Purtscher-like Retinopathy in Critically Ill Patients (Non-Traumatic Etiologies): A Systematic Review and Meta-analysis of Incidence, Associated Conditions, and Visual Outcomes
Notice bibliographique
Résumé
Introduction: Purtscher-like retinopathy (PLR) is an occlusive microvasculopathy presenting with funduscopic findings similar to Purtscher's retinopathy but occurring in the absence of direct head or chest trauma. Its association with various systemic conditions, particularly those requiring intensive care unit (ICU) admission, is recognized, but comprehensive data on its incidence, spectrum of associated non-traumatic critical illnesses, and visual prognosis in this specific population remain sparse. This study aimed to systematically review the literature and perform a meta-analysis to estimate the incidence of PLR among critically ill patients with non-traumatic conditions, identify commonly associated systemic diseases, and quantify visual outcomes. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Embase, Scopus, and Web of Science databases were searched from January 1st, 2013, to December 31st, 2023, for studies reporting PLR in critically ill adult patients admitted for non-traumatic reasons. Studies included cohort studies, case-control studies, and sufficiently large case series (n≥5 with ICU context) reporting incidence or detailed clinical data. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the Newcastle-Ottawa Scale (NOS). Pooled incidence of PLR, associated conditions, and final visual acuity (logMAR) were synthesized. A random-effects model was used for meta-analysis due to anticipated heterogeneity. Results: 6 studies met the full eligibility criteria for quantitative synthesis, encompassing 960 critically ill patients from various ICU settings. The included studies were predominantly retrospective cohorts with moderate overall quality (median NOS score 7, range 6-8). The pooled estimated incidence of PLR in the evaluated non-traumatic critically ill populations was 3.4% (95% Confidence Interval [CI]: 2.1% - 5.5%), exhibiting substantial heterogeneity (I² = 80%, p < 0.001). The most frequently reported associated conditions were severe acute pancreatitis (reported in 4/6 studies) and sepsis/septic shock (4/6 studies). Other identified associations included acute kidney injury requiring renal replacement therapy, HELLP syndrome in post-partum patients admitted to ICU, and systemic lupus erythematosus/antiphospholipid syndrome flares requiring intensive care. Visual outcomes were generally poor; the pooled mean final best-corrected visual acuity (BCVA) was 0.85 logMAR (approx. Snellen 20/140; 95% CI: 0.65 - 1.05 logMAR), again with significant heterogeneity (I² = 75%). Approximately 45% of affected eyes had a final BCVA of less than 20/200. Conclusion: Purtscher-like retinopathy represented a notable, albeit relatively uncommon, complication among heterogeneous populations of critically ill patients admitted for non-traumatic conditions. It was most frequently associated with severe systemic inflammatory states such as acute pancreatitis and sepsis. Increased awareness and ophthalmoscopic screening in high-risk ICU patients may be warranted. The observed heterogeneity highlights the need for larger prospective studies with standardized diagnostic and reporting criteria.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
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 | 0,013 | 0,085 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,012 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,002 |
| 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 ».