Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis
Objectives To quantify the prognostic effects of demographic and modifiable factors in streptococcal toxic shock syndrome (STSS).Design Systematic review and meta-analysis.Data sources MEDLINE, EMBASE and CINAHL from inception to 19 September 2022, along with citations of included studies.Eligibilit...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/12/e063023.full |
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| author | Lehana Thabane Mark Loeb Jessica J Bartoszko Dominik Mertz Zeyad Elias Paulina Rudziak Carson K L Lo |
| author_facet | Lehana Thabane Mark Loeb Jessica J Bartoszko Dominik Mertz Zeyad Elias Paulina Rudziak Carson K L Lo |
| author_sort | Lehana Thabane |
| collection | DOAJ |
| description | Objectives To quantify the prognostic effects of demographic and modifiable factors in streptococcal toxic shock syndrome (STSS).Design Systematic review and meta-analysis.Data sources MEDLINE, EMBASE and CINAHL from inception to 19 September 2022, along with citations of included studies.Eligibility criteria Pairs of reviewers independently screened potentially eligible studies of patients with Group A Streptococcus-induced STSS that quantified the association between at least one prognostic factor and outcome of interest.Data extraction and synthesis We performed random-effects meta-analysis after duplicate data extraction and risk of bias assessments. We rated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach.Results One randomised trial and 40 observational studies were eligible (n=1918 patients). We found a statistically significant association between clindamycin treatment and mortality (n=144; OR 0.14, 95% CI 0.06 to 0.37), but the certainty of evidence was low. Within clindamycin-treated STSS patients, we found a statistically significant association between intravenous Ig treatment and mortality (n=188; OR 0.34, 95% CI 0.15 to 0.75), but the certainty of evidence was also low. The odds of mortality may increase in patients ≥65 years when compared with patients 18–64 years (n=396; OR 2.37, 95% CI 1.47 to 3.84), but the certainty of evidence was low. We are uncertain whether non-steroidal anti-inflammatory drugs increase the odds of mortality (n=50; OR 4.14, 95% CI 1.13 to 15.14; very low certainty). Results failed to show a significant association between any other prognostic factor and outcome combination (very low to low certainty evidence) and no studies quantified the association between a prognostic factor and morbidity post-infection in STSS survivors.Conclusions Treatment with clindamycin and within clindamycin-treated patients, IVIG, was each significantly associated with mortality, but the certainty of evidence was low. Future research should focus on morbidity post-infection in STSS survivors.PROSPERO registration number CRD42020166961. |
| format | Article |
| id | doaj-art-4d34d82038d54b0db8db166d474dce1b |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-4d34d82038d54b0db8db166d474dce1b2025-08-20T02:15:58ZengBMJ Publishing GroupBMJ Open2044-60552022-12-01121210.1136/bmjopen-2022-063023Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysisLehana Thabane0Mark Loeb1Jessica J Bartoszko2Dominik Mertz3Zeyad Elias4Paulina Rudziak5Carson K L Lo6Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada6 Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canadamethodologistassistant professor2 Department of Medicine, University of Toronto, Toronto, Ontario, Canada3 Department of Biology, Western University, London, Ontario, Canada4 Department of Medicine, McMaster University, Hamilton, Ontario, CanadaObjectives To quantify the prognostic effects of demographic and modifiable factors in streptococcal toxic shock syndrome (STSS).Design Systematic review and meta-analysis.Data sources MEDLINE, EMBASE and CINAHL from inception to 19 September 2022, along with citations of included studies.Eligibility criteria Pairs of reviewers independently screened potentially eligible studies of patients with Group A Streptococcus-induced STSS that quantified the association between at least one prognostic factor and outcome of interest.Data extraction and synthesis We performed random-effects meta-analysis after duplicate data extraction and risk of bias assessments. We rated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach.Results One randomised trial and 40 observational studies were eligible (n=1918 patients). We found a statistically significant association between clindamycin treatment and mortality (n=144; OR 0.14, 95% CI 0.06 to 0.37), but the certainty of evidence was low. Within clindamycin-treated STSS patients, we found a statistically significant association between intravenous Ig treatment and mortality (n=188; OR 0.34, 95% CI 0.15 to 0.75), but the certainty of evidence was also low. The odds of mortality may increase in patients ≥65 years when compared with patients 18–64 years (n=396; OR 2.37, 95% CI 1.47 to 3.84), but the certainty of evidence was low. We are uncertain whether non-steroidal anti-inflammatory drugs increase the odds of mortality (n=50; OR 4.14, 95% CI 1.13 to 15.14; very low certainty). Results failed to show a significant association between any other prognostic factor and outcome combination (very low to low certainty evidence) and no studies quantified the association between a prognostic factor and morbidity post-infection in STSS survivors.Conclusions Treatment with clindamycin and within clindamycin-treated patients, IVIG, was each significantly associated with mortality, but the certainty of evidence was low. Future research should focus on morbidity post-infection in STSS survivors.PROSPERO registration number CRD42020166961.https://bmjopen.bmj.com/content/12/12/e063023.full |
| spellingShingle | Lehana Thabane Mark Loeb Jessica J Bartoszko Dominik Mertz Zeyad Elias Paulina Rudziak Carson K L Lo Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis BMJ Open |
| title | Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis |
| title_full | Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis |
| title_fullStr | Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis |
| title_full_unstemmed | Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis |
| title_short | Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis |
| title_sort | prognostic factors for streptococcal toxic shock syndrome systematic review and meta analysis |
| url | https://bmjopen.bmj.com/content/12/12/e063023.full |
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