PDF(Pubmed)
Abstract：
OBJECTIVE: Acute kidney injury (AKI) is frequent among in-hospital patients with high incidence and mortality. Implementing a series of evidence-based AKI care bundles may improve patient outcomes by reducing changeable standards of care. The aim of this meta-analysis was therefore to appraise the influences of AKI care bundles on patient outcomes.
METHODS: We explored three international databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) and two Chinese databases (Wanfang Data and China National Knowledge Infrastructure) for studies from databases inception until November 30, 2022, comparing the impact of different AKI care bundles with usual standards of care in patients with or at risk for AKI. The study quality of non-randomized controlled trials and randomized controlled trials was evaluated by the NIH Study Quality Assessment Tool and the Cochrane risk of bias tool. Heterogeneity between studies was appraised by Cochran\'s Q test and I2 statistics. The possible origins of heterogeneity between studies were assessed adopting Meta-regression and subgroup analyses. Funnel plot asymmetry and Egger regression and Begg correlation tests were performed to discover potential publication bias. Data analysis was completed by software (RevMan 5.3 and Stata 15.0). The primary outcome was short- or long-term mortality. The secondary outcomes involved the incidence and severity of AKI.
RESULTS: Sixteen studies containing 25,690 patients and 25,903 AKI episodes were included. In high-risk AKI patients determined by novel biomarkers, electronic alert or risk prediction score, the application of AKI care bundles significantly reduced the AKI incidence (OR, 0.71; 95% CI, 0.53-0.96; p = 0.02; I2 = 84%) and AKI severity (OR, 0.59; 95% CI, 0.39-0.89; p = 0.01; I2 = 65%). No strong evidence is available to prove that care bundles can significantly reduce mortality (OR, 1.16; 95% CI, 0.58-2.30; p = 0.68; I2 = 97%).
CONCLUSIONS: The introduction of AKI care bundles in routine clinical practice can effectively improve the outcomes of patients with or at-risk of AKI. However, the accumulated evidence is limited and not strong enough to make definite conclusions.
METHODS: We explored three international databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) and two Chinese databases (Wanfang Data and China National Knowledge Infrastructure) for studies from databases inception until November 30, 2022, comparing the impact of different AKI care bundles with usual standards of care in patients with or at risk for AKI. The study quality of non-randomized controlled trials and randomized controlled trials was evaluated by the NIH Study Quality Assessment Tool and the Cochrane risk of bias tool. Heterogeneity between studies was appraised by Cochran\'s Q test and I2 statistics. The possible origins of heterogeneity between studies were assessed adopting Meta-regression and subgroup analyses. Funnel plot asymmetry and Egger regression and Begg correlation tests were performed to discover potential publication bias. Data analysis was completed by software (RevMan 5.3 and Stata 15.0). The primary outcome was short- or long-term mortality. The secondary outcomes involved the incidence and severity of AKI.
RESULTS: Sixteen studies containing 25,690 patients and 25,903 AKI episodes were included. In high-risk AKI patients determined by novel biomarkers, electronic alert or risk prediction score, the application of AKI care bundles significantly reduced the AKI incidence (OR, 0.71; 95% CI, 0.53-0.96; p = 0.02; I2 = 84%) and AKI severity (OR, 0.59; 95% CI, 0.39-0.89; p = 0.01; I2 = 65%). No strong evidence is available to prove that care bundles can significantly reduce mortality (OR, 1.16; 95% CI, 0.58-2.30; p = 0.68; I2 = 97%).
CONCLUSIONS: The introduction of AKI care bundles in routine clinical practice can effectively improve the outcomes of patients with or at-risk of AKI. However, the accumulated evidence is limited and not strong enough to make definite conclusions.
摘要：
目的：急性肾损伤（AKI）在住院患者中发病率高，死亡率高。实施一系列基于证据的AKI护理服务可以通过降低不断变化的护理标准来改善患者的预后。因此，这项荟萃分析的目的是评估AKI护理包对患者预后的影响。
方法：我们探索了三个国际数据库(PubMed，Embase,和Cochrane中央对照试验登记册）和两个中国数据库（万方数据和中国国家知识基础设施），用于从数据库开始到2022年11月30日的研究，比较了不同的AKI护理捆绑和常规护理标准对患有或有AKI风险的患者的影响。通过NIH研究质量评估工具和Cochrane偏倚风险工具评估非随机对照试验和随机对照试验的研究质量。通过Cochran的Q检验和I2统计来评估研究之间的异质性。通过Meta回归和亚组分析评估研究之间异质性的可能来源。进行漏斗图不对称性，Egger回归和Begg相关性检验，以发现潜在的发表偏倚。数据分析通过软件(RevMan5.3和Stata15.0)完成。主要结果是短期或长期死亡率。次要结果涉及AKI的发生率和严重程度。
结果：纳入了16项研究，包括25,690例患者和25,903例AKI发作。在由新型生物标志物确定的高危AKI患者中，电子警报或风险预测评分，AKI护理捆绑的应用显着降低了AKI发生率(OR，0.71；95%CI，0.53-0.96；p=0.02；I2=84%）和AKI严重程度（OR，0.59；95%CI，0.39-0.89；p=0.01；I2=65%）。没有强有力的证据证明护理捆绑可以显着降低死亡率(OR，1.16；95%CI，0.58-2.30；p=0.68；I2=97%）。
结论：在常规临床实践中引入AKI护理捆绑可以有效改善患有AKI或有AKI风险的患者的预后。然而,积累的证据有限，不足以做出明确的结论。
方法：我们探索了三个国际数据库(PubMed，Embase,和Cochrane中央对照试验登记册）和两个中国数据库（万方数据和中国国家知识基础设施），用于从数据库开始到2022年11月30日的研究，比较了不同的AKI护理捆绑和常规护理标准对患有或有AKI风险的患者的影响。通过NIH研究质量评估工具和Cochrane偏倚风险工具评估非随机对照试验和随机对照试验的研究质量。通过Cochran的Q检验和I2统计来评估研究之间的异质性。通过Meta回归和亚组分析评估研究之间异质性的可能来源。进行漏斗图不对称性，Egger回归和Begg相关性检验，以发现潜在的发表偏倚。数据分析通过软件(RevMan5.3和Stata15.0)完成。主要结果是短期或长期死亡率。次要结果涉及AKI的发生率和严重程度。
结果：纳入了16项研究，包括25,690例患者和25,903例AKI发作。在由新型生物标志物确定的高危AKI患者中，电子警报或风险预测评分，AKI护理捆绑的应用显着降低了AKI发生率(OR，0.71；95%CI，0.53-0.96；p=0.02；I2=84%）和AKI严重程度（OR，0.59；95%CI，0.39-0.89；p=0.01；I2=65%）。没有强有力的证据证明护理捆绑可以显着降低死亡率(OR，1.16；95%CI，0.58-2.30；p=0.68；I2=97%）。
结论：在常规临床实践中引入AKI护理捆绑可以有效改善患有AKI或有AKI风险的患者的预后。然而,积累的证据有限，不足以做出明确的结论。
