European journal of internal medicine
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Eur. J. Intern. Med. · Apr 2024
Meta AnalysisRisk of subclinical atherosclerosis in primary Sjogren's syndrome: A systematic review and meta-analysis.
Currently, the guidelines for prevention and management of atherosclerosis in patients with Sjogren's syndrome (SS) do not differentiate from those concerning the general population. ⋯ Patients with pSS have an increased risk of subclinical atherosclerosis compared to healthy population and thus possibly require early and disease-specific intervention. Further research is warranted for more accurate cardiovascular risk management in SS.
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Eur. J. Intern. Med. · Mar 2024
Meta AnalysisEarly prediction of ventilator-associated pneumonia with machine learning models: A systematic review and meta-analysis of prediction model performance✰.
Machine learning-based prediction models can catalog, classify, and correlate large amounts of multimodal data to aid clinicians at diagnostic, prognostic, and therapeutic levels. Early prediction of ventilator-associated pneumonia (VAP) may accelerate the diagnosis and guide preventive interventions. The performance of a variety of machine learning-based prediction models were analyzed among adults undergoing invasive mechanical ventilation. ⋯ A variety of the prediction models, prediction intervals, and prediction windows were identified to facilitate timely diagnosis. In addition, care-related risk factors susceptible for preventive interventions were identified. In future, there is a need for dynamic machine learning models using time-depended predictors in conjunction with feature importance of the models to predict real-time risk of VAP and related outcomes to optimize bundled care.
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Eur. J. Intern. Med. · Jan 2024
Meta AnalysisEfficacy and safety of direct oral anticoagulants vs vitamin K antagonists in patients with atrial fibrillation and end-stage renal disease on hemodialysis: A systematic review and meta-analysis.
The prevalence of atrial fibrillation (AF) in individuals with end-stage renal disease (ESRD) on chronic hemodialysis is increasing. The optimal anticoagulant choice in this population is unclear since these patients were excluded from the pivotal randomized controlled trials (RCTs) of direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs) in the general AF population. We aimed to assess the efficacy and safety of DOACs vs. VKAs in patients with AF and ESRD on chronic hemodialysis through a systematic review and meta-analysis of all available evidence. ⋯ PROSPERO CRD42023391966.
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Eur. J. Intern. Med. · Jan 2024
Meta AnalysisNovel potassium binders to optimize RAASi therapy in heart failure: A systematic review and meta-analysis.
Hyperkalemia often occurs among heart failure (HF) patients, particularly when treated with renin-angiotensin-aldosterone system inhibitors (RAASi). Even modest potassium levels variations raise the risk of mortality and prompt patients to discontinue disease-modifying treatment, as RAASi. Novel potassium binders (NPB), patiromer and sodium zirconium cyclosilicate, are effective in reducing potassium levels and are approved for the treatment of hyperkalemia in HF, but whether their use results in a real optimization of HF treatment remains to be seen. The aim of the present meta-analysis was to assess the efficacy of NPB on the optimization of RAASi therapy in HF patients. ⋯ CRD42022351811 URL: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=351811.
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Eur. J. Intern. Med. · Nov 2023
Review Meta AnalysisCatheter-based renal artery denervation: facts and expectations.
Catheter-based renal artery denervation (RAD) is entering a new era. After the disappointing results of SYMPLICITY-HTN 3 trial in year 2014, several technical and methodological advancements led to execution of important SHAM-controlled randomized trials with promising results. Now, the 2023 ESH Guidelines give RAD a class of recommendation II with a Level of Evidence B. ⋯ Overall, the reduction in 24-h systolic blood pressure (BP) after RAD exceeded that after SHAM by 4.58 mmHg (95% CI 3.07-6.10) in untreated patients, and by 3.82 mmHg (95% CI 2.46-5.18) in treated patients, without significant heterogeneity across trials, patient phenotype (untreated versus treated patients) and technique (radiofrequency versus ultrasound). There were no important safety signals related to the procedure. Notably, some data suggest that RAD could be an effective additional approach in patients with atrial fibrillation and other conditions characterized by sympathetic nervous system overactivity.