Meta-Analysis Comparing Torsemide Versus Furosemide in Patients With Heart Failure
Meta-Analysis Comparing Torsemide Versus Furosemide in Patients With Heart Failure
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DOI：
10.1016/j.amjcard.2019.09.039
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发表时间：
2020-01-01
影响因子：
2.8
通讯作者：
Sharma, Rajaninder
中科院分区：
文献类型：
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作者：
Abraham, Bishoy;Megaly, Michael;Sharma, Rajaninder
尽管托拉塞米的口服生物利用度和半衰期理论上使其成为比呋塞米更有效的利尿剂，但托拉塞米与呋塞米相比的临床结果仍不明确。我们进行了一项系统综述和荟萃分析，纳入了1996年1月至2019年8月期间所有已发表的关于心力衰竭患者使用托拉塞米和呋塞米比较的研究。共纳入19项研究（9项随机对照试验[RCT]和10项观察性研究），总计19280名患者。在平均15个月的随访期间，与呋塞米相比，托拉塞米因心力衰竭住院的风险在数值上较低（10.6%对18.4%；优势比[OR]为0.72，95%置信区间[CI]为[0.51, 1.03]，p = 0.07，I² = 18%；需治疗人数[NNT] = 23）。托拉塞米与从纽约心脏协会（NYHA）III/IV级到I/II级功能状态的改善在统计学上更显著相关（72.5%对58%；OR为2.32，95%CI为(1.32, 4.1)，p = 0.004，I² = 27%；NNT = 5），并且心脏死亡风险更低（1.5%对4.4%；OR为0.37，95%CI为(0.20, 0.66)，p……（此处原文似乎不完整）
Although torsemide's oral bioavailability and half-life theoretically render it a more efficient diuretic than furosemide, the clinical outcomes of torsemide compared with furosemide remain unclear. We performed a systematic review and meta-analysis, including all published studies that compared torsemide and furosemide use in heart failure patients from January 1996 through August 2019. Nineteen studies (9 randomized control trials [RCTs] and 10 observational studies) with a total of 19,280 patients were included. During a mean follow-up duration of 15 months, torsemide was associated with a numerically lower risk of hospitalization due to heart failure (10.6% vs 18.4%; odds ratio [OR] 0.72, 95% confidence interval [CI] [0.51, 1.03], p = 0.07, I-2 = 18%; number needed to treat [NNT] = 23) compared with furosemide. Torsemide was associated with statistically significant more improvement in functional status from New York Heart Association (NYHA) class III/IV to I/II (72.5% vs 58%; OR 2.32, 95% CI (1.32, 4.1), p = 0.004, I-2 = 27%; NNT = 5) and lower risk of cardiac mortality (1.5% vs 4.4%; OR 0.37, 95% CI (0.20, 0.66), p