Association of postoperative fluid overload with adverse outcomes after congenital heart surgery: a systematic review and dose-response meta-analysis

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 correlat...

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Bibliographic Details
Published in:Pediatric nephrology (Berlin, West) West), 2020-06, Vol.35 (6), p.1109-1119
Main Authors: Bellos, Ioannis, Iliopoulos, Dimitrios C., Perrea, Despina N.
Format: Article
Language:English
Subjects:
Acute Kidney Injury - epidemiology
Acute Kidney Injury - etiology
Acute renal failure
Cardiac Surgical Procedures - adverse effects
Cardiac Surgical Procedures - mortality
Care and treatment
Children
Congenital heart disease
Demographic aspects
Female
Heart
Heart Defects, Congenital - surgery
Heart surgery
Humans
Infant
Infant, Newborn
Intensive Care Units, Pediatric - statistics & numerical data
Length of Stay - statistics & numerical data
Male
Mechanical ventilation
Medicine
Medicine & Public Health
Meta-analysis
Morbidity
Mortality
Nephrology
Original Article
Patients
Pediatrics
Postoperative Complications - etiology
Postoperative Complications - mortality
Risk factors
Surgery
Urology
Water-Electrolyte Imbalance - etiology
Water-Electrolyte Imbalance - mortality
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Summary: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 ( χ 2  = 6.22, p value = 0.01) and AKI ( χ 2  = 35.84, p value 
ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-020-04489-4