scholarly journals Effect of Tocilizumab in Reducing the Mortality Rate in COVID-19 Patients: A Systematic Review with Meta-Analysis

2021 ◽  
Vol 11 (7) ◽  
pp. 628
Author(s):  
Valeria Conti ◽  
Graziamaria Corbi ◽  
Carmine Sellitto ◽  
Francesco Sabbatino ◽  
Chiara Maci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mortality Rate ◽  
Critically Ill Patients ◽  
Odds Ratio ◽  
Observational Studies ◽  
Meta Analysis ◽  
Regression Analyses ◽  
Log Odds ◽  
Meta Regression ◽  
Reduction Of Mortality

Data supporting the use of Tocilizumab (TCZ) in COVID-19 are contrasting and inconclusive. This meta-analysis aimed to assess TCZ effectiveness in reducing the mortality rate in COVID-19 patients. PubMed, Scopus, Embase, Cochrane, WILEY, and ClinicalTrials.gov were searched to evaluate observational studies and RCTs. The outcome was the mortality rate. Forty observational studies and seven RCTs, involving 9640 and 5556 subjects treated with Standard Therapy (ST) + TCZ or ST alone, respectively, were included. In patients treated with ST+TCZ, a higher survival (Log odds ratio = −0.41; 95% CI: −0.68 −0.14; p < 0.001) was found. Subgroups analyses were performed to better identify the possible interference of some parameters in modifying the efficacy of TCZ therapy on COVID-19 mortality. Separating observational from RCTs, no statistically significant (p = 0.70) TCZ-related reduction of mortality regarding RCTs was found, while a significant reduction (Log odds ratio = −0.52; 95% CI: −0.82 −0.22, p < 0.001) was achieved regarding the observational studies. Stratifying for the use of Invasive Mechanic Ventilation (IMV), a higher survival was found in patients treated with TCZ in the No-IMV and IMV groups (both p < 0.001), but not in the No-IMV/IMV group. Meta-regression analyses were also performed. The meta-analysis of observational studies reveals that TCZ is associated with reducing the mortality rate in both severe and critically ill patients. Although the largest RCT, RECOVERY, is in line with this result, the meta-analysis of RCTs failed to found any difference between ST + TCZ and ST. It is crucial to personalize the therapy considering the patients’ characteristics.

scholarly journals Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis

BMJ ◽  
2020 ◽  
pp. m1361 ◽  
Author(s):  
Elpida Vounzoulaki ◽  
Kamlesh Khunti ◽  
Sophia C Abner ◽  
Bee K Tan ◽  
Melanie J Davies ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Meta Analysis ◽  
Healthy Controls ◽  
Regression Analyses ◽  
White Population ◽  
History Of ◽  
Meta Regression

AbstractObjectiveTo estimate and compare progression rates to type 2 diabetes mellitus (T2DM) in women with gestational diabetes mellitus (GDM) and healthy controls.DesignSystematic review and meta-analysis.Data sourcesMedline and Embase between January 2000 and December 2019, studies published in English and conducted on humans.Eligibility criteria for selecting studiesObservational studies investigating progression to T2DM. Inclusion criteria were postpartum follow-up for at least 12 months, incident physician based diagnosis of diabetes, T2DM reported as a separate outcome rather than combined with impaired fasting glucose or impaired glucose tolerance, and studies with both a group of patients with GDM and a control group.ResultsThis meta-analysis of 20 studies assessed a total of 1 332 373 individuals (67 956 women with GDM and 1 264 417 controls). Data were pooled by random effects meta-analysis models, and heterogeneity was assessed by use of the I2 statistic. The pooled relative risk for the incidence of T2DM between participants with GDM and controls was estimated. Reasons for heterogeneity between studies were investigated by prespecified subgroup and meta-regression analyses. Publication bias was assessed by funnel plots and, overall, studies were deemed to have a low risk of bias (P=0.58 and P=0.90). The overall relative risk for T2DM was almost 10 times higher in women with previous GDM than in healthy controls (9.51, 95% confidence interval 7.14 to 12.67, P<0.001). In populations of women with previous GDM, the cumulative incidence of T2DM was 16.46% (95% confidence interval 16.16% to 16.77%) in women of mixed ethnicity, 15.58% (13.30% to 17.86%) in a predominantly non-white population, and 9.91% (9.39% to 10.42%) in a white population. These differences were not statistically significant between subgroups (white v mixed populations, P=0.26; white v non-white populations, P=0.54). Meta-regression analyses showed that the study effect size was not significantly associated with mean study age, body mass index, publication year, and length of follow-up.ConclusionsWomen with a history of GDM appear to have a nearly 10-fold higher risk of developing T2DM than those with a normoglycaemic pregnancy. The magnitude of this risk highlights the importance of intervening to prevent the onset of T2DM, particularly in the early years after pregnancy.Systematic review registrationPROSPERO CRD42019123079.

Increased Peripheral Blood Visfatin Concentrations May Be a Risk Marker of Coronary Artery Disease: A Meta-Analysis of Observational Studies

Angiology ◽  
2018 ◽  
Vol 69 (9) ◽  
pp. 825-834 ◽  
Author(s):  
Fuling Yu ◽  
Jianwei Li ◽  
Qilei Huang ◽  
Hongbin Cai
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Peripheral Blood ◽  
Observational Studies ◽  
Meta Analysis ◽  
Density Lipoprotein ◽  
Risk Marker ◽  
Regression Analyses ◽  
Meta Regression ◽  
Artery Disease

A comprehensive quantitative evaluation of the relationship between peripheral blood visfatin concentrations and coronary artery disease (CAD) is lacking. This study is the first attempt to quantify this relationship via a meta-analysis of published observational studies in terms of weighted mean difference (WMD). Literature retrieval, article selection, and data extraction were conducted. Heterogeneity was inspected using both subgroup and meta-regression analyses. In total, 15 articles involving 1053 CAD cases and 714 controls were included. Overall, peripheral blood visfatin concentrations were significantly higher in CAD cases than in controls (WMD: 4.72 ng/mL; 95% confidence interval [CI]: 2.97-6.47; P < .001), with significant heterogeneity and publication bias. Six studies were theoretically missing based on filled funnel plot, and considering the impact of these missing studies still detected a significant overall mean difference in visfatin (WMD: 2.82 ng/mL; 95% CI: 2.22-3.58; P < .001; number of studies: 21). Subgroup and meta-regression analyses indicated age, body mass index, race, diabetes, systolic blood pressure, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were identified as possible causes of heterogeneity. In conclusion, our findings suggest that increased peripheral blood visfatin concentrations may be a risk marker of CAD.

scholarly journals Treatment Efficacy of Immune Checkpoint Inhibitors for Patients with Advanced or Metastatic Colorectal Cancer: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (16) ◽  
pp. 3599
Author(s):  
Junhee Pyo ◽  
Hyo-Jung Park
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Treatment Efficacy ◽  
Odds Ratio ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Meta Analysis ◽  
Drug Regimen ◽  
Line Therapy ◽  
Meta Regression

The treatment efficacy of immune checkpoint inhibitors (ICIs) in colorectal cancer (CRC) has been reported heterogeneously across clinical trials. We conducted a systematic review and meta-analysis to evaluate the efficacy of ICIs in patients with advanced/metastatic CRC. Ovid-Medline was searched to identify clinical trials providing the efficacy outcomes of overall response rate (ORR) or disease control rate (DCR). The pooled ORR and DCR were estimated across all studies and subgroups. Meta-regression was performed to find the influencing factors for treatment efficacy. A total of thirty studies (1870 patients) were eligible. The overall ORR and DCR were 20.1% and 58.5%, respectively, but these results were heterogeneous across studies. Multivariate meta-regression revealed that microsatellite phenotype (odds ratio of MSI-H/dMMR versus MSS/pMMR: 1.67, p < 0.001) and drug regimen (odds ratio of monotherapy versus combination therapy: 1.07, p = 0.019) were the source of heterogeneity and also significantly influenced factors for the efficacy of the treatment. Although the efficacy of ICIs as a first-line therapy was higher than that of ICIs as the second- or more-line therapy (ORR: 51.5% vs. 13.4%, DCR: 85% vs. 49.5%), multivariate regression showed that the line of therapy was not a significant factor for the treatment efficacy. Our study suggests that the microsatellite phenotype and drug regimen, rather than the line of treatment, are the primary factors influencing the treatment response among advanced/metastatic CRC patients treated with an ICI-based regimen.

scholarly journals The Incidence of Pulmonary Thromboembolism in Critically Ill Patients With COVID-19: A Systematic Review, Meta-Analysis and Meta-Regression of Observational Studies

2020 ◽  
Author(s):  
Jun Jie Ng ◽  
Zhen Chang Liang ◽  
Andrew MTL Choong
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Observational Studies ◽  
Pulmonary Thromboembolism ◽  
Meta Analysis ◽  
Weighted Average ◽  
Meta Regression ◽  
Prophylactic Anticoagulation

Abstract Purpose Coronavirus disease 2019 (COVID-19) infection is known to be associated with a hypercoagulable and prothrombotic state, especially in critically ill patients. Several observational studies have reported the incidence of thromboembolic events such as pulmonary thromboembolism (PTE). We performed a meta-analysis to estimate the weighted average incidence of PTE in critically ill COVID-19 patients who are admitted to the intensive care unit.Methods We searched MEDLINE via PubMed, Embase and Web of Science for relevant studies from 31 December 2019 till 15 Aug 2020 onwards using the search terms “coronavirus”, “COVID-19”, “SARS-CoV-2”, “2019-nCoV”, “thrombus”, “thrombo*”, “embolus” and “emboli*”. We included prospective and retrospective observational studies that reported the incidence of PTE in critically ill COVID-19 patients who required treatment in the intensive care unit. We identified 14 studies after two phases of screening and extracted data related to study characteristics, patient demographics and the incidence of PTE. Risk of bias was assessed by using the ROBINS-I tool. Statistical analysis was performed with R 3.6.3.Results We included 14 studies with a total of 1182 patients in this study. Almost 100% of patients in this meta-analysis received at least prophylactic anticoagulation. The weighted average incidence of PTE was 11.09% (95% CI 7.72% to 15.69%, I2 = 78%, Cochran’s Q test P < 0.01). We performed univariate and multivariate meta-regression which identified the proportion of males as a significant source of heterogeneity (P = 0.03, 95% CI 0.00 to -0.09)Conclusion This is the only study that had specifically reported the weighted average incidence of PTE in critically ill COVID-19 patients using meta-analytic techniques. The weighted average incidence of PTE remains high even after prophylactic anticoagulation. This study is limited by incomplete data from included studies. More studies are needed to determine the optimal anticoagulation strategy in critically ill COVID-19 patients.

scholarly journals The relationship of COVID-19 severity with cardiovascular disease and its traditional risk factors: A systematic review and meta-analysis

2020 ◽  
Author(s):  
Kunihiro Matsushita ◽  
Ning Ding ◽  
Minghao Kou ◽  
Xiao Hu ◽  
Mengkun Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cardiovascular Disease ◽  
Meta Analysis ◽  
Multivariable Analysis ◽  
Renin Angiotensin System ◽  
Regression Analyses ◽  
Male Sex ◽  
Meta Regression ◽  
Traditional Risk Factors

AbstractBackgroundWhether cardiovascular disease (CVD) and its traditional risk factors predict severe coronavirus disease 2019 (COVID-19) is uncertain, in part, because of potential confounding by age and sex.MethodsWe performed a systematic review of studies that explored pre-existing CVD and its traditional risk factors as risk factors of severe COVID-19 (defined as death, acute respiratory distress syndrome, mechanical ventilation, or intensive care unit admission). We searched PubMed and Embase for papers in English with original data (≥10 cases of severe COVID-19). Using random-effects models, we pooled relative risk (RR) estimates and conducted meta-regression analyses.ResultsOf the 661 publications identified in our search, 25 papers met our inclusion criteria, with 76,638 COVID-19 patients including 11,766 severe cases. Older age was consistently associated with severe COVID-19 in all eight eligible studies, with RR >∼5 in >60-65 vs. <50 years. Three studies showed no change in the RR of age after adjusting for covariate(s). In univariate analyses, factors robustly associated with severe COVID-19 were male sex (10 studies; pooled RR=1.73, [95%CI 1.50-2.01]), hypertension (8 studies; 2.87 [2.09-3.93]), diabetes (9 studies; 3.20 [2.26-4.53]), and CVD (10 studies; 4.97 [3.76-6.58]). RR for male sex was likely to be independent of age. For the other three factors, meta-regression analyses suggested confounding by age. Only four studies reported multivariable analysis, but most of them showed adjusted RR ∼2 for hypertension, diabetes, and CVD. No study explored renin-angiotensin system inhibitors as a risk factor for severe COVID-19.ConclusionsDespite the potential for confounding, these results suggest that hypertension, diabetes, and CVD are independently associated with severe COVID-19 and, together with age and male sex, can be used to inform objective decisions on COVID-19 testing, clinical management, and workforce planning.

scholarly journals Colchicine use in patients with COVID-19: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Leonard Chiu ◽  
Ronald Chow ◽  
Nicholas Chiu ◽  
Chun-Han Lo ◽  
Rahul Aggarwal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Odds Ratio ◽  
Lower Risk ◽  
Observational Studies ◽  
Trial Design ◽  
Meta Analysis ◽  
Point Estimate ◽  
Randomized Controlled ◽  
Risk Of Mortality ◽  
Prospective Investigation

ABSTRACTIntroductionColchicine may inhibit inflammasome signaling and reduce proinflammatory cytokines, a purported mechanism of COVID-19 pneumonia. The aim of this systematic review and meta-analysis is to report on the state of the current literature on the use of colchicine in COVID-19 and to investigate the reported clinical outcomes in COVID-19 patients by colchicine usage.MethodsThe literature was searched from January 2019 through January 28, 2021. References were screened to identify studies that reported the effect of colchicine usage on COVID-19 outcomes including mortality, intensive care unit (ICU) admissions, or mechanical ventilation. Studies were meta-analyzed for mortality by the subgroup of trial design (RCT vs observational) and ICU status. Studies reporting an odds ratio (OR) and hazard ratio (HR) were analyzed separately.ResultsSix studies, reporting on 5,033 patients, were included in this review. Across the six studies, COVID-19 patients who had colchicine had a lower risk of mortality – HR of 0.25 (95% CI: 0.09, 0.66) and OR of 0.36 (95% CI: 0.17, 0.76). Among the three observational studies, COVID-19 patients who received colchicine had a lower risk of mortality – HR of 0.25 (95% CI: 0.09, 0.66) and OR of 0.21 (95% CI: 0.06, 0.71). Among three randomized controlled trials, the summary point estimate suggests a direction toward benefit in mortality that is not statistically significant among patients receiving colchicine versus placebo– OR of 0.49 (95% CI: 0.20, 1.24).ConclusionColchicine may reduce the risk of mortality in individuals with COVID-19. Further prospective investigation is warranted to determine the efficacy of colchicine as treatment in COVID-19 patients in various care settings of the disease.

scholarly journals Anti-Xa versus time-guided anticoagulation strategies in extracorporeal membrane oxygenation: a systematic review and meta-analysis

Perfusion ◽  
2020 ◽  
pp. 026765912095298
Author(s):  
Ariane Willems ◽  
Peter P Roeleveld ◽  
Sonia Labarinas ◽  
John W Cyrus ◽  
Jennifer A Muszynski ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mortality Rate ◽  
Extracorporeal Membrane Oxygenation ◽  
Observational Studies ◽  
Meta Analysis ◽  
Lower Mortality ◽  
Bleeding Events ◽  
Membrane Oxygenation ◽  
Significant Difference

The purpose was to compare time-based vs anti-Xa-based anticoagulation strategies in patients on ECMO. We conducted a systematic review and meta-analysis using multiple electronic databases and included studies from inception to July 19, 2019. The proportion of bleeding, thrombosis, and mortality were evaluated. Twenty-six studies (2,086 patients) were included. Bleeding occurred in 34.2% (95%CI 25.1;43.9) of the patients with anti-Xa-based versus 41.6% (95%CI 24.9;59.4) of the patients with time-based anticoagulation strategies. Thrombosis occurred in 32.6% (95%CI 19.1;47.7) of the patients with anti-Xa-based versus 38.4% (95%CI 22.2;56.1) of the patients with time-based anticoagulation strategies. And mortality rate was 35.4% (95%CI 28.9;42.1) of the patients with anti-Xa-based versus 42.9% (95%CI 36.9;48.9) of the patients with time-based anticoagulation strategies. Among the seven studies providing results from both anticoagulation strategies, significantly fewer bleeding events occurred in the anti-Xa-based anticoagulation strategy (adjusted OR 0.49 (95%CI 0.32;0.74), p < 0.001) and a significantly lower mortality rate (adjusted OR 0.61 (95%CI 0.40;0.95), p = 0.03). There was no significant difference in thrombotic events (adjusted OR 0.91 (95%CI 0.56;1.49), p = 0.71). In these seven observational studies, only a small fraction of the patients were adults, and data were insufficient to analyze the effect of the type of ECMO. In this meta-analysis of observational studies of patients on ECMO, an anti-Xa-based anticoagulation strategy, when compared to a time-based strategy, was associated with fewer bleeding events and mortality rate, without an increase in thrombotic events.

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