Between-trial heterogeneity in ARDS research
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...
| Main Authors: | , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Springer
2021
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| _version_ | 1797103501393788928 |
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| author | Juschten, J Tuinman, PR Guo, T Juffermans, NP Schultz, MJ Loer, SA Girbes, ARJ de Grooth, HJ |
| author_facet | Juschten, J Tuinman, PR Guo, T Juffermans, NP Schultz, MJ Loer, SA Girbes, ARJ de Grooth, HJ |
| author_sort | Juschten, J |
| collection | OXFORD |
| description | 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 (I2 = 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.
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| first_indexed | 2024-03-07T06:20:57Z |
| format | Journal article |
| id | oxford-uuid:f2b39168-6b60-432e-8a21-5ce3b3ad438a |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T06:20:57Z |
| publishDate | 2021 |
| publisher | Springer |
| record_format | dspace |
| spelling | oxford-uuid:f2b39168-6b60-432e-8a21-5ce3b3ad438a2022-03-27T12:05:56ZBetween-trial heterogeneity in ARDS researchJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:f2b39168-6b60-432e-8a21-5ce3b3ad438aEnglishSymplectic ElementsSpringer2021Juschten, JTuinman, PRGuo, TJuffermans, NPSchultz, MJLoer, SAGirbes, ARJde Grooth, HJPurpose 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 (I2 = 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. |
| spellingShingle | Juschten, J Tuinman, PR Guo, T Juffermans, NP Schultz, MJ Loer, SA Girbes, ARJ de Grooth, HJ Between-trial heterogeneity in ARDS research |
| title | Between-trial heterogeneity in ARDS research |
| title_full | Between-trial heterogeneity in ARDS research |
| title_fullStr | Between-trial heterogeneity in ARDS research |
| title_full_unstemmed | Between-trial heterogeneity in ARDS research |
| title_short | Between-trial heterogeneity in ARDS research |
| title_sort | between trial heterogeneity in ards research |
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