scholarly journals Biomarkers in the Prediction of Hemorrhagic Transformation in Acute Stroke: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-13
Author(s):  
Soumya Krishnamoorthy ◽  
Gurpreet Singh ◽  
Jithu Jose K ◽  
Biju Soman ◽  
Christian Foerch ◽  
...  
Keyword(s):  
Systematic Review ◽  
Calcium Binding ◽  
Meta Analysis ◽  
Area Under The Curve ◽  
Plasminogen Activator Inhibitor ◽  
Diagnostic Odds Ratio ◽  
Hemorrhagic Transformation ◽  
Cochrane Library ◽  
Plasminogen Activator Inhibitor 1 ◽  
Neutrophil Lymphocyte Ratio

<b><i>Background:</i></b> Hemorrhagic transformation (HT) is a complication that occurs spontaneously or after thrombolysis in acute ischemic stroke (AIS) and can increase morbidity and mortality. The association of biomarkers with the risk of HT has been variably reported. We conducted a systematic review of the literature and meta-analysis and sought to compare blood biomarkers associated with HT and its subtypes by evaluating its predictability and correlation with outcome in AIS. <b><i>Methods:</i></b> The study protocol was registered in the PROSPERO database (CRD42020201334) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Among 2,230 articles identified from Cochrane Library, PubMed, and Web of Science databases, 30 quality-appraised articles were found eligible. Meta-analysis was conducted for matrix metalloproteinase-9 (MMP-9), cellular fibronectin (c-Fn), ferritin, S100 calcium-binding protein B (S100B), and neutrophil-lymphocyte ratio (NLR). We also reviewed biomarkers for correlation with the functional outcome at 90 days from stroke onset (poor outcome modified Rankin scale &#x3e;2). <b><i>Results:</i></b> The pooled diagnostic odds ratio (DOR<sub>pooled</sub>) was the highest for baseline c-Fn levels (299.253 [95% CI, 20.508–4,366.709]), followed by MMP-9 (DOR<sub>pooled</sub>, 29.571 [95% CI 17.750–49.267]) and ferritin (DOR<sub>pooled</sub>, 24.032 [95% CI 2.557–225.871]). However, wide confidence intervals for ferritin and c-Fn suggested lesser reliability of the markers. Patients with MMP-9 levels ≥140 ng/mL were 29.5 times at higher risk of developing symptomatic HT after AIS (area under the curve = 0.881). S100B (DOR<sub>pooled</sub>, 6.286 [95% CI, 1.861–21.230]) and NLR (DOR<sub>pooled</sub>, 5.036 [95% CI, 2.898–8.749]) had lower diagnostic accuracies. Among the markers not included for meta-analysis, caveolin-1, thrombin-activated fibrinolysis inhibitor, plasminogen activator inhibitor-1, and soluble ST2 were highly sensitive. Elevated levels of MMP-9, ferritin, and NLR were found to be associated with poor functional outcomes and mortality. <b><i>Conclusion:</i></b> Of the 5 biomarkers, there was enough evidence that MMP-9 has higher diagnostic accuracy for predicting the risk of HT before thrombolysis. MMP-9, ferritin, and NLR also predicted poor short-term outcomes.

scholarly journals Accuracy of circulating microRNAs in diagnosis of sepsis: a systematic review and meta-analysis

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Xiaomin Shen ◽  
Jiajie Zhang ◽  
Yicheng Huang ◽  
Jiepeng Tong ◽  
Li Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Area Under The Curve ◽  
Diagnostic Odds Ratio ◽  
Cochrane Library ◽  
Likelihood Ratios ◽  
Internal Reference ◽  
Chi Square ◽  
Circulating Micrornas ◽  
Chi Square Test

Abstract Objectives The aim of this study was to systematically assess the accuracy of circulating microRNAs (miRNAs) as a promising biomarker for sepsis via a meta-analysis. Methods PubMed, Cochrane Library, Embase, Web of Science, Scopus, and Ovid databases were searched up to April 3, 2020. The Quality in Prognostic Studies (QUADAS-2) tool was used to assess methodological quality. The pooled sensitivity (Sen), specificity (Spe), positive or negative likelihood ratios (PLR or NLR), diagnostic odds ratio (DOR), curve, and area under the curve (AUC) were calculated with 95% confidence interval (95% CI). The overall accuracy (OA) of miRNAs, procalcitonin (PCT), and C-reactive protein (CRP) was analyzed by the chi-square test. Results A total of 22 records were eligible for systematic review, including 2210 sepsis, 426 systemic inflammatory response syndrome (SIRS), and 1076 healthy controls (HC). The pooled Sen, Spe, and DOR of miRNAs were 0.80 (95% CI 0.75–0.83), 0.85 (95% CI 0.80–0.89), and 22 (15–32), respectively. The DOR of PCT and CRP were 17 (95% CI 4–68) and 7 (95% CI 1–48), respectively. The OA value of miRNAs (79.02%) and PCT (76.95%) were higher than CRP (61.22%) (P < 0.000). The subgroup analysis indicated that miRNAs in adults, serum type, downregulation of miRNA expression, criteria of Sepsis-3, internal reference of non-U6, and dysregulation expression of miR-223 had superior diagnostic accuracy. In addition, there was no significant publication bias among the included studies. Fagan’s nomogram showed valuable clinical utility. Conclusions Our meta-analysis indicated that the level of circulating miRNAs, particularly the miR-223, could be used as an indicator for sepsis.

scholarly journals Prothrombotic Factors in Obstructive Sleep Apnea: A Systematic Review With Meta-Analysis

2020 ◽  
pp. 014556132096520
Author(s):  
Yue Qiu ◽  
Xiaodan Li ◽  
Xin Zhang ◽  
Wei Wang ◽  
Jun Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Meta Analysis ◽  
Plasminogen Activator Inhibitor ◽  
Cochrane Library ◽  
Plasminogen Activator Inhibitor 1 ◽  
Obstructive Sleep ◽  
Mean Differences ◽  
The Relationship

Background: Previous studies revealed that the prothrombotic factors in patients with obstructive sleep apnea (OSA) remain controversial. Aim/Objective: The aim of the systematic review is to elucidate the relationship between prothrombotic factors and OSA. Materials and Methods: This systematic review was performed under the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The literature we investigated was extracted from 4 main medical databases (PubMed, Web of Science, Cochrane Library, and Chinese databases) as of February 2020. We used significant weighted mean differences (SMDs) with 95% CIs from random-effects model. Results: A total of 15 studies comprising 2190 patients were available for the meta-analysis. The pooled results showed that the levels of fibrinogen (SMD = 0.95, 95% CI = 0.26 to 1.65, P = .000), vascular endothelial growth factor (SMD = 0.37, 95% CI = −0.90 to 1.63, P = .000), and plasminogen activator inhibitor 1 (SMD = 0.61, 95% CI = 0.29 to 0.92, P = .040) increased in patients with OSA. There were no statistical differences between groups in terms of d-dimer ( P = .108) and platelet counts ( P = .233). Subgroup analyses demonstrated that specimen types and age could account for the heterogeneity. Conclusions and Significance: This meta-analysis indicated the relationship between prothrombotic factors in OSA hypopnea. Obstructive sleep apnea–related effects may underline the importance of considering the dysfunction of the hemostatic system. The prothrombotic factors in OSA can influence making a choice of appropriate therapy.

scholarly journals Diagnostic and prognostic value of miRNAs in hepatoblastoma: A systematic review with meta-analysis

2021 ◽  
Author(s):  
Bin Wu ◽  
◽  
Lixia Guo ◽  
Kaikai Zhen ◽  
Chao Sun
Keyword(s):  
Systematic Review ◽  
Prognostic Value ◽  
Meta Analysis ◽  
Area Under The Curve ◽  
Prognostic Indicator ◽  
Diagnostic Odds Ratio ◽  
Diagnostic Value ◽  
Likelihood Ratios ◽  
Clinical Value ◽  
Diagnostic And Prognostic Value

Review question / Objective: Background and aim: Increasing evidence has revealed the valuable diagnostic and prognostic applications of dysregulated microRNAs (miRNAs) in hepatoblastoma (HB), the most common hepatic malignancy during childhood. However, these results are inconsistent and remain to be elucidated. In the present study, we aimed to systematically compile up-to-date information regarding the clinical value of miRNAs in HB. Methods: Articles concerning the diagnostic and prognostic value of single miRNAs for HB were searched from databases. The sensitivity (SEN), specificity (SPE), positive and negative likelihood ratios (PLR and NLR), diagnostic odds ratio (DOR), area under the curve (AUC), and hazard ratios (HRs) were separately pooled to explore the diagnostic and prognostic performance of miRNA. Subgroup and meta-regression analyses were further carried out only in the event of heterogeneity. Results: In all, 20 studies, involving 264 HB patients and 206 healthy individuals, met the inclusion criteria in the six included literature articles. For the diagnostic analysis of miRNAs in HB, the pooled SEN and SPE were 0.76 (95% CI: 0.72–0.80) and 0.75 (95% CI: 0.70–0.80), respectively. Moreover, the pooled PLR was 2.79 (95% CI: 2.12–3.66), NLR was 0.34 (95% CI: 0.26–0.45), DOR was 10.24 (95% CI: 6.55–16.00), and AUC was 0.83, indicating that miRNAs had moderate diagnostic value in HB. For the prognostic analysis of miRNAs in HB, the abnormal expressions of miR-21, miR-34a, miR-34b, miR-34c, miR-492, miR-193, miR-222, and miR-224 in patients were confirmed to be associated with a worse prognosis. The pooled HR was 1.74 (95% CI: 1.20–2.29) for overall survival (OS) and 1.74 (95% CI: 1.31–2.18) for event-free survival (EFS), suggesting its potential as a prognostic indicator for HB. Conclusion: To the best of our knowledge, this is the first comprehensive systematic review and meta-analysis that examines the diagnostic and prognostic role of dysregulated miRNAs in HB patients. The combined meta-analysis results supported the previous individual finds that miRNAs might provide a new, noninvasive method for the diagnostic and prognostic analyses ofHB.

scholarly journals Diagnostic and prognostic significance of dysregulated expression of circular RNAs in osteosarcoma

2020 ◽  
Author(s):  
Chenghao Zhang ◽  
Jieyu He ◽  
Lin Qi ◽  
Zhixi Duan ◽  
Lu Wan ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Prognostic Significance ◽  
Area Under The Curve ◽  
Disease Free Survival ◽  
Diagnostic Odds Ratio ◽  
Cochrane Library ◽  
Clinicopathological Parameters ◽  
Circular Rnas ◽  
Diagnostic Significance ◽  
Enneking Stage

Abstract Background Circular RNAs (circRNAs) have emerged as pivotal regulators in osteosarcoma tumorigenesis and progression, but their prognostic and diagnostic significance remain unclear. Herein, we aimed to perform an updated meta-analysis to explore the clinical, diagnostic and prognostic values of circRNAs in osteosarcoma. Methods Several databases, including PubMed, Web of Science, EMBASE, Scopus and Cochrane Library, were systematically searched up to Mar 10, 2020. Eligible studies regarding the relationship between circRNAs levels and clinicopathological, diagnostic and prognostic values in osteosarcoma patients were included in this study. Pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were used to measure clinical characteristics, while hazard ratios (HRs) with 95% CIs were adopted to assess overall survival (OS) and disease-free survival (DFS). Results Overall, 26 relevant studies involving 1,652 patients with osteosarcoma were enrolled, with eighteen studies on clinicopathological parameters, ten on diagnosis and eighteen on prognosis. For clinical parameters, overexpression of oncogenic circRNAs was intimately correlated with larger tumor size (P <0.00001), advanced Enneking stage (P <0.00001), poor differentiation (P =0.0001), and distant metastasis (DM) (P <0.00001). In contrast, the downregulated circRNAs showed negative correlation with Enneking stage (P=0.002) and DM (P<0.0001). For the diagnostic values, the summary area under the curve (AUC) of circRNA for the discriminative efficacy between osteosarcoma patients and non-cancer counterparts was estimated to be 0.86 (95% CI: 0.83-0.89), with a weighted sensitivity of 0.80 (95% CI: 0.74-0.84), specificity of 0.80 (95%: 0.75-0.84), and diagnostic odds ratio (DOR) of 15.48 (10.85-22.10), respectively. For the prognostic significance, oncogenic circRNAs had poor OS (HR=1.92, 95% CI: 1.68-2.19) and DFS (HR=2.65, 95% CI: 2.02-3.49), while elevated expression of tumor-suppressor circRNAs were closely related to longer OS (HR=0.44, 95% CI: 0.28-0.69). Conclusions Taken together, our study showed that aberrantly expressed circRNA signatures could serve as potential predictive indicators in diagnosis and prognosis in patients with osteosarcoma.

scholarly journals Reliability of circulating fibrinogen in the diagnosis of prosthesis-related infections: a systematic review and meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xingyang Zhu ◽  
Haitao Zhang ◽  
Xiaobo Sun ◽  
Yijin Li ◽  
Jiahao Li ◽  
...  
Keyword(s):  
Likelihood Ratio ◽  
Meta Analysis ◽  
Joint Infection ◽  
Area Under The Curve ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Diagnostic Odds Ratio ◽  
Small Sample ◽  
Cochrane Library ◽  
Sensitivity Specificity

Abstract Background Fibrinogen (FIB) has recently been used as a biomarker to diagnose periprosthetic joint infection (PJI), but its reliability is still questionable. The aim of this study was to investigate the accuracy of FIB in the diagnosis of PJI after joint replacement. Methods We searched for literatures published in PubMed, EMBASE, and the Cochrane Library from the time of database inception to September 2020 and screened the studies according to the inclusion criteria. Then, we calculated the diagnostic parameters of FIB, including the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), area under the curve (AUC), and diagnostic odds ratio (DOR). In addition, we implemented subgroup analyses to identify the sources of heterogeneity. Results Seven studies including 1341 patients were selected in our meta-analysis. The pooled sensitivity, specificity, PLR, NLR, and DOR of FIB for PJI diagnosis were 0.78 (95% confidence interval [CI], 0.73–0.82), 0.83 (95% CI, 0.81–0.86), 4.60 (95% CI, 3.30–6.42), 0.24 (95% CI, 0.18–0.34), and 20.13 (95% CI, 14.80–27.36), respectively, while the AUC was 0.896. Conclusion The present study indicated that FIB was a reliable detection method and might be introduced into the diagnostic criteria for PJI. However, more robust studies are still needed to confirm the current findings, because most of the included studies were retrospective and had small sample sizes.

scholarly journals Diagnostic and Prognostic Significance of Dysregulated Expression of Circular RNAs in Osteosarcoma

2020 ◽  
Author(s):  
Chenghao Zhang ◽  
Jieyu He ◽  
Lin Qi ◽  
Zhixi Duan ◽  
Lu Wan ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Prognostic Significance ◽  
Area Under The Curve ◽  
Disease Free Survival ◽  
Diagnostic Odds Ratio ◽  
Cochrane Library ◽  
Clinicopathological Parameters ◽  
Circular Rnas ◽  
Diagnostic Significance ◽  
Enneking Stage

Abstract Background CircRNAs have emerged as pivotal regulators in osteosarcoma tumorigenesis and progression, but their prognostic and diagnostic significance remain unclear. Herein, we aimed to perform an updated meta-analysis to explore the clinical, diagnostic and prognostic values of circRNAs in osteosarcoma. Methods Several databases, including PubMed, Web of Science, EMBASE, Scopus and Cochrane Library, were systematically searched up to April 10, 2020. Eligible studies regarding the relationship between circRNAs levels and clinicopathological, diagnostic and prognostic values in osteosarcoma patients were included in this study. Pooled odds ratios with corresponding 95% confidence intervals were used to measure clinical characteristics, while hazard ratios with 95% CIs were adopted to assess overall survival (OS) and disease-free survival (DFS). Results Overall, 26 relevant studies involving 1,652 patients with osteosarcoma were enrolled, with eighteen studies on clinicopathological parameters, ten on diagnosis and eighteen on prognosis. For clinical parameters, overexpression of oncogenic circRNAs was intimately correlated with larger tumor size (P < 0.00001), advanced Enneking stage (P < 0.00001), poor differentiation (P = 0.0001), and distant metastasis (DM) (P < 0.00001). In contrast, the downregulated circRNAs showed negative correlation with Enneking stage (P = 0.002) and DM (P < 0.0001). For the diagnostic values, the summary area under the curve of circRNA for the discriminative efficacy between osteosarcoma patients and non-cancer counterparts was estimated to be 0.86 (95% CI: 0.83–0.89), with a weighted sensitivity of 0.80 (95% CI: 0.74–0.84), specificity of 0.80 (95%: 0.75–0.84), and diagnostic odds ratio of 15.48 (10.85–22.10), respectively. For the prognostic significance, oncogenic circRNAs had poor OS (HR = 1.92, 95% CI: 1.68–2.19) and DFS (HR = 2.65, 95% CI: 2.02–3.49), while elevated expression of tumor-suppressor circRNAs were closely related to longer OS (HR = 0.44, 95% CI: 0.28–0.69). Conclusions Taken together, our study showed that aberrantly expressed circRNA signatures could serve as potential biomarkers in diagnosis and prognosis in patients with osteosarcoma.

Hemostatic Abnormalities in Dementia: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 45 (05) ◽  
pp. 514-522 ◽  
Author(s):  
Cristina de Mello Gomide Loures ◽  
Rita Carolina Figueiredo Duarte ◽  
Marcos Vinícius Ferreira Silva ◽  
Walter Batista Cicarini ◽  
Leonardo Cruz de Souza ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Plasminogen Activator Inhibitor ◽  
The Elderly ◽  
Coagulation Cascade ◽  
Factor Vii ◽  
Cochrane Central Register ◽  
Plasminogen Activator Inhibitor 1 ◽  
Vascular Walls ◽  
D Dimer

AbstractAlzheimer's disease (AD) is considered the most frequent cause of dementia. It is known that vascular risk factors play an important role in the development and progression of this condition. Alterations in vascular walls represent documented findings in patients with AD and other dementias affecting elderly people. The authors performed a systematic review and meta-analysis, aiming to synthesize observational studies that evaluated how the hemostatic system may contribute to cognitive decline in the elderly, using papers published until April 2018 and as indexed in Medline (PubMed), Scopus, Web of Science, ScienceDirect, Lilacs, Cinahl, PsycINFO, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. Among 5,278 studies identified, 32 were included in the final synthesis, and these included 485 patients with mild cognitive impairment, 568 with vascular dementia (VD), 1,781 with AD, and 2,855 participants without dementia. AD patients had increased plasma von Willebrand factor (VWF) (standardized mean difference [SMD]: 2.53; 95% confidence interval [CI]: 0.10–4.95), D-dimer (SMD: 0.50; 95% CI: 0.35–0.66), plasminogen activator inhibitor-1 (SMD: 3.34; 95% CI: 1.01–5.67), thrombomodulin (SMD: 1.08; 95% CI: 0.53–1.62), and homocysteine levels (SMD: 0.65; 95% CI: 0.15–1.15). In contrast, the VD group showed increased fibrinogen levels (SMD: 0.77; 95% CI: 0.13–1.41), activated factor VII (SMD: 0.36; 95% CI: 0.05–0.67), factor VIII (SMD: 0.57; 95% CI: 0.22–0.91), VWF (SMD: 2.34; 95% CI: 0.38–4.29), D-dimer (SMD: 1.14; 95% CI: 0.51–1.78), and homocysteine (SMD: 2.17; 95% CI: 1.67–2.68). AD showed an elevation in some markers of endothelial dysfunction, whereas VD presented mostly an involvement of coagulation cascade components.

Prognostic Significance of Preoperative Neutrophil-Lymphocyte Ratio in Vascular Surgery: Systematic Review and Meta-Analysis

2020 ◽  
Vol 54 (8) ◽  
pp. 697-706
Author(s):  
Sarah M. Jackson ◽  
Luke A. Perry ◽  
Carla Borg ◽  
Dhruvesh M. Ramson ◽  
Ryan Campbell ◽  
...  
Keyword(s):  
Systematic Review ◽  
Risk Stratification ◽  
Vascular Surgery ◽  
Vascular Disease ◽  
Meta Analysis ◽  
Narrative Review ◽  
Cochrane Library ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Chi Squared

Objective: The global burden of surgical vascular disease is increasing and with it, the need for cost-effective, accessible prognostic biomarkers to aid optimization of peri-operative outcomes. The neutrophil-lymphocyte ratio (NLR) is emerging as a potential candidate biomarker for perioperative risk stratification. We therefore performed this systematic review and meta-analysis on the prognostic value of elevated preoperative NLR in vascular surgery. Methods: We searched Embase (Ovid), Medline (Ovid), and the Cochrane Library database from inception to June 2019. Screening was performed, and included all peer-reviewed original research studies reporting preoperative NLR in adult emergent and elective vascular surgical patients. Studies were assessed for bias and quality of evidence using a standardized tool. Meta-analysis was performed by general linear (mixed-effects) modelling where possible, and otherwise a narrative review was conducted. Between-study heterogeneity was estimated using the Chi-squared statistic and explored qualitatively. Results: Fourteen studies involving 5,652 patients were included. The overall methodological quality was good. Elevated preoperative NLR was associated with increased risk of long-term mortality (HR 1.40 [95%CI: 1.13-1.74], Chi-squared 60.3%, 7 studies, 3,637 people) and short-term mortality (OR: 3.08; 95%CI: 1.91-4.95), Chi-squared 66.59%, 4 studies, 945 people). Outcome measures used by fewer studies such as graft patency and amputation free survival were assessed via narrative review. Conclusions: NLR is a promising, readily obtainable, prognostic biomarker for mortality outcomes following vascular surgery. Heterogeneity in patient factors, severity of vascular disease, and type of vascular surgery performed renders direct comparison of outcomes from the current literature challenging. This systematic review supports further investigation for NLR measurement in pre-vascular surgical risk stratification. In particular, the establishment of a universally accepted NLR cut-off value is of importance in real-world implementation of this biomarker.

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