scholarly journals Simple Coagulation Profile as Predictor of Mortality in Adults Admitted with COVID-19: A Meta-Analysis

2021 ◽  
Vol 16 (5) ◽  
Author(s):  
Johanes Nugroho ◽  
Ardyan Wardhana ◽  
Dita Aulia Rachmi ◽  
Eka Prasetya Budi Mulia ◽  
Maya Qurota A'yun ◽  
...  
Keyword(s):  
Meta Analysis ◽  
International Normalized Ratio ◽  
Activated Partial Thromboplastin Time ◽  
Health Centers ◽  
Coagulation Parameters ◽  
Coagulation Profile ◽  
Inverse Variance ◽  
Prolonged Aptt ◽  
Standardized Mean Difference ◽  
Dichotomous Variables

Context: COVID-19 severe manifestations must be detected as soon as possible. One of the essential poor characteristics is the involvement of coagulopathy. Simple coagulation parameters, including prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), and platelet, are widely accessible in many health centers. Objectives: This meta-analysis aimed to determine the association between simple coagulation profiles and COVID-19 in-hospital mortality. Method: We systematically searched five databases for studies measuring simple coagulation parameters in COVID-19 on admission. The random-effects and inverse-variance weighting were used in the study, which used a standardized-mean difference of coagulation profile values. The odds ratios were computed using the Mantel-Haenszel formula for dichotomous variables. Results: This meta-analysis comprised a total of 30 studies (9,175 patients). In our meta-analysis, we found that non-survivors had a lower platelet count [SMD = -0.56 (95% CI: -0.79 to -0.33), P < 0.01; OR = 3.00 (95% CI: 1.66 to 5.41), P < 0.01], prolonged PT [SMD = 1.22 (95%CI: 0.71 to 1.72), P < 0.01; OR = 1.86 (95%CI: 1.43 to 2.43), P < 0.01], prolonged aPTT [SMD = 0.24 (95%CI: -0.04 to 0.52), P = 0.99], and increased INR [SMD = 2.21 (95%CI: 0.10 to 4.31), P = 0.04] than survivors. Conclusions: In COVID-19 patients, abnormal simple coagulation parameters on admission, such as platelet, PT, and INR, were associated with mortality outcomes.

scholarly journals Meta-analysis of coagulation disbalances in COVID-19: 41 studies and 17601 patients

2021 ◽  
Author(s):  
Polina Len ◽  
Gaukhar Iskakova ◽  
Zarina Sautbayeva ◽  
Aigul Kussanova ◽  
Ainur T. Tauekelova ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
Publication Bias ◽  
Partial Thromboplastin Time ◽  
Meta Analysis ◽  
Activated Partial Thromboplastin Time ◽  
Coagulation Parameters ◽  
Reticulated Platelets ◽  
Significant Difference ◽  
Funnel Plots ◽  
Egger Test

Introduction. Coagulation parameters are important determinants for COVID-19 infection. We conducted meta-analysis to assess the early hemostatic parameters in retrospective studies in association with severity of infection. Methods. Ovid, PubMed, Web of Sciences, and Google Scholar were searched for research articles that addressed clinical characteristics of COVID-19 patients and disease severity. Results were filtered using exclusion and inclusion criteria and then pooled into a meta-analysis to estimate the standardized mean difference with 95% CI for each of five coagulation parameters (D-dimers, fibrinogen, prothrombin time, platelets count, activated partial thromboplastin time). Two authors independently extracted data and assessed study quality. To explore the heterogeneity and robustness of our fundings, sensitivity and subgroup analyses were conducted. Publication bias was assessed with contour-enhanced funnel plots and Egger test by linear regression. Results. Overall, 41 original studies (17601 patients) on SARS-CoV2 were included. For the two groups of patients, stratified by severity, we identified that D-dimers, fibrinogen, activated partial thromboplastin time, and prothrombin time were significantly higher in the severe group (SMD 0.6985 with 95%CI [0.5155; 0.8815]); SMD 0.661with 95%CI [0.3387; 0.9833]; SMD 0.2683 with 95%CI [0.1357; 0.4009]; SMD 0.284 with 95%CI [0.1472; 0.4208]). In contrast, PLT was significantly lower in patients with more severe cases of COVID-19 (SMD -0.1684 with 95%CI [-0.2826; -0.0542]). Neither the analysis by the leave-one-out method nor the influence diagnostic have identified studies that solely cause significant change in the effect size estimates. Subgroup analysis showed no significant difference between articles originated from different countries but revealed that severity assessment criteria might have influence over estimated effect sizes for platelets and D-dimers. Contour-enhanced funnel plots and the Egger test for D-dimers and fibrinogen revealed significant asymmetry that might be a sign of publication bias. Conclusions. The standard coagulation laboratory parameters with exception of platelets counts are significantly elevated in patients with severe COVID-19. However, fibrinolysis shutdown requires evaluation outside conventional coagulation tests and analysis of additional specific markers related to clotting formation and PLT characteristics. We hypothesize that a proportion and parameters of immature reticulated platelets may serve as additional biomarkers for prediction of adverse events.

Changes in the blood coagulation profile after ovariohysterectomy in female dogs

2011 ◽  
Vol 14 (2) ◽  
pp. 289-290 ◽  
Author(s):  
P. Sobiech ◽  
R. Targoński ◽  
A. Stopyra ◽  
K. Żarczyńska
Keyword(s):  
Blood Coagulation ◽  
Activated Partial Thromboplastin Time ◽  
Thrombin Time ◽  
Blood Samples ◽  
Coagulation Profile ◽  
Healthy Female ◽  
At Iii ◽  
Prolonged Aptt ◽  
Fibrinogen Content ◽  
D Dimer

Changes in the blood coagulation profile after ovariohysterectomy in female dogs This study investigated changes in the coagulation profile of 10 healthy female dogs subjected to ovariohysterectomy. Blood samples were collected three times - before, directly after and 24 h after surgery. Plasma samples were analyzed to determine thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen content, D-dimer content and antithrombin (AT) III activity. The results revealed post-operative haemostatic system disorders related to prolonged APTT, higher fibrinogen and D-dimer concentrations and lower levels of AT III activity.

ctDNA as a prognostic factor in operable colon cancer patients: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Emre Yekedüz ◽  
Elif Berna Köksoy ◽  
Hakan Akbulut ◽  
Yüksel Ürün ◽  
Güngör Utkan
Keyword(s):  
Colon Cancer ◽  
Prognostic Factor ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Circulating Tumor Dna ◽  
Random Effects Model ◽  
Inverse Variance ◽  
Increased Risk ◽  
Significant Step ◽  
Tumor Dna

Aim: Using circulating tumor DNA (ctDNA) instead of historical clinicopathological factors to select patients for adjuvant chemotherapy (ACT) may reduce inappropriate therapy. Material & methods: MEDLINE was searched on March 31, 2020. Studies, including data related to the prognostic value of ctDNA in the colon cancer patients after surgery and after ACT, were included. The generic inverse-variance method with a random-effects model was used for meta-analysis. Results: Four studies were included for this meta-analysis. ctDNA-positive colon cancer patients after surgery and ACT had a significantly increased risk of recurrence compared with ctDNA-negative patients. Conclusions: ctDNA is an independent prognostic factor, and this meta-analysis is a significant step for using ctDNA instead of historical prognostic factors in the adjuvant setting.

scholarly journals A Rare Cause of Isolated Prolonged Activated Partial Thromboplastin Time: An Overview of Prekallikrein Deficiency and the Contact System

2021 ◽  
Vol 9 ◽  
pp. 232470962110121
Author(s):  
Ivy Riano ◽  
Klaorat Prasongdee
Keyword(s):  
Partial Thromboplastin Time ◽  
Normal Activity ◽  
Fresh Frozen Plasma ◽  
Activated Partial Thromboplastin Time ◽  
Recessive Trait ◽  
Bleeding Tendency ◽  
Contact Activation ◽  
Asymptomatic Patients ◽  
Prolonged Aptt ◽  
Fresh Frozen

Prekallikrein (PK) deficiency, also known as Fletcher factor deficiency, is a very rare disorder inherited as an autosomal recessive trait. It is usually identified incidentally in asymptomatic patients with a prolonged activated partial thromboplastin time (aPTT). In this article, we present the case of a 52-year-old woman, with no prior personal or family history of thrombotic or hemorrhagic disorders, who was noted to have substantial protracted aPTT through the routine coagulation assessment before a kidney biopsy. The patient had an uneventful biopsy course after receiving fresh frozen plasma (FFP). Laboratory investigations performed before the biopsy indicated normal activity for factors VIII, IX, XI, XII, and von Willebrand factor (vWF) as well as negative lupus anticoagulant (LA) screen. The plasma PK assay revealed low activity at 15% consistent with mild PK deficiency. The deficit of PK is characterized by a severely prolonged aPTT and normal prothrombin time (PT) in the absence of bleeding tendency. PK plays a role in the contact-activated coagulation pathway and the inflammatory response. Thus, other differential diagnoses of isolated prolonged aPTT include intrinsic pathway factor deficiencies and nonspecific inhibitors such as LA. We concluded that the initial evaluation of a prolonged aPTT with normal PT should appraise the measurement of contact activation factors and factor inhibitors. PK deficiency should be considered in asymptomatic patients with isolated aPTT prolongation, which corrects on incubation, with normal levels of the contact activation factors and factor inhibitors.

scholarly journals Systematic Review and Meta-Analysis of the Dose-Response and Risk Factors for Obliteration of Arteriovenous Malformations Following Radiosurgery: An Update Based on the Last 20 Years of Published Clinical Evidence

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Shaoyu Zhu ◽  
N Patrik Brodin ◽  
Madhur K Garg ◽  
Patrick A LaSala ◽  
Wolfgang A Tomé
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Dose Response ◽  
Meta Analysis ◽  
Gamma Knife Radiosurgery ◽  
Lesion Size ◽  
Intracranial Arteriovenous Malformation ◽  
Factors Associated ◽  
Obliteration Rate ◽  
Inverse Variance

ABSTRACT BACKGROUND Intracranial arteriovenous malformation (AVM) is a congenital lesion that can potentially lead to devastating consequences if not treated. Many institutional cohort studies have reported on the outcomes after radiosurgery and factors associated with successful obliteration in the last few decades. OBJECTIVE To quantitatively assess the dose-response relationship and risk factors associated with AVM obliteration using a systematic review and meta-analysis approach. METHODS Data were extracted from reports published within the last 20 yr. The dose-response fit for obliteration as a function of marginal dose was performed using inverse-variance weighting. Risk factors for AVM obliteration were assessed by combining odds ratios from individual studies using inverse-variance weighting. RESULTS The logistic model fit showed a clear association between higher marginal dose and higher rates of obliteration. There appeared to be a difference in the steepness in dose-response when comparing studies with patients treated using Gamma Knife radiosurgery (Elekta), compared to linear accelerators (LINACs), and when stratifying studies based on the size of treated AVMs. In the risk-factor analysis, AVM obliteration rate decreases with larger AVM volume or AVM diameter, higher AVM score or Spetzler-Martin (SM) grade, and prior embolization, and increases with compact AVM nidus. No statistically significant associations were found between obliteration rate and age, sex, prior hemorrhage, prior aneurysm, and location eloquence. CONCLUSION A marginal dose above 18 Gy was generally associated with AVM obliteration rates greater than 60%, although lesion size, AVM score, SM grade, prior embolization, and nidus compactness all have significant impact on AVM obliteration rate.

Meta-analyzing the prevalence and prognostic effect of antipsychotic exposure in clinical high-risk (CHR): when things are not what they seem

2020 ◽  
pp. 1-9
Author(s):  
Andrea Raballo ◽  
Michele Poletti ◽  
Antonio Preti
Keyword(s):  
High Risk ◽  
Meta Analysis ◽  
Prognostic Impact ◽  
Clinical High Risk ◽  
Qualitative Synthesis ◽  
Prognostic Effect ◽  
Inverse Variance ◽  
Arcsine Transformation ◽  
Estimate Prevalence

Abstract Background The clinical high-risk (CHR) for psychosis paradigm is changing psychiatric practice. However, a widespread confounder, i.e. baseline exposure to antipsychotics (AP) in CHR samples, is systematically overlooked. Such exposure might mitigate the initial clinical presentation, increase the heterogeneity within CHR populations, and confound the evaluation of transition to psychosis at follow-up. This is the first meta-analysis examining the prevalence and the prognostic impact on transition to psychosis of ongoing AP treatment at baseline in CHR cohorts. Methods Major databases were searched for articles published until 20 April 2020. The variance-stabilizing Freeman-Tukey double arcsine transformation was used to estimate prevalence. The binary outcome of transition to psychosis by group was estimated with risk ratio (RR) and the inverse variance method was used for pooling. Results Fourteen studies were eligible for qualitative synthesis, including 1588 CHR individuals. Out of the pooled CHR sample, 370 individuals (i.e. 23.3%) were already exposed to AP at the time of CHR status ascription. Transition toward full-blown psychosis at follow-up intervened in 112 (29%; 95% CI 24–34%) of the AP-exposed CHR as compared to 235 (16%; 14–19%) of the AP-naïve CHR participants. AP-exposed CHR had higher RR of transition to psychosis (RR = 1.47; 95% CI 1.18–1.83; z = 3.48; p = 0.0005), without influence by age, gender ratio, overall sample size, duration of the follow-up, or quality of the studies. Conclusions Baseline AP exposure in CHR samples is substantial and is associated with a higher imminent risk of transition to psychosis. Therefore, such exposure should be regarded as a non-negligible red flag for clinical risk management.

scholarly journals Polyethylene glycol versus lactulose in the treatment of hepatic encephalopathy: a systematic review and meta-analysis

2021 ◽  
Vol 8 (1) ◽  
pp. e000648
Author(s):  
Gilles Jadd Hoilat ◽  
Mohamad Fekredeen Ayas ◽  
Judie Noemie Hoilat ◽  
Ahmed Abu-Zaid ◽  
Ceren Durer ◽  
...  
Keyword(s):  
Polyethylene Glycol ◽  
Hepatic Encephalopathy ◽  
Web Of Science ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Brain Dysfunction ◽  
Cochrane Library ◽  
Continuous Data ◽  
Inverse Variance ◽  
Scoring Algorithm

BackgroundHepatic encephalopathy (HE) is defined as brain dysfunction that occurs because of acute liver failure or liver cirrhosis and is associated with significant morbidity and mortality. Lactulose is the standard of care till this date; however, polyethylene glycol (PEG) has gained the attention of multiple investigators.MethodsWe screened five databases namely PubMed, Scopus, Web of Science, Cochrane Library and Embase from inception to 10 February 2021. Dichotomous and continuous data were analysed using the Mantel-Haenszel and inverse variance methods, respectively, which yielded a meta-analysis comparing PEG versus lactulose in the treatment of HE.ResultsFour trials with 229 patients were included. Compared with lactulose, the pooled effect size demonstrated a significantly lower average HE Scoring Algorithm (HESA) Score at 24 hours (Mean difference (MD)=−0.68, 95% CI (−1.05 to –0.31), p<0.001), a higher proportion of patients with reduction of HESA Score by ≥1 grade at 24 hours (risk ratio (RR)=1.40, 95% CI (1.17 to 1.67), p<0.001), a higher proportion of patients with a HESA Score of grade 0 at 24 hours (RR=4.33, 95% CI (2.27 to 8.28), p<0.0010) and a shorter time to resolution of HE group (MD=−1.45, 95% CI (−1.72 to –1.18), p<0.001) in favour of patients treated with PEG.ConclusionPEG leads to a higher drop in the HESA Score and thus leads to a faster resolution of HE compared with lactulose.

Sacubitril/valsartan in real-life European patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Giovinazzo ◽  
L Carmisciano ◽  
M Toma ◽  
M.P Sormani ◽  
M Canepa ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Nyha Class ◽  
Real Life ◽  
Original Research ◽  
Baseline Characteristic ◽  
Class Iii ◽  
Real World Data ◽  
Full Dose ◽  
Reduced Ejection Fraction ◽  
Inverse Variance

Abstract Background Real-world data are needed to gauge how a therapy is implemented in clinical practice. Methods We systematically reviewed the abstracts presented at international congresses and the peer-reviewed original research articles, which described the use of sacubitril/valsartan in European patients with HFrEF from Sep 2014 until Nov 30, 2019. Meta-analysis estimates were combined using a random effects model with inverse variance weights. Results 15 abstracts and 11 articles, including 14,179 patients, were selected. Except for a study that evaluated 12,082 (85,2%) subjects, the sample size was 28 (0.2%) to 1,120 (7.9%) patients. Taking as reference PARADIGM-HF, few baseline characteristic were reported for &gt;80% of the pooled population (Table), while all other ones were available for 12% of subjects or less (Figure). Underreporting was less common for articles than for abstracts (OR 0.42, 95% CI: 0.20–0.91). Compared with the patients enrolled in PARADIGM-HF, those in real-life were older and more likely to being previously treated with ARB, MRA and diuretics (Table). NYHA class III-IV (OR 2.39, 95% CI: 1.58–3.59; I2=92%), ICD (OR 4.21, 95% CI: 2.31–7.69; I2=93%) and CRT (OR 4.53, 95% CI: 3.89–5.27; I2=0%) were also more likely, while a history of hypertension was less frequent (OR 0.61, 95% CI: 0.42–0.87; I2=82%). The monthly achievement rate of the full dose of sacubitril/valsartan was 6%. When follow-up was ≥6 months, the percentage of subjects reaching the full dose was about 40% and very homogenous. Age and full dose attainment were inversely related (β −2.71, 95% CI: −5.3 to −0.1). All cause-mortality and hospitalization rates were 6/100 person-year (9 studies, 1046 patients) and 25/100 person-year (5 studies, 775 patients), respectively. Conclusions With the limitation of being heterogeneous and of overall low quality, the literature suggests that, in Europe, sacubitril/valsartan is prescribed to patients with somehow more severe HFrEF than in the pivotal trial, who most often do not reach the full dose. Funding Acknowledgement Type of funding source: None

Intralymphatic immunotherapy for allergic rhinitis: A systematic review and meta-analysis

2021 ◽  
Vol 42 (4) ◽  
pp. 283-292 ◽  
Author(s):  
Michael T. Werner ◽  
John V. Bosso
Keyword(s):  
Systematic Review ◽  
Allergic Rhinitis ◽  
Adverse Event ◽  
Skin Prick Testing ◽  
Meta Analysis ◽  
Mean Difference ◽  
Random Effects Model ◽  
Nasal Provocation ◽  
Intralymphatic Immunotherapy ◽  
Standardized Mean Difference

Background: Only a fraction of patients with allergic rhinitis receive allergen-specific immunotherapy (AIT). AIT is most commonly delivered subcutaneously in a series of injections over 3‐5 years. Common obstacles to completing this therapy include cost and inconvenience. Intralymphatic immunotherapy (ILIT) has been proposed as a faster alternative, which requires as few as three injections spaced 4 weeks apart. Objective: This systematic review and meta-analysis evaluated the current evidence that supports the use of ILIT for allergic rhinitis. Methods: Clinical trials were identified in the published literature by using an electronic search strategy and were evaluated by using a risk of bias tool. Treatment outcome (symptom scores, medication scores, and combined symptom and medication scores) and provocation testing results (nasal provocation and skin-prick testing) were included in a meta-analysis of standardized mean difference with subgrouping by using a random-effects model. Overall adverse event rates were tabulated, and overall risk ratios were calculated by using a random-effects model. Results: We identified 17 clinical trials that met eligibility criteria. The standardized mean difference of ILIT on the symptom and medication score was ‐0.72 (95% confidence interval [CI], ‐0.98 to ‐0.46; p < 0.0001) (n = 10). The standardized mean difference of ILIT on nasal provocation and skin-prick testing was ‐1.00 (95% CI, ‐1.38 to ‐0.61; p < 0.0001) (n = 7) and ‐0.73 (95% CI, ‐0.99 to ‐0.47; p < 0.0001) (n = 7), respectively. No statistically significant heterogeneity was detected. The overall adverse event rate was 39.5% for ILIT and 23.5% for placebo. Also, 98.4% of adverse events were mild. Conclusion: Our meta-analysis demonstrated that ILIT was safe, conferred desensitization to seasonal and nonseasonal allergens, alleviated allergic rhinitis symptoms, and reduced medication use. A larger randomized, double-blind, placebo controlled trial will be necessary for wider adaptation of this form of AIT.

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