Extracorporeal membrane oxygenation (ECMO) in patients with severe COVID-19 adult respiratory distress syndrome: a systematic review and meta-analysis

Abstract Background COVID 19 is the most recent cause of adult respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients failing conventional mechanical ventilation, but its role is still controversial. We conducted a systematic review and meta-analysis on ECMO for COVID-associated ARDS to study its outcome. Main body CENTRAL, MEDLINE/PubMed, Cochrane Library, and Scopus were systematically searched from inception to May 28, 2020. Studies reporting five or more patients with COVID-19 infection treated venovenous with ECMO were included. The main outcome assessed was mortality and ICU/hospital discharge. Baseline, procedural, outcome, and validity data were systematically appraised and pooled with random-effect methods. The validity of all the included observational studies was appraised with the Newcastle Ottawa scale. Meta-regression and publication bias were tested. This trial was registered with PROSPERO under registration number CRD42020183861. From 1647 initial citations, 34 full-text articles were analyzed and 12 studies were selected, including 194 patients with confirmed COVID-19 infection requiring ICU admission and venovenous ECMO treatment. Median Newcastle-Ottawa scale was 6 indicating acceptable study validity. One hundred thirty-six patients reached an endpoint of weaning from ECMO with ICU/hospital discharge or death while the rest were still on ECMO or in the ICU. The median Berlin score for ARDS prior to starting ECMO was III. Patients received mechanical ventilation before ECMO implementation for a median of 4 days and ECMO was maintained for a median of 13 days. In hospital and short-term mortality were highly variable among the included studies ranging between 0 and 100%. Random-effect pooled estimates suggested an overall in-hospital mortality risk ratio of 0.49 (95% confidence interval 0.259 to 0.721; I2 = 94%). Subgroup analysis according to country of origin showed persistent heterogeneity only in the 7 Chinese studies with pooled estimate mortality risk ratio of 0.66 (I2 = 87%) (95% CI = 0.39-0.93), while the later larger studies coming from the USA showed pooled estimate mortality risk ratio of 0.41 (95% CI 0.28-0.53) with homogeneity (p=0.67) similar to France with a pooled mortality risk ratio of 0.26 (95% CI 0.08-0.43) with homogeneity (p=0.86). Meta-regression showed only younger age as a predictor of mortality (p=0.02). Publication bias was excluded by visualizing the funnel plot of standard error, Egger’s test with p=0.566, and Begg and Mazumdar test with p=0.373. Conclusion The study included the largest number of patients with outcome findings of ECMO in this current pandemic. Our findings showed that the use of venovenous ECMO at high-volume ECMO centers may be beneficial for selected COVID 19 patients with severe ARDS. However, none of the included studies involve prospective randomized analyses; and therefore, all the included studies were of low or moderate quality according to the Newcastle-Ottawa scale. In the current era and environment of the pandemic, it will likely be very challenging to conduct a prospective randomized trial of ECMO versus no-ECMO for COVID-19. Therefore, the information contained in this systematic review of the literature is valuable and provides important guidance. Trial registration The study protocol link is at www.crd.yorl.ac.uk/PROSPERO under registration number CRD42020183861.

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Extracorporeal membrane oxygenation (ECMO) in patients with severe COVID-19 adult respiratory distress syndrome: a systematic review and meta-analysis

10.21203/rs.3.rs-72963/v1 ◽

2020 ◽

Author(s):

Hany Hasan Elsayed ◽

Aly Sherif Hassaballa ◽

Taha Aly Ahmed ◽

Mohammed Gumaa ◽

Hazem Youssef Sharkawy

Keyword(s):

Systematic Review ◽

Risk Ratio ◽

Mortality Risk ◽

Distress Syndrome ◽

Meta Analysis ◽

Random Effect ◽

Newcastle Ottawa Scale ◽

Meta Regression ◽

Venovenous Ecmo ◽

Ottawa Scale

Abstract Background: COVID 19 is the most recent cause of Adult respiratory distress syndrome ARDS. Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients failing conventional mechanical ventilation, but its role is still controversial. We conducted a systematic review and meta-analysis on ECMO for COVID-associated ARDS to study its outcome.Materials and Methods: CENTRAL, MEDLINE/PubMed, Cochrane Library, and Scopus were systematically searched from inception to May 28, 2020. Studies reporting five or more patients with COVID 19 infection treated venovenous with ECMO were included. The main outcome assessed was mortality. Baseline, procedural, outcome, and validity data were systematically appraised and pooled with random-effect methods. The validity of all the included observational studies was appraised with the Newcastle Ottawa scale. Meta-regression and publication bias were tested. This trial was registered with PROSPERO under registration number CRD42020183861Results: From 1647 initial citations, 34 full text articles were analysed and 12 studies were selected, including 194 patients with confirmed COVID 19 infection requiring ICU admission and venovenous ECMO treatment. Median New Castle Ottawa scale was 6 indicating acceptable study validity. 136 patients reached an endpoint of weaning from ECMO or death while the rest were still on ECMO. The median Berlin score for ARDS prior to starting ECMO was III. Patients received mechanical ventilation before ECMO implementation for a median of four days and ECMO was maintained for a median of 13 days. In hospital and short-term mortality were highly variable among the included studies ranging between 0% and 100%. Random-effect pooled estimates suggested an overall in-hospital mortality risk ratio of 0.49 (95% confidence interval 0.259 to 0.721; I2 = 94%). Subgroup analysis according to country of origin showed persistent heterogeneity only in the 7 Chinese studies with pooled estimate mortality risk ratio of 0.66 (I2 = 87%) (95% CI = 0.39-0.93), while the later larger studies coming from the USA showed pooled estimate mortality risk ratio of 0.41 (95% CI 0.28-0.53) with homogeneity (p=0.67) similar to France with a pooled mortality risk ratio of 0.26 (95% CI 0.08-0.43) with homogeneity (p=0.86). Meta-regression showed only younger age as a predictor of mortality (p=0.02). Publication bias was excluded by visualizing the funnel plot of standard error, Egger's test with p=0.566 and Begg&Mazumdar test with p=0.373Conclusion: The study included the largest number of patients with outcome findings of ECMO in this current pandemic. Our findings showed that the use of venovenous ECMO at high-volume ECMO centres may be beneficial for selected COVID 19 patients with severe ARDS. However, none of the included studies involve prospective randomized analyses; and therefore, all the included studies were of low or moderate quality according to the Newcastle-Ottawa scale. In the current era and environment of the pandemic, it will likely be very challenging to conduct a prospective randomized trial of ECMO versus no-ECMO for COVID-19. Therefore, the information contained in this systematic review of the literature is valuable and provides important guidance.

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Variation in outcome of invasive mechanical ventilation between different countries for patients with severe COVID-19: a systematic review and meta-analysis

10.21203/rs.3.rs-52224/v1 ◽

2020 ◽

Author(s):

Hany Hasan Elsayed ◽

Aly Sherif Hassaballa ◽

Taha Aly Ahmed ◽

Mohamed Gumaa ◽

Hazem Youssef Sharkawy

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Publication Bias ◽

Risk Ratio ◽

Mortality Risk ◽

Subgroup Analysis ◽

Meta Analysis ◽

Invasive Mechanical Ventilation ◽

Random Effect ◽

Meta Regression

Abstract Background: COVID 19 is the most recent cause of Adult respiratory distress syndrome ARDS. Invasive mechanical ventilation IMV can support gas exchange in patients failing non-invasive ventilation, but its reported outcome is highly variable between countries. We conducted a systematic review and meta-analysis on IMV for COVID-associated ARDS to study its outcome among different countries.Methods: CENTRAL, MEDLINE/PubMed, Cochrane Library, and Scopus were systematically searched from June 8 2019 to June 8, 2020. Studies reporting five or more patients with end point outcome for severe COVID 19 infection treated with IMV were included. The main outcome assessed was mortality. Baseline, procedural, outcome, and validity data were systematically appraised and pooled with random-effect methods. Subgroup analysis for different countries was performed. Meta-regression for the effect of study timing and patient age and were tested. Publication bias was examined. This trial was registered with PROSPERO under registration number CRD42020190365Findings: Our electronic search retrieved 4770 citations, 103 of which were selected for full-text review. Twenty-one studies with a combined population of 37359 patients with COVID-19 fulfilled the inclusion criteria. From this population, 5800 patients were treated by invasive mechanical ventilation. Out of those, 3301 patients reached an endpoint of ICU discharge or death after invasive mechanical ventilation while the rest were still in the ICU. Mortality from IMV was highly variable among the included studies ranging between 21% and 100%. Random-effect pooled estimates suggested an overall in-hospital mortality risk ratio of 0.70 (95% confidence interval 0.608 to 0.797; I2 = 98%). Subgroup analysis according to country of origin showed homogeneity in the 8 Chinese studies with high pooled mortality risk ratio of 0.97 (I2 = 24%, p=0.23) (95% CI = 0.94-1.00), similar to Italy with a low pooled mortality risk ratio of 0.26 (95% CI 0.08-0.43) with homogeneity (p=0.86) while the later larger studies coming from the USA showed pooled estimate mortality risk ratio of 0.60 (95% CI 0.43-0.76) with persistent heterogeneity (I2 = 98%, p<0.001). Meta-regression showed that outcome from IMV improved with time (p<0.001). Age had no statistically significant effect on mortality (p= 0.102). Publication bias was excluded by visualizing the funnel plot of standard error, Egger's test with p=0.714 and Begg&Mazumdar test with p=0.334Interpretation: The study included the largest number of patients with outcome findings of IMV in this current pandemic. Our findings showed that the use of IMV for selected COVID 19 patients with severe ARDS carries a high mortality, but outcome has improved over the last few months and in more recent studies. The results should encourage physicians to use this facility when indicated for severely ill COVID-19 patients.

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Cranial Base Angle in Patients With Cleft Lip and Palate—A Systematic Review and Meta-Analysis

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211053545 ◽

2021 ◽

pp. 105566562110535

Author(s):

Chandnee Murugan ◽

Vignesh Kailasam

Keyword(s):

Systematic Review ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Meta Analysis ◽

Cranial Base ◽

Class I ◽

Base Angle ◽

Registration Number ◽

Newcastle Ottawa Scale ◽

Ottawa Scale

Background: Diverse findings have been reported for the cranial base angle (CBA) in patients with CLP (cleft lip and palate) and non-CLP controls. Objective: The aim of this study is to assess and evaluate the CBA in patients with CLP and non-CLP controls. Methods: Data from PubMed, OVID Technologies, Inc., Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scopus, Web of Science, and EMBASE for Excerpta Medica dataBASE (EMBASE) with relevant terms was extracted until December 31, 2020. Inclusion criteria were data of patients with non-syndromic unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). In the case of UCLP and BCLP, patients with craniofacial syndromes were excluded. The study proposal was registered with PROSPERO (Registration number: CRD42021228632). Results: Fifteen studies with a total of 2032 participants were included for the systematic review and 14 studies with a total of 1972 participants were included for the meta-analysis. The risk of bias was assessed using the Modified Newcastle Ottawa scale under seven domains by two authors. Thirteen studies were graded as “good” and two as “satisfactory.” The CBA in patients with CLP were greater than the non CLP Class I controls in six of the 15 studies. CBA was greater in patients with CLP than non-CLP controls by 1.21° (95% CI of 0.19-2.22). Meta-analysis reported considerable heterogeneity (I2 = 86%). Anterior (ACB) and posterior cranial base (PCB) lengths were shorter in patients with CLP than in the non-cleft Class I controls by 2.14 mm (95% CI of 0.99-3.30) and 2.06 mm (95% CI of 1.52-2.60), respectively. Conclusion: Most studies were graded as good. Patients with CLP had greater CBA and shorter ACB and PCB lengths when compared to non-CLP controls.

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Socioeconomic Factors and Caries in People between 19 and 60 Years of Age: An Update of a Systematic Review and Meta-Analysis of Observational Studies

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15081775 ◽

2018 ◽

Vol 15 (8) ◽

pp. 1775 ◽

Cited By ~ 15

Author(s):

Simone Costa ◽

Carolina Martins ◽

Mânia Pinto ◽

Mara Vasconcelos ◽

Mauro Abreu

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Socioeconomic Indicators ◽

Effect Model ◽

Statistical Heterogeneity ◽

Newcastle Ottawa Scale ◽

Meta Regression ◽

Ottawa Scale

This study is aimed to perform an update of a systematic review and meta-regression to evaluate the effect modification of the socioeconomic indicators on caries in adults. We included studies that associated social determinants with caries, with no restriction of year and language. The Newcastle-Ottawa Scale was used to evaluate the risk of bias. With regard to the meta-analysis, statistical heterogeneity was evaluated by I2, and the random effect model was used when it was high. A subgroup analysis was conducted for socioeconomic indicators, and a meta-regression was performed. Publication bias was assessed through Egger’s test. Sixty-one studies were included in the systematic review and 25 were included in the meta-analysis. All of the studies were published between 1975 and 2016. The most frequent socioeconomic indicators were schooling, income, and socioeconomic status (SES). In the quantitative analysis, the DMFT (decayed, missing, filled teeth) variation was attributed to the studies’ heterogeneity. The increase of 10.35 units in the proportion of people with lower SES was associated with an increase of one unit in DMFT, p = 0.050. The findings provide evidence that populations with the highest proportions of people with low SES are associated with a greater severity of caries. The results suggest the need for actions to reduce the inequalities in oral health (PROSPERO [CRD42017074434]).

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Epidemiology of placenta previa accreta: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-031193 ◽

2019 ◽

Vol 9 (11) ◽

pp. e031193 ◽

Cited By ~ 9

Author(s):

Eric Jauniaux ◽

Lene Grønbeck ◽

Catey Bunce ◽

Jens Langhoff-Roos ◽

Sally L Collins

Keyword(s):

Systematic Review ◽

Placenta Previa ◽

Data Extraction ◽

Meta Analysis ◽

Eligibility Criteria ◽

Registration Number ◽

Newcastle Ottawa Scale ◽

Placenta Accreta Spectrum ◽

Obstetric Population ◽

Ottawa Scale

ObjectiveTo estimate the prevalence and incidence of placenta previa complicated by placenta accreta spectrum (PAS) and to examine the different criteria being used for the diagnosis.DesignSystematic review and meta-analysis.Data sourcesPubMed, Google Scholar, ClinicalTrials.gov and MEDLINE were searched between August 1982 and September 2018.Eligibility criteriaStudies reporting on placenta previa complicated by PAS diagnosed in a defined obstetric population.Data extraction and synthesisTwo independent reviewers performed the data extraction using a predefined protocol and assessed the risk of bias using the Newcastle-Ottawa scale for observational studies, with difference agreed by consensus. The primary outcomes were overall prevalence of placenta previa, incidence of PAS according to the type of placenta previa and the reported clinical outcomes, including the number of peripartum hysterectomies and direct maternal mortality. The secondary outcomes included the criteria used for the prenatal ultrasound diagnosis of placenta previa and the criteria used to diagnose and grade PAS at birth.ResultsA total of 258 articles were reviewed and 13 retrospective and 7 prospective studies were included in the analysis, which reported on 587 women with placenta previa and PAS. The meta-analysis indicated a significant (p<0.001) heterogeneity between study estimates for the prevalence of placenta previa, the prevalence of placenta previa with PAS and the incidence of PAS in the placenta previa cohort. The median prevalence of placenta previa was 0.56% (IQR 0.39–1.24) whereas the median prevalence of placenta previa with PAS was 0.07% (IQR 0.05–0.16). The incidence of PAS in women with a placenta previa was 11.10% (IQR 7.65–17.35).ConclusionsThe high heterogeneity in qualitative and diagnostic data between studies emphasises the need to implement standardised protocols for the diagnoses of both placenta previa and PAS, including the type of placenta previa and grade of villous invasiveness.PROSPERO registration numberCRD42017068589

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Variation in outcome of invasive mechanical ventilation between different countries for patients with severe COVID-19: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0252760 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252760

Author(s):

Hany Hasan Elsayed ◽

Aly Sherif Hassaballa ◽

Taha Aly Ahmed ◽

Mohammed Gumaa ◽

Hazem Youssef Sharkawy ◽

...

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Publication Bias ◽

Risk Ratio ◽

Mortality Risk ◽

Subgroup Analysis ◽

Meta Analysis ◽

Invasive Mechanical Ventilation ◽

Random Effect ◽

Meta Regression

Background COVID 19 is the most recent cause of Adult respiratory distress syndrome ARDS. Invasive mechanical ventilation IMV can support gas exchange in patients failing non-invasive ventilation, but its reported outcome is highly variable between countries. We conducted a systematic review and meta-analysis on IMV for COVID-associated ARDS to study its outcome among different countries. Methods CENTRAL, MEDLINE/PubMed, Cochrane Library, and Scopus were systematically searched up to August 8, 2020. Studies reporting five or more patients with end point outcome for severe COVID 19 infection treated with IMV were included. The main outcome assessed was mortality. Baseline, procedural, outcome, and validity data were systematically appraised and pooled with random-effect methods. Subgroup analysis for different countries was performed. Meta-regression for the effect of study timing and patient age and were tested. Publication bias was examined. This trial was registered with PROSPERO under registration number CRD42020190365. Findings Our electronic search retrieved 4770 citations, 103 of which were selected for full-text review. Twenty-one studies with a combined population of 37359 patients with COVID-19 fulfilled the inclusion criteria. From this population, 5800 patients were treated by invasive mechanical ventilation. Out of those, 3301 patients reached an endpoint of ICU discharge or death after invasive mechanical ventilation while the rest were still in the ICU. Mortality from IMV was highly variable among the included studies ranging between 21% and 100%. Random-effect pooled estimates suggested an overall in-hospital mortality risk ratio of 0.70 (95% confidence interval 0.608 to 0.797; I2 = 98%). Subgroup analysis according to country of origin showed homogeneity in the 8 Chinese studies with high pooled mortality risk ratio of 0.97 (I2 = 24%, p = 0.23) (95% CI = 0.94–1.00), similar to Italy with a low pooled mortality risk ratio of 0.26 (95% CI 0.08–0.43) with homogeneity (p = 0.86) while the later larger studies coming from the USA showed pooled estimate mortality risk ratio of 0.60 (95% CI 0.43–0.76) with persistent heterogeneity (I2 = 98%, p<0.001). Meta-regression showed that outcome from IMV improved with time (p<0.001). Age had no statistically significant effect on mortality (p = 0.102). Publication bias was excluded by visualizing the funnel plot of standard error, Egger’s test with p = 0.714 and Begg&Mazumdar test with p = 0.334. Interpretation The study included the largest number of patients with outcome findings of IMV in this current pandemic. Our findings showed that the use of IMV for selected COVID 19 patients with severe ARDS carries a high mortality, but outcome has improved over the last few months and in more recent studies. The results should encourage physicians to use this facility when indicated for severely ill COVID-19 patients.

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What does my neighbourhood have to do with my weight? A protocol for systematic review and meta-analysis of the association between neighbourhood socioeconomic status and body weight

BMJ Open ◽

10.1136/bmjopen-2017-017567 ◽

2017 ◽

Vol 7 (9) ◽

pp. e017567

Author(s):

Shimels Hussien Mohammed ◽

Mulugeta Molla Birhanu ◽

Tesfamichael Awoke Sissay ◽

Tesfa Dejenie Habtewold ◽

Balewgizie Sileshi Tegegn ◽

...

Keyword(s):

Systematic Review ◽

Socioeconomic Status ◽

Data Extraction ◽

Meta Analysis ◽

Cross Sectional ◽

Registration Number ◽

Newcastle Ottawa Scale ◽

Neighbourhood Socioeconomic Status ◽

Using Data

IntroductionIndividuals living in poor neighbourhoods are at a higher risk of overweight/obesity. There is no systematic review and meta-analysis study on the association of neighbourhood socioeconomic status (NSES) with overweight/obesity. We aimed to systematically review and meta-analyse the existing evidence on the association of NSES with overweight/obesity.Methods and analysisCross-sectional, case–control and cohort studies published in English from inception to 15 May 2017 will be systematically searched using the following databases: PubMed, EMBASE, Web of Sciences and Google Scholar. Selection, screening, reviewing and data extraction will be done by two reviewers, independently and in duplicate. The Newcastle–Ottawa Scale (NOS) will be used to assess the quality of evidence. Publication bias will be checked by visual inspection of funnel plots and Egger’s regression test. Heterogeneity will be checked by Higgins’s method (I2statistics). Meta-analysis will be done to estimate the pooled OR. Narrative synthesis will be performed if meta-analysis is not feasible due to high heterogeneity of studies.Ethics and disseminationEthical clearance is not required as we will be using data from published articles. Findings will be communicated through a publication in a peer-reviewed journal and presentations at professional conferences.PROSPERO registration numberCRD42017063889.

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Sleep in youth with autism spectrum disorders: systematic review and meta-analysis of subjective and objective studies

Evidence-Based Mental Health ◽

10.1136/ebmental-2018-300037 ◽

2018 ◽

Vol 21 (4) ◽

pp. 146-154 ◽

Cited By ~ 23

Author(s):

Amparo Díaz-Román ◽

Junhua Zhang ◽

Richard Delorme ◽

Anita Beggiato ◽

Samuele Cortese

Keyword(s):

Systematic Review ◽

Autism Spectrum Disorders ◽

Evidence Synthesis ◽

Meta Analysis ◽

Autism Spectrum ◽

Newcastle Ottawa Scale ◽

Spectrum Disorders ◽

Sleep Alterations ◽

The Impact ◽

Ottawa Scale

BackgroundSleep problems are common and impairing in individuals with autism spectrum disorders (ASD). Evidence synthesis including both subjective (ie, measured with questionnaires) and objective (ie, quantified with neurophysiological tools) sleep alterations in youth with ASD is currently lacking.ObjectiveWe conducted a systematic review and meta-analysis of subjective and objective studies sleep studies in youth with ASD.MethodsWe searched the following electronic databases with no language, date or type of document restriction up to 23 May 2018: PubMed, PsycInfo, Embase+Embase Classic, Ovid Medline and Web of Knowledge. Random-effects models were used. Heterogeneity was assessed with Cochran’s Q and I2 statistics. Publication (small studies) bias was assessed with final plots and the Egger’s test. Study quality was evaluated with the Newcastle Ottawa Scale. Analyses were conducted using Review Manager and Comprehensive Meta-Analysis.FindingsFrom a pool of 3359 non-duplicate potentially relevant references, 47 datasets were included in the meta-analyses. Subjective and objective sleep outcome measures were extracted from 37 and 15 studies, respectively. Only five studies were based on comorbidity free, medication-naïve participants. Compared with typically developing controls, youth with ASD significantly differed in 10/14 subjective parameters and in 7/14 objective sleep parameters. The average quality score in the Newcastle-Ottawa Scale was 5.9/9.Discussion and clinical implicationsA number of subjective and, to a less extent, objective sleep alterations might characterise youth with ASD, but future studies should assess the impact of pharmacological treatment and psychiatric comorbidities.

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Diet quality during preconception or pregnancy and gestational weight gain: protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-033130 ◽

2020 ◽

Vol 10 (2) ◽

pp. e033130

Author(s):

Yamei Yu ◽

Isabelle Hardy ◽

Wenguang Sun ◽

Dean A Fergusson ◽

William Fraser ◽

...

Keyword(s):

Systematic Review ◽

Weight Gain ◽

Gestational Weight Gain ◽

Diet Quality ◽

Meta Analysis ◽

Random Effect ◽

Primary Data ◽

Gestational Weight ◽

Newcastle Ottawa Scale ◽

Scientific Meetings

IntroductionInappropriate gestational weight gain (GWG), including inadequate and excessive GWG, has become pandemic across nations and continents. This review aims to synthesise the evidence on the correlation between diet quality and GWG. If this association is confirmed, improving diet quality could become an intervention target in the efforts to reduce inappropriate GWG.Methods and analysisWe will conduct a systematic review of all prospective cohort studies on diet quality in preconception or pregnancy and GWG. Our secondary outcomes include gestational diabetes, pre-eclampsia and birth weight. A comprehensive search of all published articles in MEDLINE ALL (Ovid), Embase (Ovid), Food Science and Technology Abstracts (Ovid) and CINAHL (EBSCOHost), from database creation to 20 April 2019, will be conducted. Studies will be screened for eligibility by title, abstract and full text in duplicate by two independent reviewers. Study quality and risk of bias will be assessed using the adapted Newcastle–Ottawa Scale. Results will be reported following the meta-analysis of observational studies in epidemiology guidelines. If sufficient data are available, a meta-analysis will be conducted to synthesise the effect size reported as OR with 95% CI using both fixed-effect and random-effect models. I2 statistics and visual inspection of the forest plots will be used to assess heterogeneity and identify the potential sources of heterogeneity. Publication bias will be assessed by visual inspections of funnel plots and Egger’s test.Ethics and disseminationFormal ethical approval is not required as no primary data will be collected. We aim to publish the results of this study in a peer-reviewed journal and present them at conferences and scientific meetings to promote knowledge transfer.PROSPERO registration numberCRD42019128732

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Metabolic Syndrome and Its Components in Patients with COVID-19: Severe Acute Respiratory Syndrome (SARS) and Mortality. A Systematic Review and Meta-Analysis

Journal of Cardiovascular Development and Disease ◽

10.3390/jcdd8120162 ◽

2021 ◽

Vol 8 (12) ◽

pp. 162

Author(s):

Sergio Rico-Martín ◽

Julián F. Calderón-García ◽

Belinda Basilio-Fernández ◽

María Zoraida Clavijo-Chamorro ◽

Juan F. Sánchez Muñoz-Torrero

Keyword(s):

Systematic Review ◽

Metabolic Syndrome ◽

Severe Acute Respiratory Syndrome ◽

Meta Analysis ◽

Risk Of Bias ◽

Newcastle Ottawa Scale ◽

Abstract Screening ◽

The Relationship ◽

Metabolic Comorbidities ◽

Ottawa Scale

Recent meta-analysis studies have reported that metabolic comorbidities such as diabetes, obesity, dyslipidaemia and hypertension are associated with higher risk of severe acute respiratory syndrome (SARS) and mortality in patients with COVID-19. This meta-analysis aims to investigate the relationship between metabolic syndrome (MetS) and its components with SARS and mortality in COVID-19 patients. Methods: A systematic search was conducted in the several databases up until 1 September 2021. Primary observational longitudinal studies published in peer review journals were selected. Two independent reviewers performed title and abstract screening, extracted data and assessed the risk of bias using the Newcastle–Ottawa Scale. Results: The random effects meta-analysis showed that MetS was significantly associated with SARS with a pooled OR (95% CI) of 3.21 (2.88–3.58) and mortality with a pooled OR (95% CI) of 2.32 (1.16–4.63). According to SARS, the pooled OR for MetS was 2.19 (1.71–2.67), p < 0.001; significantly higher than the hypertension component. With regard to mortality, although the pooled OR for MetS was greater than for its individual components, no significant differences were observed. Conclusions: this meta-analysis of cohort studies, showed that MetS is better associated to SARS and mortality in COVID-19 patients than its individual components.

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