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Intensive Care Medicine Feb 2023To provide an overview and evaluate the performance of mortality prediction models for patients requiring extracorporeal membrane oxygenation (ECMO) support for...
PURPOSE
To provide an overview and evaluate the performance of mortality prediction models for patients requiring extracorporeal membrane oxygenation (ECMO) support for refractory cardiocirculatory or respiratory failure.
METHODS
A systematic literature search was undertaken to identify studies developing and/or validating multivariable prediction models for all-cause mortality in adults requiring or receiving veno-arterial (V-A) or veno-venous (V-V) ECMO. Estimates of model performance (observed versus expected (O:E) ratio and c-statistic) were summarized using random effects models and sources of heterogeneity were explored by means of meta-regression. Risk of bias was assessed using the Prediction model Risk Of BiAS Tool (PROBAST).
RESULTS
Among 4905 articles screened, 96 studies described a total of 58 models and 225 external validations. Out of all 58 models which were specifically developed for ECMO patients, 14 (24%) were ever externally validated. Discriminatory ability of frequently validated models developed for ECMO patients (i.e., SAVE and RESP score) was moderate on average (pooled c-statistics between 0.66 and 0.70), and comparable to general intensive care population-based models (pooled c-statistics varying between 0.66 and 0.69 for the Simplified Acute Physiology Score II (SAPS II), Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Sequential Organ Failure Assessment (SOFA) score). Nearly all models tended to underestimate mortality with a pooled O:E > 1. There was a wide variability in reported performance measures of external validations, reflecting a large between-study heterogeneity. Only 1 of the 58 models met the generally accepted Prediction model Risk Of BiAS Tool criteria of good quality. Importantly, all predicted outcomes were conditional on the fact that ECMO support had already been initiated, thereby reducing their applicability for patient selection in clinical practice.
CONCLUSIONS
A large number of mortality prediction models have been developed for ECMO patients, yet only a minority has been externally validated. Furthermore, we observed only moderate predictive performance, large heterogeneity between-study populations and model performance, and poor methodological quality overall. Most importantly, current models are unsuitable to provide decision support for selecting individuals in whom initiation of ECMO would be most beneficial, as all models were developed in ECMO patients only and the decision to start ECMO had, therefore, already been made.
Topics: Adult; Humans; Prognosis; Extracorporeal Membrane Oxygenation; Organ Dysfunction Scores; Respiratory Insufficiency; Retrospective Studies; Hospital Mortality
PubMed: 36600027
DOI: 10.1007/s00134-022-06947-z -
Journal of Medical Virology Oct 2020Mortality rates of coronavirus disease-2019 (COVID-19) continue to rise across the world. Information regarding the predictors of mortality in patients with COVID-19... (Meta-Analysis)
Meta-Analysis
Mortality rates of coronavirus disease-2019 (COVID-19) continue to rise across the world. Information regarding the predictors of mortality in patients with COVID-19 remains scarce. Herein, we performed a systematic review of published articles, from 1 January to 24 April 2020, to evaluate the risk factors associated with mortality in COVID-19. Two investigators independently searched the articles and collected the data, in accordance with PRISMA guidelines. We looked for associations between mortality and patient characteristics, comorbidities, and laboratory abnormalities. A total of 14 studies documenting the outcomes of 4659 patients were included. The presence of comorbidities such as hypertension (odds ratio [OR], 2.5; 95% confidence interval [CI], 2.1-3.1; P < .00001), coronary heart disease (OR, 3.8; 95% CI, 2.1-6.9; P < .00001), and diabetes (OR, 2.0; 95% CI, 1.7-2.3; P < .00001) were associated with significantly higher risk of death amongst patients with COVID-19. Those who died, compared with those who survived, differed on multiple biomarkers on admission including elevated levels of cardiac troponin (+44.2 ng/L, 95% CI, 19.0-69.4; P = .0006); C-reactive protein (+66.3 µg/mL, 95% CI, 46.7-85.9; P < .00001); interleukin-6 (+4.6 ng/mL, 95% CI, 3.6-5.6; P < .00001); D-dimer (+4.6 µg/mL, 95% CI, 2.8-6.4; P < .00001); creatinine (+15.3 µmol/L, 95% CI, 6.2-24.3; P = .001); and alanine transaminase (+5.7 U/L, 95% CI, 2.6-8.8; P = .0003); as well as decreased levels of albumin (-3.7 g/L, 95% CI, -5.3 to -2.1; P < .00001). Individuals with underlying cardiometabolic disease and that present with evidence for acute inflammation and end-organ damage are at higher risk of mortality due to COVID-19 infection and should be managed with greater intensity.
Topics: COVID-19; Comorbidity; Diabetes Mellitus; Female; Hospital Mortality; Hospitalization; Humans; Hypertension; Male; Risk Factors; Sex Factors
PubMed: 32441789
DOI: 10.1002/jmv.26050 -
BMJ Open Sep 2020This umbrella review summarises and critically appraises the evidence on the effects of regulated or high-volume perinatal care on outcome among very low birth...
OBJECTIVE
This umbrella review summarises and critically appraises the evidence on the effects of regulated or high-volume perinatal care on outcome among very low birth weight/very preterm infants born in countries with neonatal mortality <5/1000 births.
INTERVENTION/EXPOSITION
Perinatal regionalisation, centralisation, case-volume.
PRIMARY OUTCOMES
Death.
SECONDARY OUTCOMES
Disability, discomfort, disease, dissatisfaction.
METHODS
On 29 November 2019 a systematic search in MEDLINE and Embase was performed and supplemented by hand search. Relevant systematic reviews (SRs) were critically appraised with A MeaSurement Tool to Assess systematic Reviews 2.
RESULTS
The literature search revealed 508 hits and three SRs were included. Effects of perinatal regionalisation were assessed in three (34 studies) and case-volume in one SR (6 studies). Centralisation has not been evaluated. The included SRs reported effects on 'death' (eg, neonatal), 'disability' (eg, mental status), 'discomfort' (eg, maternal sensitivity) and 'disease' (eg, intraventricular haemorrhages). 'Dissatisfactions' were not reported. The critical appraisal showed a heterogeneous quality ranging from moderate to critically low. A pooled effect estimate was reported once and showed a significant favour of perinatal regionalisation in terms of neonatal mortality (OR 1.60, 95% CI 1.33-1.92). The qualitative evidence synthesis of the two SRs without pooled estimate suggests superiority of perinatal regionalisation in terms of different mortality and non-mortality outcomes. In one SR, contradictory results of lower neonatal mortality rates were reported in hospitals with higher birth volumes.
CONCLUSIONS
Regionalised perinatal care seems to be a crucial care strategy to improve the survival of very low birth weight and preterm births. To overcome the low and critically low methodological quality and to consider additional clinical and patient-reported results that were not addressed by the SRs included, we recommend an updated SR. In the long term, an international, uniformly conceived and defined perinatal database could help to provide evidence-based recommendations on optimal strategies to regionalise perinatal care.
PROSPERO REGISTRATION NUMBER
CRD42018094835.
Topics: Dietary Supplements; Female; Hospitals; Humans; Infant; Infant Mortality; Infant, Newborn; Infant, Premature; Perinatal Mortality; Pregnancy
PubMed: 32978190
DOI: 10.1136/bmjopen-2020-037135 -
International Urology and Nephrology Aug 2021At the beginning of 2020, the outbreak of coronavirus disease 2019 (COVID-19) led to a worldwide pandemic and mass panic. The number of infected people has been... (Meta-Analysis)
Meta-Analysis
At the beginning of 2020, the outbreak of coronavirus disease 2019 (COVID-19) led to a worldwide pandemic and mass panic. The number of infected people has been increasing exponentially since, and the mortality rate has also been concomitantly increasing. At present, no study has summarized the mortality risk of COVID-19 in patients with chronic kidney disease (CKD). Therefore, the aim of the present study was to conduct a literature review and meta-analysis to understand the frequency of mortality among CKD patients infected with COVID-19. A comprehensive systematic search was conducted on the PubMed, Embase, and Cochrane databases to find articles published until May 15, 2020. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale. After careful screening based on the inclusion and exclusion criteria, 3,867,367 patients from 12 studies were included. The mortality rate was significantly higher among CKD patients with COVID-19 infection than among CKD patients without COVID-19 infection, as indicated by a pooled OR of 5.81 (95% CI 3.78-8.94, P < 0.00001, I = 30%). The patients were then stratified into ≥ 70 and < 70 years, and subgroup analysis revealed that among CKD patients with COVID-19 infection, the mortality rate was higher in the < 70 years group (OR 8.69, 95% CI 7.56-9.97, P < 0.0001) than in the ≥ 70 years group (OR 2.44, 95% CI 0.75-6.63, P = 0.15). Thus, COVID-19 patients with CKD have a high mortality risk and require a comprehensive multidisciplinary management strategy.
Topics: COVID-19; Global Health; Humans; Pandemics; Renal Insufficiency, Chronic; SARS-CoV-2; Survival Rate
PubMed: 33389508
DOI: 10.1007/s11255-020-02740-3 -
Journal of the American Heart... Jul 2022Background Somnipathy and diabetes are independently associated with an increased risk of cardiovascular disease (CVD). However, whether a combination of both conditions... (Meta-Analysis)
Meta-Analysis Review
Association of the Coexistence of Somnipathy and Diabetes With the Risks of Cardiovascular Disease Events, Stroke, and All-Cause Mortality: A Systematic Review and Meta-analysis.
Background Somnipathy and diabetes are independently associated with an increased risk of cardiovascular disease (CVD). However, whether a combination of both conditions is associated with a higher risk of CVD events remains uncertain. Therefore, the aim of this meta-analysis was to clarify this association. Methods and Results We searched MEDLINE, Web of Science, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register for Controlled Trials. We included randomized controlled trials, nonrandomized trials, and prospective observational cohort studies that assessed the combined effect of diabetes and comorbid somnipathy on CVD risk and mortality for at least 1 year. Outcomes included CVD, coronary heart disease, stroke, and all-cause mortality. Twelve studies involving 582 267 participants were included in the meta-analysis. Patients with somnipathy and comorbid diabetes exhibited increased risks of CVD, coronary heart disease, stroke, and all-cause mortality (risk ratio [RR], 1.27 [95% CI, 1.12-1.45], <0.0001; RR, 1.40 [95% CI, 1.21-1.62], <0.0001; RR, 1.28 [95% CI, 1.08-1.52], =0.004, and RR, 1.56 [95% CI, 1.26-1.94], <0.0001, respectively). Conclusions The coexistence of somnipathy and diabetes is associated with higher risks of CVD, coronary heart disease, stroke, and mortality than somnipathy or diabetes alone. Resolving sleep problems in patients with diabetes may reduce the risks of CVD, stroke, and mortality. Registration Information https://www.crd.york.ac.uk/prospero/. Identifier: PROSPERO CRD42021274566.
Topics: Cardiovascular Diseases; Cause of Death; Coronary Disease; Diabetes Mellitus; Humans; Observational Studies as Topic; Stroke
PubMed: 35861844
DOI: 10.1161/JAHA.121.024783 -
Bulletin of the World Health... Oct 2021To describe the incidence and main causes of maternal near-miss events in middle-income countries using the World Health Organization's (WHO) maternal near-miss tool and... (Review)
Review
OBJECTIVE
To describe the incidence and main causes of maternal near-miss events in middle-income countries using the World Health Organization's (WHO) maternal near-miss tool and to evaluate its applicability in these settings.
METHODS
We did a systematic review of studies on maternal near misses in middle-income countries published over 2009-2020. We extracted data on number of live births, number of maternal near misses, major causes of maternal near miss and most frequent organ dysfunction. We extracted, or calculated, the maternal near-miss ratio, maternal mortality ratio and mortality index. We also noted descriptions of researchers' experiences and modifications of the WHO tool for local use.
FINDINGS
We included 69 studies from 26 countries (12 lower-middle- and 14 upper-middle-income countries). Studies reported a total of 50 552 maternal near misses out of 10 450 482 live births. Median number of cases of maternal near miss per 1000 live births was 15.9 (interquartile range, IQR: 8.9-34.7) in lower-middle- and 7.8 (IQR: 5.0-9.6) in upper-middle-income countries, with considerable variation between and within countries. The most frequent causes of near miss were obstetric haemorrhage in 19/40 studies in lower-middle-income countries and hypertensive disorders in 15/29 studies in upper-middle-income countries. Around half the studies recommended adaptations to the laboratory and management criteria to avoid underestimation of cases of near miss, as well as clearer guidance to avoid different interpretations of the tool.
CONCLUSION
In several countries, adaptations of the WHO near-miss tool to the local context were suggested, possibly hampering international comparisons, but facilitating locally relevant audits to learn lessons.
Topics: Developing Countries; Female; Humans; Live Birth; Maternal Mortality; Near Miss, Healthcare; Pregnancy; Pregnancy Complications
PubMed: 34621087
DOI: 10.2471/BLT.21.285945 -
International Immunopharmacology Jul 2021This systematic review, with meta-analysis and meta-regression aims to evaluate the effect of colchicine administration on mortality in patients with coronavirus disease... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review, with meta-analysis and meta-regression aims to evaluate the effect of colchicine administration on mortality in patients with coronavirus disease 2019 (COVID-19) and factors affecting the association.
METHODS
A systematic literature search using the PubMed, Scopus, and Embase databases were performed from inception of databases up until 3 March 2021. We included studies that fulfill all of the following criteria: 1) observational studies or randomized controlled trials (RCTs) that report COVID-19 patients, 2) reporting colchicine use, and 3) mortality within 30 days. There was no restriction on the age, inpatients or outpatients setting, and severity of diseases. The intervention was colchicine administration during treatment for COVID-19. The control was receiving placebo or standard of care. The outcome was mortality and the pooled effect estimate was reported as odds ratio (OR). Random-effects restricted maximum likelihood meta-regression was performed to evaluate factors affecting the pooled effect estimate.
RESULTS
Eight studies comprising of 5530 patients were included in this systematic review and meta-analysis. There were three RCTs and five observational studies. Pooled analysis showed that colchicine was associated with lower mortality in patients with COVID-19 (OR 0.47 [0.31, 0.72], p = 0.001; I: 30.9, p = 0.181). Meta-regression analysis showed that the association between colchicine and mortality was reduced by increasing age (OR 0.92 [0.85, 1.00], p = 0.05), but not gender (reference: male, p = 0.999), diabetes (p = 0.376), hypertension (p = 0.133), and CAD (p = 0.354).
CONCLUSION
This meta-analysis indicates that colchicine may reduce mortality in patients with COVID-19. Meta-regression analysis showed that the benefit was reduced as age increases.
PROSPERO
CRD42021240609.
Topics: Age Factors; Colchicine; Diabetes Complications; Diabetes Mellitus; Female; Gender Identity; Humans; Hypertension; Male; Mortality; Odds Ratio; Regression Analysis; SARS-CoV-2; COVID-19 Drug Treatment
PubMed: 34162130
DOI: 10.1016/j.intimp.2021.107723 -
Allopurinol to reduce cardiovascular morbidity and mortality: A systematic review and meta-analysis.PloS One 2021To compare the effectiveness of allopurinol with no treatment or placebo for the prevention of cardiovascular events in hyperuricemic patients. (Meta-Analysis)
Meta-Analysis
AIMS
To compare the effectiveness of allopurinol with no treatment or placebo for the prevention of cardiovascular events in hyperuricemic patients.
METHODS AND RESULTS
Pubmed, Web of Science and Cochrane library were searched from inception until July 2020. Randomized controlled trials (RCT) and observational studies in hyperuricemic patients without significant renal disease and treated with allopurinol, versus placebo or no treatment were included. Outcome measures were cardiovascular mortality, myocardial infarction, stroke, or a combined endpoint (CM/MI/S). For RCT's a random effects meta-analysis was performed. For observational studies a narrative synthesis was performed. Of the original 1995 references we ultimately included 26 RCT's and 21 observational studies. We found a significantly reduced risk of combined endpoint (Risk Ratio 0.65 [95% CI] [0.46 to 0.91]; p = 0.012) and myocardial infarction (RR 0.47 [0.27 to 0.80]; p = 0.01) in the allopurinol group compared to controls. We found no significant effect of allopurinol on stroke or cardiovascular mortality. Of the 15 observational studies with sufficient quality, allopurinol was associated with reduced cardiovascular mortality in 1 out of 3 studies that reported this outcome, myocardial infarction in 6 out of 8, stroke in 4 out of 7, and combined end-point in 2 out of 2. Cardiovascular benefit was only observed when allopurinol therapy was prolonged for more than 6 months and when an appropriate allopurinol dose was administered (300 mg or more/day) or sufficient reduction of serum urate concentration was achieved (<0.36 mmol/l).
CONCLUSIONS
Data from RCT's and observational studies indicate that allopurinol treatment reduces cardiovascular risk in patients with hyperuricemia. However, the quality of evidence from RCTs is low to moderate. To establish whether allopurinol lowers the risk of cardiovascular events a well-designed and adequately powered randomized, placebo-controlled trial is needed in high-risk patients with hyperuricemia.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration CRD42018089744.
Topics: Allopurinol; Antimetabolites; Cardiovascular Diseases; Humans; Morbidity; Prognosis; Survival Rate
PubMed: 34855873
DOI: 10.1371/journal.pone.0260844 -
Advances in Nutrition (Bethesda, Md.) Jan 2023There is an equivocal and inconsistent association between legume consumption and health outcomes and longevity. The purpose of this study was to examine and quantify... (Meta-Analysis)
Meta-Analysis Review
There is an equivocal and inconsistent association between legume consumption and health outcomes and longevity. The purpose of this study was to examine and quantify the potential dose-response relationship between legume consumption and all-cause and cause-specific mortality in the general population. We conducted a systematic literature search on PubMed/Medline, Scopus, ISI Web of Science, and Embase from inception to September 2022, as well as reference lists of relevant original papers and key journals. A random-effects model was used to calculate summary HRs and their 95% CIs for the highest and lowest categories, as well as for a 50 g/d increment. We also modeled curvilinear associations using a 1-stage linear mixed-effects meta-analysis. Thirty-two cohorts (31 publications) involving 1,141,793 participants and 93,373 deaths from all causes were included. Higher intakes of legumes, compared with lower intakes, were associated with a reduced risk of mortality from all causes (HR: 0.94; 95% CI: 0.91, 0.98; n = 27) and stroke (HR: 0.91; 95% CI: 0.84, 0.99; n = 5). There was no significant association for CVD mortality (HR: 0.99; 95% CI: 0.91, 1.09; n =11), CHD mortality (HR: 0.93; 95% CI: 0.78, 1.09; n = 5), or cancer mortality (HR: 0.85; 95% CI: 0.72, 1.01; n = 5). In the linear dose-response analysis, a 50 g/d increase in legume intake was associated with a 6% reduction in the risk of all-cause mortality (HR: 0.94; 95% CI: 0.89, 0.99; n = 19), but no significant association was observed for the remaining outcomes. The certainty of evidence was judged from low to moderate. A higher legume intake was associated with lower mortality from all causes and stroke, but no association was observed for CVD, CHD, and cancer mortality. These results support dietary recommendations to increase the consumption of legumes.
Topics: Humans; Prospective Studies; Fabaceae; Cardiovascular Diseases; Cause of Death; Vegetables; Stroke; Neoplasms
PubMed: 36811595
DOI: 10.1016/j.advnut.2022.10.009 -
IUBMB Life Apr 2020The association between passive smoking (PS) and cardiovascular disease (CVD) has not yet been fully clarified. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The association between passive smoking (PS) and cardiovascular disease (CVD) has not yet been fully clarified.
OBJECTIVE
This meta-analysis was performed to evaluate the association between PS and the incidence of CVDs and mortality due to CVD.
METHODS
PubMed/Medicine, Science Direct, Scopus, Web of Knowledge, and ProQuest were searched to identify observational studies that met the inclusion criteria without time, language, age, gender, ethnicity, and design restrictions until July 30, 2018. In case-control studies, relative risk (RR) with 95% confidence interval (CI) was calculated for the relationship between PS and CVD incidence. Also, in cohort studies, hazard ratio (HR) with 95% CI was calculated for the relationship between PS and CVD mortality.
RESULTS
Eighteen studies (10 cohort and 8 case-control studies) were included with 10,672 participants (2,542 cases and 8,130 controls) in case-control studies and 2,313,935 participants in cohort studies. This meta-analysis in case-control studies revealed that the PS could increase the risk of CVD incidence by 28% (adjusted RR = 1.28 [95% CI 1.09, 1.50]), where the highest risk was associated with those who were exposed to second-hand smoke at home and at work (Adjusted RR = 1.41 [95% CI 0.73, 2.70]). Also, the meta-analysis in cohort studies indicated that PS was associated with a 12% higher increase in the risk of CVD mortality (Adjusted HR = 1.12 [95% CI 1.06, 1.20]) with the highest risk of mortality being observed for those who were exposed to second-hand smoking at home, work, and public places (Adjusted HR = 1.26 [95% CI 1.13, 1.40]).
CONCLUSIONS
PS is significantly associated with an increased risk of incidence and mortality of CVD.
Topics: Cardiovascular Diseases; Humans; Mortality; Tobacco Smoke Pollution
PubMed: 31833635
DOI: 10.1002/iub.2207