危重病患者的肾功能评估忽略了肾脏功能亢进的可能性,称为增强肾清除率(ARC),这可能导致重症监护病房(ICU)的治疗失败。这项研究的目的是对危重病中ARC的患病率和危险因素进行系统评价和荟萃分析。MEDLINE,Embase,科克伦图书馆,CINAHL,Scopus,ProQuest论文和论文于2020年10月27日搜索了全球数据库。我们纳入了在报告ARC患病率和/或危险因素的危重成人中进行的研究。我们使用JoannaBriggs研究所评估工具评估研究质量。病例报告,reviews,社论和评论被排除在外。我们使用逆方差方法生成了随机效应元分析模型,并使用森林地块可视化了汇总估计值。包括70项研究。合并患病率(95%CI)为39%(34.9-43.3)。神经患病率,创伤,混合和脓毒症ICU为74(55-87),58(48-67),36(31-41)和33(21-48),分别。年龄,男性和创伤与ARC相关,合并OR(95%CI)为0.95(0.93-0.96),2.36(1.28-4.36),2.60(1.21-5.58),分别。限制包括ARC定义的变化,纳入和排除标准和研究设计。总之,ARC在危重患者中普遍存在,尤其是那些在神经重症监护和创伤ICU人群。年轻的年龄,男性和创伤是肾功能明显正常的患者发生ARC的危险因素。需要进一步研究ARC环境中药物的最佳剂量。(Prospero注册:CRD42021246417)。
Kidney function assessment in the critically ill overlooks the possibility for hyperfunctioning kidneys, known as augmented renal clearance (ARC), which could contribute to therapeutic failures in the intensive care unit (ICU). The aim of this research is to conduct a systematic
review and meta-analysis of prevalence and risk factors of ARC in the critically ill. MEDLINE, Embase, Cochrane Library, CINAHL, Scopus, ProQuest Dissertations and Theses Global databases were searched on 27 October 2020. We included studies conducted in critically ill adults who reported the prevalence and/or risk factors of ARC. We evaluated study quality using the Joanna Briggs Institute appraisal tool. Case reports, reviews, editorials and commentaries were excluded. We generated a random-effects meta-analytic model using the inverse variance method and visualized the pooled estimates using forest plots. Seventy studies were included. The pooled prevalence (95% CI) was 39% (34.9-43.3). Prevalence for neuro, trauma, mixed and sepsis ICUs were 74 (55-87), 58 (48-67), 36 (31-41) and 33 (21-48), respectively. Age, male sex and trauma were associated with ARC with pooled OR (95% CI) of 0.95 (0.93-0.96), 2.36 (1.28-4.36), 2.60 (1.21-5.58), respectively. Limitations included variations in ARC definition, inclusion and exclusion criteria and studies design. In conclusion, ARC is prevalent in critically ill patients, especially those in the neurocritical care and trauma ICU population. Young age, male sex and trauma are risk factors for ARC in those with apparently normal renal function. Further research on optimal dosing of drugs in the setting of ARC is warranted. (Prospero registration: CRD42021246417).