■用甲醇添加,乙二醇,二甘醇,丙二醇,异丙醇和异丙醇是罕见但极其危险的疾病,可能需要肾脏替代疗法的紧急管理。关于摄入后的短期和长期肾脏结果知之甚少。
■全面综合有关这些中毒后成年患者的短期和长期肾脏和其他结局的现有证据。
■我们通过OVID在MEDLINE中开发了搜索策略,然后将其转换为包括EMBASE(通过OVID)在内的其他数据库,PubMed,中央(通过OVID)。这些数据库的搜索时间从成立日期到2021年7月29日。在国际传统医学临床试验注册中心和临床试验中心进行了灰色文献检索。所有干预性和观察性研究以及病例系列,其中≥5名参与者报告了有毒酒精(甲醇,乙二醇,二甘醇,包括≥18岁的成年患者的丙二醇和异丙醇)中毒。报告死亡率的研究,毒性酒精中毒导致的肾脏结局和/或并发症符合研究条件.
■搜索策略确定了1,221条引文。67项研究(13项回顾性观察性研究,一项前瞻性观察性研究,53例病例系列)符合纳入标准(总N=2,327名参与者)。根据我们预设的标准,没有发现随机对照试验。一般来说,纳入的研究样本量较小(中位数为27名参与者),且质量较低.甲醇和/或乙二醇中毒占纳入研究的94.1%,而一项研究报道了异丙醇,没有报道丙二醇。收集13项关于甲醇和/或乙二醇中毒的观察性研究结果进行荟萃分析。合并甲醇和乙二醇中毒患者的住院死亡率估计分别为24%和11%,分别。最近出版的一年,在乙二醇中毒患者中,女性和平均年龄与较低的住院死亡率相关.尽管血液透析是最常用的肾脏替代疗法,在大多数研究中没有报告开始该治疗的适应症.出院时,64.7-96.3%的乙二醇中毒患者肾脏恢复。在甲醇和/或乙二醇中毒的研究中,2-3.7%的个体需要持续透析。只有一项研究报告了出院后的死亡率。此外,长期有毒的酒精介导的后遗症,比如视觉和神经结果,几乎没有报道。
■摄入甲醇和乙二醇与显著的短期死亡风险相关。尽管存在大量病例报告和病例系列形式的文献,缺乏关于这些中毒后肾脏结局的高质量证据.我们发现临床表现中缺乏标准化报告,成人毒性酒精中毒的治疗方法和结果。在纳入的研究中,研究类型有很大的异质性,结果,随访时间和治疗方式。这些异质性的来源限制了我们对所有感兴趣的结果进行全面荟萃分析的能力。另外的限制是缺乏关于丙二醇的研究和关于异丙醇的数据的缺乏。
■血液透析的适应症,这些中毒患者的长期肾脏恢复和长期死亡风险差异很大,且文献报道不一致.这突出了需要进一步研究与基线肾功能的标准化报告,开始肾脏替代治疗的适应症以及短期和长期肾脏结局。
■该系统审查协议在PROSPERO注册,CRD42018101955.
Ingestions with methanol, ethylene glycol, diethylene glycol, propylene glycol, and isopropanol are rare yet exceedingly dangerous conditions that may require emergent management with kidney replacement therapy. Little is known regarding short- and long-term kidney outcomes post-ingestion.
To comprehensively synthesize existing evidence regarding short- and long-term kidney and other outcomes of adult patients following these poisonings.
We developed a search strategy in MEDLINE via OVID and then translated it into other databases including EMBASE (via OVID), PubMed, CENTRAL (via OVID). The databases were searched from their dates of inception to 29 July 2021. A grey literature search was conducted in the International Traditional Medicine Clinical Trial Registry and ClinicalTrials.gov. All interventional and observational studies and case series with ≥ five participants that reported on the outcomes of toxic alcohol (methanol, ethylene glycol, diethylene glycol, propylene glycol and isopropanol) poisonings in adult patients ≥18 years old were included. Studies that reported mortality, kidney outcomes and/or complications attributed to toxic alcohol poisoning were eligible.
The search strategy identified 1,221 citations. Sixty-seven studies (13 retrospective observational studies, one prospective observational study, 53 case series) met inclusion criteria (total N = 2,327 participants). No randomized controlled trials were identified per our prespecified criteria. Generally, included studies had small sample sizes (median of 27 participants) and were of low quality. Methanol and/or ethylene glycol poisoning made up 94.1% of included studies, whereas one study reported on isopropanol and none reported on propylene glycol. Results of the 13 observational studies of methanol and/or ethylene glycol poisoning were pooled for meta-analyses. The pooled in-hospital mortality estimates amongst patients with methanol and ethylene glycol poisoning were 24 and 11%, respectively. A more recent year of publication, female sex and mean age were associated with lower in-hospital mortality amongst individuals with ethylene glycol poisoning. Although hemodialysis was the most frequently employed kidney replacement therapy, the indications for initiation of this therapy were not reported in the majority of studies. At hospital discharge, kidney recovery occurred in 64.7-96.3% of patients with ethylene glycol poisoning. In studies of methanol and/or ethylene glycol poisoning, 2-3.7% of individuals required ongoing dialysis. Only one study reported post-discharge mortality. Furthermore, long-term toxic alcohol-mediated sequelae, such as visual and neurologic outcomes, were scarcely reported.
Ingestions of methanol and ethylene glycol were associated with a significant short-term risk of mortality. Although a wealth of literature in the form of case reports and case series exists, high-quality evidence regarding kidney outcomes after these poisonings is lacking. We identified a paucity of standardized reporting in clinical presentations, therapeutics and outcomes amongst adults with toxic alcohol poisoning. Amongst the included studies, there was substantial heterogeneity encompassing study type, outcomes, duration of follow-up and treatment modalities. These sources of heterogeneity restricted our ability to perform comprehensive meta-analyses of all outcomes of interest. An additional limitation is the lack of studies pertaining to propylene glycol and the paucity of data on isopropanol.
The indications for hemodialysis, long-term kidney recovery and long-term mortality risk vary widely in these poisonings and are inconsistently reported in the literature. This highlights the need for further research with standardized reporting of baseline kidney function, indications for initiation of kidney replacement therapy and short-term and long-term kidney outcomes.
This systematic
review protocol is registered at PROSPERO, CRD42018101955.