Scoring systems for prediction of mortality in decompensated liver cirrhosis: A meta-analysis of test accuracy

AIM To compare the accuracy of the scoring systems ChildTurcotte-Pugh(CTP), Model for End-stage Liver Disease score(MELD), MELD-Na, and MELD to Serum Sodium ratio(MESO) to predict the mortality in decompensated liver cirrhosis.METHODS The PubMed, Web of Science, Cochrane Library, EMBASE, and Ovid databases were systematically searched from inception to September 2018 for relevant articles, and we evaluated the quality of the included studies. The accuracy of scoring systems was analyzed with Stata 12 and MetaDiSc 1.4.RESULTS Sixteen studies involving 2337 patients were included. The pooled areas under the summary receiver operating characteristic curves(AUROCs) of CTP, MELD, MELD-Na, and MESO to predict mortality were 0.81,0.78, 0.85, and 0.86, respectively. Within 3 mo, the AUROCs of CTP, MELD, and MELD-Na in predicting mortality were 0.78, 0.76, and 0.89, respectively. The AUROCs of CTP, MELD, and MELD-Na at 3 mo were 0.86, 0.78, and 0.86, respectively. The AUROCs of CTP, MELD, and MELD-Na at 6 mo were 0.91, 0.83, and 0.90, respectively. The AUROCs of CTP, MELD, and MELDNa at 12 mo were 0.72, 0.75 and 0.84, respectively. In cirrhotic patients with bleeding, the AUROCs of CTP and MELD were 0.76 and 0.88, respectively.CONCLUSION MESO has the highest AUROC in all assessed scoring systems. Considering the different time points, MELDNa has good accuracy in predicting the mortality of decompensated liver cirrhosis. Compared to CTP, MELD is better in predicting variceal bleeding.

Maternal serum level of resistin is associated with risk for gestational diabetes mellitus:A meta-analysis

BACKGROUND Resistin is most likely involved in the pathogenesis of gestational diabetes mellitus(GDM), but the existing findings are inconsistent.AIM To review the literature investigating the associations of the risk of GDM with serum level of resistin.METHODS A systematic literature search was performed using MEDLINE, EMBASE, and Web of Science(all databases). This meta-analysis included eligible studies that:(1) investigated the relationship between the risk of GDM and serum resistin;(2)included GDM cases and controls without GDM;(3) diagnosed GDM according to the oral glucose-tolerance test;(4) were performed in humans;(5) were published as full text articles in English; and(6) provided data with median and quartile range, median and minimum and maximum values, or mean and standard deviation. The pooled standardized mean difference(SMD) and 95%confidence interval(CI) were calculated to estimate the association between the risk of GDM and serum resistin. To analyze the potential influences of need for insulin in GDM patients and gestational age at blood sampling, we performed a subgroup analysis. Meta-regression with restricted maximum likelihood estimation was performed to assess the potentially important covariate exerting substantial impact on between-study heterogeneity.RESULTS The meta-analysis for the association between serum resistin level and GDM risk included 18 studies(22 comparisons) with 1041 cases and 1292 controls. The total results showed that the risk of GDM was associated with higher serum resistin level(SMD = 0.250, 95%CI: 0.116, 0.384). The "after 28 wk" subgroup, "no need for insulin" subgroup, and "need for insulin" subgroup indicated that higher serum resistin level was related to GDM risk("after 28 wk" subgroup: SMD =0.394, 95%CI: 0.108, 0.680; "no need for insulin" subgroup: SMD = 0.177, 95%CI:0.018, 0.336; "need for insulin" subgroup: SMD = 0.403, 95%CI: 0.119, 0.687). The"before 14 wk" subgroup, "14-28 wk" subgroup, and "no information of need for insulin" subgroup showed a nonsignificant association between serum resistin level and GDM risk("before 14 wk" subgroup: SMD = 0.087, 95%CI:-0.055, 0.230;"14-28 wk" subgroup: SMD = 0.217, 95%CI:-0.003, 0.436; "no information of need for insulin" subgroup: SMD = 0.356, 95%CI:-0.143, 0.855). The postpartum subgroup included only one study and showed that higher serum resistin level was related to GDM risk(SMD = 0.571, 95%CI: 0.054, 1.087) The meta-regression revealed that no need for insulin in GDM patients, age distribution similar between cases and controls, and ELISA all had a significant impact on between-study heterogeneity.CONCLUSION This meta-analysis supports that the maternal serum resistin level is associated with GDM risk.

Adiponectin gene polymorphisms and risk of gestational diabetes mellitus:A meta-analysis

BACKGROUND Adiponectin(ADIPOQ) is an important factor involved in the regulation of both carbohydrate and lipid metabolism. Polymorphisms in the ADIPOQ gene are known to influence an individual's predisposition to metabolic syndrome and type 2 diabetes. Moreover, women with gestational diabetes mellitus(GDM) are at an increased risk of developing type 2 diabetes. Several studies have been conducted previously to assess the association between ADIPOQ polymorphisms and GDM; however, the results of the association are inconclusive.AIM To quantitatively evaluate the association between ADIPOQ +45 T/G, +276 G/T,and-11377 C/G polymorphisms and the risk of GDM.METHODS A systematic search of EMBASE, PubMed, CNKI, Web of Science, and WANFANG DATA was conducted up to October 20, 2018. We calculated merged odds ratios(ORs) with 95% confidence intervals(CIs) using a fixed-effects or random-effects model depending on the between-study heterogeneity to evaluate the association between AIDPOQ +45 T/G, +276 G/T, and-11377 C/G polymorphisms and the risk of GDM. Subgroup analysis was performed by ethnicity. Publication and sensitivity bias analyses were performed to test the robustness of the association. All statistical analyses were conducted using Stata 12.0.RESULTS Nine studies of +45 T/G included 1024 GDM cases and 1059 controls, five studies of +276 G/T included 590 GDM cases and 595 controls, and five studies of-11377 C/G included 722 GDM cases and 791 controls. Pooled ORs indicated that+45 T/G increased GDM risk in Asians(allelic model: OR = 1.47, 95%CI: 1.27-1.70,P = 0.000; dominant model: OR = 1.54, 95%CI: 1.27-1.85, P = 0.000; recessive model: OR=2.00, 95%CI: 1.43-2.85, P = 0.000), not in South Americans(allelic model: OR = 1.21, 95%CI: 0.68-2.41, P = 0.510; dominant model: OR = 1.13, 95%CI:,0.59-2.15, P = 0.710; recessive model: OR = 2.18, 95%CI: 0.43-11.07, P = 0.350).There were no significant associations between +276 G/T(allelic model: OR = 0.88,95%CI: 0.74-1.05, P = 0.158; dominant model: OR = 0.91, 95%CI: 0.65-1.26, P =0.561; recessive model: OR = 0.82, 95%CI: 0.64-1.05, P = 0.118) or-11377 C/G(allelic model: OR = 0.96, 95%CI: 0.72-1.26, P = 0.750; dominant model: OR = 1.00,95%CI: 0.73-1.37, P = 0.980; recessive model: OR = 0.90, 95%CI: 0.61-1.32, P =0.570) and the risk of GDM.CONCLUSION Our meta-analysis shows the critical role of the ADIPOQ +45 T/G polymorphism in GDM, especially in Asians. Studies focused on delineating ethnicity-specific factors with larger sample sizes are needed.

Betel quid chewing and oral potential malignant disorders and the impact of smoking and drinking:A meta-analysis

BACKGROUND Oral potential malignant disorders(OPMDs)are a precancerous condition of oral disease.Several studies have found that betel quid chewing,smoking and alcohol drinking might be the risk factors of OPMDs.But the relationships of them,especially their interaction are still inconclusive.AIM To evaluate the relationship between betel quid chewing and OPMDs and to explore the interaction of smoking and alcohol drinking on the relationship.METHODS We searched Pub Med,Web of Science,Embase and the Cochrane Library databases with items complete until January 2021 for relevant studies.The research data were extracted according to the inclusion criteria.The pooled odds ratios(ORs)and 95%confidence intervals(CIs)were used to evaluate the effect size.Subgroup analysis was performed to assess interactions between exposures and OPMDs.Relative excess risk of interaction(RERI)was used to estimate the size of interaction.RESULTS Nine articles were selected in the final meta-analysis.The results showed that betel quid chewing(pooled OR:8.70,95%CI:5.18-14.61),alcohol consumption(pooled OR:1.95,95%CI:1.5-2.55),and smoking(pooled OR:4.35,95%CI:3.06-6.2)could significantly increase the risk of OPMDs compared to individuals without these behaviors.Smoking and alcohol drinking synergistically increased the association between betel quid chewing and OPMDs(pooled OR;:14.38,95%CI:7.14-28.95;pooled OR;:11.12,95%CI:8.00-15.45,respectively).The RERI;and RERI;were 2.33 and 1.47,respectively.CONCLUSION The synergistic effects between smoking/drinking and betel quid highlights the importance of focusing on individuals with multiple exposures.Further study should be conducted to confirm these interactions.

Impact of mTOR gene polymorphisms and gene-tea interaction on susceptibility to tuberculosis

BACKGROUND mTOR gene is a key component of the PI3K/Akt/mTOR signaling pathway,and its dysregulation is associated with various diseases.Several studies have demonstrated that tea drinking is a protective factor against tuberculosis(TB).This study was designed to explore five single nucleotide polymorphisms(SNPs)of mTOR in the Han population of China to determine how their interactions with tea drinking affect susceptibility to TB.AIM To investigate if the polymorphisms of mTOR gene and the gene-tea interaction are associated with susceptibility to TB.METHODS In this case-control study,503 patients with TB and 494 healthy controls were enrolled by a stratified sampling method.The cases were newly registered TB patients from the county-level centers for disease control and prevention,and the healthy controls were permanent residents from Xin'ansi Community,Changsha city.Demographic data and environmental exposure information including tea drinking were obtained from the study participants.We genotyped five potentially functional SNP sites(rs2295080,rs2024627,rs1057079,rs12137958,and rs7525957)of mTOR gene and assessed their associations with the risk of TB using logistic regression analysis,and marginal structural linear odds models were used to estimate the gene-environment interactions.RESULTS The frequencies of four SNPs(rs2295080,rs2024627,rs1057079,and rs7525957)were found to be associated with susceptibility to TB(P<0.05).Genotypes GT(OR 1.334),GG(OR 2.224),and GT+GG(OR 1.403)at rs2295080;genotypes CT(OR 1.562)and CT+TT(OR 1.578)at rs2024627,genotypes CT(OR 1.597),CC(OR 2.858),and CT+CC(OR 1.682)at rs1057079;and genotypes CT(OR 1.559)and CT+CC(OR 1.568)at rs7525957 of mTOR gene were significantly more prevalent in TB patients than in healthy controls.The relative excess risk of interaction between the four SNPs(rs2295080,rs2024627,rs1057079,and rs7525957)of mTOR genes and tea drinking were found to be-1.5187(95%CI:-1.9826,-1.0547,P<0.05),-1.8270(95%CI:-2.3587,-1.2952,P<0.05),-2.3246(95%CI:-2.9417,-1.7076,P<0.05)and-0.4235(95%CI:-0.7756,-0.0714,P<0.05),respectively,which suggest negative interactions.CONCLUSION The polymorphisms of mTOR(rs2295080,rs2024627,rs1057079,and rs7525957)are associated with susceptibility to TB,and there is a negative interaction between each of the four SNPs and tea drinking.