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Surgical Infections Oct 2023The correlation between pre-operative serum pre-albumin and surgical site infection (SSI) has been the focus of many studies. However, existing literature presents... (Meta-Analysis)
Meta-Analysis
The correlation between pre-operative serum pre-albumin and surgical site infection (SSI) has been the focus of many studies. However, existing literature presents conflicting evidence on this association. Therefore, this meta-analysis was conducted to determine the significance of low serum pre-albumin as a prognostic factor SSI, and to assess the potential utility of pre-albumin in predicting SSI. A comprehensive literature search and analysis was conducted in PubMed, Web of Science, Cochrane of Library, Scopus, Embase, and Google Scholar databases through August 2022 to identify studies reporting low pre-operative serum pre-albumin levels in patients undergoing surgery and their association with SSIs. The pooled risk estimates were shown in odds ratio with 95% confidence interval. The random effect model was used according to the test of heterogeneity among studies. Subgroup analyses and sensitivity analyses were performed to identify the possible sources of heterogeneity. This meta-analysis was prospectively registered in the PROSPERO database (number: CRD42022376167). Nine studies involving 5,306 patients were eligible. The results demonstrated an association between low pre-operative serum pre-albumin levels and a higher probability of developing SSI (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.28-3.26). Our findings suggest that low serum pre-albumin level may serve as an independent and valuable predictor of SSI. These results provide important insights for clinicians in identifying high-risk patients and implementing preventive measures.
Topics: Humans; Surgical Wound Infection
PubMed: 37831925
DOI: 10.1089/sur.2023.095 -
ESC Heart Failure Apr 2024The prevalence of transthyretin-associated amyloidosis cardiomyopathy (ATTR-CM) has grown because of newer non-invasive diagnosis tools. Detecting the presence of... (Review)
Review
The prevalence of transthyretin-associated amyloidosis cardiomyopathy (ATTR-CM) has grown because of newer non-invasive diagnosis tools. Detecting the presence of extra-cardiac ATTR manifestations such as musculoskeletal pathologies considered 'red flags', when there is minimal or non-cardiac clinical involvement is primordial to carry out an early diagnosis. The aim of this systematic review is to examine the prevalence of musculoskeletal, ATTR-deposition-related co-morbidities in patients already diagnosed with ATTR-CM, specifically carpal tunnel syndrome, ruptured biceps tendon, spinal stenosis, and trigger finger. We performed a systematic review using PRISMA guidelines. Inclusion criteria were all studies in English and Spanish language and participants had to be patients diagnosed with ATTR-CM, by any diagnostic method, with the musculoskeletal co-morbidities subject of this review. The quality of the studies was based on the Risk of Bias Tool. This systematic review included 22 studies for final analysis. Carpal tunnel syndrome is reported in 21 studies, brachial biceps tendon rupture is reported in three, and spinal stenosis in eight studies. No articles that accomplished all the inclusion criteria for trigger finger were found. Regarding to the quality of the studies, all of them were categorized as being of high and moderate quality. The frequent association between ATTR-CM and carpal tunnel syndrome, ruptured biceps tendon, and lumbar spinal is confirmed, and the onset of these co-morbidities usually precedes the diagnosis of by years. This association defines them as red flags that should be search proactively due to the current treatment possibilities and the severity of the presentation of cardiac amyloidosis.
Topics: Humans; Prealbumin; Spinal Stenosis; Carpal Tunnel Syndrome; Trigger Finger Disorder; Amyloid Neuropathies, Familial; Cardiomyopathies; Morbidity
PubMed: 38130034
DOI: 10.1002/ehf2.14622 -
Expert Review of Gastroenterology &... Apr 2019Several studies have investigated the relationship between ω-3 polyunsaturated fatty acids (PUFAs) administration and liver function and inflammatory reaction in... (Meta-Analysis)
Meta-Analysis
Effect of ω-3 polyunsaturated fatty acids on liver function and inflammatory reaction in patients undergoing hepatectomy: a systematic review and meta-analysis of randomized control trials.
Several studies have investigated the relationship between ω-3 polyunsaturated fatty acids (PUFAs) administration and liver function and inflammatory reaction in patients undergoing liver resection, but the results remain conflicting and inconclusive. Areas covered: In this meta-analysis, a relevant database search was performed to retrieve all the randomized controlled trials (RCTs) exploring the effect of ω-3 PUFAs administration in patients undergoing hepatectomy until the end of April 2018. A random effect model was used to conduct this meta-analysis with RevMan 5.3.5 software. The quality of evidence for each postoperative outcome was assessed using the GRADEpro analysis. Expert opinion: 4 RCTs including 553 patients (277 with and 276 without ω-3 PUFAs) were identified. ω-3 PUFAs significantly reduced alanine aminotransferase [Mean difference (MD): -68.82, 95% confidence interval (CI): -108.55 to - 29.08; p = 0.0007]; aspartate aminotransferase (MD: -64.92, 95% CI: -112.87 to -16.98; p = 0.008), white blood cell count (MD: -1.22, 95% CI: -2.15 to -0.29; p = 0.01) and increased the level of pre-albumin on postoperative day 3 (MD: 10.42, 95% CI: 4.84 to 15.99; p = 0.0002). The results indicate that ω-3 PUFAs administration has a positive impact on the liver function and inflammatory reaction in patients undergoing liver resection.
Topics: Adult; Aged; Anti-Inflammatory Agents; Biomarkers; Fatty Acids, Omega-3; Female; Hepatectomy; Humans; Inflammation; Liver; Liver Function Tests; Male; Middle Aged; Randomized Controlled Trials as Topic; Time Factors; Treatment Outcome
PubMed: 30791756
DOI: 10.1080/17474124.2019.1578648 -
European Review For Medical and... Jan 2024The purpose of this meta-analysis is to evaluate the efficacy of a keto-supplemented low-protein diet (sLPD) in enhancing nutritional status among individuals undergoing... (Meta-Analysis)
Meta-Analysis
Efficacy and safety of keto-supplemented low-protein diet on nutritional status of peritoneal-dialysis patients: a systematic review and meta-analysis of randomized controlled trials.
OBJECTIVE
The purpose of this meta-analysis is to evaluate the efficacy of a keto-supplemented low-protein diet (sLPD) in enhancing nutritional status among individuals undergoing peritoneal dialysis (PD) compared to a low-protein diet (LPD).
MATERIALS AND METHODS
Studies from PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched and reviewed up to January 2023. Randomized controlled trials (RCTs) were enrolled and analyzed using STATA MP 17. In this review, serum albumin (Alb), body mass index (BMI), and serum prealbumin (PA) were included for efficacy evaluation and serum calcium (CA) for safety evaluation. Potential heterogeneity was detected using subgroup analyses.
RESULTS
7 RCTs were included. Compared with LPD, sLPD can improve the Alb [Weighted Mean Difference (WMD)=4.16; 95% CI: 2.50, 5.83; p<0.0001), BMI [WMD=1.35; 95% CI: 0.59, 2.11; p<0.0001] and PA [WMD=0.07; 95% CI: 0.04, 0.10; p<0.0001] level of patients undergoing PD. Subgroup analyses showed that, although Alb had no difference with LPD within 12 months of PD duration, sLPD treatment could improve the levels of Alb and PA regardless of PD duration or course of treatment. sLPD can improve the BMI of patients with a PD duration of more than 24 months, regardless of the duration of treatment.
CONCLUSIONS
A sLPD is an effective intervention for improving the nutritional status of PD patients. It is suggested that patients undergoing PD should initiate sLPD at the beginning of PD to ensure sufficient nutritional intake.
Topics: Humans; Nutritional Status; Diet, Protein-Restricted; Renal Dialysis; Randomized Controlled Trials as Topic; Peritoneal Dialysis
PubMed: 38305613
DOI: 10.26355/eurrev_202401_35071 -
World Journal of Gastroenterology Nov 2019It has been suggested that chronic pancreatitis (CP) may be an independent risk factor for development of cardiovascular disease (CVD). At the same time, it seems that...
BACKGROUND
It has been suggested that chronic pancreatitis (CP) may be an independent risk factor for development of cardiovascular disease (CVD). At the same time, it seems that congestive heart failure (CHF) and CP share the responsibility for the development of important clinical conditions such as sarcopenia, cachexia and malnutrition due to development of cardiac cachexia and pancreatic exocrine insufficiency (PEI), respectively.
AIM
To explore the evidence regarding the association of CP and heart disease, more specifically CVD and CHF.
METHODS
A systematic search of MEDLINE, Web of Science and Google Scholar was performed by two independent investigators to identify eligible studies where the connection between CP and CVD was investigated. The search was limited to articles in the English language. The last search was run on the 1st of May 2019. The primary outcomes were: (1) Incidence of cardiovascular event [acute coronary syndrome (ACS), chronic coronary disease, peripheral arterial lesions] in patients with established CP; and (2) Incidence of PEI in patients with CHF.
RESULTS
Out of 1166 studies, only 8 were eligible for this review. Studies regarding PEI and CHF showed an important incidence of PEI as well as associated malabsorption of nutritional markers (vitamin D, selenium, phosphorus, zinc, folic acid, and prealbumin) in patients with CHF. However, after substitution of pancreatic enzymes, it seems that, at least, loss of appetite was attenuated. On the other side, studies investigating cardiovascular events in patients with CP showed that, in CP cohort, there was a 2.5-fold higher incidence of ACS. In another study, patients with alcohol-induced CP with concomitant type 3c diabetes had statistically significant higher incidence of carotid atherosclerotic plaques in comparison to patients with diabetes mellitus of other etiologies. Earlier studies demonstrated a marked correlation between the clinical symptoms in CP and chronic coronary insufficiency. Also, statistically significant higher incidence of arterial lesions was found in patients with CP compared to the control group with the same risk factors for atherosclerosis (hypertension, smoking, dyslipidemia). Moreover, one recent study showed that PEI is significantly associated with the risk of cardiovascular events in patients with CP.
CONCLUSION
Current evidence implicates a possible association between PEI and malnutrition in patients with CHF. Chronic pancreatic tissue hypoxic injury driven by prolonged splanchnic hypoperfusion is likely to contribute to malnutrition and cachexia in patients with CHF. On the other hand, CP and PEI seem to be an independent risk factor associated with an increased risk of cardiovascular events.
Topics: Cachexia; Exocrine Pancreatic Insufficiency; Heart; Heart Failure; Humans; Malnutrition; Pancreas; Pancreatitis, Chronic; Risk Factors
PubMed: 31802835
DOI: 10.3748/wjg.v25.i44.6561 -
International Urology and Nephrology Aug 2021Almost all CKD patients have a poor nutritional status, while elderly CKD patients are specifically frail and malnourished. Our aim is to conduct a systematic review of...
PURPOSE
Almost all CKD patients have a poor nutritional status, while elderly CKD patients are specifically frail and malnourished. Our aim is to conduct a systematic review of the up to date primary studies that look at methods of improving nutritional status in CKD patients in the elderly demographic.
METHODS
A focussed and sensitive search strategy was applied to the PUBMED database to identify relevant English language articles. Once articles were identified a detailed quality and bias assessment was performed. Two independent researchers (MZ and SM) then subsequently carried out detailed data extraction and analysis and this was subsequently verified by a third researcher (IN).
RESULTS
A total of 19 studies were included in our systematic review which included 7 non-randomised control trials and 15 randomised controlled trials. The outcomes that we considered to be most relevant for our subject title were: mortality data, SGA, albumin, total protein, isoleucine, leucine, prealbumin, transferrin, leptin, valine, TAG, HDL, LDL and total amino acids. Detailed bias analysis of the different studies was also conducted.
CONCLUSION
This is the first systematic review of the literature, so far, on the subject, involving elderly CKD patients. The quality of trials is low, very heterogenic in patients, methods and outcomes. However, we found a positive effect of dietary interventions on the nutritional status of most patients studied, highlighted by improvement in serum albumin and SGA, the most measured outcomes.
Topics: Humans; Malnutrition; Nutritional Status; Renal Insufficiency, Chronic
PubMed: 33459956
DOI: 10.1007/s11255-020-02775-6 -
Nutrition in Clinical Practice :... Aug 2013In everyday practice, clinicians use a variety of anthropometric, biochemical, and clinical indicators to monitor nutrition therapy, but these have limitations in the... (Review)
Review
BACKGROUND
In everyday practice, clinicians use a variety of anthropometric, biochemical, and clinical indicators to monitor nutrition therapy, but these have limitations in the critically ill. This systematic review of randomized controlled trials aimed to assess whether commonly used anthropometric, biochemical, and clinical nutrition indicators are predictive of patient outcomes in the critically ill.
MATERIALS AND METHODS
A computerized bibliographic search was performed using MEDLINE, EMBASE, and CINAHL from 1950 to December 2012, as well as a citation review of relevant articles. Randomized clinical trials of any nutrition interventions in critically ill patients were included if they reported any nutrition indicator after baseline and any clinically meaningful outcome variables. Information about study quality, setting, and findings was extracted using standardized protocols. Because of the heterogeneity of study characteristics, only a narrative synthesis was undertaken.
RESULTS
Of 223 studies obtained with the search strategy, 2 independent reviewers identified selected 51 studies meeting the eligibility criteria. These reported indicators such as serum albumin, serum prealbumin (transthyretin), retinol-binding protein, transferrin, and lymphocytes. Thirty studies did not report a significant difference in clinical outcomes. Of the remainder, the number of studies supporting a statistical relationship between outcome and particular nutrition indicators was equal to, or outnumbered by, the studies not supporting such a relationship.
CONCLUSION
None of the commonly used nutrition monitoring parameters demonstrated consistent associations with outcome in randomized controlled trials. Development of nutrition indicators other than laboratory tests that are more closely linked to the patient's clinical progress should be a priority.
Topics: Biomarkers; Critical Illness; Enteral Nutrition; Humans; Nutritional Status; Outcome Assessment, Health Care
PubMed: 23733884
DOI: 10.1177/0884533613486297 -
Journal of Neurochemistry Mar 2021The liver-derived, circulating transport protein transthyretin (TTR) is the cause of systemic hereditary (ATTRv) and wild-type (ATTRwt) amyloidosis. TTR stabilization...
The liver-derived, circulating transport protein transthyretin (TTR) is the cause of systemic hereditary (ATTRv) and wild-type (ATTRwt) amyloidosis. TTR stabilization and knockdown are approved therapies to mitigate the otherwise lethal disease course. To date, the variety in phenotypic penetrance is not fully understood. This systematic review summarizes the current literature on TTR pathophysiology with its therapeutic implications. Tetramer dissociation is the rate-limiting step of amyloidogenesis. Besides destabilizing TTR mutations, other genetic (RBP4, APCS, AR, ATX2, C1q, C3) and external (extracellular matrix, Schwann cell interaction) factors influence the type of onset and organ tropism. The approved small molecule tafamidis stabilizes the tetramer and significantly decelerates the clinical course. By sequence-specific mRNA knockdown, the approved small interfering RNA (siRNA) patisiran and antisense oligonucleotide (ASO) inotersen both significantly reduce plasma TTR levels and improve neuropathy and quality of life compared to placebo. With enhanced hepatic targeting capabilities, GalNac-conjugated siRNA and ASOs have recently entered phase III clinical trials. Bivalent TTR stabilizers occupy both binding groves in vitro, but have not been tested in trials so far. Tolcapone is another stabilizer with the potential to cross the blood-brain barrier, but its half-life is short and liver failure a potential side effect. Amyloid-directed antibodies and substances like doxycycline aim at reducing the amyloid load, however, none of the yet developed antibodies has successfully passed clinical trials. ATTR-amyloidosis has become a model disease for pathophysiology-based treatment. Further understanding of disease mechanisms will help to overcome the remaining limitations, including application burden, side effects, and blood-brain barrier permeability.
Topics: Amyloid; Amyloidosis, Familial; Animals; Gene Knockdown Techniques; Humans; Prealbumin
PubMed: 33155274
DOI: 10.1111/jnc.15233 -
International Journal of Cardiology May 2024Transcatheter aortic valve replacement (TAVR) is a successful treatment for aortic stenosis (AS) patients, and previous studies indicate favorable outcomes for those... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Transcatheter aortic valve replacement (TAVR) is a successful treatment for aortic stenosis (AS) patients, and previous studies indicate favorable outcomes for those with concomitant aortic stenosis and transthyretin-associated cardiac amyloidosis (TTRCA-AS). However, the impact of TAVR on more adverse outcomes in TTRCA-AS patients compared to those with AS alone is still uncertain, with conflicting findings reported in the literature.
METHODS
PubMed and Scopus were extensively searched from inception till August 2021. Studies were included if they reported data for prevalence and outcomes including mortality and cardiovascular-related hospitalization events in TTRCA-AS patients referred for TAVR. The data for these outcomes were pooled using a random effects model and forest plots were created.
RESULTS
After initially screening 146 articles, 6 were shortlisted for inclusion in our analysis. Pooled analysis demonstrated a 13.3% [95% CI: 10.9-16.5; p = 0.307] prevalence of TTRCA in patients with AS undergoing TAVR. The incidence of mortality and cardiovascular (CV) hospitalization in patients with TTRCA-AS undergoing TAVR were 28.3% [95% CI: 18.7-39.0, p = 0.478] and 21.1% [95% CI: 10.2-34.5, p = 0.211], respectively.
CONCLUSION
The overall pooled TTRCA-AS prevalence was reported to be 13.3% in AS patients who underwent TAVR. Furthermore, transthyretin-associated CA was found to be associated with an increased risk of mortality and hospitalization. Large patient population studies are required to assess the safety and efficacy of TAVR in TTRCA-AS patients, as current research report data from small patient cohorts.
Topics: Humans; Transcatheter Aortic Valve Replacement; Prealbumin; Treatment Outcome; Aortic Valve Stenosis; Amyloidosis; Aortic Valve; Risk Factors
PubMed: 38367883
DOI: 10.1016/j.ijcard.2024.131854 -
Amyloid : the International Journal of... Sep 2021Hereditary transthyretin (ATTRv) amyloidosis is a progressive multisystemic disease of adult-onset that arises from an inherited mutation in the transthyretin gene....
BACKGROUND
Hereditary transthyretin (ATTRv) amyloidosis is a progressive multisystemic disease of adult-onset that arises from an inherited mutation in the transthyretin gene. Currently available disease severity and progression evaluation tools only cover one single organ or system, impacting data collection uniformity and its use in clinical settings.
METHODS
The Jandhyala Method, including a systematic literature review and SMART interviews, was used to observe expert opinion from eight leaders in the treatment of ATTRv across Europe. The aim was to propose a multidisciplinary core dataset (CD) and disease severity scoring (DSS) tools.
RESULTS
The multidisciplinary team of experts identified 140 indicators that form part of the standard diagnostic and monitoring practice (SDMP) and should be collected as the ATTRv CD. Thirty-one (22%) of these indicators informed disease severity and comprised the ATTRv DSS, whilst 25 (18%) were deemed to monitor disease progression.
CONCLUSIONS
The resulting CD and DSS have different purposes. The ATTRv CD supports the collection of high-quality data for clinical research, whereas the ATTRv DSS can be rapidly conducted in a clinical setting and aid patient management.
Topics: Adult; Amyloid Neuropathies, Familial; Europe; Humans; Prealbumin; Severity of Illness Index
PubMed: 34042016
DOI: 10.1080/13506129.2021.1931099