scholarly journals Incidence, risk factors and prognostic effect of imaging right ventricular involvement in patients with COVID-19: a dose–response analysis protocol for systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e049866
Author(s):  
Chenghui Zhou ◽  
Baohui Lou ◽  
Hui Li ◽  
Xin Wang ◽  
Hushan Ao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Right Ventricular ◽  
Dose Response ◽  
Meta Analysis ◽  
Adult Patients ◽  
Sensitivity Analyses ◽  
Prognostic Effect ◽  
All Cause Mortality ◽  
Incidence Risk

IntroductionEmerging evidence has shown that COVID-19 infection may result in right ventricular (RV) disturbance and be associated with adverse clinical outcomes. The aim of this meta-analysis is to summarise the incidence, risk factors and the prognostic effect of imaging RV involvement in adult patients with COVID-19.MethodsA systematical search will be performed in PubMed, EMBase, ISI Knowledge via Web of Science and preprint databases (MedRxiv and BioRxiv) (until October 2021) to identify all cohort studies in adult patients with COVID-19. The primary outcome will be the incidence of RV involvement (dysfunction and/or dilation) assessed by echocardiography, CT or MRI. Secondary outcomes will include the risk factors for RV involvement and their association with all-cause mortality during hospitalisation. Additional outcomes will include the RV global or free wall longitudinal strain (RV-GLS or RV-FWLS), tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC) and RV diameter. Univariable or multivariable meta-regression and subgroup analyses will be performed for the study design and patient characteristics (especially acute or chronic pulmonary embolism and pulmonary hypertension). Sensitivity analyses will be used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of RV involvement incidence and related risk factors, association with all-cause mortality, and other RV parameters (RV-GLS or RV-FWLS, TAPSE, S’, FAC and RV diameter). Both linear and cubic spline regression models will be used to explore the dose–response relationship between different categories (>2) of RV involvement and the risk of mortality (OR or HR).Ethics and disseminationThere was no need for ethics approval for the systematic review protocol according to the Institutional Review Board/Independent Ethics Committee of Fuwai Hospital. This meta-analysis will be disseminated through a peer-reviewed journal for publication.PROSPERO registration numberCRD42021231689.

scholarly journals Association of frailty status with adverse clinical outcomes in patients with COVID-19: protocol for a systematic review and dose–response meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e046980
Author(s):  
Hanjun Pei ◽  
Ying Wang ◽  
Xinghui Zhang ◽  
Wenlong Luo ◽  
Chenghui Zhou
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Dose Response ◽  
Meta Analysis ◽  
Essential Element ◽  
Included Study ◽  
Sensitivity Analyses ◽  
Cochrane Library ◽  
Frailty Status ◽  
All Cause Mortality

IntroductionFrailty status has been recognised as an important prognostic factor of adverse clinical outcomes in various clinical settings. Recently, the role of frailty status in adverse clinical outcomes for COVID-19-infected patients has received increasing attention with controversial results. Hence, we will conduct a comprehensive dose–response meta-analysis to quantitatively evaluate the association between frailty status and adverse clinical outcomes in patients with COVID-19.MethodsThe researchers will systematically search PubMed, EMBase, Cochrane Library, ISI Knowledge via Web of Science and MedRxiv or BioRxiv databases (from inception until December 2020) to identify all retrospective and prospective cohort studies. All-cause mortality during hospitalisation will be set as the primary outcome. Univariable or multivariable meta-regression and subgroup analyses will be conducted for the comparison between frail versus non-frail categories. Sensitivity analyses will be used to assess the robustness of our results by removing each included study one at a time to obtain and evaluate the remaining overall estimates of all-cause mortality. To conduct a dose–response meta-analysis for the potential linear or restricted cubic spline regression relationship between frailty status and all-cause mortality, studies with three or more categories will be included.Ethics and disseminationIn accordance with the Institutional Review Board/Independent Ethics Committee of the First Affiliated Hospital of Baotou Medical College, ethical approval is not an essential element for the systematic review protocol. This meta-analysis will be disseminated through publication in a peer-reviewed journal.PROSPERO registration numberCRD42020220226.

scholarly journals Prevalence, classification, risk factors and outcome impact of delirium in patients with COVID-19: a meta-analysis protocol for systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e048323
Author(s):  
Baohui Lou ◽  
Jingfei Guo ◽  
Yue Liu ◽  
Chao Xiong ◽  
Jia Shi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Meta Analysis ◽  
Essential Element ◽  
Patient Characteristics ◽  
Included Study ◽  
Adult Patients ◽  
Sensitivity Analyses ◽  
Institutional Review ◽  
Secondary Outcomes

IntroductionPrevious studies have shown mixed results that delirium may result in a high risk of adverse clinical outcomes in patients with COVID-19. The aim of this meta-analysis is to summarise the evidence of prevalence, classification, risk factors and outcomes impact of delirium in adult patients with COVID-19.MethodsA systematic search will be performed in PubMed, EMBase, ISI Knowledge via Web of Science and preprint databases (MedRxiv and BioRxiv) (from inception until June 2021) to identify all cohort studies concerning delirium in adult patients with COVID-19. The primary outcome will be the prevalence of delirium with different classifications (hyperactive, hypoactive or mixed type). The secondary outcomes will include the association of risk factors and the association with all-cause mortality during hospitalisation. Univariable or multivariable meta-regression and subgroup analyses will be conducted for the study design and patient characteristics. Sensitivity analyses were used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of primary and secondary outcomes.Ethics and disseminationEthical approval is not an essential element for the systematic review protocol in accordance with the Institutional Review Board /Independent Ethics Committee of Beijing Hospital. This meta-analysis will be disseminated through a peer-reviewed journal for publication.PROSPERO registration numberCRD42020224871.

scholarly journals Optimal cut-off value of elevated cardiac troponin concentrations for myocardial injury predicts clinical outcomes in adult patients with COVID-19: a dose–response analysis protocol for systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e046575
Author(s):  
Chenghui Zhou ◽  
Hanjun Pei ◽  
Yiming Gao ◽  
Yulin Zhang ◽  
Liang Cao ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Dose Response ◽  
Cardiac Troponin ◽  
Myocardial Injury ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
All Cause Mortality

IntroductionAcute myocardial injury in patients with COVID-19 infection has been recognised as one important complication associated with in-hospital mortality. The potential dose–response effect of cardiac troponin (cTn) concentrations on adverse clinical outcomes has not been systematically studied. Hence, we will conduct a comprehensive dose–response meta-analysis to quantitatively evaluate the relationship between elevated cTn concentrations and in-hospital adverse clinical outcomes in patients with COVID-19.MethodsWe will search PubMed, EMBASE, Cochrane Library and ISI Knowledge via Web of Science databases, as well as preprint databases (medRxiv and bioRxiv), from inception to October 2021, to identify all retrospective and prospective cohorts and randomised controlled studies using related keywords. The primary outcome will be all-cause mortality during hospitalisation. The secondary outcome will be major adverse event (MAE). To conduct a dose–response meta-analysis of the potential linear or restricted cubic spline regression relationship between elevated cTn concentrations and all-cause mortality or MAE, studies with three or more categories of cTn concentrations will be included. Univariable or multivariable meta-regression and subgroup analyses will be conducted to compare elevated and non-elevated categories of cTn concentration. Sensitivity analyses will be used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of all-cause mortality or MAE.Ethics and disseminationIn accordance with the Institutional Review Board/Independent Ethics Committee of Fuwai Hospital, ethical approval was waived for this systematic review protocol. This meta-analysis will be disseminated through a peer-reviewing process for journal publication and conference communication.PROSPERO registration numberCRD42020216059.

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.

scholarly journals Natriuretic peptide-guided treatment for heart failure: a systematic review and meta-analysis

2019 ◽  
Vol 25 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Julie McLellan ◽  
Clare R Bankhead ◽  
Jason L Oke ◽  
F D Richard Hobbs ◽  
Clare J Taylor ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Natriuretic Peptide ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
Individual Outcomes ◽  
All Cause Mortality ◽  
Registration Number ◽  
Randomised Controlled ◽  
Meta Analyses

BackgroundGUIDE-IT, the largest trial to date, published in August 2017, evaluating the effectiveness of natriuretic peptide (NP)-guided treatment of heart failure (HF), was stopped early for futility on a composite outcome. However, the reported effect sizes on individual outcomes of all-cause mortality and HF admissions are potentially clinically relevant.ObjectiveThis systematic review and meta-analysis aims to combine all available trial level evidence to determine if NP-guided treatment of HF reduces all-cause mortality and HF admissions in patients with HF.Study selectionEight databases, no language restrictions, up to November 2017 were searched for all randomised controlled trials comparing NP-guided treatment versus clinical assessment alone in adult patients with HF. No language restrictions were applied. Publications were independently double screened and extracted. Fixed-effect meta-analyses were conducted.Findings89 papers were included, reporting 19 trials (4554 participants), average ages 62–80 years. Pooled risk ratio estimates for all-cause mortality (16 trials, 4063 participants) were 0.87, 95% CI 0.77 to 0.99 and 0.80, 95% CI 0.72 to 0.89 for HF admissions (11 trials, 2822 participants). Sensitivity analyses, restricted to low risk of bias, produced similar estimates, but were no longer statistically significant.ConclusionsConsidering all the evidence to date, the pooled effects suggest that NP-guided treatment is beneficial in reducing HF admissions and all-cause mortality. However, there is still insufficient high-quality evidence to make definitive recommendations on the use of NP-guided treatment in clinical practice.Trial registration numberSystematic Review Cochrane Database Number: CD008966.

scholarly journals Physical Activity and Mortality in Cancer Survivors: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Christine M Friedenreich ◽  
Chelsea R Stone ◽  
Winson Y Cheung ◽  
Sandra C Hayes
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Dose Response ◽  
Meta Analysis ◽  
Menopausal Status ◽  
Optimal Dose ◽  
Primary Objective ◽  
Survival Outcomes ◽  
All Cause Mortality ◽  
Pa Domain

Abstract Background Recommendations for improved survival after cancer through physical activity (PA) exist, although the evidence is still emerging. Our primary objective was to conduct a systematic review and meta-analysis of the association between prediagnosis and postdiagnosis PA and survival (cancer-specific, all-cause, and cardiovascular disease mortality) for all cancers and by tumor site. Secondary objectives were to examine the associations within population subgroups, by PA domain, and to determine the optimal dose of PA related to survival. Methods PubMed, EMBASE, and SportsDiscus databases were searched from inception to November 1, 2018. DerSimonian-Laird random-effects models were used to estimate the summary hazard ratios (HRs) and 95% confidence intervals (CI) for primary and secondary analyses and to conduct dose-response analyses. Results Evidence from 136 studies showed improved survival outcomes with highest vs lowest levels of prediagnosis or postdiagnosis total or recreational PA for all-cancers combined (cancer specific mortality: HR = 0.82, 95% CI = 0.79 to 0.86, and HR = 0.63, 95% CI = 0.53 to 0.75, respectively) as well as for 11 specific cancer sites. For breast and colorectal cancers, greater reductions were observed for postdiagnosis PA (HR = 0.58–0.63) compared with prediagnosis PA (HR = 0.80–0.86) for cancer-specific and all-cause mortality. Survival benefits through PA were observed in most subgroups (within sex, body mass index, menopausal status, colorectal subtypes, and PA domain) examined. Inverse dose-response relationships between PA and breast cancer-specific and all-cause mortality were observed, with steep reductions in hazards to 10–15 metabolic equivalent hours per week. Conclusion Higher prediagnosis and postdiagnosis levels of PA were associated with improved survival outcomes for at least 11 cancer types, providing support for global promotion of PA guidelines following cancer.

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