Quality assessment of meta-analyses evaluating randomized clinical trials to improve the prognosis of septic shock: an overview of systematic reviews

Abstract

Objective

Clinical guidelines for the treatment of septic shock are based on the studies with the best scientific evidence, which are meta-analyses of clinical trials. However, these meta-analyses may have methodological limitations that prevent their conclusions from being extrapolated to routine clinical practice. Therefore, the objective of this study is to determine the quality of these meta-analyses through a systematic review.

Methods

In this systematic review, we searched MEDLINE, Scopus and EMBASE from inception to May 2019. We selected meta-analyses from clinical trials that determined the effectiveness of an intervention in reducing the incidence of mortality in patients with septic shock. All items were extracted from the Overview Quality Assessment Questionnaire (OQAQ), which collects information from both systematic reviews and meta-analyses.

Results

A total of 34 studies were included. Most elements of the OQAQ were conducted satisfactorily, although 35.3% of meta-analyses did not use a quality assessment of the studies included in other analyses. In 52.9% of meta-analyses, the quality of the studies was high or very high.

Conclusions

The methods used to obtain the results should be taken into account when recommending an intervention to treat septic shock if the evidence comes from a meta-analysis of the analyzed characteristics.

Keywords:

• Septic shock
• meta-analysis as topic
• research report/standards
• research design/standards
• evidence-based medicine/standards

Transparency

Declaration of funding

No external funding was received for this study.

Declaration of financial/other relationships

The authors and peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

PL designed the study, performed the systematic review and drafted the manuscript; AP helped design the study, performed the systematic review and critically reviewed the manuscript; CB, AMM, VFG and MAC participated in the study design and critically reviewed the manuscript. All the authors approved the final version of the text to be submitted for publication.

Acknowledgements

The authors thank Maria Repice and Ian Johnstone for their help with the English version of the text.