【罂粟摘要】术前蛋白尿、术后急性肾损伤和死亡率：一项系统回顾和Meta分析

术前蛋白尿、术后急性肾损伤和死亡率：一项系统回顾和Meta分析

贵州医科大学  高鸿教授课题组

翻译：佟睿  编辑：佟睿  审校：曹莹

目的

探讨术前蛋白尿与术后急性肾损伤(AKI)发展的关系，以及短期和长期随访时肾脏替代治疗(RRT)的需求和死亡率。

背景

术后AKI与手术发病率和死亡率相关。术前蛋白尿是术后AKI和死亡率的潜在危险因素。然而，现有文献中的结果是相互矛盾的。

方法

我们检索了直至2020年6月3日PubMed、Embase、Scopus、Web of Science和Cochrane Library的所有相关文献。研究术前蛋白尿与术后AKI发展、RRT需求以及短期和长期随访全因死亡率相关性的观察性队列研究被纳入本次分析。采用随机效应模型的逆方差方法，计算合并效应估计值和95%可信区间(CI)。

结果

共纳入了28项研究。术前蛋白尿与术后AKI发展[优势比(OR)1.74，95%CI，1.45~2.09]、住院RRT(OR 1.70，95%CI，1.25~2.32)、长期随访是否需要RRT[风险比(HR)3.72，95%CI，2.03~6.82]、长期全因死亡率(风险比1.50，95%CI，1.30~1.73)相关。在亚组分析中，术前蛋白尿与心血管(OR 1.77，95%CI，1.47~2.14)和非心血管手术(OR 1.63，95%CI，1.01~2.63)术后AKI的发生几率增加有关。此外，随着蛋白尿量从微量增加到3＋，术后AKI发生的OR逐渐增加。

结论

术前蛋白尿与术后AKI和长期死亡率显著相关。术前麻醉评估应考虑蛋白尿的存在，以确定高危患者。

原始文献来源：

Chun-Yu Chang, Yung-Jiun Chien, Ming-Chang Kao, et al. Pre-operative proteinuria, postoperative acute kidney injury and mortality: A systematic review and meta-analysis.[J].Eur J Anaesthesiol 2021; 38:702–714.

Pre-operative proteinuria, postoperative acute kidney injury and mortality: A systematic review and meta-analysis

Abstract

OBJECTIVE To investigate the association of pre-operative proteinuria with postoperative acute kidney injury (AKI) development as well as the requirement for a renal replacement therapy (RRT) and mortality at short-term and long-term follow-up.

BACKGROUND Postoperative AKI is associated with surgical morbidity and mortality. Pre-operative proteinuria is potentially a risk factor for postoperative AKI and mortality. However, the results in literature are conflicting.

METHODS We searched PubMed, Embase, Scopus, Web of Science and Cochrane Library from the inception through to 3 June 2020. Observational cohort studies investigating the association of pre-operative proteinuria with postoperative AKI development, requirement for RRT, and all-cause mortality at short-term and long-term follow-up were considered eligible. Using inverse variance method with a randomeffects model, the pooled effect estimates and 95% confidence interval (CI) were calculated.

RESULTS Twenty-eight studies were included. Pre-operative proteinuria was associated with postoperative AKI development [odds ratio (OR) 1.74, 95% CI, 1.45 to 2.09], inhospital RRT (OR 1.70, 95% CI, 1.25 to 2.32), requirement for RRT at long-term follow-up [hazard ratio (HR) 3.72, 95% CI, 2.03 to 6.82], and long-term all-cause mortality (hazard ratio 1.50, 95% CI, 1.30 to 1.73). In the subgroup analysis, pre-operative proteinuria was associated with increased odds of postoperative AKI in both cardiovascular (OR 1.77, 95% CI, 1.47 to 2.14) and noncardiovascular surgery (OR 1.63, 95% CI, 1.01 to 2.63). Moreover, there is a stepwise increase in OR of postoperative AKI development when the quantity of proteinuria increases from trace to 3＋.

CONCLUSION Pre-operative proteinuria is significantlyassociated with postoperative AKI and long-term mortality. Preoperative anaesthetic assessment should take into account the presence of proteinuria to identify high-risk patients.

翻译：佟睿

编辑：佟睿

审校：曹莹

贵州医科大学高鸿教授课题组