采用碎片状QRS预测肺栓塞的临床恶化和死亡率：meta分析
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Use of fragmented QRS in prognosticating clinical deterioration and mortality in pulmonary embolism: A meta‐analysis
目的
心电图上出现碎片状QRS（fQRS）对预测急性肺栓塞（PE）具有潜在价值。心电图是急诊科首选检测方法之一，具有快速诊断、无创、价格低廉等优点，且可在乡村地区使用。本文的目的在于评价fQRS在预测PE中的作用。
方 法
我们检索了截止2017年10月前MEDLINE，EMBASE，Google Scholar，Web of Science的摘要、会议论文和参考文献。符合条件的研究为使用fQRS预测患者死亡和临床恶化或治疗升级等主要结局。由两位作者独立完成研究筛选，产生分歧时采用协商解决。我们使用随机效应模型，比值比（OR）和95％置信区间（CI）进行meta分析，所有数据都是定性合成的。使用I2指数评估统计异质性。
结 果
共纳入5篇研究（1,165名患者）。研究的选择一致。fQRS明显可预测院内死亡率（OR[95%CI], 2.92[1.73-4.91]；P<0.001）心源性休克（OR[95%CI],4.71[1.61-13.70];P=0.005)以及2年内随访死亡率(OR [95% CI], 4.42 [2.57–7.60]; p < .001).调整后的分析结果与原结果基本一致。
结 论
尽管很少有研究探索该问题，但仍表明fQRS在PE预测中具有潜在价值。在PE风险评分中，应将fQRS与其他临床和心电图检查结果一起视为评估指标。
原始文献摘要
Qaddoura A, Digby GC, Kabali C, Kukla P, Tse G, Glover B, Baranchuk AM.Use of fragmented QRS in prognosticating clinical deterioration and mortality in pulmonary embolism: A meta-analysis.Ann Noninvasive Electrocardiol. 2018 Apr 19:e12552. doi: 10.1111/anec.
Abstract
BACKGROUND:
Fragmented QRS (fQRS) on electrocardiography is potentially valuable in prognosticating acute pulmonary embolism (PE). ECG is one of the first tests performed in the emergency department, quickly interpretable, noninvasive, inexpensive, and available in remote areas. We aimed to review fQRS's role in PE prognostication.
METHODS:
We searched MEDLINE, EMBASE, Google Scholar, Web of Science, abstracts, conference proceedings, and reference lists until October 2017. Eligible studies used fQRS to prognosticate patients for the main outcomes of death and clinical deterioration or escalation of therapy. Two authors independently selected studies, with disagreement resolved by consensus. Ad hoc piloted forms were used to extract data and assess risk of bias. We used a random-effects model to pool relevant data in meta-analysis with odds ratios (OR) and 95% confidence intervals (CI), while all other data were synthesized qualitatively. Statistical heterogeneity was assessed using the I2 index.
RESULTS:
We included five studies (1,165 patients). There was complete agreement in study selection. fQRS significantly predicted in-hospital mortality (OR [95% CI], 2.92 [1.73-4.91]; p < .001), cardiogenic shock (OR [95% CI], 4.71 [1.61-13.70]; p = .005), and total mortality at 2-year follow-up (OR [95% CI], 4.42 [2.57-7.60]; p < .001). Adjusted analyses were generally consistent with these results.
CONCLUSION:
Although few studies have explored the current study's question, they showed that fQRS is potentially valuable in PE prognostication. fQRS should be considered as an entry, along with other clinical and ECG findings, in a PE risk score.
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