Article ; Online: Effects of interventions targeting the systemic inflammatory response to cardiac surgery on clinical outcomes in adults.
The Cochrane database of systematic reviews
2023 Volume 10, Page(s) CD013584
Abstract: Background: Organ injury is a common and severe complication of cardiac surgery that contributes to the majority of deaths. There are no effective treatment or prevention strategies. It has been suggested that innate immune system activation may have a ... ...
| Abstract | Background: Organ injury is a common and severe complication of cardiac surgery that contributes to the majority of deaths. There are no effective treatment or prevention strategies. It has been suggested that innate immune system activation may have a causal role in organ injury. A wide range of organ protection interventions targeting the innate immune response have been evaluated in randomised controlled trials (RCTs) in adult cardiac surgery patients, with inconsistent results in terms of effectiveness. Objectives: The aim of the review was to summarise the results of RCTs of organ protection interventions targeting the innate immune response in adult cardiac surgery. The review considered whether the interventions had a treatment effect on inflammation, important clinical outcomes, or both. Search methods: CENTRAL, MEDLINE, Embase, conference proceedings and two trial registers were searched on October 2022 together with reference checking to identify additional studies. Selection criteria: RCTs comparing organ protection interventions targeting the innate immune response versus placebo or no treatment in adult patients undergoing cardiac surgery where the treatment effect on innate immune activation and on clinical outcomes of interest were reported. Data collection and analysis: Searches, study selection, quality assessment, and data extractions were performed independently by pairs of authors. The primary inflammation outcomes were peak IL-6 and IL-8 concentrations in blood post-surgery. The primary clinical outcome was in-hospital or 30-day mortality. Treatment effects were expressed as risk ratios (RR) and standardised mean difference (SMD) with 95% confidence intervals (CI). Meta-analyses were performed using random effects models, and heterogeneity was assessed using I Main results: A total of 40,255 participants from 328 RCTs were included in the synthesis. The effects of treatments on IL-6 (SMD -0.77, 95% CI -0.97 to -0.58, I Authors' conclusions: A systematic review of RCTs of organ protection interventions targeting innate immune system activation did not resolve uncertainty as to the effectiveness of these treatments, or the role of innate immunity in organ injury following cardiac surgery. |
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| MeSH term(s) | Humans ; Adult ; Interleukin-6 ; Interleukin-8 ; Cardiac Surgical Procedures/adverse effects ; Inflammation ; Systemic Inflammatory Response Syndrome |
| Chemical Substances | Interleukin-6 ; Interleukin-8 |
| Language | English |
| Publishing date | 2023-10-24 |
| Publishing country | England |
| Document type | Systematic Review ; Journal Article ; Review ; Research Support, Non-U.S. Gov't |
| ISSN | 1469-493X |
| ISSN (online) | 1469-493X |
| DOI | 10.1002/14651858.CD013584.pub2 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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