BACKGROUND Pediatric cardiac surgery is commonly associated with acute kidney injury (AKI) and significant fluid retention, which complicate postoperative management and lead to increased rates of morbidity. This meta-analysis aimed to accumulate current literature evidence and evaluate the correlation of fluid overload degree with adverse outcome in patients undergoing congenital heart surgery. METHODS Medline, Scopus, CENTRAL, Clinicaltrials.gov, and Google Scholar were systematically searched from inception. All studies reporting the effects of fluid overload on postoperative clinical outcomes were selected. A dose-response meta-analytic method using restricted cubic splines was implemented in R-3.6.1. RESULTS Twelve studies were included, with a total of 3111 pediatric patients. Qualitative synthesis indicated that fluid overload was linked to significantly higher risk of mortality, AKI, prolonged hospital, and intensive care unit (ICU) stay, as well as with increased duration of mechanical ventilation, inotrope need, and infection rate. Meta-analysis demonstrated a linear correlation between fluid overload and the risk of mortality (χ2 = 6.22, p value = 0.01) and AKI (χ2 = 35.84, p value < 0.001), while a positive curvilinear relationship was estimated for the outcomes of hospital (χ2 = 18.84, p value = 0.0001) and ICU stay (χ2 = 63.69, p value = 0.0001). CONCLUSIONS The present meta-analysis supports that postoperative fluid overload is significantly linked to elevated risk of prolonged hospital stay, AKI development, and mortality in pediatric patients undergoing cardiac surgery. These findings warrant replication by future prospective studies, which should define the optimal cutoff values and assess the effectiveness of therapeutic strategies to limit fluid overload in the postoperative setting.

中文翻译：

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先天性心脏手术后术后液体超负荷与不良预后的关联：系统评价和剂量反应荟萃分析。

背景技术小儿心脏手术通常与急性肾损伤（AKI）和显着的体液associated留有关，这使术后管理变得复杂并导致发病率增加。这项荟萃分析旨在积累当前的文献证据，并评估先天性心脏手术患者的液体超负荷程度与不良结局的相关性。方法从开始就系统地搜索Medline，Scopus，CENTRAL，Clinicaltrials.gov和Google Scholar。选择所有报告液体超负荷对术后临床结局的影响的研究。R-3.6.1中实施了使用受限三次样条的剂量反应元分析方法。结果纳入十二项研究，共3111名儿科患者。定性综合表明，体液超负荷与死亡率，AKI，长期住院和重症监护病房（ICU）停留的风险显着较高有关，并且与机械通气时间，药物需求量和感染率的增加有关。荟萃分析表明，液体超负荷与死亡风险（χ2= 6.22，p值= 0.01）和AKI（χ2= 35.84，p值<0.001）之间呈线性关系，而医院结局的曲线呈正相关（χ2= 18.84，p值= 0.0001）和ICU停留（χ2= 63.69，p值= 0.0001）。结论本荟萃分析支持术后液体超负荷与接受心脏手术的小儿患者住院时间延长，AKI发育和死亡率升高的风险显着相关。