Comparative Effectiveness and Safety of 32 Pharmacological Interventions Recommended by Guidelines for COVID-19: A Systematic Review and Network Meta-Analysis Combining 66 Trials

Abstract Background: To evaluate comparative efficacy and safety of pharmacological interventions in patients with coronavirus disease 2019. Methods: Medline, Embase, the Cochrane Library and clinicaltrials.gov were searched for randomized controlled trials (RCTs) in patients infected with SARS-COV-2/SARS-COV. Random-effects network meta-analysis within Bayesian framework was performed, followed by Grading of Recommendations Assessment, Development and Evaluation (GRADE) system assessing quality of evidence. The primary outcome of interest includes mortality, cure, viral negative conversion (VNC) and overall adverse events (OAE). Odds ratio (OR) with 95% confidence interval (CI) was calculated as the measure of effect size.Results: 66 RCTs with 19,095 patients were included, involving standard care (SOC), 8 different antiviral agents, 6 different antibiotics, high and low dose chloroquine (CQ_HD, CQ_LD), traditional Chinese medicine (TCM), corticosteroids and other treatments. Compared with SOC, significant reduction of mortality was observed for TCM (OR=0.34, 95%CI: 0.20-0.56, moderate quality) and corticosteroids (OR=0.84, 0.75-0.96, low quality) with improved cure rate (OR=2.16, 1.60-2.91, low quality for TCM; OR=1.17, 1.05-1.30, low quality for corticosteroids). However, increased risk of mortality was found for CQ_HD versus SOC (OR=3.20, 1.18-8.73, low quality). TCM was associated with decreased risk of OAE (OR=0.52, 0.38-0.70, very low quality) but CQ_HD (OR=2.51, 1.20-5.24) and IFN (OR=2.69, 1.02-7.08) versus SOC with very low quality) were associated with an increased risk. Conclusions: Corticosteroids and TCM may reduce mortality and increase cure rate with no increased risk of OAEs compared with standard care. CQ_HD might increase the risk of mortality. CQ, IFN and other antiviral agents could increase the risk of OAEs. The current evidence is generally uncertain with low quality and further high-quality trials are needed.

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The Effectiveness of Acupuncture in Management of Functional Constipation: A Systematic Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/6137450 ◽

2020 ◽

Vol 2020 ◽

pp. 1-17

Author(s):

Lu Wang ◽

Mingmin Xu ◽

Qianhua Zheng ◽

Wei Zhang ◽

Ying Li

Keyword(s):

Quality Of Life ◽

Meta Analysis ◽

Safety Evaluation ◽

Functional Constipation ◽

Responder Rate ◽

Current Evidence ◽

Cochrane Library ◽

China National Knowledge Infrastructure ◽

Increased Risk

Objective. The purpose of this study was to assess the effectiveness and safety of acupuncture for functional constipation (FC). Methods. A rigorous literature search was performed in English (PubMed, Web of Science, the Cochrane Library, and EMBASE) and Chinese (China National Knowledge Infrastructure (CNKI), Chinese Biological Medical (CBM), Wanfang database, and China Science and Technology Journal (VIP)) electronic databases from their inception to October 2019. Included randomized controlled trials (RCTs) compared acupuncture therapy with sham acupuncture or pharmacological therapies. The outcome measures were evaluated, including the primary outcome of complete spontaneous bowel movement (CSBM) and secondary outcomes of Bristol Stool Form Scale (BSFS), constipation symptoms scores (CSS), responder rate, the Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire, and safety evaluation. Meta-analysis was performed by using RevMan5.3. Results. The merged data of 28 RCTs with 3525 participants indicated that acupuncture may be efficient for FC by increasing CSBMs (p<0.00001; MD = 0.84 [95% CI, 0.65 to 1.03]; I2 = 0%) and improving constipation symptoms (p=0.03; SMD = −0.4 [95% CI, −0.78 to −0.03]; I2 = 74%), stool formation (p<0.00001; MD = 0.24 [95% CI, 0.15 to 0.34]; I2 = 0%), quality of life (p<0.00001; N = 1, MD = −0.33 [95% CI, −0.45 to −0.21]), and responder rates (p=0.02; RR = 2.16; [95% CI, 1.1 to 4.24]; I2 = 69%) compared with the effects of sham treatment. No increased risk of adverse events was observed (p=0.44; RR = 1.18; [95% CI, 0.77 to 1.81]; I2 = 0%). With regard to medication comparisons, the pooled data indicated that acupuncture was more effective in increasing CSBMs (p=0.004; MD = 0.53 [95% CI, 0.17 to 0.88]; I2 = 88%) and improving patients’ quality of life (p<0.00001; SMD = −0.73 [95% CI, −1.02 to −0.44]; I2 = 64%), with high heterogeneity. However, there were no significant differences in responder rate (p=0.12; RR = 1.31; [95% CI, 0.94 to 1.82]; I2 = 53%), BSFS (p=0.5; MD = 0.17 [95% CI, −0.33 to 0.68]; I2 = 93%), or CSS (p=0.05; SMD = −0.62 [95% CI, −1.23 to −0.01]; I2 = 89%). Regarding safety evaluation, acupuncture was safer than medications (p<0.0001; RR = 0.3; [95% CI, 0.18 to 0.52]; I2 = 30%). Conclusions. Current evidence suggests that acupuncture is an efficient and safe treatment for FC. Acupuncture increased stool frequency, improved stool formation, alleviated constipation symptoms, and improved quality of life. However, the evidence quality was relatively low and the relationship between acupuncture and drugs is not clear. More high-quality trials are recommended in the future. PROSPERO registration number: CRD42019143347.

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Preoperative Somatostatin Analogues in Patients with Newly-diagnosed Acromegaly: A Systematic Review and Meta-analysis of Comparative Studies

Scientific Reports ◽

10.1038/s41598-019-50639-6 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Chengxian Yang ◽

Ge Li ◽

Shenzhong Jiang ◽

Xinjie Bao ◽

Renzhi Wang

Keyword(s):

Systematic Review ◽

Comparative Studies ◽

Meta Analysis ◽

Somatostatin Analogues ◽

Long Term Results ◽

Current Evidence ◽

Cochrane Library ◽

Cure Rate ◽

Short Term

Abstract Biochemical remission after transsphenoidal surgery is still unsatisfied in acromegaly patients with macroadenomas, especially with invasive macroadenomas. Concerning the impact of preoperative somatostatin analogues (SSAs) on surgical outcomes, previous studies with limited cases reported conflicting results. To assess current evidence of preoperative medical treatment, we performed a systematic review and meta-analysis of comparative studies. A literature search was conducted in Pubmed, Embase, and the Cochrane Library. Five randomized controlled trials (RCT) and seven non-RCT comparative studies were included. These studies mainly focused on pituitary macroadenomas though a small number of microadenoma cases were included. For safety, preoperative SSAs were not associated with elevated risks of postoperative complications. With respect to efficacy, the short-term cure rate was improved by preoperative SSAs, but the long-term cure rate showed no significant improvement. For invasive macroadenomas, the short-term cure rate was also improved, but the long-term results were not evaluable in clinical practice because adjuvant therapy was generally required. In conclusion, preoperative SSAs are safe in patients with acromegaly, and the favorable impact on surgical results is restricted to the short-term cure rate in macroadenomas and invasive macroadenomas. Further well-designed RCTs to examine long-term results are awaited to update the finding of this meta-analysis.

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Effect of Digoxin Therapy on Mortality in Patients With Atrial Fibrillation: An Updated Meta-Analysis

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.731135 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xiaoxu Wang ◽

Yi Luo ◽

Dan Xu ◽

Kun Zhao

Keyword(s):

Atrial Fibrillation ◽

Meta Analysis ◽

Cochrane Library ◽

Clinical Effects ◽

Hazard Ratios ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

The Cochrane Library

Background: Whether digoxin is associated with increased mortality in atrial fibrillation (AF) remains controversial. We aimed to assess the risk of mortality and clinical effects of digoxin use in patients with AF.Methods: PubMed, Embase, and the Cochrane library were systematically searched to identify eligible studies comparing all-cause mortality of patients with AF taking digoxin with those not taking digoxin, and the length of follow-up was at least 6 months. Hazard ratios (HRs) with 95% confidence intervals (CIs) were extracted and pooled.Results: A total of 29 studies with 621,478 patients were included. Digoxin use was associated with an increased risk of all-cause mortality in all patients with AF (HR 1.17, 95% CI 1.13–1.22, P < 0.001), especially in patients without HF (HR 1.28, 95% CI 1.11–1.47, P < 0.001). There was no significant association between digoxin and mortality in patients with AF and HF (HR 1.06, 95% CI 0.99–1.14, P = 0.110). In all patients with AF, regardless of concomitant HF, digoxin use was associated with an increased risk of sudden cardiac death (SCD) (HR 1.40, 95% CI 1.23–1.60, P < 0.001) and cardiovascular (CV) mortality (HR 1.27, 95% CI 1.08–1.50, P < 0.001), and digoxin use had no significant association with all-cause hospitalization (HR 1.13, 95% CI 0.92–1.39, P = 0.230).Conclusion: We conclude that digoxin use is associated with an increased risk of all-cause mortality, CV mortality, and SCD, and it does not reduce readmission for AF, regardless of concomitant HF. Digoxin may have a neutral effect on all-cause mortality in patients with AF with concomitant HF.Systematic Review Registration:https://www.crd.york.ac.ukPROSPERO.

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Association of Renal Function and Direct-Acting Antiviral Agents for HCV: A Network Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm7100314 ◽

2018 ◽

Vol 7 (10) ◽

pp. 314 ◽

Cited By ~ 6

Author(s):

Chih-Chin Kao ◽

Yu-Shiuan Lin ◽

Heng-Cheng Chu ◽

Te-Chao Fang ◽

Mai-Szu Wu ◽

...

Keyword(s):

Renal Function ◽

Hepatitis C ◽

Meta Analysis ◽

Antiviral Agents ◽

Cochrane Library ◽

Renal Disorder ◽

Direct Acting Antiviral ◽

Increased Risk ◽

Direct Acting ◽

Direct Acting Antiviral Agents

The effectiveness and safety of direct-acting antiviral agents (DAAs) in hepatitis C virus (HCV) patients with renal insufficiency remain controversial. Therefore, this network meta-analysis aims to assess effectiveness and safety of DAAs in populations with different renal function. The pooled data were obtained from Cochrane Library, EMBASE, PubMed, and Web of Science. Thirteen studies recruited 6884 patients with hepatitis C infection and reported their outcomes in relation to different levels of renal function after treatment with DAAs. The results showed no difference in the virologic responses among patients with different renal function. Regarding safety, whereas in patients without chronic kidney disease (CKD) or with early CKD DAAs were associated with a risk ratio (RR) of 0.14 (95% confidence interval (CI), 0.04 to 0.43) for renal disorder, increased risk of renal function deterioration was found in advanced-CKD patients, though this effect may be related to the natural course of advanced CKD. Similarly, patients without CKD or with early CKD showed a lower risk of anemia (RR, 0.34; 95% CI, 0.20 to 0.57) and discontinuation (RR, 0.41; 95% CI, 0.39 to 0.56) than patients with advanced CKD. The efficacy of DAAs for HCV treatment was comparable in patients with advanced CKD and in those with early CKD or without CKD. However, the safety of DAAs should be verified in future studies.

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Vitamin K for reversal of excessive vitamin K antagonist anticoagulation: a systematic review and meta-analysis

Blood Advances ◽

10.1182/bloodadvances.2018025163 ◽

2019 ◽

Vol 3 (5) ◽

pp. 789-796 ◽

Cited By ~ 6

Author(s):

Rasha Khatib ◽

Maja Ludwikowska ◽

Daniel M. Witt ◽

Jack Ansell ◽

Nathan P. Clark ◽

...

Keyword(s):

Vitamin K ◽

Meta Analysis ◽

Vitamin K Antagonists ◽

International Normalized Ratio ◽

Assessment Development ◽

Randomized Controlled ◽

Risk Of Mortality ◽

Increased Risk ◽

Meta Analyses ◽

Risk Ratios

Abstract Patients receiving vitamin K antagonists (VKAs) with an international normalized ratio (INR) between 4.5 and 10 are at increased risk of bleeding. We systematically reviewed the literature to evaluate the effectiveness and safety of administering vitamin K in patients receiving VKA therapy with INR between 4.5 and 10 and without bleeding. Medline, Embase, and Cochrane databases were searched for relevant randomized controlled trials in April 2018. Search strategy included terms vitamin K administration and VKA-related terms. Reference lists of relevant studies were reviewed, and experts in the field were contacted for relevant papers. Two investigators independently screened and collected data. Risk ratios (RRs) were calculated, and certainty of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. Six studies (1074 participants) were included in the review and meta-analyses. Pooled estimates indicate a nonsignificant increased risk of mortality (RR = 1.42; 95% confidence interval [CI], 0.62-2.47), bleeding (RR = 2.24; 95% CI, 0.81-7.27), and thromboembolism (RR = 1.29; 95% CI, 0.35-4.78) for vitamin K administration, with moderate certainty of the evidence resulting from serious imprecision as CIs included potential for benefit and harm. Patients receiving vitamin K had a nonsignificant increase in the likelihood of reaching goal INR (1.95; 95% CI, 0.88-4.33), with very low certainty of the evidence resulting from serious risk of bias, inconsistency, and imprecision. Our findings indicate that patients on VKA therapy who have an INR between 4.5 and 10.0 without bleeding are not likely to benefit from vitamin K administration in addition to temporary VKA cessation.

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Risk of non-melanoma skin cancer with biological therapy in common inflammatory diseases: a systemic review and meta-analysis

Cancer Cell International ◽

10.1186/s12935-021-02325-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ruolin Liu ◽

Qianyi Wan ◽

Rui Zhao ◽

Haitao Xiao ◽

Ying Cen ◽

...

Keyword(s):

Skin Cancer ◽

Biological Therapy ◽

Inflammatory Diseases ◽

Meta Analysis ◽

Systemic Review ◽

Current Evidence ◽

Cochrane Library ◽

Non Melanoma Skin Cancer ◽

Increased Risk ◽

Melanoma Skin

Abstract Background Most previous studies compared the risk for non-melanoma skin cancer (NMSC) in biologic-treated common inflammatory diseases with the general population. Whether the increased NMSC risk is caused by the disease itself, the biologics, or both remains unknown. Methods We systematically searched PubMed, Embase, Medline, Web of Science, and Cochrane Library from inception to May 2021. Studies were included if they assessed the risk of NMSC for rheumatoid arthritis (RA), inflammatory bowel disease (IBD), or psoriasis patients treated with biologics compared with patients not receiving biologics. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using the fixed- or random-effects model. Results The current meta-analysis included 12 studies. Compared with patients with the inflammatory disease without biologics, patients receiving biological therapy were associated with an increased risk for NMSC (RR 1.25, 95% CI 1.14 to 1.37), especially in patients with RA (RR 1.24, 95% CI 1.13 to 1.36) and psoriasis (RR 1.28, 95% CI 1.07 to 1.52), but not in patients with IBD (RR 1.49, 95% CI 0.46 to 4.91). The risks for squamous cell skin cancer and basal cell skin cancer were both increased for patients receiving biologics. However, the risk of NMSC did not increase in patients treated with biologics less than 2 years. Conclusions Current evidence suggests that increased risk of NMSC was identified in RA and psoriasis treated with biologics compared with patients not receiving biologics, but not in patients with IBD. The inner cause for the increased risk of NMSC in IBD patients should be further discussed.

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Effectiveness of Pharmacological Pain Relief Methods on Birth Experience: A Systematic Review and Meta-Analysis

Current Women s Health Reviews ◽

10.2174/1573404817999201230234158 ◽

2020 ◽

Vol 17 ◽

Author(s):

Solmaz Ghanbari-Homayi ◽

Sonia Hasani ◽

Hojjat Pourfathi ◽

Mojgan Mirghafourvand

Keyword(s):

Pain Relief ◽

Meta Analysis ◽

Random Effect ◽

Cochrane Library ◽

Secondary Outcome ◽

Birth Experience ◽

Pharmacological Interventions ◽

Assessment Development ◽

Group Grade

Background:: The use of pharmacological pain relief methods during labour is increasing, however there is no clear evidence that pharmacological interventions can also improve women’s satisfaction with birth experience. Objective:: To assess the effectiveness of pharmacological interventions on women's satisfaction with birth experience (primary outcome) and satisfaction with the received method (secondary outcome). Methods:: We searched databases in English (MEDLINE, Cochrane Library, Embase, ProQuest, Scopus and Web of Science) and Persian languages (SID and Magiran) from inception until April 30, 2018 for clinical trials that pharmacological pain relief methods were compared with standard or routine cares, or non-pharmacological methods. The evaluation of studies in term of risk of bias was conducted using the Cochrane Handbook. Meta-analysis results were reported as OR and 95% confidence interval. In meta-analysis, subgroup analysis was performed based on the type of intervention. Due to the heterogeneity of over 30%, random effect was reported instead of the fixed effect. The heterogeneity was evaluated using I2, T2 and Chi2. The evaluation of the quality of the studies was also examined using the Grading of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) approach. Results:: The results of 7 studies with low-quality in meta-analysis, showed that pharmacological methods significantly improved satisfaction with birth experience (OR = 2.99; 95% CI: 1.37 to 6.52; P = 0.006). However, meta-analysis of subgroups showed that only inhalation of Entonox gas (OR = 6.51; 95% CI: 3.47 to 12.22; P < 0.001), in contrast to epidural analgesia (OR = 1.19; 95% CI: 0.62 to 2.27; P = 0.60) and Hyoscine injection (OR = 2.58; 95% CI: 0.93 to 7.20; P = 0.07) significantly improved satisfaction with birth experience. Conclusion:: Pharmacological interventions such as epidural, although introduced as one of the effective methods for pain relief, may not provide women with satisfaction with birth. However, more studies with precise methodology, high sample size, and standard tools should be performed to more accurately investigate the effect of pharmacological interventions on birth experience.

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Adverse perinatal outcomes following the prenatal diagnosis of isolated single umbilical artery in singleton pregnancies: a systematic review and meta-analysis

Journal of Perinatal Medicine ◽

10.1515/jpm-2021-0260 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Themistoklis Dagklis ◽

Antonios Siargkas ◽

Aikaterini Apostolopoulou ◽

Ioannis Tsakiridis ◽

Apostolos Mamopoulos ◽

...

Keyword(s):

Systematic Review ◽

Prenatal Diagnosis ◽

Umbilical Artery ◽

Meta Analysis ◽

Perinatal Outcomes ◽

Current Evidence ◽

Cochrane Library ◽

Single Umbilical Artery ◽

Increased Risk ◽

Singleton Pregnancies

Abstract Objectives A systematic review and meta-analysis was conducted to quantitatively synthesize the current evidence on the association of prenatally diagnosed isolated single umbilical artery (iSUA) in singleton pregnancies with small for gestational age (SGA) neonates and other perinatal outcomes. Methods A search of PubMed/Medline, Scopus and The Cochrane Library was conducted, from inception to February 2021, in order to identify studies comparing the risk of SGA and other perinatal adverse outcomes in prenatally diagnosed iSUA singleton pregnancies vs. those with a 3-vessel cord (3VC). The quality of eligible studies was assessed according to the improved Newcastle–Ottawa Scale (NOS). The heterogeneity of results across the studies was tested using the I2 test. Funnel plots and Egger’s test were used to assess the possibility of publication bias. Prospero RN: CRD42020182586. Results The electronic search identified 7,605 studies, of which 11 were selected, including three retrospective cohort and eight retrospective case control studies, overall reporting on 1,533 iSUA cases. The risk of delivering SGA neonates was increased in cases with iSUA (OR: 2.90; 95% CI: 2.02–4.18; p<0.00001; I2=71%). Similarly, iSUA was associated with an increased risk of pregnancy-induced hypertension (PIH) (OR: 2.23; 95% CI: 1.41–3.54; p<0.000; I2=1%), intrauterine death (IUD) (OR: 2.62; 95% CI: 1.43–4.79; p=0.002; I2=0%), preterm birth (PTB) (OR: 2.48; 95% CI: 1.73–3.56; p<0.00001; I2=56%), cesarean section (CS) (OR: 1.64; 95% CI: 1.11–2.41; p=0.01; I2=78%) and admission to neonatal intensive care unit (NICU) (OR: 2.28; 95% CI: 1.52–3.44; p<0.000001; I2=73%). Conclusions In prenatally diagnosed iSUA there is a higher risk of SGA, PIH, IUD, PTB, CS and NICU admission. These findings support the value of prenatal diagnosis of iSUA, which may subsequently intensify surveillance for the detection of specific pregnancy complications.

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Dose-Response Relationship Among Body Mass Index, Abdominal Adiposity and Atrial Fibrillation in Patients Undergoing Cardiac Surgery: A Meta-Analysis of 30 Prospective Studies

10.21203/rs.3.rs-123026/v1 ◽

2020 ◽

Author(s):

Menglu Liu ◽

Kaibo Mei ◽

Lixia Xie ◽

Jianyong Ma ◽

Peng Yu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Body Mass Index ◽

Body Mass ◽

Prospective Studies ◽

Meta Analysis ◽

Valve Surgery ◽

Current Evidence ◽

Cochrane Library ◽

Exposure Effect ◽

Increased Risk

Abstract Background: Whether being overweight increases the risk of postoperative atrial fibrillation (POAF) is unclear, and whether adiposity independently contributes to POAF has not been comprehensively studied. Thus, we conducted a meta-analysis to clarify the strength and shape of the exposure-effect relationship between adiposity and POAF.Methods: The PubMed, Cochrane Library, and EMBASE databases were searched for prospective studies (RCTs, cohort studies, and nest-case control studies) reporting data regarding the relationship between adiposity and the risk of POAF.Results: Thirty publications involving 139,302 patients were included. Analysis of categorical variables showed that obesity (RR: 1.39, P<0.001), but not being underweight (RR: 1.44, P=0.13) or being overweight (RR: 1.03, P=0.48), was associated with an increased risk of POAF. In the exposure-effect analysis, the summary RR for a 5-unit increment in body mass index (BMI) was 1.09 (P<0.001) for the risk of POAF. There was a significant linear relationship between BMI and POAF (Pnonlinearity=0.91); the curve was flat and began to rise steeply at a BMI of approximately 30. Notably, BMI levels below 30 (overweight) were not associated with a higher risk of POAF. In the subgroup analysis of surgery types, the pooled RR values for a BMI increase of 5 for coronary artery bypass graft and valve surgery were 1.21 (P<0.01) and 1.34 (P=0.25), respectively, suggesting that a potential difference in the association exists by surgery type. Additionally, waist obesity was associated with the risk of POAF (RR: 1.55, P<0.001).Conclusion: Based on the current evidence, our findings show that adiposity was independently associated with an increased risk of POAF, while being underweight or overweight might not significantly increase the POAF risk. The magnitude of the effect of obesity on AF in patients undergoing valve surgery might be small, and this finding needs to be further confirmed.

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Dose-response relationship among body mass index, abdominal adiposity and atrial fibrillation in patients undergoing cardiac surgery: a meta-analysis of 35 cohorts

PeerJ ◽

10.7717/peerj.11855 ◽

2021 ◽

Vol 9 ◽

pp. e11855

Author(s):

Menglu Liu ◽

Kaibo Mei ◽

Lixia Xie ◽

Jianyong Ma ◽

Peng Yu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Body Mass Index ◽

Body Mass ◽

Meta Analysis ◽

Current Evidence ◽

Cochrane Library ◽

Categorical Variables ◽

Abdominal Adiposity ◽

Exposure Effect ◽

Increased Risk

Background Whether overweight increases the risk of postoperative atrial fibrillation (POAF) is unclear, and whether adiposity independently contributes to POAF has not been comprehensively studied. Thus, we conducted a meta-analysis to clarify the strength and shape of the exposure-effect relationship between adiposity and POAF. Methods The PubMed, Cochrane Library, and EMBASE databases were searched for revelant studies (randomized controlled trials (RCTs), cohort studies, and nest-case control studies) reporting data regarding the relationship between adiposity and the risk of POAF. Results Thirty-five publications involving 33,271 cases/141,442 patients were included. Analysis of categorical variables showed that obesity (RR: 1.39, 95% CI [1.21–1.61]; P < 0.001), but not being underweight (RR: 1.44, 95% CI [0.90–2.30]; P = 0.13) or being overweight (RR: 1.03, 95% CI [0.95–1.11]; P = 0.48) was associated with an increased risk of POAF. In the exposure-effect analysis (BMI) was 1.09 (95% CI [1.05–1.12]; P < 0.001) for the risk of POAF. There was a significant linear relationship between BMI and POAF (Pnonlinearity = 0.44); the curve was flat and began to rise steeply at a BMI of approximately 30. Notably, BMI levels below 30 (overweight) were not associated with a higher risk of POAF. Additionally, waist obesity or visceral adiposity index was associated with the risk of POAF. Conclusion Based on the current evidence, our findings showed that high body mass index or abdominal adiposity was independently associated with an increased risk of POAF, while underweight or overweight might not significantly increase the POAF risk.

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