-
Pediatric Rheumatology Online Journal Dec 2022Multisystem inflammatory syndrome in children (MIS-C) is a new syndrome with some clinical manifestations similar to Kawasaki disease (KD), which is difficult to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Multisystem inflammatory syndrome in children (MIS-C) is a new syndrome with some clinical manifestations similar to Kawasaki disease (KD), which is difficult to distinguish.
OBJECTIVE
The study aimed to characterize the demographic characteristics, clinical characteristics, laboratory features, cardiac complications, and treatment of MIS-C compared with KD.
STUDY DESIGN
Studies were selected by searching the PubMed, EMBASE and so on before February 28, 2022. Statistical analyses were performed using Review Manager 5.4 software and STATA 14.0.
RESULTS
Fourteen studies with 2928 participants were included. MIS-C patients tended to be older and there was no significant difference in the sex ratio. In terms of clinical characteristics, MIS-C patients were more frequently represented with respiratory, gastrointestinal symptoms and shock. At the same time, they had a lower incidence of conjunctivitis than KD patients. MIS-C patients had lower lymphocyte counts, platelet (PLT) counts, erythrocyte sedimentation rates (ESRs), alanine transaminase (ALT), and albumin levels and had higher levels of aspartate transaminase (AST), N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), troponin, C-reactive protein (CRP), D-dimer, fibrinogen, ferritin, and creatinine. MIS-C patients had a higher incidence of left ventricle (LV) dysfunction, valvular regurgitation, pericardial effusion, myocarditis, and pericarditis. The incidence of coronary artery lesion (CAL) was lower in MIS-C patients [OR (95% CI): 0.52 (0.29, 0.93), p =0.03], while it was similar in the acute period. MIS-C patients had higher utilization of glucocorticoids (GCs) and lower utilization of intravenous immune globulin (IVIG).
CONCLUSIONS
There were specific differences between MIS-C and KD, which might assist clinicians with the accurate recognition of MIS-C and further mechanistic research.
Topics: Child; Humans; Mucocutaneous Lymph Node Syndrome; COVID-19; Systemic Inflammatory Response Syndrome; Immunoglobulins, Intravenous; C-Reactive Protein
PubMed: 36471327
DOI: 10.1186/s12969-022-00771-x -
BMC Pulmonary Medicine May 2022Antibiotics are frequently prescribed for acute exacerbations of COPD (AECOPD) even though most do not have a bacterial aetiology. Biomarkers may help clinicians target... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Antibiotics are frequently prescribed for acute exacerbations of COPD (AECOPD) even though most do not have a bacterial aetiology. Biomarkers may help clinicians target antibiotic use by identifying AECOPD caused by bacterial pathogens. We aimed to summarise current evidence on the diagnostic accuracy of biomarkers for detecting bacterial versus non-bacterial AECOPD.
METHODS
We searched Embase and Medline using a search strategy including terms for COPD, biomarkers and bacterial infection. Data regarding diagnostic accuracy for each biomarker in predicting bacterial cause of exacerbation were extracted and summarised. We used to QUADAS-2 tool to assess risk of bias.
RESULTS
Of 509 papers identified, 39 papers evaluating 61 biomarkers were eligible for inclusion. Moderate quality evidence was found for associations between serum C-reactive protein (CRP), serum procalcitonin (PCT), sputum interleukin (IL)-8 and sputum tumour necrosis factor alpha (TNF-α), and the presence of bacterial pathogens in the sputum of patients with AECOPD. Having bacterial pathogens was associated with a mean difference (higher) CRP and PCT of 29.44 mg/L and 0.76 ng/mL respectively. There was inconsistent or weak evidence for associations between bacterial AECOPD and higher levels of sputum IL-1β, IL-6, myeloperoxidase (MPO) and neutrophil elastase (NE). We did not find any consistent evidence of diagnostic value for other biomarkers.
CONCLUSIONS
There is moderate evidence from heterogeneous studies that serum CRP and PCT are of value in differentiating bacterial from non-bacterial AECOPD, and little evidence for other biomarkers. Further high-quality research on the role of biomarkers in identifying bacterial exacerbations is needed.
Topics: Anti-Bacterial Agents; Bacteria; Biomarkers; C-Reactive Protein; Disease Progression; Humans; Procalcitonin; Pulmonary Disease, Chronic Obstructive
PubMed: 35549921
DOI: 10.1186/s12890-022-01958-4 -
International Immunopharmacology Jan 2023We sought to explore the prognostic role of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score on survival outcomes in patients with solid tumors by... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
We sought to explore the prognostic role of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score on survival outcomes in patients with solid tumors by performing a systematic review and meta-analysis.
MATERIALS AND METHODS
PubMed, EMBASE and Web of Science were searched for relevant articles through 02 Nov 2022. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) were extracted and pooled to assess the association of the HALP score with survival outcomes in solid tumors using Stata 15.0. The primary outcome was overall survival (OS), and the secondary outcomes were cancer-specific survival (CSS) and progression/disease/recurrence-free survival (PFS/DFS/RFS).
RESULTS
A total of 28 studies (31 cohorts) comprising 13,038 patients were enrolled. A low HALP score was associated with decreased OS (HR, 1.61; 95 % CI, 1.44-1.81; P < 0.001), CSS (HR, 1.80; 95 % CI: 1.54-2.09; P < 0.001) and PFS/DFS/RFS (HR, 1.61; 95 % CI: 1.45-1.80; P < 0.001). The prognostic value of HALP on OS was observed across various tumor types and tumor stages. meta-regression found that tumor stage was the major source of the heterogeneity for OS.
CONCLUSION
A low pretreatment HALP score is a reliable and negative prognostic biomarker for survival outcomes in patients with cancer.
Topics: Humans; Biomarkers, Tumor; Neoplasm Recurrence, Local; Prognosis; Albumins; Lymphocytes; Hemoglobins
PubMed: 36462339
DOI: 10.1016/j.intimp.2022.109496 -
Annals of Hepatology Dec 2021Introduction and objectives It has been suggested that albumin administration could alter the natural history of cirrhosis, and also, that long-term treatment with... (Meta-Analysis)
Meta-Analysis
Introduction and objectives It has been suggested that albumin administration could alter the natural history of cirrhosis, and also, that long-term treatment with albumin might be associated with improvement in survival, control of ascites, reduction in the incidence bacterial infections, renal dysfunction, hepatic encephalopathy (HE) and hyponatremia, as well as reduction in length of hospitalization in patients with cirrhosis and ascites. The objective of the present study is to evaluate the role of albumin in the management of HE. Materiales and methods:: This is a systematic review of randomized controlled trials that evaluated the use of albumin in adult patients with cirrhosis and HE. The search for eligible studies was performed in MEDLINE, EMBASE, and Cochrane CENTRAL databases until June 2020. The outcomes of interest were the complete reversal of HE and mortality. Meta-analysis was performed using the random effects model, through the Mantel-Haenszel method. Results: This systematic review was registered at the PROSPERO platform (CRD42020194181). The search strategy retrieved 1,118 articles. After reviewing titles and abstracts, 24 studies were considered potentially eligible, but 22 were excluded after full-text analysis. Finally, 2 studies were included. In the meta-analysis, albumin was associated to significant lower risks of persistent HE (risk ratio - RR = 0.60; 95% confidence interval - CI = 0.38-0.95, p = 0.03) and mortality (RR = 0.54; 95% CI = 0.33-0.90, p = 0.02). Conclusion: Albumin administration improves HE and reduces mortality in patients with cirrhosis and HE.
Topics: Administration, Oral; Albumins; Hepatic Encephalopathy; Humans; Quality of Life
PubMed: 34600143
DOI: 10.1016/j.aohep.2021.100541 -
The Cochrane Database of Systematic... Feb 2013Colloid solutions are widely used in fluid resuscitation of critically ill patients. There are several choices of colloid, and there is ongoing debate about the relative... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Colloid solutions are widely used in fluid resuscitation of critically ill patients. There are several choices of colloid, and there is ongoing debate about the relative effectiveness of colloids compared to crystalloid fluids.
OBJECTIVES
To assess the effects of colloids compared to crystalloids for fluid resuscitation in critically ill patients.
SEARCH METHODS
We searched the Cochrane Injuries Group Specialised Register (17 October 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library) (Issue 10, 2012), MEDLINE (Ovid) 1946 to October 2012, EMBASE (Ovid) 1980 to October 2012, ISI Web of Science: Science Citation Index Expanded (1970 to October 2012), ISI Web of Science: Conference Proceedings Citation Index-Science (1990 to October 2012), PubMed (October 2012), www.clinical trials.gov and www.controlled-trials.com. We also searched the bibliographies of relevant studies and review articles.
SELECTION CRITERIA
Randomised controlled trials (RCTs) of colloids compared to crystalloids, in patients requiring volume replacement. We excluded cross-over trials and trials involving pregnant women and neonates.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data and rated quality of allocation concealment. We analysed trials with a 'double-intervention', such as those comparing colloid in hypertonic crystalloid to isotonic crystalloid, separately. We stratified the analysis according to colloid type and quality of allocation concealment.
MAIN RESULTS
We identified 78 eligible trials; 70 of these presented mortality data.COLLOIDS COMPARED TO CRYSTALLOIDS: Albumin or plasma protein fraction - 24 trials reported data on mortality, including a total of 9920 patients. The pooled risk ratio (RR) from these trials was 1.01 (95% confidence interval (CI) 0.93 to 1.10). When we excluded the trial with poor-quality allocation concealment, pooled RR was 1.00 (95% CI 0.92 to 1.09). Hydroxyethyl starch - 25 trials compared hydroxyethyl starch with crystalloids and included 9147 patients. The pooled RR was 1.10 (95% CI 1.02 to 1.19). Modified gelatin - 11 trials compared modified gelatin with crystalloid and included 506 patients. The pooled RR was 0.91 (95% CI 0.49 to 1.72). (When the trials by Boldt et al were removed from the three preceding analyses, the results were unchanged.) Dextran - nine trials compared dextran with a crystalloid and included 834 patients. The pooled RR was 1.24 (95% CI 0.94 to 1.65). COLLOIDS IN HYPERTONIC CRYSTALLOID COMPARED TO ISOTONIC CRYSTALLOID: Nine trials compared dextran in hypertonic crystalloid with isotonic crystalloid, including 1985 randomised participants. Pooled RR for mortality was 0.91 (95% CI 0.71 to 1.06).
AUTHORS' CONCLUSIONS
There is no evidence from randomised controlled trials that resuscitation with colloids reduces the risk of death, compared to resuscitation with crystalloids, in patients with trauma, burns or following surgery. Furthermore, the use of hydroxyethyl starch might increase mortality. As colloids are not associated with an improvement in survival and are considerably more expensive than crystalloids, it is hard to see how their continued use in clinical practice can be justified.
Topics: Albumins; Blood Proteins; Colloids; Critical Illness; Crystalloid Solutions; Dextrans; Fluid Therapy; Gelatin; Humans; Hydroxyethyl Starch Derivatives; Isotonic Solutions; Plasma Substitutes; Randomized Controlled Trials as Topic; Rehydration Solutions; Resuscitation
PubMed: 23450531
DOI: 10.1002/14651858.CD000567.pub6 -
The American Journal of Medicine Sep 2015Undernutrition is often suspected in patients when serum albumin or prealbumin levels are low. We asked whether these measures are indeed low in undernourished people if... (Review)
Review
PURPOSE
Undernutrition is often suspected in patients when serum albumin or prealbumin levels are low. We asked whether these measures are indeed low in undernourished people if no inflammatory illness is present.
METHODS
We did a systematic review to identify otherwise healthy subjects who were severely nutrient-deprived due to poor access to food or unwillingness to eat. We excluded children and pregnant women. We tabulated available measures of nutrient intake, anthropometry, serum albumin and prealbumin, and, when available, changes in these measures during nutritional intervention.
RESULTS
In otherwise healthy subjects, serum albumin and prealbumin levels remained normal despite marked nutrient deprivation until the extremes of starvation, that is, body mass index <12 or more than 6 weeks of starvation.
CONCLUSIONS
In these otherwise healthy subjects, serum albumin and prealbumin levels are not "markers of nutritional status." The "markers" failed to identify subjects with severe protein-calorie malnutrition until extreme starvation. That is, they failed to identify healthy individuals who would benefit from nutrition support, becoming abnormal only when starvation was already obvious. In contrast, serum albumin and prealbumin levels are known to fall promptly with injury or illness regardless of nutrient intake. They are negative acute-phase reactants. When these measures are low in sick patients, this cannot be assumed to reflect nutritional deprivation. Decisions about nutrition support should be based on evidence of meaningful benefit from this treatment rather than on assessment of "nutritional markers."
Topics: Biomarkers; Body Mass Index; Body Weight; Energy Intake; Humans; Malnutrition; Nutritional Status; Prealbumin; Serum Albumin
PubMed: 25912205
DOI: 10.1016/j.amjmed.2015.03.032 -
Alimentary Pharmacology & Therapeutics Mar 2023Albumin is used in multiple situations in patients with cirrhosis, but the evidence of its benefit is not always clear. The aim was to synthesise the evidence on the... (Review)
Review
INTRODUCTION
Albumin is used in multiple situations in patients with cirrhosis, but the evidence of its benefit is not always clear. The aim was to synthesise the evidence on the efficacy and safety of albumin compared to other treatments or no active intervention in cirrhotic patients.
MATERIALS AND METHODS
We conducted a systematic review including randomised controlled trials (RCTs) published in MEDLINE, EMBASE and CENTRAL up to May 2022. We assessed all-cause mortality, liver transplant, cirrhosis complications of any type and serious adverse events (SAEs). Second, AEs, hospital readmission, length of hospital stay, need for paracentesis and quality of life (QoL) were evaluated. Meta-analyses with Mantel-Haenszel method and random-effects model were performed.
RESULTS
Fifty studies (5118 participants) were included. Albumin was associated with a reduction in mortality in cirrhotic patients with spontaneous bacterial peritonitis (SBP) (RR 0.49, 95% CI 0.32-0.75; low certainty) and hepatic encephalopathy (HE) (RR 0.53, 95% CI 0.34-0.83; low certainty) when compared to no administration of albumin, but not in other scenarios. In general, no additional benefit of albumin was found in liver transplants, SAEs or cirrhosis complications (low/very low certainty). Long-term administration (>3 months) of albumin led to a reduction in cirrhosis complications (RR 0.75, 95% CI 0.57-0.97; low certainty), hospital readmissions, length of hospital stay, need for paracentesis and improvement of QoL.
CONCLUSION
Albumin may reduce mortality risk in cirrhotic patients with SBP or HE. No benefit was identified in reducing liver transplants or SAEs. Long-term administration may be associated with a lower risk of cirrhosis complications and need for paracentesis.
Topics: Humans; Liver Cirrhosis; Liver Transplantation; Quality of Life; Paracentesis; Albumins; Hepatic Encephalopathy; Peritonitis
PubMed: 36524316
DOI: 10.1111/apt.17344 -
Cancer Jul 2022Depressive symptoms in patients with cancer are associated with poor quality of life and decreased survival. Although inflammation is reliably associated with depression... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Depressive symptoms in patients with cancer are associated with poor quality of life and decreased survival. Although inflammation is reliably associated with depression in otherwise healthy individuals, the association in patients with cancer remains unclear. Given the high prevalence of cancer-related inflammation, the authors aimed to establish the relationship between inflammation and depression in cancer patients based on extant literature.
METHODS
A systematic review and meta-analysis was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and registered under Prospero ID CRD42021226743. Three databases were searched including PubMed, the Cochrane Library, and PsycINFO using the following criteria for inclusion: 1) measurement of a peripheral inflammatory marker, 2) use of a validated tool/scale to measure depression, and 3) a cancer diagnosis. Risk of publication bias was assessed by Funnel plot and Egger test.
RESULTS
Seventy-three studies were included in the systematic review and 54 studies (n = 5017) were included in meta-analyses. Associations with depressive symptoms were significant for peripheral blood interleukin (IL)-6 (standardized mean difference [SMD] = 0.59; 95% confidence interval [CI], 0.35-0.82), I = 57.9%; tumor necrosis factor (TNF) (SMD = 0.73; 95% CI, 0.35-1.11), I = 74.1%; and C-reactive protein (CRP) (SMD = 0.57; 95% CI, 0.27-0.87), I = 0%. IL-5, IL-13, albumin, and neutrophil-to-lymphocyte ratio were associated with depressive symptoms but based on fewer studies. Most cancer settings were represented; the number of studies per inflammatory marker varied from 1 to 52.
CONCLUSIONS
Although peripheral inflammatory markers were unevenly studied, the most studied markers (IL-6, TNF, and CRP) were associated with depressive symptoms in cancer patients and may be useful for management of depressive symptoms in the cancer setting.
LAY SUMMARY
Peripheral blood inflammatory markers (IL-6, TNF, and CRP) were associated with depressive symptoms in various cancer settings. Although further studies are warranted, these findings may help identify and manage depressive symptoms in patients with cancer.
Topics: Biomarkers; C-Reactive Protein; Depression; Humans; Inflammation; Interleukin-6; Neoplasms; Quality of Life; Tumor Necrosis Factor-alpha
PubMed: 35417925
DOI: 10.1002/cncr.34193 -
Medicine Sep 2023Transjugular intrahepatic portosystemic shunt (TIPS) can be an effective treatment for cirrhotic patients who develop variceal bleeding and ascites. However, TIPS... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Transjugular intrahepatic portosystemic shunt (TIPS) can be an effective treatment for cirrhotic patients who develop variceal bleeding and ascites. However, TIPS placement is associated with an increased risk of developing hepatic encephalopathy (HE). Recently, there have been efforts to use the typical medical therapies prophylactically in patients undergoing TIPS placement to prevent post-TIPS HE.
METHODS
We conducted literature searches in MEDLINE, Embase, CINAHL, Scopus, and Cochrane to examine studies that use prophylactic medical therapy for preventing post-TIPS HE. A narrative synthesis and grading of recommendations assessment assessment were done for all studies. Meta-analysis was performed for eligible studies using the Mantel-Haenszel method random-effects model. Nine hundred twenty-one articles were screened and 5 studies were included in the study after 2 levels of screening. The medications studied were rifaximin, lactulose, lactitol, L-Ornithine-L-aspartate (LOLA), albumin, and combination therapies.
RESULTS
Narrative results showed that lactulose, lactitol, LOLA and albumin prophylaxis were not associated with reduction in HE occurrence or mortality. A combination of rifaximin and lactulose was found to be associated with lower occurrence of HE, and the results were not different when LOLA was added. Meta-analysis (n = 3) showed that rifaximin treatment was not associated with changes in HE occurrences.
CONCLUSION
In conclusion, a vast majority of medications were not found to be effective post-TIPS HE prophylaxis when used alone. A rifaximin and lactulose combination therapy may be beneficial. Overall, there is significant limitation in the current data and more studies are needed to yield more robust meta-analysis results in the future.
Topics: Humans; Hepatic Encephalopathy; Lactulose; Rifaximin; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Albumins; Primary Prevention
PubMed: 37746955
DOI: 10.1097/MD.0000000000035266 -
Advances in Chronic Kidney Disease Sep 2015Albumin dialysis is the best-studied extracorporeal nonbiologic liver support system as a bridge or destination therapy for patients with liver failure awaiting liver... (Meta-Analysis)
Meta-Analysis Review
Albumin dialysis is the best-studied extracorporeal nonbiologic liver support system as a bridge or destination therapy for patients with liver failure awaiting liver transplantation or recovery of liver function. We performed a systematic review to examine the efficacy and safety of 3 albumin dialysis systems (molecular adsorbent recirculating system [MARS], fractionated plasma separation, adsorption and hemodialysis [Prometheus system], and single-pass albumin dialysis) in randomized trials for supportive treatment of liver failure. PubMed, Ovid, EMBASE, Cochrane's Library, and ClinicalTrials.gov were searched. Two authors independently screened citations and extracted data on patient characteristics, quality of reports, efficacy, and safety end points. Ten trials (7 of MARS and 3 of Prometheus) were identified (620 patients). By meta-analysis, albumin dialysis achieved a net decrease in serum total bilirubin level relative to standard medical therapy of 8.0 mg/dL (95% confidence interval [CI], -10.6 to -5.4) but not in serum ammonia or bile acids. Albumin dialysis achieved an improvement in hepatic encephalopathy relative to standard medical therapy with a risk ratio of 1.55 (95% CI, 1.16-2.08) but had no effect survival with a risk ratio of 0.95 (95% CI, 0.84-1.07). Because of inconsistency in the reporting of adverse events, the safety analysis was limited but did not demonstrate major safety concerns. Use of albumin dialysis as supportive treatment for liver failure is successful at removing albumin-bound molecules, such as bilirubin and at improving hepatic encephalopathy. Additional experience is required to guide its optimal use and address safety concerns.
Topics: Albumins; Dialysis; Female; Follow-Up Studies; Humans; Liver Failure; Liver Transplantation; Male; Randomized Controlled Trials as Topic; Risk Assessment; Survival Rate; Treatment Outcome; Waiting Lists
PubMed: 26311600
DOI: 10.1053/j.ackd.2015.05.004