Author(s):
Question:
Setting:
Bibliography:
Certainty assessment№ of patientsEffectCertaintyImportance
№ of studiesStudy designRisk of biasInconsistencyIndirectnessImprecisionOther considerationslingudiureetikummitteRelative
(95% CI)		Absolute
(95% CI)
Üldine suremus (erinevad diureetikum vs platseebo, vt selgitus)a
31,2,3,4,b
randomised trials
seriousc
not serious
not serious
very seriousd,e
none
3/111 (2.7%)
12/110 (10.9%)
OR 0.24
(0.07 to 0.83)
81 fewer per 1,000
(from 101 fewer to 17 fewer)
⨁◯◯◯
Very low
Üldine suremus (erinevad diureetikumid vs platseebo; parallel design study)
11
randomised trials
not serious
not serious
not serious
seriousf
none
0/20 (0.0%)
2/18 (11.1%)
OR 0.16
(0.01 to 3.59)
92 fewer per 1,000
(from 110 fewer to 199 more)
⨁⨁⨁◯
Moderate
Üldine suremus (ära jäetud diureetikum vs diureetikum; withdrawal study)
22,3
randomised trials
seriousg
not serious
not serious
not serious
none
3/81 (3.7%)
7/83 (8.4%)
OR 0.26
(0.07 to 1.02)
61 fewer per 1,000
(from 78 fewer to 2 more)
⨁⨁⨁◯
Moderate
Üldine suremus (torasemiid vs platseebo)
15,h
randomised trials
not serious
not serious
seriousi
very seriousj
none
Täger jt 2019. aasta võrgustiku meta-analüüsi tulemused: torasemiid vs platseebo (1 RCT, Gupta 2010, n=28) PR (predictive risc) 0,81, PI 0,15 - 4,27; PI - ennustusvahemik (ingl. predictive interval)
⨁◯◯◯
Very low
Üldine suremus (furosemiid vs platseebo)
46,7,8,9,h
randomised trials
seriousk
not serious
serious
seriousl
none
Täger jt 2019. aasta võrgustiku meta-analüüsi tulemused: furosemiid vs platseebo (4 RCT, n=170 ) PR (predictive risc) 1, PI (predictive interval) 0,2 - 5,10; PI - ennustusvahemik (ingl. predictive interval)
⨁◯◯◯
Very low
Hospitaliseerimine südamepuudulikkuse dekompensatsiooni tõttu (diureetikum vs platseebo)
23,10,b
randomised trials
seriousg
not serious
not serious
seriousm
none
0/81 (0.0%)
13/88 (14.8%)
OR 0.07
(0.01 to 0.52)
136 fewer per 1,000
(from 146 fewer to 65 fewer)
⨁⨁◯◯
Low
Koormustaluvuse paranemine (diureetikum vs muu ravim)
411,12,13,14,b
randomised trials
not serious
not serious
not serious
not serious
none
Faris jt 2012. aasta süstemaatilises ülevaate andmeil (4 RCT-d, n=91) paranes diureetikumide rühmas patsientidel koormustaluvus suuremal määral vs kontrollrühmaga: WMD (difference in means) 0.72, 95% CI 0.40-1.04; P<0.0001.
⨁⨁⨁⨁
High

CI: confidence interval; OR: odds ratio

Explanations

a. Patsientidele manustati uuringutes lingudiureetikumid: piretaniid (Sherman 1986); furosemiid, moduretic, navidrex, klopamid, klortalidon (Burr 1977); hüdroklorotiasiid, furosemiid, spironolaton (Myers 1982)
b. Faris RF, Flather M, Purcell H, Poole-Wilson PA, Coats AJS. Diuretics for heart failure. Cochrane Database of Systematic Reviews. 2012, Issue 2. Art. No.: CD003838
c. Kolmest uuringust kahes on võrreldud lingudiureetikumi ärajätmisega kaasnevat mõju erinevatele tervisetulemitele, mis aga tähendab, et tegemist ei ole ravinaiivsete patsientidega; ühes uuringus (Myyers 1982) said patsiendid erinevaid diureetikume, ka MRA
d. Usaldusvahemik on lai.
e. Uuritavate ning juhtude (surmade) arv on väike. Lisaks on uuringutes eraldivõetuna usaldusvahemik väga lai, mis viitab erinevuse puudumisele üldise suremuse osas sekkumis- ja kontrollrühma vahel.
f. Väga väike uuritavate ja juhtumite arv.
g. Sekkumisrühma patsiendid pidid loobuma diureetikumi kasutamisest, mistõttu ei ole tegemist ravinaiivsete patsientidega
h. Täger T, Fröhlich H, Seiz M, Katus HA, Frankenstein L. READY: relative efficacy of loop diuretics in patients with chronic systolic heart failure - a systematic review and network meta-analysis of randomised trials. Heart Fail Rev. 2019; 24(4):461-472
i. tegemist ekstrapoleeritud andmetega (predictive risk)
j. Uuritavate arv on väike. Lisaks on ennustusvahemik väga lai, surmade arv oli 0 mõlemas rühmas.
k. Nihke riski tõstab gruppide paigutamise strateegia puudulik kirjeldamine, kahtlus valikulisele raporteerimisele mitmes uuringus
l. Uuritavate arv on väike. Lisaks on OR=1 ning ennustusvahemik väga lai, mis viitab erinevuse puudumisele sekkumis- ja kontrollrühma vahel.
m. Uuritavate ning juhtude arv on väike, kuid jälgitav selge erinevus sekkumis ja kontrollrühma vahel hospitaliseerimiste arvu poolest.

References

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2.Myers MG, Weingert ME,Fisher RH,Gryfe CI,Schulman HS. Unnecessary diuretic therapy in the elderly. Age & Ageing; 1982.
3.Burr ML, King S,Davies HE,Pathy MS. The effects of discontinuing long-term diuretic therapy in elderly. Age & Ageing; 1977.
4.Faris RF, Flather M Purcell H Poole-Wilson PA Coats AJS. Diuretics for heart failure. Cochrane Database of Systematic Reviews; 2012.
5.Gupta S, Waywell C,Gandhi N,Clayton N,Keevil B,Clark AL,Ng LL,Brooks N,Neyses L. The effects of adding torasemide to standard therapy on peak oxygen consumption, natriuretic peptides, and quality of life in patients with compensated left ventricular systolic dysfunction. Eur J Heart Fail; 2010.
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11.Richardson A, Bayliss J,Scriven AJ,Sutton GC,Poole- Wilson PA. Double-blind comparison of captopril alone against furosemide plus amiloride in mild heart failure. Lancet; 1987.
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