Meta-analysis of procalcitonin as a predictor for acute kidney injury

Background:Procalcitonin (PCT) was used for predicting the development of acute kidney injury (AKI) in several studies recently. We aimed to investigate the accuracy of PCT for predicting AKI in this study.Methods:Studies that assessed the predictive performance of PCT for the development of AKI in adult patients were searched from Medline, Embase, and the Cochrane Library from inception to June 2020. We calculated the pooled sensitivities and specificities and the area under the summary receiver-operating characteristic (SROC) curves. I² was used to test the heterogeneity and the potential heterogeneity was investigated by meta-regression.Results:In total, 9 of 119 studies with 4852 patients were included, 1272 were diagnosed with AKI. In the overall analysis, the area under the SROC curve was 0.82 (95% CI, 0.79–0.85) and the pooled sensitivity and specificity were 0.76 (95% confidence interval [CI], 0.64–0.85) and 0.75 (95% CI, 0.61–0.86), respectively. In the subgroup analysis among septic patients, the pooled sensitivity and specificity were 0.59 (95% CI, 0.29–0.84) and 0.53 (95% CI, 0.31–0.74), and the area under the SROC was 0.57 (95% CI, 0.53–0.62).Conclusion:PCT may be a potential predictor for the development of AKI.     

Detection of gestational diabetes mellitus by circulating plasma and serum microRNAs: A systematic review and meta-analysis

Background and aimsThe diagnostic performance of microRNAs (miRNAs), which have recently emerged as a potential early diagnostic tool capable of detecting gestational diabetes mellitus (GDM) in its early stages, has yet to be systematically investigated. This meta-analysis aims to investigate the diagnostic utility of circulating plasma or serum miRNAs in detecting GDM patients.MethodsEligible studies were included and assessed for risk of bias with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A bivariate meta-analysis using the hierarchical summary receiver operating characteristic model was performed to estimate the pooled diagnostic value of miRNAs.ResultsTwelve studies (32 index tests) cumulating a total of 1768 patients were included in the present study. The pooled sensitivity of miRNAs was 74.5% (95% confidence interval [CI]: 63.7–82.9) and the pooled specificity was 84.1% (95% CI: 76.8–89.3). The overall area under the curve was 0.869 (95% CI: 0.818–0.907) with a relatively narrow 95% confidence region and a wide 95% prediction region.ConclusionmiRNAs may emerge as a promising diagnostic tool in detecting GDM. Further cross-sectional cohort studies with larger sample sizes and more heterogeneous populations, and studies evaluating the accuracy of multiple miRNAs in diagnosing GDM are required to confirm our findings.     

Value of clinical tests in diagnosing anterior cruciate ligament injuries: A systematic review and meta-analysis

Objectives:This study compared 4 clinical tests with reference to magnetic resonance imaging and arthroscopic visualization to comprehensively evaluate their diagnostic value for anterior cruciate ligament injuries.Methods:We systematically searched 10 electronic databases from January 1, 2010, to May 1, 2021. Two reviewers collected data in accordance with the Preferred Reporting Item for Systematic Reviews and Meta-Analyses 2020 guidelines. The quality of each study was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A meta-analysis was performed using Meta-Disc version 1.4 and Stata SE version 15.0.Results:Eighteen articles involving 2031 participants were included. The results of the meta-analysis showed that for the Lachman test, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio, area under the curve (AUC) of summary receiver operating characteristic (SROC), and Q* were 0.76 (95% CI, 0.73–0.78), 0.89 (95% CI, 0.87–0.91), 5.65 (95% CI, 4.05–7.86), 0.28 (95% CI, 0.23–0.36), 22.95 (95% CI, 14.34–36.72), 0.88, and 0.81, respectively. For the anterior drawer test, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio, AUC of SROC, and Q* were 0.64 (95% CI, 0.61–0.68), 0.87 (95% CI, 0.84–0.90), 3.57 (95% CI, 2.13–5.96), 0.44 (95% CI, 0.32–0.59), 8.77 (95% CI, 4.11–18.74), 0.85, and 0.78, respectively. For the pivot shift test, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio, AUC of SROC, and Q* were 0.59 (95% CI, 0.56–0.62), 0.97 (95% CI, 0.95–0.98), 13.99 (95% CI, 9.96–19.64), 0.44 (95% CI, 0.35–0.55), 29.46 (95% CI, 15.60–55.67), 0.98, and 0.94, respectively. For the lever sign test, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio, AUC of SROC, and Q* were 0.79 (95% CI, 0.75–0.83), 0.92 (95% CI, 0.87–0.95), 9.56 (95% CI, 2.76–33.17), 0.23 (95% CI, 0.12–0.46), 47.38 (95% CI, 8.68–258.70), 0.94, and 0.87, respectively.Conclusions:Existing evidence shows that these clinical tests have high diagnostic efficacy for anterior cruciate ligament injuries, and that every test has its own advantages and disadvantages. However, the above results should be validated through additional studies, considering the limited quality and quantity of our sample.     

Helicobacter pylori infection and increased diabetes prevalence were the risks of colorectal adenoma for adults: A systematic review and meta-analysis (PRISMA-compliant article)

Background:Helicobacter pylori infection and hyperglycemia are associated with an increased risk of colorectal neoplasm, and may have a synergistic effect in combination. However, these 2 factors that affect colorectal neoplasm remain controversial. We aimed to carry out a meta-analysis to evaluate the study population diabetes prevalence rate and H pylori infection rate with colorectal adenoma risk for adults.Methods:We conducted systemic research through English databases for medical reports. We also recorded the diabetes prevalence and H pylori infection prevalence in each study. We classified these studies into 4 subgroups as their background population diabetes prevalence <6% (Group 1); between 6% and 8% (Group 2); between 8% and 10% (Group 3), and more than 10% (Group 4). The random-effects model had used to calculate pooled prevalence estimates with 95% confidence interval (CI).Results:Twenty-seven studies were finally eligible for meta-analysis. The random-effects model of the meta-analysis was chosen, showing pooled odds ratio (OR) equal to 1.51 (95% CI 1.39–1.63). The subgroup meta-analyses showed in Group 1 the H pylori infection associated colorectal adenoma risk OR was 1.24 (95% CI 0.86–1.78). As the diabetes rate exceed 6%, the H pylori infection became the more significant increased risk of colorectal adenoma (Group 2: OR 2.16 (95% CI 1.61–2.91); Group 3: OR 1.40 (95% CI 1.24–1.57); and Group 4: OR 1.52 (95% CI 1.46–1.57)).Conclusions:The results of this meta-analysis showed elevated diabetes prevalence combined H pylori infection increasing the risks of colorectal adenoma in the adult population.     

Effect of the combined application of orthokeratology and single-vision spectacles on slowing the progression of high myopia: A systematic review and meta-analysis

Purpose:The purpose of the study was to conduct a meta-analysis about the effect of the combined application of orthokeratology and single-vision spectacles on slowing the progression of high myopia.Methods:The literature was searched in PubMed, EMBASE, the Cochrane Library, Wang Fang Data, CNKI and sinoMed. The Cochrane Handbook was used to evaluate the quality of the included randomized clinical trials, and the Newcastle-Ottawa Scale was used to evaluate the included case–control or cohort studies. The results were analyzed by Revman 5.3.Results:Five studies (2 randomized clinical trials, 2 case–controls, and 1 cohort study) with a total of 360 patients were included in this meta-analysis. The follow-up time was at least 1 year. Combined application of orthokeratology and single-vision spectacles were used in the experimental group. The control group used single-vision spectacles only. The pooled estimates indicated that the standardized mean difference between the 2 groups was –1.46 mm (95% confidence interval: –1.88 to –1.05; P < .05) for axial length elongation and –1.85D (95% confidence interval: –2.40 to –1.31; P < .05) for change in spherical equivalent refraction. No serious adverse events were reported in all studies.Conclusion:The combined application of orthokeratology and single-vision spectacles is more effective than single-vision spectacles only on slowing the progression of high myopia.     

Diagnostic accuracy of electronic surveillance tool for catheter-associated urinary tract infections in tertiary care hospitals: A meta-analysis

Background:Automated systems have been developed to reduce labor-intensive manual recordings during nosocomial infection surveillance. The diagnostic accuracies of these systems have differed in various settings.Methods:We designed this meta-analysis to evaluate the diagnostic accuracy of an electronic surveillance tool for catheter-associated urinary tract infections (CAUTIs) in tertiary care hospitals. We systematically searched databases such as Medline, Scopus, Cochrane library and Embase (from inception until November 2019) for relevant studies. We assessed the quality of trials using the diagnostic accuracy studies-2 tool, and performed a meta-analysis to obtain a pooled sensitivity and specificity for electronic surveillance. We included 6 studies with 16,492 patients in the analysis.Results:We found a pooled sensitivity of electronic diagnostic surveillance for CAUTIs of 97.5% (95% confidence interval [CI], 67.6–99.9%) and a pooled specificity of 92.6% (95% CI, 55.2–99.2%). The diagnostic odds ratio was 494 (95% CI, 89–2747). The positive likelihood ratio was 13.1 (95% CI, 1.63–105.8) and the negative likelihood ratio 0.02 (95% CI, 0.001–0.40). A bivariate box plot indicated the possibility of heterogeneity between the included studies.Conclusion:Our review suggests that electronic surveillance is useful for diagnosing CAUTIs among hospitalized patients in tertiary care hospitals due to its high sensitivity and specificity.     

A systematic review and meta-analysis of circulating cell-free DNA as a diagnostic biomarker for non-small cell lung cancer

BackgroundEarly diagnosis of non-small cell lung cancer (NSCLC) is crucial for treatment. Circulating cell-free DNA (cfDNA) is an extracellular nucleic acid found in serum, and tumor cfDNA circulating in the blood may be used as a biomarker for early diagnosis. The purpose of this study was to evaluate the application value of cfDNA as a biomarker for the diagnosis of NSCLC through meta-analysis.MethodsWe searched the China National Knowledge Infrastructure (CNKI), Wanfang, VIP, PubMed, Cochrane Central Register of Controlled Trials, Embase, and Web of Science databases using the following search terms: lung cancer, NSCLC, biomarkers, circulating cfDNA, cfDNA, circulating tumor DNA (ctDNA), circulating cell-free tumor DNA, and diagnosis. The retrieval period was set until September 2021. According to PICOS (patients, intervention, comparison, outcomes, and study design) principles the inclusion criteria were: aged ≥18 years; at least 10 NSCLC cases; NSCLC patients diagnosed by histopathology or cytology; circulating cfDNA was detected; outcome data could be completely extracted. Bias risk assessment was conducted according to the QUADAS (Quality Assessment of Diagnostic Accuracy Studies). RevMan 5.3 was used for meta-analysis.ResultsEight studies met the inclusion criteria, including a total of 618 NSCLC patients and 635 healthy subjects. The overall sensitivity and specificity were 0.79 [95% confidence interval (CI): 0.75–0.82] and 0.81 (95% CI: 0.78–0.84), respectively. The area under the curve (AUC) of the summary receiving operating characteristic (SROC) curve was 0.8941. The pooled positive likelihood ratio, pooled negative likelihood ratio, and pooled diagnostic odds ratio were 5.37 (95% CI: 2.67–10.81), 0.24 (95% CI: 0.15–0.38), and 24.68 (95% CI: 8.85–68.84), respectively. The patient selection bias was high in two articles was high, unclear in one article, and low in the remaining five ones. The risk of bias in the research index test was unclear in one article, and low in the remaining seven articles. The reference standard bias, and flow and time bias of all articles was low.ConclusionsCirculating cfDNA is an efficacy biomarker in diagnosis of NSCLC. Its clinical application technology is worthy of further research.     

Relationship between alcohol consumption and the risks of liver cancer,esophageal cancer,and gastric cancer in China: Meta-analysis based on case–control studies

Objective: To study the correlation between alcohol consumption and the risks of liver, esophageal squamous cell carcinoma (ESCC), and gastric cancers in China mainland by meta-analysis.Methods: We systematically searched electronic databases to identify the case–control studies that reported the association between alcohol consumption and the risks of liver, ESCC, and gastric cancers from January 1, 2010 to April 1, 2020. The Newcastle–Ottawa Scale (NOS) was used to evaluate literature quality, and I² analyzes were used to evaluate the heterogeneity.Results: A total of 2855-related studies were retrieved. After conditional screening, we included 26 case–control studies for meta-analysis. Meta-analysis showed that alcohol consumption was associated with increased risks of liver, ESCC, and gastric cancers (total pooled odds ratio [OR], 1.83; 95% confidence interval [CI], 1.58–2.11; liver cancer OR, 1.83; 95% CI, 1.39–2.40; ESCC OR, 2.00; 95% CI, 1.66–2.40; gastric-cancer OR, 1.54; 95% CI, 1.10–2.15). Subgroup analysis results showed that the pooled ORs of volume of alcohol consumed, years of drinking, age of starting drinking, and drinking status were 1.71 (95% CI, 1.36–2.15), 1.65 (95% CI, 1.33–2.06), 1.38 (95% CI, 0.98–1.94), and 2.00 (95% CI, 1.42-2.81), respectively. Regression analysis showed that geographical region was a source of heterogeneity.Conclusion: Alcohol consumption increased the risks of liver cancer, ESCC, and gastric cancers in China. Volume of alcohol consumed, years of drinking, age of starting drinking, and drinking status were all significant factors for these risks.     

Prophylactic Effect of Somatostatin in Preventing Post-ERCP Pancreatitis: An Updated Meta-Analysis

Background/Aims:Somatostatin is regarded as a prophylactic agent on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), but studies are still controversial.Results:Eleven randomized controlled trials (RCTs), enrolling a total of 2869 patients, were included in the meta-analysis. After data were pooled from somatostatin trials, PEP occurred in 8.36% of controls versus 5.62% of the treated group, with a slight significance [relative risk (RR) =0.58, 95% confidence interval (CI) 0.35–0.98, P = 0.04]. The funnel plot showed no asymmetry with a negative slope (P = 0.108). The meta-analysis produced negative results for short-term infusion of somatostatin (RR = 1.40, 95% CI 0.93–2.12, P = 0.11), whereas a bolus or long-term injection of the drug proved effective (RR = 0.25, 95% CI 0.13–0.47, P < 0.0001; RR = 0.44, 95% CI 0.27–0.71, P = 0.0008). Postprocedure hyperamylasemia and pain was also observed in the meta-analysis, the pooled RR was significant for reduced risk of postprocedure hyperamylasemia (RR = 0.72, 95%CI 0.63 to 0.81, P < 0.00001), but not for the pain (RR = 0.67, 95% CI 0.42 to 1.08, P = 0.10).Conclusion:The current meta-analysis on the prophylactic use of somatostatin in patients undergoing ERCP documents a lack of benefit when given as short-term infusion, but showed an advantage of a single bolus or long-term injection. The beneficial effect of somatostatin, in reducing the incidence of postprocedural hyperamylasemia seems of marginal clinical significance. However, more new confirmatory data are needed to settle residual doubts.     

Clinical Diagnostic Implications of Body Fluid MiRNA in Oral Squamous Cell Carcinoma: A Meta-Analysis

Oral cancer, predominantly oral squamous cell carcinoma (OSCC), is one of the most leading causes of cancers worldwide. Due to a low 5-year survival rate, highly effective methods for the early detection of OSCC are totally needed. MicroRNAs (miRNAs), as promising biomarkers, can bring insights into tumorigenesis of oral cancers. However, studies on the accuracy of miRNAs detection in OSCC have inconsistent conclusions, leading us to conduct this meta-analysis. The aim of this study was to systematically review the articles investigating the diagnostic value of miRNAs in OSCC.The PubMed, Embase, Chinese National Knowledge Infrastructure (CNKI), Web of Science were searched (updated to June 11th, 2015) to identify all articles evaluating the diagnostic yield of miRNAs for OSCC. The pooled sensitivity, specificity, and other diagnostic parameters were used to assess the performance of miRNAs assays on OSCC detection. Statistical analysis was conducted by employing the R software.The present meta-analysis comprised 23 studies from 10 articles, including 598 OSCC patients and 320 healthy individuals, available for analysis. The summary receiver operator characteristic (SROC) curve was plotted. Meanwhile, the pooled diagnostic parameters and the area under curve (AUC) were calculated based on all included studies. The pooled diagnostic parameters calculated from all 23 studies were as follows: pooled sensitivity of 0.759 (95% CI: 0.701–0.809), pooled specificity of 0.773 (95% CI: 0.713–0.823) and AUC of 0.832, which indicates a relatively high diagnostic accuracy of miRNAs in differentiating OSCC patients from healthy controls. Meanwhile, In addition, subgroup analyses were conducted to access the heterogeneity between studies, which is based on specimen (serum/plasma/blood/saliva/ tissue) and ethnicity (Asian/Caucasian).In summary, our meta-analysis suggests that miRNAs might be used in noninvasive screening tests for OSCC, which needs further large-scale studies to be validated.     

Value of preoperative staging of endometrial carcinoma with contrast-enhanced ultrasonography: A PRISMA compliant meta-analysis

Introduction:Endometrial carcinoma (EC) is the most common gynecologic carcinoma in developed countries and accounts for nearly 5% of carcinoma cases and more than 2% of deaths due to female carcinomas worldwide. Because of this reported risk, it is very important to diagnose and stage it accurately. Therefore, we investigated the staging accuracy of EC with contrast-enhanced ultrasonography (CEUS). Due to a lack of studies on the use of CEUS in staging EC, we performed a systematic review and meta-analysis.Method:We searched PubMed, EMBASE, Cochrane Library, Scopus, Web of science, China National Knowledge Infrastructure (CNKI), and CBM for studies on CEUS in EC diagnosis. Our search keywords were “ultrasonic angiography,” “endometrial neoplasms,” and their synonyms. The studies were screened according to the inclusion and exclusion criteria, and 4 tabular data were extracted. Quality evaluation was performed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) scale. Statistical analysis was done with Stata version 15.1. A random effect model was selected to calculate the pooled sensitivity and specificity. The summary receiver operating characteristic (SROC) curve was obtained, and the area under the curve was calculated.Result:Fifteen studies with 685 patients were included in this quantitative synthesis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (OR) of CEUS in the diagnosis of EC was 0.81 (95% confidence interval, .76–.85), .90 (.87–.92), 8 (5.8–11.1), .21 (.16–.28), and 38 (22–67), respectively. The area under the curve was 0.93 (.90–.95).Conclusion:CEUS has a high sensitivity and specificity in the diagnosis of EC. It can be considered as an effective and feasible method for EC staging.     

Incidence of acute kidney injury during pregnancy and its prognostic value for adverse clinical outcomes: A systematic review and meta-analysis

Background:Acute kidney injury (AKI) that develops during pregnancy results from pregnancy-induced hypertension, hemorrhage, and sepsis, associated with morbidity and mortality in the fetus and mother. This meta-analysis was conducted to evaluate the incidence of pregnancy-related AKI (PR-AKI) and adverse clinical outcomes.Methods:PubMed and Scopus were systematically searched for studies published between 1980 and 2021. We included cross-sectional, retrospective, and prospective cohort studies that reported the incidence of PR-AKI as well as adverse fetal and maternal clinical outcomes. A random-effects model meta-analysis was performed to generate summary estimates.Results:The meta-analysis included 31 studies (57,529,841 participants). The pooled incidence of PR-AKI was 2.0% (95% confidence interval [CI] 1.0–3.7). Only 49.3% of patients received antenatal care. The most common cause of PR-AKI was preeclampsia (36.6%, 95% CI 29.1–44.7). The proportion of patients requiring hemodialysis was 37.2% (95% CI 26.0–49.9). More than 70% of patients had complete recovery of renal function, while 8.5% (95% CI 4.7–14.8) remained dependent on dialysis. The pooled mortality rate of PR-AKI was 12.7% (95% CI 9.0–17.7). In addition, fetal outcomes were favorable, with an alive birth rate of 70.0% (95% CI 61.2–77.4). However, the rate of abortion and/or stillbirth was approximately 25.4% (95% CI 18.1–34.4), and the rate of intrauterine death was 18.6% (95% CI 12.8–26.2).Conclusions:Although the incidence of PR-AKI is not high, this condition has a high impact on morbidity and mortality in both fetal and maternal outcomes. Early prevention and treatment from health care professionals are needed in PR-AKI, especially in the form of antenatal care and preeclampsia medication.     

Clinical impact of pretreatment albumin–globulin ratio in patients with colorectal cancer: A meta-analysis

Background:Accumulating evidence have revealed that pretreatment albumin to globulin ratio (AGR) may be a predictor of prognosis among patients with colorectal cancer (CRC). However, these findings are inconsistent. The aim of the present study was to investigate the prognostic value of pretreatment AGR in CRC.Methods:A systematic meta-analysis was conducted by searching MEDLINE, EMBASE, and Cochrane Library databases.Results:A total of 9 studies with 7939 patients were finally included. Low pretreatment AGR was associated with worse overall survival (pooled hazard ratio [HR]: 2.07, 95% CI: 1.60–2.67, P < .001) and disease-free survival/progress-free survival (pooled hazard ratio [HR]: 2.10, 95% confidence interval [CI]: 1.34–3.31, P = .001). Subgroup analyses revealed that the pooled correlation did not alter these results. Moreover, low pretreatment AGR were associated with elderly patients, tumor diameter (≥50 mm), tumor node metastasis stage (III–IV), depth of tumor (T3–4), and CA19-9 (>37 U/mL).Conclusion:The present meta-analysis suggests that low pretreatment AGR was associated with advanced clinicopathological features and worse prognosis, suggesting AGR is a useful prognostic biomarker for CRC patients.     

Usefulness of CD109 expression as a prognostic biomarker in patients with cancer: A systematic review and meta-analysis

Background:It has been revealed that CD109 expression is associated with prognosis in cancer patients, but it remains unclear thus far. Therefore, we performed a meta-analysis in the present study for a better assessment of the prognostic role of CD109 expression in cancer patients.Methods:Eligible studies were collected through a search of the PubMed, Embase, Cochrane Library, and Scopus databases. The pooled hazard ratio (HR) with 95% confidence interval (CI) was evaluated to reveal the association between CD109 expression and overall survival (OS) in cancer patients.Results:Seven studies with 1583 patients were enrolled. The pooled HR with 95% CI was calculated as 2.31 (95% CI 1.93–2.76, P < .001), suggesting an association between high expression of CD109 and unfavorable OS in cancer patients.Conclusion:This analysis indicated that CD109 expression could be used as a prognostic biomarker in cancer patients. This is the first meta-analysis to report the relationship between CD109 expression and prognosis in cancer patients.     

Diagnostic value of EUS elastography in differentiation of benign and malignant solid pancreatic masses: A meta-analysis

Background/AimsEUS elastography is a novel technique that can be used for distinguishing benign from malignant lymph nodes and focal pancreatic masses. However, the studies pertaining to EUS elastography for differential diagnosis of solid pancreatic masses have reported widely varied sensitivities and specificities. A meta-analysis of all relevant articles was performed to estimate the overall diagnostic accuracy of EUS elastography for differentiating benign and malignant solid pancreatic masses.MethodsThe literatures were identified by searching in PubMed and Embase databases. Two reviewers independently extracted the information from the literatures for constructing 2 × 2 table. A random-effect model or a fixed-effect model was used to estimate the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. A summary receiver operating characteristic curve (SROC) also was constructed. Meta-regression and subgroup analysis were used to explore the sources of heterogeneity.Results13 studies including a total of 1042 patients with solid pancreatic masses were selected for meta-analysis. The pooled sensitivity and specificity of EUS elastography for differentiating benign and malignant solid pancreatic masses were 95% (95% confidence interval [CI], 93%–96%), 69% (95% CI, 63%–75%), respectively. The area under SROC (AUC) was 0.8695. Two significant variables were associated with heterogeneity: color pattern and blinding.ConclusionAs a less invasive modality, EUS elastography is a promising method for differentiating benign and malignant solid pancreatic masses with a high sensitivity, and it can prove to be a valuable supplement to EUS-FNA.     

Spotlight influenza: Laboratory-confirmed seasonal influenza in people with acute respiratory illness: a literature review and meta-analysis,WHO European Region, 2004 to 2017

BackgroundAcross the World Health Organization European Region, there are few estimates of the proportion of people seeking medical care for influenza-like illness or acute respiratory infections and who have laboratory-confirmed seasonal influenza infection.MethodsWe conducted a meta-analysis of data extracted from studies published between 2004 and 2017 and from sentinel data from the European surveillance system (TESSy) between 2004 and 2018. We pooled within-season estimates by influenza type/subtype, setting (outpatient (OP)/inpatient (IP)) and age group to estimate the proportion of people tested who have laboratory-confirmed and medically-attended seasonal influenza in Europe.ResultsIn the literature review, the pooled proportion for all influenza types was 33% (95% confidence interval (CI): 30–36), higher among OP 36% (95% CI: 33–40) than IP 24% (95% CI: 20–29). Pooled estimates for all influenza types by age group were: 0–17 years, 26% (22–31); 18–64 years, 41% (32–50); ≥ 65 years, 33% (27–40). From TESSy data, 33% (31–34) of OP and 24% (21–27) of IP were positive. The highest proportion of influenza A was in people aged 18–64 years (22%, 16–29). By subtype, A(H1N1)pdm09 was highest in 18–64 year-olds (16%, 11–21%) whereas A(H3N2) was highest in those ≥ 65 years (10%, 2–22). For influenza B, the highest proportion of infections was in those aged 18–64 years (15%, 9–24).ConclusionsLaboratory-confirmed influenza accounted for approximately one third of all acute respiratory infections for which medical care was sought during the influenza season.     

Postoperative acute kidney injury and early and long-term mortality in acute aortic dissection patients: A meta-analysis

Objective:To evaluate the impact of postoperative acute kidney injury (AKI) on early and long-term mortality in patients with acute aortic dissection by conducting a meta-analysis.Methods:An extensive literature search was performed in PubMed and Embase databases until February 15, 2020. Observational studies that reported the associations between postoperative AKI and early (in-hospital and within 30 days) or long-term mortality in patients with acute aortic dissection were included.Results:Seven studies comprising 1525 acute aortic dissection patients were identified. A random effect meta-analysis showed that postoperative AKI was significantly associated with higher risk of long-term mortality (risk ratio [RR] 2.32; 95% confidence interval [CI] 1.50–3.59). Subgroup analysis revealed that the pooled RR of long-term mortality was 1.42 (95% CI 0.90–2.22) for stage 1 AKI, 1.72 (95% CI 0.95–3.12) for stage 2 AKI, and 4.46 (95% CI 2.72–7.32) for stage 3 AKI, respectively. Furthermore, postoperative stage 3 AKI was associated with an increased risk of early mortality (RR 11.3; 95% CI 4.2–30.5).Conclusions:This meta-analysis provided clinical evidence that postoperative stage 3 AKI is associated with higher risk of early and long-term mortality, even after adjusting important confounding factors. However, the current findings should be interpreted with caution due to the retrospective nature and limited number of studies analyzed.     

Hospital-acquired infections caused by enterococci: a systematic review and meta-analysis,WHO European Region, 1 January 2010 to 4 February 2020

BackgroundHospital-acquired infections (HAI) caused by Enterococcus spp., especially vancomycin-resistant Enterococcus spp. (VRE), are of rising concern.AimWe summarised data on incidence, mortality and proportion of HAI caused by enterococci in the World Health Organization European Region.MethodsWe searched Medline and Embase for articles published between 1 January 2010 and 4 February 2020. Random-effects meta-analyses were performed to obtain pooled estimates.ResultsWe included 75 studies. Enterococcus spp. and VRE accounted for 10.9% (95% confidence interval (CI): 8.7–13.4; range: 6.1–17.5) and 1.1% (95% CI: 0.21–2.7; range: 0.39–2.0) of all pathogens isolated from patients with HAI. Hospital wide, the pooled incidence of HAI caused by Enterococcus spp. ranged between 0.7 and 24.8 cases per 1,000 patients (pooled estimate: 6.9; 95% CI: 0.76–19.0). In intensive care units (ICU), pooled incidence of HAI caused by Enterococcus spp. and VRE was 9.6 (95% CI: 6.3–13.5; range: 0.39–36.0) and 2.6 (95% CI: 0.53–5.8; range: 0–9.7). Hospital wide, the pooled vancomycin resistance proportion among Enterococcus spp. HAI isolates was 7.3% (95% CI: 1.5–16.3; range: 2.6–11.5). In ICU, this proportion was 11.5% (95% CI: 4.7–20.1; range: 0–40.0). Among patients with hospital-acquired bloodstream infections with Enterococcus spp., pooled all-cause mortality was 21.9% (95% CI: 15.7–28.9; range: 14.3–32.3); whereas all-cause mortality attributable to VRE was 33.5% (95% CI: 13.0–57.3; range: 14.3–41.3).ConclusionsInfections caused by Enterococcus spp. are frequently identified among hospital patients and associated with high mortality.     

Effectiveness of resistance exercises in the treatment of rheumatoid arthritis: A meta-analysis

Background:We aimed to assess the efficacy of resistance exercise in rheumatoid arthritis (RA) in randomized controlled trials (RCTs).Method:PubMed, the Cochrane Library, and Embase were searched according to the index words to identify eligible RCTs, and relevant literature sources were also searched. The latest search was done in August 2019. Odds ratios (OR), mean difference (MD), and 95% confidence interval (95% CI) were used to analyze the main outcomes.Result:Seventeen RCTs were included in the meta-analysis with 512 patients in the resistance exercise group and 498 patients in the control group. The results showed that compared with the control group, resistance exercise significantly decreased disease activity score in 28 joints (DAS-28) scores (standard mean difference [SMD]: –0.69, 95% CI: –1.26 to –0.11), reduced erythrocyte sedimentation rate (ESR) (SMD: –0.86, 95% CI: –1.65 to –0.07), and shortened the time of 50 ft. walking (SMD: –0.64, 95% CI: –0.99 to –0.28). No significant difference was observed in visual analog scale (VAS) scores (SMD: –0.61, 95% CI: –1.49–0.27) and health assessment questionnaire (HAQ) scores (weighted mean difference: –0.10, 95% CI: –0.26–0.06).Conclusion:Resistance exercise showed reducing DAS-28 score, ESR score, and the time of 50 ft. walking in RA patients compared with the control group. However, high quality multicenter RCTs with larger sample sizes to confirm the conclusion.     

Effects of glucagon-like peptide 1 receptor agonists and sodium glucose cotransporter 2 inhibitors on major adverse cardiovascular events in type 2 diabetes by race,ethnicity, and region: A meta-analysis

Background:The effects of sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide 1 receptor agonists on major adverse cardiovascular events (MACE) in type 2 diabetic subgroups defined by race, ethnicity, and region are unestablished.Methods:We searched PubMed and Embase for related randomized controlled trials. We conducted random-effects meta-analysis, stratified by drug class, on MACE in various subgroups defined by 3 factors of interest (ie, race, ethnicity, and region) to estimate pooled hazard ratio (HR) and 95% confidence interval. Random-effects meta-regression was conducted to evaluate the differences between 2 drug classes.Results:We included 11 randomized controlled trials for pooled analysis. Compared with placebo, SGLT2is and GLP-1 RAs significantly reduced the risk of MACE (HR ranged from 0.76 to 0.93) in most diabetic subgroups defined by 3 factors of interest. The 2 drug classes did not significantly reduced this risk in the Black race group (HR 0.92, 95% confidence interval 0.70–1.20). The effect of the 2 drug classes on MACE was not significantly different in all diabetic subgroups of interest (P-value for subgroup differences ranged from .101 to .971).Conclusions:SGLT2is and glucagon-like peptide 1 receptor agonists can significantly reduce the risk of MACE in most type 2 diabetic subgroups defined by race, ethnicity, and region, whereas they fail to do it in Black individuals.