scholarly journals Is meta-analysis of RCTs assessing the efficacy of interventions a reliable source of evidence for therapeutic decisions?

2022 ◽  
Vol 91 ◽  
pp. 159-167
Author(s):  
Mariusz Maziarz
Keyword(s):  
Meta Analysis ◽  
Therapeutic Decisions ◽  
Reliable Source

Malleability of Meta-Analysis

2018 ◽  
Author(s):  
Jacob Stegenga
Keyword(s):  
Systematic Reviews ◽  
Gold Standard ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Medical Science ◽  
Ongoing Debate ◽  
Medical Interventions ◽  
Reliable Source ◽  
To Come ◽  
Meta Analyses

An astonishing volume and diversity of evidence is available for many hypotheses in medicine. Some of this evidence—usually from randomized trials—is amalgamated by meta-analysis. Despite the ongoing debate regarding whether or not randomized trials are the gold standard of evidence, the most reliable source of evidence in medical science is usually thought to come from systematic reviews and meta-analyses. This chapter argues that meta-analyses are malleable. Different meta-analyses of the same evidence can reach contradictory conclusions. Meta-analysis fails to provide objective grounds for assessing the effectiveness and harms of medical interventions because numerous decisions must be made when performing a meta-analysis, which allow wide latitude for subjective idiosyncrasies to influence its outcome.

scholarly journals Early changes in laboratory parameters are predictors of mortality and ICU admission in patients with COVID-19: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Szabolcs Kiss ◽  
Noémi Gede ◽  
Péter Hegyi ◽  
Dávid Németh ◽  
Mária Földi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Absolute Lymphocyte Count ◽  
Original Data ◽  
Laboratory Parameters ◽  
Reactive Protein ◽  
Therapeutic Decisions ◽  
Mean Differences ◽  
Key Terms ◽  
D Dimer

Abstract Despite the growing knowledge of the clinicopathological features of COVID-19, the correlation between early changes in the laboratory parameters and the clinical outcomes of patients is not entirely understood. In this study, we aimed to assess the prognostic value of early laboratory parameters in COVID-19. We conducted a systematic review and meta-analysis based on the available literature in five databases. The last search was on July 26, 2020, with key terms related to COVID-19. Eligible studies contained original data of at least ten infected patients and reported on baseline laboratory parameters of patients. We calculated weighted mean differences (WMDs) for continuous outcomes and odds ratios (ORs) with 95% confidence intervals. 93 and 78 studies were included in quantitative and qualitative syntheses, respectively. Higher baseline total white blood cell count (WBC), C-reactive protein (CRP), lactate-dehydrogenase (LDH), creatine kinase (CK), D-dimer and lower absolute lymphocyte count (ALC) (WMDALC = − 0.35 × 109/L [CI − 0.43, − 0.27], p < 0.001, I2 = 94.2%; < 0.8 × 109/L, ORALC = 3.74 [CI 1.77, 7.92], p = 0.001, I2 = 65.5%) were all associated with higher mortality rate. On admission WBC, ALC, D-dimer, CRP, LDH, and CK changes could serve as alarming prognostic factors. The correct interpretation of laboratory abnormalities can guide therapeutic decisions, especially in early identification of potentially critical cases. This meta-analysis should help to allocate resources and save lives by enabling timely intervention.

Deciphering meta-analytic results: a mini-review of probiotics for the prevention of paediatric antibiotic-associated diarrhoea and Clostridium difficile infections

2015 ◽  
Vol 6 (2) ◽  
pp. 189-194 ◽  
Author(s):  
L.V. McFarland
Keyword(s):  
Clostridium Difficile ◽  
Protective Efficacy ◽  
Meta Analysis ◽  
Lactobacillus Rhamnosus ◽  
Saccharomyces Boulardii ◽  
Clinical Practices ◽  
Therapeutic Decisions ◽  
Different Types ◽  
Meta Analyses ◽  
Antibiotic Associated Diarrhoea

Meta-analyses are used to evaluate pooled effects of a wide variety of investigational agents, but the interpretation of the results into clinical practices may be difficult. This mini-review offers a three-step process to enable healthcare providers to decipher pooled meta-analysis estimates into results that are useful for therapeutic decisions. As an example of how meta-analyses should be interpreted, a recent meta-analysis of probiotics for the prevention of paediatric antibiotic-associated diarrhoea (AAD) and the prevention of Clostridium difficile infections (CDI) will be used. First, the pooled results of this meta-analysis indicates a significant protective efficacy for AAD is found when the 16 different types of probiotics are combined (pooled relative risk (RR) = 0.43, 95% confidence interval (CI)=0.33-0.56) and also a significant reduction of paediatric CDI (pooled RR=0.34, 95%CI=0.16-0.74) was found pooling four different types of probiotics. Secondly, because the efficacy of probiotics is strain-specific, it is necessary to do a sensitivity analysis, restricting the meta-analysis to one specific strain. Two strains, Saccharomyces boulardii lyo and Lactobacillus rhamnosus GG showed significant efficacy for paediatric AAD when pooled (pooled RR for S. boulardii = 0.43, 95%CI=0.21-0.86 and pooled RR for L. rhamnosus GG = 0.44, 95%CI=0.20-0.95). Thirdly, if studies within probiotic types have different results, it is prudent to examine these studies individually to determine the reasons why non-significant differences in efficacy were found. By drilling down through these three analytic layers, physicians will be confident in recommending the correct probiotic strain to their patients.

scholarly journals The Prognostic Value of ctDNA and bTMB on Immune Checkpoint Inhibitors in Human Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Jiayan Wei ◽  
Jia Feng ◽  
Yiming Weng ◽  
Zexi Xu ◽  
Yao Jin ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Immune Checkpoint ◽  
Prognostic Value ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Human Cancer ◽  
Meta Analysis ◽  
Host Immune System ◽  
Therapeutic Decisions ◽  
Significant Difference

BackgroundCirculating tumor DNA (ctDNA) levels and blood tumor mutation burden (bTMB) have a significant impact on the prognosis of tumor patients. However, their prognostic role in immune checkpoint inhibitors (ICIs) in cancer patients is still unclear.MethodsWe used the Review Manager software (version 5.3) to perform a meta-analysis based on the published literature to explore the prognostic value of ctDNA and bTMB in patients receiving immunotherapy. We extracted the hazard ratios (HRs) of progression-free survival (PFS) and overall survival (OS) for each included study and their respective 95% confidence intervals (CIs) and p-values for analysis.ResultsThirteen studies were included in the meta-analysis. Higher ctDNA levels were significantly associated with shorter OS (HR = 3.35, 95%CI = 2.49–4.51, p &lt; 0.00001) and PFS (HR = 3.28, 95%CI = 2.47–4.35, p &lt; 0.00001). The results of ctDNA subgroup analysis showed that high posttreatment ctDNA levels significantly correlated with shorter OS in cancer patients receiving ICIs (HR = 5.09, 95%CI = 1.43–18.07, p = 0.01). Moreover, patients with ctDNA clearance had better OS (HR = 4.94, 95%CI = 2.96–8.26, p &lt; 0.00001). Patients with high posttreatment ctDNA levels had shorter PFS (HR = 3.00, 95%CI = 2.02–4.46, p &lt; 0.00001) and those with ctDNA clearance had longer PFS (HR = 4.61, 95%CI = 2.78–7.65, p &lt; 0.00001). However, there was no statistically significant difference in the OS benefits between a high and a low bTMB after ICI therapy (HR = 0.68, 95%CI = 0.33–1.37, p = 0.28).ConclusionsThe host immune system and tumor burden together determine whether cancer patients can benefit from ICI therapy. Our systematic review and meta-analysis revealed for the first time that the levels of pretreatment and posttreatment ctDNA and the clearance of ctDNA can independently be used as prognostic factors for antitumor immunotherapy, while bTMB cannot. In conclusion, ctDNA levels have great potential as an assistant tool for radiological assessments to make clinical therapeutic decisions. The prognostic utility of bTMB still requires further exploration.

scholarly journals Clinical Utility of Molecular Tests for Guiding Therapeutic Decisions in Bloodstream Staphylococcal Infections: A Meta-Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Ke Chen ◽  
Aijaz Ahmad Malik ◽  
Yun-Jian Sheng ◽  
Sarfraz Ahmed ◽  
Changfeng Sun ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Antimicrobial Agents ◽  
Pediatric Population ◽  
Meta Analysis ◽  
Nucleic Acid Amplification ◽  
Diagnostic Efficiency ◽  
Staphylococcal Infections ◽  
Molecular Tests ◽  
Risk Of Mortality ◽  
Therapeutic Decisions

Background: Treatment of bloodstream staphylococcal infections (BSI) necessitates the prompt initiation of appropriate antimicrobial agents and the rapid de-escalation of excessive broad-spectrum coverage to reduce the risk of mortality. We, therefore, aimed to demonstrate the diagnostic accuracy of nucleic acid amplification tests (NAAT) for the identification of methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) in clinically suspected patients.Methods: Until November 23, 2020, databases including PubMed, Scopus, Embase, and Web of Science were scanned for eligible studies. A bivariate random-effects model was used for meta-analysis of the 33 included studies obtained from 1606 citations, and pooled summary estimates with 95% confidence intervals (CI) were generated.Results: Twenty-three studies (n = 8,547) assessed NAAT accuracy for MSSA detection, while three studies (n = 479) evaluated MRSA detection in adults. The pooled NAAT sensitivity and specificity for MRSA in adults was higher [sensitivity: 0.83 (95% CI 0.59–0.96), specificity: 0.99 (95% CI 0.98–1.0)] as compared to MSSA [sensitivity: 0.76 (95% CI 0.69–0.82), specificity: 0.98 (95% CI 0.98–0.99)]. Similarly, eight studies (n = 4,089) investigating MSSA in pediatric population reported higher NAAT accuracy [sensitivity: 0.89 (95% CI 0.76–0.96), specificity: 0.98 (95% CI 0.97–0.98)] compared to adults. Among NAA tests, SeptiFast (real-time PCR, commercial) was frequently applied, and its diagnostic accuracy corresponded well to the overall summary estimates. A meta-regression and subgroup analysis of study design, sample condition, and patient selection method could not explain the heterogeneity (P &gt; 0.05) in the diagnostic efficiency.Conclusions: NAAT could be applied as the preferred initial tests for timely diagnosis and BSI management.

scholarly journals Anticoagulant therapy for splanchnic vein thrombosis: A systematic review and meta-analysis

Blood ◽  
2020 ◽  
Author(s):  
Emanuele Valeriani ◽  
Marcello Di Nisio ◽  
Nicoletta Riva ◽  
Omri Cohen ◽  
Juan-Carlos Garcia-Pagan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anticoagulant Therapy ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Splanchnic Vein Thrombosis ◽  
Vein Thrombosis ◽  
Therapeutic Decisions ◽  
Recurrent Vte ◽  
Anticoagulated Patients ◽  
Overall Mortality

Treatment of splanchnic vein thrombosis (SVT) is challenging and evidence to guide therapeutic decisions remains scarce. The objective of this systematic review and meta-analysis was to determine the efficacy and safety of anticoagulant therapy for SVT. MEDLINE, EMBASE, and Clinicaltrial.gov were searched from inception up to December 2019 without language restrictions to include observational studies and randomized controlled trials reporting radiological or clinical outcomes in patients with SVT. Pooled proportions and risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Of 4312 records identified by the search, 97 studies including 7969 patients were analyzed. In patients receiving anticoagulation, the rates of SVT recanalization, SVT progression, recurrent VTE, major bleeding, and overall mortality were 58% (95% CI, 51-64), 5% (95% CI, 3-7), 11% (95% CI, 8-15), 9% (95% CI, 7-12), and 11% (95% CI, 9-14), respectively. The corresponding values in patients without anticoagulation were 22% (95% CI, 15-31), 15% (95% CI, 8-27), 14% (95% CI, 9-21), 16% (95% CI, 13-20), and 25% (95% CI, 20-31). Compared with no treatment, anticoagulant therapy obtained higher recanalization (RR 2.39; 95% CI, 1.66-3.44) and lower thrombosis progression (RR 0.24; 95% CI, 0.13-0.42), major bleeding (RR 0.73; 95% CI, 0.58-0.92), and overall mortality (RR 0.45; 95% CI, 0.33-0.60). These results demonstrate that anticoagulant therapy improves SVT recanalization and reduces the risk of thrombosis progression without increasing major bleeding. The incidence of recurrent VTE remains substantial also in anticoagulated patients. Effects were consistent across different subgroups of patients.

scholarly journals Effectiveness and safety of oral Chinese patent medicines as adjuvant treatment for unstable angina pectoris on the national essential drugs list of China: a protocol for a systematic review and network meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e026136 ◽  
Author(s):  
Zhen Hua ◽  
Feng-Ting Zhai ◽  
Jinhui Tian ◽  
Cheng-Fei Gao ◽  
Peng Xu ◽  
...  
Keyword(s):  
Angina Pectoris ◽  
Unstable Angina ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Unstable Angina Pectoris ◽  
Symptom Improvement ◽  
Patent Medicines ◽  
Essential Drugs ◽  
Therapeutic Decisions ◽  
Chinese Patent

IntroductionAchieving efficacious and safe treatments for unstable angina pectoris (UAP) is still a challenging clinical problem. The availability of different oral Chinese patent medicines frequently poses a practical challenge to clinicians, namely, which one to choose as first-line regimen for treatment. This study aims to examine the comparative effectiveness and safety of oral Chinese patent medicines for UAP on the national essential drugs list of China.Methods and analysisWe will conduct a network meta-analysis (NMA) of all randomised controlled trials to evaluate the use of oral Chinese patent medicines as adjuvant for the treatment of UAP. We will explore eight electronic databases from their inception to June 2018 and search for grey literature. Primary outcomes include mortality and the cardiovascular events. Secondary outcomes include: (1) symptom improvement; (2) ECG improvement; (3) frequency of acute angina attack; (4) duration of angina; (5) adverse effects. Two independent authors will screen titles and abstracts, review full texts, extract data, assess the risk of bias using the Cochrane risk of bias tool and assess the quality of evidence and strength of the recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). If adequate data are available, NMA will be performed with Bayesian analysis methods.Ethics and disseminationThe NMA will help us to reduce the uncertainty of interventions and help clinicians to make optimal and more accurate therapeutic decisions for adults with UAP. Therefore, we will publish the findings of this study in a peer-reviewed journal. No ethics approval is necessary for this study based on the nature of its design.Trial registration numberCRD42018092822.

The effects of low-ratio n-6/n-3 PUFA on biomarkers of inflammation: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Yali Wei ◽  
Yan Meng ◽  
Na Li ◽  
Qian Wang ◽  
Liyong Chen
Keyword(s):  
Systematic Review ◽  
Fatty Acid ◽  
Polyunsaturated Fatty Acid ◽  
Meta Analysis ◽  
Chain Polyunsaturated Fatty Acid ◽  
Inflammation Markers ◽  
Pufa Supplementation ◽  
Long Chain

The purpose of the systematic review and meta-analysis was to determine if low-ratio n-6/n-3 long-chain polyunsaturated fatty acid (PUFA) supplementation affects serum inflammation markers based on current studies.

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