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        "titulo" => "Debilidad pulmonar asociada a COVID-19 &#40;DPAC&#41;&#58; revisi&#243;n sistem&#225;tica y metaan&#225;lisis"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Funnel plot corresponding to the assessment of publication risk of the studies included in the meta-analysis&#44; in relation to mortality&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Mechanical ventilation &#40;MV&#41; has become a basic resource in the Intensive Care Unit &#40;ICU&#41;&#46; Its use is not without risks&#44; however&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Damage related to MV can occur de novo or it may contribute to perpetuate or worsen pre-existing thoracic injuries&#44; with an impact on cardiopulmonary function&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Such disorders particularly include acute respiratory distress syndrome &#40;ARDS&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The latter is characterized by an important decrease in lung compliance&#44; and this predisposes the patient to an increased risk of barotrauma even when using MV with protective parameters&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">One of the main developments in recent decades in the field of MV has been improved knowledge and control of the complications associated with the use of the technique&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">During the COVID-19 pandemic&#44; there has been an increase in the number of cases of atraumatic pneumothorax &#40;PNX&#41; and pneumomediastinum &#40;PNMD&#41; in patients infected with SARS-CoV-2&#44; with incidences that exceed those expected in the ICU setting&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">It is difficult to know whether this increase in incidence is really due to complications of SARS-CoV-2 infection&#44; increased diagnostic performance of the ordered tests&#44; or to other factors related to excessive care burden in the ICU &#40;management of MV by less experienced professionals&#44; a greater number of patients assigned to each physician&#44; etc&#46;&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Some studies suggest that SARS-CoV-2 infection intrinsically increases the risk of spontaneous PNX&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">This respiratory virus could be responsible for the lung weakness these patients develop and which exposes them to the risk of PNX and&#47;or PNMD - both spontaneous and related to barotrauma - even when using noninvasive MV &#40;NIMV&#41; or MV with protective ventilation parameters&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Thus&#44; the objective of this review was to evaluate mortality and different clinical factors related to the development of PNX&#44; PNMD and&#47;or pneumopericardium &#40;PNPC&#41;&#44; both of an atraumatic nature and possibly associated with barotrauma &#40;patients subjected to NIMV or invasive MV &#91;IMV&#93;&#41; in critical patients as a consequence of COVID-19-associated lung weakness &#40;CALW&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Literature search</span><p id="par0055" class="elsevierStylePara elsevierViewall">A systematic review was made of the available scientific literature&#44; based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analyses &#40;PRISMA&#41; guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The study protocol was registered and published in the International Prospective Register of Systematic Reviews&#8221; &#40;PROSPERO&#41;&#58; Ref&#46; CRD42022359045&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A search was made of the Medline&#44; Web of Science Core Collection &#40;Thomson Reuters&#41; and Scopus &#40;Elsevier&#41; databases&#44; covering the period up to 1 August 2022&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The search strategy was carried out by combining the appropriate MeSH terms and Boolean operators such as &#40;&#40;Pneumothorax&#41; AND &#40;COVID-19&#41;&#41; OR &#40;&#40;pneumomediastinum&#41; AND &#40;COVID-19&#41;&#41; OR &#40;&#40;barotrauma &#91;MeSH terms&#93;&#41; AND &#40;SARS COV-2&#91;MeSH terms&#93;&#41;&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In addition&#44; we examined the references of the included articles in order to increase the sensitivity of the search&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Study selection criteria</span><p id="par0080" class="elsevierStylePara elsevierViewall">The search was limited to original research&#44; including observational studies &#40;cohort designs or case-control studies&#41; published in English or Spanish&#44; and to open access articles&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Other types of articles were excluded&#44; such as case reports&#44; research notes or communications at congresses&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">As eligibility criteria&#44; the selected studies were required to involve adult patients with a laboratory test diagnosis of COVID-19 based on reverse transcription polymerase chain reaction &#40;RT-PCR&#41;&#44; and with clinical conditions in the form of atraumatic PNX&#44; PNMD or PNPC either at initial presentation or manifesting during the management of SARS-CoV-2 pneumonia&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Accordingly&#44; and based on the PICO question&#44; the study population &#40;P&#41; comprised patients with COVID-19&#44; the intervention &#40;I&#41; was the clinical presentation of PNX and&#47;or PNMD&#44; the comparison &#40;C&#41; was the absence of the clinical presentation of PNX and&#47;or PNMD&#44; and the outcome &#40;O&#41; was mortality - with the study design &#40;S&#41; being longitudinal trials&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Primary outcome and quality assessment</span><p id="par0100" class="elsevierStylePara elsevierViewall">The primary outcome of interest was mortality stratified according to the occurring event&#46; The secondary outcomes of interest were the triggering risk factors for PNX and&#47;or PNMD and the impact of the latter upon the duration of the ICU stay&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Quality assessment of the included studies was based on the application of the 9-star Newcastle-Ottawa Scale &#40;NOS&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> by the first three authors independently&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The risk of bias referred to selection&#44; compatibility and outcomes was evaluated&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">High quality &#40;low risk of bias&#41; corresponded to studies with 8&#8211;9 stars&#44; medium quality &#40;medium risk of bias&#41; to studies with 6&#8211;7 stars&#44; and low quality &#40;high risk of bias&#41; to studies with &#8804;5 stars&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Data extraction and synthesis</span><p id="par0120" class="elsevierStylePara elsevierViewall">Data extraction from the selected studies was carried out by the first three authors independently&#44; in order to guarantee abidance with the PRISMA guidelines&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">A predefined standard form was used to collect the information of interest from the selected studies&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The following data were entered in the form&#58;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Name of the first author&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Type of study design&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Year of publication&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Country in which the study was made&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Age of the study population&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Gender&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Associated comorbidities at the time of diagnosis&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Type of event&#58; PNX&#44; PNMD or PNPC&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Type of ventilatory support&#58; none&#44; conventional low-flow oxygen therapy&#44; high-flow nasal oxygen &#40;HFNO&#41;&#44; NIMV or IMV&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Gas exchange parameters such as PaO2&#47;FiO2&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Clinical impact assessed by in-hospital mortality&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Quantitative variables were reported as odds ratios &#40;ORs&#41; and differences of means &#40;DMs&#41;&#44; with 95&#37; confidence intervals &#40;95&#37;CIs&#41;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Use was made of the inverse-variance weighting method with a random effects model&#44; and heterogeneity was analyzed based on the I2 statistic with conventional cut-off points for high &#40;&#62;75&#37;&#41;&#44; moderate &#40;50&#37;&#8211;75&#37;&#41; and low heterogeneity &#40;&#60;50&#37;&#41;&#44; along with the Cochran Q-test&#44; adopting a level of significance of <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;20&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Two-tailed tests were performed&#44; with statistical significance being accepted for <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">The Cochrane Review Manager 3&#46;0 package was used throughout&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">In addition&#44; the Egger test was used to analyze the sensitivity of risk of bias&#44; based on the Stata V&#46;15 statistical package &#40;Stata Corp&#46;&#44; College Station&#44; TX&#44;</p><p id="par0215" class="elsevierStylePara elsevierViewall">USA&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Included studies and flowchart</span><p id="par0220" class="elsevierStylePara elsevierViewall">The initial search yielded a total of 1102 published articles&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">The identification and exclusion of duplicates reduced the total to 541 articles for screening&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">After the screening and eligibility assessment process&#44; only 12 articles were seen to meet the inclusion criteria for our review&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#8211;21</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">The article selection process is summarized in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Principal results of the qualitative analysis</span><p id="par0240" class="elsevierStylePara elsevierViewall">The 12 included studies contributed data corresponding to a total of 4901 patients&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">The geographical distribution of the studies was heterogeneous&#58; 4 &#40;33&#46;33&#37;&#41; studies were carried out in America &#40;exclusively in the United States&#41;&#44; 3 &#40;25&#37;&#41; studies in Europe&#44; 4 &#40;33&#46;33&#37;&#41; in the Middle East&#44; and 1 &#40;8&#46;33&#37;&#41; in Asia&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Most of the included patients were males&#58; 62&#46;34&#37; of the total &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3060&#41;&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">The most frequent comorbidities at the time of patient admission were diabetes mellitus &#40;72&#46;27&#37; of the total&#41;&#44; arterial hypertension &#40;68&#46;18&#37;&#41;&#44; chronic obstructive pulmonary disease &#40;COPD&#41; &#40;59&#46;09&#37;&#41;&#44; chronic kidney disease &#40;45&#46;45&#37;&#41;&#44; coronary disease &#40;45&#46;45&#37;&#41; and cancer &#40;31&#46;81&#37;&#41;&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">All the studies included the appearance of PNX in the study population&#44; except two articles&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a></p><p id="par0265" class="elsevierStylePara elsevierViewall">The development of PNMD was recorded in 9 of the included studies &#40;75&#37;&#41;&#44; and PNPC in two &#40;16&#46;66&#37;&#41;&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the main characteristics of the selected studies&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Quantitative analysis</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Meta-analysis</span><p id="par0275" class="elsevierStylePara elsevierViewall">The quantitative analysis was divided into various subgroups&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">The odds ratios for the studies that evaluated mortality in atraumatic PNX&#44; PNMD and PNX<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>PNMD are reported in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0285" class="elsevierStylePara elsevierViewall">The pooled analysis yielded OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;42 &#40;95&#37;CI&#58; 0&#46;80&#8211;2&#46;51&#41;&#44; with high heterogeneity &#40;I2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>79&#46;00&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;00001&#41;&#44; though there were differences between the evaluated subgroups&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">The subgroup evaluating mortality in PNMD yielded OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;36 &#40;95&#37;CI&#58; 1&#46;35&#8211;4&#46;12&#41;&#44; though the heterogeneity index I2 was found to be 52&#37;&#44; evidencing statistically significant heterogeneity &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;13&#41;&#46;</p><p id="par0295" class="elsevierStylePara elsevierViewall">On the other hand&#44; mortality was evaluated and stratified according to the geographical setting of the studies &#40;Europe<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>United States versus others&#41;&#44; as can be seen in Supplementary Figure 1&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">The OR was 1&#46;51 &#40;95&#37;CI&#58; 0&#46;92&#8211;2&#46;49&#41; for Europe<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>the United States&#44; while the OR was 1&#46;42 &#40;95&#37;CI&#58; 0&#46;22&#8211;7&#46;33&#41; for the rest of countries&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">Nevertheless&#44; it should be noted that high heterogeneity persisted &#40;I2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>79&#46;00&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;00001&#41;&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">The difference of means for PaO2&#47;FiO2 was &#8722;43&#46;16<span class="elsevierStyleHsp" style=""></span>mmHg &#40;95&#37;CI&#58; &#8722;56&#46;40 to &#8722;29&#46;92&#41; with a low heterogeneity index &#40;I2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;25&#41;&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">These results indicate that the mean for the group of patients that developed atraumatic PNX and&#47;or PNMD was lower than in the group that did not develop the studied event&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">Specifically&#44; the difference was greater in the subgroup that developed PNMD&#44; with an estimated difference of means of &#8722;45&#46;89 &#40;95&#37;CI&#58; &#8722;70&#46;45 to &#8722;21&#46;33&#41;&#44; but with a high heterogeneity index &#40;I2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;12&#41;&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">However&#44; in the case of the development of PNX&#44; the estimated differences of means were similar to those of the previous subgroup&#44; but with a low heterogeneity index &#40;I2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;68&#41;&#44; as can be seen in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0330" class="elsevierStylePara elsevierViewall">It is important to point out that the limited sample size and number of studies included in the forest plot make it necessary to interpret these articles with caution&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Publication and risk of bias assessment</span><p id="par0335" class="elsevierStylePara elsevierViewall">The quality of the studies included in the meta-analysis was assessed according to the risk of selection&#44; comparison and outcome bias&#44; as indicated by the NOS&#46;</p><p id="par0340" class="elsevierStylePara elsevierViewall">The mean score of the global studies was 5&#46;91 &#40;median 5&#46;5&#44; range 4&#8211;8&#41;&#46;</p><p id="par0345" class="elsevierStylePara elsevierViewall">Fifty percent of the studies &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41; presented a high risk of bias &#40;score<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; one-quarter &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; presented a moderate risk of bias &#40;score 6&#8211;7&#41;&#44; and the remaining 25&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; showed a low risk of bias &#40;score 8&#8211;9&#41;&#46;</p><p id="par0350" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a> summarizes the main results of the risk of bias assessment&#44; which can be consulted more in detail in Supplementary Figure 2&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0355" class="elsevierStylePara elsevierViewall">The publication bias referred to mortality risk in patients with atraumatic PNX and&#47;or PNMD was represented by a funnel plot&#44; as can be seen in <a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#46; The plot evidences no significant bias&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0360" class="elsevierStylePara elsevierViewall">This was verified by the Egger test for the effect of small studies&#44; which was not statistically significant&#44; as can be seen in Supplementary Figure 3&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Discussion</span><p id="par0365" class="elsevierStylePara elsevierViewall">This meta-analysis documents and combines the available information on the association of developing atraumatic PNX&#44; PNMD or PNPC&#44; whether spontaneous in patients not subjected to MV or attributable to barotrauma in patients subjected to MV&#44; in some groups of patients with COVID-19 admitted to the ICU&#46;</p><p id="par0370" class="elsevierStylePara elsevierViewall">Although our results appear to indicate a positive association with in-hospital mortality&#44; the summarizing estimates must be interpreted with caution due to the great heterogeneity observed and the many studies with low to medium methodological quality&#46;</p><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">COVID-19-associated lung weakness&#58; a disorder to be defined&#63;</span><p id="par0375" class="elsevierStylePara elsevierViewall">The previously reported coronavirus epidemics &#40;SARS in China&#44; in 2002&#41; evidenced an association between the clinical presentation of pneumonia and the development of PNX and PNMD&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0380" class="elsevierStylePara elsevierViewall">Some viruses of the SARS family are characterized by a cell penetration mechanism through angiotensin-converting enzyme II &#40;ACE II&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0385" class="elsevierStylePara elsevierViewall">Pneumocytes have abundant ACE II receptors but are not the only cells in the human body to have such receptors&#46;</p><p id="par0390" class="elsevierStylePara elsevierViewall">In effect&#44; the gastrointestinal tract is also characterized by abundant ACE II receptors&#44; and different therapeutic strategies targeted to these molecules have been investigated in certain disease processes such as type 2 diabetes or Crohn&#39;s disease&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Likewise&#44; there have been reports of spontaneous pneumoperitoneum in seriously ill patients with COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0395" class="elsevierStylePara elsevierViewall">The host response to the virus is based on the prolonged release of proinflammatory cytokines and antibodies targeted to this intracellular microorganism&#44; and the alveolar wall is damaged as a consequence of this immune attack&#46;</p><p id="par0400" class="elsevierStylePara elsevierViewall">The intervention of the perialveolar macrophages accounts for the observed radiological condensation and the impossibility of adequate gas exchange&#44; which triggers a decrease in PaO2&#47;FiO2 and the development of ARDS&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0405" class="elsevierStylePara elsevierViewall">Such alveolar rupture has been suggested to represent the pathophysiological basis of spontaneous PNX and PNMD in non-ventilated patients&#46;</p><p id="par0410" class="elsevierStylePara elsevierViewall">In contrast&#44; PNX associated with barotrauma occurs as a result of the so-called Macklin effect&#46;</p><p id="par0415" class="elsevierStylePara elsevierViewall">This effect accounts for the dissecting action exerted by the intrapulmonary air upon the bronchopulmonary interstice towards the lung hilum&#44; at the mediastinal level&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0420" class="elsevierStylePara elsevierViewall">Both clinical conditions constitute medical emergencies requiring rapid intervention&#46;</p><p id="par0425" class="elsevierStylePara elsevierViewall">Such events are mainly managed by inserting a chest drain combined with ventilatory support involving a positive end-expiratory pressure &#40;PEEP&#41; as low as possible&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0430" class="elsevierStylePara elsevierViewall">These authors also consider ventilator-induced lung injury &#40;VILI&#41; to be a possible causal mechanism&#44; and have proposed some preventive measures to palliate its development&#44; such as the limitation of tidal volume and breathing effort&#44; the optimum adjustment of PEEP to each patient&#44; and efforts to identify which patients genuinely intubation and MV&#46;</p><p id="par0435" class="elsevierStylePara elsevierViewall">On the other hand&#44; it must be mentioned that computed tomography &#40;CT&#41; has been crucial for diagnosis in most of the studies found in the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a></p><p id="par0440" class="elsevierStylePara elsevierViewall">The uncertainty as to whether such conditions truly constitute a complication inherent to the disease or instead reflect the improved diagnostic performance of the ordered tests led Knox et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> to carry out a multicenter study evaluating the pre-pandemic cases of PNX and PNMD versus those occurring during the pandemic&#44; in a large cohort of critically ill patients&#46;</p><p id="par0445" class="elsevierStylePara elsevierViewall">Their data indicated that there is indeed a greater risk of developing atraumatic PNX as a complication of COVID-19&#46; These results are consistent with our findings&#44; though with a lesser risk and a more limited confidence interval&#46;</p><p id="par0450" class="elsevierStylePara elsevierViewall">It has been demonstrated that COVID-19 causes lung weakness that may be associated with the development of atraumatic PNX and PNMD&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> The identification of such events as being atraumatic could increase the homogeneity of the studies focused on the same type of event&#46;</p><p id="par0455" class="elsevierStylePara elsevierViewall">For this reason&#44; we propose the identification of a new clinical entity referred to as COVID-19-Associated Lung Weakness &#40;CALW&#41;&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Limitations and applicability of the results</span><p id="par0460" class="elsevierStylePara elsevierViewall">Our study has several limitations&#46;</p><p id="par0465" class="elsevierStylePara elsevierViewall">Firstly&#44; the great heterogeneity of the included studies implies that the results obtained must be interpreted with caution&#46;</p><p id="par0470" class="elsevierStylePara elsevierViewall">This heterogeneity is explained by the variability of the study designs and the low to medium methodological quality of most of the articles&#46;</p><p id="par0475" class="elsevierStylePara elsevierViewall">Secondly&#44; mention must be made of the high risk of bias referred to adequate monitoring of the case-control study in assessing mortality in the meta-analysis&#46;</p><p id="par0480" class="elsevierStylePara elsevierViewall">Although the inclusion of this study increased the sensitivity of the search and minimized possible publication bias&#44; it could complicate the interpretation of this analysis&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0485" class="elsevierStylePara elsevierViewall">On the other hand&#44; and from a methodological perspective&#44; no authors of previous studies were contacted to allow more in-depth knowledge of different aspects of the published data and about studies not yet published&#44; since no articles from the grey literature were included&#46;</p><p id="par0490" class="elsevierStylePara elsevierViewall">Furthermore&#44; the search strategy might not have reached optimum sensitivity and specificity levels&#44; since the cluster search for other identified articles yielded several studies that we had not identified in the literature search&#46;</p><p id="par0495" class="elsevierStylePara elsevierViewall">As strong points&#44; the present study establishes the need to identify CALW as a clinical entity&#44; since it could improve the homogeneity of future studies and allow greater consensus in management of the critical patient&#46;</p><p id="par0500" class="elsevierStylePara elsevierViewall">Likewise&#44; it could establish differences between the identification of confounding factors and factors that may truly intervene or predict the development of the events described in this study&#46;</p><p id="par0505" class="elsevierStylePara elsevierViewall">Lastly&#44; the general sequelae of COVID-19 have been clinically relevant&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31&#44;32</span></a></p><p id="par0510" class="elsevierStylePara elsevierViewall">This would make it interesting to know the possible long-term sequelae among patients who have recovered from these events&#46;</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Conclusions</span><p id="par0515" class="elsevierStylePara elsevierViewall">Mortality among COVID-19 patients was higher among those who developed atraumatic PNX and&#47;or PNMD than in those who did not&#46;</p><p id="par0520" class="elsevierStylePara elsevierViewall">The mean PaO2&#47;FiO2 was lower among the COVID-19 patients who developed atraumatic PNX and&#47;or PNMD&#46;</p><p id="par0525" class="elsevierStylePara elsevierViewall">We propose the application of the term COVID-19-Associated Lung Weakness &#40;CALW&#41; to those cases of atraumatic PNX and PNMD in COVID-19 patients not subjected to ventilation or who receive low-pressure ventilation &#40;tidal volume<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>6&#8722;8<span class="elsevierStyleHsp" style=""></span>ml&#47;kg body weight&#41;&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Author contributions</span><p id="par0530" class="elsevierStylePara elsevierViewall">Study conception and design&#58; P&#46;R&#46;G&#46;&#44; M&#46;R&#46;I&#46; and A&#46;C&#46;C&#46;&#59; methodology&#58; P&#46;R&#46;G&#46;&#44; A&#46;J&#46;L&#46;R&#46;B&#46;&#44; A&#46;C&#46;C&#46;&#44; A&#46;R&#46;L&#46; and M&#46;R&#46;I&#46;&#59; formal analysis and data compilation&#58; P&#46;R&#46;G&#46;&#44; M&#46;R&#46;P&#46; and C&#46;J&#46;G&#46;&#59; writing of the manuscript&#58; P&#46;R&#46;G&#46;&#44; M&#46;R&#46;P&#46;&#44; C&#46;J&#46;G&#46;&#44; P&#46;J&#46;G&#46; and A&#46;J&#46;L&#46;R&#46;B&#46;&#59; review and editing of the manuscript&#44; P&#46;R&#46;G&#46;&#44; M&#46;R&#46;P&#46;&#44; C&#46;J&#46;G&#46;&#44; P&#46;J&#46;G&#46;&#44; A&#46;J&#46;L&#46;R&#46;B&#46;&#44; A&#46;C&#46;C&#46;&#44; A&#46;R&#46;L&#46;&#44; M&#46;R&#46;I&#46; and A&#46;C&#46;C&#46;&#59; supervision&#44; A&#46;C&#46;C&#46;&#44; M&#46;R&#46;I&#46; and A&#46;J&#46;L&#46;R&#46;B&#46; All the authors have read and approved the manuscript version submitted for publication&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Funding</span><p id="par0535" class="elsevierStylePara elsevierViewall">This study has not received funding of any kind&#46; Financiaci&#243;n de la tasa de acceso abierto&#58; Universidad de Granada&#47;CBUA&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0195">Conflicts of interest</span><p id="par0540" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">To assess mortality and different clinical factors derived from the development of atraumatic pneumothorax &#40;PNX&#41; and&#47;or pneumomediastinum &#40;PNMD&#41; in critically ill patients as a consequence of COVID-19-associated lung weakness &#40;CALW&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Systematic review with meta-analysis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Setting</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Intensive Care Unit &#40;ICU&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Participants</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Original research evaluating patients&#44; with or without the need for protective invasive mechanical ventilation &#40;IMV&#41;&#44; with a diagnosis of COVID-19&#44; who developed atraumatic PNX or PNMD on admission or during hospital stay&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interventions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Data of interest were obtained from each article and analyzed and assessed by the Newcastle-Ottawa Scale&#46; The risk of the variables of interest was assessed with data derived from studies including patients who developed atraumatic PNX or PNMD&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Main variables of interest</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Mortality&#44; mean ICU stay and mean PaO2&#47;FiO2 at diagnosis&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Information was collected from 12 longitudinal studies&#46; Data from a total of 4901 patients were included in the meta-analysis&#46; A total of 1629 patients had an episode of atraumatic PNX and 253 patients had an episode of atraumatic PNMD&#46; Despite the finding of significantly strong associations&#44; the great heterogeneity between studies implies that the interpretation of results should be made with caution&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Mortality among COVID-19 patients was higher in those who developed atraumatic PNX and&#47;or PNMD compared to those who did not&#46; The mean PaO2&#47;FiO2 index was lower in patients who developed atraumatic PNX and&#47;or PNMD&#46; We propose grouping these cases under the term COVID-19-associated lung weakness &#40;CALW&#41;&#46;</p></span>"
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        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objetivo</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Evaluar la mortalidad y diversos factores cl&#237;nicos derivados del desarrollo de neumot&#243;rax &#40;NTX&#41; y&#47;o neumomediastino &#40;NMD&#41; atraum&#225;ticos en pacientes cr&#237;ticos como consecuencia de la debilidad pulmonar asociada a COVID-19 &#40;DPAC&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Dise&#241;o</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Revisi&#243;n sistem&#225;tica con metaan&#225;lisis&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">&#193;mbito</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Unidad de Cuidados Intensivos &#40;UCI&#41;&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Participantes</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Investigaciones originales en las que se evaluase a pacientes&#44; con o sin necesidad de ventilaci&#243;n mec&#225;nica invasiva &#40;VMI&#41;&#44; con diagn&#243;stico de COVID-19 que hubiesen desarrollado NTX o NMD atraum&#225;ticos al ingreso o durante su estancia hospitalaria&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Intervenciones</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Se obtuvieron los datos de inter&#233;s de cada art&#237;culo que fueron analizados y evaluados por la Escala Newcastle-Ottawa&#46; El riesgo de las variables de inter&#233;s principales se evalu&#243; por los datos derivados de los estudios que incluyeron a pacientes que desarrollaron NTX o NMD atraum&#225;ticos&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables de inter&#233;s principals</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Mortalidad&#44; estancia media en la UCI y PaO2&#47;FiO2 media en el momento diagn&#243;stico&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Se recogieron datos de 12 estudios longitudinales&#46; En el metaan&#225;lisis se incluyeron datos de un total de 4&#46;901 pacientes&#44; entre los cuales 1&#46;629 presentaron un episodio de NTX y 253 de NMD atraum&#225;ticos&#46; A pesar de encontrar asociaciones significativamente fuertes&#44; la alta heterogeneidad entre los estudios hace que la interpretaci&#243;n de los resultados deba hacerse con cautela&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusiones</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">La mortalidad de los pacientes COVID-19 fue mayor en los que desarrollaron NTX y&#47;o NMD atraum&#225;ticos con respecto a los que no lo hicieron&#46; La media del &#237;ndice PaO2&#47;FiO2 fue menor en los pacientes que desarrollaron NTX y&#47;o NMD atraum&#225;ticos&#46; Proponemos agrupar bajo el t&#233;rmino de<span class="elsevierStyleItalic">DPAC</span> estos casos&#46;</p></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flowchart of the selection of the studies included in the systematic review according to the PRISMA guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p>"
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      1 => array:8 [
        "identificador" => "fig0010"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Forest plot assessing mortality among the patients with atraumatic PNX&#44; PNMD or PNX with PNMD&#46;</p>"
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        "identificador" => "fig0015"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Forest plot corresponding to the ventilatory parameter PaO2&#47;FiO2 in the group of patients with atraumatic PNX or PNMD&#44; stratified according to the event occurred&#46;</p>"
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      ]
      3 => array:8 [
        "identificador" => "fig0020"
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        "figura" => array:1 [
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Graphic summary of the risk of bias of the studies included in the meta-analysis&#46; The elements evaluated are classified according to risk of selection&#44; comparison and outcome&#46;</p>"
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      4 => array:8 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Funnel plot corresponding to the assessment of publication risk of the studies included in the meta-analysis&#44; in relation to mortality&#46;</p>"
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      5 => array:8 [
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          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">N&#58; number of subjects&#59; NA&#58; information not available&#59; ICU&#58; Intensive Care Unit&#59; M&#58; males&#59; F&#58; females&#59; AHT&#58; arterial hypertension&#59; DM&#58; diabetes mellitus&#59; CD&#58; coronary disease&#59; CHF&#58; chronic heart failure&#59; CKD&#58; chronic kidney disease&#59; AD&#58; autoimmune disease&#59; COPD&#58; chronic obstructive pulmonary disease&#59; ILD&#58; interstitial lung disease&#59; HFNO&#58; high-flow nasal oxygen&#59; NIMV&#58; noninvasive mechanical ventilation&#59; IMV&#58; invasive mechanical ventilation&#59; MV&#58; mechanical ventilation&#59; PNX&#58; pneumothorax&#59; PNMD&#58; pneumomediastinum&#59; PNPC&#58; pneumopericardium&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study and year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gender&#58; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comorbidities&#58; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ventilatory support&#58; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Event&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ICU stay<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Cohort studies</span></span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Taha et al&#46; 2022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">334&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58;188 &#40;56&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">COPD&#58;75 &#40;22&#41;&#59; Asma&#58;34 &#40;10&#41;&#59; AHT&#58;266 &#40;79&#41;&#59; DM&#58;200 &#40;60&#41;&#59; CD 67 &#40;20&#41;&#59; CHF&#58;68 &#40;20&#41;&#59; Ictus&#58;49 &#40;14&#41;&#59; CKD&#58;56 &#40;16&#41;&#59; AD&#58;18 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HFNO&#58; 7 &#40;2&#46;1&#41;&#59; NIMV&#58; 28 &#40;8&#46;4&#41;&#59; IMV&#58; 299 &#40;89&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PNX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;3&#8211;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#58; 148 &#40;44&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Paul et al&#46; 2021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">India&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58; 37 &#40;82&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DM&#58; 17 &#40;65&#46;3&#41;&#59; AHT&#58; 11 &#40;42&#46;3&#41;&#59; CD&#58; 5 &#40;19&#46;2&#41;&#59; Hypothyroidism&#58; 2 &#40;7&#46;6&#41;&#59; Cancer&#58; 5 &#40;19&#46;2&#41;&#59; CKD&#58; 2 &#40;7&#46;6&#41;&#59; Hypertriglyceridemia&#58; 1 &#40;3&#46;8&#41;&#59; COPD&#47;Asthma&#58; 1 &#40;3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HFNO&#58; 8 &#40;17&#46;8&#41;&#59; NIMV&#58; 10 &#40;22&#46;2&#41;&#59; IMV&#58; 7 &#40;15&#46;5&#41;&#59; O2 conventional&#58; 16 &#40;35&#46;6&#41;&#59; none&#58; 4 &#40;8&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PNX&#46; PNMD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#58; 8 &#40;17&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#214;zdemir et al&#46; 2021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Turkey&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">427&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58; 288 &#40;67&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NIMV&#58; 73 &#40;17&#46;1&#41;&#59; IMV&#58; 354 &#40;82&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PNX&#46; PNMD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#58; 139 &#40;32&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gazivoda et al 2021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">281&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58; 192 &#40;68&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arrhythmia&#58; 26 &#40;9&#46;3&#41;&#59; Asthma&#58; 22 &#40;7&#46;8&#41;&#59; CD&#58; 48 &#40;17&#46;1&#41;&#59; COPD&#58; 17 &#40;6&#41;&#59; DM&#58; 147 &#40;52&#46;3&#41;&#59; Hyperlipidemia&#58; 102 &#40;36&#46;3&#41;&#59; AHT&#58; 169 &#40;60&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IMV&#58; 281 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PNX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;5&#8722;22&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#58; 89 &#40;31&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Guven et al&#46; 2021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Turkey&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58; 51 &#40;68&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD&#46; AHT&#46; DM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IMV&#58; 75 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PNX&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#58; 24&#40;32&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Belletti et al&#46; 2021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Italy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">116&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58; 98 &#40;84&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arrhythmia&#58; 7 &#40;6&#41;&#59; Stroke&#58; 6 &#40;5&#46;2&#41;&#59; AHT&#58; 52 &#40;44&#46;8&#41;&#59; Asthma&#58; 4 &#40;3&#46;5&#41;&#59; COPD&#58; 2 &#40;1&#46;7&#41;&#59; Chronic neurological problem&#58; 3 &#40;2&#46;6&#41;&#59; CKD&#58; 7 &#40;6&#41;&#59; DM&#58; 19 &#40;16&#46;4&#41;&#59; Cancer&#58; 4 &#40;3&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IMV&#58; 116 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PNX&#46; PNMD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;14&#46;5&#8722;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#58; 18 &#40;15&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ozsoy et al&#46; 2021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Turkey&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58; 32 &#40;45&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AHT&#58; 37 &#40;52&#46;9&#41;&#59; DM&#58; 29 &#40;41&#46;4&#41;&#59; Asthma&#58; 17 &#40;24&#46;3&#41;&#59; COPD&#58; 2 &#40;2&#46;9&#41;&#59; CKD&#58; 7 &#40;10&#41;&#59; Cancer&#58; 10 &#40;14&#46;3&#41;&#59; CD&#58; 5 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No MV&#58; 56 &#40;80&#41;&#59; MV&#58; 14 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PNX&#46; PNMD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#58; 38 &#40;54&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Elsaaran et al&#46; 2021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kuwait&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">343&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58; 70 &#40;65&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NIMV&#58; 64 &#40;18&#46;8&#41;&#59; IMV&#58; 279 &#40;81&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PNX&#46; PNMD&#46; PNPC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#58; 37 &#40;34&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Jones et al&#46; 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">United Kingdom&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58; 61 &#40;73&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asthma&#58; 10 &#40;12&#46;8&#41;&#59; Connective tissue disease&#58; 4 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NIMV&#58; 34 &#40;41&#41;&#59; IMV&#58; 49 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PNX&#46; PNMD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#58; 22 &#40;26&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Kahn et al&#46; 2021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#58; 55 &#40;73&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AHT&#58; 36 &#40;48&#41;&#59; DM II&#58; 43 &#40;57&#46;3&#41;&#59; COPD&#58; 1 &#40;1&#46;3&#41;&#59; Asthma&#58; 2 &#40;2&#46;7&#41;&#59; CKD&#58; 14 &#40;18&#46;7&#41;&#59; Cirrhosis&#58; 3 &#40;4&#41;&#59; Cancer&#58; 4 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No IMV&#58; 36 &#40;48&#41;&#59; IMV&#58; 39 &#40;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PNX&#46; PNMD&#46; PNPC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;15&#8722;30&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">F&#58; 20 &#40;26&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lemmers et al&#46; 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Italy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">332&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">M&#58; 239 &#40;72&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DM&#58; 73 &#40;22&#41;&#59; AHT&#58; 186 &#40;56&#41;&#59; COPD&#58; 26 &#40;7&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">IMV&#58; 332 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">PNMD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9 &#40;5&#8211;18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">F&#58; 93 &#40;28&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Case-control study</span></span></td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Reis et al&#46; 2022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">174&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">61<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">M&#58; 112 &#40;64&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">COPD&#58; 14 &#40;8&#41;&#59; CKD&#58; 26 &#40;14&#46;9&#41;&#59; Asthma&#58; 27 &#40;15&#46;5&#41;&#59; AHT&#58;107 &#40;61&#46;5&#41;&#59; CHF&#58; 11 &#40;6&#46;3&#41;&#59; DM&#58; 78 &#40;44&#46;8&#41;&#59; Obesity&#58; 70 &#40;40&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">PNMD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">F&#58; 62 &#40;35&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                            0 => "T&#46; Pham"
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