The prognostic value of extravascular lung water (EVLW) measured by transpulmonary thermodilution (TPTD) in critically ill patients is debated. We performed a systematic review and meta-analysis of studies assessing the effects of TPTD-estimated EVLW on mortality in critically ill patients. Cohort studies published in English from Embase, MEDLINE, and the Cochrane Database of Systematic Reviews from 1960 to 1 June 2021 were systematically searched. From eligible studies, the values of the odds ratio (OR) of EVLW as a risk factor for mortality, and the value of EVLW in survivors and non-survivors were extracted. Pooled OR were calculated from available studies. Mean differences and standard deviation of the EVLW between survivors and non-survivors were calculated. A random effects model was computed on the weighted mean differences across the two groups to estimate the pooled size effect. Subgroup analyses were performed to explore the possible sources of heterogeneity. Of the 18 studies included (1296 patients), OR could be extracted from 11 studies including 905 patients (464 survivors vs. 441 non-survivors), and 17 studies reported EVLW values of survivors and non-survivors, including 1246 patients (680 survivors vs. 566 non-survivors). The pooled OR of EVLW for mortality from eleven studies was 1.69 (95% confidence interval (CI) [1.22; 2.34], p < 0.0015). EVLW was significantly lower in survivors than non-survivors, with a mean difference of −4.97 mL/kg (95% CI [−6.54; −3.41], p < 0.001). The results regarding OR and mean differences were consistent in subgroup analyses. The value of EVLW measured by TPTD is associated with mortality in critically ill patients and is significantly higher in non-survivors than in survivors. This finding may also be interpreted as an indirect confirmation of the reliability of TPTD for estimating EVLW at the bedside. Nevertheless, our results should be considered cautiously due to the high risk of bias of many studies included in the meta-analysis and the low rating of certainty of evidence. Trial registration the study protocol was prospectively registered on PROSPERO: CRD42019126985.

中文翻译：

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血管外肺水水平与死亡率相关：系统评价和荟萃分析

经肺热稀​​释法 (TPTD) 测量的血管外肺水 (EVLW) 在危重患者中的预后价值存在争议。我们对评估 TPTD 估计的 EVLW 对危重病患者死亡率影响的研究进行了系统回顾和荟萃分析。系统检索了从 1960 年至 2021 年 6 月 1 日从 Embase、MEDLINE 和 Cochrane 系统评价数据库以英语发表的队列研究。从符合条件的研究中，提取 EVLW 作为死亡风险因素的优势比 (OR) 值，以及 EVLW 在幸存者和非幸存者中的值。根据现有研究计算汇总 OR。计算幸存者和非幸存者之间 EVLW 的平均差和标准差。对两组的加权平均差异计算随机效应模型，以估计合并的大小效应。进行亚组分析以探索异质性的可能来源。在纳入的 18 项研究中（1296 名患者），OR 可以从 11 项研究中提取，包括 905 名患者（464 名幸存者与 441 名非幸存者），17 项研究报告了幸存者和非幸存者的 EVLW 值，包括 1246 名患者（680 名幸存者）与 566 名非幸存者相比）。来自 11 项研究的 EVLW 死亡率汇总 OR 为 1.69（95% 置信区间 (CI) [1.22; 2.34]，p < 0.0015）。幸存者的 EVLW 显着低于非幸存者，平均差异为 -4.97 mL/kg（95% CI [-6.54；-3.41]，p < 0.001）。关于 OR 和平均差异的结果在亚组分析中是一致的。由 TPTD 测量的 EVLW 值与危重病患者的死亡率相关，并且在非幸存者中显着高于幸存者。这一发现也可以解释为间接证实了 TPTD 在床边估计 EVLW 的可靠性。然而，由于纳入荟萃分析的许多研究存在高偏倚风险以及证据确定性的低等级，我们的结果应谨慎考虑。试验注册 研究方案在 PROSPERO 上前瞻性注册：CRD42019126985。由于荟萃分析中包含的许多研究存在高偏倚风险以及证据确定性的低等级，我们的结果应谨慎考虑。试验注册 研究方案在 PROSPERO 上前瞻性注册：CRD42019126985。由于荟萃分析中包含的许多研究存在高偏倚风险以及证据确定性的低等级，我们的结果应谨慎考虑。试验注册 研究方案在 PROSPERO 上前瞻性注册：CRD42019126985。