Generic Inverse Variance Model Research Articles

Neurological Manifestations and Complications of Neonatal Meningitis: A Systematic Review and Meta-analysis

Background: Neonatal meningitis has significant worldwide morbidity and mortality rates. Nevertheless, the clinical manifestations of neonatal meningitis are subtle and nonspecific which can pose challenges in terms of timely diagnosis and intervention. This meta-analysis aims to the prevalence of neurological manifestations and complications associated with neonatal meningitis in term and preterm neonates. Methods: A systematic literature search was conducted in PubMed, SCOPUS, and Ovid SP to identify relevant studies. Pooled prevalence of neurological manifestations and complications with a 95% confidence interval (CI) were calculated using the random-effects generic inverse variance model. Statistical analysis was performed using Review Manager v5.4 and R programming. Results: A total of 25 studies with 2252 patients evaluated for neurological symptoms and 1822 patients evaluated for neurological complications were included in this meta-analysis. The overall prevalence of neurological manifestations in neonatal meningitis was 23% (95% CI, 20% to 26%). The overall prevalence of neurological complications in neonatal meningitis was 8% (95% CI, 6% to 9%). Conclusion: Our meta-analysis revealed a low prevalence of neurological manifestations and complications in neonatal meningitis. Although neurological complications occur less frequently, the complications are significantly associated with higher mortality and morbidity rates.

Prevalence and mortality of haemophagocytic lymphohistiocytosis in dengue fever: a systematic review and meta-analysis.

Haemophagocytic lymphohistiocytosis (HLH) is a rare complication of dengue fever with potentially life-threatening consequences and high mortality. Therefore, this study aims to investigate the prevalence, management and outcome of HLH in dengue fever. The major electronic databases, including PubMed, ScienceDirect and Ovid SP, were searched from inception until 31 January 2024 to identify relevant studies. Pooled prevalence and mortality were calculated using the random-effects generic inverse variance model with a 95% CI. All the statistical analysis was conducted using R programming. A total of nine studies with 157 patients with HLH, 576 patients with severe dengue and 5081 patients with dengue fever were included in this meta-analysis. The prevalence of HLH in severe dengue (22.1%, 95% CI 8.07 to 48.0%) was significantly higher than the prevalence in dengue fever (3.12%, 95% CI 0.37 to 21.9%). The prevalence of HLH in severe dengue was higher in the paediatric population (22.8%, 95% CI 3.9 to 68.4%) compared with the adult population (19.0%, 95% CI 3.0 to 63.9%). The overall mortality rate was 20.2% (95% CI 9.7 to 37.2%). The prevalence of dengue-associated HLH was low in patients with dengue fever but is significantly higher in patients with severe dengue and a high mortality rate.

Prevalence and clinical significance of late gadolinium enhancement in children and adolescents with hypertrophic cardiomyopathy: a systematic review and meta-analysis.

Hypertrophic cardiomyopathy is the leading cause of sudden cardiac death among the paediatric population. The aim of this study is to investigate the prevalence and clinical significance of late gadolinium enhancement, as assessed by cardiac MRI, in paediatric hypertrophic cardiomyopathy. A systematic literature search was conducted in PubMed, SCOPUS, and Ovid SP to identify relevant studies. Pooled estimates with a 95% confidence interval were calculated using the random-effects generic inverse variance model. Statistical analysis was performed using Review Manager v5.4 and R programming. Seventeen studies were included in this meta-analysis, encompassing a total of 778 patients. Late gadolinium enhancement was highly prevalent in paediatric hypertrophic cardiomyopathy, with a pooled prevalence of 51% (95% confidence interval, 40-62%). The estimated extent of focal fibrosis expressed as a percentage of left ventricular mass was 4.70% (95% confidence interval, 2.11-7.30%). The presence of late gadolinium enhancement was associated with an increased risk of adverse cardiac events (pooled odds ratio 3.49, 95% confidence interval 1.10-11.09). The left ventricular mass index of late gadolinium enhancement-positive group was higher than the negative group, with a standardised mean difference of 0.91 (95% confidence interval, 0.42-1.41). This meta-analysis demonstrates that prevalence of late gadolinium enhancement in paediatric hypertrophic cardiomyopathy is similar to that in the adult population. The presence and extent of late gadolinium enhancement are independent predictors of adverse cardiac events, underscoring their prognostic significance among the paediatric population.

Urolithiasis in patients with inflammatory bowel disease: A systematic review and meta-analysis of 13,339,065 individuals.

This study aimed to summarize the current literature regarding the prevalence of renal stones in patients with inflammatory bowel disease (IBD). Moreover, we aimed to evaluate the risk factors of urolithiasis in patients with IBD and the difference between patients with IBD and healthy controls in terms of urinary profile. On February 23, 2022, a computerized search was conducted on PubMed, OVID via MEDLINE, Web of Science, and Scopus using relevant keywords. Three independent reviewers performed 2-stage screening and data extraction. The National Institutes of Health tools were employed for quality assessment. Review Manager 5.4 software was used to calculate the mean difference (MD) between IBD patients and non-IBD in terms of urine profile using the Inverse-variance model and to estimate the odds ratio of reported risk factors for renal stones with the Generic Inverse-Variance model. Thirty-two articles (n = 13,339,065 patients) were included. The overall prevalence of renal stones in patients with IBD was 6.3%, 95% Confidence interval (4.8%-8.3%). The prevalence of urolithiasis was more common in Chron's disease vs Ulcerative colitis (7.9% vs 5.6%) and in old studies (1964-2009) than in more recent studies (2010-2022) (7.3% vs 5.2%), respectively. Compared to non-IBD patients, patients with IBD were associated with significantly lower urine volume (MD = -518.84 mL/day, P < .00001), calcium 24-hour urine (MD = -28.46 mg/day, P < .0001), citrate 24-hour urine (MD = -144.35 mg/day, P < .00001), sodium 24-hour urine (MD = -23.72 mg/day, P = .04), and magnesium 24-hour urine (MD = -33.25 mg/day, P < .00001). The overall prevalence of renal stones in patients with IBD was comparable to the general population. Patients with Chron's disease were associated with a higher prevalence of urolithiasis compared to Ulcerative colitis. Drugs that induce renal calculi should be stopped in high-risk patients.

S1189 Efficacy of Corticosteroid Administration in Patients With Hemolysis, Elevated Liver Enzymes, and Low Platelet Count (HELLP) Syndrome: A Meta-Analysis

Introduction: Hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is considered an obstetrical emergency, posing risk for high maternal morbidity and mortality if left untreated. While corticosteroids (CS) have been postulated to modify some of the pro-inflammatory features of HELLP syndrome, results from meta-analyses have thus far lacked the evidence to support CS’ overall benefit in attenuating disease process. In the past several years, there has been additional data published on the use of CS in HELLP syndrome, prompting an updated meta-analysis on the matter. Our study aims to evaluate the prognostic benefits of CS in HELLP syndrome. Methods: We performed a systematic literature review using multiple electronic databases. Continuous data under the generic inverse variance model was pooled and expressed as a standardized mean difference while the dichotomous data was analyzed using the Mantel-Haenszel model and expressed as odds ratios. Results: Nineteen studies were included. Administration of CS in HELLP syndrome was associated with a significantly increased platelet count (MD: 38.71 p < 0.05), decreased LDH (MD: -0.17 p < 0.05), decreased requirement for packed red blood cell transfusion (OR: 0.46 p < 0.05), decreased requirement for plasma transfusion (OR: 0.29 p < 0.05), and an increased risk of infection (OR: 1.65 p < 0.05). There was no significant difference in the following outcomes: hemorrhage, cardiopulmonary edema, renal failure, transaminitis, mode of delivery, eclampsia, and maternal death. Conclusion: Our results reaffirm those of prior meta-analyses conducted on the effects of CS in HELLP syndrome. Particularly, they highlight CS known effect in optimizing platelet count for the obstetrical patient. Interestingly, our meta-analysis demonstrates a significant decrease in LDH amongs patients with HELLP who received CS. As LDH is a known byproduct of hepatic dysfunction, our findings suggest a possible hepato-protective role of CS on the cellular level. While the effect of CS on hepatic morbidity was not statistically significant, the small sample size of women diagnosed with serious liver pathology made it challenging to assess the clinical impact thereof. At this time, there is not enough evidence to recommend utilization of CS for a hepatic benefit, given their deleterious effect on rates of maternal infection. Future studies with larger sample size data of liver injury in HELLP are warranted to evaluate the impact of CS on hepatic morbidity.Figure 1.: This forrest plot reflects that platelet count increases with corticosteroid administration in patients with HELLP syndrome.

P4988Beta-blockers in diabetes with stable coronary heart disease - a cause for concern?

Abstract Background Beta-blocker (BB) therapy is a cornerstone for the treatment of coronary heart disease (CHD). The evidence of the benefit from long-term BB therapy in diabetic patients with stable CHD is scarce. This meta-analysis summarises the evidence relating to the BB therapy in diabetic patients with stable CHD. Methods A meta-analysis was performed according to PRISMA and MOOSE guidelines for reporting of systematic reviews of observational studies. PubMed, Embase, and Cochrane central were searched and two authors independently screened studies for eligibility. The quality of studies was assessed with the Newcastle Ottawa scale. The primary outcome of interest was all-cause mortality, cardiovascular (CV) mortality and major adverse cardiovascular events (MACE) in diabetic patients with and without BB therapy. A generic inverse variance model was used to pool the odds ratio or hazards ratio from included studies to calculate the overall effect estimate. The significance threshold was set at p-value &lt;0.05. Heterogeneity was assessed by I2. Results Four non-randomized studies with 9,515 participants were selected for the analyses. Four studies were post-hoc analyses of randomised controlled trials, and 1 article was an analysis of a nationally representative survey. In a fixed effects model, BB therapy in diabetic patients with stable CHD was found to be associated with increased risk of CV mortality, and MACE (27%, and 32% respectively; p-value &lt;0.05) and was not associated with a reduction in all-cause mortality (HR 1.12; 95% CI 0.94–1.33; p-value =0.22). Conclusion BB therapy in diabetic patients with stable CHD appears to be linked to higher mortality. Large randomised trials are needed in this population to confirm these findings. Acknowledgement/Funding None

Effect of β-blocker therapy in diabetic patients with stable coronary heart disease: a meta-analysis.

Backgroundβ-blocker (BB) therapy is a cornerstone for the treatment of coronary heart disease (CHD). The evidence of the benefit from long-term BB therapy in diabetic patients with stable CHD is scarce. This meta-analysis summarizes the evidence relating to the BB therapy in diabetic patients with stable CHD.MethodsA meta-analysis was performed according to PRISMA and MOOSE guidelines for reporting of systematic reviews of observational studies. PubMed, Embase, and Cochrane central were searched and two authors independently screened studies for eligibility. The quality of studies was assessed with the Newcastle Ottawa scale. The primary outcome of interest was all-cause mortality, cardiovascular (CV) mortality and major adverse cardiovascular events (MACE) in diabetic patients with and without BB therapy. A generic inverse variance model was used to pool odds ratio or hazards ratio from included studies to calculate the overall effect estimate. The significance threshold was set at P-value < 0.05. Heterogeneity was assessed by I2.ResultsFour non-randomized studies with 9515 participants were selected for the analyses. Four studies were post-hoc analyses of randomized controlled trials, and one article was an analysis of a nationally representative survey. In a fixed effects model, BB therapy in diabetic patients with stable CHD was found to be associated with increased risk of CV mortality, and MACE (27% and 32% respectively; P-value < 0.05) and was not associated with a reduction in all-cause mortality (HR 1.12; 95% CI: 0.94–1.33; P-value = 0.22).ConclusionBB therapy in diabetic patients with stable CHD appears to be linked to higher mortality. Large randomized trials are needed in this population to confirm these findings.

Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis

We aimed to assess the impact of timing of surgery in elderly patients with acute hip fracture on morbidity and mortality. We systematically searched MEDLINE, the Cochrane Library, Embase, PubMed, and trial registries from 01/1997 to 05/2017, as well as reference lists of relevant reviews, archives of orthopaedic conferences, and contacted experts. Eligible studies had to be randomised controlled trials (RCTs) or prospective cohort studies, including patients 60 years or older with acute hip fracture. Two authors independently assessed study eligibility, abstracted data, and critically appraised study quality. We conducted meta-analyses using the generic inverse variance model. We included 28 prospective observational studies reporting data of 31,242 patients. Patients operated on within 48 hours had a 20% lower risk of dying within 12 months (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.66–0.97). No statistical significant different mortality risk was observed when comparing patients operated on within or after 24 hours (RR 0.82, 95% CI 0.67–1.01). Adjusted data demonstrated fewer complications (8% vs. 17%) in patients who had early surgery, and increasing risk for pressure ulcers with increased time of delay in another study. Early hip surgery within 48 hours was associated with lower mortality risk and fewer perioperative complications.

Abstract 10819: Prognostic Value of Coronary Artery Calcium Score in Acute Chest Pain Patients Without Known Coronary Artery Disease in Emergency Department: Systematic Review and Meta-analysis

Backgrounds: Role of coronary artery calcium score (CACS) in acute chest pain patients is currently not well defined. The objective of this study was to investigate the prognostic value of CACS obtained by noncontrast electrocardiogram-gated CT in acute chest pain patients suspected for cardiac origin in emergency department. Methods: We search Pubmed, Embase, Cochrane databases for longitudinal studies of CACS in acute chest pain patients without known coronary artery disease (CAD) in emergency department which reported major adverse cardiovascular events (MACE), consisting of death, nonfatal myocardial infarction (NFMI), revascularization or stroke. Pooled annualized event rate, risk ratios and 95% confidence intervals (CI) were analyzed. A random-effect, generic inverse variance model was used. Result: Eight studies evaluated 3556 patients (mean age = 51 years, 47% men) with the pooled prevalence of hypertension, diabetes mellitus, dyslipidemia and smoking of 42%, 16%, 33% and 33% respectively. During a median follow-up of 5 months (range 1-60 months, 37234 patient-months), the overall pooled MACE rate was 7.6%/y. The pooled event rate of MACE for CACS=0 versus CACS&gt;0 was 0.8%/y (13 events in 18874 patient-months) versus 14.6%/y (224 events in 18360 patient-months). The pooled risk ratio with CACS=0 was 0.04 (95% CI: 0.02-0.07, p&lt;0.001) for MACE compared to CACS&gt;0. The sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio of CACS for MACE was 94.5%, 64.1%, 15.8%, 99.4%, 2.63 and 0.09 respectively. The heterogeneity among studies was low with an I 2 of 13%. Conclusion: In acute-chest-pain patients without known CAD presenting to emergency department, MACE was rare in those with CACS=0. Zero CACS by noncontrast electrocardiogram-gated CT in this population has high negative predictive value (&gt;99%) for subsequent cardiac events.

Autoimmune disease in people with multiple sclerosis and their relatives: a systematic review and meta-analysis

Additional autoimmune diseases in people with multiple sclerosis (MS) and their relatives have been studied many times. Studies have employed different designs, and yielded conflicting results. We performed a systematic review, and calculated overall risk of additional autoimmune diseases in people with MS and their first-degree relatives. PubMed and Web of Science were searched. Thyroid disease, diabetes, inflammatory bowel disease, psoriasis, rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) were studied. A generic inverse variance model was used, and subgroup analysis was used to explore heterogeneity. The OR of thyroid disease was increased in both people with MS (OR 1.66; p < 0.00001) and their relatives (OR 2.38; p < 0.00001). A similar association was seen between MS and inflammatory bowel disease (OR 1.56; p < 0.0001) and psoriasis (OR 1.31; p < 0.0001), although not in relatives. There was no increase in the rate of either SLE or RA. Studies examining diabetes showed significant heterogeneity and evidence of publication bias. There is an increase in the rate of certain autoimmune diseases in people with MS and their first-degree relatives. However, this does not extend to all conditions studied. Given the nonspecific clinical presentation of thyroid disease, it should be considered in all people with MS presenting with nonspecific symptoms.

Meta analysis on the co-infection between Mycobacterium tuberculosis and HIV/AIDS in China

To understand and estimate the rate of co-infection between Mycobacterium tuberculosis (M. tuberculosis) and the human immunodeficiency virus (HIV). Based on the related literature regarding Chinese M. tuberculosis and HIV co-infection being published between 2000 and 2012 in PubMed, China National Knowledge Infrastructure (CNKI), Wan Fang Databases and the Chinese Science & Technology Journal Database (VIP), we extracted related information and applied the generic inverse variance model to estimate the following parameters as: co-infection rate, differences on gender, region and subgroups. We also used the STROBE Statement and observational quality evaluation standard to evaluate the quality of literature, and employed sensitivity analyses to evaluate the impact of research quality. 39 papers were included in this Meta-analysis, which contained a total sample size of 168 286. The co-infection rate of HIV in TB patients was 0.86% (95%CI: 0.80% - 0.93%), when using the generic inverse variance model. According to subgroups analyses, at α = 0.05 level, men had a higher co-infection rate (1.53%) than women (0.54%) and areas with high infection rate of HIV/AIDS (0.91%) were more commonly seen than low infection rate areas of HIV/AIDS (0.71%) and with significant differences. The co-infection rate of M. tuberculosis in patients infected with HIV was 14.44% (95%CI: 13.62% - 15.30%). Data from subgroup analyses also showed that at the α = 0.05 level, the co-infection rates from hospital samples (28.64%) were higher than those from the population samples' (4.74%). The co-infection rate (15.79%) from the western region was higher than that in the Central and Eastern regions (13.88% and 6.47% respectively), with significant differences. After excluding the papers that only met a few items of the STRODE Statement, results of the Meta-analysis were very close to the original results. The co-infection rate of both M. tuberculosis and HIV was high in China. Therefore, it was crucial for people and related organizations to pay more attention to this problem of co-infection.

Fish and Marine Omega-3 Polyunsatured Fatty Acid Consumption and Incidence of Type 2 Diabetes: A Systematic Review and Meta-Analysis

Objective. To examine the association between fish and marine long-chain omega-3 polyunsaturated fatty acid (LC n-3 PUFA) consumption and incidence of type 2 diabetes (T2D) in prospective cohort studies. Methods. Meta-analytic procedures were used to estimate the relative risk (RR) using random effects or fixed effects generic inverse variance model. Publication bias and study heterogeneity were assessed using Egger's test and I2 statistic. Results. We found no significant association between the intake of fish/seafood (pooled RR: 1.04; P = 0.63, 95% CI: 0.9 to 1.2, 549, 955 participants) or marine LC n-3 PUFA (pooled RR: 1.08, P = 0.39, 95% CI: 0.90 to 1.30, 346, 710 participants) and T2D risk. Significant study heterogeneity was observed in fish/seafood and marine LC n-3 PUFA studies (P < 0.00001). Subgroup analysis revealed no obvious sources for high heterogeneity. We also found a significant protective effect of oily fish intake on T2D risk (pooled RR = 0.89, P = 0.005, 95% CI: 0.82 to 0.96). Dose-response analysis suggested that every 80 g per day intake of oily fish may reduce 20% risk of T2D. Conclusion. We found no significant effect of fish/seafood or marine LC n-3 PUFA intake on risk of T2D but a significant effect of oily fish intake on risk of T2D.