The effect of anti-platelet agents on end organ dysfunction and mortality in community acquired pneumonia: A protocol for a systematic review and meta-analysis
Bibliographic record
Abstract
ABSTRACT Background Community acquired pneumonia (CAP) is a common cause of morbidity and mortality globally. Poor outcomes are driven by maladaptive inflammatory and thrombotic host responses. Effective therapies that modulate host responses are lacking. Anti-platelet medications modulate thrombotic and inflammatory pathways and improve long term outcomes in COVID-19 pneumonia, however, the role of anti-platelets in other etiologies of CAP remains uncertain. Methods We will conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies including adult patients hospitalized for non-COVID-19 community acquired pneumonia (CAP) investigating the effect of anti-platelets (ASA or P2Y12 inhibitors) vs. control on all-cause mortality. We will search electronic databases including MEDLINE® (Epub Ahead of Print and In-Process, In-Data-Review & Other Non-Indexed Citations), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), clinical trial registries (clinicaltrials.gov, International Clinical Trials Registry Platform) and conference abstracts from inception to August 2023. Two blinded reviewers will extract data in parallel from included studies after title and abstract screening and application of eligibility criteria. We will use the Cochrane Risk of Bias tool and Newcastle Ottawa Scale to assess risk of bias and study quality from included studies. The primary meta-analysis will be conducted separately for RCTs and observational studies using Random effect inverse variance model. For observational studies, adjusted mortality estimates will be presented as hazard ratios (HR) or adjusted odds ratios (OR) whenever possible. Heterogeneity will be expressed using the I 2 statistic. The evidence will be evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Discussion The overall treatment effect and safety of anti-platelets in non-COVID-19 CAP will be summarized. The findings may be used to inform the relevance and potential study design of a future RCT evaluating anti-platelets in CAP. If anti-platelets are shown to be safe and effective, this research is expected to contribute to a new standard of treatment for CAP, and a paradigm shift towards targeting host responses in serious infections. Systematic Review Registration This protocol is reported in accordance with the guidelines produced by PRISMA-P. The protocol was registered with Open Science Framework on January 30, 2024 (DOI https://doi.org/10.17605/OSF.IO/H2G7C )
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.060 | 0.089 |
| Meta-epidemiology (narrow) | 0.006 | 0.005 |
| Meta-epidemiology (broad) | 0.023 | 0.038 |
| Bibliometrics | 0.012 | 0.012 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.007 | 0.006 |
| Open science | 0.006 | 0.005 |
| Research integrity | 0.006 | 0.006 |
| Insufficient payload (model declined to judge) | 0.048 | 0.005 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".