Increased risk for posterior circulation ischaemia in patients with vertebral artery hypoplasia: A systematic review and meta-analysis

Introduction Although several study protocols reported that vertebral artery hypoplasia can predispose to posterior circulation ischaemia, the role of vertebral artery hypoplasia in the risk of posterior circulation ischaemia still remains controversial. The aim of the present meta-analysis was to investigate the association of vertebral artery hypoplasia and posterior circulation ischaemia. Patients and methods We performed a systematic review and random effects meta-analysis of all eligible observational study protocols reporting prevalence rates of vertebral artery hypoplasia in patients with anterior circulation ischaemia and posterior circulation ischaemia. Results We identified eight study protocols including a total of 3875 acute ischemic stroke patients (mean age: 64.2 years, 61.3% males) and reporting a pooled prevalence of vertebral artery hypoplasia 18.6% (95%CI: 10.8–30.0%). In the overall analysis, a significantly higher probability of vertebral artery hypoplasia presence was found in posterior circulation ischaemia patients compared to patients with anterior circulation ischaemia (risk ratio = 2.12, 95%CI: 1.60–2.82, p < 0.001). In the subsequent sensitivity analysis, vertebral artery hypoplasia was again found to be significantly more prevalent in patients with posterior circulation ischaemia compared to anterior circulation ischaemia (risk ratio = 1.81, 95%CI: 1.58–2.06, p < 0.001), with no evidence of heterogeneity (I2 = 0%, p for Cochran Q = 0.55) between included studies. Discussion The present report is a meta-analysis of retrospective observational study protocols, with all the inherent limitations of included studies. The heterogeneity on the reported rates of vertebral artery hypoplasia could be attributed to differences in population age, sex, race, imaging protocols and vertebral artery hypoplasia definition between included studies. Conclusion Our meta-analysis provides further evidence for a possible causal relationship between vertebral artery hypoplasia and cryptogenic posterior circulation ischaemia, an association which undoubtedly deserves further investigation in future prospective study protocols.

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Obesity and Mortality Among Patients Diagnosed With COVID-19: A Systematic Review and Meta-Analysis

Frontiers in Medicine ◽

10.3389/fmed.2021.620044 ◽

2021 ◽

Vol 8 ◽

Cited By ~ 1

Author(s):

Tahmina Nasrin Poly ◽

Md. Mohaimenul Islam ◽

Hsuan Chia Yang ◽

Ming Chin Lin ◽

Wen-Shan Jian ◽

...

Keyword(s):

Systematic Review ◽

Risk Ratio ◽

Web Of Science ◽

Meta Analysis ◽

Epidemiological Studies ◽

Class Iii ◽

Risk Of Death ◽

Risk Of Mortality ◽

Increased Risk ◽

Class Iii Obesity

Coronavirus disease 2019 (COVID-19) has already raised serious concern globally as the number of confirmed or suspected cases have increased rapidly. Epidemiological studies reported that obesity is associated with a higher rate of mortality in patients with COVID-19. Yet, to our knowledge, there is no comprehensive systematic review and meta-analysis to assess the effects of obesity and mortality among patients with COVID-19. We, therefore, aimed to evaluate the effect of obesity, associated comorbidities, and other factors on the risk of death due to COVID-19. We did a systematic search on PubMed, EMBASE, Google Scholar, Web of Science, and Scopus between January 1, 2020, and August 30, 2020. We followed Cochrane Guidelines to find relevant articles, and two reviewers extracted data from retrieved articles. Disagreement during those stages was resolved by discussion with the main investigator. The random-effects model was used to calculate effect sizes. We included 17 articles with a total of 543,399 patients. Obesity was significantly associated with an increased risk of mortality among patients with COVID-19 (RRadjust: 1.42 (95%CI: 1.24–1.63, p < 0.001). The pooled risk ratio for class I, class II, and class III obesity were 1.27 (95%CI: 1.05–1.54, p = 0.01), 1.56 (95%CI: 1.11–2.19, p < 0.01), and 1.92 (95%CI: 1.50–2.47, p < 0.001), respectively). In subgroup analysis, the pooled risk ratio for the patients with stroke, CPOD, CKD, and diabetes were 1.80 (95%CI: 0.89–3.64, p = 0.10), 1.57 (95%CI: 1.57–1.91, p < 0.001), 1.34 (95%CI: 1.18–1.52, p < 0.001), and 1.19 (1.07–1.32, p = 0.001), respectively. However, patients with obesity who were more than 65 years had a higher risk of mortality (RR: 2.54; 95%CI: 1.62–3.67, p < 0.001). Our study showed that obesity was associated with an increased risk of death from COVID-19, particularly in patients aged more than 65 years. Physicians should aware of these risk factors when dealing with patients with COVID-19 and take early treatment intervention to reduce the mortality of COVID-19 patients.

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Progestin-Only Contraceptives and the Risk of Venous Thromboembolism: Systematic Review and Meta-Analysis,

Blood ◽

10.1182/blood.v118.21.3344.3344 ◽

2011 ◽

Vol 118 (21) ◽

pp. 3344-3344

Author(s):

Simon Mantha ◽

Vidya Raghavan ◽

Rebecca Karp ◽

Norma Terrin ◽

Kenneth A. Bauer ◽

...

Keyword(s):

Systematic Review ◽

Venous Thromboembolism ◽

Risk Ratio ◽

Meta Analysis ◽

Control Group ◽

Thrombotic Risk ◽

Increased Risk ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Estimated Risk

Abstract Abstract 3344 Background: Combined oral contraceptives (COC) containing estrogens and progestins are associated with a 2 to 4-fold increased risk of venous thromboembolic events. Progestin-only contraceptives are commonly prescribed to women with a higher risk for thrombosis, although a lower thrombotic risk than COC has not been clearly established. We performed a systematic review and meta-analysis of published studies to estimate the risk ratio of venous thromboembolism (VTE) in women taking progesterone for the purpose of contraception. Materials and methods: We performed a literature search of cohort, case-control and randomized studies including women treated with progestin-only contraception compared with a no-hormone control group. All administration routes (oral, injectable and intra-uterine) were considered. The primary endpoint was the corrected risk ratio of VTE analyzed using a random effects model. Results: 1150 references were retrieved; 7 studies were retained for analysis. The summary estimate of the adjusted risk ratio of VTE for women taking a progestin for contraception versus no hormone was 1.02 (95% CI=0.76–1.37, p=0.89). Heterogeneity between studies was minimal (Q-value=7.1, I2=15.49 and p=0.31). An analysis combining the unadjusted odds ratios of VTE gave a similar result (OR=1.24, 95% CI=0.93–1.66, p=0.14). Analysis by subgroup suggests a higher risk of thrombotic events for individuals using an injectable progestin, with an estimated risk ratio of VTE equal to 2.67 (95% CI=1.29–5.53, p=0.008), compared to 0.87 (95% CI=0.53–1.42, p=0.58) for oral administration. Conclusions: Progestin-only oral formulations used for contraception do not appear to increase the risk of venous thromboembolic disease, although injectable administration was associated with an increased incidence of VTE relative to women not taking hormones that is comparable to the risk associated with COC. Estimated risk ratio of VTE for progestin versus no hormone, using adjusted values; A, all routes of administration for all studies; B, injectable progestins only, for studies where those results were reported. This publication was supported by Grant Number UL1 RR025752 from the National Center for Research Resources. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NCRR. Disclosures: No relevant conflicts of interest to declare.

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Predictors of episodic migraine transformation to chronic migraine: A systematic review and meta-analysis of observational cohort studies

Cephalalgia ◽

10.1177/0333102419883355 ◽

2019 ◽

Vol 40 (5) ◽

pp. 503-516 ◽

Cited By ~ 5

Author(s):

Jingjing Xu ◽

Fanyi Kong ◽

Dawn C Buse

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Cohort Studies ◽

Chronic Migraine ◽

Risk Ratio ◽

Household Income ◽

Meta Analysis ◽

Episodic Migraine ◽

Annual Household Income ◽

Increased Risk

Background and purpose An estimated 2.5–3.1% of people with episodic migraine develop chronic migraine in a year. Several risk factors are associated with an increased risk for this transformation. We conducted a systematic review and meta-analysis to provide quantitative and qualitative data on predictors of this transformation. Methods An electronic search was conducted for published, prospective, cohort studies that reported risk factors for chronic migraine among people with episodic migraine. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. Quality of evidence was determined according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Effect estimates were retrieved and summarized using risk ratios. Results Of 5695 identified publications, 11 were eligible for inclusion. The pooled analysis (GRADE system) found “high” evidence for monthly headache day frequency ≥ 10 (risk ratio = 5.95), “moderate” evidence for depression (risk ratio = 1.58), monthly headache day frequency ≥ 5 (risk ratio = 3.18), and annual household income ≥ $50,000 (risk ratio = 0.65) and “very low” evidence for allodynia (risk ratio = 1.40) and medication overuse (risk ratio = 8.82) in predicting progression to chronic migraine. Conclusions High frequency episodic migraine and depression have high quality evidence as predictors of the transformation from episodic migraine to chronic migraine, while annual household income over $50,000 may be protective.

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Systematic Review with Meta-analysis: The Impact of Co-occurring Immune-mediated Inflammatory Diseases on the Disease Course of Inflammatory Bowel Diseases

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa167 ◽

2020 ◽

Cited By ~ 1

Author(s):

Mohamed Attauabi ◽

Mirabella Zhao ◽

Flemming Bendtsen ◽

Johan Burisch

Keyword(s):

Systematic Review ◽

Risk Ratio ◽

Inflammatory Diseases ◽

Meta Analysis ◽

Disease Course ◽

Immune Mediated ◽

Increased Risk ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

The Impact

Abstract Background and Aims Patients with inflammatory bowel diseases (IBDs) are at risk of developing a variety of other immune-mediated inflammatory diseases (IMIDs). The influence of co-occurring IMIDs on the disease course of IBD remains unknown. The aim of this study was therefore to conduct a systematic review and meta-analysis of the impact of IMIDs on phenotypic presentation and outcome in patients with IBD. Methods PubMed and Embase were searched from their earliest records through December 2018 and updated in October 2019 for studies reporting proportions or ratios of IBD-related disease outcomes in patients with and without co-occurring IMIDs. Meta-analyses were performed to estimate summary proportions and risks of the main outcomes. PRISMA guidelines were used, and study quality was assessed according to the Newcastle-Ottawa Scale. Results A total of 93 studies were identified, comprising 16,064 IBD patients with co-occurring IMIDs and 3,451,414 IBD patients without IMIDs. Patients with IBD and co-occurring IMIDs were at increased risk of having extensive colitis or pancolitis (risk ratio, 1.38; 95% Cl, 1.25–1.52; P < 0.01, I2 = 86%) and receiving IBD-related surgeries (risk ratio, 1.17; 95% Cl, 1.01–1.36; P = 0.03; I2 = 85%) compared with patients without IMIDs. Co-occurrence of IMIDs other than primary sclerosing cholangitis in patients with IBD was associated with an increased risk of receiving immunomodulators (risk ratio, 1.15; 95% Cl, 1.06–1.24; P < 0.01; I2 = 60%) and biologic therapies (risk ratio, 1.19; 95% Cl, 1.08–1.32; P < 0.01; I2 = 53%). Conclusion This meta-analysis found that the presence of co-occurring IMIDs influences the disease course of IBD, including an increased risk of surgery and its phenotypical expression.

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Psoriasis and Risk of Uveitis: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2020/9308341 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Chayada Chaiyabutr ◽

Patompong Ungprasert ◽

Narumol Silpa-archa ◽

Chanisada Wongpraparut ◽

Leena Chularojanamontri

Keyword(s):

Systematic Review ◽

Psoriatic Arthritis ◽

Risk Ratio ◽

Meta Analysis ◽

Random Effect ◽

Study Groups ◽

Seronegative Spondyloarthropathy ◽

Analysis Technique ◽

Inverse Variance ◽

Increased Risk

Background. Uveitis is a known ophthalmologic manifestation of seronegative spondyloarthropathy, including psoriatic arthritis. However, the data is less clear among patients with psoriasis due to the limited number of published studies. Aims. To investigate whether the risk of incident and prevalent uveitis is elevated among patients with psoriasis using systematic review and meta-analysis technique. Methods. The MEDLINE and EMBASE databases were searched from their inception to May 2019. Eligible studies must have included a psoriasis group and a nonpsoriasis group. Eligible studies must also have investigated for prevalent or incident uveitis, and the magnitude of difference between the study groups must have been reported. Pooled risk ratio and 95% confidence interval (CI) were calculated using random-effect generic inverse variance methods. Results. Of 7,107 potentially eligible articles from the EMBASE and MEDLINE databases, 7 studies were included in the meta-analysis. Two of those studies compared the incidence, and 5 studies compared the prevalence of uveitis between the psoriasis and nonpsoriasis groups. For incident uveitis, a total of 5,865,801 patients (222,083 with psoriasis and 5,643,718 without psoriasis) were analyzed. For prevalent uveitis, a total of 1,343,436 patients (37,891 with psoriasis and 1,305,545 without psoriasis) were studied. The risk of incident uveitis was significantly higher among patients with psoriasis with a pooled risk ratio of 1.23 (95% CI: 1.05-1.45, I2=55%). The risk of prevalent uveitis was also significantly higher among patients with psoriasis with a pooled risk ratio of 1.97 (95% CI: 1.68-2.31, I2=0%). Conclusions. The results of this study revealed significantly increased risk of both prevalent and incident uveitis among patients with psoriasis.

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EXPRESS: Stroke risk following traumatic brain injury: systematic review and meta-analysis

International Journal of Stroke ◽

10.1177/17474930211004277 ◽

2021 ◽

pp. 174749302110042

Author(s):

Grace Mary Turner ◽

Christel McMullan ◽

Olalekan Lee Aiyegbusi ◽

Danai Bem ◽

Tom Marshall ◽

...

Keyword(s):

Systematic Review ◽

Stroke Risk ◽

Meta Analysis ◽

Vitamin K Antagonists ◽

Cochrane Library ◽

Control Group ◽

Large Sample Size ◽

Hazard Ratios ◽

Increased Risk ◽

The Cochrane Library

Aims To investigate the association between TBI and stroke risk. Summary of review We undertook a systematic review of MEDLINE, EMBASE, CINAHL, and The Cochrane Library from inception to 4th December 2020. We used random-effects meta-analysis to pool hazard ratios (HR) for studies which reported stroke risk post-TBI compared to controls. Searches identified 10,501 records; 58 full texts were assessed for eligibility and 18 met the inclusion criteria. The review included a large sample size of 2,606,379 participants from four countries. Six studies included a non-TBI control group, all found TBI patients had significantly increased risk of stroke compared to controls (pooled HR 1.86; 95% CI 1.46-2.37). Findings suggest stroke risk may be highest in the first four months post-TBI, but remains significant up to five years post-TBI. TBI appears to be associated with increased stroke risk regardless of severity or subtype of TBI. There was some evidence to suggest an association between reduced stroke risk post-TBI and Vitamin K antagonists and statins, but increased stroke risk with certain classes of antidepressants. Conclusion TBI is an independent risk factor for stroke, regardless of TBI severity or type. Post-TBI review and management of risk factors for stroke may be warranted.

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Prognostic role of Krebs von den Lungen-6 (KL-6) measurement in idiopathic pulmonary fibrosis: a systematic review and meta-analysis

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2021-0199 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Elena Aloisio ◽

Federica Braga ◽

Chiara Puricelli ◽

Mauro Panteghini

Keyword(s):

Systematic Review ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Binary Data ◽

Meta Analysis ◽

Mortality Prediction ◽

Asian Populations ◽

Increased Risk ◽

Using Data ◽

Patient Prognosis

Abstract Objectives Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial disease with limited therapeutic options. The measurement of Krebs von den Lungen-6 (KL-6) glycoprotein has been proposed for evaluating the risk of IPF progression and predicting patient prognosis, but the robustness of available evidence is unclear. Methods We searched Medline and Embase databases for peer-reviewed literature from inception to April 2020. Original articles investigating KL-6 as prognostic marker for IPF were retrieved. Considered outcomes were the risk of developing acute exacerbation (AE) and patient survival. Meta-analysis of selected studies was conducted, and quantitative data were uniformed as odds ratio (OR) or hazard ratio (HR) estimates, with corresponding 95% confidence intervals (CI). Results Twenty-six studies were included in the systematic review and 14 were finally meta-analysed. For AE development, the pooled OR (seven studies) for KL-6 was 2.72 (CI 1.22–6.06; p=0.015). However, a high degree of heterogeneity (I2=85.6%) was found among selected studies. Using data from three studies reporting binary data, a pooled sensitivity of 72% (CI 60–82%) and a specificity of 60% (CI 52–68%) were found for KL-6 measurement in detecting insurgence of AE in IPF patients. Pooled HR (seven studies) for mortality prediction was 1.009 (CI 0.983–1.036; p=0.505). Conclusions Although our meta-analysis suggested that IPF patients with increased KL-6 concentrations had a significant increased risk of developing AE, the detection power of the evaluated biomarker is limited. Furthermore, no relationship between biomarker concentrations and mortality was found. Caution is also needed when extending obtained results to non-Asian populations.

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The incidence and prevalence of cardiovascular diseases in gout: a systematic review and meta-analysis

Rheumatology International ◽

10.1007/s00296-021-04876-6 ◽

2021 ◽

Author(s):

Peter Cox ◽

Sonal Gupta ◽

Sizheng Steven Zhao ◽

David M. Hughes

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Cardiovascular Diseases ◽

Small Sample Size ◽

Meta Analysis ◽

Random Effect ◽

Small Sample ◽

Future Research ◽

Increased Risk

AbstractThe aims of this systematic review and meta-analysis were to describe prevalence of cardiovascular disease in gout, compare these results with non-gout controls and consider whether there were differences according to geography. PubMed, Scopus and Web of Science were systematically searched for studies reporting prevalence of any cardiovascular disease in a gout population. Studies with non-representative sampling, where a cohort had been used in another study, small sample size (< 100) and where gout could not be distinguished from other rheumatic conditions were excluded, as were reviews, editorials and comments. Where possible meta-analysis was performed using random-effect models. Twenty-six studies comprising 949,773 gout patients were included in the review. Pooled prevalence estimates were calculated for five cardiovascular diseases: myocardial infarction (2.8%; 95% confidence interval (CI)s 1.6, 5.0), heart failure (8.7%; 95% CI 2.9, 23.8), venous thromboembolism (2.1%; 95% CI 1.2, 3.4), cerebrovascular accident (4.3%; 95% CI 1.8, 9.7) and hypertension (63.9%; 95% CI 24.5, 90.6). Sixteen studies reported comparisons with non-gout controls, illustrating an increased risk in the gout group across all cardiovascular diseases. There were no identifiable reliable patterns when analysing the results by country. Cardiovascular diseases are more prevalent in patients with gout and should prompt vigilance from clinicians to the need to assess and stratify cardiovascular risk. Future research is needed to investigate the link between gout, hyperuricaemia and increased cardiovascular risk and also to establish a more thorough picture of prevalence for less common cardiovascular diseases.

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Prediction of all-cause mortality with malnutrition assessed by controlling nutritional status score in patients with heart failure: a systematic review and meta-analysis

Public Health Nutrition ◽

10.1017/s1368980021002470 ◽

2021 ◽

pp. 1-8

Author(s):

Huiyang Li ◽

Peng Zhou ◽

Yikai Zhao ◽

Huaichun Ni ◽

Xinping Luo ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Nutritional Status ◽

Meta Analysis ◽

Predictive Values ◽

Increased Risk ◽

Patients With Heart Failure ◽

All Cause Mortality ◽

Conut Score

Abstract Objective: The aim of this meta-analysis was to investigate the association between malnutrition assessed by the controlling nutritional status (CONUT) score and all-cause mortality in patients with heart failure. Design: Systematic review and meta-analysis. Settings: A comprehensively literature search of PubMed and Embase databases was performed until 30 November 2020. Studies reporting the utility of CONUT score in prediction of all-cause mortality among patients with heart failure were eligible. Patients with a CONUT score ≥2 are grouped as malnourished. Predictive values of the CONUT score were summarized by pooling the multivariable-adjusted risk ratios (RR) with 95 % CI for the malnourished v. normal nutritional status or per point CONUT score increase. Participants: Ten studies involving 5196 patients with heart failure. Results: Malnourished patients with heart failure conferred a higher risk of all-cause mortality (RR 1·92; 95 % CI 1·58, 2·34) compared with the normal nutritional status. Subgroup analysis showed the malnourished patients with heart failure had an increased risk of in-hospital mortality (RR 1·78; 95 % CI 1·29, 2·46) and follow-up mortality (RR 2·01; 95 % CI 1·58, 2·57). Moreover, per point increase in CONUT score significantly increased 16% risk of all-cause mortality during the follow-up. Conclusions: Malnutrition defined by the CONUT score is an independent predictor of all-cause mortality in patients with heart failure. Assessment of nutritional status using CONUT score would be helpful for improving risk stratification of heart failure.

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Systematic review and meta-analysis of female lifestyle factors and risk of recurrent pregnancy loss

Scientific Reports ◽

10.1038/s41598-021-86445-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ka Ying Bonnie Ng ◽

George Cherian ◽

Alexandra J. Kermack ◽

Sarah Bailey ◽

Nick Macklon ◽

...

Keyword(s):

Systematic Review ◽

General Population ◽

Pregnancy Loss ◽

Recurrent Pregnancy Loss ◽

Meta Analysis ◽

Lifestyle Factors ◽

Caffeine Intake ◽

Increased Risk ◽

Secondary Outcomes

AbstractIt is known that lifestyle factors affect sporadic miscarriage, but the extent of this on RPL (recurrent pregnancy loss) is less well known. A systematic review and meta-analysis was performed to assess the associations between lifestyle factors and RPL. Studies that analysed RPL in the context of BMI, smoking, alcohol and caffeine intake were included. The primary and secondary outcomes were odds of having RPL in the general population and odds of further miscarriage, respectively. Underweight and women with BMI > 25 are at higher odds of RPL in the general population (OR 1.2, 95% CI 1.12–1.28 and OR 1.21, 95% CI 1.06–1.38, respectively). In women with RPL, having BMI > 30 and BMI > 25 has increased odds of further miscarriages (OR 1.77, 95% CI 1.25–2.50 and OR 1.35, 95% CI 1.07–1.72, respectively). The quality of the evidence for our findings was low or very low. Being underweight and BMI > 25 contributes significantly to increased risk of RPL (general population). BMI > 25 or BMI > 30 increases the risk of further miscarriages (RPL population). Larger studies addressing the effects of alcohol, cigarette smoking and caffeine on the risk of RPL with optimisation of BMI in this cohort of women are now needed.

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