Beneficiary effect of a-lipoic acid supplementation on C-reactive protein level among adults

PurposeClinical evidence has suggested that alpha-lipoic acid (ALA), a potent antioxidant, seems to have some effects on inflammatory process. However, these results are equivocal. The purpose of this paper is to investigate the nature of association between ALA and serum C-reactive protein (CRP) level by pooling the results from clinical trial studies.Design/methodology/approachRelevant studies were identified by systematic literature search of PubMed/MEDLINE, Scopus, Web of Sciences and Cochrane library up to September 2016 for randomized controlled trials (RCTs) evaluating the impact of ALA supplementation on CRP. The pooled data were summarized as weighted mean difference (WMD) and 95 per cent confidence interval (CI). Effect sizes of eligible studies were pooled using random- or fixed-effects (the DerSimonian–Laird estimator) depending on the results of heterogeneity tests.FindingsOf 212 papers, 15 were eligible RCTs according to inclusion criteria. The selected studies comprised 1,408 cases and 457 controls. The dose of ALA supplement ranged from 300 to 1,200 mg, and the duration of follow-up was from 1 to 48 weeks. ALA supplementation significantly reduced the levels of circulating CRP (WMD: −0.088, 95 per cent CI: −0.131, −0.045,p< 0.001) with significant heterogeneity (I2= 73.4 per cent,p< 0.001). Populations with age younger than 50 years (PMD: −0.060 mg/dl), receiving doses less than 600 mg/day (PMD: −0.057 mg/dl), having cardiovascular disease (PMD: −0.105 mg/dl), hemodialysis (PMD: −0.209 mg/dl), diabetes (PMD: −0.021 mg/dl) and otherwise healthy subjects (PMD: −0.045 mg/dl) were sources of heterogeneity.Originality/ValueThis meta-analysis of RCTs suggests that ALA supplementation seems to significantly reduce circulating CRP level.

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Does glutamine supplementation have favorable effects on glucose control and insulin sensitivity?

Nutrition & Food Science ◽

10.1108/nfs-04-2019-0116 ◽

2019 ◽

Vol 50 (1) ◽

pp. 197-215 ◽

Cited By ~ 1

Author(s):

Hamed Kord-Varkaneh ◽

Ammar Salehi-Sahlabadi ◽

Seyed Mohammad Mousavi ◽

Somaye Fatahi ◽

Ehsan Ghaedi ◽

...

Keyword(s):

Randomized Clinical Trials ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Glutamine Supplementation ◽

Cochrane Library ◽

Model Assessment ◽

Content Type ◽

Insulin Levels ◽

Polynomial Modeling ◽

The Impact

Purpose The authors performed a systematic review and meta-analysis of all published randomized controlled trials with the aim to determine and quantify the anti-hyperglycemic effects of glutamine (Gln) in acute and chronic clinical settings. Design/methodology/approach The authors conducted a comprehensive search of all randomized clinical trials performed up to December 2018, to identify those investigating the impact of Gln supplementation on fasting blood sugar (FBS), insulin levels and homeostatic model assessment-insulin resistance (HOMA-IR) via ISI Web of Science, Cochrane library PubMed and SCOPUS databases. A meta-analysis of eligible studies was conducted using random effects model to estimate the pooled effect size. Fractional polynomial modeling was used to explore the dose–response relationships between Gln supplementation and diabetic indices. Findings The results of the present meta-analysis suggest that of Gln supplementation had a significant effect on FBS (weighted mean difference (WMD): –2.868 mg/dl, 95 per cent CI: –5.467, –0.269, p = 0.031). However, the authors failed to observe that Gln supplementation affected insulin levels (WMD: 1.06 units, 95 per cent CI: –1.13, 3.26, p = 0.34) and HOMA-IR (WMD: 0.001 units, 95 per cent CI: –2.031, 2.029, p = 0.999). Subgroup analyses showed that the highest decrease in FBS levels was observed when the duration of intervention was less than two weeks (WMD: –4.064 mg/dl, 95 per cent CI: –7.428, –0.700, p = 0.01) and when Gln was applied via infusion (WMD: –5.334 mg/dl, 95 per cent CI: –10.48, 0.17, p = 0.04). Originality/value The results from this meta-analysis show that Gln supplementation did not have a significant effect on insulin levels and HOMA-IR. However, it did significantly reduce the levels of FBS, obtaining a higher effect when the duration of the intervention period was less than two weeks.

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Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews

BMC Infectious Diseases ◽

10.1186/s12879-021-06214-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Israel Júnior Borges do Nascimento ◽

Dónal P. O’Mathúna ◽

Thilo Caspar von Groote ◽

Hebatullah Mohamed Abdulazeem ◽

Ishanka Weerasekara ◽

...

Keyword(s):

Systematic Reviews ◽

Troponin I ◽

Clinical Symptoms ◽

Meta Analysis ◽

Severe Disease ◽

Ground Glass Opacity ◽

Cochrane Library ◽

Reactive Protein ◽

Overview Of Systematic Reviews ◽

The Impact

Abstract Background Navigating the rapidly growing body of scientific literature on the SARS-CoV-2 pandemic is challenging, and ongoing critical appraisal of this output is essential. We aimed to summarize and critically appraise systematic reviews of coronavirus disease (COVID-19) in humans that were available at the beginning of the pandemic. Methods Nine databases (Medline, EMBASE, Cochrane Library, CINAHL, Web of Sciences, PDQ-Evidence, WHO’s Global Research, LILACS, and Epistemonikos) were searched from December 1, 2019, to March 24, 2020. Systematic reviews analyzing primary studies of COVID-19 were included. Two authors independently undertook screening, selection, extraction (data on clinical symptoms, prevalence, pharmacological and non-pharmacological interventions, diagnostic test assessment, laboratory, and radiological findings), and quality assessment (AMSTAR 2). A meta-analysis was performed of the prevalence of clinical outcomes. Results Eighteen systematic reviews were included; one was empty (did not identify any relevant study). Using AMSTAR 2, confidence in the results of all 18 reviews was rated as “critically low”. Identified symptoms of COVID-19 were (range values of point estimates): fever (82–95%), cough with or without sputum (58–72%), dyspnea (26–59%), myalgia or muscle fatigue (29–51%), sore throat (10–13%), headache (8–12%) and gastrointestinal complaints (5–9%). Severe symptoms were more common in men. Elevated C-reactive protein and lactate dehydrogenase, and slightly elevated aspartate and alanine aminotransferase, were commonly described. Thrombocytopenia and elevated levels of procalcitonin and cardiac troponin I were associated with severe disease. A frequent finding on chest imaging was uni- or bilateral multilobar ground-glass opacity. A single review investigated the impact of medication (chloroquine) but found no verifiable clinical data. All-cause mortality ranged from 0.3 to 13.9%. Conclusions In this overview of systematic reviews, we analyzed evidence from the first 18 systematic reviews that were published after the emergence of COVID-19. However, confidence in the results of all reviews was “critically low”. Thus, systematic reviews that were published early on in the pandemic were of questionable usefulness. Even during public health emergencies, studies and systematic reviews should adhere to established methodological standards.

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Association of inflammatory markers with the severity of COVID-19

10.1101/2020.04.14.20065680 ◽

2020 ◽

Cited By ~ 2

Author(s):

Furong Zeng ◽

Ying Guo ◽

Mingzhu Yin ◽

Xiang Chen ◽

Guangtong Deng

Keyword(s):

Inflammatory Markers ◽

Fixed Effects ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Cochrane Library ◽

Global Public Health ◽

China National Knowledge Infrastructure ◽

Bias Assessment ◽

Knowledge Infrastructure ◽

Severe Group

AbstractBackgroundThe ongoing worldwide epidemic of Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2), has posed a huge threat to global public health. However, with regard to the effects of inflammatory markers on the severity of COVID-19, studies have reported associations that vary in strength and direction.AimsIn the meta-analysis, we aimed to provide an overview of the association of inflammatory markers with severity of COVID-19.MethodsThe following databases were searched: PubMed, Embase, Cochrane Library, Wanfang database and CNKI (China National Knowledge Infrastructure) database until March 20, 2020. Weighted mean difference (WMD) and 95% confidence intervals (CIs) were pooled using random or fixed-effects models.ResultsA total of 16 studies were included in our analysis comprising of 3962 patients with COVID-19. Random-effects results demonstrated that patients with COVID-19 in non-severe group had lower levels for CRP (WMD = -41.78 mg/l, 95% CI = [-52.43, - 31.13], P < 0.001), PCT (WMD = -0.13 ng/ml, 95% CI = [-0.20, -0.05], P < 0.001), IL- 6 (WMD = -21.32 ng/l, 95% CI = [-28.34, -14.31], P < 0.001), ESR (WMD = - 8.40 mm/h, 95% CI = [-14.32, -2.48], P = 0.005), SAA (WMD = -43.35 μg/ml, 95% CI = [-80.85, -5.85], P = 0.020) and serum ferritin (WMD = -398.80 mg/l, 95% CI = [- 625.89, -171.71], P < 0.001), compared with those in severe group. Moreover, survivors had lower level for IL-6 than non-survivors with COVID-19 (WMD = -4.80 ng/ml, 95% CI = [-5.87, -3.73], P < 0.001). These results were consistent through sensitivity analysis and publication bias assessment.ConclusionsThe meta-analysis highlights the association of inflammatory markers with the severity of COVID-19. Measurement of inflammatory markers might help clinicians to monitor and evaluate the severity and prognosis of COVID-19.

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The Effect of Celiac Neurolysis and Splanchnicectomy on Survival in Unresectable Pancreatic Cancer: A Systematic Review and Meta-Analysis

Digestive Surgery ◽

10.1159/000520456 ◽

2021 ◽

pp. 1-9

Author(s):

Linhan Ye ◽

Stephan Schorn ◽

Ilaria Pergolini ◽

Okan Safak ◽

Elke Demir ◽

...

Keyword(s):

Systematic Review ◽

Pancreatic Cancer ◽

Fixed Effects ◽

Meta Analysis ◽

Stage Iv ◽

Stage Iii ◽

Cochrane Library ◽

Unresectable Pancreatic Cancer ◽

Relevant Effect ◽

The Impact

Background: Intractable pancreatic pain is one of the most common symptoms of patients with pancreatic ductal adenocarcinoma (PDAC). Celiac neurolysis (CN) and splanchnicectomy were already described as effective methods to manage abdominal pain in unresectable PDAC, but their impact on overall survival (OS) has not yet been established. Objective: We aimed to investigate the impact of CN and splanchnicectomy on the survival of patients with unresectable pancreatic cancer. Methods: A systematic review of PubMed and Cochrane Library according to predefined searching terms was conducted in March 2020. Hazard ratios (HR) of OS data were calculated using the Mantel-Haenszel model for random effects or fixed effects. Result: Four randomized-controlled trials (RCTs) and 2 non-RCTs with a total of 2,507 patients were identified. The overall pooled HR did not reveal any relevant effect of CN and splanchnicectomy on OS (HR: 1.03; 95% CI: 0.81–1.32), which was also underlined by the sensitivity analysis of RCTs (HR: 1.0; 95% CI: 0.72–1.39) and non-RCTs (HR: 1.07; 95% CI: 0.71–1.63). However, subgroup analyses depending on tumor stage revealed that CN or splanchnicectomy was associated with a worsened OS in AJCC (American Joint Committee on Cancer) stage III patients with unresectable PDAC (HR: 1.22; 95% CI: 1.03–1.45), but nor for AJCC stage IV patients (HR: 1.27; 95% CI: 0.9–1.80). Conclusion: Although only few data are currently available, this systematic review with meta-analysis showed that in unresectable PDAC, CN or splanchnicectomy is associated with a worsened survival in stage III PDAC patients, with no effect on stage IV PDAC patients. These data call for caution in the usage of CN or splanchnicectomy in stage III PDAC and for further studies addressing this observation.

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Effect of maternal birth positions on duration of second stage of labor: systematic review and meta-analysis

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2620-0 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Marta Berta ◽

Helena Lindgren ◽

Kyllike Christensson ◽

Sollomon Mekonnen ◽

Mulat Adefris

Keyword(s):

Weighted Mean Difference ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Significant Heterogeneity ◽

Second Stage Of Labor ◽

Second Stage ◽

Birth Position ◽

Study Designs ◽

The Impact

Abstract Background It is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the uterus to contract more strongly and efficiently, the baby gets in a better position and thus can pass through the pelvis faster. Upright and lateral positions enables flexibility in the pelvis and facilitates the extension of the outlet. Before implementing a change in birthing positions in our clinics we need to review evidences available and context valid related to duration of second stage of labor and birthing positions. Therefore this review aimed to examine the effect of maternal flexible sacrum birth position on duration of second stage of labor. Method The research searched articles using bibliographical Databases: Medline/PUBMED, SCOPUS, Google scholar and Google. All study designs were considered while investigating the impact of maternal flexible sacrum birthing positioning in relation duration of second stage of labor. Studies including laboring mothers with normal labor and delivery. A total of 1985 women were included in the reviewed studies. We included both qualitative and quantitative analysis. Results We identified 1680 potential citations, of which 8 articles assessed the effect of maternal upright birth positioning on the reduction during the duration of second stage of labor. Two studies were excluded because of incomplete reports for meta analysis. The result suggested a reduction in duration of second stage of labor among women in a flexible sacrum birthing position, with a mean duration from 3.2–34.8. The pooled weighted mean difference with random effect model was 21.118(CI: 11.839–30.396) minutes, with the same significant heterogeneity between the studies (I2 = 96.8%, p < 000). Conclusion The second stage duration was reduced in cases of a flexible sacrum birthing position. Even though the reduction in duration varies across studies with considerable heterogeneity, laboring women should be encouraged to choose her comfortable birth position. Researchers who aim to compare different birthing positions should consider study designs which enable women to choose birthing position. Prospero registration number [CRD42019120618]

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A Meta-Analysis of the Impact of Resveratrol Supplementation on Markers of Renal Function and Blood Pressure in Type 2 Diabetic Patients on Hypoglycemic Therapy

Molecules ◽

10.3390/molecules25235645 ◽

2020 ◽

Vol 25 (23) ◽

pp. 5645

Author(s):

Tawanda M. Nyambuya ◽

Bongani B. Nkambule ◽

Sithandiwe E. Mazibuko-Mbeje ◽

Vuyolwethu Mxinwa ◽

Kabelo Mokgalaboni ◽

...

Keyword(s):

Blood Pressure ◽

Renal Function ◽

Fixed Effects ◽

Meta Analysis ◽

Cochrane Library ◽

Total Protein Content ◽

Diabetic Patients ◽

Hypoglycemic Therapy ◽

The Impact

Evidence on the beneficial effects of resveratrol supplementation on cardiovascular disease-related profiles in patients with type 2 diabetes (T2D) is conflicting, while its impact on renal function and blood pressure measurements remains to be established in these patients. The current meta-analysis included randomized controlled trials (RCTs) reporting on the impact of resveratrol supplementation on markers of renal function and blood pressure in patients with T2D on hypoglycemic medication. Electronic databases such as MEDLINE, Cochrane Library, Scopus, and EMBASE were searched for eligible studies from inception up to June 2020. The random and fixed effects model was used in the meta-analysis. A total of five RCTs met the inclusion criteria and involved 388 participants with T2D. Notably, most of the participants were on metformin therapy, or metformin in combination with other hypoglycemic drugs such as insulin and glibenclamide. Pooled estimates showed that resveratrol supplementation in patients with T2D lowered the levels of fasting glucose (SMD: −0.06 [95% CI: −0.24, 0.12]; I2 = 4%, p = 0.39) and insulin (SMD: −0.08 [95% CI: −0.50, 0.34], I2 = 73%, p = 0.002) when compared to those on placebo. In addition, supplementation significantly lowered systolic blood pressure (SMD: −5.77 [95% CI: −8.61, −2.93], I2 = 66%, p = 0.02) in these patients. Although resveratrol supplementation did not affect creatinine or urea levels, it reduced the total protein content (SMD: −0.19 [95% CI: −0.36, −0.02]; I2 = 91%, p = 0.001). In all, resveratrol supplementation in hypoglycemic therapy improves glucose control and lowers blood pressure; however, additional evidence is necessary to confirm its effect on renal function in patients with T2D.

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Prognostic role of pre-treatment C-reactive protein/albumin ratio in esophageal cancer: a meta-analysis

BMC Cancer ◽

10.1186/s12885-019-6373-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Zhenhua Liu ◽

Hongtai Shi ◽

Longyun Chen

Keyword(s):

Esophageal Cancer ◽

Prognostic Value ◽

Meta Analysis ◽

Pooled Analysis ◽

Cochrane Library ◽

C Reactive Protein ◽

Albumin Ratio ◽

Reactive Protein ◽

Pre Treatment

Abstract Background In recent years, the role of pre-treatment C-reactive protein/albumin ratio (CAR) in prognosis of esophageal cancer (EC) has been investigated by several studies. This meta-analysis aimed to provide a more accurate and objective assessment of the prognostic value of pre-treatment CAR in EC. Methods Studies assessing the role of pre-treatment CAR in prognosis of EC were searched from PubMed, Embase and the Cochrane Library (last update by April 16, 2019). The hazard ratios (HRs) of CAR and the corresponding 95% CIs for overall survival (OS) or cancer-specific survival (CSS) in EC were extracted for pooled analysis. Results A total of eight observational studies including 2255 patients were collected. The pooled analysis showed that high CAR was related to worse OS in EC (pooled HR = 1.81; 95% CI = 1.40–2.35; P < 0.001). Subgroup analyses showed that the negative correlation between the CAR and OS was consistently demonstrated in subgroups stratified by country, pathological type, and cut-off value (P < 0.05). However, there was no relation between CAR and OS in subgroup of patients receiving neoadjuvant chemotherapy at a proportion of 100% (HR = 1.15, 95% CI = 0.56–2.69; P = 0.715). In addition, high CAR was also related to worse CSS in EC (pooled HR = 2.61; 95% CI = 1.67–4.06; P < 0.001). Conclusions High pre-treatment CAR was an adverse prognostic factor for EC patients. More large-sample clinical trials are still needed to verify the prognostic value of pre-treatment CAR in EC.

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Adverse effects of ADT on cognitive function and dementia for men with prostate cancer: A meta-analysis and systematic review.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.150 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 150-150 ◽

Cited By ~ 1

Author(s):

Maxine Sun ◽

Alexander Cole ◽

Nawar Hanna ◽

Adam S. Kibel ◽

Toni K. Choueiri ◽

...

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Cognitive Function ◽

Cognitive Decline ◽

English Language ◽

Meta Analysis ◽

Pooled Analysis ◽

Cochrane Library ◽

Significant Heterogeneity ◽

The Impact

150 Background: Nearly 50% of men diagnosed with prostate cancer may receive treatment with some form of androgen deprivation therapy (ADT). While some side effects of ADT are well acknowledged, the specific impact of ADT on cognitive function is uncertain. Our objective was to perform a systematic review and meta-analysis assessing the impact of ADT on overall cognitive decline, and the risks of Alzheimers, Parkinson’s disease. Methods: Relevant studies were identified through search of English language articles indexed in PubMed Medline, PsycINFO, Cochrane Library and Web of Knowledge/Science. First, we assessed rates of cognitive decline in five cohorts from three studies. Second, we assessed rates of Alzheimer’s or Parkinson disease using three large retrospective studies. A pooled-analysis was conducted using a meta-analysis. Weighted averages were reported as odds ratios (OR) with 95% confidence intervals (CI) using RevMan and a DerSimonian and Laird random-effects model. The heterogeneity test was measured using the Q-Mantel-Haenszel ( P< 0.10 was considered of significant heterogeneity). Results: With respect to overall cognitive decline (defined as scoring 1.5 standard deviations [SD] in two or more objective cognitive tests), patients receiving ADT had higher odds of overall cognitive decline than patients with prostate cancer not treated with ADT or health controls (OR: 2.03, 95% CI: 1.42–2.90). Furthermore, men with a history of ADT for prostate cancer had higher odds of developing Alzheimer’s and Parkinson dementia compared to men with prostate cancer not treated with ADT (OR: 1.32, 95% CI: 1.27–1.37). Conclusions: Men receiving ADT for prostate cancer performed significantly worse on measures of overall cognitive function. Additionally, results from the three large observational trials included suggest men exposed to ADT for prostate cancer have higher rates of Parkinson/Alzheimer’s compared to men without ADT.

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Effect of maternal birth positions on duration of second stage of labor: Systematic review and meta-analysis

10.21203/rs.2.13898/v1 ◽

2019 ◽

Author(s):

Marta Berta Badi ◽

Helena Lindgren ◽

Kyllike Christensson ◽

Sollomon Mekonnen ◽

Mulat Adefris

Keyword(s):

Weighted Mean Difference ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Significant Heterogeneity ◽

Second Stage Of Labor ◽

Second Stage ◽

Birth Position ◽

Study Designs ◽

The Impact

Abstract Background: it is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the uterus to contract more strongly and efficiently, the baby gets in a better position and thus can pass through the pelvis faster. Upright and lateral positions enables flexibility in the pelvis and facilitates the extension of the outlet. Before implementing a change in birthing positions in our clinics we need to review evidences available and context valid related to duration of second stage of labor and birthing positions. Objective: The aim of this review was to examine the effect of maternal flexible sacrum birth position on duration of second stage of labor. Method: The research searched articles using bibliographical Databases: Medline/PUBMED, SCOPUS, Google scholar and Google. All study designs were considered while investigating the impact of maternal flexible sacrum birthing positioning in relation duration of second stage of labor. Studies including laboring mothers with normal labor and delivery. A total of 1,985 women were included in the reviewed studies. We included both qualitative and quantitative analysis. Results: We identified 1,680 potential citations, of which 8 articles assessed the effect of maternal upright birth positioning on the reduction during the duration of second stage of labor. Two studies were excluded because of incomplete reports for meta analysis. The result suggested a reduction in duration of second stage of labor among women in a flexible sacrum birthing position, with a mean duration from 3.2-34.8. The pooled weighted mean difference with random effect model was 21.118(CI: 11.839-30.396) minutes, with the same significant heterogeneity between the studies (I2=96.8%, p<000). Conclusion: The second stage duration was reduced in cases of a flexible sacrum birthing position. Even though the reduction in duration varies across studies with considerable heterogeneity, laboring women should be encouraged to choose her comfortable birth position. Researchers who aim to compare different birthing positions should consider study designs which enable women to choose birthing position. Prospero registration number [CRD42019120618]

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Prognostic and Clinicopathological Significance of C-Reactive Protein to Albumin Ratio in Patients With Pancreatic Cancer: A Meta-Analysis

Dose-Response ◽

10.1177/1559325820931290 ◽

2020 ◽

Vol 18 (2) ◽

pp. 155932582093129

Author(s):

Qinfen Xie ◽

Lidong Wang ◽

Shusen Zheng

Keyword(s):

Pancreatic Cancer ◽

Meta Analysis ◽

Disease Free Survival ◽

Progression Free Survival ◽

Cochrane Library ◽

Survival Outcomes ◽

C Reactive Protein ◽

Free Survival ◽

Albumin Ratio ◽

Reactive Protein

Background: This meta-analysis explored the correlation between the C-reactive protein to albumin ratio (CAR) and survival outcomes and clinicopathological characteristics in patients with pancreatic cancer. Methods: PubMed, Embase, Web of Science, and Cochrane Library databases were comprehensively searched through October 17, 2019. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were used to evaluate the association between CAR and overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) in pancreatic cancer. Results: The meta-analysis included 11 studies comprising 2271 patients. The pooled results showed that a high CAR was predictive of worse OS (HR = 1.84, 95% CI = 1.65-2.06, P < .001), PFS (HR = 1.53, 95% CI = 1.27-1.85, P < .001), and DFS (HR = 1.77, 95% CI = 1.30-2.41, P < .001). An elevated CAR was also associated with male sex (OR = 1.38, 95% CI = 1.10-1.74, P = .006). Conclusion: Elevated pretreatment CAR effectively predicts inferior survival outcomes in patients with pancreatic cancer and may be a powerful prognostic indicator for these patients.

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