Author: Juschten, J.; Tuinman, P. R.; Guo, T.; Juffermans, N. P.; Schultz, M. J.; Loer, S. A.; Girbes, A. R. J.; de Grooth, H. J.
Title: Between-trial heterogeneity in ARDS research Cord-id: zrcdazw2 Document date: 2021_3_13
ID: zrcdazw2
Snippet: PURPOSE: Most randomized controlled trials (RCTs) in patients with acute respiratory distress syndrome (ARDS) revealed indeterminate or conflicting study results. We aimed to systematically evaluate between-trial heterogeneity in reporting standards and trial outcome. METHODS: A systematic review of RCTs published between 2000 and 2019 was performed including adult ARDS patients receiving lung-protective ventilation. A random-effects meta-regression model was applied to quantify heterogeneity (n
Document: PURPOSE: Most randomized controlled trials (RCTs) in patients with acute respiratory distress syndrome (ARDS) revealed indeterminate or conflicting study results. We aimed to systematically evaluate between-trial heterogeneity in reporting standards and trial outcome. METHODS: A systematic review of RCTs published between 2000 and 2019 was performed including adult ARDS patients receiving lung-protective ventilation. A random-effects meta-regression model was applied to quantify heterogeneity (non-random variability) and to evaluate trial and patient characteristics as sources of heterogeneity. RESULTS: In total, 67 RCTs were included. The 28-day control-group mortality rate ranged from 10 to 67% with large non-random heterogeneity (I(2) = 88%, p < 0.0001). Reported baseline patient characteristics explained some of the outcome heterogeneity, but only six trials (9%) reported all four independently predictive variables (mean age, mean lung injury score, mean plateau pressure and mean arterial pH). The 28-day control group mortality adjusted for patient characteristics (i.e. the residual heterogeneity) ranged from 18 to 45%. Trials with significant benefit in the primary outcome reported a higher control group mortality than trials with an indeterminate outcome or harm (mean 28-day control group mortality: 44% vs. 28%; p = 0.001). CONCLUSION: Among ARDS RCTs in the lung-protective ventilation era, there was large variability in the description of baseline characteristics and significant unexplainable heterogeneity in 28-day control group mortality. These findings signify problems with the generalizability of ARDS research and underline the urgent need for standardized reporting of trial and baseline characteristics. SUPPLEMENTARY INFORMATION: The online version of this article (10.1007/s00134-021-06370-w) contains supplementary material, which is available to authorized users.
Search related documents:
Co phrase search for related documents- acute physiology and logistic regression model: 1, 2, 3
- acute physiology score and logistic regression: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24
- acute physiology score and logistic regression model: 1
- acute respiratory and logistic regression: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25
- acute respiratory and logistic regression model: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25
- acute respiratory and low baseline: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16
- acute respiratory and low high intervention: 1
- acute respiratory distress syndrome and logistic regression: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25
- acute respiratory distress syndrome and logistic regression model: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23
- acute respiratory distress syndrome and low baseline: 1, 2, 3
- acute respiratory distress syndrome and low high intervention: 1
- logistic regression and low baseline: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12
- logistic regression model and low baseline: 1, 2, 3
Co phrase search for related documents, hyperlinks ordered by date