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Tytuł:
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Association of postoperative fluid overload with adverse outcomes after congenital heart surgery: a systematic review and dose-response meta-analysis.
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Autorzy:
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Bellos I; Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Athens, Greece. .
Iliopoulos DC; Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Perrea DN; Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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Źródło:
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Pediatric nephrology (Berlin, Germany) [Pediatr Nephrol] 2020 Jun; Vol. 35 (6), pp. 1109-1119. Date of Electronic Publication: 2020 Feb 10.
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Typ publikacji:
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Journal Article; Meta-Analysis; Systematic Review
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Język:
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English
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Imprint Name(s):
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Publication: Berlin : Springer International
Original Publication: Berlin : Springer International, c1987-
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MeSH Terms:
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Acute Kidney Injury/*etiology
Cardiac Surgical Procedures/*adverse effects
Heart Defects, Congenital/*surgery
Water-Electrolyte Imbalance/*etiology
Acute Kidney Injury/epidemiology ; Cardiac Surgical Procedures/mortality ; Female ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Pediatric/statistics & numerical data ; Length of Stay/statistics & numerical data ; Male ; Postoperative Complications/etiology ; Postoperative Complications/mortality ; Water-Electrolyte Imbalance/mortality
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References:
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Contributed Indexing:
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Keywords: Cardiac surgery; Congenital heart; Fluid overload; Meta-analysis; Pediatric
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Entry Date(s):
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Date Created: 20200211 Date Completed: 20210504 Latest Revision: 20210504
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Update Code:
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20240105
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DOI:
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10.1007/s00467-020-04489-4
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PMID:
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32040627
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Background: Pediatric cardiac surgery is commonly associated with acute kidney injury (AKI) and significant fluid retention, which complicate postoperative management and lead to increased rates of morbidity. This meta-analysis aimed to accumulate current literature evidence and evaluate the correlation of fluid overload degree with adverse outcome in patients undergoing congenital heart surgery.
Methods: Medline, Scopus, CENTRAL, Clinicaltrials.gov, and Google Scholar were systematically searched from inception. All studies reporting the effects of fluid overload on postoperative clinical outcomes were selected. A dose-response meta-analytic method using restricted cubic splines was implemented in R-3.6.1.
Results: Twelve studies were included, with a total of 3111 pediatric patients. Qualitative synthesis indicated that fluid overload was linked to significantly higher risk of mortality, AKI, prolonged hospital, and intensive care unit (ICU) stay, as well as with increased duration of mechanical ventilation, inotrope need, and infection rate. Meta-analysis demonstrated a linear correlation between fluid overload and the risk of mortality (χ 2 = 6.22, p value = 0.01) and AKI (χ 2 = 35.84, p value < 0.001), while a positive curvilinear relationship was estimated for the outcomes of hospital (χ 2 = 18.84, p value = 0.0001) and ICU stay (χ 2 = 63.69, p value = 0.0001).
Conclusions: The present meta-analysis supports that postoperative fluid overload is significantly linked to elevated risk of prolonged hospital stay, AKI development, and mortality in pediatric patients undergoing cardiac surgery. These findings warrant replication by future prospective studies, which should define the optimal cutoff values and assess the effectiveness of therapeutic strategies to limit fluid overload in the postoperative setting.