{"title":"肺动脉高压患者的急性失代偿肺动脉高压结局：系统回顾和比例荟萃分析。","authors":"Marcos Vinicius Fernandes Garcia MD PhD , Abdelrahman Nanah MD , Pedro Caruso MD PhD","doi":"10.1016/j.hrtlng.2024.11.009","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Acute decompensated pulmonary arterial hypertension (ADPH) is characterized by right heart failure due to elevated afterload and inadequate cardiac output, and it presents a significant mortality risk. Understanding mortality proportions and the impact of life-sustaining therapies is crucial for informing clinical practice and patient prognosis.</div></div><div><h3>Objectives</h3><div>To assess mortality proportions in ADPH across different clinical settings and to assess how they vary depending on the type of life-sustaining interventions used.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis of proportions were conducted, examining mortality in ADPH focusing on three primary outcomes: ICU mortality, hospital mortality, and hospital mortality in patients requiring extracorporeal membrane oxygenation (ECMO). Common and random-effects meta-analyses were performed to calculate pooled mortality proportions with 95% confidence intervals (CI95%). Temporal trends were analyzed using meta-regression.</div></div><div><h3>Results</h3><div>Twenty-five observational studies conducted between 2003 and 2023, involving 1,249 ADPH patients, were included. The random-effect analysis revealed an ICU pooled mortality proportion of 29% (CI95% 25–34, <em>I</em><sup>2</sup>=40%, <em>p</em>=0.12) and a pooled hospital mortality proportion of 38% (CI95% 31–47, <em>I</em><sup>2</sup>=70%, <em>p</em><0.01). Pooled mortality proportion for patients on ECMO was 45% (CI95% 38–52, <em>I</em><sup>2</sup>=0%, <em>p</em>=0.96). Patients receiving inotropes or vasopressors had pooled mortality proportion of 56% (CI95% 44–68, <em>I</em><sup>2</sup>=42%, <em>p</em>=0.18) and 57% (CI95% 48–65, <em>I</em><sup>2</sup>=57%, <em>p</em>=0.02), respectively. Meta-regression analysis revealed no significant trend in hospital mortality over the span of twenty years.</div></div><div><h3>Conclusions</h3><div>Variation in ADPH mortality across hospital settings and life-sustaining therapies underscores the complexity of managing ADPH. These findings inform clinical practice and support prognostic discussions with patients and families.</div></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"70 ","pages":"Pages 57-64"},"PeriodicalIF":2.4000,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Acute decompensated pulmonary hypertension outcomes in pulmonary arterial hypertension patients: systematic review and meta-analysis of proportions\",\"authors\":\"Marcos Vinicius Fernandes Garcia MD PhD , Abdelrahman Nanah MD , Pedro Caruso MD PhD\",\"doi\":\"10.1016/j.hrtlng.2024.11.009\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Acute decompensated pulmonary arterial hypertension (ADPH) is characterized by right heart failure due to elevated afterload and inadequate cardiac output, and it presents a significant mortality risk. Understanding mortality proportions and the impact of life-sustaining therapies is crucial for informing clinical practice and patient prognosis.</div></div><div><h3>Objectives</h3><div>To assess mortality proportions in ADPH across different clinical settings and to assess how they vary depending on the type of life-sustaining interventions used.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis of proportions were conducted, examining mortality in ADPH focusing on three primary outcomes: ICU mortality, hospital mortality, and hospital mortality in patients requiring extracorporeal membrane oxygenation (ECMO). Common and random-effects meta-analyses were performed to calculate pooled mortality proportions with 95% confidence intervals (CI95%). Temporal trends were analyzed using meta-regression.</div></div><div><h3>Results</h3><div>Twenty-five observational studies conducted between 2003 and 2023, involving 1,249 ADPH patients, were included. The random-effect analysis revealed an ICU pooled mortality proportion of 29% (CI95% 25–34, <em>I</em><sup>2</sup>=40%, <em>p</em>=0.12) and a pooled hospital mortality proportion of 38% (CI95% 31–47, <em>I</em><sup>2</sup>=70%, <em>p</em><0.01). Pooled mortality proportion for patients on ECMO was 45% (CI95% 38–52, <em>I</em><sup>2</sup>=0%, <em>p</em>=0.96). Patients receiving inotropes or vasopressors had pooled mortality proportion of 56% (CI95% 44–68, <em>I</em><sup>2</sup>=42%, <em>p</em>=0.18) and 57% (CI95% 48–65, <em>I</em><sup>2</sup>=57%, <em>p</em>=0.02), respectively. Meta-regression analysis revealed no significant trend in hospital mortality over the span of twenty years.</div></div><div><h3>Conclusions</h3><div>Variation in ADPH mortality across hospital settings and life-sustaining therapies underscores the complexity of managing ADPH. These findings inform clinical practice and support prognostic discussions with patients and families.</div></div>\",\"PeriodicalId\":55064,\"journal\":{\"name\":\"Heart & Lung\",\"volume\":\"70 \",\"pages\":\"Pages 57-64\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2024-11-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Heart & Lung\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0147956324002243\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart & Lung","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0147956324002243","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Acute decompensated pulmonary hypertension outcomes in pulmonary arterial hypertension patients: systematic review and meta-analysis of proportions
Background
Acute decompensated pulmonary arterial hypertension (ADPH) is characterized by right heart failure due to elevated afterload and inadequate cardiac output, and it presents a significant mortality risk. Understanding mortality proportions and the impact of life-sustaining therapies is crucial for informing clinical practice and patient prognosis.
Objectives
To assess mortality proportions in ADPH across different clinical settings and to assess how they vary depending on the type of life-sustaining interventions used.
Methods
A systematic review and meta-analysis of proportions were conducted, examining mortality in ADPH focusing on three primary outcomes: ICU mortality, hospital mortality, and hospital mortality in patients requiring extracorporeal membrane oxygenation (ECMO). Common and random-effects meta-analyses were performed to calculate pooled mortality proportions with 95% confidence intervals (CI95%). Temporal trends were analyzed using meta-regression.
Results
Twenty-five observational studies conducted between 2003 and 2023, involving 1,249 ADPH patients, were included. The random-effect analysis revealed an ICU pooled mortality proportion of 29% (CI95% 25–34, I2=40%, p=0.12) and a pooled hospital mortality proportion of 38% (CI95% 31–47, I2=70%, p<0.01). Pooled mortality proportion for patients on ECMO was 45% (CI95% 38–52, I2=0%, p=0.96). Patients receiving inotropes or vasopressors had pooled mortality proportion of 56% (CI95% 44–68, I2=42%, p=0.18) and 57% (CI95% 48–65, I2=57%, p=0.02), respectively. Meta-regression analysis revealed no significant trend in hospital mortality over the span of twenty years.
Conclusions
Variation in ADPH mortality across hospital settings and life-sustaining therapies underscores the complexity of managing ADPH. These findings inform clinical practice and support prognostic discussions with patients and families.
期刊介绍：
Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders.
The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.
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