Table 5.
GRADE table PICO 4.
| Question: Lifestyle modification or medical treatment compared to no modification or treatment for improve outcome | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Setting: UIA patients | ||||||||||||
| Certainty assessment | No. of patients | Effect | Certainty | Importance | ||||||||
| No. of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Lifestyle modification or medical treatment | No modification or treatment | Relative (95% CI) | Absolute (95% CI) | ||
| Smoking cessation and aneurysm rupture | ||||||||||||
| 1 | Observational studies | Not serious a | Not serious | Not serious | Very seriousb,c | None | 0/11 (0.0%) | 8/26 (30.8%) | Not estimable | ⨁◯◯◯ Very low | Critical | |
| Smoking cessation and aneurysm growth rupture | ||||||||||||
| 1 | Observational studies | Not serious a | Not serious | Not serious | Very seriousb,c | None | 3/11 (27.3%) | 12/26 (46.2%) | Not estimable | ⨁◯◯◯ Very low | Critical | |
| Aspirin intake and aneurysm rupture | ||||||||||||
| 1 | Observational studies | Serious d | Not serious | Not serious | Not serious | None | 11/1087 (1%) | 1/643 (0.2%) | OR 0.11 (0.01–0.86) | – per 1000 (from – to –) | ⨁◯◯◯ Very low | Critical |
| Aspirin intake and aneurysm growth | ||||||||||||
| 1 | Observational studies | Not serious a | Not serious | Not serious | Serious c | None | –/113 | −/159 | HR 0.29 (0.11–0.77) | – per 1000 (from – to –) | ⨁◯◯◯ Very low | Critical |
| Controlled hypertension and aneurysm rupture | ||||||||||||
| 1 | Observational studies | Not serious a | Not serious | Not serious | Seriousc,e | None | 2/– | HR 16.66 (2.10–132.90) | 17 Fewer per 1000 (from 133 fewer to 2 fewer) | ⨁◯◯◯ Very low | Critical | |
| Controlled hypertension and aneurysm growth | ||||||||||||
| 1 | Observational studies | Not serious a | Not serious | Not serious | Seriousc,e | None | HR 1.55 (0.63–3.80) | Two fewer per 1000 (from 4 fewer to 1 fewer) | ⨁◯◯◯ Very low | Critical | ||
| Statin intake and aneurysm rupture or rupture | ||||||||||||
| 1 | Randomised trials | Serious f | Not serious | Not serious | Very seriousc,g | None | −/93 | −/116 | HR 0.759 (0.415–1.386) | – per 1000 (from – to –) | ⨁◯◯◯ Very low | Critical |
CI: confidence interval; HR: hazard Ratio; OR: odds ratio.
a
Using Robins-I: overall risk of bias is moderate.
b
Small sample size and number of cases.
c
Only one study.
d
At least one study has an overall serious risk of bias using Robins-I.
e
Wide confidence interval.
f
Using ROB-2: randomisation raised some concerns; deviation high concerns; missing outcomes and measuring outcome low concerns; and selection of reported results raised some concerns.
g
Confidence interval not allowing to exclude substantial benefit or harm.