Risk of cardiovascular disease morbidity and mortality in frail and pre-frail older adults: Results from a meta-analysis and exploratory meta-regression analysis

Abstract BACKGROUND The influence of age on balance of benefit vs. potential harm of blood pressure (BP)-lowering therapy for elderly hypertensives is unclear. We evaluated the modifying effects of age on BP lowering for various adverse outcomes in hypertensive patients older than 60 years without specified comorbidities. METHODS All relevant randomized controlled trials (RCTs) were systematically identified. Coronary heart disease, stroke, heart failure (HF), cardiovascular death, major adverse cardiovascular events (MACE), renal failure (RF), and all-cause death were assessed. Meta-regression analysis was used to explore the relationship between achieved systolic BP (SBP) and the risk of adverse events. Random-effects meta-analysis was used to pool the estimates. RESULTS Our study included 18 RCTs (n = 53,993). Meta-regression analysis showed a lower achieved SBP related with a lower risk of stroke and cardiovascular death, but an increased risk of RF. The regression slopes were comparable between populations stratifying by age 75 years. In subgroup analysis, the relative risks of a more aggressive BP lowering strategy were similar between patients aged older or less than 75 years for all outcomes except for RF (P for interaction = 0.02). Compared to treatment with final achieved SBP 140–150 mm Hg, a lower achieved SBP (<140 mm Hg) was significantly associated with decreased risk of stroke (relative risk = 0.68; 95% confidence interval = 0.55–0.85), HF (0.77; 0.60–0.99), cardiovascular death (0.68; 0.52–0.89), and MACE (0.83; 0.69–0.99). CONCLUSIONS To treat hypertension in the elderly, age had trivial effect modification on most outcomes, except for renal failure. Close monitoring of renal function may be warranted in the management of elderly hypertension.

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Long-term manifestations and modifiers of prevalence estimates of the post-COVID-19 syndrome: A systematic review and meta-analysis.

10.1101/2021.10.17.21265123 ◽

2021 ◽

Author(s):

Daniel De-la-Rosa-Martínez ◽

Marco Antonio Delaye-Martínez ◽

Omar Yaxmehen Bello-Chavolla ◽

Alejandro Sicilia-Andrade ◽

Isaac David Juárez-Cruz ◽

...

Keyword(s):

Systematic Review ◽

Regression Analysis ◽

Meta Analysis ◽

Population Characteristics ◽

Published Data ◽

System Disease ◽

Prevalence Estimates ◽

Meta Regression ◽

Meta Regression Analysis

Background: Post-acute COVID-19 syndrome (PACS) is a multi-system disease comprising persistent symptomatology after the acute phase of infection. Long-term PACS effects significantly impact patient outcomes, but their incidence remains uncharacterized due to high heterogeneity between studies. Therefore, we aimed to summarize published data on PACS, characterizing the clinical presentation, prevalence, and modifiers of prevalence estimates. Method: In this systematic review and meta-analysis, we research MEDLINE for original studies published from January 1st, 2020, to January 31st, 2021, that reported proportions of PACS manifestations. Studies were eligible for inclusion if they included patients aged ≥18 years with confirmed COVID-19 by RT-PCR or antigen testing and a minimum follow-up of 21 days. The prevalence of individual manifestations across studies was pooled using random-effects meta-analysis. For evaluating determinants of heterogeneity, meta-regression analysis was performed. This study was registered in PROSPERO (CRD42019125025). Results: After screening 1,235 studies, we included 29 reports for analysis. Twenty-seven meta-analyses were performed, and 61 long-term manifestations were described. The pooled prevalence of PACS was 56% (95%CI 45-66%), with the most common manifestations being diminished health status, fatigue, asthenia, dyspnea, myalgias, hyposmia and dysgeusia. Most of the included studies presented high heterogeneity. After conducting the meta-regression analysis, we identified that age, gender, number of comorbidities, and reported symptoms significantly modify the prevalence estimation of PACS long-term manifestations. Conclusion: PACS is inconsistently reported between studies, and population characteristics influence the prevalence estimates due to high heterogeneity. A systematized approach for the study of PACS is needed to characterize its impact adequately.

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Value of Variation of End-Tidal Carbon Dioxide for Predicting Fluid Responsiveness During the Passive Leg Raising Test in Patients with Mechanical Ventilation: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-1069765/v1 ◽

2021 ◽

Author(s):

Haijun Huang ◽

Chenxia Wu ◽

Qinkang Shen ◽

Yixin Fang ◽

Hua Xu

Keyword(s):

Carbon Dioxide ◽

Mechanical Ventilation ◽

Sensitivity Analysis ◽

Regression Analysis ◽

Fluid Responsiveness ◽

Meta Analysis ◽

End Tidal Carbon Dioxide ◽

Meta Regression ◽

Meta Regression Analysis ◽

End Tidal

Abstract Background: The variation of end-tidal carbon dioxide(ΔEtCO2) has have been extensively studied with respect to its value in predicting fluid responsiveness, but the results are conflicting. This meta-analysis aimed to explore the value of ΔEtCO2 for predicting fluid responsiveness during the passive leg raising(PLR) test in patients with mechanical ventilation. Methods: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched up to November 2021. The diagnostic odds ratio (DOR), sensitivity, and specificity were calculated. The summary receiver operating characteristic curve was estimated, and the area under the curve (AUROC) was calculated. We performed meta-regression analysis for heterogeneity exploration and sensitivity analysis for the publication bias.Results: Overall, 298 patients were included in this review, of whom 149 (50%) were fluid responsive. The cutoff values of ΔEtCO2 varied across studies, ranging from 5% to 5.8% or absolute increase 2mmHg. Heterogeneity between studies was assessed with an overall Q = 4.098, I2 = 51%, and P = 0.064. The pooled sensitivity and specificity for the overall population were 0.79 (95% CI: 0.72–0.85) and 0.90 (95% CI: 0.77–0.96), respectively. The DOR was 35 (95% CI: 12–107) (Fig. 4). The pooled AUROC was 0.81 (95% CI: 0.77–0.84). On meta-regression analysis, the number of patients was sources of heterogeneity. The sensitivity analysis showed that the pooled DOR ranged from 21 to 140 and the pooled AUC ranged from 0.92 to 0.96 when one study was omitted.Conclusions: This study was the first meta-analysis to evaluate the diagnostic accuracy of ΔEtCO2 in predicting fluid responsiveness during PLR test in patients with mechanical ventilation. This study confirmed that the ΔEtCO2 performed well in predicting fluid responsiveness in patients with mechanical ventilation.

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Abstract 16653: Ventricular Arrhythmias With Ibrutinib Use: A Systematic Review and Meta-Analysis

Circulation ◽

10.1161/circ.142.suppl_3.16653 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Yaser Khallid ◽

Neethi Dasu ◽

Ankit Shah ◽

Michael G Fradley ◽

Kirti Dasu ◽

...

Keyword(s):

Regression Analysis ◽

Ventricular Arrhythmias ◽

Kinase Inhibitors ◽

Meta Analysis ◽

Lymphocytic Leukemia ◽

Duration Of Treatment ◽

Treatment Regimens ◽

Mantle Cell ◽

Meta Regression ◽

Meta Regression Analysis

Introduction: Ibrutinib is a widely used treatment option for patients with chronic lymphocytic leukemia, mantle cell lymphoma, and Waldenstrom’s macroglobulinemia. There is limited investigation on the relationship between ibrutinib and the development of ventricular arrhythmias. Hypothesis: We hypothesized that the incidence of ventricular arrhythmias in patients taking ibrutinib compared to the patients on other treatment regimens would be higher. Methods: We performed an aggregate data meta-analysis on nine studies to examine the incidence of ventricular arrhythmias. We further assessed a meta-regression analysis to evaluate the effect of duration of therapy on incidence of ventricular arrhythmias. Relative risk (RR) and 95% confidence intervals (CI) were estimated using a random-effects model. Results: Of 3809 patients being treated with ibrutinib, the incidence of ventricular arrhythmias was almost 8-fold higher in patients being treated with ibrutinib compared to other tyrosine kinase inhibitors (TKIs), other chemotherapies, or immunotherapy. (RR 8.13, 95% CI 4.37-15.10, p <0.0001). On meta-regression analysis, the incidence increased further with longer duration of treatment (coefficient = 0.0206, p=0.049); patient populations greater than 60 years have a higher incidence of ventricular arrhythmias (coefficient = 0.0237, p=0.044). Over 50% of patients diagnosed with ventricular arrhythmias on ibrutinib died of sudden death. Conclusions: For patients treated with ibrutinib, there was a markedly higher rate of ventricular arrhythmias and an increased incidence with longer duration of treatment. These data highlight the need for guidelines on surveillance and management for ventricular arrhythmias for patients taking ibrutinib.

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