A systematic review of the efficacy of direct hemoperfusion with a polymyxin B–immobilized fibre column to treat rapidly progressive interstitial pneumonia

Objectives: Rapidly progressive interstitial pneumonia is a fatal disease with no established therapeutic options. The aim of this systematic review is to clarify the efficacy of interstitial pneumonia treatment utilizing direct hemoperfusion with a polymyxin B–immobilized fibre column. Methods: All patients with adult-onset rapidly progressive interstitial pneumonia including acute exacerbation of underlying chronic interstitial pneumonia were eligible. Primary studies of any design, which compared outcomes of direct hemoperfusion with a polymyxin B–immobilized fibre column treatment such as oxygenation and all-cause mortality with those of conventional therapy, were included. Electronic databases such as Medline and EMBASE were searched through October 7, 2018, and ICHUSHI, the largest database for medical articles in Japan, was also searched. Two reviewers independently extracted the relevant data and assessed the risk of bias in individual studies. The results were reported qualitatively due to substantial heterogeneity between studies. Results: Out of 775 records retrieved, 10 reports were eligible and 8 of them were included for further analysis. They were all retrospective studies including a total of 327 patients and contained some risk of bias. There was variation in the administration method of direct hemoperfusion with a polymyxin B–immobilized fibre column treatment such as the timing, frequency, duration and interval. Multivariate analyses of only two studies with historical controls demonstrated beneficial effects of direct hemoperfusion with a polymyxin B–immobilized fibre column treatment over conventional therapy with all-cause mortality hazard ratios of 0.345 (95% confidence interval: 0.127–0.936) and 0.505 (95% confidence interval: 0.270–0.904), respectively. A significant difference of an improvement in the ratio of partial arterial oxygen pressure to the fraction of inspired oxygen in-between two treatment groups was also reported in two studies utilizing historical controls with mean differences of 56.8 and 57.5 mmHg, respectively. Conclusions: There is currently insufficient data to support the use of direct hemoperfusion with a polymyxin B–immobilized fibre column treatment for rapidly progressive interstitial pneumonia. It should be instituted for research purposes only until new evidence is available.

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Systematic review and meta-analysis of the prognosis and prognostic factors of interstitial pneumonia with autoimmune features

BMJ Open ◽

10.1136/bmjopen-2019-031444 ◽

2019 ◽

Vol 9 (12) ◽

pp. e031444 ◽

Cited By ~ 1

Author(s):

Hiroyuki Kamiya ◽

Ogee Mer Panlaqui

Keyword(s):

Systematic Review ◽

Prognostic Factors ◽

Interstitial Pneumonia ◽

Evaluation System ◽

Meta Analysis ◽

Usual Interstitial Pneumonia ◽

Risk Of Bias ◽

Significant Difference ◽

All Cause Mortality

ObjectiveTo clarify the prognosis and prognostic factors of interstitial pneumonia with autoimmune features (IPAF) in comparison to idiopathic pulmonary fibrosis (IPF), the most common idiopathic interstitial pneumonia, and connective tissue disease-associated interstitial pneumonia (CTD-IP).DesignA systematic review and meta-analysis.Data sourcesElectronic databases such as Medline and Embase were searched from 2015 through 6 September 2019.Eligibility criteria for selecting studiesPrimary studies that comparatively investigated the prognosis or prognostic factors of IPAF were eligible.Data extraction and analysisTwo reviewers extracted relevant data and assessed the risk of bias independently. A meta-analysis was conducted using a random-effects model. The quality of presented evidence was assessed by the Grades of Recommendation, Assessment, Development, and Evaluation system.ResultsOut of a total of 656 records retrieved, 12 studies were reviewed. The clinical features of IPAF were diverse between studies, which included a radiological and/or pathological usual interstitial pneumonia (UIP) pattern of between 0% and 73.8%. All studies contained some risk of bias. There was no significant difference of all-cause mortality between IPAF-UIP and IPF in all studies, although the prognosis of IPAF in contrast to IPF or CTD-IP varied between studies depending on the proportion of UIP pattern. Among the potential prognostic factors identified, age was significantly associated with all-cause mortality of IPAF by a pooled analysis of univariate results with a hazard ratio (HR) of 1.06 (95% confidence interval (CI) 1.04 to 1.07). The adjusted effect of age was also significant in all studies. The quality of presented evidence was deemed as very low.ConclusionThere was no significant difference of all-cause mortality between IPAF-UIP and IPF. Age was deemed as a prognostic factor for all-cause mortality of IPAF. The findings should be interpreted cautiously due to the low quality of the presented evidence.PROSPERO registration numberCRD42018115870.

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Abstract 20: The Effect of Resistance Training on Survival and Cardiovascular Outcomes: A Systematic Review and Meta-Analysis

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.11.suppl_1.20 ◽

2018 ◽

Vol 11 (suppl_1) ◽

Author(s):

Farzane Saeidifard ◽

Jose R Medina Inojosa ◽

Colin P West ◽

Thomas P Olson ◽

Virend K Somers ◽

...

Keyword(s):

Systematic Review ◽

Heart Disease ◽

Resistance Training ◽

Subgroup Analysis ◽

Cancer Mortality ◽

Meta Analysis ◽

Cardiovascular Outcomes ◽

Risk Of Bias ◽

Cochrane Central Register ◽

All Cause Mortality

Background: This is the first systematic review and meta-analysis to investigate the effect of resistance training (RT) on survival and other cardiovascular outcomes including ischemic heart disease events and stroke. Methods: An experienced librarian searched databases up to September 25 th , 2017, for randomized trials and cohort studies that evaluated the effect of RT on survival and cardiovascular events in the general population. The databases included Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus. Two investigators conducted the screening process independently and in duplicate. Cochrane tools were used to assess the risk of bias in clinical trials and observational studies. We calculated hazard ratios and 95% confidence intervals using RevMan and fixed and random effect models and had a subgroup analysis based on doses of RT and for the combination of RT and aerobic exercise (AE) vs no exercise. Results: The search identified 1429 studies from which 10 (one randomized trial) met the inclusion criteria, including 338,254 participants with a mean follow up of 8.14 years. The meta-analysis showed that RT, in comparison with no exercises, is associated with 24% lower all-cause mortality and 48% lower mortality when combined with AE. Based on subgroup analysis, performing 1-2 sessions of RT/week is associated with lower all-cause mortality by 28% (HR 0.72, 95% CI 0.66-0.78) whereas > 5 sessions of RT/week has no association with all-cause mortality (HR 0.99, 95% CI 0.76-1.31). Further, RT alone or combined with AE is associated with lower CV mortality compared to no exercise (Figures). Finally, RT alone also showed a borderline association with lower all-cancer mortality. Heterogeneity was present for several comparisons, and subsequent analysis will explore sources of this variability. Using study design-specific Cochrane risk of bias tools, no major sources of bias were identified in the included studies. One cohort study looked at the effect of RT on coronary heart disease events and found 23% risk reduction in men, while no study specifically assessed the effect of RT on cerebrovascular outcomes. Conclusion: RT is associated with lower all-cause, CV and all-cancer mortality. RT appears to have an additive effect when combined with AE.

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Abstract P269: Cardio-Ankle Vascular Index and the Risk of Cardiovascular Outcomes and All-cause Mortality: A Systematic Review

Circulation ◽

10.1161/circ.137.suppl_1.p269 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Kunihiro Matsushita ◽

Ning Ding ◽

Esther Kim

Keyword(s):

Systematic Review ◽

Arterial Stiffness ◽

Cohort Studies ◽

Statistical Significance ◽

Risk Of Bias ◽

Cvd Risk ◽

Cross Sectional ◽

Stiffness Evaluation ◽

All Cause Mortality ◽

Cross Sectional Studies

Introduction: Arterial stiffness is widely used as an index of arteriosclerosis and is associated with cardiovascular disease (CVD). Recently, cardio-ankle vascular index (CAVI) was developed as a measurement of arterial stiffness that is independent of blood pressure at the time of arterial stiffness evaluation. The associations of CAVI with CVD events and all-cause mortality have not been extensively assessed. We therefore systematically reviewed the studies reporting CAVI and relevant outcomes. Methods: We searched for both prospective and cross-sectional studies using MEDLINE, Embase, and Cochrane from inception to April 11, 2017. Two independent reviewers screened the retrieved papers, extracted relevant data and assessed the risk of bias. Any discrepancy was solved by discussion or a third reviewer. Heterogeneity among studies was assessed using the I 2 statistic. We pooled the results of studies that were sufficiently homogeneous. Results: Among 1,519 records, we identified 9 cohort studies (n=5,292) and 17 cross-sectional eligible studies (n=7,309). All 9 cohort studies reported the outcome of composited CVD (498 cases), but the categorization/modeling of CAVI was not consistent across those studies. The pooled hazard ratio (HR) of CVD for the highest vs. lowest CAVI category in 3 studies was borderline significant (pooled HR=1.34 [0.95, 1.87], p=0.092) (I 2 = 25.2%, p=0.263). For 3 studies examining the continuous association between CAVI and CVD, 1standard deviation (SD) increment of CAVI was significantly associated with CVD risk (pooled HR=1.22 [1.03, 1.45], p=0.023) (I 2 = 27.1%, p=0.253). Only 3 cohort studies investigated CAVI and all-cause mortality, and none of them reported a significant association. All 17 cross-sectional studies reported higher CAVI values in patients with CVD compared to those without CVD, with statistical significance in most studies. Conclusions: CAVI was generally higher in patients with CVD compared to their counterparts. In terms of the prospective prognostic value of CAVI, we found a limited number of studies, but they indicated a modest association between CAVI and CVD risk. Our systematic review highlighted the need for large prospective studies to assess the usefulness of CAVI as a predictor of CVD and mortality.

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Comparison of peritoneal dialysis and hemodialysis as first renal replacement therapy in patients with end-stage renal disease and diabetes: a systematic review

Renal Replacement Therapy ◽

10.1186/s41100-019-0234-7 ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 3

Author(s):

Yukio Maruyama ◽

Chieko Higuchi ◽

Hiroaki Io ◽

Keiichi Wakabayashi ◽

Hiraku Tsujimoto ◽

...

Keyword(s):

Systematic Review ◽

Peritoneal Dialysis ◽

Renal Replacement Therapy ◽

End Stage Renal Disease ◽

Risk Of Bias ◽

Diabetic Patients ◽

All Cause Mortality ◽

Stage Renal Disease ◽

End Stage

Abstract Background Diabetes has become the most common cause of end-stage renal disease (ESRD) requiring renal replacement therapy (RRT) in most countries around the world. Peritoneal dialysis (PD) is valuable for patients newly requiring RRT because of the preservation of residual renal function (RRF), higher quality of life, and hemodynamic stability in comparison with hemodialysis (HD). A previous systematic review produced conflicting results regarding patient survival. As several advances have been made in therapy for diabetic patients receiving PD, we conducted a systematic review of studies published after 2014 to determine whether incident PD or HD is advantageous for the survival of patients with diabetes. Methods For this systematic review, the MEDLINE, EMBASE, and CENTRAL databases were searched to identify articles published between February 2014 and August 2017. The quality of studies was assessed using the GRADE approach. Outcomes of interest were all-cause mortality; RRF; major morbid events, including cardiovascular disease (CVD) and infectious disease; and glycemic control. This review was performed using a predefined protocol published in PROSPERO (CRD42018104258). Results Sixteen studies were included in this review. All were retrospective observational studies, and the risk of bias, especially failure to adequately control confounding factors, was high. Among them, 15 studies investigated all-cause mortality in diabetic patients initiating PD and HD. Differences favoring HD were observed in nine studies, whereas those favoring PD were observed in two studies. Two studies investigated effects on CVD, and both demonstrated the superiority of incident HD. No study investigated the effect of any other outcome. Conclusions In the present systematic review, the risk of death tended to be higher among diabetic patients with ESRD newly initiating RRT with incident PD in comparison with incident HD. However, we could not obtain definitive results reflecting the superiority of PD or HD with regard to patient outcomes because of the severe risk of bias and the heterogeneity of management strategies for diabetic patients receiving dialysis. Further studies are needed to clarify the advantages of PD and HD as RRT for diabetic patients with ESRD.

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The Efficacy and Safety Of Therapeutic Aheresis In Sepsis and Septic Shock: A Systematic Review and Meta-Analysis

Blood ◽

10.1182/blood.v122.21.1119.1119 ◽

2013 ◽

Vol 122 (21) ◽

pp. 1119-1119

Author(s):

Emily K. Rimmer ◽

Brett L. Houston ◽

Anand Kumar ◽

Ahmed Abou-Setta ◽

Carol Friesen ◽

...

Keyword(s):

Systematic Review ◽

Septic Shock ◽

Clinical Trials ◽

Risk Of Bias ◽

Controlled Trials ◽

Efficacy And Safety ◽

Randomized Controlled ◽

All Cause Mortality ◽

The Mean ◽

Sepsis And Septic Shock

Abstract Introduction Sepsis and septic shock are leading causes of ICU mortality. They are characterized by excessive host inflammation, upregulation of procoagulant proteins and depletion of natural anticoagulants. Therapeutic apheresis has the potential to improve survival in sepsis by removing injurious elements and inflammatory cytokines and restoring deficient plasma proteins. The objective of our systematic review was to evaluate the efficacy and safety of apheresis in patients with sepsis or septic shock. Methods We searched PubMed, EMBASE, and CENTRAL (from inception to February 2013), the International Clinical Trials Registry Platform, relevant conference proceedings and bibliographies of pertinent reviews and included clinical trials. Two reviewers independently identified randomized controlled trials of patients diagnosed with sepsis, severe sepsis, septic shock or disseminated intravascular coagulation due to infection who received plasmapheresis, plasma exchange, or plasma filtration compared to placebo or usual care. Two reviewers independently extracted trial-level data including population characteristics, interventions, outcomes, and funding sources. We assessed risk of bias using the Cochrane risk of bias tool. Our primary outcome was all-cause mortality reported at the longest follow-up. Secondary outcomes were hospital and ICU lengths of stay, and reported adverse events. We expressed summary effect measures as odds ratios (OR) with 95% confidence intervals (CI). Random effect models using the Mantel-Haenszel method were used for pooled analyses. Results We identified 1771 potential citations of which 3 trials (144 patients) met inclusion criteria. The mean age of patients ranged from 38 to 53 years in the two adult trials and 1 to 18 years in the single pediatric trial. The mean APACHE score was 25.2 (APACHE II) in one study and 54.9 (APACHE III) in the other study reporting illness severity scores. All 3 studies were adjudicated to be unclear or high risk of bias. We observed that the use of apheresis was not associated with a significant reduction in all cause mortality (OR 0.42, 95% CI 0.16 - 1.12, I2=30%) (see Figure). In a subgroup analysis of studies including children exclusively, we observed that apheresis was associated with a significant reduction in mortality (OR 0.03, 95% CI 0.00 – 0.94). None of the included studies reported ICU or hospital length of stay. Only one study reported adverse events associated with apheresis including 6 episodes of hypotension and one allergic reaction to fresh frozen plasma. Central-venous catheter related complications were not reported. Conclusions In patients with sepsis or septic shock, apheresis is not associated a significant reduction in all cause mortality. There is currently insufficient evidence to recommend apheresis as an adjunctive therapy in patients with sepsis or septic shock. Rigorous randomized controlled trials powered to detect differences in patient-centered, clinically relevant outcomes are required to evaluate the impact of apheresis in this patient population. Disclosures: No relevant conflicts of interest to declare.

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Direct hemoperfusion with polymyxin B-immobilized fibre treatment for acute exacerbation of interstitial pneumonia

Respirology ◽

10.1111/resp.13054 ◽

2017 ◽

Vol 22 (7) ◽

pp. 1357-1362 ◽

Cited By ~ 6

Author(s):

Haruhiko Furusawa ◽

Makiko Sugiura ◽

Chieko Mitaka ◽

Naohiko Inase

Keyword(s):

Acute Exacerbation ◽

Interstitial Pneumonia ◽

Polymyxin B ◽

Direct Hemoperfusion ◽

Fibre Treatment

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Early initiation of direct hemoperfusion with a polymyxin B-immobilized fiber column for the acute exacerbation of interstitial pneumonia

Nihon Toseki Igakkai Zasshi ◽

10.4009/jsdt.50.607 ◽

2017 ◽

Vol 50 (10) ◽

pp. 607-614

Author(s):

Masamitsu Ubukata ◽

Masaki Hara ◽

Kumiko Momoki ◽

Kosaku Nitta ◽

Akihito Ohta

Keyword(s):

Acute Exacerbation ◽

Interstitial Pneumonia ◽

Polymyxin B ◽

Early Initiation ◽

Direct Hemoperfusion

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ASSOCIATION BETWEEN ETHNICITY AND SEVERE COVID-19 DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS.

10.1101/2020.08.12.20157271 ◽

2020 ◽

Author(s):

Antony Raharja ◽

Alice Tamara ◽

Li Teng Kok

Keyword(s):

Systematic Review ◽

Risk Factor ◽

Ethnic Minorities ◽

Independent Risk Factor ◽

Case Reports ◽

Data Extraction ◽

Meta Analysis ◽

Risk Of Bias ◽

Research Database ◽

All Cause Mortality

Background: Multiple reports suggested disproportionate impact of Covid-19 on ethnic minorities. Whether ethnicity is an independent risk factor for severe Covid-19 illness is unclear. Purpose: Review the association between ethnicity and poor Covid-19 outcomes including all-cause mortality, hospitalisation, critical care admission, respiratory and kidney failure. Data Sources: MEDLINE, EMBASE, Cochrane COVID-19 Study Register, WHO COVID-19 Global Research Database up to 15/06/2020, and preprint servers. No language restriction. Study Selection: All studies providing ethnicity-aggregated data on the pre-specified outcomes, except case reports or interventional trials Data Extraction: Pairs of investigators independently extracted data, assessed risk of bias using Newcastle-Ottawa scale (NOS), and rated certainty of evidence following GRADE framework. Data Synthesis: Seventy-two articles (59 cohort studies with 17,950,989 participants; 13 ecological studies; 54 US-based and 15 UK-based; 41 peer-reviewed) were included for systematic review and 45 for meta-analyses. Risk of bias was low, with median NOS of 7 (interquartile range 6-8). In the unadjusted analyses, compared to white ethnicity, all-cause mortality risk was similar in Black (RR:0.96 [95%CI: 0.83-1.08]), Asian (RR:0.99 [0.85-1.16]) but reduced in Hispanic ethnicity (RR:0.69 [0.57-0.84]). Age and sex-adjusted-risks were significantly elevated for Black (HR:1.38 [1.09-1.75]) and Asian (HR:1.42 [1.15-1.75]), but not for Hispanic (RR:1.14 [0.93-1.40]). Further adjusting for comorbidities attenuated these association to non-significance; Black (HR:0.95 [0.72-1.25]); Asian (HR:1.17 [0.84-1.63]); Hispanic (HR:0.94 [0.63-1.44]). Similar results were observed for other outcomes. In subgroup analysis, there is a trend towards greater disparity in outcomes for UK ethnic minorities, especially hospitalisation risks. Limitations: Paucity of evidence on native ethnic groups, and studies outside US and UK. Conclusions: Currently available evidence cannot confirm ethnicity as an independent risk factor for severe Covid-19 illness, but indicates that disparity may be partially attributed to greater burden of comorbidities. Registration: PROSPERO, CRD42020188421 Funding source: none

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Antioxidants as Adjuvants in Periodontitis Treatment: A Systematic Review and Meta-Analysis

Oxidative Medicine and Cellular Longevity ◽

10.1155/2019/9187978 ◽

2019 ◽

Vol 2019 ◽

pp. 1-24 ◽

Cited By ~ 3

Author(s):

Micaele Maria Lopes Castro ◽

Nathallia Neves Duarte ◽

Priscila Cunha Nascimento ◽

Marcela Barauna Magno ◽

Nathalia Carolina Fernandes Fagundes ◽

...

Keyword(s):

Systematic Review ◽

Conventional Therapy ◽

Meta Analysis ◽

Clinical Parameter ◽

Risk Of Bias ◽

Eligibility Criteria ◽

Clinical Attachment Loss ◽

Nonsurgical Periodontal Therapy ◽

Significant Difference ◽

Meta Analyses

This systematic review with meta-analysis aimed to evaluate the effect of antioxidants as an adjuvant in periodontitis treatment. The following databases were consulted: PubMed, Scopus, Web of Science, Cochrane, Lilacs, OpenGrey, and Google Scholar. Based on the PICO strategy, the inclusion criteria comprised interventional studies including periodontitis patients (participants) treated with conventional therapy and antioxidants (intervention) compared to patients treated only with conventional therapy (control) where the periodontal response (outcome) was evaluated. The risk of bias was evaluated using the Cochrane RoB tool (for randomized studies) and ROBINS-I tool (for nonrandomized studies). Quantitative data were analyzed in five random effects meta-analyses considering the following periodontal parameters: clinical attachment loss (CAL), plaque index (PI), gingival index (GI), bleeding on probing (BOP), and probing depth (PD). After all, the level of certainty was measured with the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) tool. Among the 1884 studies identified, only 15 interventional studies were according to the eligibility criteria and they were included in our review. From them, 4 articles presented a high risk of bias. The meta-analysis showed a statistically significant difference for CAL (SMD 0.29 (0.04, 0.55), p=0.03, I2=13%), PI (SMD 0.41 (0.18, 0.64), p=0.0005, I2=47%), and BOP (SMD 0.55 (0.27, 0.83), p=0.0001, I2=0%). The GRADE tool showed a moderate to high certainty in the quality of evidence depending on the clinical parameter and antioxidants used. These results suggest that the use of antioxidants is an adjunct approach to nonsurgical periodontal therapy which may be helpful in controlling the periodontal status.

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Systematic Review and Meta-Analysis of the Efficacy of Appropriate Empiric Antibiotic Therapy for Sepsis

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00627-10 ◽

2010 ◽

Vol 54 (11) ◽

pp. 4851-4863 ◽

Cited By ~ 383

Author(s):

Mical Paul ◽

Vered Shani ◽

Eli Muchtar ◽

Galia Kariv ◽

Eyal Robenshtok ◽

...

Keyword(s):

Systematic Review ◽

Confidence Interval ◽

Antibiotic Treatment ◽

Effect Size ◽

Observational Studies ◽

Meta Analysis ◽

Empiric Antibiotic Therapy ◽

Clinical Variable ◽

Empirical Antibiotic Treatment ◽

All Cause Mortality

ABSTRACT Quantifying the benefit of early antibiotic treatment is crucial for decision making and can be assessed only in observational studies. We performed a systematic review of prospective studies reporting the effect of appropriate empirical antibiotic treatment on all-cause mortality among adult inpatients with sepsis. Two reviewers independently extracted data. Risk of bias was assessed using the Newcastle-Ottawa score. We calculated unadjusted odds ratios (ORs) with 95% confidence intervals for each study and extracted adjusted ORs, with variance, methods, and covariates being used for adjustment. ORs were pooled using random-effects meta-analysis. We examined the effects of methodological and clinical confounders on results through subgroup analysis or mixed-effect meta-regression. Seventy studies were included, of which 48 provided an adjusted OR for inappropriate empirical antibiotic treatment. Inappropriate empirical antibiotic treatment was associated with significantly higher mortality in the unadjusted and adjusted comparisons, with considerable heterogeneity occurring in both analyses (I 2 > 70%). Study design, time of mortality assessment, the reporting methods of the multivariable models, and the covariates used for adjustment were significantly associated with effect size. Septic shock was the only clinical variable significantly affecting results (it was associated with higher ORs). Studies adjusting for background conditions and sepsis severity reported a pooled adjusted OR of 1.60 (95% confidence interval = 1.37 to 1.86; 26 studies; number needed to treat to prevent one fatal outcome, 10 patients [95% confidence interval = 8 to 15]; I 2 = 46.3%) given 34% mortality with inappropriate empirical treatment. Appropriate empirical antibiotic treatment is associated with a significant reduction in all-cause mortality. However, the methods used in the observational studies significantly affect the effect size reported. Methods of observational studies assessing the effects of antibiotic treatment should be improved and standardized.

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