Lactate clearance as a useful biomarker for the prediction of all-cause mortality in critically ill patients: a systematic review study protocol

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

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Early rehabilitation for the prevention of postintensive care syndrome in critically ill patients: a study protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2016-013828 ◽

2017 ◽

Vol 7 (3) ◽

pp. e013828 ◽

Cited By ~ 5

Author(s):

Yutaka Kondo ◽

Ryota Fuke ◽

Toru Hifumi ◽

Junji Hatakeyama ◽

Tetsuhiro Takei ◽

...

Keyword(s):

Systematic Review ◽

Critically Ill ◽

Study Protocol ◽

Critically Ill Patients ◽

Meta Analysis ◽

Early Rehabilitation

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Lactate Clearance Is a Useful Biomarker for the Prediction of All-Cause Mortality in Critically Ill Patients

Critical Care Medicine ◽

10.1097/ccm.0000000000000405 ◽

2014 ◽

Vol 42 (9) ◽

pp. 2118-2125 ◽

Cited By ~ 111

Author(s):

Zhongheng Zhang ◽

Xiao Xu

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Lactate Clearance ◽

All Cause Mortality

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Accelerated versus standard initiation of renal replacement therapy for critically ill patients with acute kidney injury: a systematic review and meta-analysis of RCT studies

Critical Care ◽

10.1186/s13054-020-03434-z ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Heng-Chih Pan ◽

Ying-Ying Chen ◽

I-Jung Tsai ◽

Chih-Chung Shiao ◽

Tao-Min Huang ◽

...

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

Kidney Injury ◽

All Cause Mortality ◽

Surgical Icu

Abstract Background Acute kidney injury (AKI) is a common yet possibly fatal complication among critically ill patients in intensive care units (ICU). Although renal replacement therapy (RRT) is an important supportive management for severe AKI patients, the optimal timing of RRT initiation for these patients is still unclear. Methods In this systematic review, we searched all relevant randomized controlled trials (RCTs) that directly compared accelerated with standard initiation of RRT from PUBMED, MEDLINE, EMBASE, and Cnki.net published prior to July, 20, 2020. We extracted study characteristics and outcomes of being free of dialysis, dialysis dependence and mortality. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. Results We identified 56 published relevant studies from 1071 screened abstracts. Ten RCTs with 4753 critically ill AKI patients in intensive care unit (ICU) were included in this meta-analysis. In our study, accelerated and standard RRT group were not associated with all-cause mortality (log odds-ratio [OR]: − 0.04, 95% confidence intervals [CI] − 0.16 to 0.07, p = 0.46) and free of dialysis (log OR: − 0.03, 95% CI − 0.14 to 0.09, p = 0.65). In the subgroup analyses, accelerated RRT group was significantly associated with lower risk of all-cause mortality in the surgical ICU and for those who received continuous renal replacement therapy (CRRT). In addition, patients in these two subgroups had higher chances of being eventually dialysis-free. However, accelerated initiation of RRT augmented the risk of dialysis dependence in the subgroups of patients treated with non-CRRT modality and whose Sequential Organ Failure Assessment (SOFA) score were more than 11. Conclusions In this meta-analysis, critically ill patients with severe AKI would benefit from accelerated RRT initiation regarding all-cause mortality and being eventually free of dialysis only if they were surgical ICU patients or if they underwent CRRT treatment. However, the risk of dialysis dependence was increased in the accelerated RRT group when those patients used non-CRRT modality or had high SOFA scores. All the literatures reviewed in this study were highly heterogeneous and potentially subject to biases. Trial registration CRD42020201466, Sep 07, 2020. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=201466.

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Association between Vitamin D supplementation and mortality in critically ill patients: A systematic review and meta-analysis of randomized clinical trials

PLoS ONE ◽

10.1371/journal.pone.0243768 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243768

Author(s):

Liyuan Peng ◽

Linjie Li ◽

Peng Wang ◽

Weelic Chong ◽

Yin Li ◽

...

Keyword(s):

Systematic Review ◽

Vitamin D ◽

Critically Ill ◽

Critically Ill Patients ◽

Sequential Analysis ◽

Randomized Clinical Trials ◽

Vitamin D Supplementation ◽

Trial Sequential Analysis ◽

All Cause Mortality

Background Observational studies suggest that low 25-hydroxyvitamin D status is common and has been associated with higher mortality in critically ill patients. This study aim to investigate whether vitamin D supplementation is associated with lower mortality in critically ill patients. Method We searched Medline, Embase, and Cochrane databases from inception to January 12, 2020, without language restrictions, for randomized controlled trials comparing the effect of vitamin D supplementation with placebo in critically ill patients. Two authors independently performed data extraction and assessed study quality. The primary outcome was all-cause mortality at the longest follow-up. Result We identified nine trials with a total of 2066 patients. Vitamin D supplementation was not associated with reduced all-cause mortality at the longest follow-up (RR 0.90, 95% CI 0.74 to 1.09, I2 = 20%), at 30 days (RR 0.81, 95% CI 0.56 to 1.15), at 90 days (RR 1.15, 95% CI 0.92 to 1.44), and at 180 days (RR 0.82, 95% CI 0.65 to 1.03). Results were similar in the sensitivity analysis. The sample size met the optimum size in trial sequential analysis. Similarly, supplemental vitamin D was not associated with length of ICU stay, hospital stay, or mechanical ventilation. Conclusion Vitamin D supplement was not associated with reduced all-cause mortality in critically ill patients. Systematic review registration Open Science Framework https://osf.io/bgsjq

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