Prognostic Value of Retinal Microvascular Alterations Detected by Fundus Examination in Critically Ill Patients: A Meta-Analysis
Notice bibliographique
Résumé
Introduction: The ocular fundus provides a unique window into the human microcirculation. Retinal microvascular alterations (RMVAs), such as hemorrhages, cotton wool spots, and vessel caliber changes, are observed in critically ill patients and may reflect systemic microvascular dysfunction, a key element in the pathophysiology of critical illness and organ failure. However, the prognostic significance of these findings in the intensive care unit (ICU) setting remains uncertain due to variability among individual studies. This meta-analysis aimed to synthesize existing evidence on the association between RMVAs detected by fundus examination and mortality in critically ill adult patients. Methods: We conducted a systematic literature search across PubMed, Embase, Scopus, and Web of Science databases for observational studies published between January 1st, 2013, and December 31st, 2023. Studies evaluating the association between RMVAs during ICU stay and mortality in adult ICU patients were included. Two reviewers independently performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale (NOS). Data on the presence versus absence of any significant RMVA and mortality were pooled using a random-effects model to calculate an overall odds ratio (OR) with a 95% confidence interval (CI). Heterogeneity was assessed using the I² statistic and Cochrane's Q test. Results: Our search yielded 1,872 unique records, of which 28 were assessed in full text. Six cohort studies, published between 2015 and 2023, met the inclusion criteria, encompassing a total of 1,358 critically ill patients. The included studies varied in population characteristics (medical, surgical, mixed ICUs) and methods of RMVA assessment. The overall quality of included studies was moderate to good (median NOS score 7, range 6-8). The prevalence of any significant RMVA ranged from 18% to 45% across studies. The pooled analysis demonstrated a statistically significant association between the presence of any RMVA detected on fundus examination and increased odds of mortality (Pooled OR = 2.48; 95% CI: 1.65–3.71; p < 0.0001). Moderate heterogeneity was observed among the studies (I² = 58%; p = 0.03 for Cochran's Q test). Conclusion: The presence of retinal microvascular alterations identified through fundus examination during ICU stay is significantly associated with an increased risk of short-term mortality in critically ill adult patients. These alterations may serve as an accessible marker of underlying systemic microvascular pathology and disease severity. Further large-scale, prospective studies with standardized protocols are warranted to confirm these findings and explore the utility of specific retinal signs.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,023 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».