included LVAD as destination therapy (OR 1.85; 95% CI, 0.8-4.3), prior history of GIB (OR 2.22; 95% CI, 0.83-5.96), hypertension (OR 1.6; 95% CI, 0.87-2.97), and/or the presence of a continuous-flow LVAD (OR 4.5; 95% CI, 2.1-9.5). Recurrence of GIB occurred in 9.3% (95% CI, 7%-12%), with a GIB mortality rate of 23% (95% CI, 16%-32%). The pooled event rates were 48% (95% CI, 39%-57%) for upper GIB, 22% (95% CI, 16%-31%) for lower GIB, and 15% (95% CI, 8%-25%) for small-bowel bleeding. GIAD in the proximal GI tract were the most common cause of GIB (29%).Limitations: Lack of information regarding endoscopic therapy and follow-up in most studies.Conclusions: The prevalence of GIB is increased in patients with continuous-flow LVADs, primarily secondary to the presence of GIAD.