OBJECTIVE: This study aimed to compare the clinical efficacy of continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) in patients with renal failure in intensive care unit (ICU).
METHODS: Relevant studies were searched in the databases including EMBASE, Cochrane Library, and MEDLINE (PubMed) from inception to January 04, 2021. The inclusion of available studies and the collection of data were independently conducted by two authors after reviewing the full text. Pooled analyses of relative risk (RR) and weighted mean difference (WMD) were performed to compare the outcomes of renal recovery, short-term mortality, length of ICU stays, and length of in-hospital stays between the two different treatment groups. Publication bias was assessed by the funnel plot.
RESULTS: A total of 11 RCT studies including 1740 patients with renal failure were eligible for final analysis. Among them, 894 patients (51.4%) underwent CRRT and 846 patients (48.6%) received IHD. Pooled analysis did not find significant differences in renal recovery and short-term mortality between the two groups. Interestingly, patients underwent CRRT showed significantly shorter length of ICU stay and in-hospital stay than those who underwent IHD (ICU stay: RR: -0.61, 95%CI: -1.10--0.11, P < 0.05; I2 = 93.6%; in-hospital stay: RR: -0.56, 95%CI: -1.41-0.28, P < 0.05; I2 = 97.7%). No significant publication biases were observed on the funnel plots.
CONCLUSION: Compared with IHD, CRRT had similar effects on renal recovery and short-term mortality in patients with renal failure in ICU. As a promising technique in clinical practice, CRRT could significantly reduce the length of ICU stay and in-hospital stay of patients, which was of great significance for the reduction of medical costs and the long-term benefits of patients, thereby reducing the burden on society and individuals.
目的：本次审查的目的是评估在没有事先诊断为痛风的患者中诊断痛风的测试的准确性和安全性的证据。该评估还评估影响诊断测试精度的因素。测试包括结合临床体征和症状的算法，双能计算机断层扫描（DECT），超声和平原x线，特别强调可在初级和急性（紧急和紧急）护理环境中进行的测试。数据来源：我们搜索了Medline（®）（1946年），Embase（®）（1972年），Cochrane图书馆（1945年）和Web of Science（TM）（1980年）至2014年11月7日发表研究。我们还搜索了ClinicalTrials.gov和Web of Science，并联系了成像设备和测试工具的制造商，了解未发布的痛风诊断数据。回顾方法：我们审查了已发表和未出版的前瞻性队列，横断面和病例对照研究，以及以前对痛风诊断测试的准确性（敏感性和特异性）的系统评价，与没有以前的痛风诊断我们还回顾了影响滑液中尿酸单钠晶体评估精度的因素的研究和以前的综述。我们审查了前瞻性队列，横断面和病例对照研究;任何规模的病例报告;和系统评估报告与痛风诊断测试和痛风误诊结果相关的不良事件。使用具有预定义标准的标准化协议来提取研究设计，干预措施，结果和研究质量的细节，并评估每个结论的证据强度。结果：已经测试了包括临床体征和症状的六种临床算法，用于诊断准确性，以防止从受影响的关节吸出的滑液中存在一次性尿酸钠晶体。大多数研究是在学术风湿病部门进行的小组患者。两个最近开发的临床算法，诊断规则是唯一一个由初级保健医师和患者开发和验证的诊断规则，以及临床痛风诊断（CGD），分别显示了88％和97％的敏感性，特异性为75％分别为短期（2年以下）患者和症状持续时间较长的患者，分别为96％，96％。然而，支持其使用的证据的力量很低，因为这些工具的验证仍然有限。对于没有先前痛风诊断的患者进行的三项DECT研究显示，在诊断痛风时，敏感度范围为85％至100％，特异度为83％至92％关于使用DECT进行痛风诊断的证据的力量很低。根据所评估的超声波征象，四项针对未经过诊断的患者进行的超声检查显示，敏感性范围为37％至100％，特异度为68％至97％。超声诊断痛风的实用性证据的力量很低。少数研究检查影响痛风诊断测试准确性的因素。滑液中单尿酸钠分析的准确性在实践者中差异很大，但技能和经验影响的证据不足。没有研究检查从业者在联合成功率方面的差异。没有研究报告与用于诊断痛风的技术直接相关的不良事件。然而，在一项小型研究中，误诊了痛风诊断导致不必要的手术，住院时间延长和延迟适当的治疗。结论：有希望的诊断性临床算法，如诊断规则和CGD需要在初级和紧急护理环境中更广泛地验证。具有高诊断准确性的临床算法理想地可以形成诊断决策树的一部分，将更多的临床挑战性病例转介给风湿病学家进行更多侵入性检测或成像。需要进行研究以评估滑液单钠尿酸盐晶体分析和成像的增量值超过诊断临床算法的增量值。
This study aimed to compare the clinical efficacy of continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) in patients with renal failure in intensive care unit (ICU).
METHODS:
Relevant studies were searched in the databases including EMBASE, Cochrane Library, and MEDLINE (PubMed) from inception to January 04, 2021. The inclusion of available studies and the collection of data were independently conducted by two authors after reviewing the full text. Pooled analyses of relative risk (RR) and weighted mean difference (WMD) were performed to compare the outcomes of renal recovery, short-term mortality, length of ICU stays, and length of in-hospital stays between the two different treatment groups. Publication bias was assessed by the funnel plot.
RESULTS:
A total of 11 RCT studies including 1740 patients with renal failure were eligible for final analysis. Among them, 894 patients (51.4%) underwent CRRT and 846 patients (48.6%) received IHD. Pooled analysis did not find significant differences in renal recovery and short-term mortality between the two groups. Interestingly, patients underwent CRRT showed significantly shorter length of ICU stay and in-hospital stay than those who underwent IHD (ICU stay: RR.: -0.61, 95%CI: -1.10--0.11, P < 0.05; I2 = 93.6%; in-hospital stay: RR.: -0.56, 95%CI: -1.41-0.28, P < 0.05; I2 = 97.7%). No significant publication biases were observed on the funnel plots.
CONCLUSION:
Compared with IHD, CRRT had similar effects on renal recovery and short-term mortality in patients with renal failure in ICU. As a promising technique in clinical practice, CRRT could significantly reduce the length of ICU stay and in-hospital stay of patients, which was of great significance for the reduction of medical costs and the long-term benefits of patients, thereby reducing the burden on society and individuals.
Systematic Review Question»Systematic review of interventions
