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Neurocritical Care

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09.07.2020 | Review Article

Incidence and Risk Factors for Silent Brain Infarction After On-Pump Cardiac Surgery: A Meta-analysis and Meta-regression of 29 Prospective Cohort Studies

verfasst von: Jingfei Guo, Chenghui Zhou, Liu Yue, Fuxia Yan, Jia Shi

Erschienen in: Neurocritical Care | Ausgabe 2/2021

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Abstract

Background

Silent brain infarction (SBI) happens at a considerable rate after on-pump cardiac surgery. Though termed silent, SBI is related to unfavorable clinical outcomes including higher incidence of future stroke and neurocognitive impairment in the general population. The risk factors of SBI have not been fully identified in both individual studies and several meta-analyses addressing the topic. In this meta-analysis, we aimed to conduct meta-regression analysis for the first time to explore risk factors for SBI after on-pump cardiac surgery.

Methods

This meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Medline, Embase, Central, Web of Science, and Wiley databases were searched for relevant studies. Preoperative patient baseline characteristics and intraoperative surgical parameters were extracted from included studies. For meta-regression, a P value of less than 0.1 was considered statistically significant in both univariable and multivariable analyses.

Results

Twenty-nine studies with 1478 patients were included in this meta-analysis. The summarized SBI rate after on-pump cardiac surgery was 37% (95% CI 0.27–0.47, P < 0.0001). Heterogeneity between studies was significant (I² = 94.9%, P < 0.0001). In multivariable meta-regression, we found that age (coefficient 0.014, 95% CI 0.001–0.029, P = 0.043), diabetes (coefficient 0.006, 95% CI − 0.001 to 0.013, P = 0.075), and proportion of CABG (coefficient − 0.001, 95% CI − 0.003 to 0.0003, P = 0.096) were significantly associated with SBI incidence.

Conclusion

From the meta-regression, we concluded that advanced age and diabetes were related to increased SBI incidence after on-pump cardiac surgery, while CABG procedure alone was associated with less SBI onset. Studies with more accurate diagnoses of SBI are required to add more conclusive evidence to the field.

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Titel: Incidence and Risk Factors for Silent Brain Infarction After On-Pump Cardiac Surgery: A Meta-analysis and Meta-regression of 29 Prospective Cohort Studies
verfasst von: Jingfei Guo
Chenghui Zhou
Liu Yue
Fuxia Yan
Jia Shi
Publikationsdatum: 09.07.2020
Verlag: Springer US
Erschienen in: Neurocritical Care / Ausgabe 2/2021
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-020-01048-5

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