Clipping versus coiling for aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of prospective studies

AbstractNeurosurgical clipping and endovascular coiling are both standard therapies to prevent rebleeding after aneurysmal subarachnoid hemorrhage (aSAH). However, controversy still exists about which is the optimal treatment. This meta-analysis aims to assess the effectiveness and safety of two treatments with high-quality evidence. Web of Science, Cochrane Library, EMBASE, Pubmed, Sinomed, China National Knowledge Infrastructure, and Wanfang Data databases were systematically searched on August 5, 2021. Randomized controlled trials (RCTs) and prospective cohort studies that evaluated the effectiveness and safety of clipping versus coiling in aSAH patients at discharge or within 1-year follow-up period were eligible. No restriction was set on the publication date. Meta-analyses were conducted to calculate the pooled estimates and 95% confidence intervals (CI) of relative risk (RR). Eight RCTs and 20 prospective cohort studies were identified. Compared to coiling, clipping was associated with a lower rebleeding rate at discharge (RR: 0.52, 95% CI: 0.29––0.94) and a higher aneurysmal occlusion rate (RR: 1.33, 95% CI: 1.19–1.48) at 1-year follow-up. In contrast, coiling reduced the vasospasm rate at discharge (RR: 1.45, 95% CI: 1.23–1.71) and 1-year poor outcome rate (RR: 1.27, 95% CI: 1.16–1.39). Subgroup analyses presented that among patients with a poor neurological condition at admission, no statistically significant outcome difference existed between the two treatments. The overall prognosis was better among patients who received coiling, but this advantage was not significant among patients with a poor neurological condition at admission. Therefore, the selection of treatment modality for aSAH patients should be considered comprehensively.

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Effect of statin treatment on vasospasm-related morbidity and functional outcome in patients with aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

Journal of Neurosurgery ◽

10.3171/2016.5.jns152900 ◽

2017 ◽

Vol 127 (2) ◽

pp. 291-301 ◽

Cited By ~ 9

Author(s):

Jian Shen ◽

Kai-Yuan Huang ◽

Yu Zhu ◽

Jian-Wei Pan ◽

Hao Jiang ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Infarction ◽

Cohort Studies ◽

Cerebral Vasospasm ◽

Prospective Cohort ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Meta Analysis ◽

Statin Treatment ◽

Favorable Outcome ◽

Prospective Cohort Studies

OBJECTIVEThe efficacy of statin therapy in treating aneurysmal subarachnoid hemorrhage (SAH) remains controversial. In this meta-analysis, the authors investigated whether statin treatment significantly reduced the incidence of cerebral vasospasm and delayed neurological deficits, promoting a better outcome after aneurysmal SAH.METHODSA literature search of the PubMed, Ovid, and Cochrane Library databases was performed for randomized controlled trials (RCTs) and prospective cohort studies investigating the effect of statin treatment. The end points of cerebral vasospasm, delayed ischemic neurological deficit (DIND), delayed cerebral infarction, mortality, and favorable outcome were statistically analyzed.RESULTSSix RCTs and 2 prospective cohort studies met the eligibility criteria, and a total of 1461 patients were included. The meta-analysis demonstrated a significant decrease in the incidence of cerebral vasospasm (relative risk [RR] 0.76, 95% confidence interval [CI] 0.61–0.96) in patients treated with statins after aneurysmal SAH. However, no significant benefit was observed for DIND (RR 0.88, 95% CI 0.70–1.12), delayed cerebral infarction (RR 0.66, 95% CI 0.33–1.31), mortality (RR 0.69, 95% CI 0.39–1.24) or favorable outcome, according to assessment by the modified Rankin Scale or Glasgow Outcome Scale (RR 0.99, 95% CI 0.92–1.17).CONCLUSIONSTreatment with statins significantly decreased the occurrence of vasospasm after aneurysmal SAH. The incidence of DIND, delayed cerebral infarction, and mortality were not affected by statin treatment. Future research should focus on DIND and how statins influence DIND.

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Subclinical thyroid dysfunction and depressive symptoms: protocol for a systematic review and individual participant data meta-analysis of prospective cohort studies

BMJ Open ◽

10.1136/bmjopen-2019-029716 ◽

2019 ◽

Vol 9 (7) ◽

pp. e029716

Author(s):

Lea Wildisen ◽

Elisavet Moutzouri ◽

Shanthi Beglinger ◽

Lamprini Syrogiannouli ◽

Anne R Cappola ◽

...

Keyword(s):

Systematic Review ◽

Depressive Symptoms ◽

Cohort Studies ◽

Prospective Cohort ◽

Thyroid Dysfunction ◽

Meta Analysis ◽

Individual Participant Data ◽

Prospective Cohort Studies ◽

Individual Participant

IntroductionProspective cohort studies on the association between subclinical thyroid dysfunction and depressive symptoms have yielded conflicting findings, possibly because of differences in age, sex, thyroid-stimulating hormone cut-off levels or degree of baseline depressive symptoms. Analysis of individual participant data (IPD) may help clarify this association.Methods and analysisWe will conduct a systematic review and IPD meta-analysis of prospective studies on the association between subclinical thyroid dysfunction and depressive symptoms. We will identify studies through a systematic search of the literature in the Ovid Medline, Ovid Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases from inception to April 2019 and from the Thyroid Studies Collaboration. We will ask corresponding authors of studies that meet our inclusion criteria to collaborate by providing IPD. Our primary outcome will be depressive symptoms at the first available individual follow-up, measured on a validated scale. We will convert all the scores to the Beck Depression Inventory scale. For each cohort, we will estimate the mean difference of depressive symptoms between participants with subclinical hypothyroidism or hyperthyroidism and control adjusted for depressive symptoms at baseline. Furthermore, we will adjust our multivariable linear regression analyses for age, sex, education and income. We will pool the effect estimates of all studies in a random-effects meta-analysis. Heterogeneity will be assessed by I2. Our secondary outcomes will be depressive symptoms at a specific follow-up time, at the last available individual follow-up and incidence of depression at the first, last and at a specific follow-up time. For the binary outcome of incident depression, we will use a logistic regression model.Ethics and disseminationFormal ethical approval is not required as primary data will not be collected. Our findings will have considerable implications for patient care. We will seek to publish this systematic review and IPD meta-analysis in a high-impact clinical journal.PROSPERO registration numberCRD42018091627.

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Prognostic value of von Willebrand factor for patients with atrial fibrillation: a meta-analysis of prospective cohort studies

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-136842 ◽

2019 ◽

Vol 96 (1135) ◽

pp. 267-276 ◽

Cited By ~ 2

Author(s):

Yuan-Zheng Ye ◽

Ya-Fei Chang ◽

Bao-Zhu Wang ◽

Yi-Tong Ma ◽

Xiang Ma

Keyword(s):

Atrial Fibrillation ◽

Cohort Studies ◽

Von Willebrand Factor ◽

Prospective Cohort ◽

Meta Analysis ◽

Cardiovascular Death ◽

Cochrane Library ◽

Prospective Cohort Studies ◽

Von Willebrand ◽

Willebrand Factor

BackgroundIt is unknown whether an abnormal level of von Willebrand factor (vWF) is correlated with the prognosis of patients with atrial fibrillation (AF) and current findings are controversial. This meta-analysis aimed to evaluate the association between vWF levels and the clinical prognosis of patients with AF.MethodsWe searched prospective cohort studies on PubMed, Embase, Web of Science, Cochrane Library and WanFang databases for vWF and adverse events of AF from inception of the databases to July 2019. The risk ratios of all-cause death, cardiovascular death, major adverse cardiac events (MACE), stroke and bleeding prognosis in patients with AF were analysed using a fixed-effects model or random-effects model, and all included studies were evaluated with heterogeneity and publication bias analysis.ResultsTwelve studies which included 7449 patients with AF were used in the meta-analysis. The average age was 71.3 years and the average follow-up time was 3.38 years. The analysis found that high vWF levels were associated with increased risks of all-cause death (RR 1.56; 95% CI 1.16 to 2.11, p=0.00400), cardiovascular death (RR 1.91; 95% CI 1.20 to 3.03, p=0.00600), MACE (RR 1.83; 95% CI 1.28 to 2.62, p=0.00090), stroke (RR 1.69; 95% CI 1.08 to 2.64, p=0.02000) and bleeding (RR 2.01; 95% CI 1.65 to 2.45, p<0.00001) in patients with AF.ConclusionsvWF is a risk factor for poor prognosis of AF, and patients with higher vWF levels have a higher risk of all-cause death, cardiovascular death, MACE, stroke and bleeding.

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Association between maternal vitamin D deficiency and small for gestational age: evidence from a meta-analysis of prospective cohort studies

BMJ Open ◽

10.1136/bmjopen-2017-016404 ◽

2017 ◽

Vol 7 (8) ◽

pp. e016404 ◽

Cited By ~ 25

Author(s):

Yao Chen ◽

Beibei Zhu ◽

Xiaoyan Wu ◽

Si Li ◽

Fangbiao Tao

Keyword(s):

Vitamin D ◽

Cohort Studies ◽

Vitamin D Deficiency ◽

Gestational Age ◽

Small For Gestational Age ◽

Prospective Cohort ◽

Meta Analysis ◽

Cochrane Library ◽

Maternal Vitamin ◽

Prospective Cohort Studies

ObjectiveTo determine whether maternal vitamin D deficiency during pregnancy is associated with small for gestational age (SGA).MethodsA comprehensive literature search of PubMed, the Cochrane Library, Embase, and the Elsevier ScienceDirect library was conducted to identify relevant articles reporting prospective cohort studies in English, with the last report included published in February 2017. Pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were used to evaluate the correlation in a random effects model.ResultsA total of 13 cohort studies were included in this meta-analysis with a sample of 28 285 individuals from seven countries. The pooled overall OR for babies born SGA was 1.588 (95%CI 1.138 to 2.216; p<0.01) for women with vitamin D deficiency. The prevalence of vitamin D deficiency during pregnancy varied from 13.2% to 77.3%. Subgroup analyses identified no significant differences in the association between vitamin D deficiency and SGA based on study quality, gestational week during which blood sampling was performed, cut-off vitamin D levels, sample size, adjustment for critical confounders and method for measuring vitamin D.ConclusionThis meta-analysis suggests that vitamin D deficiency is associated with an increased risk of SGA.

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Breastfeeding and Atopic Dermatitis Risk: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Dermatology ◽

10.1159/000503781 ◽

2019 ◽

Vol 236 (4) ◽

pp. 345-360 ◽

Cited By ~ 2

Author(s):

Bingjiang Lin ◽

Ru Dai ◽

Lingyi Lu ◽

Xin Fan ◽

Yingzhe Yu

Keyword(s):

Atopic Dermatitis ◽

Cohort Studies ◽

Exclusive Breastfeeding ◽

Prospective Cohort ◽

Meta Analysis ◽

Cochrane Library ◽

Protective Function ◽

Prospective Cohort Studies ◽

Weak Evidence ◽

Comprehensive Search

Objectives: The effect of breastfeeding on atopic dermatitis (AD) remains controversial. To determine the association between breastfeeding and AD, we conducted an updated meta-analysis of prospective cohort studies. Methods: A comprehensive search of PubMed, EMBASE, MEDLINE and Cochrane Library was conducted. Studies meeting the predetermined criteria were evaluated by 2 authors independently. The pooled relative risk (RR) adjusted for confounders with its 95% CI was calculated by a random-effects model. Heterogeneity was explored by subgroup analysis and meta-regression. Results: A total of 27 studies were included for meta-analysis. The pooled estimates for the effect of total and exclusive breastfeeding on AD were 1.01 (95% CI 0.93–1.10) and 0.99 (95% CI 0.88–1.11), respectively. Heterogeneity was substantial across studies (total: p < 0.01 or I2 = 65.2%; exclusive: p < 0.01 or I2 = 72.3%). There was a weak evidence for a protective effect of breastfeeding against AD in cohorts with atopic heredity (total: RR 0.85, 95% CI 0.74–0.98; exclusive: RR 0.83, 95% CI 0.70–0.97). In cohorts without atopic heredity, the effect shifted to the risk side when limited to exclusive breastfeeding (RR 1.19, 95% CI 1.02–1.40) while it dropped towards null when limited to total breastfeeding (RR 1.11, 95% CI 0.94–1.31). Conclusions: There is no association between AD and breastfeeding, regardless of total or exclusive breastfeeding patterns. There is some evidence for a protective function of exclusive and total breastfeeding in a cohort with atopic heredity. The effect shifts to the risk side in cohorts without atopic heredity. However, these findings should be interpreted with caution because heterogeneity is evident.

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Adiponectin and the risk of new-onset atrial fibrillation: a meta-analysis of prospective cohort studies

Bioscience Reports ◽

10.1042/bsr20182284 ◽

2019 ◽

Vol 39 (6) ◽

Cited By ~ 1

Author(s):

Ying Guo ◽

Lixin Liu ◽

Jianjun Wang

Keyword(s):

Atrial Fibrillation ◽

General Population ◽

Cohort Studies ◽

Prospective Cohort ◽

Meta Analysis ◽

Serum Adiponectin ◽

Prospective Cohort Studies ◽

Subgroup Analyses ◽

New Onset

Abstract Background: Adiponectin has been suggested as a marker of many cardiovascular diseases. However, the association between serum adiponectin and incidence of atrial fibrillation (AF) in general population remains unclear. A meta-analysis was performed to systematically evaluate the potential influence of serum adiponectin at baseline on the incidence of AF during follow-up in general population. Methods: Prospective cohort studies were identified via electronic search of PubMed and Embase databases. A randomized effect model was applied to combine the results. Predefined subgroup analyses were performed to evaluate the influence of study characteristics on the association between baseline adiponectin and risk of new-onset AF. Results: Six cohort studies with 18558 community-derived participants were included, and 3165 AF cases were developed with a mean follow-up duration of up to 22 years. Meta-analysis showed that higher baseline circulating adiponectin was significantly associated with higher risk of new-onset AF during follow-up (hazard ratio [HR]: 1.17, 95% confidence interval [CI]: 1.08–1.27, P<0.001, I2 = 52%). Subgroup analyses showed that the association between adiponectin and new-onset AF was significant in studies with mean follow-up duration over 10 years (five cohorts, HR = 1.22, P<0.001), but not in that with a follow-up duration < 10 years (one cohort, HR = 0.95, P=0.51; P for subgroup difference = 0.002). Conclusions: Higher circulating adiponectin at baseline may be an independent risk factor for the development of new-onset AF during follow-up, particularly in cohort studies with longer follow-up durations.

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Important food sources of fructose-containing sugars and incident gout: a systematic review and meta-analysis of prospective cohort studies

BMJ Open ◽

10.1136/bmjopen-2018-024171 ◽

2019 ◽

Vol 9 (5) ◽

pp. e024171 ◽

Cited By ~ 7

Author(s):

Sabrina Ayoub-Charette ◽

Qi Liu ◽

Tauseef A Khan ◽

Fei Au-Yeung ◽

Sonia Blanco Mejia ◽

...

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Prospective Cohort ◽

Fruit Juice ◽

Meta Analysis ◽

Food Sources ◽

Cochrane Library ◽

Fruit Intake ◽

Important Food ◽

Prospective Cohort Studies

ObjectiveSugar-sweetened beverages (SSBs) are associated with hyperuricaemia and gout. Whether other important food sources of fructose-containing sugars share this association is unclear.DesignTo assess the relation of important food sources of fructose-containing sugars with incident gout and hyperuricaemia, we conducted a systematic review and meta-analysis of prospective cohort studies.MethodsWe searched MEDLINE, Embase and the Cochrane Library (through 13 September 2017). We included prospective cohort studies that investigated the relationship between food sources of sugar and incident gout or hyperuricaemia. Two independent reviewers extracted relevant data and assessed the risk of bias. We pooled natural-log transformed risk ratios (RRs) using the generic inverse variance method with random effects model and expressed as RR with 95% confidence intervals (CIs). The overall certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system.ResultsWe identified three studies (1 54 289 participants, 1761 cases of gout), comparing the highest with the lowest level of exposure for SSBs, fruit juices and fruits. No reports were found reporting incident hyperuricaemia. Fruit juice and SSB intake showed an adverse association (fruit juice: RR=1.77, 95% CI 1.20 to 2.61; SSB: RR=2.08, 95% CI 1.40 to 3.08), when comparing the highest to lowest intake of the most adjusted models. There was no significant association between fruit intake and gout (RR 0.85, 95% CI 0.63 to 1.14). The strongest evidence was for the adverse association with SSB intake (moderate certainty), and the weakest evidence was for the adverse association with fruit juice intake (very low certainty) and lack of association with fruit intake (very low certainty).ConclusionThere is an adverse association of SSB and fruit juice intake with incident gout, which does not appear to extend to fruit intake. Further research is needed to improve our estimates.Trial registration numberNCT02702375; Results.

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Egg consumption and risk of type 2 diabetes: findings from 3 large US cohort studies of men and women and a systematic review and meta-analysis of prospective cohort studies

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqaa115 ◽

2020 ◽

Vol 112 (3) ◽

pp. 619-630 ◽

Cited By ~ 1

Author(s):

Jean-Philippe Drouin-Chartier ◽

Amanda L Schwab ◽

Siyu Chen ◽

Yanping Li ◽

Frank M Sacks ◽

...

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Cohort Studies ◽

Prospective Cohort ◽

Meta Analysis ◽

Egg Consumption ◽

Prospective Cohort Studies ◽

Incident Cases

ABSTRACT Background Whether egg consumption is associated with the risk of type 2 diabetes (T2D) remains unsettled. Objectives We evaluated the association between egg consumption and T2D risk in 3 large US prospective cohorts, and performed a systematic review and meta-analysis of prospective cohort studies. Methods We followed 82,750 women from the Nurses’ Health Study (NHS; 1980–2012), 89,636 women from the NHS II (1991–2017), and 41,412 men from the Health Professionals Follow-up Study (HPFS; 1986–2016) who were free of T2D, cardiovascular disease, and cancer at baseline. Egg consumption was assessed every 2–4 y using a validated FFQ. We used Cox proportional hazard models to estimate HRs and 95% CIs. Results During a total of 5,529,959 person-years of follow-up, we documented 20,514 incident cases of T2D in the NHS, NHS II, and HPFS. In the pooled multivariable model adjusted for updated BMI, lifestyle, and dietary confounders, a 1-egg/d increase was associated with a 14% (95% CI: 7%, 20%) higher T2D risk. In random-effects meta-analysis of 16 prospective cohort studies (589,559 participants; 41,248 incident T2D cases), for each 1 egg/d, the pooled RR of T2D was 1.07 (95% CI: 0.99, 1.15; I2 = 69.8%). There were, however, significant differences by geographic region (P for interaction = 0.01). Each 1 egg/d was associated with higher T2D risk among US studies (RR: 1.18; 95% CI: 1.10, 1.27; I2 = 51.3%), but not among European (RR: 0.99; 95% CI: 0.85, 1.15; I2 = 73.5%) or Asian (RR: 0.82; 95% CI: 0.62, 1.09; I2 = 59.1%) studies. Conclusions Results from the updated meta-analysis show no overall association between moderate egg consumption and risk of T2D. Whether the heterogeneity of the associations among US, European, and Asian cohorts reflects differences in egg consumption habits warrants further investigation. This systematic review was registered at www.crd.york.ac.uk/prospero as CRD42019127860.

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Height and Risk of Hip Fracture: A Meta-Analysis of Prospective Cohort Studies

BioMed Research International ◽

10.1155/2016/2480693 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8

Author(s):

Zhihong Xiao ◽

Dong Ren ◽

Wei Feng ◽

Yan Chen ◽

Wusheng Kan ◽

...

Keyword(s):

Hip Fracture ◽

Cohort Studies ◽

Prospective Cohort ◽

Web Of Science ◽

Meta Analysis ◽

Cochrane Library ◽

Response Analysis ◽

Prospective Cohort Studies ◽

Increased Risk ◽

The Cochrane Library

The association between height and risk of hip fracture has been investigated in several studies, but the evidence is inconclusive. We therefore conducted this meta-analysis of prospective cohort studies to explore whether an association exists between height and risk of hip fracture. We searched PubMed and EMBASE, Web of Science, and the Cochrane Library for studies of height and risk of hip fracture up to February 16, 2016. The random-effects model was used to combine results from individual studies. Seven prospective cohort studies, with 7,478 incident hip fracture cases and 907,913 participants, were included for analysis. The pooled relative risk (RR) was 1.65 (95% confidence interval (CI): 1.26–2.16) comparing the highest with the lowest category of height. Result from dose-response analysis suggested a linear association between height and hip fracture risk (P-nonlinearity = 0.0378). The present evidence suggests that height is positively associated with increased risk of hip fracture. Further well-designed cohort studies are needed to confirm the present findings in other ethnicities.

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Coffee consumption and the risk of cerebrovascular disease: a meta-analysis of prospective cohort studies

BMC Neurology ◽

10.1186/s12883-021-02411-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lung Chan ◽

Chien-Tai Hong ◽

Chyi-Huey Bai

Keyword(s):

Ischemic Stroke ◽

Cohort Studies ◽

Prospective Cohort ◽

Hemorrhagic Stroke ◽

Stroke Risk ◽

Meta Analysis ◽

Coffee Consumption ◽

Healthy People ◽

Prospective Cohort Studies

Abstract Background Stroke is a crucial health threat to adults worldwide. Despite extensive knowledge of risk-factor mitigation, no primary prevention exists for healthy people. Coffee is a widely consumed beverage globally. Health benefit of coffee for several neurological diseases has been identified; however, the association between stroke risk and coffee consumption in healthy people has not been determined. We investigated the effect of coffee on stroke risk by conducting a meta-analysis of prospective cohort studies. Methods Electronic databases, namely PubMed, BioMed Central, Medline, and Google Scholar, were searched using terms related to stroke and coffee. Articles that described clear diagnostic criteria for stroke and details on coffee consumption were included. The reference lists of relevant articles were reviewed to identify eligible studies not shortlisted using these terms. Enrolled studies were grouped into three outcome categories: overall stroke, hemorrhagic stroke, and ischemic stroke. Results Seven studies were included and all of them were large-scale, long-term, follow-up cohort studies of a healthy population. Upon comparing the least-coffee-consuming groups from each study, the meta-analysis revealed a reduction in the risk of overall stroke during follow-up (hazard ratio [HR] for overall stroke = 0.922, 95% confidence interval [CI] = 0.855–0.994, P = 0.035). In studies with a clear definition of hemorrhagic and ischemic stroke, coffee consumption reduced the risk of ischemic stroke more robustly than that of hemorrhagic stroke (hemorrhagic, HR = 0.895, 95% CI = 0.824–0.972, P = .008; ischemic, HR = 0.834, 95% CI = 0.739–0.876, P < .001). No obvious dose-dependent or U-shaped effect was observed. Conclusions Coffee consumption reduces the risk of overall stroke, especially ischemic stroke. Further investigation is required to identify beneficial components in coffee, including caffeine and phenolic acids, to develop preventive medication for stroke.

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