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Association of body mass index and all-cause mortality in patients after cardiac surgery: A dose-response meta-analysis.
Liu, X, Xie, L, Zhu, W, Zhou, Y
Nutrition (Burbank, Los Angeles County, Calif.). 2020;:110696
Abstract
Ample studies have reported the effect of body mass index (BMI) on the prognosis of patients undergoing cardiac surgery, but the results remain inconsistent. Therefore, we aimed to conduct a dose-response meta-analysis to clarify the relationship between BMI and all-cause mortality in this population. A systematic search was performed in the PubMed and Embase databases through April 2019 for studies that reported the impact of BMI on all-cause mortality in patients after cardiac surgery. Pooled risk ratios (RRs) were calculated using a random-effects model. Non-linear associations were explored with restricted cubic spline models. Forty-one studies with a total of 54,300 cases/1,774,387 patients were included. The pooled RR for all-cause mortality was 0.93 (95% CI 0.89-0.97) for every 5-unit increment in BMI, indicating that higher BMI did not increase the risk of all-cause mortality in patients after cardiac surgery. A U-shaped association with the nadir of risk at a BMI of 25-27.5 kg/m2 was observed, as well as a higher mortality risk for the underweight and the extremely obese patients. The subgroup analysis revealed that this phenomenon remained regardless of mean age, surgery type, geographic location and number of cases. Overall, for patients after cardiac surgery, a slightly higher BMI may be instrumental in survival, whereas underweight and extreme obesity is associated with a worse prognosis.
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Efficacy of N-Acetylcysteine in Preventing Acute Kidney Injury After Cardiac Surgery: A Meta-Analysis Study.
Mei, M, Zhao, HW, Pan, QG, Pu, YM, Tang, MZ, Shen, BB
Journal of investigative surgery : the official journal of the Academy of Surgical Research. 2018;(1):14-23
Abstract
PURPOSE To evaluate whether perioperative N-acetylcysteine (NAC) administration reduces the risk of cardiac surgery associated acute kidney injury (CSA-AKI). MATERIALS AND METHODS A systematic literature review (Medline, PubMed, Cochrane, Biomedical central, Google Scholar) identified 10 studies (1391 patients; 695 NAC and 696 placebo) that compared the efficacy and adverse effects of perioperative NAC administration for CSA-AKI prevention in adults undergoing elective cardiac surgery. Meta-analysis was performed using Comprehensive Meta-Analysis statistical software. RESULTS Patients in the NAC-treated and placebo groups had similar rate of CSA-AKI occurrence, change in creatinine levels, as well as the in-hospital mortality rate (RR = 0.841, 95% CI = 0.691 to 1.023, p = 0.083; pooled difference in means = -0.328, 95% CI = -0.712 to 0.056, p = 0.094; RR = 0.741, 95% CI = 0.388 to 1.418, p = 0.366, respectively). CONCLUSIONS Our study does not support perioperative NAC administration as a mean to reduce the risk of CSA-AKI.
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Sole and combined vitamin C supplementation can prevent postoperative atrial fibrillation after cardiac surgery: A systematic review and meta-analysis of randomized controlled trials.
Shi, R, Li, ZH, Chen, D, Wu, QC, Zhou, XL, Tie, HT
Clinical cardiology. 2018;(6):871-878
Abstract
We undertook a systematic review and meta-analysis to evaluate the effect of vitamin C supplementation (vitamin C solely or as adjunct to other therapy) on prevention of postoperative atrial fibrillation (POAF) in patients after cardiac surgery. PubMed, Embase, Web of Science, and Cochrane Library were systematically searched to identify randomized controlled trials assessing the effect of vitamin C supplementation in adult patients undergoing cardiac surgery, and the meta-analysis was performed with a random-effects model. Thirteen trials involving 1956 patients were included. Pooling estimate showed a significantly reduced incidence of POAF (relative risk [RR]: 0.68, 95% confidence interval [CI]: 0.54 to 0.87, P = 0.002) both in vitamin C alone (RR: 0.75, 95% CI: 0.63 to 0.90, P = 0.002) and as an adjunct to other therapy (RR: 0.32, 95% CI: 0.20 to 0.53, P < 0.001). The results remain stable and robust in subgroup and sensitivity analyses, and trial sequential analysis also confirmed that the evidence was sufficient and conclusive. Additionally, vitamin C could significantly decrease intensive care unit length of stay (weighted mean difference: -0.24 days, 95% CI: -0.45 to -0.03, P = 0.023), hospital length of stay (weighted mean difference: -0.95 days, 95% CI: -1.64 to -0.26, P = 0.007), and risk of adverse events (RR: 0.45, 95% CI: 0.21 to 0.96, P = 0.039). Use of vitamin C alone and as adjunct to other therapy can prevent POAF in patients undergoing cardiac surgery and should be recommended for patients receiving cardiac surgery for prevention of POAF.
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Levosimendan in patients with left ventricular dysfunction undergoing cardiac surgery: a meta-analysis and trial sequential analysis of randomized trials.
Xing, Z, Tang, L, Chen, P, Huang, J, Peng, X, Hu, X
Scientific reports. 2018;(1):7775
Abstract
Patients with left ventricular dysfunction (LVD) undergoing cardiac surgery have a high mortality rate. Levosimendan, a calcium sensitizer, improves myocardial contractility without increasing myocardial oxygen demand. It is not clear whether levosimendan can reduce mortality in cardiac surgery patients with LVD. The PubMed, Embase, and Cochrane Central databases were searched to identify randomized trials comparing levosimendan with conventional treatment in cardiac surgery patients with LVD. We derived pooled risk ratios (RRs) with random effects models. The primary endpoint was perioperative mortality. Secondary endpoints were renal replacement treatment, atrial fibrillation, myocardial infarction, ventricular arrhythmia, and hypotension. Fifteen studies enrolling 2606 patients were included. Levosimendan reduced the incidence of perioperative mortality (RR: 0.64, 95%CI: 0.45-0.91) and renal replacement treatment (RR:0.71, 95%CI:0.52-0.95). However, sensitivity analysis, subgroup analysis and Trial Sequential Analysis (TSA) indicated that more evidence was needed. Furthermore, levosimendan did not reduce the incidence of atrial fibrillation (RR:0.82, 95%CI:0.64-1.07), myocardial infarction (RR:0.56, 95%CI:0.26-1.23), or ventricular arrhythmia (RR:0.74, 95%CI:0.49-1.11), but it increased the incidence of hypotension (RR:1.11,95%CI:1.00-1.23). There was not enough high-quality evidence to either support or contraindicate the use of levosimendan in cardiac surgery patients with LVD.
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N-Acetylcysteine for Preventing of Acute Kidney Injury in Chronic Kidney Disease Patients Undergoing Cardiac Surgery: A Metaanalysis.
He, G, Li, Q, Li, W, Wang, L, Yang, J, Zeng, F
The heart surgery forum. 2018;(6):E513-E521
Abstract
OBJECTIVE The aim of this study was to determine whether N-acetylcysteine (NAC) has an effect on acute kidney injury (AKI) in chronic kidney disease patients undergoing cardiac surgery. METHODS We reviewed literature through PubMed, Medline through PubMed and OVID, The Cochrane Library, Wan Fang Database, China Biology Medicine Database, Chinese Periodical Database, China Knowledge Resource Integrated Database, and Chinese Clinical Trial Registry (1980 to July 10, 2018). Two investigators independently collected the data and assessed the quality of each study. RevMan 5.3 was used for the present metaanalysis. RESULTS A total of 5 RCTs (N = 678 participants) were included in the primary analysis. Pooled analysis showed that intravenous infusion of NAC significantly reduced the incidence of AKI (RR = 0.77, 95% = 0.63 to 0.94, P < .01) and that NAC could decrease the adverse cardiac events (RR = 0.83, 95% = 0.70 to 0.97, P < .05), but that it may increase the length of stay in the ICU (mean difference [MD] = 2.1, 95% CI = 1.61 to 2.60, P < .01). There were no statistically significant differences between the 2 groups in the requirement for renal replacement therapy(RRT) (RR = 1.33, 95% = 0.63 to 2.81, P = .45) and all-cause mortality (RR = 0.51, 95% = 0.25 to 1.06, P = .07). CONCLUSION Our study shows that intravenous infusion of NAC could prevent postoperative AKI in preexisting-renal-failure patients undergoing cardiac surgery.
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Preoperative Use of Oral Beta-Adrenergic Blocking Agents and the Incidence of New-Onset Atrial Fibrillation After Cardiac Surgery. A Systematic Review and Meta-Analysis.
Thein, PM, White, K, Banker, K, Lunny, C, Mirzaee, S, Nasis, A
Heart, lung & circulation. 2018;(3):310-321
Abstract
BACKGROUND Current epidemiological data suggests that postoperative atrial fibrillation or atrial flutter (POAF) causes significant morbidity and mortality after cardiac surgery. The literature for prophylactic management of POAF is limited, resulting in the lack of clear guidelines on management recommendations. AIM: To examine the efficacy of prophylactic rate control agents in reducing the incidence of new-onset POAF in patients undergoing elective cardiac surgery. METHODS Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Medline were systematically searched for blinded randomised controlled studies (RCT) evaluating adults with no history of atrial fibrillation randomised to a pharmacological agent (either beta blocker, calcium channel blocker or digoxin), compared to placebo. Utilising Cochrane guidance, three reviewers screened, extracted and the quality of the evidence was assessed. We used a random effects meta-analysis to compare a rate-control agent with placebo. RESULTS Five RCTs (688 subjects, mean age 61±8.9, 69% male) were included. Beta blocker administration prior to elective cardiac surgery significantly reduced the incidence of POAF (OR 0.43, 95%Cl [0.30-0.61], I2=0%) without significant impact on ischaemic stroke (OR 0.49, 95%Cl [0.10-2.44], I2=0%), non-fatal myocardial infarction (OR 0.76, 95%Cl [0.08-7.44], I2=0%), overall mortality (OR 0.83, 95%Cl [0.19-3.66], I2=0%), or length of stay (mean -0.96days 95%Cl [-1.49 to -0.42], I2=0%). An increased rate of bradycardic episodes was observed (OR 3.53, 95%Cl [1.22-10.23], I2=0%). CONCLUSIONS This review suggests that selective administration of prophylactic oral beta blockers prior to elective cardiac surgery is safe and may reduce the incidence of POAF.
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Preoperative Statin Treatment for the Prevention of Acute Kidney Injury in Patients Undergoing Cardiac Surgery: A Meta-Analysis of Randomised Controlled Trials.
Xiong, B, Nie, D, Cao, Y, Zou, Y, Yao, Y, Qian, J, Rong, S, Huang, J
Heart, lung & circulation. 2017;(11):1200-1207
Abstract
BACKGROUND The effect of preoperative statin treatment (PST) on the risk of postoperative acute kidney injury (AKI) after cardiac surgery remains controversial. We performed a meta-analysis of randomised controlled trials (RCT) to investigate whether PST could improve the renal outcomes in patients undergoing cardiac surgery. METHODS We conducted a comprehensive search on PubMed, Embase and Cochrane Central Register of Controlled Trials. Randomised controlled trials which reported incidence of AKI and renal replacement treatment (RRT), mean change of serum creatine (SCr) and C-reactive protein (CRP), length of stay in intensive care unit (LOS-ICU) and hospital (LOS-HOS) were included. RESULTS A total of nine RCTs, covering 3,201 patients were included. Based on the results of our meta-analysis, PST could not reduce the incidence of AKI (risk ratio (RR) 1.12, 95% confidence interval (CI) 0.97 to 1.29, p=0.37), and RRT (RR 1.13, 95% CI 0.45 to 2.85, p=0.80). Furthermore, SCr was not likely to be improved by PST (weighted mean difference (WMD) 0.03, 95% CI 0.00 to 0.06, p=0.055). However, the level of CRP (WMD -5.93, 95% CI 11.71 to 0.15, p=0.044) in patients treated with PST was significantly lower than that of patients administered with placebo. In addition, no significant difference was observed in LOS-ICU and LOS-HOS between PST and control groups. CONCLUSION Our meta-analysis suggests that PST cannot provide any benefit for improving renal complications and clinical outcomes, but may slightly reduce postoperative inflammation in patients undergoing cardiac surgery. In the future, more powerful RCTs will be needed to confirm these findings.
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Meta-analysis of ascorbic acid for prevention of postoperative atrial fibrillation after cardiac surgery.
Baker, WL, Coleman, CI
American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists. 2016;(24):2056-2066
Abstract
PURPOSE Results of a systematic review and meta-analysis of published data on use of ascorbic acid to prevent postoperative atrial fibrillation (POAF) after cardiac surgery are presented. METHODS MEDLINE and other sources were searched for reports on trials evaluating the effects of preoperative and/or postoperative use of ascorbic acid in patients undergoing cardiac surgery. For each study selected for meta-analysis, an assessment for risks of methodological bias was performed. Data on POAF frequency and length of stay (LOS) outcomes were pooled and analyzed via random-effects modeling. RESULTS The 11 identified studies involved patients receiving coronary artery bypass grafts with or without valve replacement; both i.v. and oral ascorbic acid formulations were used. Analysis of pooled outcomes data on treatment and control groups indicated that ascorbic acid prophylaxis was associated with reductions in POAF frequency (odds ratio, 0.44; 95% confidence interval [CI], 0.32 to 0.61), intensive care unit (ICU) LOS (difference in means, -0.24 day; 95% CI, -0.45 to -0.03 day), and total hospital LOS (difference in means, -0.94 day; 95% CI, -1.65 to -0.23 day). Significant statistical, methodological, and clinical heterogeneity were observed. CONCLUSION A meta-analysis revealed that, compared with use of a placebo or a nonplacebo control, perioperative administration of ascorbic acid to patients undergoing cardiac surgery was associated with a reduced frequency of POAF and a shorter ICU LOS and total hospital LOS.
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Neurodevelopmental delay with critical congenital heart disease is mainly from prenatal injury not infant cardiac surgery: current evidence based on a meta-analysis of functional magnetic resonance imaging.
Li, Y, Yin, S, Fang, J, Hua, Y, Wang, C, Mu, D, Zhou, K
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2015;(6):639-48
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Abstract
OBJECTIVE No consensus has been reached regarding whether brain injury related to congenital heart disease (CHD) is caused by infant cardiac surgery and/or prenatal injury resulting from the CHD. We performed this meta-analysis to identify the likely cause of neurodevelopmental delay in CHD patients. METHODS We carried out a literature search without language restriction in December 2013, retrieving records from PubMed, EMBASE, the Cochrane Library and the World Health Organization trials center, to identify studies applying functional magnetic resonance imaging (fMRI) evaluation of brain function before surgery and, in some cases, after surgery (both immediate term and short term postoperatively). The preoperative and postoperative fMRI results were extracted, and meta-analysis was performed using Revman 5.1.1 and STATA 11.0, according to the guidelines from the Cochrane review and MOOSE groups. RESULTS The electronic search yielded 937 citations. Full text was retrieved for 15 articles and eight articles (nine studies) were eligible for inclusion: six studies (n = 312 cases) with fMRI analysis before surgery and three (n = 36 cases) with complete perioperative fMRI analysis. The overall average diffusivity of CHD cases was significantly higher than that of controls, with a summarized standard (std) mean difference of 1.39 (95% CI, 0.70-2.08), and the fractional anisotropy was lower in CHD cases, with a summarized mean difference of -1.43 (95% CI, -1.95 to -0.91). N-acetylaspartate (NAA)/choline (Cho) for the whole brain was significantly lower in CHD cases compared with healthy ones, while lactate/Cho was significantly higher in CHD cases. Immediate term postoperatively, significant changes in NAA/creatine and NAA/Cho, relative to preoperative values, were found. However, the difference did not persist at the short-term follow-up. CONCLUSION This meta-analysis suggests that the delay in neurological development in newborns with CHD is due mainly to prenatal injury, and cardiac surgery might lead to mild brain injuries postoperatively, but fMRI shows recovery within a short period.
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Sodium bicarbonate and renal function after cardiac surgery: a prospectively planned individual patient meta-analysis.
Bailey, M, McGuinness, S, Haase, M, Haase-Fielitz, A, Parke, R, Hodgson, CL, Forbes, A, Bagshaw, SM, Bellomo, R
Anesthesiology. 2015;(2):294-306
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Abstract
BACKGROUND The effect of urinary alkalinization in cardiac surgery patients at risk of acute kidney injury (AKI) is controversial and trial findings conflicting. Accordingly, the authors performed a prospectively planned individual patient data meta-analysis of the double-blind randomized trials in this field. METHODS The authors studied 877 patients from three double-blind, randomized controlled trials enrolled to receive either 24 h of intravenous infusion of sodium bicarbonate or sodium chloride. The primary outcome measure was a postoperative increase in serum creatinine concentration of greater than 25% or 0.5 mg/dl (> 44 μM/L) within the first five postoperative days. Secondary outcomes included the raw change in serum creatinine, greater than 50% and greater than 100% rises in serum creatinine, developing AKI (Acute Kidney Injury Network criteria), initiation of renal replacement therapy, morbidity, and mortality. RESULTS Patients were similar in demographics, comorbidities, and cardiac procedures. Sodium bicarbonate increased plasma bicarbonate (P < 0.001) and urine pH (P < 0.001). There were no differences in the development of the primary outcome (Bicarbonate 45% [39-51%] vs. Saline 42% [36-48%], P = 0.29). This result remained unchanged when controlling for study and covariates (odds ratio [OR], 99% confidence interval [CI]: Bicarbonate vs. Control, 1.11 [0.77-1.60], P = 0.45). There was, however, a significant study-adjusted benefit in elective coronary artery bypass surgery patients in terms of renal replacement therapy (Bicarbonate vs. Control, OR: 0.38 [99% CI: 0.25-0.58], P < 0.0001) and the development of an Acute Kidney Injury Network grade = 3 (Bicarbonate vs. Control, OR: 0.45 [99% CI: 0.43-0.48], P < 0.0001). CONCLUSIONS Urinary alkalinization using sodium bicarbonate infusion is not associated with an overall lower incidence of AKI; however, it reduces severe AKI and need for renal replacement therapy in elective coronary artery bypass patients.