Résumé
Objectives: Living systematic reviews (LSRs) maintain the relevance of systematic reviews through regular, continuous updates. This research aimed to assess if all LSRs are equal and to identify areas of methodological confusion to provide clarity for those undertaking an LSR. Method(s): A scoping exercise was conducted, informed by pragmatic searches of MEDLINE, Embase and Epistemonikos, to identify records explicitly referring to LSRs. No date limits were applied. Study selection was conducted by double independent reviewers. Where a preprint LSR was superseded by a peer-reviewed publication, the preprint record was excluded. A single reviewer conducted brief data extraction. A narrative synthesis was conducted. Result(s): 760 records were screened at title and , and 241 were assessed for eligibility at full text. 141 LSRs (either full LSR or protocol only) were extracted and synthesised. 97 LSRs focussed on COVID-19, and 44 were non-COVID-19 related. 29 were Cochrane LSRs. Of the 112 non-Cochrane LSRs, 77 were registered on PROSPERO. There appears to be some confusion amongst reviewers regarding PROSPERO's acceptance of LSRs. Justification for the use of LSR methodology and a description of how this methodology would be followed was not always reported. 40 reviews did not describe a clear schedule for search updates or stated that updates would only be conducted if new evidence became available;these may more accurately be described as standard review updates. 32 reviews did not report updates at the purported schedule (whilst not reporting that the review had been officially terminated). Thus, many "living" reviews are effectively dead on arrival. Very few authors reported under what circumstances the LSR would cease. Conclusion(s): LSRs present an opportunity to ensure that a body of evidence is kept up to date. However, caution is advised regarding jumping on a methodological bandwagon without sufficient understanding of the methods and funding required. Copyright © 2022
Résumé
Introduction: Numerous studies have reported increased risk for adverse COVID-19 outcomes in patients with obesity. However, diagnosis through body mass index (BMI) does not acknowledge the health burden associated with adipose tissue dysfunction. We compared the predictive performance of the Edmonton Obesity Staging System (EOSS), a clinical scheme to assess the obesity-related comorbidity, for adverse COVID-19 outcomes to that of BMI. Methods: Multi-center case series of 1071 patients hospitalized for COVID-19 in 11 hospitals adapted as COVID-19 centres in Mexico. We classified patients into 5 EOSS stages, from no obesity-related risk factors in the medical, mental, and functional areas (stage 0), to severe disease in any of those areas (stage 4). We calculated adjusted risk factors and performed survival analyses for mechanical ventilation and death according to EOSS stages and BMI categories. Results: Compared to patients with normal weight, intubation was higher in patients with EOSS stages 2 and 4 (HR 1.42, 95%CI 1.02-1.97 and 2.78, 95%CI 1.83-4.24), and in patients with class II and III obesity (HR 1,71, 95%CI 1.06-2.74, and 2.62, 95%CI 1.65-4.17). Death rates were lower in patients in EOSS stages 0 and 1 (HR 0.62, 95%CI 0.42-0.92) and higher in patients with class III obesity (HR 1.58, 95%CI 1.03-2.42). In the analysis of the group of patients with BMI ≥25 kg/m2, increasing EOSS stages were associated with increased HRs for intubation (EOSS stage 2 1.91, 95%CI 1.35-2.72, EOSS stage 3 1.74, 95%CI 1.06-2.85, and EOSS stage 4 3.75, 95%CI 2.38-5.90);by comparison, BMI group was only associated with intubation in individual with class III (40 kg/m2) (HR 2.24, 95%CI 1.50-3.34). Risk for death was increased in patients with EOSS stages 2 and 4 (EOSS stage 2 1.55, 95%CI 1.10-2.19, and EOSS stage 4 2.19, 95%CI 1.43-3.36) compared to EOSS 0 and 1, and in patients with class II and III obesity, compared to patients with overweight (class II HR 1.52, 95%CI 1.00-2.30 and class III 1.92, 95%CI 1.30-2.84). Conclusion: Risk for adverse COVID-19 outcomes was predicted better by the EOSS category, which was associated with the highest BMI class. Patients with overweight and obesity in EOSS stages 0 and 1 had lower risk for adverse outcomes than patients with normal weight, showing that BMI can assign “healthy” and “sick” category wrongly, and fails to identify pathways to guide chronic-disease management. Patients with EOSS stages 0 and 1 had the highest survival, followed by patients with normal weight, EOSS stage 3 and 2, and EOSS 4 had reduced survival starting from the first days of hospitalization. According to BMI, Class I and II obesity had the longest survival, followed by normal weight and overweight, and class III obesity had the lowest survival. Similarly, in the patients with a BMI ≥25 kg/m2, EOSS stages 0 and 1 had the highest survival, compared to EOSS stage 4, which had significantly lower survival. Class I and II obesity had longer survival than patients with overweight, and the lowest survival occurred in patients with class III obesity.