scholarly journals New Evidence of Potential Benefits of Dexamethasone and Added on Therapy of Fludrocortisone on Clinical Outcomes of Corticosteroid in Sepsis Patients: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 (6) ◽  
pp. 544
Author(s):  
Ji-young Son ◽  
Sooyoung Shin ◽  
Yeo Jin Choi
Keyword(s):  
Adverse Events ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Substantial Reduction ◽  
Corticosteroid Treatment ◽  
Subgroup Analyses ◽  
Potential Benefits ◽  
Reduction Of Mortality ◽  
New Evidence ◽  
Keyword Searches

The aim of this study is to investigate clinical outcomes of corticosteroid treatment in patients with sepsis or septic shock. An electronic keyword searches of PubMed, EMBASE, and Google Scholar were conducted per PRISMA guidelines. The pooled analyses on the corticosteroid impact on mortality, adverse events, and clinical outcomes were performed. Subgroup analyses on the clinical outcomes in relation to corticosteroid dose, duration, and agents were performed. Pooled analyses of 21 randomized control trials revealed substantially reduced mortality (RR 0.93, 95% CI 0.88–0.99, p = 0.02) and length of stay in intensive care unit (SMD −1.66, 95% CI −1.91–−1.40, p < 0.00001) without increased risks of adverse events (RR 1.04, 95% CI 0.96–1.12, p = 0.38). No significant improvements of other clinical outcomes were observed. Subgroup analyses demonstrated substantially reduced mortality with short-term (≤7 days) low-dose (<400 mg/day) corticosteroid treatment (RR 0.91, 95% CI 0.87–0.95, p < 0.0001). Moreover, dexamethasone (RR 0.40, 95% CI 0.20–0.81, p = 0.01) and combined hydrocortisone and fludrocortisone treatment (RR 0.89, 95% CI 0.84–0.94, p < 0.00001) provided substantial reduction of mortality whereas hydrocortisone alone did not reduce the mortality risk in sepsis patients. Thus, further controlled studies on the clinical outcomes of potential corticosteroid options on sepsis-related clinical outcomes are warranted.

scholarly journals Verification of the Efficacy and Safety of Qi-Replenishing Chinese Medicine in Treating Prediabetes: A Meta-Analysis and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-15
Author(s):  
Shujie Xia ◽  
Bizhen Gao ◽  
Shujiao Chen ◽  
Xuejuan Lin ◽  
Ping Zhang ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Blood Glucose ◽  
Chinese Medicine ◽  
Adverse Events ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Postprandial Blood Glucose ◽  
Syndrome Differentiation ◽  
Efficacy And Safety ◽  
Subgroup Analyses

Background. Qi-replenishing Chinese medicines (QCMs) are used for treating prediabetes in the traditional Chinese medicine (TCM) clinical practice. The aims of this meta-analysis were to (i) verify the efficacy and safety of QCMs in treating prediabetes and (ii) investigate the clinical outcomes between the trials complying with and not complying with the principle of “syndrome differentiation.” Methods. We included only randomized controlled clinical trials (RCTs) whose Jadad scores were not less than 4. The overall clinical outcomes, including the incidence rate of diabetes, normalization of blood glucose, changes in fasting blood glucose (FBG), 2 h postprandial blood glucose, HbA1c, and occurrence of adverse events, were evaluated. Subgroup analyses were performed. Results. A total of 11 RCTs that enrolled 2210 patients with prediabetes were included. We observed that overall treatment with QCMs significantly ameliorated the clinical outcomes of prediabetes without increasing incidence of adverse events. The results of subgroup analyses revealed that prescribing QCMs complying with syndrome differentiation ameliorated all the clinical indices, whereas prescribing not complying with syndrome differentiation could not achieve significant amelioration in FBG and HbA1c levels. Furthermore, the subgroup with syndrome differentiation reported more adverse events. Conclusions. The overall results suggested that QCMs are effective and safe in treating prediabetes. Results of subgroup analyses indicated that the groups with syndrome differentiation presented better efficacy but had a higher occurrence of adverse events. This study indicated the important role of the principle of syndrome differentiation in TCM and that the adverse events of QCMs cannot be ignored in TCM clinical practice.

scholarly journals Clinical outcomes and prognostic factors in bloodstream infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae among patients with malignancy: a meta-analysis

2020 ◽  
Author(s):  
Ai-Min Jiang ◽  
Na Liu ◽  
Rui Zhao ◽  
Hao-Ran Zheng ◽  
Xue Chen ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Clinical Outcomes ◽  
Hematological Malignancy ◽  
Meta Analysis ◽  
Bloodstream Infections ◽  
Icu Admission ◽  
Predictors Of Mortality ◽  
Oncological Patients ◽  
Subgroup Analyses

Abstract Background The colonization of Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) in bloodstream infections (BSIs) has been increased dramatically worldwide, and it was associated with worse clinical outcomes in patients with malignancy. We performed the meta-analysis to investigate the prognosis and risk factors in BSIs caused by ESBL-PE in oncological patients. Methods PubMed and EMBASE were searched for related studies. All-cause mortality was considered as the primary outcome. Subgroup analyses, meta-regression analyses, and sensitivity analysis were used to investigate heterogeneity and reliability in results. Results 6729 patients from 25 studies were eligible. Six studies enrolled oncological patients with BSIs caused by ESBL-PE only, while 19 studies both enrolled ESBL-PE and non-ESBL-PE infections. The results showed that BSIs caused by ESBL-PE in patients with malignancy was associated with higher mortality than non-ESBL-PE infections (RR = 2.21, 95% CI: 1.60–3.06, P < 0.001), with a significant between-study heterogeneity (I2 = 78.3%, P < 0.001). Subgroup analyses showed that children (RR = 2.80, 95% CI: 2.29–3.43, P < 0.001) and hematological malignancy (RR =3.20, 95% CI: 2.54–4.03, P < 0.001) were associated with a higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality. Conclusions Our study identified that BSIs caused by ESBL-PE in patients with malignancy was associated with worse clinical outcomes compared with non-ESBL-PE infections. Furthermore, children and hematological malignancy were associated with higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality.

scholarly journals Correlation between immune-related adverse events and the efficacy of PD-1/PD-L1 inhibitors in the treatment of non-small cell lung cancer: systematic review and meta-analysis

2021 ◽  
Author(s):  
Qian Zhang ◽  
Wei Wang ◽  
Qi Yuan ◽  
Li Li ◽  
Yu-Chao Wang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cell Death ◽  
Programmed Cell Death ◽  
Adverse Events ◽  
Small Cell Lung Cancer ◽  
Meta Analysis ◽  
Small Cell ◽  
Low Grade ◽  
Small Cell Lung ◽  
Subgroup Analyses

Abstract Objective Anti-programmed cell death-1 and programmed cell death ligand-1 (PD-1/PD-L1) inhibitors have been proved to have a significant clinical efficacy in the treatment of non-small cell lung cancer (NSCLC). Many studies have demonstrated that immune-related adverse events (irAEs) are significantly correlated with clinical efficacy, but the results are not consistent. This meta-analysis aimed to evaluate the associations between irAEs and efficacy. Methods Comprehensive searches were conducted on PubMed and EMBASE database. The HR and 95% CI were used to assess the associations between immune-related adverse events and efficacy of overall survival and progression-free survival. Subgroup analyses were performed based on irAEs type and grade of irAEs. Heterogeneity and publication bias were also assessed by Q test, I2, and funnel plot. Results Compared with non-irAEs, the development of irAEs was significantly improved PFS and OS (PFS: HR = 0.55, 95% CI = 0.51–0.60, p < 0.001; OS: HR = 0.74, 95% CI = 0.68–0.81, p < 0.001). In the subgroup analyses, the occurrence of endocrine irAEs, gastrointestinal irAEs, skin lesions and low-grade irAEs was also significantly correlated with the efficacy. Additionally, the association between severe-grade irAEs and survival benefits on PFS was significant, but not on OS. Conclusions The results indicated that the occurrence of irAEs was significantly associated with a better efficacy in the treatment of NSCLC, especially endocrine, gastrointestinal, skin and low-grade irAEs.

FOLFOXIRI/bevacizumab (bev) versus doublets/bev as initial therapy of unresectable metastatic colorectal cancer (mCRC): A meta-analysis of individual patient data (IPD) from five randomized trials.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4015-4015 ◽  
Author(s):  
Chiara Cremolini ◽  
Carlotta Antoniotti ◽  
Alexander Stein ◽  
Johanna C. Bendell ◽  
Thomas Gruenberger ◽  
...  
Keyword(s):  
Adverse Events ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Objective Response ◽  
Initial Therapy ◽  
R0 Resection ◽  
Significant Heterogeneity ◽  
Resection Rate ◽  
Significant Interaction Effect ◽  
Subgroup Analyses

4015 Background: Several randomized trials demonstrated that intensifying the upfront chemotherapy in combination with bev is beneficial for mCRC patients with an increased incidence of some adverse events. All trials had primary endpoints other than OS, and a proper estimation of the magnitude of the OS benefit from FOLFOXIRI/bev versus doublets (FOLFIRI or FOLFOX)/bev is currently lacking. Within each trial, subgroup analyses failed to identify predictors of benefit from the intensified therapy. To test OS with higher power compared to single trials, and to explore interaction of treatment effect with main patients’ and disease characteristics, we performed an IPD meta-analysis. Methods: IPD were collected from 5 randomized trials: CHARTA (NCT01321957), OLIVIA (NCT00778102), STEAM (NCT01765582, only combined FOLFOXIRI/bev and FOLFOX/bev arms), TRIBE (NCT00719797) and TRIBE2 (NCT02339116). Primary endpoint was OS. Secondary endpoints included PFS, objective response rate (ORR), R0 resection rate, G3/4 adverse events, and subgroup analyses. All statistical analyses were by intention-to-treat, stratified by trial. Results: 1697 pts randomized to FOLFOXIRI/bev (N=846) or doublets/bev (N=851) were included. Among pts in the doublets/bev group, 595 (70%) received FOLFOX/bev and 256 (30%) FOLFIRI/bev. At a median follow up of 39.9 mos, pts assigned to FOLFOXIRI/bev reported significantly longer OS than those assigned to doublets/bev (median OS 28.9 vs 24.5 months; HR 0.81 [95%CI 0.72-0.91], p<0.001), with no significant heterogeneity among trials (p=0.39; I2=2%). The estimated 5-yr OS was 22.3% vs 10.7% (p<0.001). No significant interaction effect between treatment arm and OS was demonstrated in terms of metastatic spread (liver-limited vs. not liver-limited p=0.665), primary side (p=0.656), and RAS/BRAF status (p=0.337). Pts assigned to FOLFOXIRI/bev achieved longer PFS (median PFS 12.2 vs 9.9 months; HR 0.74 [95%CI 0.67-0.82], p<0.001), higher ORR (64.5% vs 53.6%, p<0.001), higher R0 resection rate (16.4% vs 11.8%, p=0.007), and experienced higher rates of G3/4 neutropenia (p<0.001), febrile neutropenia (p=0.019), mucositis (p=0.024), nausea (p=0.016), and diarrhea (p<0.001). Conclusions: FOLFOXIRI/bev determines a clinically and statistically significant improvement of mCRC patients’ OS vs doublets/bev with a meaningful effect also on 5-yr OS, PFS, ORR and R0 resection rate. No significant heterogeneity among explored subgroups was found.

Checkpoint inhibitor-associated immune-related adverse events as harbinger of favorable clinical outcome: Systematic review and meta-analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e15129-e15129
Author(s):  
Robin Park ◽  
Laércio Lopes da Silva ◽  
Anwaar Saeed
Keyword(s):  
Adverse Events ◽  
Clinical Outcomes ◽  
Checkpoint Inhibitors ◽  
Metastatic Cancer ◽  
Meta Analysis ◽  
Area Under The Curve ◽  
Final Analysis ◽  
Receiver Operating Curve ◽  
Predictive Values ◽  
Favorable Clinical Outcome

e15129 Background: Recent studies have observed an association between immune-related adverse events (irAE) and favorable clinical outcomes in the setting of cancer treatment with immune checkpoint inhibitors (ICI). However, results have been variable and inconclusive. Therefore, we have conducted a pan-cancer meta-analysis evaluating the relationship between irAEs and clinical outcomes. Methods: The search included PubMed, Embase, and Web of Science from conception to 12.28.2019 as well as abstracts published in the ASCO and ESMO meetings from 2015 to 2019. Studies were included if ICI was used in advanced or metastatic cancer settings and excluded if data contained only combination therapy regimens or contained anti-CTLA-4. Pooled sensitivity (SN), specificity (SP), positive (PPV) and negative predictive values (NPV), and odds ratios (ORs) were calculated using the 2 x 2 table and logit transformed proportions; and summary receiver operating curve (sROC) was generated using the bivariate approach for ORR. Pooled HRs were calculated using the means weighted by inverse of the variance for OS and PFS. Heterogeneity was assumed and random effects model was used throughout analyses. Results: Final analysis included 32 studies encompassing non-small cell lung cancer, melanoma, gastric cancer, renal cell carcinoma, urothelial carcinoma, and head and neck cancer. With respect to ORR, pooled SN, SP, PPV and NPV, and OR were 0.522 [0.423-0.619], 0.810 [0.771-0.844], 0.516 [0.413-0.618], 0.819 [0.764-0.864], and 4.59 [3.24-6.50] respectively. The area under the curve (AUC) derived from the sROC was 0.773. HR for OS and PFS were 0.47 [95% CI 0.37-0.60] and 0.46 [95% CI 0.37-0.56] respectively. Between-study publication bias was present for ORR, OS, and PFS but results remained significant after trim-fill analysis. Conclusions: irAEs predict OR, OS, and PFS across different types of cancer and may represent useful biomarkers in the clinical setting. [Table: see text]

Effect of mediterranean diets on cardiovascular risk factors and diseases in the primary prevention setting: a systematic review and meta-analysis of randomized controlled trials

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.V Hernandez ◽  
A Piscoya ◽  
K.M Marti ◽  
K.E Marti ◽  
V Pasupuleti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Primary Prevention ◽  
Randomized Controlled Trials ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Obese Patients ◽  
Randomized Controlled ◽  
Subgroup Analyses

Abstract Background The effects of Mediterranean diets (MED) on various health parameters suggest potential cardiovascular (CV) health benefits. Purpose We evaluated the effects of MED for primary prevention of CV risk factors and disease in overweight or obese adults. Methods A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed using PRISMA guidelines. PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, clinicaltrials.gov, and clinicaltrialsregister.eu were searched until January 2020. RCTs evaluating any type of MED compared to other diets or advice in adults were included. Predefined CV risk factors were lipid, liver, glucose, anthropometric, and blood pressure outcomes. Clinical outcomes were all cause mortality, CV mortality, myocardial infarction (MI), coronary artery disease, stroke, cerebrovascular disease, and diabetes. Meta-analyses of random effects models were performed and effects were described as mean difference (MD) and their 95% confidence intervals (CI). Subgroup analyses by weight, type of MED, type of control, and trial duration were performed when heterogeneity was high (I2&gt;60%). Results Eighteen RCTs (n=915) were included. Two RCTs evaluated only obese patients, 13 evaluated overweight and obese patients, and three did not specify. Fifteen RCTs evaluated MED alone while three evaluated MED combined with another diet. Thirteen RCTs evaluated effects of another diet while five evaluated diet advice or no treatment as controls. The median time to follow up was 6 months (range 6 weeks to 24 months). Clinical outcomes were only described in the revised 2018 PREDIMED trial where MED were associated with 35% lower risk of MI, stroke, and CV death vs advice (HR 0.65, 95% CI 0.50 to 0.85). MED were significantly associated with lower levels of triglycerides (TG) (MD −12.70 mg/dL, 95% CI −18.58 to −6.82), waist circumference (WC) (MD −1.92 cm, 95% CI −3.59 to −0.24), weight (MD −1.75 kg, 95% CI −2.82 to −0.69), and body mass index (BMI) (MD −0.69 kg/m2, 95% CI −1.11 to −0.27), and higher levels of HDL (MD 2.03 mg/dL, 95% CI 1.13 to 2.92) compared to other diets or advice. MED did not significantly change any other CV risk factors. Subgroup analyses showed some differences vs main analyses, but were based on a small set of RCTs in most of cases. Excluding five high risk of bias RCTs showed significant reductions in total cholesterol (MD −6.57 mg/dL, 95% CI −12.22 to −0.93), Fatty Liver Index (MD −23.30, 95% CI −30.20 to −16.40), HOMA-IR (MD −0.53, 95% CI −1.02 to −0.05), and SBP (MD −2.35 mmHg, 95% CI −4.02 to −0.68). Conclusion MED significantly decreased TG and anthropometric outcomes, and increased HDL when compared to other diets or advice. There was no significant association between MED and the other predefined CV risk factors. Newer RCTs without the flaws of PREDIMED are needed to further evaluate clinical outcomes. Funding Acknowledgement Type of funding source: None

scholarly journals Efficacy and Safety of Mesenchymal Stem Cells in Treatment of Complex Perianal Fistulas: A Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Fang Cheng ◽  
Zhong Huang ◽  
Zhi Li
Keyword(s):  
Adverse Events ◽  
Fibrin Glue ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Perianal Fistula ◽  
Control Group ◽  
Efficacy And Safety ◽  
Pelvic Magnetic Resonance Imaging ◽  
Perianal Fistulas ◽  
Subgroup Analyses

Complex perianal fistula is a highly debilitating and difficult to treat condition. Local mesenchymal stem cell (MSC) therapy for perianal fistula has shown considerable promise but still remains controversial. Therefore, we performed the meta-analysis to evaluate the efficacy and safety of local MSC therapy for complex perianal fistula. PubMed and Embase databases were searched for published randomized clinical trials (RCTs) that reported local MSC therapy for complex perianal fistulas. The effectiveness and safety data analysis was conducted using RevMan5.3. Subgroup analyses were performed based on the characteristics of the studies. Seven RCTs with 730 participants were included. Local MSC treatment showed significantly higher healing rate (HR) of perianal fistulas compared to control (odds ratio (OR) = 2.03; 95% confidence interval (CI) 1.50, 2.74; P < 0.00001 ). MSCs combined with fibrin glue therapy can improve the HR compared with fibrin glue alone ( OR = 3.27 ; 95% CI 1.15, 9.28; P = 0.03 ). Subgroup analyses showed that local therapy can improve the HR in patients with perianal fistulas associated with Crohn’s disease (CD) ( OR = 2.05 ; 95% CI 1.41, 3.00; P = 0.0002 ) and cryptoglandular origin (no-Crohn) ( OR = 2.98 ; 95% CI 0.86, 10.29; P = 0.08 ). The pooled OR for studies that combined reepithelialization of the external opening with pelvic magnetic resonance imaging (MRI) to evaluate the healing of fistulas was 1.77 (95% CI 1.28, 2.45; P = 0.0006 ). The pooled OR for studies where fistula healing was defined as complete reepithelialization of external openings was 5.92 (95% CI 1.34, 26.15; P = 0.02 ). Both autologous MSCs ( OR = 3.19 ; 95% CI 1.05, 9.65; P = 0.04 ) and allogeneic MSCs ( OR = 1.97 ; 95% CI 1.34, 2.91; P = 0.0006 ) can obtain higher HR for perianal fistula compared with control. The adipose-derived MSC group can obtain higher HR than the control group ( OR = 2.29 ; 95% CI 1.38, 3.79; P = 0.001 ). There were no significant differences in adverse events (AEs) ( OR = 1.06 ; 95% CI 0.71, 1.59; P = 0.77 ). None of the adverse events was judged to be related to MSCs. Our study supported that local MSC therapy alone or combined with fibrin glue is safe and efficacious for complex perianal fistula. In the future, more RCTs are needed to confirm this conclusion.

scholarly journals The Association between Influenza Vaccination and COVID-19 and Its Outcomes: A Systematic Review and Meta-Analysis of Observational Studies

Vaccines ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 529
Author(s):  
Ruitong Wang ◽  
Min Liu ◽  
Jue Liu
Keyword(s):  
Influenza Vaccination ◽  
Clinical Outcomes ◽  
Lower Risk ◽  
Observational Studies ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Policy Makers ◽  
Subgroup Analyses ◽  
Funnel Plots

Influenza could circulate in parallel with COVID-19. In the context of COVID-19, some studies observed inverse associations between influenza vaccination and SARS-CoV-2 infection and clinical outcomes, while others did not. We conducted a meta-analysis to assess the association between influenza vaccination and SARS-CoV-2 infection and clinical outcomes, aiming to provide evidence for COVID-19 prevention and vaccination promotion. We searched four databases from inception to 10 March, 2021. Random effects and fixed effects models were used to pool odds ratios (ORs) and adjusted estimates with 95% confidence intervals (CIs). We used funnel plots to evaluate the publication bias, I2 statistics to evaluate the heterogeneity, and conducted subgroup analyses. Sixteen observational studies involving 290,327 participants were included. Influenza vaccination was associated with a lower risk of SARS-CoV-2 infection (pooled adjusted OR: 0.86, 95%CI: 0.81–0.91), while not significantly associated with adverse outcomes (intensive care: adjusted OR 0.63, 95%CI: 0.22–1.81; hospitalization: adjusted OR 0.74, 95%CI: 0.51–1.06; mortality: adjusted OR 0.89, 95%CI: 0.73–1.09). Our findings suggest that influenza vaccination is associated with a lower risk of SARS-CoV-2 infection. It is crucial for policy makers to implement strategies on influenza vaccination, for it may also have benefits for COVID-19 prevention.

scholarly journals Immune-Related Adverse Events Associated With Outcomes in Patients With NSCLC Treated With Anti-PD-1 Inhibitors: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Zhe Zhao ◽  
Xinfeng Wang ◽  
Jinghan Qu ◽  
Wei Zuo ◽  
Yan Tang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Objective Response ◽  
Progression Free Survival ◽  
Predictive Biomarker ◽  
Pooled Analysis ◽  
Conclusive Evidence ◽  
Risk Of Death

Background and ObjectiveAlthough anti-programmed cell death protein 1 (PD-1) antibodies have exerted remarkable anticancer activity in non-small cell lung cancer (NSCLC), it remains a challenge to identify patients who can benefit from these treatments. Immune-related adverse events (irAEs) may be associated with improved clinical outcomes after immune checkpoint inhibition. However, no conclusive evidence of this correlation has been summarized in patients with NSCLC receiving PD-1 inhibitors. We performed a systematic review and meta-analysis to evaluate the association between irAEs induced by anti-PD-1 antibodies and clinical outcomes in patients with NSCLC.MethodsVarious databases were searched from their inception to January 9, 2021, followed by screening of eligible studies. Hazard ratios were used for the pooled analysis of overall survival (OS) and progression-free survival (PFS), while odds ratios (ORs) were utilized to pool objective response rates (ORRs) and disease control rates (DCRs). A random-effects model was applied to all analyses.ResultsA total of 26 cohorts, including 8,452 patients with NSCLC receiving anti-PD-1 antibodies, were enrolled in the study. Significantly improved OS (HR: 0.51; 95% CI: 0.44-0.60; P &lt; 0.01) and PFS (HR: 0.50; 95% CI: 0.43-0.58; P &lt; 0.01) were found to be correlated with irAEs. In addition, patients with NSCLC who developed irAEs after PD-1 inhibition demonstrated better responses to therapies, confirmed by pooled ORs of ORRs (OR: 3.41; 95% CI: 2.66-4.35; P &lt; 0.01) and DCRs (OR: 4.08; 95% CI: 2.30-7.24; P &lt; 0.01). Furthermore, subgroup analysis suggested that both skin and endocrine irAEs are closely correlated with a reduced risk of death, whereas pulmonary irAEs showed no association with longer OS.ConclusionsIn patients with NSCLC treated with anti-PD-1 therapies, the presence of irAEs was strongly correlated with better survival and response, suggesting its potential role as a predictive biomarker for outcomes after PD-1 inhibition.

scholarly journals Clinical outcomes and prognostic factors in bloodstream infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae among patients with malignancy: a meta-analysis

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Ai-Min Jiang ◽  
Na Liu ◽  
Rui Zhao ◽  
Hao-Ran Zheng ◽  
Xue Chen ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Clinical Outcomes ◽  
Hematological Malignancy ◽  
Meta Analysis ◽  
Bloodstream Infections ◽  
Icu Admission ◽  
Predictors Of Mortality ◽  
Oncological Patients ◽  
Subgroup Analyses

Abstract Background The colonization of Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) in bloodstream infections (BSIs) has been increased dramatically worldwide, and it was associated with worse clinical outcomes in patients with malignancy. We performed the meta-analysis to investigate the prognosis and risk factors in BSIs caused by ESBL-PE in oncological patients. Methods PubMed, EMBASE, and Cochrane Library were searched for related studies. All-cause mortality was considered as the primary outcome. Subgroup analyses, meta-regression analyses, and sensitivity analysis were used to investigate heterogeneity and reliability in results. Results 6,729 patients from 25 studies were eligible. Six studies enrolled oncological patients with BSIs caused by ESBL-PE only, while 19 studies both enrolled ESBL-PE and non-ESBL-PE infections. The results showed that BSIs caused by ESBL-PE in patients with malignancy was associated with higher mortality than non-ESBL-PE infections (RR = 2.21, 95% CI: 1.60–3.06, P < 0.001), with a significant between-study heterogeneity (I2 =78.3%, P < 0.001). Subgroup analyses showed that children (RR = 2.80, 95% CI: 2.29–3.43, P < 0.001) and hematological malignancy (RR = 3.20, 95% CI: 2.54–4.03, P < 0.001) were associated with a higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality. Conclusions Our study identified that BSIs caused by ESBL-PE in patients with malignancy were associated with worse clinical outcomes compared with non-ESBL-PE infections. Furthermore, children and hematological malignancy were associated with higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality.

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