Association of conflicts of interest with the results and conclusions of goal-directed hemodynamic therapy research: a s
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SYSTEMATIC REVIEW
Association of conflicts of interest with the results and conclusions of goal‑directed hemodynamic therapy research: a systematic review with meta‑analysis Lina Zhang1, Feng Dai2, Alexandria Brackett3, Yuhang Ai1 and Lingzhong Meng4* © 2018 Springer-Verlag GmbH Germany, part of Springer Nature and ESICM
Abstract Purpose: The association between conflicts of interest (COI) and study results or article conclusions in goal-directed hemodynamic therapy (GDHT) research is unknown. Methods: Randomized controlled trials comparing GDHT with usual care were identified. COI were classified as industry sponsorship, author conflict, device loaner, none, or not reported. The association between COI and study results (complications and mortality) was assessed using both stratified meta-analysis and mixed effects meta-regression. The association between COI and an article’s conclusion (graded as GDHT-favorable, neutral, or unfavorable) was investigated using logistic regression. Results: Of the 82 eligible articles, 43 (53%) had self-reported COI, and 50 (61%) favored GDHT. GDHT significantly reduced complications on the basis of the meta-analysis of studies with any type of COI, studies declaring no COI, industry-sponsored studies, and studies with author conflict but not on studies with a device loaner. However, no significant relationship between COI and the relative risk (GDHT vs. usual care) of developing complications was found on the basis of meta-regression (p = 0.25). No significant effect of GDHT was found on mortality. COI had a significant overall effect (p = 0.016) on the odds of having a GDHT-favorable vs. neutral conclusion based on 81 studies. Eightyfour percent of the industry-sponsored studies had a GDHT-favorable conclusion, while only 27% of the studies with a device loaner had the same conclusion grade. Conclusions: The available evidence does not suggest a close relationship between COI and study results in GDHT research. However, a potential association may exist between COI and an article’s conclusion in GDHT research. Keywords: Conflicts of interest, Goal-directed hemodynamic therapy, Study results, Article conclusions, Association Introduction Goal-directed hemodynamic therapy (GDHT) is the management of global and/or regional blood flow guided *Correspondence: [email protected] 4 Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3, New Haven, CT, 208051, USA Full author information is available at the end of the article Essential gist Conflicts of interest may have a potential association with article conclusions in goal-directed hemodynamic therapy research.
by predetermined hemodynamic parameters with specified goals for intervention. Since pioneering work in 1988 [1] and 1995 [2], GDHT has revolutionized hemodynamic care in patients receiving anesthesia and surgery or admitted to the intensive care unit. The efficacy of GDHT among different randomized controlled trials (RCTs) has been inconsistent. For example, in patients with
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