ABSTRACT
OBJECTIVE: To investigate risk factors for mortality in dengue. METHODS: We performed a systematic review and meta-analysis searching MEDLINE, Embase, SciELO, LILACS Bireme, and OpenGrey databases to identify eligible observational studies of patients with dengue, of both genders, aged 14 years or older, that analysed risk factors associated with mortality and reported adjusted risk measures with their respective confidence intervals (CIs). We estimated the pooled weighted mean difference and 95% CIs with a DerSimonian and Laird random-effects model. We assessed the methodological quality using the Newcastle-Ottawa Scale. RESULTS: Of 1,170 citations reviewed, 18 papers, with a total of 25,851 patients, were included in the systematic review and 12 in the meta-analysis. Severe hepatitis (OR 29.222, 95% CI 3.876-220.314), dengue shock syndrome (OR 23.575, 95% CI 3.664-151.702), altered mental status (OR 3.76, 95% CI 1.67-8.42), diabetes mellitus (OR 3.698, 95% CI 1.196-11.433), and higher pulse rate (OR 1.039, 95% CI 1.011-1.067) are associated with mortality in patients with dengue. All studies included were classified as having a high quality. CONCLUSIONS: Proper identification and management of these risk factors should be considered to improve patient outcomes and reduce the hidden burden of this neglected tropical disease. Future well-designed studies are needed to investigate the association of other clinical, radiological, and laboratorial findings with mortality in dengue, as well as to develop prognostic models based on the risk factors found in our study.
Subject(s)
Dengue , Diabetes Mellitus , Female , Humans , Male , Risk FactorsABSTRACT
BACKGROUND: Few data are available on the use of spontaneous breathing trials (SBTs) in the neonatal population, despite advocacy of the practice in many neonatal ICUs. In this meta-analysis, we systematically reviewed the literature regarding the accuracy of SBTs as a predictor for extubation failure in premature infants. METHODS: Following the PRISMA recommendations, scientific articles were collected in December 2019 and January 2020 using PubMed, LILACS, Web of Science, Scopus, Google Scholar, OATD, and BDTD databases. The risk of bias in the studies included herein was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The pooled sensitivity and specificity of the studies were estimated using a mixed logistic regression model of 2 levels and a normal bivariate model. RESULTS: Six studies were included for qualitative and quantitative evaluation in this study. All SBTs were performed with endotracheal CPAP, with a total observation time of 3-5 min. The parameters for passing/failing the test were similar in 5 of the 6 studies and included bradycardia or desaturation during the test. The SBT showed a high pooled sensitivity (0.97, 95% CI 0.85-0.99), indicating proper identification of neonates "ready" for successful extubation. However, a low pooled specificity (0.40, 95% CI 0.24-0.58), with many false-positive cases, indicated inaccurate prediction of extubation failure. Heterogeneity of included studies was considerable for sensitivity and substantial for specificity. CONCLUSIONS: The SBT in premature infants can accurately predict extubation success but not extubation failure. Therefore, even though it is an attractive, practical, and easy-to-perform bedside assessment tool, there is a lack of evidence to support its use as an independent predictor of extubation failure in premature infants. Its routine use should be evaluated and monitored carefully.
Subject(s)
Infant, Premature , Ventilator Weaning , Airway Extubation , Humans , Infant , Infant, Newborn , Sensitivity and SpecificityABSTRACT
Abstract Objective: To identify, using a systematic review and meta-analysis of observational studies, which risk factors are significantly associated with neonatal mortality in Brazil, and to build a comprehensive national analysis on neonatal mortality. Sources: This review included observational studies on neonatal mortality, performed between 2000 and 2018 in Brazilian cities. The MEDLINE, Elsevier, Cochrane, LILACS, SciELO, and OpenGrey databases were used. For the qualitative analysis, the Newcastle-Ottawa Scale was used. For the quantitative analysis, the natural logarithms of the risk measures and their confidence intervals were used, as well as the DerSimonian and Laird method as a random effects model, and the Mantel-Haenszel model for heterogeneity estimation. A confidence level of 95% was considered. Summary of findings: The qualitative analysis resulted in six studies of low and four studies of intermediate-low bias risk. The following exposure factors were significant: absence of partner, maternal age ≥35 years, male gender, multiple gestation, inadequate and absent prenatal care, presence of complications during pregnancy, congenital malformation in the assessed pregnancy, Apgar < 7 at the fifth minute, low and very low birth weight, gestational age ≤ 37 weeks, and caesarean delivery. Conclusion: The most significant risk factors presented in this study are modifiable, allowing aiming at a real reduction in neonatal deaths, which remain high in the country.
Resumo: Objetivo: Identificar, através de uma revisão sistemática e da metanálise de estudos observacionais, quais fatores de risco associam-se significativamente com a mortalidade neonatal no Brasil e construir uma análise nacional abrangente sobre a mortalidade neonatal. Fontes: Foram avaliados os estudos observacionais sobre mortalidade neonatal realizados entre 2000 e 2018 em cidades brasileiras. Usaram-se as bases MEDLINE, Elsevier, Cochrane, LILACS, SciELO e OpenGrey. Para a análise qualitativa, foi usada a Escala Newcastle-Ottawa. Para a análise quantitativa, foram utilizados os logaritmos naturais das medidas de risco e de seus intervalos de confiança, o método de DerSimonian e Laird como modelo de efeitos aleatórios e o modelo de Mantel-Haenszel para estimativa da heterogeneidade. Considerou-se nível de confiança de 95%. Resumo dos achados: A análise qualitativa resultou em seis estudos de baixo e quatro estudos de intermediário-baixo risco de viés. Foram significativos os seguintes fatores de exposição: ausência de companheiro, idade materna ≥ 35 anos, sexo masculino, gestação múltipla, pré-natal inadequado e ausente, presença de intercorrências durante a gestação, de malformação congênita na gestação em estudo, Apgar < 7 no quinto minuto, baixo e muito baixo peso ao nascer, idade gestacional ≤ 37 semanas e parto cesariano. Conclusão: Os fatores de risco mais significativos apresentados neste estudo são modificáveis, o que possibilita almejar uma redução real das mortes neonatais, que ainda permanecem elevadas no país.
Subject(s)
Humans , Female , Pregnancy , Infant , Infant Mortality , Pregnancy Complications , Socioeconomic Factors , Brazil/epidemiology , Infant, Low Birth Weight , Infant, Premature , Risk Factors , Risk Assessment , Observational Studies as TopicSubject(s)
Humans , Male , Female , Child , Adolescent , Adult , Sound , Speech , Autism Spectrum Disorder , Acoustic Stimulation , HearingABSTRACT
OBJECTIVE: To identify, using a systematic review and meta-analysis of observational studies, which risk factors are significantly associated with neonatal mortality in Brazil, and to build a comprehensive national analysis on neonatal mortality. SOURCES: This review included observational studies on neonatal mortality, performed between 2000 and 2018 in Brazilian cities. The MEDLINE, Elsevier, Cochrane, LILACS, SciELO, and OpenGrey databases were used. For the qualitative analysis, the Newcastle-Ottawa Scale was used. For the quantitative analysis, the natural logarithms of the risk measures and their confidence intervals were used, as well as the DerSimonian and Laird method as a random effects model, and the Mantel-Haenszel model for heterogeneity estimation. A confidence level of 95% was considered. SUMMARY OF FINDINGS: The qualitative analysis resulted in six studies of low and four studies of intermediate-low bias risk. The following exposure factors were significant: absence of partner, maternal age ≥35 years, male gender, multiple gestation, inadequate and absent prenatal care, presence of complications during pregnancy, congenital malformation in the assessed pregnancy, Apgar<7 at the fifth minute, low and very low birth weight, gestational age≤37 weeks, and caesarean delivery. CONCLUSION: The most significant risk factors presented in this study are modifiable, allowing aiming at a real reduction in neonatal deaths, which remain high in the country.
