目的:这项荟萃分析旨在研究血浆生物标志物之间的相关性,如白蛋白和纤维蛋白原,以及非心脏手术患者术后谵妄(POD)的比率。
方法:在PubMed,EMBASE,CINAHL,以及截至2023年3月的Cochrane图书馆数据库。本Meta分析采用RevMan5.4.1和Stata15.0软件进行。对于具有非均匀单位的连续变量,使用标准化平均差(SMD)和95%置信区间(CI);否则,采用平均差(MD)和95%CI。采用纽卡斯尔-渥太华量表(NOS)对纳入文献的质量进行评价。
结果:纳入了18项研究,包括7,011名患者。荟萃分析显示白蛋白水平显着降低(16项研究,5,813名患者,SMD=-0.45,95%CI=-0.64至-0.26,P<0.00001,I2=80%)和白蛋白-纤维蛋白原比率(AFR)(四项研究,824名患者,神志不清组的MD=-0.62,95%CI=-0.76至-0.48,P=0.56,I2=0%)。相反,更高的纤维蛋白原浓度(两项研究,441名患者,在谵妄组中观察到MD=0.13,95%CI=0.02至0.24,P=0.69,I2=0%)。由于白蛋白水平的高度异质性(P<0.00001,I2=80%),我们进行了亚组和敏感性分析,并证实白蛋白水平的关联不受手术类型的影响,设计或谵妄评估工具。
结论:术前白蛋白,纤维蛋白原和AFR水平与POD相关,可能有助于识别高危患者,并在预防POD方面发挥关键作用。
OBJECTIVE: This meta-analysis aimed to investigate the correlation between plasma biomarkers, such as albumin and
fibrinogen, and their ratio with postoperative delirium (POD) in patients undergoing non-cardiac surgery.
METHODS: Relevant observational cohort studies were systematically searched in PubMed, EMBASE, CINAHL, and the Cochrane Library databases as of March 2023. This meta-analysis was conducted using RevMan 5.4.1 and Stata 15.0 software. For continuous variables with non-uniform units, the standardized mean difference (SMD) and 95% confidence intervals (CIs) were used; otherwise, the mean difference (MD) and 95% CIs were employed. The Newcastle-Ottawa Scale (NOS) was applied to assess the quality of included literature.
RESULTS: Eighteen studies encompassing 7,011 patients were included. The meta-analysis revealed significantly lower albumin levels (sixteen studies, 5,813 patients, SMD = -0.45, 95% CI = -0.64 to -0.26, P < 0.00001, I2 = 80%) and albumin-
fibrinogen ratio (AFR) (four studies, 824 patients, MD = -0.62, 95% CI = -0.76 to -0.48, P = 0.56, I2 = 0%) in the delirious group. Conversely, higher
fibrinogen concentrations (two studies, 441 patients, MD = 0.13, 95% CI = 0.02 to 0.24, P = 0.69, I2 = 0%) were observed in the delirious group. Due to high heterogeneity in albumin levels (P < 0.00001, I2 = 80%), we conducted a subgroup and sensitivity analysis, and confirmed that the association of albumin levels was not influenced by surgery type, design or delirium evaluation instruments.
CONCLUSIONS: Preoperative albumin,
fibrinogen and AFR levels were associated with POD, potentially aiding in identifying high-risk patients and playing a key role in preventing POD.