TY - JOUR
TI - Association of postoperative fluid overload with adverse outcomes after congenital heart surgery: a systematic review and dose-response meta-analysis
AU - Bellos, I.
AU - Iliopoulos, D.C.
AU - Perrea, D.N.
JO - Pediatric Nephrology
PY - 2020
VL - 35
TODO - 6
SP - 1109-1119
PB - Springer-Verlag
SN - 0931-041X, 1432-198X
TODO - 10.1007/s00467-020-04489-4
TODO - inotropic agent, acute kidney failure;  adverse outcome;  Article;  artificial ventilation;  child;  congenital heart disease;  heart surgery;  human;  hypervolemia;  infant;  infection rate;  intensive care unit;  length of stay;  major clinical study;  meta analysis;  mortality risk;  newborn;  postoperative complication;  priority journal;  systematic review;  acute kidney failure;  adverse event;  congenital heart malformation;  female;  heart surgery;  male;  metabolic disorder;  mortality;  pediatric intensive care unit;  postoperative complication, Acute Kidney Injury;  Cardiac Surgical Procedures;  Female;  Heart Defects, Congenital;  Humans;  Infant;  Infant, Newborn;  Intensive Care Units, Pediatric;  Length of Stay;  Male;  Postoperative Complications;  Water-Electrolyte Imbalance
TODO - Background: Pediatric cardiac surgery is commonly associated with acute kidney injury (AKI) and significant fluid retention, which complicate postoperative management and lead to increased rates of morbidity. This meta-analysis aimed to accumulate current literature evidence and evaluate the correlation of fluid overload degree with adverse outcome in patients undergoing congenital heart surgery. Methods: Medline, Scopus, CENTRAL, Clinicaltrials.gov, and Google Scholar were systematically searched from inception. All studies reporting the effects of fluid overload on postoperative clinical outcomes were selected. A dose-response meta-analytic method using restricted cubic splines was implemented in R-3.6.1. Results: Twelve studies were included, with a total of 3111 pediatric patients. Qualitative synthesis indicated that fluid overload was linked to significantly higher risk of mortality, AKI, prolonged hospital, and intensive care unit (ICU) stay, as well as with increased duration of mechanical ventilation, inotrope need, and infection rate. Meta-analysis demonstrated a linear correlation between fluid overload and the risk of mortality (χ2 = 6.22, p value = 0.01) and AKI (χ2 = 35.84, p value < 0.001), while a positive curvilinear relationship was estimated for the outcomes of hospital (χ2 = 18.84, p value = 0.0001) and ICU stay (χ2 = 63.69, p value = 0.0001). Conclusions: The present meta-analysis supports that postoperative fluid overload is significantly linked to elevated risk of prolonged hospital stay, AKI development, and mortality in pediatric patients undergoing cardiac surgery. These findings warrant replication by future prospective studies, which should define the optimal cutoff values and assess the effectiveness of therapeutic strategies to limit fluid overload in the postoperative setting. © 2020, IPNA.
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