Ioannis Bellos

Helicobacter pylori infection increases the risk of developing preeclampsia: A meta-analysis of observational studies

Helicobacter pylori has been previously linked with preeclampsia on the basis of altered angiogenesis and activation of inflammatory cytokines.

Serum ceruloplasmin levels in preeclampsia: a meta-analysis

Abstract Purpose: To evaluate the differences in serum ceruloplasmin levels between patients with preeclampsia and healthy controls. Materials and methods: We searched the Medline (1966–2017), Scopus (2004–2017), Clinicaltrials.gov (2008–2017), Cochrane Central Register of Controlled Trials CENTRAL (1999–2017), and Google Scholar (2004–2017) databases. Meta-analysis was performed with the RevMan 5.3 software. Results: Fifteen studies were finally included in the present review, with a total number of 1927 women. Maternal serum ceruloplasmin concentration was significantly higher in preeclamptic than in the healthy pregnant women (mean differences (MD): 12.57 mg/dl, 95% CI: [8.81, 16.33]). Ceruloplasmin levels were significantly higher both in mild (MD: 13.8 mg/dl, 95% CI: [2.64, 23.53]) and severe (MD: 21.84 mg/dl, 95% CI: [0.97, 42.71]) preeclampsia, when compared to the control group. The severity of the disease did not significantly affect the levels of the protein (MD: −9.34 mg/dl, 95% CI: [−20.93, 2.26]). Conclusions: Serum ceruloplasmin may be a useful screening and follow-up tool for the evaluation of pregnant women with an indicative history of developing preeclampsia. Future studies are needed to evaluate the levels of this specific protein throughout the pregnancy course and provide data on its sensitivity and specificity by introducing cut-off values.

The diagnostic accuracy of presepsin in neonatal sepsis: a meta-analysis

There is growing evidence that presepsin is a promising biomarker in the diagnosis of sepsis in adults. The objective of our study is to investigate current evidence related to the diagnostic accuracy of presepsin in neonatal sepsis. To accomplish this, we searched the Medline (1966–2017), Scopus (2004–2017), Clinicaltrials.gov (2008–2017), EMBASE (1980–2017), Cochrane Central Register of Controlled Trials CENTRAL (1999–2017), and Google Scholar (2004–2017) databases. Eleven studies were included in the present meta-analysis, with a total number of 783 neonates. The pooled sensitivity of serum presepsin for the prediction of neonatal sepsis was 0.91 (95% CI [0.87–0.93]) and the pooled specificity was 0.91 (95% CI [0.88–0.94]). The diagnostic odds ratio was 170.28 (95% CI [51.13–567.11]) and the area under the curve (AUC) was 0.9751 (SE 0.0117). Head-to-head comparison with AUC values of C-reactive protein (0.9748 vs. 0.8580) and procalcitonin (0.9596 vs. 0.7831) revealed that presepsin was more sensitive in detecting neonatal sepsis.Conclusion: Current evidence support the use of presepsin in the early neonatal period in high-risk populations as its diagnostic accuracy seems to be high in detecting neonatal sepsis.What is known:• Neonatal sepsis is a leading cause of morbidity and mortality.• Current laboratory tests cannot accurately discriminate endangered neonates.What is new:• The diagnostic odds ratio of presepsin is 170.28 and the area under the curve is 0.9751.• According to our meta-analysis, presepsin is a useful protein that may help clinicians identify neonates at risk.

Mean platelet volume values in preeclampsia: A systematic review and meta-analysis

OBJECTIVE Mean platelet volume (MPV) has been explored in several observational studies in the field of preeclampsia and current evidence seem to be conflicting. The purpose of the present meta-analysis is to evaluate the reported MPV differences in patients that develop preeclampsia and to compare them to those of otherwise healthy women. DESIGN AND METHODS We searched the international literature using the Medline (1966-2018), Scopus (2004-2018), EMBASE (1947-2018) and Clinicaltrials.gov (2008-2018) databases. Statistical meta-analysis was performed using the RevMan 5.3 software. RESULTS The meta-analysis was based on outcomes reported from 50 studies that included 14,614 women. MPV was significantly higher in preeclamptic than healthy pregnant women (7905 women, MD: 1.04 fl, 95% CI [0.76, 1.32]). The mean difference was less evident among women with mild preeclampsia (6604 women, MD: 0.65 fl, 95% CI [0.19, 1.11]), compared to the severe ones (6119 women, MD: 1.28 fl, 95% CI [0.75, 1.80]). The results of the univariate meta-regression analysis showed that region, sample size, time to analysis, anticoagulant, platelet count and NOS score did not affect the outcomes of the meta-analysis. CONCLUSIONS The findings of our meta-analysis suggest that mean platelet volume represents a promising biomarker for the detection and follow-up of patients that develop preeclampsia. However, given that the available evidence is drawn from case-control studies, future cohorts are needed in this field to accurately determine optimal timing and cut-off values that may be used in the clinical setting.

Effectiveness of artificial pancreas in the non-adult population: a systematic review and network meta-analysis

OBJECTIVE Artificial pancreas is a technology that minimizes user input by bridging continuous glucose monitoring and insulin pump treatment, and has proven safety in the adult population. The purpose of this systematic review and meta-analysis is to evaluate the efficacy of closed-loop (CL) systems in the glycemic control of non-adult type 1 diabetes patients in both a pairwise and network meta-analysis (NMA) context and investigate various parameters potentially affecting the outcome. METHODS Literature was systematically searched using the MEDLINE (1966-2018), Scopus (2004-2018), Cochrane Central Register of Controlled Trials (CENTRAL) (1999-2018), Clinicaltrials.gov (2008-2018) and Google Scholar (2004-2018) databases. Studies comparing the glycemic control in CL (either single- or dual-hormone) with continuous subcutaneous insulin infusion (CSII) in people with diabetes (PWD) aged <18 years old were deemed eligible. The primary outcome analysis was conducted with regard to time spent in the target glycemic range. All outcomes were evaluated in NMA in order to investigate potential between-algorithm differences. Pairwise meta-analysis and meta-regression were performed using the RevMan 5.3 and Open Meta-Analyst software. For NMA, the package pcnetmetain R 3.5.1 was used. RESULTS The meta-analysis was based on 25 studies with a total of 504 PWD. The CL group was associated with significantly higher percentage of time spent in the target glycemic range (Mean (SD): 67.59% (SD: 8.07%) in the target range and OL PWD spending 55.77% (SD: 11.73%), MD: -11.97%, 95% CI [-18.40, -5.54%]) and with lower percentages of time in hyperglycemia (MD: 3.01%, 95% CI [1.68, 4.34%]) and hypoglycemia (MD: 0.67%, 95% CI [0.21, 1.13%]. Mean glucose was also decreased in the CL group (MD: 0.75 mmol/L, 95% CI [0.18-1.33]). The NMA arm of the study showed that the bihormonal modality was superior to other algorithms and standard treatment in lowering mean glucose and increasing time spent in the target range. The DiAs platform was superior to PID in controlling hypoglycemia and mean glucose. Time in target range and mean glucose were unaffected by the confounding factors tested. CONCLUSIONS The findings of this meta-analysis suggest that artificial pancreas systems are superior to the standard sensor-augmented pump treatment of type 1 diabetes mellitus in non-adult PWD. Between-algorithm differences are also addressed, implying a superiority of the bihormonal treatment modality. Future large-scale studies are needed in the field to verify these outcomes and to determine the optimal algorithm to be used in the clinical setting.

Random urine uric acid to creatinine and prediction of perinatal asphyxia: a meta-analysis

Abstract Objective: The purpose of the present review is to evaluate whether urine uric acid to creatinine ratio is increased in perinatal asphyxia and hypoxic-ischemic encephalopathy (HIE), as well as to assess its predictive accuracy in the disease. Methods: We used the Medline (1966–2017), Scopus (2004–2017), Clinicaltrials.gov (2008–2017), Embase (1980–2017), Cochrane Central Register of Controlled Trials CENTRAL (1999–2017), and Google Scholar (2004–2017) databases in our primary search along with the reference lists of electronically retrieved full-text papers. The hierarchical summary receiver operating characteristic (HSROC) model was used for the meta-analysis of diagnostic accuracy. Results: Fourteen studies were finally included in the present review, that investigated 1226 neonates. Urinary uric acid to creatinine ratio was significantly higher in neonates with perinatal asphyxia than in healthy controls (mean differences (MD): 1.43 95%CI [1.17, 1.69]). Specifically, the mean difference for Sarnat stage 1 was 0.70 (95%CI [0.28, 1.13]), for stage 2 1.41 (95%CI [0.99, 1.84]), and for stage 3 2.71 (95%CI [2.08, 3.35]). The estimated sensitivity for the summary point was 0.90 (95%CI (0.82–0.95)), the specificity was 0.88 (95%CI (0.73–0.95)) and the diagnostic odds ratio was calculated at 63.62 (95%CI (17.08–236.96)). Conclusions: Urinary uric acid to creatinine ratio is a rapid and an easily detected biomarker that may help physicians identify neonates at risk of developing perinatal asphyxia and HIE. However, large-scale prospective studies are still needed to determine its value in predicting mortality, as well as short- and long-term adverse neurological outcomes.

Soluble TREM-1 as a predictive factor of neonatal sepsis: a meta-analysis

BackgroundThe efficacy of soluble triggering receptor expressed on myeloid cell-1 (TREM-1) in detecting sepsis in adults has already been proven. To date, however, consensus in the field of neonatal sepsis is lacking. The purpose of the present systematic review is to accumulate current evidence in this field.Search strategyWe systematically searched Medline (1966–2017), Scopus (2004–2017), Clinicaltrials.gov (2008–2017), EMBASE (1980–2017), Cochrane Central Register of Controlled Trials CENTRAL (1999–2017) and Google Scholar (2004–2017) along with reference lists from included studies.Main resultsEight studies were finally included in the present analysis, with a total number of 667 neonates. The estimated sensitivity for the summary point was 0.95 [95% CI (0.81–0.99)] and the specificity was 0.87 [95% CI (0.56–0.97)]. The diagnostic odds ratio was calculated at 132.49 [95% CI (6.85–2560.70)]. Fagan’s nomogram demonstrated that the post-test probability increased to 71% and decreased to 2%, when the pre-test probability was set at 25%. However, significant discrepancy was observed in terms of the used cut-offs; therefore, the sensitivity and specificity presented in our meta-analysis should be reviewed with caution, as they may present an overestimation of the actual predictive efficacy of this protein.ConclusionCurrent evidence suggests that sTREM-1 may become a useful biomarker for the prediction of neonatal sepsis. However, the small number of studies and the variation of the threshold values limit its implementation in clinical practice. Future large-scale studies are needed to determine the optimal cut-off value that may discriminate normal levels from those suggestive of the presence of neonatal sepsis.

Neutrophil gelatinase-associated lipocalin as predictor of acute kidney injury in neonates with perinatal asphyxia: a systematic review and meta-analysis

There is growing evidence that neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker of acute kidney injury. The objective of this meta-analysis is to determine the accuracy of serum and urinary NGAL in the detection of acute kidney injury in neonates with perinatal asphyxia. Medline (1966–2018), Scopus (2004–2018), EMBASE (1980–2018), Clinicaltrials.gov (2008–2018), and Google Scholar (2004–2018) databases, along with the reference lists of the electronically retrieved articles, were systematically searched. Eleven studies were included, with a total number of 652 neonates. The summary sensitivity of serum NGAL was 0.818 (95% CI [0.668, 0.909]), the specificity 0.870 (95% CI [0.754, 0.936]), and the area under the curve 0.912. Regarding urinary NGAL, pooled sensitivity was calculated at 0.897 (95% CI [0.829, 0.940]), specificity at 0.729 (95% CI [0.561, 0.850]), and area under the curve at 0.899.Conclusion: Serum and urinary NGAL represent candidate biomarkers with high performance in the prediction of acute kidney injury in newborns with perinatal asphyxia. Before NGAL can be widely used in clinical practice, future large prospective studies are needed to define the optimal cutoffs and accurately determine which levels are suggestive of post-asphyxial acute kidney injury.What is Known:• Acute kidney injury is a major cause of morbidity and mortality in perinatal asphyxia.• Current markers are insufficient in predicting post-asphyxial acute kidney injury.What is New:• Area under the curve for serum and urinary neutrophil gelatinase-associated lipocalin is 0.818 and 0.899, respectively.• Neutrophil gelatinase-associated lipocalin is a useful marker for detecting asphyxiated neonates at risk of developing acute kidney injury.

The role of interleukins in preeclampsia: A comprehensive review: XXXX

Preeclampsia is a multi‐system hypertensive disorder of pregnancy, with significant rates of maternal and neonatal morbidity. It represents a major cause of preterm birth, as definitive treatment demands fetal delivery. Although its pathophysiology is complicated, placental hypoxia and endothelial dysfunction constitute established pathogenetic steps of the disease. Inflammation is considered to be a crucial mediator of preeclampsia process, as an imbalance between TH1, TH2, and TH17 immune responses is observed. The present review accumulates current knowledge about the contribution of interleukins in preeclampsia, summarizing the pathways through which each interleukin exerts its function in the disease. Also, the role of genetic polymorphisms is explored and the predictive efficacy of maternal serum interleukin levels is evaluated. Finally, recommendations about the safe interpretation of the outcomes, as well as guidance for future research, are provided.