Background The long-term sequelae of COVID-19 in children and adolescents remain poorly understood and characterized.This systematic review and meta-analysis sought to summarize the risk factors for long COVID in the ...Background The long-term sequelae of COVID-19 in children and adolescents remain poorly understood and characterized.This systematic review and meta-analysis sought to summarize the risk factors for long COVID in the pediatric population.Methods We searched six databases from January 2020 to May 2023 for observational studies reporting on risk factors for long COVID or persistent symptoms those were present 12 or more weeks post-infection using multivariable regression analyses.Trial registries,reference lists of included studies,and preprint servers were hand-searched for relevant studies.Random-effects meta-analyses were conducted to pool odds ratios for each risk factor.Individual study risk of bias was rated using QUIPS,and the GRADE framework was used to assess the certainty of evidence for each unique factor.Results Sixteen observational studies(N=46,262)were included,and 19 risk factors were amenable to meta-analysis.With moderate certainty in the evidence,age(per 2-year increase),allergic rhinitis,obesity,previous respiratory diseases,hospitalization,severe acute COVID-19,and symptomatic acute COVID-19 are probably associated with an increased risk of long COVID.Female sex,asthma,comorbidity,and heart diseases may be associated with an increased risk of long COVID,and Asian and Black races may be associated with a decreased risk of long COVID.We did not observe any credible subgroup effects for any risk factor.Conclusions The current body of literature presents several compelling risk factors for the development of long COVID in the pediatric population.Further research is necessary to elucidate the pathophysiology of long COVID.展开更多
目的评价2型糖尿病患者使用肠促胰素类药物治疗对全因死亡的影响。设计随机对照试验（RCT）的系统性综述和meta分析。数据来源来自Medline、Embase、the Cochrane Central Register of Controlled Trials（CENTRAL）、Clinical Trials．...目的评价2型糖尿病患者使用肠促胰素类药物治疗对全因死亡的影响。设计随机对照试验（RCT）的系统性综述和meta分析。数据来源来自Medline、Embase、the Cochrane Central Register of Controlled Trials（CENTRAL）、Clinical Trials．gov。纳入标准2型糖尿病患者使用胰高血糖素样肽-1（GLP-1）受体激动剂或二肽基肽酶-4（DPP-4）抑制剂与使用安慰剂或其他降糖药物治疗相比的RCT。数据收集和分析2名研究者独立筛选文献，评价纳入研究的偏倚风险，并提取数据。采用Peto法作为合并来自RCT效应估计的主要方法，采用其他统计方法进行敏感性分析，针对6种预先设定的假设开展meta回归来探索异质性。使用GRADE方法评价证据质量。结果纳入189个RCT（n=155145），偏倚风险为低至中等。其中77个RCT报告零死亡事件，112个RCT报告在151614例患者中发生3888例死亡事件。meta分析结果显示：肠促胰素类药物与对照组相比，死亡风险在组间差异无统计学意义f1925／84136比1963／67478；比值比（OR）=0．96，95％可信区间（CI）：0．90-1．02，I^2=0％；率差（RD）=比对照低3／1000，95％C1（比对照低7／1000～比对照高1／1090）／5年·1000例患者；中等质量证据1。亚组分析结果提示：GLP-1受体激动剂可能降低死亡风险，但DPP-4抑制剂未发现类似结果；该亚组效应的可信度较低。敏感性分析结果未发现明显差异。结论当前证据不支持肠促胰素类药物增加2型糖尿病患者死亡风险的假设。需进一步研究证实GLP-1受体激动剂与DPP．4抑制剂两类肠促胰素类药物之间是否存在差异。展开更多
文摘Background The long-term sequelae of COVID-19 in children and adolescents remain poorly understood and characterized.This systematic review and meta-analysis sought to summarize the risk factors for long COVID in the pediatric population.Methods We searched six databases from January 2020 to May 2023 for observational studies reporting on risk factors for long COVID or persistent symptoms those were present 12 or more weeks post-infection using multivariable regression analyses.Trial registries,reference lists of included studies,and preprint servers were hand-searched for relevant studies.Random-effects meta-analyses were conducted to pool odds ratios for each risk factor.Individual study risk of bias was rated using QUIPS,and the GRADE framework was used to assess the certainty of evidence for each unique factor.Results Sixteen observational studies(N=46,262)were included,and 19 risk factors were amenable to meta-analysis.With moderate certainty in the evidence,age(per 2-year increase),allergic rhinitis,obesity,previous respiratory diseases,hospitalization,severe acute COVID-19,and symptomatic acute COVID-19 are probably associated with an increased risk of long COVID.Female sex,asthma,comorbidity,and heart diseases may be associated with an increased risk of long COVID,and Asian and Black races may be associated with a decreased risk of long COVID.We did not observe any credible subgroup effects for any risk factor.Conclusions The current body of literature presents several compelling risk factors for the development of long COVID in the pediatric population.Further research is necessary to elucidate the pathophysiology of long COVID.
文摘目的评价2型糖尿病患者使用肠促胰素类药物治疗对全因死亡的影响。设计随机对照试验（RCT）的系统性综述和meta分析。数据来源来自Medline、Embase、the Cochrane Central Register of Controlled Trials（CENTRAL）、Clinical Trials．gov。纳入标准2型糖尿病患者使用胰高血糖素样肽-1（GLP-1）受体激动剂或二肽基肽酶-4（DPP-4）抑制剂与使用安慰剂或其他降糖药物治疗相比的RCT。数据收集和分析2名研究者独立筛选文献，评价纳入研究的偏倚风险，并提取数据。采用Peto法作为合并来自RCT效应估计的主要方法，采用其他统计方法进行敏感性分析，针对6种预先设定的假设开展meta回归来探索异质性。使用GRADE方法评价证据质量。结果纳入189个RCT（n=155145），偏倚风险为低至中等。其中77个RCT报告零死亡事件，112个RCT报告在151614例患者中发生3888例死亡事件。meta分析结果显示：肠促胰素类药物与对照组相比，死亡风险在组间差异无统计学意义f1925／84136比1963／67478；比值比（OR）=0．96，95％可信区间（CI）：0．90-1．02，I^2=0％；率差（RD）=比对照低3／1000，95％C1（比对照低7／1000～比对照高1／1090）／5年·1000例患者；中等质量证据1。亚组分析结果提示：GLP-1受体激动剂可能降低死亡风险，但DPP-4抑制剂未发现类似结果；该亚组效应的可信度较低。敏感性分析结果未发现明显差异。结论当前证据不支持肠促胰素类药物增加2型糖尿病患者死亡风险的假设。需进一步研究证实GLP-1受体激动剂与DPP．4抑制剂两类肠促胰素类药物之间是否存在差异。
