Frequency of Neurologic Manifestations in COVID-19: A Systematic Review and Meta-analysis

Background and Objectives:One year since the onset of the COVID-19 pandemic, we aimed to summarize the frequency of neurological manifestations reported in COVID-19 patients and investigate the association of these manifestations with disease severity and mortality.Methods:We searched PubMed, Medline, Cochrane library, clinicaltrials.gov and EMBASE from 31st December 2019 to 15th December 2020 for studies enrolling consecutive COVID-19 patients presenting with neurological manifestations. Risk of bias was examined using Joanna Briggs Institute (JBI) scale. A random-effects meta-analysis was performed, and pooled prevalence and 95% Confidence Intervals (CI) were calculated for neurological manifestations. Odds ratio (OR) and 95%CI were calculated to determine the association of neurological manifestations with disease severity and mortality. Presence of heterogeneity was assessed using I-square, meta-regression, and subgroup analyses. Statistical analyses were conducted in R version 3.6.2.Results:Of 2,455 citations, 350 studies were included in this review, providing data on 145,721 COVID-19 patients, 89% of whom were hospitalized. Forty-one neurological manifestations (24 symptoms and 17 diagnoses) were identified. Pooled prevalence of the most common neurological symptoms included: fatigue (32%), myalgia (20%), taste impairment (21%), smell impairment (19%) and headache (13%). A low risk of bias was observed in 85% of studies; studies with higher risk of bias yielded higher prevalence estimates. Stroke was the most common neurological diagnosis (pooled prevalence- 2%). In COVID-19 patients aged ≥60, the pooled prevalence of acute confusion/delirium was 34% and the presence of any neurological manifestations in this age group was associated with mortality (OR 1.80; 95%CI 1.11 to 2.91).Discussion:Up to one-third of COVID-19 patients analysed in this review experienced at least one neurological manifestation. One in 50 patients experienced stroke. In those over 60, more than one-third had acute confusion/delirium; the presence of neurological manifestations in this group was associated with near doubling of mortality. Results must be interpreted keeping in view the limitations of observational studies and associated bias.

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Frequency of neurological manifestations in COVID-19: a systematic review and meta-analysis of 350 studies

10.1101/2021.04.20.21255780 ◽

2021 ◽

Author(s):

Shubham Misra ◽

Kavitha Kolappa ◽

Manya Prasad ◽

Divya Radhakrishnan ◽

Kiran T Thakur ◽

...

Keyword(s):

Systematic Review ◽

Disease Severity ◽

Meta Analysis ◽

Case Series ◽

Risk Of Bias ◽

Cochrane Library ◽

Neurological Manifestations ◽

Pooled Prevalence ◽

Prevalence Estimates ◽

Acute Confusion

SummaryObjectiveTo summarize the frequency of neurological manifestations reported in COVID-19 patients and investigate the association of these manifestations with disease severity and mortality.DesignSystematic review and meta-analysisEligibility criteriaStudies enrolling consecutive COVID-19 patients (probable or confirmed) presenting with neurological manifestations.Data sourcesPubMed, Medline, Cochrane library, clinicaltrials.gov and EMBASE from 31st December 2019 to 15th December 2020.Data extraction and analysisTwo authors independently screened titles and abstracts retrieved by literature search. Risk of bias was examined using Joanna Briggs Institute (JBI) scale. A random-effects meta-analysis was performed, and pooled prevalence and 95% Confidence Intervals (CI) were calculated for neurological manifestations. Odds ratio (OR) and 95%CI were calculated to determine the association of neurological manifestations with disease severity and mortality. Presence of heterogeneity was assessed using I-square, meta-regression, and subgroup analyses. Statistical analyses were conducted in R version 3.6.2.ResultsOf 2,455 citations, 350 studies were included in this review, providing data on 145,634 COVID-19 patients, 89% of whom were hospitalized. Forty-one neurological manifestations (24 symptoms and 17 diagnoses) were identified. Pooled prevalence of the most common neurological symptoms included: fatigue (32%), myalgia (20%), taste impairment (21%), smell impairment (19%) and headache (13%). A low risk of bias was observed in 85% of studies; studies with higher risk of bias yielded higher prevalence estimates. Stroke was the most common neurological diagnosis (pooled prevalence-2%). In COVID-19 patients aged >60, the pooled prevalence of acute confusion/delirium was 34% and the presence of any neurological manifestations in this age group was associated with mortality (OR 1.80; 95%CI 1.11 to 2.91).ConclusionsUp to one-third of COVID-19 patients analysed in this review experienced at least one neurological manifestation. One in 50 patients experienced stroke. In those over 60, more than one-third had acute confusion/delirium; the presence of neurological manifestations in this group was associated with near doubling of mortality. Results must be interpreted keeping in view the limitations of observational studies and associated bias.Systematic review registrationPROSPERO CRD42020181867.What is already known on this topicThe frequency of neurological manifestations including fatigue, myalgia, taste and smell impairments, headache and dizziness in COVID-19 patients has been reported in a few systematic reviews and meta-analyses. However, considerable heterogeneity has been observed in terms of methodological quality of the studies, severity of the disease, mean age and hospitalization status of the patients. The evidence regarding the frequency of neurological diagnoses including stroke, encephalitis, Guillain Barré syndrome (GBS) is also limited to case reports and case series and no data exists thus far on the pooled prevalence estimates for neurological diagnoses in COVID-19 patients.What this study addsTo the best of the authors’ knowledge, this is the largest systematic review and meta-analysis to date (including 350 studies with data on 145,634 cases) summarizing the evidence on the frequency of the full spectrum of neurological manifestations in COVID-19 patients in the overall, young and elderly populations. For the first time, our review reports the pooled prevalence of stroke in COVID-19 patients. Risk of bias, old age and disease severity were potential determinants of the frequency and nature of neurological manifestations as well as its association with mortality. Our review also highlights the need to develop reporting standards for studies describing the frequency of clinical features. Moreover, we note that this will be the first systematic review and meta-analysis on this subject to include studies reported in all languages.

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The effect of bearing surface on risk of periprosthetic joint infection in total hip arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.100b2.bjj-2017-0575.r1 ◽

2018 ◽

Vol 100-B (2) ◽

pp. 134-142 ◽

Cited By ~ 22

Author(s):

A. T. Hexter ◽

S. M. Hislop ◽

G. W. Blunn ◽

A. D. Liddle

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Periprosthetic Joint Infection ◽

Observational Studies ◽

Meta Analysis ◽

Joint Infection ◽

Risk Of Bias ◽

Cochrane Library ◽

Bearing Surface ◽

Total Hip

Aims Periprosthetic joint infection (PJI) is a serious complication of total hip arthroplasty (THA). Different bearing surface materials have different surface properties and it has been suggested that the choice of bearing surface may influence the risk of PJI after THA. The objective of this meta-analysis was to compare the rate of PJI between metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), and ceramic-on-ceramic (CoC) bearings. Patients and Methods Electronic databases (Medline, Embase, Cochrane library, Web of Science, and Cumulative Index of Nursing and Allied Health Literature) were searched for comparative randomized and observational studies that reported the incidence of PJI for different bearing surfaces. Two investigators independently reviewed studies for eligibility, evaluated risk of bias, and performed data extraction. Meta-analysis was performed using the Mantel–Haenzel method and random-effects model in accordance with methods of the Cochrane group. Results Our search strategy revealed 2272 studies, of which 17 met the inclusion criteria and were analyzed. These comprised 11 randomized controlled trials and six observational studies. The overall quality of included studies was high but the observational studies were at high risk of bias due to inadequate adjustment for confounding factors. The overall cumulative incidence of PJI across all studies was 0.78% (1514/193 378). For each bearing combination, the overall incidence was as follows: MoP 0.85% (1353/158 430); CoP 0.38% (67/17 489); and CoC 0.53% (94/17 459). The meta-analysis showed no significant difference between the three bearing combinations in terms of risk of PJI. Conclusion On the basis of the clinical studies available, there is no evidence that bearing choice influences the risk of PJI. Future research, including basic science studies and large, adequately controlled registry studies, may be helpful in determining whether implant materials play a role in determining the risk of PJI following arthroplasty surgery. Cite this article: Bone Joint J 2018;100-B:134–42.

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Prevalence and Risk Factors for Spasticity After Stroke: A Systematic Review and Meta-Analysis

Frontiers in Neurology ◽

10.3389/fneur.2020.616097 ◽

2021 ◽

Vol 11 ◽

Author(s):

Huangling Zeng ◽

Jian Chen ◽

Yang Guo ◽

Sheng Tan

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Observational Studies ◽

Hemorrhagic Stroke ◽

Meta Analysis ◽

Cochrane Library ◽

Stroke Patients ◽

Pooled Prevalence ◽

Severe Spasticity

Background: Spasticity is a common sequela of stroke. The incidence of poststroke spasticity (PSS) has not been systematically reviewed in recent years, and some risk factors remain debated. This systematic review and meta-analysis was conducted to determine the prevalence and risk factors for PSS.Methods: We searched electronic databases (PubMed, Embase, Cochrane Library, CNKI, WANFANG and CBM) inception to May 12, 2020. Observational studies summarizing the incidence or risk factors for PSS were included. Only cohort studies were enrolled in meta-analysis. For risk factors examined in at least three different studies, we combined effects into odds ratios (OR) and 95% confidence intervals (CI).Results: One thousand four hundred sixty-seven studies were retrieved and 23 were involved in meta-analysis. The pooled prevalence of spasticity after stroke was 25.3% and that after the first-ever stroke was 26.7%. The incidence of spasticity after the first-ever stroke with paresis was 39.5%. The prevalence of disabling or severe spasticity (MAS ≥ 3) in stroke patients with paresis was 9.4% (95% CI 0.056–0.133), and severe spasticity was 10.3% (95% CI 0.058–0.149). Moderate to severe paresis (OR = 6.573, 95% CI 2.579–16.755, I2 = 0.0%), hemorrhagic stroke (OR = 1.879, 95% CI 1.418–2.490, I2 = 27.3%) and sensory disorder were risk factors for PSS.Conclusions: The incidence of PSS was significantly higher in stroke patients with paresis. Patients with moderate to severe paresis and sensory disorder should be closely followed up. The role of hemorrhagic stroke in predicting PSS remains to be further explored.

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Prevalence of chronic pain after spinal cord injury: a systematic review and meta-analysis

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-101960 ◽

2021 ◽

pp. rapm-2020-101960

Author(s):

Christine Hunt ◽

Rajat Moman ◽

Ashley Peterson ◽

Rachel Wilson ◽

Stephen Covington ◽

...

Keyword(s):

Systematic Review ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Chronic Pain ◽

Classification System ◽

Meta Analysis ◽

Risk Of Bias ◽

Pooled Prevalence ◽

Cord Injury ◽

Prevalence Estimates

BackgroundThe reported prevalence of chronic pain after spinal cord injury (SCI) varies widely due, in part, to differences in the taxonomy of chronic pain. A widely used classification system is available to describe subcategories of chronic pain in SCI, but the prevalence of chronic pain in SCI based on this system is unknown.ObjectiveThe primary objective of this systematic review and meta-analysis is to determine the prevalence of chronic pain after SCI based on the International Spinal Cord Injury Pain (ISCIP) classification system.Evidence reviewA comprehensive search of databases from January 1980 to August 2019 was conducted. The risk of bias was assessed using a modified tool developed for uncontrolled studies. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to assess certainty in prevalence estimates.FindingsA total of 1305 records were screened, and 37 studies met inclusion criteria. The pooled prevalence of overall chronic pain was 68% (95% CI 63% to 73%). The pooled prevalence of neuropathic pain in 13 studies was 58% (95% CI 49% to 68%); the pooled prevalence of musculoskeletal pain in 11 studies was 56% (95% CI 41% to 70%); the pooled prevalence of visceral pain in 8 studies was 20% (95% CI 11% to 29%) and the pooled prevalence of nociceptive pain in 2 studies was 45% (95% CI 13% to 78%). Meta-regression of risk of bias (p=0.20), traumatic versus non-traumatic etiology of injury (p=0.59), and studies where pain was a primary outcome (p=0.32) demonstrated that these factors were not significant moderators of heterogeneity. Certainty in prevalence estimates was judged to be low due to unexplained heterogeneity.ConclusionThis systematic review and meta-analysis extends the findings of previous studies by reporting the prevalence of chronic pain after SCI based on the ISCIP classification system, thereby reducing clinical heterogeneity in the reporting of pain prevalence related to SCI.

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Prevalence of extra-articular manifestations in patients with ankylosing spondylitis: a systematic review and meta-analysis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2013-203582 ◽

2013 ◽

Vol 74 (1) ◽

pp. 65-73 ◽

Cited By ~ 148

Author(s):

Carmen Stolwijk ◽

Astrid van Tubergen ◽

José Dionisio Castillo-Ortiz ◽

Annelies Boonen

Keyword(s):

Ankylosing Spondylitis ◽

Meta Analysis ◽

Geographical Area ◽

Cochrane Library ◽

Pooled Prevalence ◽

Prevalence Estimates ◽

Large Heterogeneity ◽

Inflammatory Bowel ◽

Substantial Heterogeneity ◽

Summary Data

ObjectivesUveitis, psoriasis and inflammatory bowel disease (IBD) are common extra-articular manifestations (EAM) in patients with ankylosing spondylitis (AS); however, summary data of reported prevalence are lacking. The aim of the present study was to summarise the prevalence of EAMs among patients with AS and to identify underlying factors to explain potential heterogeneity of prevalence.MethodsA systematic literature search was performed (Medline, Embase and Cochrane Library) to identify relevant articles. Risk of bias was assessed and data were extracted. Pooled prevalences were calculated. Potential sources of any observed clinical or methodological heterogeneity in the estimates were explored by subgroup and metaregression analysis.ResultsIn the 156 selected articles, 143 reported the prevalence of uveitis (44 372 patients), 56 of psoriasis (27 626 patients) and 69 of IBD (30 410 patients). Substantial heterogeneity was observed in prevalence estimates among all EAMs (I2=84–95%). The pooled prevalence of uveitis was 25.8% (95% CI 24.1% to 27.6%), and was positively associated in multivariable metaregression with disease duration (β 0.05, 95% CI 0.03 to 0.08) and random selection of patients (β −0.24, 95% CI −0.43 to −0.04). The pooled prevalence of psoriasis was 9.3% (95% CI 8.1% to 10.6%). The pooled prevalence of IBD was 6.8% (95% CI 6.1% to 7.7%) and was positively associated with the percentage of women in the studies (β 0.02, 95% CI 0.00 to 0.03). Geographical area was associated in multivariable metaregressions with prevalence of all EAMs.ConclusionsEAMs are common in patients with AS. The large heterogeneity between studies can be partly explained by differences in clinical as well as methodological characteristics.

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COVID 19 Vaccine Hesitancy: A Protocol for Systematic Review and Meta-Analysis

10.21203/rs.3.rs-150209/v1 ◽

2021 ◽

Author(s):

Emmanuel Okechukwu Nna ◽

Michael Abel Alao ◽

Babatunde Ogunbosi ◽

Uchenna Okeke ◽

Canice Anyachukwu

Keyword(s):

Systematic Review ◽

Quality Assessment ◽

Observational Studies ◽

Meta Analysis ◽

Herd Immunity ◽

Risk Of Bias ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Cochrane Library ◽

Geographical Regions

Abstract Background The unprecedented development of COVID 19 vaccine within a few months and its introduction into the population brought a sigh of relief with the promise of preventing primary infections, halting spread, reducing hospitalization of infected people, and ultimately inducing herd immunity. However, public perception in many communities leaves a lot to worry about as the so much sort-after vaccine has been met with safety concerns, scepticism and hesitancy. We seek to produce a protocol for a reliable and accurate systematic review and meta-analysis on the hesitancy of COVID 19 vaccine uptake in the mist of a global pandemic.MethodsWe developed a search strategy using MeSH terms, text words and entry terms. Nine databases will be searched: PubMed, Embase, CINAHL, AJOL, Google Scholar, Web of Science, Cochrane Library, Research gate and Scopus. Only observational studies retrievable in the English Language will be included. The primary measurable outcome is the prevalence of COVID 19 vaccine hesitancy globally. The secondary outcomes are factors that influence COVID 19 vaccine hesitancy including race, age, gender, occupation, socioeconomic class, level of education, geographic location, misinformation, social media influence and vaccine safety. Identified studies will be screened, deduplicated, selected and data items extracted using DistillerSR software. All studies will be assessed for methodological, clinical and statistical heterogeneity. Assessment of risk of bias in the selected studies will be performed using the NIH Quality assessment tool for observational studies and the Cochrane tool of risk of bias. Publication bias will be assessed using the funnel plot as well as Egger’s regression intercept. The pooled prevalence, standard error and 95% CI will be reported. The strength of evidence from this analysis will be assessed by using NIH Quality Assessment for Systematic Reviews and Meta-analysis.DiscussionThe outcome of this analysis will give insight into the level of COVID 19 vaccine hesitancy and its correlates across geographical regions globally. It will examine if herd immunity via vaccination is attainable at the pooled rate of hesitancy. This will help Governments to redesign their public messages and sensitization. Systematic Review RegistrationThis protocol has been registered with PROSPERO, registration number CRD42021231165.

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Mandibular alignment changes after full-fixed orthodontic treatment: a systematic review and meta-analysis

European Journal of Orthodontics ◽

10.1093/ejo/cjz004 ◽

2019 ◽

Vol 41 (6) ◽

pp. 609-621 ◽

Cited By ~ 2

Author(s):

Ahmad J Swidi ◽

Andreea E Griffin ◽

Peter H Buschang

Keyword(s):

Observational Studies ◽

Orthodontic Treatment ◽

Meta Analysis ◽

Risk Of Bias ◽

Post Treatment ◽

Assessment Tools ◽

Cochrane Library ◽

Meta Analyses

SummaryBackgroundAlthough post-treatment mandibular alignment has been extensively investigated, the findings remain controversial.ObjectivesThe objective was to assess mandibular alignment changes, as measured by the irregularity index, of patients who underwent full-fixed orthodontic treatment and were followed up at least 1 year after retention.Search methodsMEDLINE, EMBASE, and Cochrane library, in addition, the reference lists of included studies, were screened. The search was conducted up to April 2018.Selection criteriaThe study designs included both interventional and observational studies of orthodontic patients who received either extraction or non-extraction treatment.Data collection and analysisThe interventional studies were assessed using the Cochrane Collaboration’s risk of bias assessment tool. The quality of the observational studies was evaluated using National Institution of Health quality assessment tools. The first two authors independently applied the eligibility criteria, extracted the data, and assessed the risk of bias. Any conflicts were resolved with consensus discussion with the third author.ResultsThe search retrieved 11 326 articles, 170 of which were assessed for eligibility. There were 44 studies included in the qualitative assessments and 30 in the meta-analyses. The studies included 1 randomized control trial (RCT) and 43 observational studies. The RCT was judged to have a high risk of bias and all of the observational studies had either fair or poor quality. The meta-analysis was based on studies judged to be of fair quality, including a total of 1859 patients. All meta-analyses were performed using random-effect models. The standardized mean difference between post-treatment and post-retention irregularity was 1.22 (95% CI, 1.04–1.40) and 0.85 (95% CI, 0.63–1.07) after extraction and non-extraction treatments, respectively. There was a substantial heterogeneity for the extraction (I2 = 75.2%) and non-extraction (I2 = 70.1%) studies. The follow-up duration (1–10 versus 10–20 years) explained 33% of the heterogeneity, with longer follow-up studies showing more irregularity.LimitationsThe quality of evidence provided by the studies was low. There was a risk of publication bias, and the search was limited to English language.Conclusions and implicationsPost-treatment mandibular irregularity increases are limited. Irregularity increases are slightly greater in patients treated with mandibular premolars extractions, and in patients followed up over longer periods of time.RegistrationThe study protocol was not registered.

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A systematic review and meta-analysis of the prevalence of left ventricular non-compaction in adults

European Heart Journal ◽

10.1093/eurheartj/ehz317 ◽

2019 ◽

Vol 41 (14) ◽

pp. 1428-1436 ◽

Cited By ~ 23

Author(s):

Samantha B Ross ◽

Katherine Jones ◽

Bianca Blanch ◽

Rajesh Puranik ◽

Kevin McGeechan ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Left Ventricular ◽

Risk Of Bias ◽

Physiological Adaptation ◽

Pooled Prevalence ◽

Prevalence Estimates ◽

Pathological Disease ◽

Cmr Imaging

Abstract Aims To assess the reported prevalence of left ventricular non-compaction (LVNC) in different adult cohorts, taking in to consideration the role of diagnostic criteria and imaging modalities used. Methods and results A systematic review and meta-analysis of studies reporting LVNC prevalence in adults. Studies were sourced from Pre-Medline, Medline, and Embase and assessed for eligibility according to inclusion criteria. Eligible studies provided a prevalence of LVNC in adult populations (≥12 years). Studies were assessed, and data extracted by two independent reviewers. Fifty-nine eligible studies documenting LVNC in 67 unique cohorts were included. The majority of studies were assessed as moderate or high risk of bias. The pooled prevalence estimates for LVNC were consistently higher amongst cohorts diagnosed on cardiac magnetic resonance (CMR) imaging (14.79%, n = 26; I2 = 99.45%) compared with echocardiogram (1.28%, n = 36; I2 = 98.17%). This finding was unchanged when analysis was restricted to studies at low or moderate risk of bias. The prevalence of LVNC varied between disease and population representative cohorts. Athletic cohorts demonstrated high pooled prevalence estimates on echocardiogram (3.16%, n = 5; I2 = 97.37%) and CMR imaging (27.29%, n = 2). Conclusion Left ventricular non-compaction in adult populations is a poorly defined entity which likely encompasses both physiological adaptation and pathological disease. There is a higher prevalence with the introduction of newer imaging technologies, specifically CMR imaging, which identify LVNC changes more readily. The clinical significance of these findings remains unclear; however, there is significant potential for overdiagnosis, overtreatment, and unnecessary follow-up.

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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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Prevalence and prognostic associations of cardiac abnormalities among hospitalized patients with COVID-19: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-87961-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Louie F. Dy ◽

Ryan C. V. Lintao ◽

Cynthia P. Cordero ◽

Ian Theodore G. Cabaluna ◽

Leonila F. Dans

Keyword(s):

Disease Severity ◽

Odds Ratio ◽

Meta Analysis ◽

Final Analysis ◽

Cochrane Library ◽

Significant Heterogeneity ◽

Cardiac Abnormalities ◽

Pooled Prevalence ◽

Increased Risk

AbstractAlthough most patients recover from COVID-19, it has been linked to cardiac, pulmonary, and neurologic complications. Despite not having formal criteria for its diagnosis, COVID-19 associated cardiomyopathy has been observed in several studies through biomarkers and imaging. This study aims to estimate the proportion of COVID-19 patients with cardiac abnormalities and to determine the association between the cardiac abnormalities in COVID-19 patients and disease severity and mortality. Observational studies published from December 1, 2019 to September 30, 2020 were obtained from electronic databases (PubMed, Embase, Cochrane Library, CNKI) and preprint servers (medRxiv, bioRxiv, ChinaXiv). Studies that have data on prevalence were included in the calculation of the pooled prevalence, while studies with comparison group were included in the calculation of the odds ratio. If multiple tests were done in the same study yielding different prevalence values, the largest one was used as the measure of prevalence of that particular study. Metafor using R software package version 4.0.2 was used for the meta-analysis. A total of 400 records were retrieved from database search, with 24 articles included in the final analysis. Pooled prevalence of cardiac abnormalities in 20 studies was calculated to be 0.31 [95% Confidence Intervals (CI) of (0.23; 0.41)], with statistically significant heterogeneity (percentage of variation or I-squared statistic I2 = 97%, p < 0.01). Pooled analysis of 19 studies showed an overall odds ratio (OR) of 6.87 [95%-CI (3.92; 12.05)] for cardiac abnormalities associated with disease severity and mortality, with statistically significant heterogeneity (I2 = 85%, between-study variance or tau-squared statistic τ2 = 1.1485, p < 0.01). Due to the high uncertainty in the pooled prevalence of cardiac abnormalities and the unquantifiable magnitude of risk (although an increased risk is certain) for severity or mortality among COVID-19 patients, much more long-term prognostic studies are needed to check for the long-term complications of COVID-19 and formalize definitive criteria of “COVID-19 associated cardiomyopathy”.

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