Wang Yun-Yun, Huang Qiao, Shen Quan, Zi Hao, Li Bing-Hui, Li Ming-Zhen, He Shao-Hua, Zeng Xian-Tao, Yao Xiaomei, Jin Ying-Hui
Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
Department of Evidence-Based Medicine and Clinical Epidemiology, Second Clinical College, Wuhan University, Wuhan, China.
Front Med (Lausanne). 2021 Jun 10;8:630765. doi: 10.3389/fmed.2021.630765. eCollection 2021.
The morbidity and mortality of coronavirus disease 2019 (COVID-19) are still increasing. This study aimed to assess the quality of relevant COVID-19 clinical practice guidelines (CPGs) and to compare the similarities and differences between recommendations. A comprehensive search was conducted using electronic databases (PubMed, Embase, and Web of Science) and representative guidelines repositories from December 1, 2019, to August 11, 2020 (updated to April 5, 2021), to obtain eligible CPGs. The Appraisal of Guidelines for Research and Evaluation (AGREE II) tool was used to evaluate the quality of CPGs. Four authors extracted relevant information and completed data extraction forms. All data were analyzed using R version 3.6.0 software. In total, 39 CPGs were identified and the quality was not encouragingly high. The median score (interquartile range, IQR) of every domain from AGREE II for evidence-based CPGs (EB-CPGs) versus (vs.) consensus-based CPG (CB-CPGs) was 81.94% (75.00-84.72) vs. 58.33% (52.78-68.06) in scope and purpose, 59.72% (38.89-75.00) vs. 36.11% (33.33-36.11) in stakeholder involvement, 64.58% (32.29-71.88) vs. 22.92% (16.67-26.56) in rigor of development, 75.00% (52.78-86.81) vs. 52.78% (50.00-63.89) in clarity of presentation, 40.63% (22.40-62.50) vs. 20.83% (13.54-25.00) in applicability, and 58.33% (50.00-100.00) vs. 50.00% (50.00-77.08) in editorial independence, respectively. The methodological quality of EB-CPGs were significantly superior to the CB-CPGs in the majority of domains ( < 0.05). There was no agreement on diagnosis criteria of COVID-19. But a few guidelines show Remdesivir may be beneficial for the patients, hydroxychloroquine +/- azithromycin may not, and there were more consistent suggestions regarding discharge management. For instance, after discharge, isolation management and health status monitoring may be continued. In general, the methodological quality of EB-CPGs is greater than CB-CPGs. However, it is still required to be further improved. Besides, the consistency of COVID-19 recommendations on topics such as diagnosis criteria is different. Of them, hydroxychloroquine +/- azithromycin may be not beneficial to treat patients with COVID-19, but remdesivir may be a favorable risk-benefit in severe COVID-19 infection; isolation management and health status monitoring after discharge may be still necessary. Chemoprophylaxis, including SARS-CoV 2 vaccines and antiviral drugs of COVID-19, still require more trials to confirm this.
2019冠状病毒病（COVID-19）的发病率和死亡率仍在上升。本研究旨在评估相关COVID-19临床实践指南（CPG）的质量，并比较各指南推荐意见之间的异同。于2019年12月1日至2020年8月11日（更新至2021年4月5日），通过电子数据库（PubMed、Embase和Web of Science）以及代表性指南库进行全面检索，以获取符合条件的CPG。使用研究与评价指南评估（AGREE II）工具来评估CPG的质量。四位作者提取了相关信息并填写了数据提取表。所有数据均使用R 3.6.0版软件进行分析。共识别出39份CPG，其质量不尽人意。基于证据的CPG（EB-CPG）与基于共识的CPG（CB-CPG）在AGREE II各领域的中位数得分（四分位间距，IQR）分别为：范围与目的领域，81.94%（75.00 - 84.72）对58.33%（52.78 - 68.06）；利益相关者参与领域，59.72%（38.89 - 75.00）对36.11%（33.33 - 36.11）；制定严谨性领域，64.58%（32.29 - 71.88）对22.92%（16.67 - 26.56）；表述清晰度领域，75.00%（52.78 - 86.81）对52.78%（50.00 - 63.89）；适用性领域，40.63%（22.40 - 62.50）对20.83%（13.54 - 25.00）；编辑独立性领域，58.33%（50.00 - 100.00）对50.00%（50.00 - 77.08）。在大多数领域，EB-CPG的方法学质量显著优于CB-CPG（P < 0.05）。关于COVID-19的诊断标准尚无统一意见。但少数指南显示，瑞德西韦可能对患者有益，羟氯喹啉±阿奇霉素可能无益，且在出院管理方面有更一致的建议。例如，出院后可继续进行隔离管理和健康状况监测。总体而言，EB-CPG的方法学质量高于CB-CPG。然而，仍需进一步改进。此外，COVID-19在诊断标准等主题上的推荐意见一致性存在差异。其中，羟氯喹啉±阿奇霉素可能对治疗COVID-19患者无益，但瑞德西韦在重症COVID-19感染中可能具有良好的风险效益比；出院后隔离管理和健康状况监测可能仍有必要。化学预防，包括SARS-CoV 2疫苗和COVID-19抗病毒药物，仍需更多试验来证实。
