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Pediatric Nephrology

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10.02.2020 | Original Article

Association of postoperative fluid overload with adverse outcomes after congenital heart surgery: a systematic review and dose-response meta-analysis

verfasst von: Ioannis Bellos, Dimitrios C. Iliopoulos, Despina N. Perrea

Erschienen in: Pediatric Nephrology | Ausgabe 6/2020

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Abstract

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 (χ² = 6.22, p value = 0.01) and AKI (χ² = 35.84, p value < 0.001), while a positive curvilinear relationship was estimated for the outcomes of hospital (χ² = 18.84, p value = 0.0001) and ICU stay (χ² = 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.

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Titel: Association of postoperative fluid overload with adverse outcomes after congenital heart surgery: a systematic review and dose-response meta-analysis
verfasst von: Ioannis Bellos
Dimitrios C. Iliopoulos
Despina N. Perrea
Publikationsdatum: 10.02.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Nephrology / Ausgabe 6/2020
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-020-04489-4

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Association of postoperative fluid overload with adverse outcomes after congenital heart surgery: a systematic review and dose-response meta-analysis

Abstract

Background

Methods

Results

Conclusions

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Background

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Results

Conclusions

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