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Pneumococcal vaccination in adults at very high cardiovascular risk : a systematic review and meta-analysis
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Fundamentação: Existem diversas diretrizes que recomendam a vacinação com a vacina pneumocócica (PPSV23 e/ou PCV13) em adultos com doença cardiovascular estabelecida cardiovasculares ou com muito alto risco cardiovascular. No entanto, não existe qualquer revisão sistemática que procure aferir o impacte da vacinação em mortalidade de todas as causas ou em eventos adversos cardiovasculares major (MACE).
Objectivo: Produzir uma revisão sistemática e meta-análise sobre o impacto da vacinação pneumocócica na população referida. Métodos: Fez se uma pesquisa na CENTRAL e MEDLINE para estudos randomizados controlados (RCTs) e estudos observacionais relevantes. Os dados obtidos foram analisados, extraídos e avaliados por dois revisores independentes. Os resultados foram agrupados usando um modelo de efeitos aleatórios. A confiança na evidência foi avaliada usando os critérios GRADE. Foram seguidas as diretrizes PRISMA e MOOSE. Resultados: Não foram encontrados quaisquer RCTs. Sete estudos observacionais foram incluídos para a síntese qualitativa e quantitativa. Os resultados agrupados de cinco estudos que compreendem um total de 163,756 participantes mostraram uma diferença significativa na mortalidade de todas as causas (HR 0.78, 95% CI 0.73 to 0.83, baixo mostraram uma diferença significativa em MACE (HR 1.07, 95% CI 0.80 to 1.44, muito baixa confiança).Conclusões: A vacinação pneumocócica está associada com um decréscimo de 22% da mortalidade de todas as causas em doentes com doença cardiovascular estabelecida ou que estejam em muito alto risco cardiovascular. No entanto, limitações devido ao desenho dos estudos incluídos e um sério risco de viés em três dos mesmos leva-nos a ter um baixo nível de confiança no resultado.
Background: There are several guidelines that recommend vaccination with a pneumococcal vaccine (PPSV23 and/or PCV13) in adults with a history of cardiovascular disease or at a very-high risk of cardiovascular disease. However, there is no systematic review that looks into the impact of vaccination on all-cause mortality and major adverse cardiovascular events (MACE). Objective: To conduct a systematic review and meta-analysis of the impact of pneumococcal vaccination in the referred population. Methods: We searched CENTRAL and MEDLINE for relevant randomized controlled trials (RCTs) and observational studies. Data were screened, extracted, and appraised by two independent reviewers. We pooled results using a random-effects model. We assessed the confidence in the evidence using the GRADE framework. We followed the MOOSE and PRISMA guidelines. Results: No RCTs and seven observational studies were included for both qualitative and quantitative synthesis. Pooled results from five studies enrolling a total of 163,756 participants showed a significant decrease in all-cause mortality (HR 0.78, 95% CI 0.73 to 0.83, low confidence). Pooled results from two studies enrolling a total of 28,255 participants found no significant difference in MACE (HR 1.07, 95% CI 0.80 to 1.44, very low confidence). Conclusions: Pneumococcal vaccination was associated with a 22% decrease of all-cause mortality in patients with cardiovascular disease or at a very high cardiovascular risk. However, limitations due to study design and the serious risk of bias in three of the included studies leads to a low level of result confidence.
Background: There are several guidelines that recommend vaccination with a pneumococcal vaccine (PPSV23 and/or PCV13) in adults with a history of cardiovascular disease or at a very-high risk of cardiovascular disease. However, there is no systematic review that looks into the impact of vaccination on all-cause mortality and major adverse cardiovascular events (MACE). Objective: To conduct a systematic review and meta-analysis of the impact of pneumococcal vaccination in the referred population. Methods: We searched CENTRAL and MEDLINE for relevant randomized controlled trials (RCTs) and observational studies. Data were screened, extracted, and appraised by two independent reviewers. We pooled results using a random-effects model. We assessed the confidence in the evidence using the GRADE framework. We followed the MOOSE and PRISMA guidelines. Results: No RCTs and seven observational studies were included for both qualitative and quantitative synthesis. Pooled results from five studies enrolling a total of 163,756 participants showed a significant decrease in all-cause mortality (HR 0.78, 95% CI 0.73 to 0.83, low confidence). Pooled results from two studies enrolling a total of 28,255 participants found no significant difference in MACE (HR 1.07, 95% CI 0.80 to 1.44, very low confidence). Conclusions: Pneumococcal vaccination was associated with a 22% decrease of all-cause mortality in patients with cardiovascular disease or at a very high cardiovascular risk. However, limitations due to study design and the serious risk of bias in three of the included studies leads to a low level of result confidence.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Vacinação pneumocócica Mortalidade de todas as causas Doença cardiovascular Meta-análise