ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions

Sterne, Jonathan A C; Hernán, Miguel A.; Reeves, Barnaby C; Savović, Jelena; Berkman, Nancy D; Viswanathan, Meera; Henry, David; Altman, Douglas G.; Ansari, Mohammed; Boutron, Isabelle; Carpenter, James; Chan, An‐Wen; Churchill, Rachel; Deeks, Jonathan J; Hróbjartsson, Asbjørn; Kirkham, Jamie J; Jüni, Peter; Loke, Yoon K.; Pigott, Theresa D; Ramsay, Craig R; Regidor, Deborah L.; Rothstein, Hannah R.; Sandhu, Lakhbir; Santaguida, Pasqualina; Schünemann, Holger J.; Shea, Beverly; Shrier, Ian; Tugwell, Peter; Turner, Lucy; Valentine, Jeffrey C.; Waddington, Hugh; Waters, Elizabeth; Wells, George A.; Whiting, Penny; Higgins, Julian P T

doi:10.1136/bmj.i4919

Cited by 10,545 publications

(8,845 citation statements)

References 20 publications

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“…In a formal risk of bias analysis, we used the Cochrane risk of bias tool for nonrandomized studies (ROBINS‐I)34 to assess risk of bias in primary studies. We rated the evidence for the association between alcohol consumption and incidence of hypertension based on the Grades of Recommendation, Assessment, Development and Evaluation system 35…”

Section: Methodsmentioning

confidence: 99%

Sex‐Specific Associations Between Alcohol Consumption and Incidence of Hypertension: A Systematic Review and Meta‐Analysis of Cohort Studies

Roerecke

Tobe

Kaczorowski

et al. 2018

JAHA

131

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BackgroundAlthough it is well established that heavy alcohol consumption increases the risk of hypertension, the risk associated with low levels of alcohol intake in men and women is unclear.Methods and ResultsWe searched Medline and Embase for original cohort studies on the association between average alcohol consumption and incidence of hypertension in people without hypertension. Random‐effects meta‐analyses and metaregressions were conducted. Data from 20 articles with 361 254 participants (125 907 men and 235 347 women) and 90 160 incident cases of hypertension (32 426 men and 57 734 women) were included. In people drinking 1 to 2 drinks/day (12 g of pure ethanol per drink), incidence of hypertension differed between men and women (relative riskwomen vs men=0.79; 95% confidence interval, 0.67–0.93). In men, the risk for hypertension in comparison with abstainers was relative risk=1.19 (1.07–1.31; I2=59%), 1.51 (1.30–1.76), and 1.74 (1.35–2.24) for consumption of 1 to 2, 3 to 4, and 5 or more standard drinks per day, respectively. In women, there was no increased risk for 1 to 2 drinks/day (relative risk=0.94; 0.88–1.01; I2=73%), and an increased risk for consumption beyond this level (relative risk=1.42; 1.22–1.66).ConclusionsAny alcohol consumption was associated with an increase in the risk for hypertension in men. In women, there was no risk increase for consumption of 1 to 2 drinks/day and an increased risk for higher consumption levels. We did not find evidence for a protective effect of alcohol consumption in women, contrary to earlier meta‐analyses.

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Section: Methodsmentioning

confidence: 99%

Sex‐Specific Associations Between Alcohol Consumption and Incidence of Hypertension: A Systematic Review and Meta‐Analysis of Cohort Studies

Roerecke

Tobe

Kaczorowski

et al. 2018

JAHA

131

View full text Add to dashboard Cite

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“…Quality assessment was performed using two tools: the Newcastle–Ottawa Scale (NOS) 20 and the Risk Of Bias In Non‐randomized Studies of Interventions (ROBINS‐I) 21. We opted to use both tools because the NOS offers a good overview of study methodology and representativeness, whereas the ROBINS‐I offers a more comprehensive assessment of bias.…”

Section: Methodsmentioning

confidence: 99%

Investigating the longitudinal association between diabetes and anxiety: a systematic review and meta‐analysis

2018

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AimPrevious research has indicated an association between diabetes and anxiety. However, no synthesis has determined the direction of this association. The aim of this study was to determine the longitudinal relationship between anxiety and diabetes.MethodsWe searched seven databases for studies examining the longitudinal relationship between anxiety and diabetes. Two independent reviewers screened studies from a population aged 16 or older that examined either anxiety as a risk factor for incident diabetes or diabetes as a risk factor for incident anxiety. Studies that met eligibility criteria were put forward for data extraction and meta‐analysis.ResultsIn total 14 studies (n = 1 760 800) that examined anxiety as a risk factor for incident diabetes and two (n = 88 109) that examined diabetes as a risk factor for incident anxiety were eligible for inclusion in the review. Only studies examining anxiety as a risk factor for incident diabetes were put forward for the meta‐analysis. The least adjusted (unadjusted or adjusted for age only) estimate indicated a significant association between baseline anxiety with incident diabetes (odds ratio 1.47, 1.23–1.75). Furthermore, most‐adjusted analyses indicated a significant association between baseline anxiety and incident diabetes. Included studies that examined diabetes to incident anxiety found no association.ConclusionsThere was an association between baseline anxiety and incident diabetes. The results also indicate the need for more research to examine the direction of association from diabetes to incident anxiety. This work adds to the growing body of evidence that poor mental health increases the risk of developing diabetes.

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“…The second identified study was a retrospective cohort study including 47 patients with CAT and thrombocytopenia (platelets <50 x10 9 /L) and 81 patients without thrombocytopenia 25. Among the thrombocytopenic patients, 14 received therapeutic anticoagulation with LMWH and 22 received dose‐modified LMWH (enoxaparin 40 mg daily during the period of significant thrombocytopenia).…”

Section: Resultsmentioning

confidence: 99%

Management of anticoagulation for cancer‐associated thrombosis in patients with thrombocytopenia: A systematic review

Bannow

Lee

Khorana

et al. 2018

Research and Practice in Thrombosis and Haemostasis

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Essentials The management of anticoagulation in patients with thrombocytopenia is controversial.Some studies suggest to administer reduced‐dose low‐molecular‐weight heparin (LMWH).While other studies suggest full‐dose anticoagulation using LMWH and transfusion support.The results from our systematic review do not support one management strategy over another. BackgroundThe management of anticoagulation for cancer‐associated thrombosis (CAT) in patients with thrombocytopenia is controversial. Whereas some studies suggest that administration of reduced‐dose low‐molecular‐weight heparin (LMWH) or temporary discontinuation for moderate and severe thrombocytopenia may be a safe and effective, others suggest full‐dose anticoagulation with transfusion support. We sought to address this important knowledge gap and summarize the literature comparing these two common management strategies.MethodsA systematic review of the literature (PROSPERO CRD42017077127) using MEDLINE (inception to September 2017) was conducted. We included studies that reported recurrent venous thromboembolism (VTE) and major bleeding complications among patients treated with both of the two most common management strategies: therapeutic anticoagulation with platelet transfusion support and dose‐modified anticoagulation for periods when the platelet count is <50 × 109/L.ResultsA total of 134 article records were identified on the initial search and 10 articles underwent full text review. Two observational studies met the inclusions criteria. A total of 121 patients with CAT and thrombocytopenia were included. Forty‐two of these patients had pulmonary embolism and 87 had deep vein thrombosis (DVT) including 38 upper extremity DVT. Overall, 27% of patients, regardless of their treatment strategy, experienced recurrent VTE. Thirteen percent of anticoagulated patients (15% of all patients) experienced a major bleeding episode. Meta‐analysis could not be conducted.ConclusionsOur findings do not support one management strategy over another to treat CAT patients with thrombocytopenia. However, the data highlights the heightened risk of recurrent VTE in this patient population despite the thrombocytopenia.

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ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions

Cited by 10,545 publications

References 20 publications

Sex‐Specific Associations Between Alcohol Consumption and Incidence of Hypertension: A Systematic Review and Meta‐Analysis of Cohort Studies

Sex‐Specific Associations Between Alcohol Consumption and Incidence of Hypertension: A Systematic Review and Meta‐Analysis of Cohort Studies

Investigating the longitudinal association between diabetes and anxiety: a systematic review and meta‐analysis

Management of anticoagulation for cancer‐associated thrombosis in patients with thrombocytopenia: A systematic review

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