The impact of cardiopulmonary manifestations on the mortality of SSc: a systematic review and meta-analysis of observational studies

Abstract Background The primary objective of this study is twofold: (1) to examine the effect of COVID-19 safety measures, enacted to prevent transmission of SARS-nCOV-2, on total physical activity in the adult general population (≥ 18 years) and (2) to analyze the impact of the factor “severity of safety measures” on potential changes in physical activity. The secondary objective is to investigate the effects of safety measures on the respective PA intensities, i.e., sedentary behavior, light, moderate, and vigorous physical activity. Methods A systematic literature search will be performed in the following online databases: Medline (on Ovid), Web of Science, Scopus, L.OVE Coronavirus disease by Epistemonikos, and ProQuest Dissertations & Theses A&I. All obtained citations will undergo title and abstract as well as full-text screening by two independent reviewers. Observational studies investigating the effects of safety measures on physical activity patterns in the adult general population will be included. The standardized mean difference in total physical activity per time unit between pre- and during COVID-19 or between normative data and during COVID-19 will be the primary outcome. The standardized mean difference in sedentary time, light, moderate, and vigorous physical activity will be assessed as secondary outcomes. Eligible studies will be divided between the reviewers for data extraction using a pilot-tested data form. Risk of bias assessment will be performed using a standard assessment tool. If suitable, a random-effects meta-analysis and meta-regression with a unit of safety measure severity as the independent variable will be performed. Discussion This study will synthesize available data reporting the effect of COVID-19 safety measures on physical activity patterns in adults. Furthermore, we will incorporate a unit for the severity of safety measures for better generalizability of the results. These findings will be of great value for public health policymaking and estimating future health consequences. Systematic review registration PROSPERO CRD42021231039.

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Renin Angiotensin System Inhibition and Susceptibility and Outcomes from COVID-19: A Systematic Review and Meta-analysis of 69,200 COVID-19 Patients

10.1101/2020.10.03.20206375 ◽

2020 ◽

Author(s):

Yi Zhang ◽

Shikai Yu ◽

Yawei Xu ◽

Bryan Williams

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Meta Analysis ◽

Renin Angiotensin System ◽

Risk Of Infection ◽

Angiotensin System ◽

Renin Angiotensin ◽

Significant Difference ◽

The Impact ◽

Ras Inhibitors

ABSTRACTBackgroundEarly observational studies suggested that the use of the renin angiotensin system (RAS) inhibitors, specifically angiotensin converting enzyme inhibitors or angiotensin receptor blockers, may increase the risk of infection with SARS-CoV-2 and adversely affect the prognosis or survival of infected patients. To explore the impact of RAS inhibitor use on the risk of SARS-CoV-2 infection and the prognosis of SARS-CoV-2 infected patients, from all published studies.Methods and FindingsA systematic review and meta-analysis of the use of RAS inhibitors in relation to infection with SARS-CoV-2 and/or the severity and mortality associated with COVID-19 was conducted. English language bibliographic databases PubMed, Web of Science, OVID Embase, Scopus, MedRxiv, BioRxiv, searched from Jan 1st, 2020 to July 20th, 2020. 58 observational studies (69,200 COVID-19 patients and 3,103,335 controls) were included. There was no difference in the susceptibility to SARS-CoV-2 infection between RAS inhibitor users and non-users (unadjusted OR 1.05, 95% CI 0.90 to 1.21), (adjusted OR 0.93, 95% CI 0.85 to 1.02), (adjusted HR 1.07, 95% CI 0.87 to 1.31). There was no significant difference in the severe Covid-19 case rate between RAS inhibitor users and non-users (unadjusted OR 1.05, 95% CI 0.81 to 1.36), (adjusted OR 0.76, 95% CI 0.52 to 1.12), or in mortality due to COVID-19 between RAS inhibitor users and non-users (unadjusted OR 1.12, 95% CI 0.88 to 1.44), (adjusted OR 0.97, 95% CI 0.77 to 1.23), (adjusted HR 0.62, 95% CI 0.34 to 1.14).ConclusionsIn the most comprehensive analysis of all available data to date, treatment with RAS inhibitors was not associated with increased risk of infection, severity of disease, or mortality due to COVID-19. The best available evidence suggests that these treatments should not be discontinued on the basis of concern about risk associated with COVID-19.

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Improvements in Fatigue at Higher Achieved Hemoglobin Levels Among Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis

10.21203/rs.2.24371/v1 ◽

2020 ◽

Author(s):

Murilo Guedes ◽

Camila R. Guetter ◽

Lucas HO Erbano ◽

Andre G. Palone ◽

Jarcy Zee ◽

...

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Observational Studies ◽

Meta Analysis ◽

Diabetic Patients ◽

Related Quality ◽

The Impact ◽

Physical Hrqol ◽

Anemia Treatment

Abstract Background: The impact anemia treatment with erythropoietin stimulating agents (ESA) on health-related quality of life (HRQOL) in chronic kidney disease (CKD) patients is controversial, particularly regarding optimal hemoglobin (Hb) target ranges.Methods: We conducted a systematic review and meta-analysis of observational studies and randomized controlled trials (RCT) with ESA to estimate the effect of different Hb ranges on physical HRQOL and functionality. We searched PubMed, EMBASE, CENTRAL, PEDro, PsycINFO and Web of Science databases, until May 2019Two authors independently extracted data from studies.We included observational and RCTs that enrolled CKD patients undergoing anemia treatment with ESA with different achieved Hb levels among groups. We excluded studies with achieved Hb < 9 g/dL. For the meta-analysis, we included RCTs with control groups achieving Hb 10-11.5 g/dL and active groups with Hb >11.5 g/dL. We analyzed the standardized mean difference (SMD) between groups for physical HRQOL.Results: Among 8,171 studies, fifteen RCTs and five observational studies were included for the systematic review. We performed the meta-analysis in a subset of eleven eligible RCTs. For physical role and physical function, SMDs were 0.0875 [CI:-0.0025 – 0.178] and 0.08 [CI: -0.03 – 0.19], respectively. For fatigue, SMD was 0.16 [0.09 - 0.24]. Subgroup analysis showed that trials with greater achieved Hb had greater pooled effects sizes — 0.21 [0.07 - 0.36] for Hb > 13 g/dL vs. 0.09 [0.02 - 0.16] for Hb 11.5-13 g/dL. Proportion of older and long-term diabetic patients across studies were associated with lower effect sizes.Conclusion: Achieved hemoglobin higher than currently recommended targets is associated with small but clinically significant improvement in fatigue. Younger and non-diabetic patients may experience more pronounced benefits of higher Hb levels after treatment with ESAs.

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The impact of atrial fibrillation type on the risks of thromboembolic recurrence, mortality and major haemorrhage in patients with previous stroke: A systematic review and meta-analysis of observational studies

European Stroke Journal ◽

10.1177/2396987319896674 ◽

2020 ◽

Vol 5 (2) ◽

pp. 155-168

Author(s):

Antonia Mentel ◽

Terence J Quinn ◽

Alan C Cameron ◽

Kennedy R Lees ◽

Azmil H Abdul-Rahim

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Confidence Interval ◽

Odds Ratio ◽

Observational Studies ◽

Meta Analysis ◽

Major Haemorrhage ◽

Risk Of Bias ◽

Previous Stroke ◽

The Impact

Introduction There is conflicting evidence on the impact of atrial fibrillation (AF) type, i.e. non-paroxysmal AF or paroxysmal AF, on thromboembolic recurrence. The consensus of risk equivalence is greatly based on historical evidence, focussing on initial stroke risks. We conducted a systematic review and meta-analysis to describe the impact of AF type on the risk of thromboembolic recurrence, mortality and major haemorrhage in patients with previous stroke. Methods We systematically searched four multidisciplinary databases from inception to December 2018. We selected observational studies investigating clinical outcomes in patients with ischaemic stroke and AF, stratified by AF type. We assessed all included studies for risk of bias using the ‘Risk of Bias In Non-randomised Studies – of Exposures’ tool. The Comprehensive Meta-Analysis Software was used to calculate odds ratios from crude event rates. Results After reviewing 14,127 citations, we selected 108 studies for full-text screening. We extracted data from a total of 26 studies, reporting outcomes on 23,054 patients. Overall, risk of bias was moderate. The annual incidence rates of thromboembolism in patients with non-paroxysmal AF and paroxysmal AF were 7.1% (95% confidence interval: 4.2–11.7) and 5.2% (95% confidence interval: 3.2–8.2), respectively. The odds ratio for thromboembolism in patients with non-paroxysmal AF versus paroxysmal AF was 1.47 (95% confidence interval: 1.08–1.99, p = 0.013). The annual mortality rates in patients with non-paroxysmal AF and paroxysmal AF were 20.0% (95% confidence interval: 13.2–28.0) and 10.1% (95% confidence interval: 5.4–17.3), respectively, and odds ratio was 1.90 (95% confidence interval: 1.43–2.52, p < 0.001). There was no difference in rates of major haemorrhage, odds ratio = 1.01 (95% confidence interval: 0.61–1.69, p = 0.966). Conclusion In patients with prior stroke, non-paroxysmal AF is associated with significantly higher risk of thromboembolic recurrence and mortality than paroxysmal AF. Although current guidelines make no distinction between non-paroxysmal AF and paroxysmal AF for secondary stroke prevention, future guidance and risk stratification tools may need to consider this differential risk (PROSPERO ID: CRD42019118531).

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1391. Vancomycin Area Under the Curve (AUC) to Predict Nephrotoxicity: A Systematic Review and Meta-Analysis of Observational Studies

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1222 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S427-S427

Author(s):

Doaa Aljefri ◽

Sean Avedissian ◽

Nathaniel J Rhodes ◽

Michael Postelnick ◽

Marc H Scheetz

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Primary Outcome ◽

Meta Analysis ◽

Prospective Trial ◽

Area Under The Curve ◽

Threshold Value ◽

Case Control Studies ◽

The Impact ◽

The Relationship

Abstract Background Recent studies have proposed monitoring vancomycin area under the curve (AUC) as a more precise method of attaining goal exposures compared with trough monitoring. Different dosing methods and different exposure-toxicity thresholds have been proposed. Therefore, we aimed to analyze the relationship between vancomycin AUC and nephrotoxicity reported across recent studies. Methods A systematic review of Pubmed, Medline, Scopus and compiled references was conducted. We included randomized, cohorts and case–control studies that reported vancomycin AUCs and risk of nephrotoxicity from (January 1, 1990 to January 31, 2018). The primary outcome was nephrotoxicity, defined as an increase in serum creatinine of ≥0.5 mg/L or a 50% increase from baseline on two or more consecutive measurements. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated. Subset analyses were conducted when possible on the impact of AUC0-24 hours and AUC24-48 hoursr exposures and AUC vs. trough guided dosing on the outcome of nephrotoxicity. AUC nephrotoxicity thresholds ranged between 550 and 700 mg hour/L. We grouped values according to lower (i.e., <650) or higher average AUC, with a threshold value of ≥650 mg hour/L defining higher AUC based on a recent prospective trial. Results We identified eight eligible observational studies with a total of 2,491 patients. Of those, five studies reported AUC0-24 associated with nephrotoxicity, two studies reported AUC24-48, and two studies reported nephrotoxicity associated with AUC vs. trough-guided dosing. No RCTs were identified. Lower AUC0-24 values were associated with significantly reduced risk of nephrotoxicity (OR 0.36, 95% CI 0.23–0.56). In a sub-analysis of two studies, AUC24-48<650 mg hour/L was associated with significantly lower risk of nephrotoxicity (OR 0.45, 95% CI 0.27–0.75). Nephrotoxicity associated with AUC-guided dosing was significantly lower than trough-guided dosing (OR 0.68, 95% CI 0.46–0.99). Conclusion This meta-analysis suggests that AUC0-24 lower than 650 mg hour/L may result in a decreased risk of nephrotoxicity. AUC-guided vancomycin dosing may result in less vancomycin-associated nephrotoxicity. Additional investigations into the benefit of AUC-guided dosing are warranted. Disclosures All authors: No reported disclosures.

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Exploring the Impact of Flavonoids on Symptoms of Depression: A Systematic Review and Meta-Analysis

Antioxidants ◽

10.3390/antiox10111644 ◽

2021 ◽

Vol 10 (11) ◽

pp. 1644

Author(s):

Sawan Ali ◽

Graziamaria Corbi ◽

Michael Maes ◽

Giovanni Scapagnini ◽

Sergio Davinelli

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Meta Analysis ◽

Eligibility Criteria ◽

Symptoms Of Depression ◽

Flavonoid Intake ◽

Brain Changes ◽

Intervention Trials ◽

The Impact ◽

Dietary Flavonoids

Recent evidence suggests that diet modifies key biological factors associated with the development of depression. It has been suggested that this could be due to the high flavonoid content commonly found in many plant foods, beverages and dietary supplements. Our aim was to conduct a systematic review to evaluate the effects of dietary flavonoids on the symptoms of depression. A total of 46 studies met the eligibility criteria. Of these, 36 were intervention trials and 10 were observational studies. A meta-analysis of 36 clinical trials involving a total of 2788 participants was performed. The results showed a statistically significant effect of flavonoids on depressive symptoms (mean difference = −1.65; 95% C.I., −2.54, −0.77; p < 0.01). Five of the 10 observational studies included in the systematic review reported significant results, suggesting that a higher flavonoid intake may improve symptoms of depression. Further studies are urgently required to elucidate whether causal and mechanistic links exist, along with substantiation of functional brain changes associated with flavonoid consumption.

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Association between progestin-only contraceptive use and cardiometabolic outcomes: A systematic review and meta-analysis

European Journal of Preventive Cardiology ◽

10.1177/2047487318774847 ◽

2018 ◽

Vol 25 (10) ◽

pp. 1042-1052 ◽

Cited By ~ 21

Author(s):

Marija Glisic ◽

Sara Shahzad ◽

Stergiani Tsoli ◽

Mahmuda Chadni ◽

Eralda Asllanaj ◽

...

Keyword(s):

Myocardial Infarction ◽

Systematic Review ◽

Venous Thromboembolism ◽

Observational Studies ◽

Contraceptive Use ◽

Meta Analysis ◽

Relative Risks ◽

Increased Risk ◽

Stratified Analysis ◽

The Impact

Aims The association between progestin-only contraceptive (POC) use and the risk of various cardiometabolic outcomes has rarely been studied. We performed a systematic review and meta-analysis to determine the impact of POC use on cardiometabolic outcomes including venous thromboembolism, myocardial infarction, stroke, hypertension and diabetes. Methods and results Nineteen observational studies (seven cohort and 12 case–control) were included in this systematic review. Of those, nine studies reported the risk of venous thromboembolism, six reported the risk of myocardial infarction, six reported the risk of stroke, three reported the risk of hypertension and two studies reported the risk of developing diabetes with POC use. The pooled adjusted relative risks (RRs) for venous thromboembolism, myocardial infarction and stroke for oral POC users versus non-users based on the random effects model were 1.06 (95% confidence interval (CI) 0.70–1.62), 0.98 (95% CI 0.66–1.47) and 1.02 (95% CI 0.72–1.44), respectively. Stratified analysis by route of administration showed that injectable POC with a RR of 2.62 (95% CI 1.74–3.94), but not oral POCs (RR 1.06, 95% CI 0.7–1.62), was associated with an increased risk of venous thromboembolism. A decreased risk of venous thromboembolism in a subgroup of women using an intrauterine levonorgestrel device was observed with a RR of 0.53 (95% CI 0.32–0.89). No effect of POC use on blood pressure was found, but there was an indication for an increased risk of diabetes with injectable POCs, albeit non-significant. Conclusions This systematic review and meta-analysis suggests that oral POC use is not associated with an increased risk of developing various cardiometabolic outcomes, whereas injectable POC use might increase the risk of venous thromboembolism.

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Impact and variability of social determinants of health on the transmission and outcomes of COVID-19 across the world: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2021-053481 ◽

2021 ◽

Vol 11 (12) ◽

pp. e053481

Author(s):

Minhazul Abedin ◽

Abrar Wahab ◽

Farah Naz Rahman ◽

Fardina Rahman Omi ◽

Saadia Shareen ◽

...

Keyword(s):

Systematic Review ◽

Social Determinants Of Health ◽

Social Determinants ◽

Observational Studies ◽

Meta Analysis ◽

Geographical Location ◽

Determinants Of Health ◽

Wide Range ◽

Meta Analyses ◽

The Impact

IntroductionThe COVID-19 pandemic has exacerbated health inequalities across the globe, disproportionately affecting those with poor social determinants of health (SDOHs). It is imperative to understand how SDOH influences the transmission and outcomes (positive case, hospitalisation and mortality) of COVID-19. This systematic review will investigate the impact of a wide range of SDOHs across the globe on the transmission and outcomes of COVID-19.Methods and analysisThis review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines. We will search three electronic bibliographical databases (MEDLINE via PubMed, Embase and Scopus), as well as the WHO COVID-19 Global Research on Coronavirus Disease database. We will consider observational studies that report statistical relationships between the SDOHs (as listed in PROGRESS-Plus and Healthy People 2020) and COVID-19 transmission and outcomes. There will be no limitation on the geographical location of publications. The quality of included observational studies will be assessed using a modified version of the Newcastle-Ottawa Scale. A narrative synthesis without meta-analysis reporting standards will be used to report the review findings.Ethics and disseminationThis review will be based on published studies obtained from publicly available sources, and therefore, ethical approval is not required. We will publish the results of this review in a peer-reviewed journal, as well as present the study findings at a national conference.PROSPERO registration numberCRD42021228818.

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