Protease activity as a prognostic factor for wound healing in venous leg ulcers

Westby, Maggie J; Dumville, Jo C; Stubbs, Nikki; Norman, Gill; Wong, Jason; Cullum, Nicky; Riley, Richard D

doi:10.1002/14651858.cd012841.pub2

Cited by 32 publications

(41 citation statements)

References 200 publications

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“…Therefore, future research may focus on conducting larger cohort studies investigating the association between results from clinical investigation and ulcer healing. While we excluded comparative effectiveness studies, a recent Cochrane review 63 included RCTs to investigate the prognostic value of protease for the healing of venous leg ulcers, resulting in the inclusion of 11 studies for meta-analysis. A hierarchical approach or down-weighting of observational data through the use of a power prior would be advised 64 in this circumstance.…”

Section: Recommendations For Future Researchmentioning

confidence: 99%

Potential prognostic factors for delayed healing of common, non‐traumatic skin ulcers: A scoping review

Jenkins

Mohamed

Taylor

et al. 2019

International Wound Journal

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Healing of non‐traumatic skin ulcers is often suboptimal. Prognostic tools that identify people at high risk of delayed healing within the context of routine ulcer assessments may improve this, but robust evidence on which factors to include is lacking. Therefore, we scoped the literature to identify which potentially prognostic factors may warrant future systematic reviews and meta‐analyses. We conducted electronic searches in MEDLINE and Embase to identify studies in English published between 1997 and 2017 that tested the association between healing of the three most common non‐traumatic skin ulcers encountered by health care professionals (venous leg, diabetic foot, and pressure ulcers) and patient characteristics, ulcer characteristics, and results from clinical investigations. We included 42 studies that investigated factors which may be associated with the healing of venous leg ulcers (n = 17), diabetic foot ulcers (n = 15), and pressure ulcers (n = 10). Across ulcer types, ulcer characteristics were most commonly reported as potential prognostic factors for healing (n = 37), including the size of the ulcer area (n = 29) and ulcer duration at first assessment (n = 16). A total of 35 studies investigated the prognostic value of patient characteristics (n = 35), including age (n = 31), gender (n = 30), diabetes (n = 22), smoking status (n = 15), and history of deep vein thrombosis (DVT) (n = 13). Of these studies, 23 reported results from clinical investigations as potential prognostic factors, with the majority regarding vessel quality. Age, gender, diabetes, smoking status, history of DVT, ulcer area, and ulcer duration at time of first assessment warrant a systematic review and meta‐analysis to quantify their prognostic value for delayed ulcer healing.

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Section: Recommendations For Future Researchmentioning

confidence: 99%

Potential prognostic factors for delayed healing of common, non‐traumatic skin ulcers: A scoping review

Jenkins

Mohamed

Taylor

et al. 2019

International Wound Journal

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“…Is protease activity (prognostic factor) an independent prognostic factor for wound healing (outcome) at 24 weeks (timeframe) in people with venous leg ulcers (population)? 8 Prognostic reviewprognostic models…”

Section: Pfo-s (Population Factor or Model Outcome And Study Design)mentioning

confidence: 99%

Toolkit of methodological resources to conduct systematic reviews

et al. 2020

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Background: Systematic reviews (SR) can be classified by type depending on the research question they are based on. This work identifies and describes the most relevant methodological resources to conduct high-quality reviews that answer health care questions regarding prevalence, prognosis, diagnostic accuracy and effects of interventions. Methods: Methodological resources have been identified from literature searches and consulting guidelines from institutions that develop SRs. The selected resources are organized by type of SR, and stage of development of the review (formulation of the research question, development of the protocol, literature search, risk of bias assessment, synthesis of findings, assessment of the quality of evidence, and report of SR results and conclusions). Results: Although the different types of SRs are developed following the same steps, each SR type requires specific methods, differing in characteristics and complexity. The extent of methodological development varies by type of SR, with more solid guidelines available for diagnostic accuracy and effects of interventions SRs. This methodological toolkit describes the most up-to-date risk of bias instruments: Quality in Prognostic Studies (QUIPS) tool and Prediction model study Risk Of Bias Assessment Tool (PROBAST) for prognostic SRs, Quality assessment of diagnostic accuracy studies tool (QUADAS-2) for diagnostic accuracy SRs, Cochrane risk of bias tool (ROB-2) and Risk of bias in non-randomised studies of interventions studies tool (ROBINS-I) for effects of interventions SRs, as well as the latest developments on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Conclusions: This structured compilation of the best methodological resources for each type of SR may prove to be a very useful tool for those researchers that wish to develop SRs or conduct methodological research works on SRs

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“…We assessed the certainty of the evidence using the GRADE (grading of recommendations assessment, development, and evaluation) approach and guidance for prognosis studies (See Supplementary Table 4, Additional File 1) [26,[34][35][36][37][38][39]. We summarised our results for each outcome in a "Summary of ndings" table using the GRADEpro GDT software [37].…”

Section: Assessing the Certainty Of The Evidencementioning

confidence: 99%

Evaluation of the role of sex as a prognostic factor in critically ill adults with sepsis: a systematic review and meta-analysis

Antequera

López‐Alcalde

Stallings

et al. 2020

Preprint

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Background: Incidence and sepsis-related mortality are failing, but sepsis continues to be a leading cause of admission and death in intensive care units (ICUs). Although the preceding evidence suggests sex-related risk differences for developing sepsis, the influence of sex on mortality outcomes remains unclear as previous studies showed discordant results. This systematic review assesed the independent effect of sex for mortality among critically ill patients with sepsis.Methods: Electronic databases were searched up to 17th July 2020 for studies that examined independent associations between sex and mortality outcomes in critically ill adults with sepsis while controlling for covariates. Primary meta-analyses were performed by pooling adjusted estimates for a pre-specified core set of adjustment factors. The primary outcomes included all-cause hospital mortality and 28-day all-cause hospital mortality. The secondary outcomes included 7-day all-cause hospital mortality, 1-year all-cause mortality, and all-cause ICU mortality.Results: Among the 14304 records identified, 12 studies (71850 participants) were included. Meta-analysis showed inconclusive results on sex-based differences in hospital mortality (OR 0.95, 95% CI 0.55 to 1.64; very low-certainty evidence) and ICU mortality (OR 1.19, 95% CI 0.79 to 1.78; very low-certainty evidence). Meta-analysis found higher 28-day hospital mortality in the female group (OR 1.18, 95% CI 1.05 to 1.32; very low-certainty evidence). No studies reported on 7-day hospital mortality. A single study provided adjusted estimates on 1-year mortality reporting lower risk in the female group (OR 0.83 95% CI 0.68 to 0.98; low-certainty of evidence). The main reasons for assessing the certainty of evidence as very low were inconsistency and imprecision while downgrading to low-certainty was risk of bias and imprecision.Conclusions: The prognostic independent effect of sex on hospital mortality, 28-day hospital mortality, and ICU mortality for critically ill adults with sepsis is uncertain. Female sex may be associated with decreased 1-year mortality. No included studies reported on 7-day all-cause hospital mortality.

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Protease activity as a prognostic factor for wound healing in venous leg ulcers

Abstract: This review identified very low validity evidence regarding any association between protease activity and VLU healing and there is complete uncertainty regarding the relationship. The review offers information for both future research and systematic review methodology.

Cited by 32 publications

References 200 publications

Potential prognostic factors for delayed healing of common, non‐traumatic skin ulcers: A scoping review

Potential prognostic factors for delayed healing of common, non‐traumatic skin ulcers: A scoping review

Toolkit of methodological resources to conduct systematic reviews

Evaluation of the role of sex as a prognostic factor in critically ill adults with sepsis: a systematic review and meta-analysis

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