Adolopment of guideline on diabetic foot ulcers: an umbrella review with de novo meta-analyses of randomized controlled trials for autologous cell therapy in no-option chronic limb-threatening ischemia
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| Year of publication | 2021 |
| Type | Appeared in Conference without Proceedings |
| MU Faculty or unit | |
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| Description | Background One of the approved guidelines by the Czech Health Research Council in the Project Clinical Practice Guidelines is focused on the issue of Diabetic foot ulcers (DFU). We identified several existing high-quality guidelines for adaptation; however, none addressed the question of proper use of autologous cell therapy (ACT) optimally. Objective This work presents methods and results of an umbrella systematic review following the JBI methodology to evaluate the effectiveness and safety of ACT in no-option critical limb-threatening ischemia (CLTI) for the DFU guideline adolopment process. Methods To keep up with the highest methodological standards and choose a feasible solution, we first searched 12 electronic sources via Epistemonikos in January 2021. We identified 19 systematic reviews (SR) of various quality and conflicting findings. We used the PRISMA guidelines and an a priori published protocol. To get conclusive answers, we decided to extract primary study results from the eligible SRs and undertake de novo meta-analyses, with detailed sensitivity and subgroup analyses, as discussed with clinical experts. We carried out a GRADE assessment of the certainty of evidence. Results We found 20 RCTs with 1140 participants in the SRs to be eligible for this review and the guideline under preparation. We assessed mortality, healed ulcers, major amputations, amputation-free survival, rest pain, and ischemic parameters. Discussion ACT likely improves healing, reduces amputations, alleviates pain, and may lead to a slight increase in the ankle-brachial index and transcutaneous oxygen pressure in CLTI patients. |
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