Acute Kidney Injury and Prognosis After Cardiopulmonary Bypass: A Meta-analysis of Cohort Studies

摘要: Background Robust estimates and sources of variation in risks clinical outcomes for cardiopulmonary bypass (CPB)-associated acute kidney injury (AKI) are needed to inform practice policy. We aimed assess whether the methods defining disease modify estimated association AKI with CPB. Study Design Systematic review meta-analysis. Setting & Population Adults undergoing Selection Criteria Studies Cohort studies reporting adjusted associations between CPB-associated early mortality, later stroke, myocardial infarction, congestive heart failure, all-cause hospitalization, chronic disease, end-stage bleeding complications, or perioperative infection. Predictors renal replacement therapy. Outcomes The primary outcome was mortality (in-hospital within 90 days surgery) secondary including total cardiovascular major adverse events, rehospitalization, bleeding, Results 46 47 unique cohorts comprising 242,388 participants were included. pooled rate 18.2%, therapy, 2.1%. associated (risk ratio [RR], 4.0; 95% CI, 3.1-5.2; crude AKI, 4.6%; without CPB-AKI, 1.5%) considerable heterogeneity ( I 2 =87%). definition did not prognostic P subgroup analysis = 0.9). When fully accounted using credibility ceilings, attenuated (RR, 2.2; 1.8-2.8) but remained high. Renal therapy also 5.3; 3.4-8.1). long-term 2.0; 1.7-2.3) stroke 1.1-4.5). No other reported more than 3 studies. Limitations Unclear attrition from follow-up most variable adjustment confounders across Conclusions is a 2-fold increase regardless definition.