1.
Risk Factors for Central Venous Access Device-Related Thrombosis in Hospitalized Children: A Systematic Review and Meta-Analysis.
Tian, L, Li, W, Su, Y, Gao, H, Yang, Q, Lin, P, Wang, L, Zeng, J, Li, Y
Thrombosis and haemostasis. 2021;(5):625-640
Abstract
OBJECTIVE To identify the potential associations of patient-, treatment-, and central venous access device (CVAD)-related factors with the CVAD-related thrombosis (CRT) risk in hospitalized children. METHODS A systematic search of PubMed, EMBASE, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, Wanfang, and VIP database was conducted. RevMan 5.3 and Stata 12.0 statistical software were employed for data analysis. RESULTS In terms of patient-related factors, the patient history of thrombosis (odds ratio [OR] = 3.88, 95% confidence interval [CI]: 2.57-5.85), gastrointestinal/liver disease (OR = 1.85, 95% CI: 0.99-3.46), hematologic disease (OR = 1.45, 95% CI: 1.06-1.99), and cancer (OR = 1.58, 95% CI: 1.01-2.48) were correlated with an increased risk of CRT. In terms of treatment-related factors, parenteral nutrition (PN)/total PN (OR = 1.70, 95% CI: 1.21-2.39), hemodialysis (OR = 2.17, 95% CI: 1.34-3.51), extracorporeal membrane oxygenation (OR = 1.51, 95% CI: 1.31-1.71), and cardiac catheterization (OR = 3.92, 95% CI: 1.06-14.44) were associated with an increased CRT risk, while antibiotics (OR = 0.46, 95% CI: 0.32-0.68) was associated with a reduced CRT risk. In terms of the CVAD-related factors, CRT risk was more significantly increased by peripherally inserted central catheter than tunneled lines (OR = 1.81, 95% CI: 1.15-2.85) or totally implantable venous access port (OR = 2.81, 95% CI: 1.41-5.60). And subclavian vein catheterization significantly contributed to a lower CRT risk than femoral vein catheterization (OR = 0.36, 95% CI: 0.14-0.88). Besides, multiple catheter lines (OR = 4.06, 95% CI: 3.01-5.47), multiple catheter lumens (OR = 3.71, 95% CI: 1.99-6.92), central line-associated bloodstream infection (OR = 2.66, 95% CI: 1.15-6.16), and catheter malfunction (OR = 1.65, 95% CI: 1.07-2.54) were associated with an increased CRT risk. CONCLUSION The exact identification of the effect of risk factors can boost the development of risk assessment tools with stratifying risks.
2.
Meta-analysis of rosuvastatin efficacy in prevention of contrast-induced acute kidney injury.
Zhang, J, Guo, Y, Jin, Q, Bian, L, Lin, P
Drug design, development and therapy. 2018;:3685-3690
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is a complication after the intravascular administration of a contrast medium injection. Previous studies have investigated statins as therapy for CIN due to its positive results in the prevention of contrast-induced acute kidney injury (CI-AKI). Nevertheless, the beneficial effects of rosuvastatin pretreatment in preventing CIN in patients with acute coronary syndromes still remain controversial. In this study, we performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the beneficial impact of rosuvastatin in the prevention of CI-AKI in acute coronary syndrome patients. METHODS PubMed, Embase, and Cochrane library were searched, for RCTs, updated on January 2018. The method was to evaluate rosuvastatin prior to angiography for the prevention of CI-AKI in patients undergoing coronary angiography, of which the main outcome was the incidence of CIN. RESULTS A total of five RCTs were included in this analysis. Patients treated with rosuvastatin prior to invasive angiography had a significantly lower incidence of CI-AKI than controls (odds ratio [OR]: 0.53, 95% CI: 0.40-0.71, P<0.0001). Moreover, the subgroup analysis also showed that the benefit of rosuvastatin for patients with chronic kidney disease (OR: 0.49, 95% CI: 0.26-0.92, P=0.03) and diabetes mellitus (OR: 0.56, 95% CI: 0.38-0.83, P=0.004) which was consistent in compared with the respective control groups. CONCLUSION The findings of this meta-analysis suggest that the preoperative rosuvastatin treatment significantly reduces the risk of renal insufficiency of CIN in at-risk patients with chronic kidney disease or diabetes mellitus. Additional studies are needed to identify at-risk patients, provide optimum dose peri-procedural treatment, and reduce the incidence of CIN.