Abstract 13608: The Association Between Cardiometabolic Disorders/Cardiovascular Disease and the Distribution of Monocyte Subsets: A Systematic Review and Meta-Analysis

Introduction: Monocytes play a crucial role in the pathology of atherosclerosis, a major cause of cardiovascular disease (CVD). Previous studies in preclinical models report that monocyte subsets (i.e. classical, intermediate and non-classical monocytes) may differently contribute to the pathogenesis of atherosclerosis. However, changes in the distribution and the role of each monocyte subset in cardiometabolic disorders (overweight/obesity, metabolic syndrome, hypercholesterolemia, and type 2 diabetes) and CVD in humans is less clear. Therefore, the aim of the current systematic review and meta-analysis was to evaluate the association between the monocyte subset distribution and cardiometabolic disorders/CVD in humans. Methods: Articles were systematically searched in CINAHL, Cochrane Central Register of Controlled Trials, and PubMed until April 2020. A total of 1592 articles were independently screened by 2 reviewers. A total of 25 studies were selected for qualitative analyses. Among them, 6 studies reported the percentage of each monocyte subset and were included in the meta-analyses. For the meta-analyses, a random-effects model was used to generate pooled standardized mean differences (SMD) between subjects with cardiometabolic disorders and healthy controls. Results: In total, sample size ranged from 22 to 135, and mean age of subjects ranged from 22 to 70 years. The percentage of classical monocytes was lower [SMD = -1.21; 95% CI (-1.92, -0.50); P < 0.001; I 2 = 91%] in subjects with cardiometabolic disorders compared to healthy controls. However, the percentage of intermediate [SMD = 0.56; 95% CI (0.23, 0.88); P < 0.001; I 2 = 65%] and non-classical monocytes [SMD = 1.39; 95% CI (0.59, 2.19); P < 0.001; I 2 = 93%] was higher in subjects with cardiometabolic disorders compared to healthy controls. Conclusions: There may be a shift in the distribution of monocytes from classical to intermediate and non-classical monocytes in individuals with cardiometabolic disorders. This shift may be an underlying cause of chronic low-grade inflammation, exacerbate atherosclerotic risk, and contribute to the development of CVD based on preclinical studies. However, additional mechanistic studies are needed in humans to evaluate this question.

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The Association Between Monocyte Subsets and Cardiometabolic Disorders/Cardiovascular Disease: A Systematic Review and Meta-Analysis

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.640124 ◽

2021 ◽

Vol 8 ◽

Author(s):

Ester S. Oh ◽

Muzi Na ◽

Connie J. Rogers

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Meta Analysis ◽

Biological Significance ◽

Total Sample ◽

Cochrane Library ◽

Monocyte Subset ◽

Healthy Controls ◽

Monocyte Subsets ◽

Cardiometabolic Disorders

Background: Monocyte subsets in humans, i.e., classical (CM), intermediate (IM), and non-classical monocytes (NCM), are thought to differentially contribute to the pathogenesis of atherosclerosis, the leading cause of cardiovascular disease (CVD). However, the association between monocyte subsets and cardiometabolic disorders and CVD is not well-understood. Thus, the aim of the current systematic review and meta-analysis was to evaluate recent findings from clinical studies that examined the association between the distribution of monocyte subsets in subjects with cardiometabolic disorders and CVD compared to healthy controls.Methods: Articles were systematically searched in CINAHL, PubMed and Cochrane Library. Articles were independently screened and selected by two reviewers. Studies that reported the percentage of each monocyte subset were included in the systematic review and meta-analysis. For the meta-analysis, a random-effects model was used to generate pooled standardized mean differences (SMD) between subjects with cardiometabolic disorders and healthy controls.Results: A total of 1,693 articles were screened and 27 studies were selected for qualitative analyses. Among them, six studies were included in the meta-analysis. In total, sample size ranged from 22 to 135 and mean or median age from 22 to 70 years old. We found studies that reported higher percentage and number of IM and/or NCM in subjects with cardiometabolic disorders (9 out of 13 studies) and in subjects with CVD (11 out of 15 studies) compared to healthy controls. In the meta-analysis, the percentage of CM was lower [SMD = −1.21; 95% CI (−1.92, −0.50); P = 0.0009; I2 = 91%] and the percentage of IM [SMD = 0.56; 95% CI (0.23, 0.88); P = 0.0008; I2 = 65%] and NCM [SMD = 1.39; 95% CI (0.59, 2.19); P = 0.0007; I2 = 93%] were higher in subjects with cardiometabolic disorders compared to healthy controls.Conclusions: Individuals with cardiometabolic disorders and CVD may have a higher percentage of IM and NCM than healthy controls. Future studies are needed to evaluate the cause and biological significance of this potential altered distribution of monocyte subsets.

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eHealth interventions for reducing cardiovascular disease risk in men: a systematic review and meta-analysis

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab060.059 ◽

2021 ◽

Vol 20 (Supplement_1) ◽

Author(s):

J Mcmahon ◽

DR Thompson ◽

MC Pascoe ◽

K Brazil ◽

CF Ski

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Behavior Change ◽

Systematic Reviews ◽

Meta Analysis ◽

Database Search ◽

Controlled Trials ◽

Cochrane Central Register ◽

Cvd Risk ◽

Meta Analyses

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Department for the Economy (DfE) studentships Background. Men remain at a higher risk of developing cardiovascular disease (CVD) than women and behavioral risk factor modification is an important preventive measure. However, engaging men in behavior change interventions is challenging. eHealth interventions have the potential to address this gap, though their effectiveness for reducing CVD risk in men is unclear. Purpose. To conduct a systematic review and meta-analysis to evaluate the effectiveness of eHealth interventions for reducing CVD risk in men. Methods. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and principles laid out by the Cochrane Handbook for Systematic Reviews of Interventions. A search of published randomised controlled trials (RCTs) with no date restrictions up to July 2020 was conducted across five electronic databases: Cochrane Central register of Controlled Trials (CENTRAL), Medline, CINAHL Plus, PsycINFO and SCOPUS. Reference lists of relevant systematic reviews and meta-analyses were manually searched for additional trials not identified during the database search. Eligible studies were RCTs that focused on the use of eHealth to improve a minimum of two major CVD related risk factors in males aged 18 years or older. Results. A total of 3168 records were retrieved from the online database search, with nine trials meeting the inclusion criteria following screening and full-text assessment. Study quality ranged from low to unclear, with one trial at a high risk of bias. Compared to those in a control group or receiving printed materials, participants randomised to an eHealth intervention had statistically significant improvements in BMI (Z=-2.75, p = 0.01), body weight (Z=-3.25, p = 0.01), waist circumference (Z=-2.30, p = 0.02) and systolic (Z=-3.57, p = 0.01) and diastolic (Z=-3.56, p = 0.01) blood pressure. Though less evident, there were also improvements in physical activity and diet in favour of the intervention group. Conclusion. This was the first systematic review and meta-analysis conducted on the effectiveness of eHealth interventions for reducing CVD risk in men. This review suggests that eHealth interventions can reduce CVD risk in adult men through behavior change. However, we were unable to determine the association between intervention characteristics and outcomes. Also, overall, participant adherence to the intervention was poor. Both of these issues should be considered in future studies.

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Almond Consumption and Risk Factors for Cardiovascular Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Advances in Nutrition ◽

10.1093/advances/nmz043 ◽

2019 ◽

Vol 10 (6) ◽

pp. 1076-1088 ◽

Cited By ~ 11

Author(s):

Michelle A Lee-Bravatti ◽

Jifan Wang ◽

Esther E Avendano ◽

Ligaya King ◽

Elizabeth J Johnson ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Body Weight ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Meta Analyses

ABSTRACT Evidence suggests that eating nuts may reduce the risk of cardiovascular disease (CVD). We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating almond consumption and risk factors for CVD. MEDLINE, Cochrane Central, Commonwealth Agricultural Bureau, and previous systematic reviews were searched from 1990 through June 2017 for RCTs of ≥3 wk duration that evaluated almond compared with no almond consumption in adults who were either healthy or at risk for CVD. The most appropriate stratum was selected with an almond dose closer to 42.5 g, with a control most closely matched for macronutrient composition, energy intake, and similar intervention duration. The outcomes included risk factors for CVD. Random-effects model meta-analyses and subgroup meta-analyses were performed. Fifteen eligible trials analyzed a total of 534 subjects. Almond intervention significantly decreased total cholesterol (summary net change: −10.69 mg/dL; 95% CI: −16.75, −4.63 mg/dL), LDL cholesterol (summary net change: −5.83 mg/dL; 95% CI: −9.91, −1.75 mg/dL); body weight (summary net change: −1.39 kg; 95% CI: −2.49, −0.30 kg), HDL cholesterol (summary net change: −1.26 mg/dL; 95% CI: −2.47, −0.05 mg/dL), and apolipoprotein B (apoB) (summary net change: −6.67 mg/dL; 95% CI: −12.63, −0.72 mg/dL). Triglycerides, systolic blood pressure, apolipoprotein A1, high-sensitivity C-reactive protein, and lipoprotein (a) showed no difference between almond and control in the main and subgroup analyses. Fasting blood glucose, diastolic blood pressure, and body mass index significantly decreased with almond consumption of >42.5 g compared with ≤42.5 g. Almond consumption may reduce the risk of CVD by improving blood lipids and by decreasing body weight and apoB. Substantial heterogeneity in eligible studies regarding almond interventions and dosages precludes firmer conclusions.

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Local anaesthetics combined with vasoconstrictors in patients with cardiovascular disease undergoing dental procedures: systematic review and meta-analysis protocol

BMJ Open ◽

10.1136/bmjopen-2016-014611 ◽

2017 ◽

Vol 7 (11) ◽

pp. e014611 ◽

Cited By ~ 1

Author(s):

Caio Chaves Guimaraes ◽

Rogério Heládio Lopes Motta ◽

Cristiane de Cássia Bergamaschi ◽

Jimmy de Oliveira Araújo ◽

Natalia Karol de Andrade ◽

...

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Data Extraction ◽

Meta Analysis ◽

Local Anaesthetics ◽

Cochrane Central Register ◽

Assessment Development ◽

Dental Procedures ◽

Central Register ◽

Registration Number

IntroductionThe use of vasoconstrictors combined with local anaesthetics (LAs) in dentistry for patients with cardiovascular disease (CVD) is still controversial in the scientific literature. It raises concerns regarding the possibility of transient episodes, triggering negative cardiovascular outcomes.Method/designTrials eligible for our systematic review will enrol patients with CVD who have undergone dental treatments carried out with the use of LAs by comparing two arms: LAs with vasoconstrictors and LAs without vasoconstrictors. The research will be conducted in the electronic databases, namely Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Healthstar (via Ovid), Cumulative Index to Nursing and Allied Health Literature and Web of Science, from their inception to December 2017, without any restrictions in terms of language and status of publication. A team of reviewers will independently assess titles, abstracts and complete text to determine eligibility. For eligible studies, the same reviewers will perform data extraction and evaluate the risk of bias in the selected articles. The selected outcomes comprise death, mortality by a specific cause, stroke, acute myocardial infarction, hospitalisation, pain, bleeding, arrhythmias, ischaemic episodes, anxiety, adverse effects, changes in blood pressure, changes in heart rate, anxiety and results obtained via oximetry. Whenever possible, we will conduct a meta-analysis to establish the effects of LAs with and without vasoconstrictors in the patients with CVD, and the overall quality of evidence for each outcome will be determined using the Grading of Recommendations Assessment, Development and Evaluation classification system.Ethics and disseminationEthics committee approval was not necessary because this is a protocol of systematic review. This systematic review will be submitted for presentation at conferences and for publication in a peer-reviewed journal. Our review will assess the risks of cardiovascular events when using LAs with and without vasoconstrictors in patients with CVD, focusing on important clinical outcomes.PROSPERO registration numberCRD42016045421.

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Outcomes of Medication Misadventure Among People With Cognitive Impairment or Dementia: A Systematic Review and Meta-analysis

Annals of Pharmacotherapy ◽

10.1177/1060028020949125 ◽

2020 ◽

pp. 106002802094912

Author(s):

Anum Saqib Zaidi ◽

Gregory M. Peterson ◽

Luke R.E. Bereznicki ◽

Colin M. Curtain ◽

Mohammed Salahudeen

Keyword(s):

Systematic Review ◽

Cognitive Impairment ◽

Adverse Drug Events ◽

Data Extraction ◽

Meta Analysis ◽

Published Data ◽

Potentially Inappropriate Medications ◽

Cochrane Central Register ◽

Increased Risk ◽

Meta Analyses

Objective: To investigate mortality and hospitalization outcomes associated with medication misadventure (including medication errors [MEs], such as the use of potentially inappropriate medications [PIMs], and adverse drug events [ADEs]) among people with cognitive impairment or dementia. Data Sources: Ovid MEDLINE, Ovid EMBASE, Ovid International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials were searched from inception to December 2019. Study Selection and Data Extraction: Relevant studies using any study design were included. Reviewers independently performed critical appraisal and extracted relevant data. Data Synthesis: The systematic review included 10 studies that reported the outcomes of mortality or hospitalization associated with medication misadventure, including PIMs (n=5), ADEs (n=2), a combination of MEs and ADEs (n=2), and drug interactions (n=1). Five studies examining the association between PIMs and mortality/hospitalization were included in the meta-analyses. Exposure to PIMs was not associated with either mortality (odds ratio [OR]=1.36; 95%CI=0.79-2.35) or hospitalization (OR=1.02; 95%CI=0.83-1.26). In contrast, single studies indicated that ADEs with cholinesterase inhibitors were associated with mortality and hospitalization. Relevance to Patient Care and Clinical Practice: Individuals with cognitive impairment or dementia are at increased risk of medication misadventure; based on relatively limited published data, this does not necessarily translate to increased mortality and hospitalization. Conclusions: Overall, medication misadventure was not associated with mortality or hospitalization in people with cognitive impairment or dementia, noting the limited number of studies, difficulty in controlling potential confounding variables, and that most studies focus on PIMs.

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TaiChi and Qigong for Depressive Symptoms in Patients with Chronic Heart Failure: A Systematic Review with Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/5585239 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Wei Jiang ◽

Shaojun Liao ◽

Xiankun Chen ◽

Cecilia Stålsby Lundborg ◽

Gaetano Marrone ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Depressive Symptoms ◽

Meta Analysis ◽

Controlled Trials ◽

Therapeutic Effects ◽

Cochrane Central Register ◽

China National Knowledge Infrastructure ◽

Beneficial Effects ◽

Meta Analyses

Background. Depression is a debilitating comorbidity of heart failure (HF) that needs assessment and management. Along with mind-body exercise to deal with HF with depression, the use of TaiChi and/or Qigong practices (TQPs) has increased. Therefore, this systematic review assesses the effects of TQPs on depression among patients with HF. Methods. Randomized controlled trials (RCTs) that examined the effect of TQPs on depression in patients with HF were searched by five databases (PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, CINAHL, and China National Knowledge Infrastructure (CNKI)). With standardized mean difference (SMD) and 95% confidence intervals (95% CI), random-effects meta-analyses of the effect of TQPs on depressive symptoms were performed. Results. Of eight included RCTs, seven (481 patients) provided data for the meta-analysis. The pooling revealed that TQPs contribute to depression remission in HF (SMD −0.66; 95% CI −0.98 to −0.33, P < 0.0001 ; I2 = 64%). Its antidepressive effect was not influenced by intervention duration or exercise setting, but rather by ejection fraction subtype, depressive severity, and depression instruments. The beneficial effects were preserved when the study with the largest effect was removed. Conclusion. This study suggests that TQPs might be a good strategy for alleviating depressive symptoms in patients with HF. And rigorous-design RCTs, which focus on the identified research gaps, are needed to further establish the therapeutic effects of TQPs for depression in HF.

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Nutritional interventions for the management of frailty in older adults: systematic review and meta-analysis of randomized clinical trials

Nutrition Reviews ◽

10.1093/nutrit/nuaa101 ◽

2020 ◽

Author(s):

Mariana B de Moraes ◽

Christina Avgerinou ◽

Fernanda B Fukushima ◽

Edison I O Vidal

Keyword(s):

Systematic Review ◽

Older Adults ◽

Muscle Strength ◽

Older People ◽

Meta Analysis ◽

Nutritional Supplements ◽

Cochrane Central Register ◽

Nutritional Education ◽

Nutritional Interventions ◽

Meta Analyses

Abstract Context Although nutrition is considered an important intervention for the management of frailty, the actual effectiveness of interventions addressing nutrition in frail older people remains unclear. Objective The aim for this systematic review was to appraise the evidence regarding the effectiveness of nutritional interventions for the management of frailty in older adults. Data Extraction We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Web of Science, and Latin American and Caribbean Health Sciences Literature databases were searched from January 2001 to November 2019. Two independent reviewers extracted relevant data. From 2370 initial records, 19 publications presenting data from 17 studies (1564 individuals; follow-up: 7–96 weeks) were included. Data Analysis None of the Bayesian random-effects meta-analyses comparing nutritional supplements with placebo regarding mortality, body mass index, weight, frailty status, muscle strength, gait speed, body composition, and cognitive function showed statistically significant differences. The same applies to a single meta-analysis comparing nutritional education with general health advice regarding muscle strength. Conclusion Our results suggest, mostly with low to very low degrees of certainty, that nutritional supplements or nutritional education delivered in isolation may not be effective for the management of frailty in older people. Review registration number CRD42018111510 (PROSPERO).

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Reactive Balance Adaptability and Retention in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis

Neurorehabilitation and Neural Repair ◽

10.1177/1545968320929681 ◽

2020 ◽

Vol 34 (8) ◽

pp. 675-685

Author(s):

Mohamed Suhair Bin Mohamed Suhaimy ◽

Yoshiro Okubo ◽

Phu D. Hoang ◽

Stephen R. Lord

Keyword(s):

Multiple Sclerosis ◽

Systematic Review ◽

Response Times ◽

Balance Control ◽

Meta Analysis ◽

Healthy Controls ◽

Functional Impairments ◽

Training Effects ◽

Meta Analyses ◽

Reactive Balance

Aim. To compare reactive balance in people with multiple sclerosis (MS) with healthy controls and to examine the ability of people with MS to adapt their reactive balance and retain training effects. Data Sources. Electronic databases (PubMed, EMBASE, PsychINFO) and reference lists of included articles from inception to February 25, 2019. Study Selection. Case-control and intervention studies that assessed reactive balance using mechanical perturbations in people with a confirmed diagnosis of MS. Results. Meta-analyses of 9 studies (n = 342) showed that people with MS have significantly worse reactive balance than healthy controls (standardized mean difference [SMD] 0.78, 95% CI 0.44-1.11, P < .0001, I2 = 47%). Specifically, people with MS have greater center of mass displacements (SMD 0.41, 95% CI 0.05-0.77, P = .02, I2 = 9%) and longer response times (MD (ms) 31.45, 95% CI 19.91-42.98, P < .0001, I2 = 75%) in response to standing perturbations than healthy controls. Subsequent meta-analyses revealed training comprising repeated exposure to perturbations improved response times ( P < .001) and training effects on response times could be retained for 24 hours ( P < .001) in people with MS. Conclusions. Reactive balance assessments can highlight functional impairments related to falls in people with MS, and perturbation training can acutely improve reactive balance control and such improvements can be retained for 24 hours in this population. Systematic review registration number: CRD42019126130.

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Efficacy of Adjunctive Treatments Added to Olanzapine or Clozapine for Weight Control in Patients with Schizophrenia: A Systematic Review and Meta-Analysis

The Scientific World JOURNAL ◽

10.1155/2015/970730 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 13

Author(s):

Yun-Jung Choi

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Adverse Effects ◽

Weight Reduction ◽

Weight Control ◽

Randomized Clinical Trials ◽

Psychiatric Symptoms ◽

Meta Analysis ◽

Cochrane Central Register ◽

Meta Analyses

Objectives. This study was conducted to review systematically adjunctive treatments for weight reduction in patients with schizophrenia and compare efficacies of clinical trials through meta-analysis, so as to provide effective clinical guideline regarding weight control for patients taking atypical antipsychotics.Methods. Candidate clinical trials were identified through searching the Cochrane Central Register of Controlled Trials, PubMed, and PsycINFO. Fourteen randomized clinical trials were included for systematic review and meta-analysis from 132 potential trials. The Comprehensive Meta-Analysis version 2 was used for meta-analysis.Results. Difference in means and significances from meta-analyses regarding weight control by adjunctive treatments showed that topiramate, aripiprazole, or sibutramine was more effective than metformin or reboxetine. Psychiatric evaluations did not show statistically significant changes between treatment groups and placebo groups except topiramate adjunctive treatments. Adverse effects regarding adjunctive therapies were tolerable and showed statistically no significances compared to control groups.Conclusion. Though having several reports related to exacerbation of psychiatric symptoms, topiramate and aripiprazole are more efficacious than other medications in regard to weight reduction and less burden of critical adverse effects as well as being beneficial for clinical improvement.

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Association between components of the delirium syndrome and outcomes in hospitalised adults: a systematic review and meta-analysis

BMC Geriatrics ◽

10.1186/s12877-021-02095-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zoë Tieges ◽

Terence Quinn ◽

Lorn MacKenzie ◽

Daniel Davis ◽

Graciela Muniz-Terrera ◽

...

Keyword(s):

Systematic Review ◽

Assessment Tool ◽

Meta Analysis ◽

Risk Of Bias ◽

Evaluation Framework ◽

Cochrane Central Register ◽

Symptom Domains ◽

Meta Analyses ◽

Psychotic Features ◽

Quality Evidence

Abstract Background Delirium is a heterogeneous syndrome with inattention as the core feature. There is considerable variation in the presence and degree of other symptom domains such as altered arousal, psychotic features and global cognitive dysfunction. Delirium is independently associated with increased mortality, but it is unclear whether individual symptom domains of delirium have prognostic importance. We conducted a systematic review and meta-analysis of studies in hospitalised adults in general settings to identify the relationship between symptom domains of delirium and outcomes. (PROSPERO: CRD42018093935). Methods We searched MEDLINE, EMBASE, PsycINFO, CINAHL, clinicaltrials.gov and the Cochrane Central Register of Controlled Trials from inception to November 2019. We included studies of hospitalised adults that reported associations between symptom domains of delirium and 30-day mortality (primary outcome), and other outcomes including mortality at other time points, length of stay, and dementia. Reviewer pairs independently screened articles, extracted data, and assessed risk of bias (Risk of Bias Assessment tool for Non-randomized Studies) and quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation framework. We performed random-effects meta-analyses stratified by delirium domain where possible. Results From 7092 citations we included 6 studies (6002 patients, 1112 with delirium). Higher mortality (ranging from in-hospital to follow-up beyond 12 months) was associated with altered arousal (pooled Odds Ratio (OR) 2.80, 95% Confidence Interval (CI) 2.33–3.37; moderate-quality evidence), inattention (pooled OR 2.57, 95% CI 1.74–3.80; low-quality evidence), and in single studies with disorientation, memory deficits and disorganised thoughts. Risk of bias varied across studies but was moderate-to-high overall, mainly due to selection bias, lack of blinding of assessments and unclear risk of selective outcome reporting. We found no studies on the association between psychotic features, visuospatial deficits or affective disturbances in delirium and outcomes, or studies reporting non-mortality outcomes. Conclusions Few studies have related symptom domains of delirium to outcomes, but the available evidence suggests that altered arousal and inattention in delirium are associated with higher mortality than normal arousal and attention in people with or without delirium. Measurable symptom domains of delirium may have value in predicting survival and stratifying patients for treatment. We recommend that future delirium studies report outcomes by symptom domain.

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