Estimación preoperatoria del filtrado glomerular como predictor de la evolución postoperatoria: Revisión sistemática y meta-análisis

Estimación preoperatoria del filtrado glomerular como predictor de la evolución postoperatoria: Revisión sistemática y meta-análisis


Preoperative Estimates of Glomerular Filtration Rate as Predictors of Outcome after Surgery: A Systematic Review and Meta-analysis
Mooney, John F. M.B.B.S.; Ranasinghe, Isuru M.B.Ch.B., M.Med.(Clin. Epi.); Chow, Clara K. M.B.B.S., Ph.D.; Perkovic, Vlado M.B.B.S., Ph.D.; Barzi, Federica B.Sc., Ph.D.; Zoungas, Sophia M.B.B.S., Ph.D.; Holzmann, Martin J. M.D., Ph.D.; Welten, Gijs M. M.D., Ph.D. Biancari, Fausto M.D., Ph.D.; Wu, Vin-Cent M.D., Ph.D.; Tan, Timothy C. M.B.B.S., Ph.D.; Cass, Alan M.B.B.S., Ph.D.; Hillis, Graham S. M.B.Ch.B., Ph.D.
Anestesiology April 2013 - Volume 118 - Issue 4 - p 809-824
doi: 10.1097/ALN.0b013e318287b72c

Abstract
Background: Kidney dysfunction is a strong determinant of prognosis in many settings.
Methods: A systematic review and meta-analysis was undertaken to explore the relationship between estimated glomerular filtration rate (eGFR) and adverse outcomes after surgery. Cohort studies reporting the relationship between eGFR and major outcomes, including all-cause mortality, major adverse cardiovascular events, and acute kidney injury after cardiac or noncardiac surgery, were included. Results: Forty-six studies were included, of which 44 focused exclusively on cardiac and vascular surgery. Within 30 days of surgery, eGFR less than 60 ml*min*1.73 m−2 was associated with a threefold increased risk of death (multivariable adjusted relative risk [RR] 2.98; 95% confidence interval [CI] 1.95-4.96) and acute kidney injury (adjusted RR 3.13; 95% CI 2.22-4.41). An eGFR less than 60 ml*min*1.73 m−2 was associated with an increased risk of all-cause mortality (adjusted RR 1.61; 95% CI 1.38-1.87) and major adverse cardiovascular events (adjusted RR 1.49; 95% CI 1.32-1.67) during long-term follow-up. There was a nonlinear association between eGFR and the risk of early mortality such that, compared with patients having an eGFR more than 90 ml*min*1.73 m−2 the pooled RR for death at 30 days in those with an eGFR between 30 and 60 ml*min*1.73 m−2 was 1.62 (95% CI 1.43-1.80), rising to 2.85 (95% CI 2.49-3.27) in patients with an eGFR less than 30 ml*min*1.73 m−2 and 3.75 (95% CI 3.44-4.08) in those with an eGFR less than 15 ml*min*1.73 m−2.
Conclusion: There is a powerful relationship between eGFR, and both short- and long-term prognosis after, predominantly cardiac and vascular, surgery.

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