Risk factors of flare in patients with systemic lupus erythematosus after glucocorticoids withdrawal. A systematic review and meta-analysis

ObjectiveGlucocorticoids (GC) withdrawal is part of the targets in current recommendations for SLE, but relapse is the most worrying issue. We aimed to investigate the predictors for flare in patients with SLE after GC withdrawal.MethodsWe systematically searched PubMed, EMBASE and Cochrane Library as well as Scopus databases up to 9 July 2021 for studies concerning predictive factors of relapses in patients with SLE after GC cessation. Pooled OR and 95% CI were combined using a random-effects or fixed-effects model.Results635 patients with SLE with GC discontinuation in 9 publications were eligible for the final analysis. Of them, 99.5% patients were in clinical remission before GC withdrawal. Serologically active yet clinically quiescent (SACQ) was associated with an increased risk of flare after GC withdrawal (OR 1.78, 95% CI (1.00 to 3.15)). Older age and concomitant use of hydroxychloroquine (HCQ) trended towards decreased risk of flare (weighted mean difference (WMD) −2.04, 95% CI (−4.15 to 0.06) for age and OR 0.50, 95% CI (0.23 to 1.07) for HCQ), yet not statistically significant. No significant association was observed regarding gender (pooled OR 1.75; 95% CI (0.59 to 5.20)), disease duration (WMD −11.91, 95% CI (−27.73 to 3.91)), remission duration (WMD −8.55, 95% CI (−33.33 to 16.23)), GC treatment duration (WMD −10.10, 95% CI (−64.09 to 43.88)), concomitant use of immunosuppressant (OR 0.86, 95% CI (0.48 to 1.53)).ConclusionYounger age and SACQ were potential risk factors of SLE flare among patients who discontinued GC. HCQ, but not immunosuppressant might prevent flare. GC withdrawal should be done with caution in this subgroup of patients.

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Acute kidney injury is associated with severe and fatal outcomes in patients with Coronavirus disease 2019 (COVID-19) infection: a systematic review and meta-analysis of observational studies

10.1101/2020.08.27.20183632 ◽

2020 ◽

Author(s):

Mohammad Parohan ◽

Sajad Yaghoubi ◽

Mahmoud Djalali ◽

Asal Seraji ◽

Mohammad Hassan Javanbakht ◽

...

Keyword(s):

Acute Kidney Injury ◽

Disease Severity ◽

Fixed Effects ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Kidney Injury ◽

Cochrane Library ◽

Pool Data ◽

Fixed Effects Model ◽

Death Cases

Coronavirus disease 2019 (COVID-19) is a pandemic impacting 213 countries and territories with more than 17,918,582 cases worldwide. Kidney dysfunction has been reported to occur in severe and death cases. This meta-analysis was done to summarize available studies on the association between acute kidney injury and severity of COVID-19 infection. Online databases including Web of Science, PubMed/Medline, Cochrane Library, Scopus and Google Scholar were searched to detect relevant articles up to 1 July 2020, using relevant keywords. To pool data, a random- or fixed-effects model was used based on the heterogeneity between studies. In total, 50 studies with 8,180 COVID-19 confirmed cases (severe cases=1,823 and death cases=775), were included in this meta-analysis. Higher serum levels of creatinine (weighted mean difference (WMD) for disease severity=5.47 μmol/L, 95% CI=2.89 to 8.05, P<0.001 and WMD for mortality=18.32 μmol/L, 95% CI=12.88 to 23.75, P<0.001), blood urea nitrogen (BUN) (WMD for disease severity=1.10 mmol/L, 95% CI=0.67 to 1.54, P<0.001 and WMD for mortality=3.56 mmol/L, 95% CI=2.65 to 4.48, P<0.001) and lower levels of estimated glomerular filtration rate (eGFR) (WMD for disease severity=-15.34 mL/min/1.73 m2, 95% CI=-18.46 to -12.22, P<0.001 and WMD for mortality=-22.74 mL/min/1.73 m2, 95% CI=-27.18 to -18.31, P<0.001) were associated with a significant increase in the severity and mortality of COVID-19 infection. Acute kidney injury, as assessed by kidney biomarkers (serum creatinine, BUN and eGFR), was associated with severe outcome and death from COVID-19 infection.

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Predictive Value of Hypoalbuminemia for Contrast-Associated Acute Kidney Injury: A Systematic Review and Meta-Analysis

Angiology ◽

10.1177/0003319721989185 ◽

2021 ◽

pp. 000331972198918

Author(s):

Liwei Liu ◽

Zhubin Lun ◽

Bo Wang ◽

Li Lei ◽

Guoli Sun ◽

...

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Predictive Value ◽

Fixed Effects ◽

Meta Analysis ◽

Kidney Injury ◽

Clinical Intervention ◽

Cochrane Library ◽

Fixed Effects Model ◽

Increased Risk

Contrast-associated acute kidney injury (CA-AKI) is a major adverse complication of intravascular administration of contrast medium. Current studies have shown that hypoalbuminemia might be a novel risk factor of CA-AKI. This systematic review and meta-analysis was performed to evaluate the predictive value of hypoalbuminemia for CA-AKI. Relevant studies were identified in Ovid-Medline, PubMed, Embase, and Cochrane Library up to December 31, 2019. Two authors independently screened studies, consulting with a third author when necessary to resolve discrepancies. The pooled odds ratio (OR) was calculated to assess the association between hypoalbuminemia and CA-AKI using a random-effects model or fixed-effects model. Eight relevant studies involving a total of 18 687 patients met our inclusion criteria. The presence of hypoalbuminemia was associated with an increased risk of CA-AKI development (pooled OR: 2.59, 95% CI: 1.80-3.73). Hypoalbuminemia is independently associated with the occurrence of CA-AKI and may be a potentially modifiable factor for clinical intervention. This systematic review and meta-analysis was registered in PROSPERO (CRD42020168104).

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Abstract 18967: Analysis of Vitamin D Levels in Patients With and Without Statin-induced Myalgia - A Systematic Review and Meta-analysis of 7 Studies with 2416 Patients

Circulation ◽

10.1161/circ.130.suppl_2.18967 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Marta Michalska-Kasiczak ◽

Amirhossein Sahebkar ◽

Dimitri P Mikhailidis ◽

Jacek Rysz ◽

Paul Muntner ◽

...

Keyword(s):

Vitamin D ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Final Analysis ◽

Vitamin D Supplementation ◽

Cochrane Library ◽

Increased Risk ◽

Vitamin D Levels ◽

Study Characteristics ◽

The Impact

Introduction: Vitamin D (vit D) deficiency may be associated with an increased risk of statin-related muscle complaints, and symptomatic myalgia in statin-treated patients. Hypothesis: The aim of this meta-analysis was to investigate whether subjects with statin-induced myalgia have lower serum vit D levels compared with those who are asymptomatic. Methods: We searched PubMed, Web of Science, Cochrane Library, Scopus and EMBASE (up to March 2014) to identify studies that investigated the impact of vit D levels in statin-treated subjects with and without myalgia. Two independent reviewers extracted data on study characteristics, methods and outcomes. Results: The electronic search yielded 437 articles, of those 20 were scrutinized in the full text, of which 13 studies were considered unsuitable. The final analysis included 7 studies with 2416 statin-treated patients divided to subgroups of patients with (n = 666 [27.6%]) or without (n = 1750) myalgia. The combination of data from individual observational studies revealed a significantly lower vit D plasma concentration in the statin-induced myalgia compared with the asymptomatic subgroup with weighted mean difference -9.41 ng/mL(95% confidence interval (Cl): -10.17 to -8.64; p < 0.00001) (figure) . Conclusions: This meta-analysis provides evidence that low vit D levels are associated with myalgia in patients on statin therapy. Well-designed, randomized controlled trials are necessary to establish whether vitamin D supplementation reduces risk for statin myalgia in patients with vitamin D deficiency.

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Association between early bronchiolitis and the development of childhood asthma: a meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-043956 ◽

2021 ◽

Vol 11 (5) ◽

pp. e043956

Author(s):

Guizuo Wang ◽

Dong Han ◽

Zhengdong Jiang ◽

Manxiang Li ◽

Shumei Yang ◽

...

Keyword(s):

Early Life ◽

Fixed Effects ◽

Late Onset ◽

Meta Analysis ◽

Later Life ◽

Analysis Data ◽

Fixed Effects Model ◽

Case Control Studies ◽

Increased Risk ◽

Registration Number

ObjectiveEarly life bronchiolitis has been hypothesised to be associated with the subsequent risk of persistent wheezing or asthma. However, the link remains controversial. The objective of our study was to evaluate the association between bronchiolitis before 2 years of age and the late-onset wheezing/asthma.DesignSystematic review and meta-analysis.MethodsPubMed, Embase and Web of Science databases were systematically searched for studies published between 1955 and January 2020. Meanwhile, we also checked through the reference lists of relevant articles to see whether these references included reports of other studies that might be eligible for the review. Cohort and case–control studies assessing the association between early-life bronchiolitis and late-onset wheezing/asthma were included in this meta-analysis. Data were extracted by two independent reviewers. Results were pooled using a random-effects model or fixed-effects model according to the heterogeneity among studies.Results32 original articles with 292 844 participants, which met the criteria, were included in this meta-analysis. Bronchiolitis before 2 years of age was associated with an increased risk of subsequent wheezing/asthma (relative risk=2.46, 95% CI 2.14 to 2.82, p<0.001). After categorising studies into different groups based on age at the end of follow-up, geographical region and study quality, the association still remained significant.ConclusionsThe meta-analysis indicates an association between bronchiolitis before 2 years of age and the wheezing/asthma in later life. Well-designed and highly standardised prospective studies that better address bias due to potential confounding factors are needed to validate the risk identified in our meta-analysis.PROSPERO registration numberCRD42018089453.

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Association of dyslipidemia with the severity and mortality of coronavirus disease 2019 (COVID-19): a meta-analysis

Virology Journal ◽

10.1186/s12985-021-01604-1 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Yanli Liu ◽

Yilong Pan ◽

Yuyao Yin ◽

Wenhao Chen ◽

Xiaodong Li

Keyword(s):

Fixed Effects ◽

Meta Analysis ◽

Cochrane Library ◽

Case Control Studies ◽

Risk Of Death ◽

Potential Association ◽

Increased Risk ◽

Language Restriction ◽

Newcastle Ottawa Scale

Abstract Background The numbers of confirmed cases of coronavirus disease 2019 (COVID-19) and COVID-19 related deaths are still increasing, so it is very important to determine the risk factors of COVID-19. Dyslipidemia is a common complication in patients with COVID-19, but the association of dyslipidemia with the severity and mortality of COVID-19 is still unclear. The aim of this study is to analyze the potential association of dyslipidemia with the severity and mortality of COVID-19. Methods We searched the PubMed, Embase, MEDLINE, and Cochrane Library databases for all relevant studies up to August 24, 2020. All the articles published were retrieved without language restriction. All analysis was performed using Stata 13.1 software and Mantel–Haenszel formula with fixed effects models was used to compare the differences between studies. The Newcastle Ottawa scale was used to assess the quality of the included studies. Results Twenty-eight studies involving 12,995 COVID-19 patients were included in the meta-analysis, which was consisted of 26 cohort studies and 2 case–control studies. Dyslipidemia was associated with the severity of COVID-19 (odds ratio [OR] = 1.27, 95% confidence interval [CI] 1.11–1.44, P = 0.038, I2 = 39.8%). Further, patients with dyslipidemia had a 2.13-fold increased risk of death compared to patients without dyslipidemia (95% CI 1.84–2.47, P = 0.001, I2 = 66.4%). Conclusions The results proved that dyslipidemia is associated with increased severity and mortality of COVID-19. Therefore, we should monitor blood lipids and administer active treatments in COVID-19 patients with dyslipidemia to reduce the severity and mortality.

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Poly(ADP-Ribose) Polymerase Inhibitors (PARPi) for Patients With Advanced Breast Cancer: a Meta-analysis of Randomized Controlled Trials

10.21203/rs.3.rs-48500/v1 ◽

2020 ◽

Author(s):

YongCheng Su ◽

XiaoGang Zheng

Keyword(s):

Breast Cancer ◽

Randomized Controlled Trials ◽

Fixed Effects ◽

Meta Analysis ◽

Parp Inhibitors ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled ◽

Increased Risk ◽

Grade 3

Abstract BACKGROUND: Poly(ADP–ribose) polymerase (PARP) inhibitors are new class of drugs that are currently being studied in several malignancies. However, datas about the efficacy and safety of the PARP inhibitors are limited. Therefore, we conducted a meta-analysis of randomized controlled trials (RCT) in patients with breast cancer.METHODS: Pubmed/Medline, Embase, Cochrane Library, and abstracts presented at the annual meeting of the American Society of Clinical Oncology (ASCO) were searched for articles published from 2000 to June 2018.Summary incidences and the RR, HR with 95% confidence intervals, were calculated by using a random-effects or fixed-effects model.RESULTS: The summary HR indicated PARPi was not associated with OS (HR=0.83, 95%CI 0.66–1.06, Z=1.49, P=0.14), while it could significantly improve PFS ande time to deterioration (TTD) of global health status/quality of life(GHS/QoL) as compared with traditional standard therapy, the HR was 0.60(95%CI 0.50-0.72; Z=5.52, P＜0.00001) and 0.4 (95%CI 0.29–0.54,z=5.80 ,p=0.000),respectively.The RR of grade 3 or more anemia ,fatigue and headache was 3.02 (95% CI, 0.69–13.17;p = 0.14,,I2=90%),0.77 (95%CI, 0.34–1.73;p=0.52,I2=7%) and 1.13 (95% CI,0.30–4.18;p=0.86,I2=0%),respectively.CONCLUSION: The findings of this meta-analysis showed that PARPi has no significant effect on OS, while it could significantly improve in PFS and TTD of GHS/QoL for patients with advanced or metastatic breast cancer.Furthermore,our findings also demonstrated that the PARPi treatment is connected with an increased risk of grade 3 or more anemia adverse events.

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Efficacy of mesenchymal stem cell therapy for sepsis: A meta-analysis of preclinical studies

10.21203/rs.3.rs-15951/v2 ◽

2020 ◽

Author(s):

xueyi sun ◽

xianfei ding ◽

huoyan liang ◽

xiaojuan zhang ◽

shaohua liu ◽

...

Keyword(s):

Stem Cell ◽

Mortality Rate ◽

Animal Models ◽

Mesenchymal Stem Cell ◽

Fixed Effects ◽

Meta Analysis ◽

Experimental Models ◽

Lower Mortality ◽

Cochrane Library ◽

Fixed Effects Model

Abstract Background: Multiple studies have reported that mesenchymal stem cell (MSC) therapy has beneficial effects in experimental models of sepsis. However, this finding remains inconclusive. This study was performed to systematically determine the connection between MSC therapy and mortality in sepsis animal models by pooling and analyzing data from newly published studies. Methods: A detailed search of related studies from 2009 to 2019 was conducted in four databases, including MEDLINE, EMBASE, Cochrane Library, and Web of Science. After browsing and filtering out articles that met the inclusion criteria for statistical analysis, the inverse variance method of the fixed effects model was used to calculate the pooled odds ratios (ORs) and their 95% confidence intervals (CIs). Results: Twenty-nine animal studies, including 1,266 animals, were identified. None of the studies were judged to have a low risk of bias. The meta-analysis demonstrated that MSC therapy was related to a significantly lower mortality rate (OR 0.29, 95% CI 0.22–0.38, P <0.001). Subgroup analyses performed based on the MSC injection dose (<1.0 × 10 6 cells, OR=0.33, 95% CI 0.20–0.56, P <0.001; 1.0 × 10 6 cells, OR=0.24, 95% CI 0.16–0.35, P <0.001) and injection time (<1 hour, OR=0.24, 95% CI 0.13–0.45, P <0.001; 1 hour, OR=0.28, 95% CI 0.17–0.46, P <0.001) demonstrated that treatment with MSCs significantly reduced the mortality rate of animals with sepsis. Conclusion: This up-to-date meta-analysis showed a connection between MSC therapy and lower mortality in sepsis animal models, supporting the potential therapeutic effect of MSC treatment in future clinical trials. The results in this study contradict a previous meta-analysis with regards to the ideal dose of MSC therapy. Thus, further research is required to support these findings.

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Tissue inhibitor of metalloproteinase-1 (TIMP-1) as a prognostic biomarker in gastrointestinal cancer: a meta-analysis

PeerJ ◽

10.7717/peerj.10859 ◽

2021 ◽

Vol 9 ◽

pp. e10859

Author(s):

Lili Qin ◽

Yueqi Wang ◽

Na Yang ◽

Yangyu Zhang ◽

Tianye Zhao ◽

...

Keyword(s):

Systematic Reviews ◽

Gastrointestinal Cancer ◽

Fixed Effects ◽

Prognostic Value ◽

Meta Analysis ◽

Tissue Inhibitor Of Metalloproteinase ◽

Cochrane Library ◽

Fixed Effects Model ◽

Tissue Inhibitor ◽

Pretreatment Serum

Background Tissue inhibitor of metalloproteinase 1 (TIMP-1) has recently been shown to be dependent on or independent of Matrix metalloproteinases (MMPs) in its roles in tumorigenesis and progression. This appreciation has prompted various studies assessing the prognostic value of TIMP-1 in patients with gastrointestinal cancer, however, the conclusions were still inconsistent. The aim of this study was to assess the prognostic value of TIMP-1-immunohistochemistry (IHC) staining and pretreatment serum/plasma TIMP-1 level in gastrointestinal cancer survival as well as the association between TIMP-1 and clinicopathologic features. Methods The meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO; Registration NO. CRD42020185407) and followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. A highly sensitive literature search was performed in electronic databases including PubMed, EMBASE and the Cochrane Library. Heterogeneity analysis was conducted using both chi-square-based Q statistics and the I2 test. The pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to assess the prognostic value of TIMP-1 using the fixed-effects model. Odds ratios (ORs) with 95% CIs were calculated to evaluate the associations between TIMP-1 and clinicopathological characteristics. The meta-analysis was conducted using STATA 12.0 software. Results A total of 3,958 patients from twenty-two studies were included in the meta-analysis. Elevated TIMP-1 levels were significantly associated with poor survival in gastrointestinal cancer (TIMP-1-IHC staining: HR = 2.04, 95% CI [1.59–2.61], I2 = 35.7%, PQ = 0.156; pretreatment serum/plasma TIMP-1 levels: HR = 2.02, 95% CI [1.80–2.28], I2 = 0%, PQ = 0.630). Moreover, clinicopathological parameter data analysis showed that elevated TIMP-1 levels were significantly associated with lymph node metastasis (N1/N2/N3 vs N0: OR = 2.92, 95% CI [1.95–4.38]) and higher TNM stages (III/IV vs I/II: OR = 2.73, 95% CI [1.23–6.04]). Conclusion Both TIMP-1-positive IHC staining and high serum/plasma TIMP-1 levels are poor prognostic factors for the survival of gastrointestinal cancer. In addition, TIMP-1 overexpression was correlated with more advanced clinicopathological features.

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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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A meta-analysis of biologic therapies on risk of new or recurrent cancer in patients with rheumatoid arthritis and a prior malignancy

Rheumatology ◽

10.1093/rheumatology/kez475 ◽

2019 ◽

Vol 59 (5) ◽

pp. 930-939 ◽

Cited By ~ 5

Author(s):

Wenhui Xie ◽

Shiyu Xiao ◽

Yanrong Huang ◽

Xiaoying Sun ◽

Dai Gao ◽

...

Keyword(s):

Relative Risk ◽

Fixed Effects ◽

Meta Analysis ◽

Cochrane Library ◽

Optimal Time ◽

Biologic Therapies ◽

Recurrent Cancer ◽

Increased Risk ◽

Risk Of Cancer ◽

Prior Malignancy

Abstract Objectives To explore the risk of new and recurrent cancer in adult RA patients with prior malignancy and subsequently exposed to biologic therapies. Methods Separate searches were performed of PubMed, EMBASE and Cochrane Library and conference proceedings for observational studies reporting cancer incidence or recurrence in patients with RA and prior malignancy treated with biologics and conventional synthetic DMARDs (csDMARDs). Mantel-Haenszel fixed-effects method was conducted to calculate relative risk and 95% CI. Results A total of 12 studies involving 13 598 patients and 32 473 patient-years of follow-up were included (10, 3 and 1 studies for TNF inhibitors [TNFi], rituximab and anakinra, respectively). The crude incidence of new and recurrent cancer per 1000 patient-years were 34.4 for TNFi, 32.3 for rituximab, 32.3 for anakinra and 31.8 for csDMARDs. In the quantitative meta-analysis, biologics were not associated with an increased risk of new or recurrent cancer compared with csDMARDs in patients with RA and prior cancer (TNFi: relative risk = 0.95, 95% CI = 0.83, 1.09; rituximab: relative risk = 0.89, 95% CI = 0.52, 1.53). Secondary analyses of stratification of cancer types, the interval between initiation of TNFi and prior cancer diagnosis, and duration of TNFi exposure, found similar results. Conclusion Compared with csDMARDs, there is no increased risk of developing cancer overall or some specific subtypes in RA patients with a prior cancer receiving biologics. More investigations are warranted to explore the risk of cancer development in individual cancer as well as to determine optimal time to initiate biologic therapy after the diagnosis of cancer or completion of cancer treatment.

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