Sarcopenia as a predictor of postoperative risk of complications, mortality and length of stay following gastrointestinal oncological surgery

Introduction Sarcopenia has drawn considerable attention as a predictor of postoperative risk, although the relationship between sarcopenia and postoperative risk is contentious. This meta-analysis was conducted to evaluate this relationship. Methods A systematic literature search up to May 2020 was carried out and 43 studies were identified (with 16,716 patients) reporting on the relationship between sarcopenia and postoperative risk. In order to evaluate this relationship, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the dichotomous and continuous method with a random or fixed effects model. Results Compared with non-sarcopenic patients, those with sarcopenia have a higher major complications rate (OR: 4.03, 95% CI: 2.49–5.57, p<0.001), a higher total complications rate (OR: 1.77, 95% CI: 1.40–2.24, p<0.001), a higher 30-day mortality rate (OR: 2.38, 95% CI: 1.56–3.63, p<0.001) and a longer hospital stay (mean difference: 4.54 days, 95% CI: 2.49–6.59 days, p<0.001). Conclusions Sarcopenia significantly increases the risk of major complications, total complications, 30-day mortality and length of hospital stay. For this reason, it is recommended that sarcopenia is added to preoperative risk evaluation to avoid any possible negative outcomes following gastrointestinal oncological surgery.

Download Full-text

The relationship between migraine and infant colic: A systematic review and meta-analysis

Cephalalgia ◽

10.1177/0333102414534326 ◽

2014 ◽

Vol 35 (1) ◽

pp. 63-72 ◽

Cited By ~ 18

Author(s):

Amy A Gelfand ◽

Peter J Goadsby ◽

I Elaine Allen

Keyword(s):

Systematic Review ◽

Random Effects ◽

Odds Ratio ◽

Fixed Effects ◽

Meta Analysis ◽

Random Effects Model ◽

Fixed Effects Model ◽

Primary Analysis ◽

Infant Colic ◽

The Relationship

Context Infant colic is a common and distressing disorder of early infancy. Its etiology is unknown, making treatment challenging. Several articles have suggested a link to migraine. Objective The objective of this article was to perform a systematic review and, if appropriate, a meta-analysis of the studies on the relationship between infant colic and migraine. Data sources Studies were identified by searching PubMed and ScienceDirect and by hand-searching references and conference proceedings. Study selection For the primary analysis, studies specifically designed to measure the association between colic and migraine were included. For the secondary analysis, studies that collected data on colic and migraine but were designed for another primary research question were also included. Data extraction Data were abstracted from the original studies, through communication with study authors, or both. Two authors independently abstracted data. Main outcomes and measures The main outcome measure was the association between infant colic and migraine using both a fixed-effects model and a more conservative random-effects model. Results Three studies were included in the primary analysis; the odds ratio for the association between migraine and infant colic was 6.5 (4.6–8.9, p < 0.001) for the fixed-effects model and 5.6 (3.3–9.5, p = 0.004) for the random-effects model. In a sensitivity analysis wherein the study with the largest effect size was removed, the odds ratio was 3.6 (95% CI 1.7–7.6, p = 0.001) for both the fixed-effects model and random-effects model. Conclusions In this meta-analysis, infant colic was associated with increased odds of migraine. If infant colic is a migrainous disorder, this would have important implications for treatment. The main limitation of this meta-analysis was the relatively small number of studies included.

Download Full-text

Can Statin Treatment Reduce the Risk of Hepatocellular Carcinoma? A Systematic Review and Meta-Analysis

Technology in Cancer Research & Treatment ◽

10.1177/1533033820934881 ◽

2020 ◽

Vol 19 ◽

pp. 153303382093488

Author(s):

Yue Chang ◽

Qinyu Liu ◽

Zidong Zhou ◽

Yuping Ding ◽

Mei Yang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Relative Risk ◽

Fixed Effects ◽

Meta Analysis ◽

Statin Treatment ◽

Fixed Effects Model ◽

The Relationship ◽

Dose Dependent ◽

Reduced Risk ◽

Statin Use

Background: Whether statins can reduce the incidence of cancers has been an interesting topic in recent years. This meta-analysis aimed to determine the relationship between statin treatment with the risk of hepatocellular carcinoma. Methods: Studies published up to July 2019 were screened from databases. The data from approved studies were pooled. Random-effects or fixed-effects model was used to calculate the relative risk with 95% CIs in the overall group and subgroups. Sensitivity and meta-regression analyses were performed, and publication bias was evaluated. Results: A total of 18 studies involving 1 611 596 patients were included in this meta-analysis. The overall result showed a significantly reduced risk of hepatocellular carcinoma (relative risk = 0.54, 95% CI: 0.42-0.66) in statin users. In comparison to the risk in nonstatin users, the risk of hepatocellular carcinoma was reduced in all subgroups. The dose of statins and their pharmacokinetics can partly explain the heterogeneity in the overall meta-analysis ( I 2 = 94.6%, P = .000). A dose-dependent effect of statin use for the reduced risk of hepatocellular carcinoma was found. Conclusions: Findings from this meta-analysis support that statin use can significantly reduce the incidence of hepatocellular carcinoma.

Download Full-text

Is Floppy Eyelid Syndrome More Prevalent in Obstructive Sleep Apnea Syndrome Patients?

Journal of Ophthalmology ◽

10.1155/2016/6980281 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Ping Wang ◽

Dao-Jiang Yu ◽

Gang Feng ◽

Zhen-Hai Long ◽

Chang-Jiang Liu ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Fixed Effects ◽

Meta Analysis ◽

Sleep Apnea Syndrome ◽

Fixed Effects Model ◽

Obstructive Sleep ◽

Apnea Syndrome ◽

The Relationship

Controversial findings are reported about the relationship between floppy eyelid syndrome (FES) and obstructive sleep apnea syndrome (OSAS). The main goal of this study was to evaluate whether FES is more prevalent in OSAS patients by performing a meta-analysis. A comprehensive literature search of Pubmed, Embase, and Cochrane databases was performed. Only studies related to the prevalence of FES in OSAS were included in the meta-analysis. We estimated a pooled odds ratio (OR) for the prevalence of FES in OSAS. In total, 6 studies with 767 participants met the inclusion criteria. Using a fixed-effects model, the pooled OR was 4.12. The test for the overall effect revealed that FES was statistically prevalent in OSAS patients when compared with that in non-OSAS subjects (Z=4.98,p<0.00001). In the subgroup analysis by OSAS severity, the incidence of FES in OSAS increased with severity of OSAS as indicated with increased OR values (OR = 2.56, 4.62, and 7.64 for mild, moderate, and severe OSAS). In conclusion, the results indicate that FES is more prevalent in OSAS patients. However, this result was based only on unadjusted estimates. Prospective cohort studies are needed to determine whether OSAS is an independent risk factor for FES.

Download Full-text

The relationship between time to surgery after neoadjuvant chemotherapy and survival in breast cancer patients:a meta-analysis

10.21203/rs.3.rs-44882/v2 ◽

2020 ◽

Author(s):

YongCheng Su ◽

XiaoGang Zheng

Keyword(s):

Neoadjuvant Chemotherapy ◽

Random Effects ◽

Fixed Effects ◽

Meta Analysis ◽

Disease Free Survival ◽

Significant Heterogeneity ◽

Fixed Effects Model ◽

Free Survival ◽

The Impact ◽

The Relationship

Abstract PURPOSE: This meta-analysis aims to evaluate the impact of delaying surgery in operable breast tumor patients after neoadjuvant chemotherapy (NAC) on survival. METHODS:An electronic literature retrieval was conducted on PubMed/Medline and EMBASE((between January 2000 and June 2020).The primary end point was overall survival(OS),secondary end points included disease-free survival (DFS) or recurence-free survival (RFS).The HR with 95% confidence intervals were calculated using a random-effects or fixed-effects model. RESULTS:The combined HR for OS was 1.51 (95% CI:1.30-1.76; P=0.000) by fixed effects model.No statistically significant heterogeneity was found (P=0.168, I 2 =31.3%).The pooled HR for RFS/DFS was 1.59 (95%CI:1.30-1.95,I 2 = 66.0%) by random-effects model,with significant heterogeneity. CONCLUSION:Our meta-analysis revealed a significant adverse association between longer TTS after NAC and more inferior OS and RFS/DFS in patients with breast cancer.Clinicians and patients should minimize surgical delay after NAC as much as possible.

Download Full-text

Clinical Efficacy of Perioperative Immunonutrition Containing Omega-3-Fatty Acids in Patients Undergoing Hepatectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Annals of Nutrition and Metabolism ◽

10.1159/000509979 ◽

2020 ◽

pp. 1-12

Author(s):

Benjian Gao ◽

Jia Luo ◽

Ying Liu ◽

Furui Zhong ◽

Xiaoli Yang ◽

...

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Randomized Controlled Trials ◽

Fixed Effects ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled ◽

The Impact

Background: The effect of immunonutrition in patients undergoing hepatectomy remains unclear. This meta-analysis aimed to assess the impact of immunonutrition on postoperative clinical outcomes in patients undergoing hepatectomy. Methods: A literature search of PubMed, Cochrane Library, Web of Science, and Embase databases was performed to identify all randomized controlled trials (RCTs) exploring the effect of perioperative immunonutrition in patients undergoing hepatectomy until the end of March 10, 2020. Quality assessment and data extraction of RCTs were conducted independently by 3 reviewers. Mean difference (MD) and odds ratio (OR) with 95% confidence interval (CI) were calculated using a fixed-effects or random-effects model. The meta-analysis was performed with RevMan 5.3 software. Results: Nine RCTs involving a total of 966 patients were finally included. This meta-analysis showed that immunonutrition significantly reduced the incidences of overall postoperative complications (OR = 0.57, 95% CI: 0.34–0.95; p = 0.03), overall postoperative infectious complications (OR = 0.53, 95% CI: 0.37–0.75; p = 0.0003), and incision infection (OR = 0.50, 95% CI: 0.28–0.89; p = 0.02), and it shortened the length of hospital stay (MD = −3.80, 95% CI: −6.59 to −1.02; p = 0.007). There were no significant differences in the incidences of pulmonary infection (OR = 0.60, 95% CI: 0.32–1.12; p = 0.11), urinary tract infection (OR = 1.30, 95% CI: 0.55–3.08; p = 0.55), liver failure (OR = 0.54, 95% CI: 0.23–1.24; p = 0.15), and postoperative mortality (OR = 0.69, 95% CI: 0.26–1.83; p = 0.46). Conclusion: Given its positive impact on postoperative complications and the tendency to shorten the length of hospital stay, perioperative immunonutrition should be encouraged in patients undergoing hepatectomy.

Download Full-text

Effects of Enteral Immunonutrition in Patients Undergoing Pancreaticoduodenectomy: A Meta-Analysis of Randomized Controlled Trials

Annals of Nutrition and Metabolism ◽

10.1159/000495468 ◽

2018 ◽

Vol 74 (1) ◽

pp. 53-61 ◽

Cited By ~ 10

Author(s):

Haonan Guan ◽

Sanwei Chen ◽

Qiang Huang

Keyword(s):

Hospital Stay ◽

Randomized Controlled Trials ◽

Fixed Effects ◽

Meta Analysis ◽

Postoperative Mortality ◽

Length Of Hospital Stay ◽

Infectious Complications ◽

Controlled Trials ◽

Randomized Controlled ◽

The Impact

Background: The effect of enteral immunonutrition (EIN) in patients undergoing pancreaticoduodenectomy (PD) is still doubtful. This meta-analysis aimed to assess the impact of EIN on postoperative clinical outcomes for patients undergoing PD. Methods: A literature search was carried out to identify all of the randomized controlled trials (RCTs) concerning the use of EIN for PD. Data collection ended on April 1, 2018. Pooled risk ratios (RRs) and the mean difference (MD) with a 95% CI were calculated using fixed effects or random effects models. The analyses were performed with RevMan 5.3.5. Results: Four RCTs with a total of 299 patients were included. Immunonutrition reduced the incidence of postoperative infectious complications (RR 0.58, 95% CI 0.37–0.92; p = 0.02) and shortened the length of hospital stay (MD –1.79, 95% CI –3.40 to 0.18; p = 0.03). Conversely, there were no significant differences in the incidence of overall postoperative complications (RR 0.81, 95% CI 0.62–1.05; p = 0.11), non-infectious complications (RR 0.94, 95% CI 0.69–1.28; p = 0.70) and postoperative mortality (RR 2.43, 95% CI 0.37–16.10; p = 0.36). Conclusions: EIN reduced postoperative infectious complications and shortened the length of the hospital stay; immunonutrition should be encouraged in patients undergoing PD.

Download Full-text

Prognostic role of the prognostic nutritional index (PNI) in patients with head and neck neoplasms undergoing radiotherapy: A meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0257425 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257425

Author(s):

Yujie Shi ◽

Yue Zhang ◽

Yaling Niu ◽

Yingjie Chen ◽

Changgui Kou

Keyword(s):

Head And Neck ◽

Head And Neck Neoplasms ◽

Fixed Effects ◽

Meta Analysis ◽

Survival Outcomes ◽

Fixed Effects Model ◽

Prognostic Role ◽

Free Survival ◽

The Relationship

Background This novel meta-analysis was conducted to systematically and comprehensively evaluate the prognostic role of the pretreatment PNI in patients with head and neck neoplasms (HNNs) undergoing radiotherapy. Methods Three databases, PubMed, Embase, and Web of Science, were used to retrieve desired literature. Hazard ratios (HRs) with 95% confidence intervals (CIs) were extracted and pooled by fixed-effects or random-effects models to analyze the relationship between the PNI and survival outcomes: overall survival (OS), distant metastasis-free survival (DMFS), and progression-free survival (PFS). Results Ten eligible studies involving 3,458 HNN patients were included in our analysis. The robustness of the pooled results was ensured by heterogeneity tests (I2 = 22.6%, 0.0%, and 0.0% for OS, DMFS, and PFS, respectively). The fixed-effects model revealed a lower pretreatment PNI was significantly related to a worse OS (HR = 1.974; 95% CI: 1.642–2.373; P<0.001), DMFS (HR = 1.959; 95% CI: 1.599–2.401; P<0.001), and PFS (HR = 1.498; 95% CI: 1.219–1.842; P<0.001). The trim-and-fill method (HR = 1.877; 95% CI: 1.361–2.589) was also used to prove that the existing publication bias did not deteriorate the reliability of the relationship. Conclusion The pretreatment PNI is a promising indicator to evaluate and predict the long-term prognostic survival outcomes in HNN patients undergoing radiotherapy.

Download Full-text

Association between Cu/Zn/Iron/Ca/Mg levels and Chinese children with cerebral palsy

10.21203/rs.3.rs-703495/v1 ◽

2021 ◽

Author(s):

Haiquan Zhu ◽

Song Mao ◽

Wei Li

Keyword(s):

Cerebral Palsy ◽

Fixed Effects ◽

Meta Analysis ◽

Chinese Children ◽

Sensitivity Analyses ◽

Fixed Effects Model ◽

Frequent Monitoring ◽

Significant Difference ◽

Mean Differences ◽

The Relationship

Abstract Objective: It is well documented that the macro/trace elements are associated with neurodevelopment. We aimed to investigate the relationship between copper (Cu)/ zinc (Zn)/iron/calcium (Ca)/magnesium (Mg) levels and cerebral palsy (CP) risk in Chinese children by performing a meta-analysis.Method: We searched the PubMed, Embase, Cochrane and Chinese WanFang databases from January 1985 to June 2019 to yield studies that met our predefined criteria. Fourteen studies were enrolled. Standard mean differences (SMDs) of Cu/Zn/Iron/Ca/Mg levels between CP cases and controls were calculated using the fixed-effects model or the random-effects model, in the presence of heterogeneity.95% confidence intervals (CI) were also computed. Results: A total of 14 studies including 1452 CP cases and 1538 controls were involved. CP cases showed significantly lower levels of Cu, Zn, iron and Ca than those in controls (95% CI:-4.960- -2.302, p<10-4; 95% CI:-4.061- -2.044, p<10-4; 95% CI:-1.873 - -0.776, p<10-4; 95% CI:-2.239- -0.487, p=0.002). Sensitivity analyses did not change the overall results markedly. No significant difference of Mg level between CP cases and controls (95% CI:-0.741-0.070, p=0.105) was observed. No marked publication bias was obseved.Conclusions: CP cases demonstrated significantly lower levels of Cu/Zn/iron/Ca than those in healthy controls. Lower levels of Cu/Zn/iron/Ca may be associated CP risk. Frequent monitoring and early intervention may be needed.

Download Full-text

A Systematic Review and Meta-Analysis about the Effect of Bisphosphonates on the Risk of Skeletal-Related Event in Men with Prostate Cancer

Anti-Cancer Agents in Medicinal Chemistry ◽

10.2174/1871520620666200521114815 ◽

2020 ◽

Vol 20 (13) ◽

pp. 1604-1612

Author(s):

Congcong Wu ◽

Hua Jiang ◽

Jianghua Chen

Keyword(s):

Prostate Cancer ◽

Fixed Effects ◽

Data Extraction ◽

Controlled Trial ◽

Meta Analysis ◽

Control Group ◽

Fixed Effects Model ◽

Related Event ◽

Mineral Density ◽

Skeletal Related Event

Background: Although the adjuvant therapy of bisphosphonates in prostate cancer is effective in improving bone mineral density, it is still uncertain whether bisphosphonates could decrease the risk of Skeletal- Related Event (SRE) in patients with prostate cancer. We reviewed and analyzed the effect of different types of bisphosphonates on the risk of SRE, defined as pathological fracture, spinal cord compression, radiation therapy to the bone, surgery to bone, hypercalcemia, bone pain, or death as a result of prostate cancer. Methods: A systemic literature search was conducted on PubMed and related bibliographies. The emphasis during data extraction was laid on the Hazard Ratio (HR) and the corresponding 95% Confidence Interval (CI) from every eligible Randomized Controlled Trial (RCT). HR was pooled with the fixed effects model, and preplanned subgroup analyses were performed. Results: 5 RCTs (n = 4651) were included and analyzed finally after screening 51 articles. The meta-analysis of all participants showed no significant decrease in the risk of SRE when adding bisphosphonates to control group (HR = 0.968, 95% CI = 0.874 - 1.072, p = 0.536) with low heterogeneity (I2 = 0.0% (d.f. = 4) p = 0.679). There was no significant improvement on SRE neither in the subgroups with Metastases (M1) or Castration-Sensitive Prostate Cancer (CSPC) (respectively HR = 0.968, 95% CI = 0.874 - 1.072, p = 0.536, I2 = 0.0% (d.f. = 4) p = 0.679; HR = 0.954, 95% CI = 0.837 - 1.088, p = 0.484, I2 = 0.0% (d.f. = 3) p = 0.534). Conclusion: Our study demonstrated that bisphosphonates could not statistically significantly reduce the risk of SRE in patients with prostate cancer, neither in the subgroups with M1 or CSPC.

Download Full-text

Statin use and clinical outcomes in patients with COVID-19: An updated systematic review and meta-analysis

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2020-139172 ◽

2021 ◽

pp. postgradmedj-2020-139172

Author(s):

Rimesh Pal ◽

Mainak Banerjee ◽

Urmila Yadav ◽

Sukrita Bhattacharjee

Keyword(s):

Clinical Outcomes ◽

Observational Studies ◽

Fixed Effects ◽

Controlled Trial ◽

Meta Analysis ◽

Adverse Outcomes ◽

Fixed Effects Model ◽

Adjusted Risk ◽

Risk Estimates ◽

Statin Use

PurposeObservations studies have shown that prior use of statins is associated with a reduced risk of adverse clinical outcomes in patients with COVID-19. However, the available data are limited, inconsistent and conflicting. Besides, no randomised controlled trial exists in this regard. Hence, the present meta-analysis was conducted to provide an updated summary and collate the effect of statin use on clinical outcomes in COVID-19 using unadjusted and adjusted risk estimates.MethodsPubMed, Scopus and Web of Science databases were systematically searched using appropriate keywords till December 18 2020, to identify observational studies reporting clinical outcomes in COVID-19 patients using statins versus those not using statins. Prior and in-hospital use of statins were considered. Study quality was assessed using the Newcastle-Ottawa Scale. Unadjusted and adjusted pooled odds ratio (OR) with 95% CIs were calculated.ResultsWe included 14 observational studies pooling data retrieved from 19 988 patients with COVID-19. All the studies were of high/moderate quality. Pooled analysis of unadjusted data showed that statin use was not associated with improved clinical outcomes (OR 1.02; 95% CI 0.69 to 1.50, p=0.94, I2=94%, random-effects model). However, on pooling adjusted risk estimates, the use of statin was found to significantly reduce the risk of adverse outcomes (OR 0.51; 95% CI 0.41 to 0.63, p<0.0005, I2=0%, fixed-effects model).ConclusionsStatin use is associated with improved clinical outcomes in patients with COVID-19. Individuals with multiple comorbidities on statin therapy should be encouraged to continue the drug amid the ongoing pandemic.

Download Full-text