Incidence and management of seizures after ischemic stroke

Objective:We conducted a meta-analysis of the incidence of early and late seizures following ischemic stroke as well as a systematic review of their pharmacologic treatment.Methods:Observational studies that reported incidence of seizures following ischemic stroke and those that reported treatment response to any particular antiepileptic drugs (AEDs) were included. Risk of bias was assessed by predefined study characteristics. Random effects meta-analysis was conducted for all studies where data were available for the incidence of early and late stroke-related seizures. Heterogeneity was measured with I2 statistic and sensitivity analyses were performed using prespecified variables. A qualitative synthesis of studies reporting use of AEDs for stroke-related seizures was performed.Results:Forty-one studies from 10,554 articles were identified; 35 studies reported incidence of stroke-related seizures and 6 studies reported effects of specific AEDs. Most studies were of low to moderate quality. Rate of early seizures was 3.3% (95% confidence interval 2.8%–3.9%, I2 = 92.8%), while the incidence of late seizures or epilepsy was 18 per 1,000 person-years (95% confidence interval 1.5–2.2, I2 = 94.1%). The high degree of heterogeneity could not be explained from the sensitivity analyses. For management of stroke-related seizures, no single AED was found to be more effective over others, though newer AEDs were associated with fewer side effects.Conclusions:The burden of stroke-related seizures and epilepsy due to ischemic stroke is substantial. Further studies are required to determine risk factors for epilepsy following ischemic stroke and optimal secondary prevention.

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Changes in apical base sagittal relationship in Class II malocclusion treatment with and without premolar extractions: A systematic review and meta-analysis

The Angle Orthodontist ◽

10.2319/030716-198.1 ◽

2016 ◽

Vol 87 (2) ◽

pp. 338-355 ◽

Cited By ~ 1

Author(s):

Guilherme Janson ◽

Aron Aliaga-Del Castillo ◽

Ana Niederberger

Keyword(s):

Meta Analysis ◽

Cochrane Collaboration ◽

Class Ii ◽

Risk Of Bias ◽

Sensitivity Analyses ◽

Cochrane Library ◽

Control Group ◽

Qualitative Synthesis ◽

Class Ii Treatment ◽

Apical Base

ABSTRACT Objective: To evaluate the changes in apical base sagittal relationship in Class II treatment with and without premolar extractions. Materials and Methods: Controlled studies evaluating ANB angle changes after Class II Division 1 malocclusion treatment with or without premolar extractions were considered. Electronic databases (PubMed, Embase, Web of Science, Scopus, The Cochrane Library, Lilacs, and Google Scholar) without limitations regarding publication year or language were searched. Risk of bias was assessed with Risk Of Bias in Non-randomized Studies—of Interventions tool of the Cochrane Collaboration. Mean difference (MD) and 95% confidence interval (CI) were calculated from the random-effects meta-analysis. Subgroup and sensitivity analyses were also performed. Results: Twenty-five studies satisfied the inclusion criteria and were included in the qualitative synthesis. Eleven nonextraction and only one extraction Class II treatment studies presented untreated Class II control group. Therefore, meta-analysis was performed only for the nonextraction protocol. In treated Class II nonextraction patients, the average of the various effects was a reduction in the ANB angle of 1.56° (95% CI: 1.03, 2.09, P < .001) compared with untreated Class II subjects. Class II malocclusions treated with two maxillary-premolar extractions and four-premolar extractions produced estimated mean reductions in ANB of −1.88° and −2.55°, respectively. However, there is a lack of low-risk-of-bias studies. Conclusions: According to the existing low quality evidence, the apical base sagittal relationship in nonextraction, two-maxillary and four-premolar extractions Class II treatments decreases −1.56°, 1.88° and 2.55°, respectively. Further studies are necessary to obtain more robust information.

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The impact of atrial fibrillation type on the risks of thromboembolic recurrence, mortality and major haemorrhage in patients with previous stroke: A systematic review and meta-analysis of observational studies

European Stroke Journal ◽

10.1177/2396987319896674 ◽

2020 ◽

Vol 5 (2) ◽

pp. 155-168

Author(s):

Antonia Mentel ◽

Terence J Quinn ◽

Alan C Cameron ◽

Kennedy R Lees ◽

Azmil H Abdul-Rahim

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Confidence Interval ◽

Odds Ratio ◽

Observational Studies ◽

Meta Analysis ◽

Major Haemorrhage ◽

Risk Of Bias ◽

Previous Stroke ◽

The Impact

Introduction There is conflicting evidence on the impact of atrial fibrillation (AF) type, i.e. non-paroxysmal AF or paroxysmal AF, on thromboembolic recurrence. The consensus of risk equivalence is greatly based on historical evidence, focussing on initial stroke risks. We conducted a systematic review and meta-analysis to describe the impact of AF type on the risk of thromboembolic recurrence, mortality and major haemorrhage in patients with previous stroke. Methods We systematically searched four multidisciplinary databases from inception to December 2018. We selected observational studies investigating clinical outcomes in patients with ischaemic stroke and AF, stratified by AF type. We assessed all included studies for risk of bias using the ‘Risk of Bias In Non-randomised Studies – of Exposures’ tool. The Comprehensive Meta-Analysis Software was used to calculate odds ratios from crude event rates. Results After reviewing 14,127 citations, we selected 108 studies for full-text screening. We extracted data from a total of 26 studies, reporting outcomes on 23,054 patients. Overall, risk of bias was moderate. The annual incidence rates of thromboembolism in patients with non-paroxysmal AF and paroxysmal AF were 7.1% (95% confidence interval: 4.2–11.7) and 5.2% (95% confidence interval: 3.2–8.2), respectively. The odds ratio for thromboembolism in patients with non-paroxysmal AF versus paroxysmal AF was 1.47 (95% confidence interval: 1.08–1.99, p = 0.013). The annual mortality rates in patients with non-paroxysmal AF and paroxysmal AF were 20.0% (95% confidence interval: 13.2–28.0) and 10.1% (95% confidence interval: 5.4–17.3), respectively, and odds ratio was 1.90 (95% confidence interval: 1.43–2.52, p < 0.001). There was no difference in rates of major haemorrhage, odds ratio = 1.01 (95% confidence interval: 0.61–1.69, p = 0.966). Conclusion In patients with prior stroke, non-paroxysmal AF is associated with significantly higher risk of thromboembolic recurrence and mortality than paroxysmal AF. Although current guidelines make no distinction between non-paroxysmal AF and paroxysmal AF for secondary stroke prevention, future guidance and risk stratification tools may need to consider this differential risk (PROSPERO ID: CRD42019118531).

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Prognostic and therapeutic role of vitamin D in COVID-19: systematic review and meta-analysis

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab892 ◽

2021 ◽

Author(s):

Harsha Anuruddhika Dissanayake ◽

Nipun Lakshitha de Silva ◽

Manilka Sumanatilleke ◽

Sawanawadu Dilantha Neomal de Silva ◽

Kavinga Kalhari Kobawaka Gamage ◽

...

Keyword(s):

Vitamin D ◽

High Risk ◽

Vitamin D Deficiency ◽

Observational Studies ◽

Meta Analysis ◽

Severe Disease ◽

Risk Of Bias ◽

Sensitivity Analyses ◽

Cochrane Library

Abstract Purpose Vitamin D deficiency/insufficiency may increase the susceptibility to COVID-19. We aimed to determine the association between vitamin D deficiency/insufficiency and susceptibility to COVID-19, its severity, mortality and role of vitamin D in its treatment. Methods We searched CINHAL, Cochrane library, EMBASE, PubMED, Scopus, and Web of Science up to 30.05.2021 for observational studies on association between vitamin D deficiency/insufficiency and susceptibility to COVID-19, severe disease and death among adults, and, randomized controlled trials (RCTs) comparing vitamin D treatment against standard care or placebo, in improving severity or mortality among adults with COVID-19. Risk of bias was assessed using Newcastle-Ottawa scale for observational studies and AUB-KQ1 Cochrane tool for RCTs. Study-level data were analyzed using RevMan 5.3 and R (v4∙1∙0). Heterogeneity was determined by I 2 and sources were explored through pre-specified sensitivity analyses, subgroup analyses and meta-regressions. Results Of 1877 search results, 76 studies satisfying eligibility criteria were included. Seventy-two observational studies were included in the meta-analysis (n=1976099). Vitamin D deficiency/insufficiency increased the odds of developing COVID-19 (OR 1∙46, 95% CI 1∙28–1∙65, p<0∙0001, I 2=92%), severe disease (OR 1∙90, 95% CI 1∙52–2∙38, p<0.0001, I 2=81%) and death (OR 2∙07, 95% CI 1∙28–3∙35, p=0.003, I 2=73%). 25-hydroxy vitamin D (25(OH)D) concentration were lower in individuals with COVID-19 compared to controls (mean difference [MD] -3∙85 ng/mL, 95% CI -5∙44,-2∙26, p=<0.0001), in patients with severe COVID-19 compared to controls with non-severe COVID19 (MD -4∙84 ng/mL, 95% CI -7∙32,-2∙35, p=0∙0001) and in non-survivors compared to survivors (MD -4∙80 ng/mL, 95%-CI -7∙89,-1∙71, p=0∙002). The association between vitamin D deficiency/insufficiency and death was insignificant when studies with high risk of bias or studies reporting unadjusted effect estimates were excluded. Risk of bias and heterogeneity were high across all analyses. Discrepancies in timing of vitamin D testing, definitions of severe COVID-19 and vitamin D deficiency/insufficiency partly explained the heterogeneity. Four RCTs were widely heterogeneous precluding meta-analysis. Conclusion Multiple observational studies involving nearly two million adults suggest vitamin D deficiency/insufficiency increases susceptibility to COVID-19 and severe COVID-19, although with a high risk of bias and heterogeneity. Association with mortality was less robust. Heterogeneity in RCTs precluded their meta-analysis.

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WED 255 SSRIS and risk of intracranial haemorrhage

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2018-abn.126 ◽

2018 ◽

Vol 89 (10) ◽

pp. A36.3-A36

Author(s):

Melanie P Jensen ◽

Oliver J Ziff ◽

Gargi Banerjee ◽

Gareth Ambler ◽

David J Werring

Keyword(s):

Observational Studies ◽

Intracranial Haemorrhage ◽

Selective Serotonin Reuptake Inhibitors ◽

Meta Analysis ◽

Risk Of Bias ◽

Sensitivity Analyses ◽

Randomised Trials ◽

Increased Risk ◽

Comprehensive Search ◽

The Impact

The abstract has also been presented as an oral presentation at the ESOC conference.Background and aimsObservational studies have suggested increased risk of intracranial haemorrhage (ICrH) in patients receiving selective serotonin reuptake inhibitors (SSRI). We sought to clarify the impact of SSRI on ICrH, accounting for study methodology.MethodA comprehensive search of Medline, Embase and Cochrane from 1960 to December 2017 comparing SSRI with control. ICrH was meta-analysed using a random-effects model and the review was prospectively registered (PROSPERO:CRD42017084513).Results25 observational studies, but no randomised trials, were available for meta-analysis, with a combined total of 4,843,857 patient-years follow-up. Those treated with SSRI were more likely to have depression (p<0.001) and be female (p=0.04). Compared to control, SSRI were significantly associated with first-ever ICrH (RR: 1.31; 95% CI: 1.15 to 1.49); however, in survivors of ICrH there was no association between SSRI and recurrence (0.95, 0.83–1.09). Sensitivity analyses revealed a greater association between SSRI and ICrH in studies with a high risk of bias (p<0.001) than those with a lower risk of bias (p=0.10).ConclusionSSRI are associated with increased risk of first-ever ICrH, but not with recurrence. These findings, based solely on observational data, should be taken with caution due to fundamental differences in patients receiving treatment, highlighting the need for randomised trials.

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Electronic Health Interventions to Improve Adherence to Antiretroviral Therapy in People Living With HIV: Systematic Review and Meta-Analysis (Preprint)

10.2196/preprints.14404 ◽

2019 ◽

Author(s):

Ziqi Wang ◽

Yaxin Zhu ◽

Liyuan Cui ◽

Bo Qu

Keyword(s):

Antiretroviral Therapy ◽

Meta Analysis ◽

Risk Of Bias ◽

Sensitivity Analyses ◽

Controlled Trials ◽

People Living With Hiv ◽

Art Adherence ◽

Study Characteristics ◽

Participant Characteristics ◽

Living With Hiv

BACKGROUND Electronic health (eHealth) is increasingly used for self-management and service delivery of HIV-related diseases. With the publication of studies increasingly focusing on antiretroviral therapy (ART) adherence, this makes it possible to quantitatively and systematically assess the effectiveness and feasibility of eHealth interventions. OBJECTIVE The purpose of this review was to explore the effectiveness of eHealth interventions on improving ART adherence in people living with HIV. The effects of different intervention characteristics, participant characteristics, and study characteristics were also assessed. METHODS We systematically searched MEDLINE (via PubMed), EMBASE, the Cochrane Central Register of Controlled Trials, and 3 conference abstract databases using search terms related to HIV, ART, adherence, and eHealth interventions. We independently screened the studies, extracted the data, and assessed the study quality and then compared the information in pairs. Articles published in English that used randomized controlled trials to assess eHealth interventions to improve ART adherence of people living with HIV were identified. We extracted the data including study characteristics, participant characteristics, intervention characteristics, and outcome measures. The Cochrane risk-of-bias tool was used to assess the risk of bias and study overall quality. Odds ratios, Cohen <italic>d</italic>, and their 95% CIs were estimated using random-effects models. We also performed multiple subgroup analyses and sensitivity analyses to define any sources of heterogeneity. RESULTS Among 3941 articles identified, a total of 19 studies (including 21 trials) met the inclusion criteria. We found 8 trials from high-income countries and 13 trials from low- and middle-income countries. Furthermore, at baseline, the health status of participants in 14 trials was healthy. Of the trials included, 7 of 21 used personality content, 12 of 21 used a 2-way communication strategy, and 7 of 21 used medical content. In the pooled analysis of 3937 participants (mean age: 35 years; 47.16%, 1857/3937 females), eHealth interventions significantly improved the ART adherence of people living with HIV (pooled Cohen <italic>d</italic>=0.25; 95% CI 0.05 to 0.46; <italic>P</italic>=.01). The interventions were also correlated with improved biochemical outcomes reported by 11 trials (pooled Cohen <italic>d</italic>=0.25; 95% CI 0.11 to 0.38; <italic>P</italic><.001). The effect was sensitive to sample size (<italic>Q</italic>=5.56; <italic>P</italic>=.02) and study duration (<italic>Q</italic>=8.89; <italic>P</italic>=.003), but it could not be explained by other moderators. The primary meta-analysis result was stable in the 3 sensitivity analyses. CONCLUSIONS Some of the eHealth interventions may be used as an effective method to increase the ART adherence of people living with HIV. Considering that most of the trials included a small sample size and were conducted for a short duration, these results should be interpreted with caution. Future studies need to determine the features of eHealth interventions to better improve ART adherence along with long-term effectiveness of interventions, effectiveness of real-time adherence monitoring, enhancement of study design, and influences on biochemical outcomes.

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Electronic Health Interventions to Improve Adherence to Antiretroviral Therapy in People Living With HIV: Systematic Review and Meta-Analysis

JMIR mhealth and uhealth ◽

10.2196/14404 ◽

2019 ◽

Vol 7 (10) ◽

pp. e14404 ◽

Cited By ~ 6

Author(s):

Ziqi Wang ◽

Yaxin Zhu ◽

Liyuan Cui ◽

Bo Qu

Keyword(s):

Antiretroviral Therapy ◽

Meta Analysis ◽

Risk Of Bias ◽

Sensitivity Analyses ◽

Controlled Trials ◽

People Living With Hiv ◽

Art Adherence ◽

Study Characteristics ◽

Participant Characteristics ◽

Living With Hiv

Background Electronic health (eHealth) is increasingly used for self-management and service delivery of HIV-related diseases. With the publication of studies increasingly focusing on antiretroviral therapy (ART) adherence, this makes it possible to quantitatively and systematically assess the effectiveness and feasibility of eHealth interventions. Objective The purpose of this review was to explore the effectiveness of eHealth interventions on improving ART adherence in people living with HIV. The effects of different intervention characteristics, participant characteristics, and study characteristics were also assessed. Methods We systematically searched MEDLINE (via PubMed), EMBASE, the Cochrane Central Register of Controlled Trials, and 3 conference abstract databases using search terms related to HIV, ART, adherence, and eHealth interventions. We independently screened the studies, extracted the data, and assessed the study quality and then compared the information in pairs. Articles published in English that used randomized controlled trials to assess eHealth interventions to improve ART adherence of people living with HIV were identified. We extracted the data including study characteristics, participant characteristics, intervention characteristics, and outcome measures. The Cochrane risk-of-bias tool was used to assess the risk of bias and study overall quality. Odds ratios, Cohen d, and their 95% CIs were estimated using random-effects models. We also performed multiple subgroup analyses and sensitivity analyses to define any sources of heterogeneity. Results Among 3941 articles identified, a total of 19 studies (including 21 trials) met the inclusion criteria. We found 8 trials from high-income countries and 13 trials from low- and middle-income countries. Furthermore, at baseline, the health status of participants in 14 trials was healthy. Of the trials included, 7 of 21 used personality content, 12 of 21 used a 2-way communication strategy, and 7 of 21 used medical content. In the pooled analysis of 3937 participants (mean age: 35 years; 47.16%, 1857/3937 females), eHealth interventions significantly improved the ART adherence of people living with HIV (pooled Cohen d=0.25; 95% CI 0.05 to 0.46; P=.01). The interventions were also correlated with improved biochemical outcomes reported by 11 trials (pooled Cohen d=0.25; 95% CI 0.11 to 0.38; P<.001). The effect was sensitive to sample size (Q=5.56; P=.02) and study duration (Q=8.89; P=.003), but it could not be explained by other moderators. The primary meta-analysis result was stable in the 3 sensitivity analyses. Conclusions Some of the eHealth interventions may be used as an effective method to increase the ART adherence of people living with HIV. Considering that most of the trials included a small sample size and were conducted for a short duration, these results should be interpreted with caution. Future studies need to determine the features of eHealth interventions to better improve ART adherence along with long-term effectiveness of interventions, effectiveness of real-time adherence monitoring, enhancement of study design, and influences on biochemical outcomes.

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Predictability of rotational tooth movement with orthodontic aligners comparing software-based and achieved data: A systematic review and meta-analysis of observational studies

Journal of Orthodontics ◽

10.1177/14653125211027266 ◽

2021 ◽

pp. 146531252110272

Author(s):

Despina Koletsi ◽

Anna Iliadi ◽

Theodore Eliades

Keyword(s):

Effect Size ◽

Tooth Movement ◽

Data Extraction ◽

Meta Analysis ◽

Risk Of Bias ◽

Patient Treatment ◽

Qualitative Synthesis ◽

Meta Analyses ◽

Enamel Reduction

Objective: To evaluate all available evidence on the prediction of rotational tooth movements with aligners. Data sources: Seven databases of published and unpublished literature were searched up to 4 August 2020 for eligible studies. Data selection: Studies were deemed eligible if they included evaluation of rotational tooth movement with any type of aligner, through the comparison of software-based and actually achieved data after patient treatment. Data extraction and data synthesis: Data extraction was done independently and in duplicate and risk of bias assessment was performed with the use of the QUADAS-2 tool. Random effects meta-analyses with effect sizes and their 95% confidence intervals (CIs) were performed and the quality of the evidence was assessed through GRADE. Results: Seven articles were included in the qualitative synthesis, of which three contributed to meta-analyses. Overall results revealed a non-accurate prediction of the outcome for the software-based data, irrespective of the use of attachments or interproximal enamel reduction (IPR). Maxillary canines demonstrated the lowest percentage accuracy for rotational tooth movement (three studies: effect size = 47.9%; 95% CI = 27.2–69.5; P < 0.001), although high levels of heterogeneity were identified (I2: 86.9%; P < 0.001). Contrary, mandibular incisors presented the highest percentage accuracy for predicted rotational movement (two studies: effect size = 70.7%; 95% CI = 58.9–82.5; P < 0.001; I2: 0.0%; P = 0.48). Risk of bias was unclear to low overall, while quality of the evidence ranged from low to moderate. Conclusion: Allowing for all identified caveats, prediction of rotational tooth movements with aligner treatment does not appear accurate, especially for canines. Careful selection of patients and malocclusions for aligner treatment decisions remain challenging.

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Cannabis and its derivatives for the use of motor symptoms in Parkinson’s disease: a systematic review and meta-analysis

Therapeutic Advances in Neurological Disorders ◽

10.1177/17562864211018561 ◽

2021 ◽

Vol 14 ◽

pp. 175628642110185

Author(s):

Susan J. Thanabalasingam ◽

Brandan Ranjith ◽

Robyn Jackson ◽

Don Thiwanka Wijeratne

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Motor Function ◽

Observational Studies ◽

Meta Analysis ◽

Risk Of Bias ◽

Motor Symptom ◽

Quality Data ◽

Symptom Improvement ◽

Motor Symptoms

Background: Recent changes to the legal status of cannabis across various countries have renewed interest in exploring its use in Parkinson’s disease (PD). The use of cannabinoids for alleviation of motor symptoms has been extensively explored in pre-clinical studies. Objective: We aim to systematically review and meta-analyze literature on the use of medical cannabis or its derivatives (MC) in PD patients to determine its effect on motor function and its safety profile. Methods: We reviewed and analyzed original, full-text randomized controlled trials (RCTs) and observational studies. Primary outcomes were change in motor function and dyskinesia. Secondary outcomes included adverse events and side effects. All studies were analyzed for risk of bias. Results: Fifteen studies, including six RCTs, were analyzed. Of these, 12/15 (80%) mention concomitant treatment with antiparkinsonian medications, most commonly levodopa. Primary outcomes were most often measured using the Unified Parkinson Disease Rating Scale (UPDRS) among RCTs and patient self-report of symptom improvement was widely used among observational studies. Most of the observational data lacking appropriate controls had effect estimates favoring the intervention. However, the controlled studies demonstrated no significant motor symptom improvement overall. The meta-analysis of three RCTs, including a total of 83 patients, did not demonstrate a statistically significant improvement in UPDRS III score variation (MD −0.21, 95% CI −4.15 to 3.72; p = 0.92) with MC use. Only one study reported statistically significant improvement in dyskinesia ( p < 0.05). The intervention was generally well tolerated. All RCTs had a high risk of bias. Conclusion: Although observational studies establish subjective symptom alleviation and interest in MC among PD patients, there is insufficient evidence to support its integration into clinical practice for motor symptom treatment. This is primarily due to lack of good quality data.

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Use of Statins and Breast Cancer: A Meta-Analysis of Seven Randomized Clinical Trials and Nine Observational Studies

Journal of Clinical Oncology ◽

10.1200/jco.2005.02.7045 ◽

2005 ◽

Vol 23 (34) ◽

pp. 8606-8612 ◽

Cited By ~ 139

Author(s):

Stefanos Bonovas ◽

Kalitsa Filioussi ◽

Nikolaos Tsavaris ◽

Nikolaos M. Sitaras

Keyword(s):

Breast Cancer ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Publication Bias ◽

Observational Studies ◽

Fixed Effects ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Sensitivity Analyses ◽

Fixed Effects Model

Purpose A growing body of evidence suggests that statins may have chemopreventive potential against breast cancer. Laboratory studies demonstrate that statins induce apoptosis and reduce cell invasiveness in various cell lines, including breast carcinoma cells. However, the clinical relevance of these data remains unclear. The nonconclusive nature of the epidemiologic data prompted us to conduct a detailed meta-analysis of the studies published on the subject in peer-reviewed literature. Patients and Methods A comprehensive search for articles published up until 2005 was performed; reviews of each study were conducted; and data were abstracted. Before meta-analysis, the studies were evaluated for publication bias and heterogeneity. Pooled relative risk (RR) estimates and 95% CIs were calculated using the random and the fixed-effects models. Subgroup and sensitivity analyses were also performed. Results Seven large randomized trials and nine observational studies (five case-control and four cohort studies) contributed to the analysis. We found no evidence of publication bias or heterogeneity among the studies. Statin use did not significantly affect breast cancer risk (fixed effects model: RR = 1.03; 95% CI, 0.93 to 1.14; random effects model: RR = 1.02; 95% CI, 0.89 to 1.18). When the analyses were stratified into subgroups, there was no evidence that study design substantially influenced the estimate of effects. Furthermore, the sensitivity analysis confirmed the stability of our results. Conclusion Our meta-analysis findings do not support a protective effect of statins against breast cancer. However, this conclusion is limited by the relatively short follow-up times of the studies analyzed. Further studies are required to investigate the potential decrease in breast cancer risk among long-term statin users.

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Association between Prior Calcium Channel Blocker use and Mortality in Septic Patients: A Meta-Analysis of Cohort Studies

10.21203/rs.3.rs-41244/v1 ◽

2020 ◽

Author(s):

Xianfei Ding ◽

Yuqing Cui ◽

Yanhui Zhu ◽

Huoyan Liang ◽

Dong Wang ◽

...

Keyword(s):

Septic Shock ◽

Cohort Studies ◽

Calcium Channel ◽

Calcium Channel Blocker ◽

Channel Blocker ◽

Meta Analysis ◽

Risk Of Bias ◽

Sensitivity Analyses ◽

Sepsis Management ◽

Term Survival

Abstract Background: To comprehensively review the literature and synthesize evidence concerning the relationship between preadmission calcium channel blocker (CCB) use and mortality in patients with sepsis.Methods: The MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched from their inception to April 9, 2020. Cohort studies that related to prior CCB use in patients with sepsis were analysed. Pairs of reviewers independently screened studies, extracted data, and assessed the risk of bias. Two primary outcomes related to mortality, namely, 30-day mortality and 90-day mortality, were analysed; heterogeneity between studies was assessed using I2 and was considered moderate if I2 was equivalent to 50–75% and high if I2 ≥ 75%. Fixed and random-effects models were used to calculate the pooled odds ratios (ORs) and 95% confidence intervals (CIs). The quality of outcomes was evaluated with the Newcastle-Ottawa Scale (NOS). Sensitivity analyses were performed to examine the robustness of the results.Results: 552 potentially relevant studies were identified, and the full texts of 25 articles were reviewed. Ultimately, five cohort studies involving 280,982 patients were confirmed to have a low risk of bias and were included. Preadmission CCB use was associated with a significantly lower 30-day mortality in septic shock (OR, 0.61 [0.38-0.97]; P = 0.035; I2 = 62.4%), not in sepsis (OR, 0.83 [0.66-1.04]; P = 0.103; I2 = 95.4%). Moreover, prior CCB use could significantly reduce 30-day mortality in sepsis (OR, 0.90 [0.85-0.95]; P < 0.001; I2 = 31.9%). Conclusions: This meta-analysis suggests that preadmission CCB use is significantly associated with improving long-term prognosis of sepsis, and also short-term survival of septic shock patients. This finding may provide an attractive direction for sepsis management.

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