scholarly journals The incidence of pulmonary thromboembolism in COVID-19 patients admitted to the intensive care unit: a meta-analysis and meta-regression of observational studies

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Jun Jie Ng ◽  
Zhen Chang Liang ◽  
Andrew M. T. L. Choong
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Studies ◽  
Pulmonary Thromboembolism ◽  
Meta Analysis ◽  
Weighted Average ◽  
Study Characteristics ◽  
Meta Regression ◽  
Almost All ◽  
Prophylactic Anticoagulation

Abstract Objectives Coronavirus disease 2019 (COVID-19) infection is associated with a prothrombotic state. We performed a meta-analysis of proportions to estimate the weighted average incidence of pulmonary thromboembolism (PTE) in COVID-19 patients who were admitted to the intensive care unit (ICU). Methods We searched various medical databases for relevant studies from 31 December 2019 till 30 September 2020. We included observational studies that reported the incidence of PTE in COVID-19 patients admitted to the ICU. We extracted data related to study characteristics, patient demographics, and the incidence of PTE. Risk of bias was assessed by using the ROBINS-I tool. Statistical analysis was performed with R 3.6.3. Results We included 14 studies with a total of 1182 patients in this study. Almost all patients in this meta-analysis received at least prophylactic anticoagulation. The weighted average incidence of PTE was 11.1% (95% CI 7.7% to 15.7%, I2 = 78%, Cochran’s Q test P < 0.01). We performed univariate and multivariate meta-regression, which identified the proportion of males as a significant source of heterogeneity (P = 0.03, 95% CI 0.00 to − 0.09) Conclusion The weighted average incidence of PTE remains high even after prophylactic anticoagulation. PTE is a significant complication of COVID-19 especially in critically ill patients in the ICU.

scholarly journals The Incidence of Pulmonary Thromboembolism in Critically Ill Patients With COVID-19: A Systematic Review, Meta-Analysis and Meta-Regression of Observational Studies

2020 ◽  
Author(s):  
Jun Jie Ng ◽  
Zhen Chang Liang ◽  
Andrew MTL Choong
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Observational Studies ◽  
Pulmonary Thromboembolism ◽  
Meta Analysis ◽  
Weighted Average ◽  
Meta Regression ◽  
Prophylactic Anticoagulation

Abstract Purpose Coronavirus disease 2019 (COVID-19) infection is known to be associated with a hypercoagulable and prothrombotic state, especially in critically ill patients. Several observational studies have reported the incidence of thromboembolic events such as pulmonary thromboembolism (PTE). We performed a meta-analysis to estimate the weighted average incidence of PTE in critically ill COVID-19 patients who are admitted to the intensive care unit.Methods We searched MEDLINE via PubMed, Embase and Web of Science for relevant studies from 31 December 2019 till 15 Aug 2020 onwards using the search terms “coronavirus”, “COVID-19”, “SARS-CoV-2”, “2019-nCoV”, “thrombus”, “thrombo*”, “embolus” and “emboli*”. We included prospective and retrospective observational studies that reported the incidence of PTE in critically ill COVID-19 patients who required treatment in the intensive care unit. We identified 14 studies after two phases of screening and extracted data related to study characteristics, patient demographics and the incidence of PTE. Risk of bias was assessed by using the ROBINS-I tool. Statistical analysis was performed with R 3.6.3.Results We included 14 studies with a total of 1182 patients in this study. Almost 100% of patients in this meta-analysis received at least prophylactic anticoagulation. The weighted average incidence of PTE was 11.09% (95% CI 7.72% to 15.69%, I2 = 78%, Cochran’s Q test P < 0.01). We performed univariate and multivariate meta-regression which identified the proportion of males as a significant source of heterogeneity (P = 0.03, 95% CI 0.00 to -0.09)Conclusion This is the only study that had specifically reported the weighted average incidence of PTE in critically ill COVID-19 patients using meta-analytic techniques. The weighted average incidence of PTE remains high even after prophylactic anticoagulation. This study is limited by incomplete data from included studies. More studies are needed to determine the optimal anticoagulation strategy in critically ill COVID-19 patients.

Intelligence Outcome of Pediatric Intensive Care Unit Survivors: A Systematic Meta-Analysis and Meta-Regression

2021 ◽  
Author(s):  
Eleonore Susanne Victoria de Sonnaville ◽  
Marsh Kӧnigs ◽  
Ouke van Leijden ◽  
Hennie Knoester ◽  
Job BM van Woensel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Meta Analysis ◽  
Pediatric Intensive Care ◽  
Meta Regression

scholarly journals Prevalence And Definitions of Polypharmacy: A Systematic Review And Meta-Analysis

2021 ◽  
Author(s):  
Mahin Delara ◽  
Lauren Murray ◽  
Behnaz Jafari ◽  
Anees Bahji ◽  
Zahra Goodarzi ◽  
...  
Keyword(s):  
Observational Studies ◽  
Meta Analysis ◽  
Population Based ◽  
Administrative Databases ◽  
Significant Heterogeneity ◽  
Cross Sectional ◽  
Factors Associated ◽  
Inpatient Settings ◽  
Study Characteristics ◽  
Meta Regression

Abstract INTRODUCTION: Polypharmacy is common associated with several adverse health outcomes. There are currently no systematic reviews or meta-analyses on the prevalence of polypharmacy and associated factors. We aimed to identify population-based observational studies reporting on the prevalence of polypharmacy and factors associated with polypharmacy. METHODS: MEDLINE, EMBASE, and Cochrane databases with no restriction on date. Population-based observational studies with cross-sectional, case-control, or cohort designs using administrative databases or registries to define or measure polypharmacy among individuals over 19. Using a standardized form, two reviewers independently extracted study characteristics, a crude prevalence rate of polypharmacy and its standard error with 95% confidence intervals (CIs). The risk of bias and quality of studies was assessed using the Newcastle-Ottawa Scale. The main outcome was the prevalence of polypharmacy and factors associated with polypharmacy. Using a random-effects model, pooled prevalence estimates with 95% CI was reported. Subgroup analysis was performed if significant heterogeneity was explored. Meta-regression analysis was conducted to predict polypharmacy prevalence.RESULTS: 106 full-text articles were identifies using 21 unique terms with 138 descriptive definitions of polypharmacy. The pooled estimated prevalence polypharmacy in studies reporting all medication classes was 37% (95% CI: 31%-43%). Differences in polypharmacy prevalence were reported for studies using different numerical threshold and polypharmacy was also associated with study year in meta-regression. Sex, study geography, study design and study setting were not associated with differences in polypharmacy prevalence. DISCUSSION: Our review highlights that polypharmacy is common particularly among older adults and those in inpatient settings. A variety of definitions are used to define polypharmacy and differences in polypharmacy definitions may have implications for understanding the burden or polypharmacy and outcomes associated with polypharmacy. CONCLUSIONS AND IMPLICATIONS: Clinicians should be aware of the common occurrence of polypharmacy in all populations and undertake efforts to minimize inappropriate polypharmacy whenever possible.

scholarly journals COVID-19 Related Cardiovascular Comorbidities and Complications in Critically Ill Patients: A Systematic Review and Meta-analysis

2021 ◽  
Vol 15 ◽  
pp. 117954842199232
Author(s):  
Michael Koeppen ◽  
Peter Rosenberger ◽  
Harry Magunia
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Observational Studies ◽  
Meta Analysis ◽  
Cardiovascular Complications ◽  
Cardiovascular Comorbidity ◽  
Cardiovascular Comorbidities ◽  
The Impact

Objective: This systematic-review and meta-analysis aimed to assess the prevalence of cardiovascular comorbidities and complications in ICU-admitted coronavirus disease 2019 (COVID-19) patients. Data sources: PubMed and Web of Science databases were referenced until November 25, 2020. Data extraction: We extracted retrospective and prospective observational studies on critically ill COVID-19 patients admitted to an intensive care unit. Only studies reporting on cardiovascular comorbidities and complications during ICU therapy were included. Data synthesis: We calculated the pooled prevalence by a random-effects model and determined heterogeneity by Higgins’ I2 test. Results: Of the 6346 studies retrieved, 29 were included in this review. The most common cardiovascular comorbidity was arterial hypertension (50%; 95% confidence interval [CI], 0.42-058; I2 = 94.8%, low quality of evidence). Among cardiovascular complications in the ICU, shock (of any course) was most common, being present in 39% of the patients (95% CI, 0.20-0.59; I2 = 95.6%; 6 studies). Seventy-four percent of patients in the ICU required vasopressors to maintain target blood pressure (95% CI, 0.58-0.88; I2 = 93.6%; 8 studies), and 30% of patients developed cardiac injury in the ICU (95% CI, 0.19-0.42; I2 = 91%; 14 studies). Severe heterogeneity existed among the studies. Conclusions: Cardiovascular complications are common in patients admitted to the intensive care unit for COVID-19. However, the existing evidence is highly heterogeneous in terms of study design and outcome measurements. Thus, prospective, observational studies are needed to determine the impact of cardiovascular complications on patient outcome in critically ill COVID-19 patients.

scholarly journals Association of Obesity with COVID-19 Severity and Mortality: A Systemic Review and Meta-Regression

2021 ◽  
Author(s):  
Romil Singh ◽  
Sawai Singh Rathore ◽  
Hira Khan ◽  
Smruti Karale ◽  
Abhishek Bhurwal ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Cardiovascular Diseases ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Female Gender ◽  
All Cause Mortality ◽  
Meta Regression ◽  
High Bmi

Objective: To estimate the association of obesity with severity (defined as use of invasive mechanical ventilation or intensive care unit admission) and all-cause mortality in coronavirus disease 2019 (COVID-19) patients. Patients and Methods: A systematic search was conducted from inception of COVID-19 pandemic through January 31st, 2021 for full-length articles focusing on the association of increased BMI/ Obesity and outcome in COVID-19 patients with help of various databases including Medline (PubMed), Embase, Science Web, and Cochrane Central Controlled Trials Registry. Preprint servers such as BioRxiv, MedRxiv, ChemRxiv, and SSRN were also scanned. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used for study selection and data extraction. The severity in hospitalized COVID-19 patients, such as requirement of invasive mechanical ventilation and intensive care unit admission with high BMI/ Obesity was the chief outcome. While all-cause mortality in COVID-19 hospitalized patients with high BMI/ Obesity was the secondary outcome. Results: A total of 576,784 patients from 100 studies were included in this meta-analysis. Being obese was associated with increased risk of severe disease (RR=1.46, 95% CI 1.34-1.60, p<0.001, I2 = 92 %). Similarly, high mortality was observed in obese patients with COVID-19 disease (RR=1.12, 95% CI 1.06-1.19, p<0.001, I2 = 88%). In a multivariate meta-regression on severity outcome, the covariate of female gender, pulmonary disease, diabetes, older age, cardiovascular diseases, and hypertension was found to be significant and explained R2= 50% of the between-study heterogeneity for severity. Similarly, for mortality outcome, covariate of female gender, proportion of pulmonary disease, diabetes, hypertension, and cardiovascular diseases were significant, these covariates collectively explained R2=53% of the between-study variability for mortality. Conclusions: Our findings suggest that obesity is significantly associated with increased severity and higher mortality among COVID-19 patients. Therefore, the inclusion of obesity or its surrogate body mass index in prognostic scores and streamlining the management strategy and treatment guidelines to account for the impact of obesity in patient care management is recommended.

scholarly journals Quantification of the association between predisposing health conditions, demographic, and behavioural factors with hospitalisation, intensive care unit admission, and death from COVID-19: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Nathalie Veronica Fernandez Villalobos ◽  
Joerdis Jennifer Ott ◽  
Carolina Judith Klett-Tammen ◽  
Annabelle Bockey ◽  
Patrizio Vanella ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Health Conditions ◽  
Targeted Prevention ◽  
Icu Admission ◽  
Meta Regression ◽  
Behavioural Factors

Background Comprehensive evidence synthesis on the associations between comorbidities and behavioural factors with hospitalisation, Intensive Care Unit (ICU) admission, and death due to COVID-19 is lacking leading to inconsistent national and international recommendations on who should be targeted for non-pharmaceutical interventions and vaccination strategies. Methods We performed a systematic review and meta-analysis on studies and publicly available data to quantify the association between predisposing health conditions, demographics, and behavioural factors with hospitalisation, ICU admission, and death from COVID-19. We provided ranges of reported and calculated effect estimates and pooled relative risks derived from a meta-analysis and meta-regression. Results 75 studies were included into qualitative and 74 into quantitative synthesis, with study populations ranging from 19 - 44,672 COVID-19 cases. The risk of dying from COVID-19 was significantly associated with cerebrovascular [pooled RR 2.7 (95% CI 1.7-4.1)] and cardiovascular [RR 3.2 (CI 2.3-4.5)] diseases, hypertension [RR 2.6 (CI 2.0-3.4)], and renal disease [RR 2.5 (CI 1.8-3.4)]. Health care workers had lower risk for death and severe outcomes of disease (RR 0.1 (CI 0.1-0.3). Our meta-regression showed a decrease of the effect of some comorbidities on severity of disease with higher median age of study populations. Associations between comorbidities and hospitalisation and ICU admission were less strong than for death. Conclusions We obtained robust estimates on the magnitude of risk for COVID-19 hospitalisation, ICU admission, and death associated with comorbidities, demographic, and behavioural risk factors. We identified and confirmed population groups that are vulnerable and that require targeted prevention approaches.

Sign in / Sign up

Export Citation Format

Share Document