Pneumonia Is Associated with Increased Mortality in Hospitalized COPD Patients: A Systematic Review and Meta-Analysis

Respiration ◽  
2021 ◽  
Vol 100 (1) ◽  
pp. 64-76
Author(s):  
Yan Yu ◽  
Wei Liu ◽  
Hong-Li Jiang ◽  
Bing Mao
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Readmission Rate ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Mortality And Morbidity ◽  
Icu Stay ◽  
Copd Patients ◽  
The Impact

<b><i>Background:</i></b> Patients with chronic obstructive pulmonary disease (COPD) are at a heightened risk of pneumonia. Whether coexisting community-acquired pneumonia (CAP) can predict increased mortality in hospitalized COPD patients is still controversial. <b><i>Objective:</i></b> This systematic review and meta-analysis aims to assess the association between CAP and mortality and morbidity in COPD patients hospitalized for acute worsening of respiratory symptoms. <b><i>Methods:</i></b> In this review, cohort studies and case-control studies investigating the impact of CAP in hospitalized COPD patients were retrieved from 4 electronic databases from inception until December 2019. Methodological quality of included studies was assessed using Newcastle-Ottawa Quality Assessment Scale. The primary outcome was mortality. The secondary outcomes included length of hospital stay, need for mechanical ventilation, intensive care unit (ICU) admission, length of ICU stay, and readmission rate. The Mantel-Haenszel method and inverse variance method were used to calculate pooled relative risk (RR) and mean difference (MD), respectively. <b><i>Results:</i></b> A total of 18 studies were included. The presence of CAP was associated with higher mortality (RR = 1.85; 95% CI: 1.50–2.30; <i>p</i> &#x3c; 0.00001), longer length of hospital stay (MD = 1.89; 95% CI: 1.19–2.59; <i>p</i> &#x3c; 0.00001), more need for mechanical ventilation (RR = 1.48; 95% CI: 1.32–1.67; <i>p</i> &#x3c; 0.00001), and more ICU admissions (RR = 1.58; 95% CI: 1.24–2.03; <i>p</i> = 0.0002) in hospitalized COPD patients. CAP was not associated with longer ICU stay (MD = 5.2; 95% CI: −2.35 to 12.74; <i>p</i> = 0.18) or higher readmission rate (RR = 1.02; 95% CI: 0.96–1.09; <i>p</i> = 0.47). <b><i>Conclusion:</i></b> Coexisting CAP may be associated with increased mortality and morbidity in hospitalized COPD patients, so radiological confirmation of CAP should be required and more attention should be paid to these patients.

scholarly journals Efficacy of probiotics in the prevention of VAP in critically ill ICU patients: an updated systematic review and meta-analysis of randomized control trials

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Priyam Batra ◽  
Kapil Dev Soni ◽  
Purva Mathur
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Critically Ill ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Mean Difference ◽  
Icu Stay ◽  
Length Of Icu Stay

Abstract Introduction Ventilator-associated pneumonia (VAP) is reported as the second most common nosocomial infection among critically ill patients with the incidence ranging from 2 to 16 episodes per 1000 ventilator days. The use of probiotics has been shown to have a promising effect in many RCTs. Our systematic review and meta-analysis were thus planned to determine the effect of probiotic use in critically ill ventilated adult patients on the incidence of VAP, length of hospital stay, length of ICU stay, duration of mechanical ventilation, the incidence of diarrhea, and the incidence of oropharyngeal colonization and in-hospital mortality. Methodology Systematic search of various databases (such as Embase, Cochrane, and Pubmed), published journals, clinical trials, and abstracts of the various major conferences were made to obtain the RCTs which compare probiotics with placebo for VAP prevention. The results were expressed as risk ratios or mean differences. Data synthesis was done using statistical software - Review Manager (RevMan) Version 5.4 (The Cochrane Collaboration, 2020). Results Nine studies met our inclusion criterion and were included in the meta-analysis. The incidence of VAP (risk ratio: 0.70, CI 0.56, 0.88; P = 0.002; I2 = 37%), duration of mechanical ventilation (mean difference −3.75, CI −6.93, −0.58; P 0.02; I2 = 96%), length of ICU stay (mean difference −4.20, CI −6.73, −1.66; P = 0.001; I2 = 84%) and in-hospital mortality (OR 0.73, CI 0.54, 0.98; P = 0.04; I2 = 0%) in the probiotic group was significantly lower than that in the control group. Probiotic administration was not associated with a statistically significant reduction in length of hospital stay (MD −1.94, CI −7.17, 3.28; P = 0.47; I2 = 88%), incidence of oro-pharyngeal colonization (OR 0.59, CI 0.33, 1.04; P = 0.07; I2 = 69%), and incidence of diarrhea (OR 0.59, CI 0.34, 1.03; P = 0.06; I2 = 38%). Discussion Our meta-analysis shows that probiotic administration has a promising role in lowering the incidence of VAP, the duration of mechanical ventilation, length of ICU stay, and in-hospital mortality.

scholarly journals Clinical usefulness of prethymectomy plasmapheresis in patients with myasthenia gravis: a systematic review and meta-analysis

2019 ◽  
Vol 29 (6) ◽  
pp. 867-875
Author(s):  
Tarcisio A Reis ◽  
Daniele C Cataneo ◽  
Antônio Jose Maria Cataneo
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Myasthenia Gravis ◽  
Hospital Stay ◽  
Meta Analysis ◽  
Severe Disease ◽  
Myasthenic Crisis ◽  
Preoperative Period ◽  
Icu Stay ◽  
Number Of Patients

Abstract OBJECTIVES Our goal was to evaluate, through a systematic review, the efficacy of plasmapheresis in the preoperative preparation of the patient for a thymectomy for the treatment of myasthenia gravis. METHODS MEDLINE, Embase, LILACS, Scopus and CENTRAL databases were searched. The following outcomes were evaluated: myasthenic crisis, mortality, pneumonia, bleeding, use of mechanical ventilation, length of hospital stay and intensive care unit (ICU) stay. RevMan 5.3 software provided by the Cochrane Collaboration was used for the meta-analysis. RESULTS The total number of patients evaluated in the 7 included studies was 360. Plasmapheresis during the preoperative period did not decrease the myasthenic crisis [risk ratio (RR) 0.36, 95% confidence interval (CI) 0.08–1.66; I2 = 44%; 5 studies, 243 patients]. There was also no change in the mortality rate (RR 0.7, 95% CI 0.11–4.62; I2 = 0%; 3 studies, 172 patients) or pneumonia cases (RR 0.28, 95% CI 0.07–1.09; I2 = 27%; 5 studies, 272 patients). Bleeding was greater in patients who underwent plasmapheresis (mean difference 34.34 ml; 95% CI 24.93–43.75; I2 = 0%). We evaluated the following outcomes: need for mechanical ventilation, hospital stay, ICU stay and mechanical ventilation, but these outcomes were not adequate to perform the meta-analysis due to the high heterogeneity among the studies. Subgroup analysis showed that plasmapheresis performed during the preoperative period in patients with severe disease (Osserman III and IV) decreased the myasthenic crisis postoperatively (RR 0.12, 95% CI 0.02–0.65; I2 = 63%). CONCLUSIONS Plasmapheresis may reduce the myasthenic crisis during the postoperative period in patients with severe disease but may produce little or no difference in patients with mild clinical expression of the disease.

scholarly journals Pudendal nerve block in hemorrhoid surgery: A systematic review and meta-analysis

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
F Mongelli ◽  
G Treglia ◽  
D La Regina ◽  
M Di Giuseppe ◽  
J Galafassi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Hospital Stay ◽  
Nerve Block ◽  
Readmission Rate ◽  
Pudendal Nerve ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Opioid Consumption ◽  
Pudendal Nerve Block

Abstract Objective Postoperative pain represents an important issue in traditional hemorrhoidectomy. Optimal pain control is mandatory, in particular in a surgical day care setting. The aim of this study was to investigate the use of pudendal nerve block (PNB) in patients undergoing hemorrhoidectomy. Methods PubMed, Google Scholar, Cochrane Library and Web of Science databases were searched up to December 2020. Randomized trials evaluating the PNB use on postoperative outcomes in patients undergoing hemorrhoidectomy were selected. Opioid consumption, pain on the visual analogue scale, length of hospital stay and readmission rate were the main outcomes of interest and were plotted by using a random-effect model. Results The literature search revealed 749 articles, of which 14 with were deemed eligible. A total of 1,214 patients was included, of whom 565 received the PNB and 649 did not. After hemorrhoidectomy, patients in the PNB group received opioids less frequently (RR 0.364, 95%CI 0.292 to 0.454, p &lt; 0.001) and in a lower cumulative dose (SMD -0.935, 95%CI -1.280 to -0.591, p &lt; 0.001). Patients receiving PNB experienced less pain at 24 hours (SMD -1.862, 95%CI -2.495 to -1.228, p &lt; 0.001), had a shorter length of hospital stay (SMD -0.742, 95%CI -1.145 to -0.338, p &lt; 0.001) and a lower readmission rate (RR 0.239, 95%CI 0.062 to 0.916, p = 0.037). Sensitivity analysis excluded the occurrence of publication bias on the primary endpoint and the overall evidence quality was judged “high”. Conclusion This systematic review and meta-analysis shows significant advantages of the PNB use. A reduction in opioid consumption, postoperative pain, complications and length of stay can be demonstrated. Despite limitations, PNB in patients undergoing hemorrhoidectomy should be taken into account.

scholarly journals Effect of timing of intubation on clinical outcomes of critically ill patients with COVID-19: a systematic review and meta-analysis of non-randomized cohort studies

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Eleni Papoutsi ◽  
Vassilis G. Giannakoulis ◽  
Eleni Xourgia ◽  
Christina Routsi ◽  
Anastasia Kotanidou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Meta Analysis ◽  
Mortality And Morbidity ◽  
Icu Admission ◽  
All Cause Mortality ◽  
Detectable Difference

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.

Haemostatic devices in parotid surgery: a systematic review

2021 ◽  
pp. 1-7
Author(s):  
L Allen ◽  
C MacKay ◽  
M H Rigby ◽  
J Trites ◽  
S M Taylor
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Facial Nerve ◽  
Hospital Stay ◽  
Outcome Measures ◽  
Meta Analysis ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Operative Blood Loss ◽  
Parotid Surgery

Abstract Objective The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery. Method A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay. Results A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay. Conclusion Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.

scholarly journals Impact of Lymphadenectomy on the Oncologic Outcome of Patients with Adrenocortical Carcinoma—A Systematic Review and Meta-Analysis

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 291
Author(s):  
Anne Hendricks ◽  
Sophie Müller ◽  
Martin Fassnacht ◽  
Christoph-Thomas Germer ◽  
Verena A. Wiegering ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adrenocortical Carcinoma ◽  
Survival Benefit ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Length Of Hospital Stay ◽  
Oncologic Outcome ◽  
Stage I ◽  
Tumor Stages ◽  
The Impact

(1) Background: Locoregional lymphadenectomy (LND) in adrenocortical carcinoma (ACC) may impact oncological outcome, but the findings from individual studies are conflicting. The aim of this systematic review and meta-analysis was to determine the oncological value of LND in ACC by summarizing the available literature. (2) Methods: A systematic search on studies published until December 2020 was performed according to the PRISMA statement. The primary outcome was the impact of lymphadenectomy on overall survival (OS). Two separate meta-analyses were performed for studies including patients with localized ACC (stage I–III) and those including all tumor stages (I–IV). Secondary endpoints included postoperative mortality and length of hospital stay (LOS). (3) Results: 11 publications were identified for inclusion. All studies were retrospective studies, published between 2001–2020, and 5 were included in the meta-analysis. Three studies (N = 807 patients) reported the impact of LND on disease-specific survival in patients with stage I–III ACC and revealed a survival benefit of LND (hazard ratio (HR) = 0.42, 95% confidence interval (95% CI): 0.26–0.68). Based on results of studies including patients with ACC stage I–IV (2 studies, N = 3934 patients), LND was not associated with a survival benefit (HR = 1.00, 95% CI: 0.70–1.42). None of the included studies showed an association between LND and postoperative mortality or LOS. (4) Conclusion: Locoregional lymphadenectomy seems to offer an oncologic benefit in patients undergoing curative-intended surgery for localized ACC (stage I–III).

The Impact of Perioperative Glutamine-supplemented Parenteral Nutrition on Outcomes of Patients Undergoing Abdominal Surgery: A Meta-analysis of Randomized Clinical Trials

2013 ◽  
Vol 79 (5) ◽  
pp. 506-513 ◽  
Author(s):  
Chao Yue ◽  
Weiliang Tian ◽  
Wei Wang ◽  
Qian Huang ◽  
Risheng Zhao ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Abdominal Surgery ◽  
Parenteral Nutrition ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Nitrogen Balance ◽  
Infectious Complication ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
The Impact

The objective of this study was to evaluate the impact of perioperative glutamine-supplemented parenteral nutrition (GLN-PN) on clinical outcomes in patients undergoing abdominal surgery. MEDLINE, EMBASE, and the Cochrane Controlled Clinical Trials Register were searched to retrieve the eligible studies. Eligible studies were randomized controlled trials (RCTs) that compared the effect of GLN-PN and standard PN on clinical outcomes in patients undergoing abdominal surgery. Clinical outcomes of interest were postoperative mortality, length of hospital stay, morbidity of infectious complication, and cumulative nitrogen balance. Statistical analysis was conducted by RevMan 5.0 software from the Cochrane Collaboration. Sixteen RCTs with 773 patients were included in this meta-analysis. The results showed a significant decrease in the infectious complication rates of patients undergoing abdominal surgery receiving GLN-PN (risk ratio [RR], 0.48; 95% confidence interval [CI], 0.32 to 0.72; P = 0.0004). The overall effect indicated glutamine significantly reduced the length of hospital stay in the form of alanyl-glutamine (weighted mean difference [WMD], -3.17; 95% CI, -5.51 to -0.82; P = 0.008) and in the form of glycyl-glutamine (WMD, -3.40; 95% CI, -5.82 to -0.97; P = 0.006). A positive effect in improving postoperative cumulative nitrogen balance was observed between groups (WMD, 7.40; 95% CI, 3.16 to 11.63; P = 0.0006), but no mortality (RR, 1.52; 95% CI, 0.21 to 11.9; P = 0.68). Perioperative GLN-PN is effective and safe to shorten the length of hospital stay, reduce the morbidity of postoperative infectious complications, and improve nitrogen balance in patients undergoing abdominal surgery.

scholarly journals Drug treatments for covid-19: living systematic review and network meta-analysis

BMJ ◽  
2020 ◽  
pp. m2980 ◽  
Author(s):  
Reed AC Siemieniuk ◽  
Jessica J Bartoszko ◽  
Long Ge ◽  
Dena Zeraatkar ◽  
Ariel Izcovich ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Standard Care ◽  
Interferon Beta ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Drug Discontinuation ◽  
Duration Of Symptoms ◽  
Risk Of Death ◽  
The Impact

Abstract Objective To compare the effects of treatments for coronavirus disease 2019 (covid-19). Design Living systematic review and network meta-analysis. Data sources WHO covid-19 database, a comprehensive multilingual source of global covid-19 literature, up to 3 December 2020 and six additional Chinese databases up to 12 November 2020. Study selection Randomised clinical trials in which people with suspected, probable, or confirmed covid-19 were randomised to drug treatment or to standard care or placebo. Pairs of reviewers independently screened potentially eligible articles. Methods After duplicate data abstraction, a bayesian network meta-analysis was conducted. Risk of bias of the included studies was assessed using a modification of the Cochrane risk of bias 2.0 tool, and the certainty of the evidence using the grading of recommendations assessment, development and evaluation (GRADE) approach. For each outcome, interventions were classified in groups from the most to the least beneficial or harmful following GRADE guidance. Results 85 trials enrolling 41 669 patients met inclusion criteria as of 21 October 2020; 50 (58.8%) trials and 25 081 (60.2%) patients are new from the previous iteration; 43 (50.6%) trials evaluating treatments with at least 100 patients or 20 events met the threshold for inclusion in the analyses. Compared with standard care, corticosteroids probably reduce death (risk difference 17 fewer per 1000 patients, 95% credible interval 34 fewer to 1 more, moderate certainty), mechanical ventilation (29 fewer per 1000 patients, 54 fewer to 1 more, moderate certainty), and days free from mechanical ventilation (2.6 fewer, 0.2 fewer to 5.0 fewer, moderate certainty). The impact of remdesivir on mortality, mechanical ventilation, length of hospital stay, and duration of symptoms is uncertain, but it probably does not substantially increase adverse effects leading to drug discontinuation (0 more per 1000, 9 fewer to 40 more, moderate certainty). Azithromycin, hydroxychloroquine, lopinavir/ritonavir, interferon-beta, and tocilizumab may not reduce risk of death or have an effect on any other patient-important outcome. The certainty in effects for all other interventions was low or very low. Conclusion Corticosteroids probably reduce mortality and mechanical ventilation in patients with covid-19 compared with standard care, whereas azithromycin, hydroxychloroquine, interferon-beta, and tocilizumab may not reduce either. Whether or not remdesivir confers any patient-important benefit remains uncertain. Systematic review registration This review was not registered. The protocol is included as a supplement. Readers’ note This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication. This version is the second update of the original article published on 30 July 2020 ( BMJ 2020;370:m2980), and previous versions can be found as data supplements. When citing this paper please consider adding the version number and date of access for clarity.

scholarly journals Nonoperative treatment for nonperforated appendicitis in children: a systematic review and meta-analysis

2019 ◽  
Vol 36 (3) ◽  
pp. 261-269 ◽  
Author(s):  
Sonia Maita ◽  
Björn Andersson ◽  
Jan F. Svensson ◽  
Tomas Wester
Keyword(s):  
Systematic Review ◽  
Acute Appendicitis ◽  
Hospital Stay ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Nonoperative Treatment ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Search Terms ◽  
Initial Hospital

AbstractAcute appendicitis is the most common surgical emergency in children. Nonoperative treatment of nonperforated acute appendicitis in children is an alternative to appendectomy. The purpose of this systematic review and meta-analysis was to determine the outcomes of nonoperative treatment of nonperforated acute appendicitis in children in the literature. Databases were searched to identify abstracts, using predefined search terms. The abstracts were reviewed by two independent reviewers and articles were selected according to inclusion and exclusion criteria. Data were extracted by the two reviewers and analyzed. The literature search yielded 2743 abstracts. Twenty-one articles were selected for analysis. The study design was heterogenous, with only one randomized controlled study. The symptoms resolved in 92% [95% CI (88; 96)] of the nonoperatively treated patients. Meta-analysis showed that an additional 16% (95% CI 10; 22) of patients underwent appendectomy after discharge from initial hospital stay. Complications and length of hospital stay was not different among patients treated with antibiotics compared with those who underwent appendectomy. Nonoperative treatment of nonperforated acute appendicitis children is safe and efficient. There is a lack of large randomized controlled trials to compare outcomes of nonoperative treatment with appendectomy.

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