Abstract P598: Increased Risk of Acute Stroke in Patients With Severe Course of Covid-19: A Multicenter Study and Meta-Analysis

Introduction: Recent studies linked coronavirus disease 2019 (COVID-19) to thromboembolic complications likely mediated by increased blood coagulability and inflammatory endothelial impairment. Objective: We aimed to assess the risk of acute stroke in patients with COVID-19 related to clinical severity of the disease. Methods: We conducted an observational multicenter cohort study in four participating hospitals in Saxony, Germany to characterize consecutive patients with laboratory-confirmed COVID-19 who experienced acute stroke during hospitalization. Furthermore, we performed a systematic review using PubMed/MEDLINE, EMBASE, Cochrane Library and bibliographies of identified articles following PRISMA guidelines including data from observational studies of acute stroke in COVID-19 patients. Data was extracted by two independent reviewers and pooled with multicenter data to calculate risk ratios (RR) and 95% confidence intervals (95%CIs) for acute stroke related to COVID-19 severity using random effects model. Between-study heterogeneity was assessed using Cochran’s Q and I 2 -statistics. PROSPERO identifier : CRD42020187194. Results: Of 165 patients hospitalized for COVID-19 (49.1% males, median age 67 [57-79], 72.1% severe or critical) included in the multicenter study, overall stroke rate was 4.2% (95%CI: 1.9-8.7). Systematic literature search identified two observational studies involving 576 patients that were eligible for meta-analysis. Among 741 pooled COVID-19 patients overall stroke rate was 2.9% (95%CI: 1.9-4.5). Risk of acute stroke was increased for patients with severe compared to non-severe COVID-19 (RR 4.12, 95%CI 1.7-10.25; p=0.002) with no evidence of heterogeneity (I 2 =0%, p=0.82). Conclusions: Synthesized analysis of data from our multicenter study and previously published cohorts demonstrate that severity of COVID-19 is associated with an increased risk of acute stroke, underscoring the necessity of neurological monitoring in patients infected with SARS-CoV-2.

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Urolithiasis, Independent of Uric Acid, Increased Risk of Coronary Artery and Carotid Atherosclerosis: A Meta-Analysis of Observational Studies

BioMed Research International ◽

10.1155/2020/1026240 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Wei Luo ◽

Yao Zhou ◽

Chenlin Gao ◽

Pijun Yan ◽

Ling Xu

Keyword(s):

Uric Acid ◽

Coronary Artery ◽

Serum Uric Acid ◽

Observational Studies ◽

Carotid Atherosclerosis ◽

Meta Analysis ◽

Renal Calculi ◽

Cochrane Library ◽

Increased Risk ◽

Cv Disease

Background and Aims. Recent epidemiological evidence indicates an association between urolithiasis and atherosclerosis; however, results are incongruous. Our aim is to summarize the association between urolithiasis and arteriosclerosis risk through a detailed meta-analysis. Methods. Relevant studies published before April 2019 were identified by searching OVID, EMBASE, PubMed, Web of Science database, and Cochrane Library. The relationship between urolithiasis and the risk of atherosclerosis was assessed by using odds ratio (OR) values and the corresponding 95% confidence intervals (CIs), and the selection of fixed- or random-effects model based on heterogeneity. Results. The meta-analysis includes 8 observational studies that contained 70,716 samples. Pooled results showed that urolithiasis was associated with an increased adjusted and unadjusted risk estimated for atherosclerosis (P=0.017 and P=0.014, respectively), especially in coronary artery and carotid atherosclerosis, which was associated with the outcome of CV disease. Interestingly, when we merged the data from the vast majority of these samples (n = 65,751/70,716) with serum uric acid levels less than 6.0 mg/dl, it still showed that urolithiasis was associated with a higher risk of atherosclerosis (P<0.001) and with no evidence of heterogeneity (I2 = 0.0%, P=0.697). Furthermore, we also found that renal calculi would increase the risk of moderate or severe atherosclerosis (P<0.001) and recurrent renal calculi were associated with the incidence of atherosclerosis (P=0.007). Conclusions. Urolithiasis is associated with an increased risk for atherosclerosis, especially in coronary artery and carotid atherosclerosis. Urolithiasis may be another potential risk factor of atherosclerosis, which is independent of serum uric acid levels.

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Micro-Embolic Signals and Dissection: Association or Causation for Stroke? A Systematic Review and Meta-Analysis

Cerebrovascular Diseases ◽

10.1159/000519553 ◽

2021 ◽

pp. 1-8

Author(s):

Pachipala Sudheer ◽

Deepti Vibha

Keyword(s):

Systematic Review ◽

Acute Stroke ◽

Meta Analysis ◽

Small Population ◽

Cochrane Library ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Pooled Prevalence ◽

Increased Risk ◽

Embolic Signals

Background and Objective: Although the mechanism of stroke in cervical artery dissection (CAD) has been hypothesized to be embolization rather than hemodynamic compromise, there are a limited number of studies supporting this hypothesis. Detection of micro-embolic signals (MESs) using transcranial Doppler (TCD) helps in understanding the mechanism in these patients. A systematic review and meta-analysis were performed to estimate the prevalence of MES and its association with stroke outcomes in patients with acute stroke/TIA secondary to dissection. Methods: A comprehensive literature search was conducted for studies before January 26, 2021, in PubMed, Embase, Google Scholar, Cochrane Library, and ClinicalTrials.gov. Studies were identified that used TCD to detect MES in stroke/TIA patients secondary to CAD. Pooled prevalence was calculated. Entire statistical analysis was conducted in R version 3.6.2. Results: Eleven studies involving 112 patients (50 MES+, 62 MES−) were included in our meta-analysis. The pooled prevalence of MES among acute stroke/TIA patients secondary to dissection was 46.0% (95% CI 26.0–67.0%). The presence of MES was associated with an increased risk of early ischemic recurrence in patients with CAD. We could not estimate the functional outcome and mortality associated with the presence of MES due to the scarcity of data. Conclusions: Our meta-analysis showed 46% prevalence of MES in the studies which looked at acute stroke/TIA secondary to CAD using TCD. This finding supports the assumption that embolism may be a major cause of stroke in patients with dissection although this could be determined only in a small population.

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Meta-analysis of proton pump inhibitors induced risk of community-acquired pneumonia

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzaa041 ◽

2020 ◽

Vol 32 (5) ◽

pp. 292-299 ◽

Cited By ~ 2

Author(s):

Phung Anh Nguyen ◽

Mohaimenul Islam ◽

Cooper J Galvin ◽

Chih-Cheng Chang ◽

Soo Yeon An ◽

...

Keyword(s):

Systematic Review ◽

Random Effects ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Observational Studies ◽

Meta Analysis ◽

Community Acquired Pneumonia ◽

Cochrane Library ◽

High Dose ◽

Increased Risk

Abstract Purpose Proton pump inhibitors (PPIs), one of the most widely used medications, are commonly used to suppress several acid-related upper gastrointestinal disorders. Acid-suppressing medication use could be associated with increased risk of community-acquired pneumonia (CAP), although the results of clinical studies have been conflicting. Data sources A comprehensive search of MEDLINE, EMBASE and Cochrane library and Database of Systematic Reviews from the earliest available online year of indexing up to October 2018. Study selection We performed a systematic review and meta-analysis of observational studies to evaluate the risk of PPI use on CAP outcomes. Data extraction Included study location, design, population, the prevalence of CAP, comparison group and other confounders. We calculated pooled odds ratio (OR) using a random-effects meta-analysis. Results of data synthesis Of the 2577 studies screening, 11 papers were included in the systematic review and 7 studies with 65 590 CAP cases were included in the random-effects meta-analysis. In current PPI users, pooled OR for CAP was 1.86 (95% confidence interval (CI), 1.30–2.66), and in the case of recent users, OR for CAP was 1.66 (95% CI, 1.22–2.25). In the subgroup analysis of CAP, significance association is also observed in both high-dose and low-dose PPI therapy. When stratified by duration of exposure, 3–6 months PPIs users group was associated with increased risk of developing CAP (OR, 2.05; 95% CI, 1.22–3.45). There was a statistically significant association between the PPI users and the rate of hospitalization (OR, 2.59; 95% CI, 1.83–3.66). Conclusion We found possible evidence linking PPI use to an increased risk of CAP. More randomized controlled studies are warranted to clarify an understanding of the association between PPI use and risk of CAP because observational studies cannot clarify whether the observed epidemiologic association is a causal effect or a result of unmeasured/residual confounding.

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Use of Antibiotics and Risk of Cancer: A Systematic Review and Meta-Analysis of Observational Studies

Cancers ◽

10.3390/cancers11081174 ◽

2019 ◽

Vol 11 (8) ◽

pp. 1174 ◽

Cited By ~ 8

Author(s):

Fausto Petrelli ◽

Michele Ghidini ◽

Antonio Ghidini ◽

Gianluca Perego ◽

Mary Cabiddu ◽

...

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Meta Analysis ◽

Antibiotic Use ◽

Cochrane Library ◽

Cancer Occurrence ◽

Incident Cancer ◽

Increased Risk ◽

The Cochrane Library ◽

Risk Of Cancer

The association between antibiotic use and risk of cancer development is unclear, and clinical trials are lacking. We performed a systematic review and meta-analysis of observational studies to assess the association between antibiotic use and risk of cancer. PubMed, the Cochrane Library and EMBASE were searched from inception to 24 February 2019 for studies reporting antibiotic use and subsequent risk of cancer. We included observational studies of adult subjects with previous exposure to antibiotics and available information on incident cancer diagnoses. For each of the eligible studies, data were collected by three reviewers. Risk of cancer was pooled to provide an adjusted odds ratio (OR) with a 95% confidence interval (CI). The primary outcome was the risk of developing cancer in ever versus non-antibiotic users. Cancer risk’s association with antibiotic intake was evaluated among 7,947,270 participants (n = 25 studies). Overall, antibiotic use was an independent risk factor for cancer occurrence (OR 1.18, 95%CI 1.12–1.24, p < 0.001). The risk was especially increased for lung cancer (OR 1.29, 95%CI 1.03–1.61, p = 0.02), lymphomas (OR 1.31, 95%CI 1.13–1.51, p < 0.001), pancreatic cancer (OR 1.28, 95%CI 1.04–1.57, p = 0.019), renal cell carcinoma (OR 1.28, 95%CI 1.1–1.5, p = 0.001), and multiple myeloma (OR 1.36, 95%CI 1.18–1.56, p < 0.001). There is moderate evidence that excessive or prolonged use of antibiotics during a person’s life is associated with slight increased risk of various cancers. The message is potentially important for public health policies because minimizing improper antibiotic use within a program of antibiotic stewardship could also reduce cancer incidence.

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Increased risk of acute stroke among patients with severe COVID‐19: a multicenter study and meta‐analysis

European Journal of Neurology ◽

10.1111/ene.14535 ◽

2020 ◽

Vol 28 (1) ◽

pp. 238-247 ◽

Cited By ~ 6

Author(s):

T. Siepmann ◽

A. Sedghi ◽

E. Simon ◽

S. Winzer ◽

J. Barlinn ◽

...

Keyword(s):

Acute Stroke ◽

Multicenter Study ◽

Meta Analysis ◽

Increased Risk

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Current antipsychotic agent use and risk of venous thromboembolism and pulmonary embolism: a systematic review and meta-analysis of observational studies

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125320982720 ◽

2021 ◽

Vol 11 ◽

pp. 204512532098272

Author(s):

Yinzhao Liu ◽

Jun Xu ◽

Kacey Fang ◽

Yue Xu ◽

Ju Gao ◽

...

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Observational Studies ◽

Fixed Effects ◽

Meta Analysis ◽

Cochrane Library ◽

Psychotic Symptoms ◽

Significant Heterogeneity ◽

Increased Risk ◽

Subgroup Analyses

Background: Antipsychotic agents (APS) are widely used drugs to treat psychotic symptoms and can effectively reduce both positive and negative symptoms of schizophrenia. For decades, some studies suggested that there is a relationship between using APS and the risk of venous thromboembolism (VTE) and pulmonary embolism (PE). However, results remain inconclusive. Method: This review has been registered in International Prospective Register of Systematic Reviews (PROSPERO, ID: CDR42020155620). Relevant studies were identified among observational studies published up to 1 October 2019 in the databases MEDLINE, EMBASE, and Cochrane Library. Random or fixed-effects models were used to calculate the pooled odds ratio (OR). Results: In total, 28 observational studies were included. The results showed that compared with non-users, current APS users have significantly increased risks of VTE [OR 1.55 95% confidence interval (CI) 1.36, 1.76] and PE (OR 3.68, 95% CI 1.23, 11.05). Subgroup analyses suggested that new users were associated with a higher risk of VTE (OR 2.06, 95% CI 1.81, 2.35). For individual drugs, increased risk of VTE and PE was observed in taking haloperidol, risperidone, olanzapine, prochlorperazine but not in chlorpromazine, quetiapine or aripiprazole. However, careful interpretation is needed because of high heterogeneity among studies and scarce data. Conclusion: The present comprehensive meta-analysis further indicates a significantly increased risk of VTE and PE in current APS users compared with non-users. Subgroup analyses suggest that new users are more likely to develop VTE. However, due to significant heterogeneity among studies, conclusions should be considered with caution.

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Abstract P227: Diabetes Mellitus and Venous Thromboembolism: A Systematic Review and Meta-analysis

Circulation ◽

10.1161/circ.129.suppl_1.p227 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Elizabeth J Bell ◽

Aaron R Folsom ◽

Pamela L Lutsey ◽

Elizabeth Selvin ◽

Mary Cushman ◽

...

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Venous Thromboembolism ◽

Observational Studies ◽

Meta Analysis ◽

Diabetes Mellitus Type 1 ◽

Vein Thrombosis ◽

Increased Risk ◽

Study Heterogeneity ◽

Control Of Diabetes

Introduction: Reported associations of diabetes with venous thromboembolism (VTE) are inconsistent. We conducted a systematic review and meta-analysis to quantify the association between diabetes mellitus (type 1 or 2) and VTE (deep vein thrombosis or pulmonary embolism). Methods: A systematic review of observational studies was conducted using PubMed, Web of Science, and CINAHL through Dec 31, 2012. Additional studies were identified by contacting experts and through manual review of reference lists of review articles and articles eligible for the present study. We abstracted information on relative risk (RR) estimates and pooled these data using a random-effects model. We queried authors of papers that did not adjust for important confounders to request controlled RR estimates. Results: We identified 10 studies (N participants: 240,940; 7 cohort, 3 case-control: Heit, Lidegaard, and Poulter) which provided RRs adjusted for age and BMI (Figure), and 8 additional studies which did not adjust for these confounders (N participants = 150,205). The pooled RR for the association of diabetes with VTE in the 10 studies was 1.18 (95% CI, 1.03-1.34). The test for heterogeneity was not significant (I 2 = 23.8%, p = 0.22). Amongst the 10 studies, smaller studies tended to have lower RR estimates: Both the Begg and Egger tests were significant (p = 0.02 and 0.01, respectively). The other 8 studies showed evidence of significant between-study heterogeneity (I 2 = 75.5%, p <0.0001), making a pooled estimate inappropriate. Conclusions: Diabetes is associated with an 18% increased risk of VTE in observational studies after accounting for age and obesity. Possible explanations for the association of diabetes with VTE include increased hypercoagulability or vascular damage caused by the metabolic derangements of diabetes or increased exposure to VTE risk factors in individuals with diabetes. Further research is needed to elucidate the mechanisms of this association and whether improved control of diabetes is associated with reduced VTE risk.

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Acid-Suppressive Drugs and Risk of Fracture in Children and Young Adults: A Meta-Analysis of Observational Studies

Frontiers in Pharmacology ◽

10.3389/fphar.2021.712939 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jiangbi Li ◽

Xiaoping Xie ◽

Weibing Liu ◽

Feng Gu ◽

Ke Zhang ◽

...

Keyword(s):

Young Adults ◽

North America ◽

Fracture Risk ◽

Observational Studies ◽

Meta Analysis ◽

Significant Risk ◽

Cochrane Library ◽

Risk Of Fracture ◽

Increased Risk ◽

Children And Young Adults

Background: Recent studies have suggested that proton pump inhibitors (PPIs) and histamine type 2 receptor antagonists (H2RAs) may increase the risk of fracture. We performed a meta-analysis to evaluate the risk of fracture with PPIs and H2RAs use in children and young adults.Methods: PubMed, EMBASE database, Cochrane Library, and Web of Science for relevant articles published before May 2021 were searched. We included all the observational studies reporting on the risk of fracture with acid-suppressive drug (PPIs and H2RAs) use in children and young adults. We calculated pooled risk ratios (RRs) for fracture using random-effects models and conducted subgroup analyses.Results: A total of six studies were included in our analysis. Pooled analysis of PPIs use showed significant risk for fracture (RR = 1.23; 95% CI, 1.12–1.34; I2 = 79.3), but not significant for PPIs combined with H2RAs use (RR = 1.22; 95% CI, 0.94–1.60; I2 = 44.0%), as well as for H2RAs use alone (RR = 1.08; 95% CI, 0.94-1.24; I2 = 84.1%). Grouping of studies by region showed a significantly increased fracture risk with PPIs use in North America (RR = 1.24; 95% CI, 1.16–1.32; I2 =0.0%) than in Europe (RR = 1.23; 95% CI, 1.00–1.52; I2 = 94.6%) and Asia (RR = 1.10; 95% CI, 0.96–1.25). However, there was no significant association between the H2RAs use and the fracture risk in North America (RR = 1.08; 95% CI, 1.00–1.09; I2 = 0.0%). Moreover, PPIs use showed an increased risk of fracture in women (RR = 1.13; 95% CI, 1.07–1.19; I2 = 0.0%), whereas there was no significant association between the PPIs use and the risk of fracture in men (RR = 0.93; 95% CI, 0.66–1.31; I2 = 0.0%).Conclusion: PPIs use alone could increase the risk of fracture in children and young adults, but not for PPIs combined with H2RAs use or H2RAs use alone. Clinicians should exercise caution when prescribing PPIs for patients.

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Typical chest CT features can determine the severity of Coronavirus Disease 2019 (COVID-19): a systematic review and meta-analysis of observational studies

10.21203/rs.3.rs-52445/v1 ◽

2020 ◽

Author(s):

Nahid Hashemimadani ◽

Zahra Emami ◽

Leila Janani ◽

Mohammad E. Khamseh

Keyword(s):

Observational Studies ◽

Fixed Effects ◽

Clinical Presentation ◽

Meta Analysis ◽

Chest Ct ◽

Clinical Severity ◽

Cochrane Library ◽

Forest Plot ◽

The Relationship ◽

Ct Features

Abstract Background It remains unclear whether a specific chest CT characteristic is associated with the clinical severity of COVID-19. This meta-analysis was performed to assess the relationship between different chest CT features and severity of clinical presentation in COVID-19.Methods PubMed, Embase, Scopus, web of science databases (WOS), Cochrane library, and Google scholar were searched up to May 19, 2020 for observational studies that assessed the relationship of different chest CT manifestations and the severity of clinical presentation in COVID-19 infection. Risk of bias assessment was evaluated applying the Newcastle-Ottawa Scale. A random-effects model or fixed-effects model, as appropriately, were used to pool results. Heterogeneity was assessed using Forest plot, Cochran's Q test, and I2. Publication bias was assessed applying Egger’s test.Results A total of 18 studies involving 3323 patients were included. Bronchial wall thickening (OR 11.64, 95% CI 1.81- 74.66) was more likely to be associated with severe cases of COVID-19 infection, followed by linear opacity (OR 3.27, 95% CI 1.10- 9.70), and GGO (OR 1.37, 95% CI 1.08- 1.73). However, there was no significant association between the presence of consolidation and severity of clinical presentation (OR 2.33, 95% CI 0.85- 6.36). Considering the lesion distribution bilateral lung involvement was more frequently associated with severe clinical presentation (OR 3.44, 95% CI 1.74- 6.79).Conclusions Our meta-analysis of observational studies suggests some specific chest CT features. The presence of these CT features can help the physicians to early and appropriately approach to the severe and fatal cases of COVID-19.

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Association between metformin and neurodegenerative diseases of observational studies: systematic review and meta-analysis

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001370 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001370

Author(s):

Fan Ping ◽

Ning Jiang ◽

Yuxiu Li

Keyword(s):

Systematic Review ◽

Neurodegenerative Diseases ◽

Observational Studies ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Cochrane Library ◽

Increased Risk ◽

Registration Number ◽

Underlying Mechanisms

Background and aimsAging becomes a growing global concern with an increased risk of neurodegenerative diseases (NDs) that mainly consist of cognitive decline and Parkinson disease (PD). As the most commonly prescribed antidiabetic drug, metformin has been shown to have inconsistent roles in the incidence of NDs. We performed a systematic review and meta-analysis of observational studies to evaluate the effect of metformin exposure on onset of NDs.MethodsThe observational studies that investigated the associations between metformin and the incidence of NDs were searched in MEDLINE, Embase and Cochrane Library databases. A random-effect model was performed using STATA to calculate the combined ORs.ResultsIn total, 23 comparisons out of 19 studies with 285 966 participants were included. Meta-analysis found there was no significant effect on incidence of all the subtypes of NDs with metformin exposure (OR 1.04, 95% CI 0.92 to 1.17). However, metformin monotherapy was associated with a significantly increased risk of PD incidence compared with non-metformin users or glitazone users (OR 1.66, 95% CI 1.14 to 2.42).ConclusionMetformin has failed to demonstrate a beneficial effect on NDs. In addition, it may increase the risk of PD development. In light of current results, how metformin would impact NDs, especially the potential risk of PD, needs to be scrutinized. The underlying mechanisms are vital to achieve some more profound understanding on the regimen.Trial registration numberCRD 42019133285.

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