A meta-analysis of N-acetylcysteine in contrast-induced nephrotoxicity: unsupervised clustering to resolve heterogeneityReportar como inadecuado




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BMC Medicine

, 5:32

First Online: 14 November 2007Received: 17 May 2007Accepted: 14 November 2007DOI: 10.1186-1741-7015-5-32

Cite this article as: Gonzales, D.A., Norsworthy, K.J., Kern, S.J. et al. BMC Med 2007 5: 32. doi:10.1186-1741-7015-5-32

Abstract

BackgroundMeta-analyses of N-acetylcysteine NAC for preventing contrast-induced nephrotoxicity CIN have led to disparate conclusions. Here we examine and attempt to resolve the heterogeneity evident among these trials.

MethodsTwo reviewers independently extracted and graded the data. Limiting studies to randomized, controlled trials with adequate outcome data yielded 22 reports with 2746 patients.

ResultsSignificant heterogeneity was detected among these trials I = 37%; p = 0.04. Meta-regression analysis failed to identify significant sources of heterogeneity. A modified L-Abbé plot that substituted groupwise changes in serum creatinine for nephrotoxicity rates, followed by model-based, unsupervised clustering resolved trials into two distinct, significantly different p < 0.0001 and homogeneous populations I = 0 and p > 0.5, for both. Cluster 1 studies n = 18; 2445 patients showed no benefit relative risk RR = 0.87; 95% confidence interval CI 0.68–1.12, p = 0.28, while cluster 2 studies n = 4; 301 patients indicated that NAC was highly beneficial RR = 0.15; 95% CI 0.07–0.33, p < 0.0001. Benefit in cluster 2 was unexpectedly associated with NAC-induced decreases in creatinine from baseline p = 0.07. Cluster 2 studies were relatively early, small and of lower quality compared with cluster 1 studies p = 0.01 for the three factors combined. Dialysis use across all studies five control, eight treatment; p = 0.42 did not suggest that NAC is beneficial.

ConclusionThis meta-analysis does not support the efficacy of NAC to prevent CIN.

Electronic supplementary materialThe online version of this article doi:10.1186-1741-7015-5-32 contains supplementary material, which is available to authorized users.

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Autor: Denise A Gonzales - Kelly J Norsworthy - Steven J Kern - Steve Banks - Pamela C Sieving - Robert A Star - Charles Nata

Fuente: https://link.springer.com/







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