RESUMO
BACKGROUND: This systematic review and meta-analysis investigated all prediction models for sarcopenia in Maintenance Hemodialysis (MHD) patients. METHODS: This study used the Systematic Reviews and Meta-Analysis statement (PRISMA) for systematic review. DATA SOURCES: PubMed, Web of Science, Embase, Cochrane Library and Medline databases up to September 2023. DATA ANALYSIS: Risk of bias (ROB) was evaluated using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). Random effect models were calculated due to high heterogeneity identified. RESULTS: Fifteen models from twelve studies were analyzed. All studies had high ROB and three of them posed a high risk in terms of applicability. The pooled AUC, sensitivity, and specificity were 0.715, 0.583 and 0.656 respectively. The diagnostic criteria (P=0.0046), country (P=0.0046), and study design (P=0.0087) were significant sources of the heterogeneity. Analysing purely from the data perspective, grouping by diagnostic criterias, the AUC and specificity [(0.773, 95% CI 0.12-0.99, (0.652, 95% CI 0.641-0.664)] of the Asian Working Group for Sarcopenia (AWGS) group was lower than the European Working Group on Sarcopenia in Older People (EWGSOP) group [(0.859, 95% CI 0.12-1.00), (0.874, 95% CI 0.803-0.926)]. Grouping by styles of research, the AUC, sensitivity, and specificity in development group [(0.890, 95% CI 0.16-1.00), (0.751, 95% CI 0.697-0.800), (0.875, 95% CI 0.854-0.895)] were all higher than validation group [(0.715, 95% CI 0.09-0.98), (0.550, 95% CI 0.524-0.576), (0.617, 95% CI 0.604-0.629)]. CONCLUSIONS: Moving forward, there is a critical need to create low-ROB, high-applicability, and more accurate sarcopenia prediction models for MHD patients, customized for diverse global populations.
RESUMO
OBJECTIVE: To explore the diagnostic value of transthoracic echocardiogram (TTE) and/or plasma B-type natriuretic peptide (BNP) for left ventricular (LV) systolic dysfunction and/or LV diastolic dysfunction in septic patients. METHODS: In this prospective observational study, 90 septic patients and 30 non-septic ones underwent serial TTEs to measure LV ejection fraction (LVEF) and blood flow velocity of mitral annulus during early diastole (E) and atrial contraction (A) ratio (E/A) within 24 h of admission, 2, 3, 5 and 7 days. Enzyme-linked immunosorbent assay (ELISA) was used to detect the plasma levels of BNP simultaneously. Patient medical records were used to obtain the information of demographics, APACHE II scores and 28-day survival rates. RESULTS: LVEF and E/A decreased significantly more in sepsis group (P = 0.00) while BNP elevated in sepsis group (P = 0.00). LVEF and E/A showed an initial drop and a subsequent rise. On the contrary, BNP increased and then decreased. There was a positive correlation between LVEF and E/A (r = 0.670, P = 0.00) while BNP level had a negative correlation with LVEF and E/A (r1 = -0.733, P1 = 0.00; r2 = -0.929, P2 = 0.00). Receiver operating characteristic (ROC) curve analysis showed that a cutoff point of BNP at 536.3 ng/L for diagnosing sepsis-induced LV systolic dysfunction had a sensitivity of 84.4% and a specificity of 68.7%. When at 505.0 ng/L, the valves were 56.0% and 97.4% respectively. CONCLUSION: TTE may uncover septic patients whose LV diastolic dysfunction occurs earlier and reverses later than systolic type. And it may also participate in systolic dysfunction. The levels of BNP, probably as an adjustment to LV function, are more closely aligned with the severity of septic LV diastolic dysfunction. The combined application of TTE and plasma BNP appears to be efficacious for dynamically assessing cardiac function in septic patients.
