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Meta-Analysis
. 2023 Jul;23(3):751-758.
doi: 10.1007/s10238-022-00833-0. Epub 2022 May 5.

A systematic review and meta-analysis of homocysteine concentrations in chronic obstructive pulmonary disease

Angelo Zinellu #  1 , Elisabetta Zinellu #  2 , Maria Carmina Pau  3 , Alessandro G Fois  2   3 , Sabrina Mellino  1 , Barbara Piras  3 , Valentina Scano  3 , Sara S Fois  3 , Arduino A Mangoni  4 , Ciriaco Carru  1 , Pietro Pirina  5   6
Affiliations
Meta-Analysis

A systematic review and meta-analysis of homocysteine concentrations in chronic obstructive pulmonary disease

Angelo Zinellu et al. Clin Exp Med. 2023 Jul.

Abstract

Patients with chronic obstructive pulmonary disease (COPD) often suffer from other conditions, such as cardiovascular disease, that further increase the risk of adverse outcomes in this group. Serum homocysteine concentrations are positively associated with cardiovascular risk and have also been reported to be increased in COPD. This meta-analysis investigated the association between homocysteine concentrations and COPD. A systematic search of publications in the electronic databases PubMed, Web of Science, Scopus, and Google Scholar, from inception to September 2021, was conducted using the following terms: "Homocysteine" or "Hcy" and "Chronic Obstructive Pulmonary Disease" or "COPD". Weighted mean differences (WMDs) were calculated to evaluate differences in homocysteine concentrations between COPD patients and non-COPD subjects. Risk of bias and certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively. Nine studies in 432 COPD patients (mean age 65 years, 65% males) and 311 controls (mean age 65 years, 56% males) were identified. Pooled results showed that serum homocysteine concentrations were significantly higher in patients with COPD (WMD = 2.91 µmol/L, 95% CI 2.00-3.82 µmol/L; p < 0.001; high certainty of evidence). No publication bias was observed. Our results support the hypothesis that increased homocysteine concentrations are significantly associated with COPD and may account, at least in part, for the increased cardiovascular risk in these patients.

Keywords: COPD; Cardiovascular risk; Comorbidities; Homocysteine.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Flow chart of study selection
Fig. 2
Fig. 2
Forest plot of serum homocysteine concentrations in COPD patients and non-COPD subjects
Fig. 3
Fig. 3
Sensitivity analysis of the association between serum homocysteine and COPD. The influence of individual studies on the overall weighted mean difference (WMD) is shown. The middle vertical axis indicates the overall WMD, and the two vertical axes indicate the 95% confidence intervals (CIs). The hollow circles represent the pooled WMD when the remaining study is omitted from the meta-analysis. The two ends of each broken line represent the 95% CIs
Fig. 4
Fig. 4
Funnel plot of studies investigating serum homocysteine in COPD patients and non-COPD subjects
Fig. 5
Fig. 5
Forest plot of studies examining serum homocysteine in COPD patients and non-COPD subjects after removing three outliers
See this image and copyright information in PMC

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