-
Heart (British Cardiac Society) Feb 2006To determine whether dietary supplementation with alpha linolenic acid (ALA) can modify established and emerging cardiovascular risk markers. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine whether dietary supplementation with alpha linolenic acid (ALA) can modify established and emerging cardiovascular risk markers.
DESIGN
Systematic review and meta-analysis of randomised controlled trials identified by a search of Medline, Embase, Cochrane Controlled Trials Register (CENTRAL), and the metaRegister of Controlled Trials (mRCT).
PATIENTS
All human studies were reviewed.
MAIN OUTCOME MEASURES
Changes in concentrations of total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, very low density lipoprotein (VLDL) cholesterol, triglyceride, fibrinogen, and fasting plasma glucose, and changes in body mass index, weight, and systolic and diastolic blood pressure.
RESULTS
14 studies with minimum treatment duration of four weeks were reviewed. ALA had a significant effect on three of the 32 outcomes examined in these studies. Concentrations of fibrinogen (0.17 micromol/l, 95% confidence interval (CI) -0.30 to -0.04, p = 0.01) and fasting plasma glucose (0.20 mmol/l, 95% CI -0.30 to -0.10, p < 0.01) were reduced. There was a small but clinically unimportant decrease in HDL (0.01 mmol/l, 95% CI -0.02 to 0.00, p < 0.01). Treatment with ALA did not significantly modify total cholesterol, triglycerides, weight, body mass index, LDL, diastolic blood pressure, systolic blood pressure, VLDL, and apolipoprotein B.
CONCLUSIONS
Although ALA supplementation may cause small decreases in fibrinogen concentrations and fasting plasma glucose, most cardiovascular risk markers do not appear to be affected. Further trials are needed, but dietary supplementation with ALA to reduce cardiovascular disease cannot be recommended.
Topics: Blood Glucose; Blood Pressure; Body Weight; Cardiovascular Diseases; Cholesterol; Dietary Supplements; Fibrinogen; Humans; Risk Factors; Triglycerides; alpha-Linolenic Acid
PubMed: 15890766
DOI: 10.1136/hrt.2004.053538 -
The Cochrane Database of Systematic... Jan 2010Interleukin 2 receptor antagonists (IL2Ra) are used as induction therapy for prophylaxis against acute rejection in kidney transplant recipients. Use of IL2Ra has... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Interleukin 2 receptor antagonists (IL2Ra) are used as induction therapy for prophylaxis against acute rejection in kidney transplant recipients. Use of IL2Ra has increased steadily since their introduction, but the proportion of new transplant recipients receiving IL2Ra differs around the globe, with 27% of new kidney transplant recipients in the United States, and 70% in Australasia receiving IL2Ra in 2007.
OBJECTIVES
To systematically identify and summarise the effects of using an IL2Ra, as an addition to standard therapy, or as an alternative to another immunosuppressive induction strategy.
SEARCH STRATEGY
We searched the Cochrane Renal Group's specialised register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE to identify new records, and authors of included reports were contacted for clarification where necessary.
SELECTION CRITERIA
Randomised controlled trials (RCTs) in all languages comparing IL2Ra to placebo, no treatment, other IL2Ra or other antibody therapy.
DATA COLLECTION AND ANALYSIS
Data was extracted and assessed independently by two authors, with differences resolved by discussion. Dichotomous outcomes are reported as relative risk (RR) and continuous outcomes as mean difference (MD) with 95% confidence intervals (CI).
MAIN RESULTS
We included 71 studies (306 reports, 10,537 participants). Where IL2Ra were compared with placebo (32 studies; 5,784 patients) graft loss including death with a functioning graft was reduced by 25% at six months (16 studies: RR 0.75, 95% CI 0.58 to 0.98) and one year (24 studies: RR 0.75, 95% CI 0.62 to 0.90), but not beyond this. At one year biopsy-proven acute rejection was reduced by 28% (14 studies: RR 0.72, 95% CI 0.64 to 0.81), and there was a 19% reduction in CMV disease (13 studies: RR 0.81, 95% CI 0.68 to 0.97). There was a 64% reduction in early malignancy within six months (8 studies: RR 0.36, 95% CI 0.15 to 0.86), and creatinine was lower (7 studies: MD -8.18 micromol/L 95% CI -14.28 to -2.09) but these differences were not sustained.When IL2Ra were compared to ATG (16 studies, 2211 participants), there was no difference in graft loss at any time point, or for acute rejection diagnosed clinically, but the was benefit of ATG therapy over IL2Ra for biopsy-proven acute rejection at one year (8 studies:, RR 1.30 95% CI 1.01 to 1.67), but at the cost of a 75% increase in malignancy (7 studies: RR 0.25 95% CI 0.07 to 0.87) and a 32% increase in CMV disease (13 studies: RR 0.68 95% CI 0.50 to 0.93). Serum creatinine was significantly lower for IL2Ra treated patients at six months (4 studies: MD -11.20 micromol/L 95% CI -19.94 to -2.09). ATG patients experienced significantly more fever, cytokine release syndrome and other adverse reactions to drug administration and more leucopenia but not thrombocytopenia. There were no significant differences in outcomes according to cyclosporine or tacrolimus use, azathioprine or mycophenolate, or to the study populations baseline risk for acute rejection. There was no evidence that effects were different according to whether equine or rabbit ATG was used.
AUTHORS' CONCLUSIONS
Given a 38% risk of rejection, per 100 recipients compared with no treatment, nine recipients would need treatment with IL2Ra to prevent one recipient having rejection, 42 to prevent one graft loss, and 38 to prevent one having CMV disease over the first year post-transplantation. Compared with ATG treatment, ATG may prevent some experiencing acute rejection, but 16 recipients would need IL2Ra to prevent one having CMV, but 58 would need IL2Ra to prevent one having malignancy. There are no apparent differences between basiliximab and daclizumab. IL2Ra are as effective as other antibody therapies and with significantly fewer side effects.
Topics: Creatinine; Cytomegalovirus Infections; Glomerular Filtration Rate; Graft Rejection; Humans; Immunosuppressive Agents; Kidney Transplantation; Randomized Controlled Trials as Topic; Receptors, Interleukin-2
PubMed: 20091551
DOI: 10.1002/14651858.CD003897.pub3 -
American Journal of Kidney Diseases :... Sep 2006Radiocontrast-induced nephropathy (RCIN) causes acute kidney injury and increases mortality. Studies have examined the capacity of various forms of extracorporeal blood... (Review)
Review
BACKGROUND
Radiocontrast-induced nephropathy (RCIN) causes acute kidney injury and increases mortality. Studies have examined the capacity of various forms of extracorporeal blood purification therapies for the prevention of RCIN, with conflicting results. We conducted a systematic review of published trials to determine whether periprocedural extracorporeal blood purification prevents RCIN.
METHODS
We searched PubMed, the Cochrane Collaboration Database, EMBASE, and CINAHL through January 2006 and bibliographies of retrieved articles and consulted with experts to identify relevant studies. Published studies of extracorporeal blood purification for the prevention of RCIN in patients receiving radiocontrast were included. Two authors reviewed all citations. The primary end point is the incidence of RCIN, defined as an increase in serum creatinine concentration (>or=0.5 mg/dL [>or=44 micromol/L]). Results were combined on the risk ratio scale. Random-effects models were used. Sensitivity analyses were performed to evaluate the effects of extracorporeal blood purification modality, study design, and sample size.
RESULTS
Eight trials (6 randomized controlled trials, 2 nonrandomized trials) were included in the analysis (pooled sample size, 412). Six trials assessed hemodialysis, whereas 1 trial each assessed continuous venovenous hemofiltration and continuous venovenous hemodiafiltration. The incidence of RCIN was 35.2% in the standard-medical-therapy group and 27.8% in the extracorporeal-blood-purification group. Extracorporeal blood purification did not decrease the incidence of RCIN significantly compared with standard medical therapy (risk ratio, 0.97; 95% confidence interval, 0.44 to 2.14); however, intertrial heterogeneity was high. Limiting analysis to only randomized trials did not eliminate heterogeneity, but limiting analysis to only hemodialysis trials did. Periprocedural hemodialysis did not decrease the incidence of RCIN.
CONCLUSION
This critical analysis of the published literature suggests that periprocedural extracorporeal blood purification does not decrease the incidence of RCIN compared with standard medical therapy.
Topics: Contrast Media; Hemofiltration; Humans; Kidney Diseases; Randomized Controlled Trials as Topic; Renal Dialysis
PubMed: 16931209
DOI: 10.1053/j.ajkd.2006.05.023 -
Nutrition Reviews Dec 2019Very preterm neonates (VPNs) are unable to digest breast milk and therefore rely on parenteral nutrition (PN) formulations. This systematic review was prepared following...
CONTEXT
Very preterm neonates (VPNs) are unable to digest breast milk and therefore rely on parenteral nutrition (PN) formulations. This systematic review was prepared following PRISMA-P 2015 guidelines. For the purpose of this review, desirable mean plasma arginine concentration is defined as ≥80 micromoles/L.
OBJECTIVE
The review was performed to answer the following research question: "In VPNs, are high amounts of arginine in PN, compared with low amounts of arginine, associated with appropriate circulating concentrations of arginine?" Therefore, the aims were to 1) quantify the relationship between parenteral arginine intakes and plasma arginine concentrations in PN-dependent VPNs; 2) identify any features of study design that affect this relationship; and 3) estimate the target parenteral arginine dose to achieve desirable preterm plasma arginine concentrations.
DATA SOURCES
The PubMed, Scopus, Web of Science, and Cochrane databases were searched regardless of study design; review articles were not included.
DATA EXTRACTION
Only articles that discussed amino acid (AA) intake and measured plasma AA profile post PN in VPNs were included. Data were obtained using a data extraction checklist that was devised for the purpose of this review.
DATA ANALYSIS
Twelve articles met the inclusion criteria. The dose-concentration relationship of arginine content (%) and absolute arginine intake (mg/(kg × d)) with plasma arginine concentrations showed a significant positive correlation (P < 0.001).
CONCLUSION
Future studies using AA solutions with arginine content of 17%-20% and protein intakes of 3.5-4.0 g/kg per day may be needed to achieve higher plasma arginine concentrations.
Topics: Arginine; Dose-Response Relationship, Drug; Humans; Infant, Newborn; Infant, Premature; Parenteral Nutrition
PubMed: 31504841
DOI: 10.1093/nutrit/nuz049 -
The Cochrane Database of Systematic... 2000Patients with cancer who are treated with chemotherapy or receive a bone marrow transplant have an increased risk of acquiring fungal infections. Such infections can be... (Review)
Review
BACKGROUND
Patients with cancer who are treated with chemotherapy or receive a bone marrow transplant have an increased risk of acquiring fungal infections. Such infections can be life-threatening. Antifungal drugs are therefore often given prophylactically to such patients, or when they have a fever.
OBJECTIVES
To compare the effect and adverse effects of AmBisome and other lipid soluble formulations of amphotericin B with conventional amphotericin B in cancer patients with neutropenia.
SEARCH STRATEGY
MEDLINE and Cochrane Library. Unpublished trials from conference proceedings and contact to industry.
SELECTION CRITERIA
Randomised trials comparing lipid soluble formulations of amphotericin B with conventional amphotericin B.
DATA COLLECTION AND ANALYSIS
Data on mortality, invasive fungal infection, nephrotoxicity, serum creatinine and dropouts were extracted by both authors independently.
MAIN RESULTS
AmBisome vs conventional amphotericin B (3 trials, 1149 patients): AmBisome tended to be more effective than conventional amphotericin B for invasive fungal infection (relative risk 0.63, 95% confidence interval 0.39 to 1.01, P=0.053) whereas there was no significant difference in mortality (relative risk 0.74, 95% CI 0.52 to 1.07). AmBisome decreased significantly the incidence of nephrotoxicity, defined as a 100% increase in serum creatinine (relative risk 0.51, 95% CI 0.40 to 0.64). Fewer patients dropped out on AmBisome but the difference was not significant (relative risk 0.78, 95% CI 0.56 to 1. 08). Amphotericin B in Intralipid vs conventional amphotericin B (4 trials, 145 patients): There were no significant differences in clinical effect whereas the patients treated with the lipid soluble formulation experienced significantly less nephrotoxicity (relative risk 0.34, 95% CI 0.15 to 0.75) and smaller increases in serum creatinine (weighted mean difference 32 micromol/l, 95% CI 21 to 43 micromol/l). Amphotericin B colloidal dispersion (ABCD) vs conventional amphotericin B (1 trial, 213 patients): There was lower nephrotoxicity with ABCD (relative risk 0.38, 95% CI 0.25 to 0.59).
REVIEWER'S CONCLUSIONS
AmBisome is a better drug than conventional amphotericin B but its high cost prohibits routine use in most settings. Furthermore, the advantages of AmBisome may be smaller than indicated in our review if conventional amphotericin B is administered under optimal circumstances. It is not clear whether other lipid formulations of amphotericin B could offer a worthwhile advantage compared to conventional amphotericin B.
Topics: Amphotericin B; Antifungal Agents; Chemistry, Pharmaceutical; Humans; Neoplasms; Neutropenia; Randomized Controlled Trials as Topic
PubMed: 10908480
DOI: 10.1002/14651858.CD000969 -
Clinical Lymphoma & Myeloma Dec 2008Hyperammonemic encephalopathy is a rarely reported complication of multiple myeloma (MM). We describe an illustrative case of hyperammonemia in the setting of an... (Review)
Review
Hyperammonemic encephalopathy is a rarely reported complication of multiple myeloma (MM). We describe an illustrative case of hyperammonemia in the setting of an immunoglobulin (Ig) D-lambda MM, and perform a systematic review of the English-written literature. Our search yielded 26 more cases. Median age was 64 years, and 54% of patients were male. All presented with progressive impairment of their level of consciousness. Median ammonium concentration was 109 micromol/L (interquartile range, 73-149 micromol/L). Most were IgA type (10 cases), and there were 2 cases of IgD type. Most cases were aggressive or chemotherapy-resistant forms of MM. Eight patients were diagnosed with MM at the same time as the episode of hyperammonemia. Only 1 patient had signs of portal hypertension as a result of concomitant hyperdynamic heart failure. Determination of amino acid in 10 patients showed high levels of glycine, low levels of tyrosine, and a low Fischer ratio. Two patients did not receive chemotherapy and died. Twenty-two out of 25 patients who received chemotherapy against MM showed a decrease in ammonium blood concentration, and of those, 15 survived the episode (68%). Overall mortality was 44%. In conclusion, hyperammonemia is a severe complication of MM, associated with a high mortality. It should be considered in any patient with MM and a low level of consciousness. Chemotherapy directed against MM seems to be the most effective measure in order to achieve normal ammonium levels and clinical improvement.
Topics: Adult; Aged; Aged, 80 and over; Consciousness Disorders; Female; Humans; Hyperammonemia; Male; Middle Aged; Multiple Myeloma; Neurotoxicity Syndromes
PubMed: 19064403
DOI: 10.3816/CLM.2008.n.054 -
BMC Cardiovascular Disorders Sep 2008Experimental and epidemiological evidence suggests that homocysteine (tHcy) may be a causal risk factor for atherosclerosis. B-vitamin supplements reduce tHcy and... (Meta-Analysis)
Meta-Analysis Randomized Controlled Trial Review
The effect of long-term homocysteine-lowering on carotid intima-media thickness and flow-mediated vasodilation in stroke patients: a randomized controlled trial and meta-analysis.
BACKGROUND
Experimental and epidemiological evidence suggests that homocysteine (tHcy) may be a causal risk factor for atherosclerosis. B-vitamin supplements reduce tHcy and improve endothelial function in short term trials, but the long-term effects of the treatment on vascular structure and function are unknown.
METHODS
We conducted a sub-study of VITATOPS, a randomised, double-blind, placebo-controlled intervention trial designed to test the efficacy of long term B-vitamin supplementation (folic acid 2 mg, vitamin B6 25 mg and vitamin B12 0.5 mg) in the prevention of vascular events in patients with a history of stroke. We measured carotid intima-medial thickness (CIMT) and flow-mediated dilation (FMD) at least two years after randomisation in 162 VITATOPS participants. We also conducted a systematic review and meta-analysis of studies designed to test the effect of B-vitamin treatment on CIMT and FMD.
RESULTS
After a mean treatment period of 3.9 +/- 0.9 years, the vitamin-treated group had a significantly lower mean plasma homocysteine concentration than the placebo-treated group (7.9 micromol/L, 95% CI 7.5 to 8.4 versus 11.8 micromol/L, 95% CI 10.9 to 12.8, p < 0.001). Post-treatment CIMT (0.84 +/- 0.17 mm vitamins versus 0.83 +/- 0.18 mm placebo, p = 0.74) and FMD (median of 4.0%, IQR 0.9 to 7.2 vitamins versus 3.0%, IQR 0.6 to 6.6 placebo, p = 0.48) did not differ significantly between groups. A meta-analysis of published randomised data, including those from the current study, suggested that B-vitamin supplements should reduce CIMT (-0.10 mm, 95% CI -0.20 to -0.01 mm) and increase FMD (1.4%, 95% CI 0.7 to 2.1%). However, the improvement in endothelial function associated with homocysteine-lowering treatment was significant in short-term studies but not in longer trials.
CONCLUSION
Although short-term treatment with B-vitamins is associated with increased FMD, long-term homocysteine-lowering did not significantly improve FMD or CIMT in people with a history of stroke.
Topics: Aged; Carotid Arteries; Dietary Supplements; Double-Blind Method; Down-Regulation; Drug Combinations; Female; Folic Acid; Homocysteine; Humans; Male; Middle Aged; Regional Blood Flow; Stroke; Time Factors; Treatment Outcome; Tunica Intima; Tunica Media; Vasodilation; Vitamin B 12; Vitamin B 6; Vitamin B Complex
PubMed: 18803866
DOI: 10.1186/1471-2261-8-24 -
The Cochrane Database of Systematic... Apr 2008Lead poisoning is associated with physical, cognitive and neurobehavioral impairment in children and many household interventions to prevent lead exposure have been... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Lead poisoning is associated with physical, cognitive and neurobehavioral impairment in children and many household interventions to prevent lead exposure have been trialled.
OBJECTIVES
To determine the effectiveness of household interventions in preventing or reducing lead exposure in children as measured by reductions in blood lead levels and/or improvements in cognitive development.
SEARCH STRATEGY
Trials were identified through electronic searches of CENTRAL 2006 (Issue 1), MEDLINE 1966 to March 2006, and thirteen other electronic databases and contacting experts to find unpublished studies.
SELECTION CRITERIA
Randomised and quasi randomised trials of household educational or environmental interventions to prevent lead exposure in children where at least one standardised outcome measure was reported.
DATA COLLECTION AND ANALYSIS
Two reviewers independently reviewed all eligible studies for inclusion, assessed study quality and extracted data. Triallists were contacted to obtain missing information.
MAIN RESULTS
Twelve studies (2239 children) were included. All studies reported blood lead level outcomes and none reported on cognitive or neurobehavioural outcomes. Studies were subgrouped according to their intervention type. Meta-analysis of both continuous and dichotomous data was performed for subgroups where appropriate. Educational interventions were not effective in reducing blood lead levels (continuous: WMD 0.13, 95% CI -0.30, 0.56, I2 = 41.6; dichotomous >/= 10 microg/dL (>/= 0.48 micromol/l): RR 1.02 (95% CI 0.79, 1.30, I2 = 0); dichotomous >/= 15 microg/dL (>/=0.72 micromol/l): RR 0.60, 95% CI 0.33, 1.09, I2 = 0). Meta-analysis of the dichotomous data for the dust control subgroup found no evidence of effectiveness. The studies using soil abatement (removal and replacement) and combination intervention groups were not able to be meta-analysed due to substantial differences between studies.
AUTHORS' CONCLUSIONS
Currently there is no evidence of effectiveness for household interventions for education or dust control measures in reducing blood lead levels in children as a population health measure. There is insufficient evidence for soil abatement or combination interventions. Further trials are required to establish the most effective intervention for prevention of lead exposure. Key elements should include longer term follow up and measures of compliance as well as performing trials in developing countries and differing socio-economic groups in developed countries.
Topics: Child; Dust; Environmental Exposure; Environmental Restoration and Remediation; Humans; Lead Poisoning; Paint; Soil
PubMed: 18425934
DOI: 10.1002/14651858.CD006047.pub2 -
The Cochrane Database of Systematic... 2002Indomethacin therapy for closure of patent ductus arteriosus frequently causes oliguria, and occasionally more serious renal dysfunction. Low dose dopamine has been... (Review)
Review
BACKGROUND
Indomethacin therapy for closure of patent ductus arteriosus frequently causes oliguria, and occasionally more serious renal dysfunction. Low dose dopamine has been suggested as a means for preventing this side effect.
PRIMARY OBJECTIVE
To determine whether dopamine therapy may prevent indomethacin-mediated deterioration in renal function in the preterm newborn infant without serious adverse effects.
SECONDARY OBJECTIVE
To assess the effects of dopamine on the above variables in two subgroups: (1) patients given indomethacin as prophylaxis of intraventricular hemorrhage, and (2) patients given indomethacin as treatment of patent ductus arteriosus
SEARCH STRATEGY
Standard methods of the Cochrane Neonatal Review Group (CNRG) were used. We searched MEDLINE (1966-2001) using PubMed as the search engine, EMBASE (1974-2001) and the Cochrane Controlled Trials Register (CCTR) from the Cochrane Library (Issue 3, 2001). In addition we contacted the principal investigators if necessary to ascertain the required information.
SELECTION CRITERIA
Randomized or quasi-randomized studies of the effects of dopamine on urine output, glomerular filtration rate, fluid balance or incidence of renal failure, in preterm newborn infants receiving indomethacin. The comparison group should have received no dopamine.
DATA COLLECTION AND ANALYSIS
We used the standard methods of the Cochrane Collaboration and those of the CNRG. The primary outcomes of interest were: mortality before discharge; intraventricular hemorrhage, grade three or four; cystic periventricular leukomalacia; renal failure (either oliguria, defined as a urine output less than 1 ml/kg/hour or an elevation in creatinine by more than 40 micromoles/L); failure to close the ductus arteriosus; need for surgical PDA ligation. For categorical outcomes, we calculated typical estimates for relative risk and risk difference. For continuous outcomes the weighted mean difference (WMD) was calculated. Fixed effect models were assumed for meta-analysis.
MAIN RESULTS
Three studies were found (total number randomized patients, 75) which fulfilled the entry criteria for this review. All were single center trials which enrolled NICU patients receiving indomethacin for symptomatic patent ductus arteriosus. There are no (or only partial) results for effects of dopamine on several of the primary outcomes, including death before discharge, serious intraventricular hemorrhage, cystic periventricular leukomalacia, or renal failure. There has been inadequate investigation of the effects of dopamine on cerebral perfusion or cardiac output, or GI complications, or endocrine toxicity. Dopamine improved urine output [WMD 0.68 ml/kg/hour (95% CI 0.22, 1.44)], but there was no evidence of effect on serum creatinine (WMD 2.04 micromoles/liter, CI -17.90, 21.97) or the incidence of oliguria (urine output < 1 ml/kg/hour) (RR 0.73, CI 0.35, 1.54). There was no evidence of effect of dopamine on the frequency of failure to close the ductus arteriosus (RR 1.11, CI 0.56, 2.19).
REVIEWER'S CONCLUSIONS
There is no evidence from randomized trials to support the use of dopamine to prevent renal dysfunction in indomethacin-treated preterm infants.
Topics: Cardiovascular Agents; Dopamine; Ductus Arteriosus, Patent; Humans; Indomethacin; Infant, Newborn; Infant, Premature; Renal Agents; Renal Insufficiency
PubMed: 12137683
DOI: 10.1002/14651858.CD003213 -
Journal of Vascular Surgery Nov 2006The aims of the present study were to (1) analyze preoperative predictors for outcome suggested by Hardman and surgical mortality after open repair and endovascular... (Review)
Review
BACKGROUND
The aims of the present study were to (1) analyze preoperative predictors for outcome suggested by Hardman and surgical mortality after open repair and endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (rAAA), and (2) further evaluate the Hardman index in a systematic review.
METHODS
Patients operated on for rAAA during a 5-year period between 2000 and 2004 were scored according to Hardman-1 point for either age >76 years, loss of consciousness after presentation, hemoglobin <90 g/L, serum creatinine >190 micromol/L or electrocardiographic (ECG) signs of ischemia-with blinded evaluation of ECGs by a specialist in clinical physiology. The results were included in a systematic review of studies evaluating the Hardman index.
RESULTS
In-hospital mortality after operation was 41% (67/162). There was no difference in in-hospital mortality between open repair (n = 106) and EVAR (n = 56), whereas the Hardman index was associated with operative mortality in our institution and in the systematic review of 970 patients (P < .001). Mortality rate in patients with Hardman index > or =3 was 77% in the pooled analysis. A full data set of all five scoring variables was obtained in 94 (58%) of 162 patients in our study, and potential underscoring was thus possible in 68 patients. Of the available ECGs, 12 (8.7%) of 138 were judged nondiagnostic. Five studies did not state their missing data on ECG and hemoglobin and serum creatinine concentrations, nor did they specify the criteria for ECG ischemia.
CONCLUSIONS
A strong correlation between the Hardman index and mortality was found. A Hardman index > or =3 cannot be used as an absolute limit for denial of surgery. The utility of the Hardman index seems to be impeded by variability in scoring resulting from missing or nondiagnostic data.
Topics: Aneurysm, Ruptured; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Hospital Mortality; Humans; Prognosis; Rupture, Spontaneous; Survival Rate; Sweden; Tomography, X-Ray Computed
PubMed: 17098525
DOI: 10.1016/j.jvs.2006.07.041