Association between splenectomy and chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis
Liyan Zhang, Peijing Yan, Kehu Yang, Shanlian Wu, Yuping Bai, Xinyu Zhu, Xiaojie Chen, Li Li, Yunshan Cao, Min Zhang
Abstract
Objective Whether splenectomy increases the risk of chronic thromboembolic pulmonary hypertension (CTEPH) remains unclear. We conducted a systematic review and meta-analysis to explore the association between splenectomy and CTEPH. Design Systematic review and meta-analysis. Data sources PubMed, Embase and Cochrane Library databases. Methods Two authors independently searched and extracted the data. The Newcastle-Ottawa Scale and the Strengthening the Reporting of Observational Studies in Epidemiology guidelines were used to assess the quality of the included studies, and each quality item was graded as low risk or high risk. A random-effects model was used to calculate different effective values. Results In total, 8 trials involving 6183 participants fulfilled the inclusion criteria. The overall pooled crude prevalence of splenectomy was 4.0% (95% CI 0.03 to 0.06, I 2 =71.5%, p<0.001) in patients with CTEPH. Subgroup analysis showed a statistically significant high incidence of splenectomy in patients with CTEPH (OR=2.94, 95% CI 1.62 to 5.33, I 2 =0.0%, p<0.001) compared with patients with pulmonary arterial hypertension. There was a significantly high incidence of splenectomy in patients with CTEPH (OR=5.59, 95% CI 2.12 to 14.74, I 2 =0.0%, p<0.001) compared with patients with thromboembolism disease (venous thromboembolism or pulmonary embolism). Conclusion The prevalence of splenectomy in patients with CTEPH was 4.0% and CTEPH might be associated with splenectomy. However, high-quality prospective trials are needed. PROSPERO registration number CRD42020137591.