Assignment: Meta-Analysis

Identify your selected article. Explain what characteristics make this a meta-analysis.
The article I choose to discuss is a meta-analysis by De Almeida-Pititto et al. (2020) that
explores the ‘mortality and severity of COVID-19 in patients diagnosed with cardiovascular
disease, hypertension, and diabetes.’ This study is a meta-analysis because it uses a systematic
approach to condense multiple studies into one design. It uses a written protocol that spells out
the systematic literature search, eligibility (inclusion & exclusion) criteria, data outcomes and
extraction, and data synthesis & analysis. The included studies also display diversity regarding
populations, treatment settings, and variables used. Most importantly, the study reveals
quantitative outcomes, differentiating meta-analytic research from a systematic or general
literature review (Dekkers, 2018).
Were the inclusion and exclusion criteria clearly stated? How were the articles that were
included selected?
Inclusion and exclusion criteria were clearly stated. Observational studies that fulfilled
the following criteria/conditions were included: (1) adults patients aged 18 and above, (2) use of
ARB and/or ACE inhibitors, (3) presence of three comorbidities, including cardiovascular
disease, hypertension, and diabetes mellitus, (4) articles in English and Chinese, and (5) use of
three study designs, including retrospective cohort studies, self-controlled case series, or cross-
sectional studies. Experimental and animal studies, expert opinions, letters, editorials, case
reports, and reviews were excluded. Studies that failed to report mortality and severity (interest
outcomes) were omitted. The researchers also excluded non-English and non-Chinese articles.
Most importantly, the articles included in the study were selected using four steps of the
PRISMA checklist: (a) identification from databases using specific search words [729 abstracts],

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(b) screening for study design [112 articles], (c) eligibility testing [72], and (d) inclusion criteria
[40 studies).
Do you agree with the researchers’ approach? Explain why or why not.
I completely agree with the researchers’ decision to use a meta-analysis because it
allowed them to combine smaller studies (with minuscule sample sizes) into a giant study with
significantly larger sample size. Specifically, for the three comorbidities studied (diabetes
mellitus, hypertension, and cardiovascular disease), the researchers combined multiple studies
from different settings and countries (the Us, Greece, Italy, and France) to form a more accurate,
valid, reliable, and generalizable outcome. For example, for COVID-19 severity among diabetes
mellitus patients, the researchers examined 18 studies (with a sample size of 4,305 patients).
Using a random-effect meta-analytic approach also ensured little heterogeneity and no
substantial publication bias. All these factors increase the study’s accuracy and validity and the
generalizability of the outcomes.
Do you agree with the conclusions? Explain why or why not.
I agree with the study’s conclusion that hypertension, diabetes, and cardiovascular disease
are critical risk factors for mortality and severity in COVID-19 patients for two reasons. Firstly,
the meta-analytic approach employed by the researchers is systematic and reproducible,
rendering the outcomes accurate, valid, and generalizable. In particular, the Comprehensive
Meta-Analysis Software (CMA) is a more recognized and accurate way of obtaining quantitative
estimates of the correlation between the three comorbidities and COVID-19’s severity and
mortality. Specifically, this model allowed the researchers to precisely compute adjusted ORs
with a 95% CI (confidence interval). The researchers also calculated heterogeneity using the I 2
statistic and X 2 test and assessed publication bias by performing Funnel Plots and Egger’s

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regression test. Secondly, I agree with the researchers’ conclusions because they corroborate
what other researchers have established. For example, a study by Li et al. (2020) found the
proportions of diabetes, cardiovascular disease, and hypertension in Covid-19 patients to be
9.7%, 16.4%, and 17.1%, respectively. This only confirms De Almeida-Pititto et al.’s findings
showing the significant correlation between the three comorbidities and COVID-19, increasing
mortality and severity in COVID-19 patients.
Explain how you could apply implications from the study to your nursing practice.
As a nurse practitioner, I would apply information from this study to care for COVID-19
patients diagnosed with underlying chronic conditions like diabetes mellitus, cardiovascular
disease, and hypertension. Since the severity and mortality of COVID-19 patients diagnosed with
these conditions are higher, I would prioritize them when allocating critical care resources or
when making triaging decisions by ensuring they receive more attention, counseling, and
treatment support than patients without these underlying conditions, remarkably when resources
are limited. Triage decisions during the pandemic have proven burdensome and thorny, often
raising ethical issues associated with justice, autonomy, nonmaleficence, and beneficence (Janig
et al., 2020).

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References

De Almeida-Pititto, B., Dualib, P. M., Zajdenverg, L., Dantas, J. R., et al. (2020). Severity and
mortality of COVID-19 patients with diabetes, hypertension, and cardiovascular disease:
A meta-analyses. Diabetology & Metabolic Syndrome, 12(75). doi: 10.1186/s13098-020-
00586-4
Dekkers, O. M. (2018). Meta-analysis: Key features, potentials, and misunderstandings.
Research and Practice in Thrombosis and Hemostasis, 2(4), 658-663. doi:
10.1002/rth2.12153
Janig, C., et al. (2020). Triage decisions in the context of COVID-19: Old burden, a new
challenge—the structured approach for intensive care unit triage (SAINT) protocol.
Military Medicine. doi: 10.1093/milmed/usaa287
Li, B., Yang, J., Zhao, F., Zhi, L., Wang, X., & Liu, L. (2020). Prevalence and impact of
cardiovascular, metabolic diseases on COVID-19 in China. Clinical Research in
Cardiology, 109(5), 531–8. https://doi.org/10.1007/s00392-020-01626-9.