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Protease activity as a prognostic factor for wound healing in complex wounds
- Source :
- Westby, M J, Norman, G, Watson, R E B, Cullum, N A & Dumville, J C 2020, ' Protease activity as a prognostic factor for wound healing in complex wounds ', Wound Repair and Regeneration . https://doi.org/10.1111/wrr.12835
- Publication Year :
- 2020
- Publisher :
- Wiley, 2020.
-
Abstract
- Healing mechanisms are disrupted in complex wounds. Proteases may persist longer in nonhealing wounds. We sought to investigate whether protease activity, protease inhibitor activity, or their combinations are independent prognostic factors for healing of complex wounds. We searched MEDLINE, EMBASE, CINAHL, and The Cochrane Library to March 2019. Study selection comprised longitudinal studies assessing the independent effect of proteases, their inhibitors or ratios of the two, on healing of complex wounds, while controlling for confounding factors. Two reviewers independently extracted data and assessed risk of bias. We conducted meta-analyses separately for proteases, inhibitors, and ratios. We graded the evidence certainty (quality). We identified eight eligible studies in 10 cohorts involving 343 participants. Risk of bias was moderate or high. Elevated protease activity may be associated with less wound healing (standardized mean difference [SMD]: −0.41, 95% CI −0.72 to −0.11; nine cohorts); and elevated protease inhibitor activity with more healing (SMD: 0.37, 95% CI 0.06-0.68; five cohorts), this is low certainty evidence. Increased protease: inhibitor ratios may be associated with less healing (SMD −0.47, 95% CI −0.94 to −0.01; four cohorts), but this evidence is of very low certainty. Heterogeneity in protease activity was unexplained by prespecified subgroup analyses for wound type or protease activity status, but partially explained by protease class. Posthoc analysis suggested elevated levels of a particular protease, MMP-1, may be associated with more healing and other proteases with less healing. This is low/very low certainty evidence. Limitations were small included studies at moderate or high risk of bias, and the use of posthoc analyses. Elevated protease activity and protease: inhibitor ratios may be associated with less healing, and elevated inhibitor levels with more healing. There may be important differences between MMP-1 and other proteases. High quality research is needed to explore these new findings further.
- Subjects :
- Oncology
Wound Healing
medicine.medical_specialty
Protease inhibitor activity
Prognostic factor
Proteases
Protease
business.industry
medicine.medical_treatment
Confounding
Dermatology
Cochrane Library
Prognosis
030207 dermatology & venereal diseases
03 medical and health sciences
0302 clinical medicine
Strictly standardized mean difference
Internal medicine
medicine
Humans
Protease Inhibitors
Surgery
Wound healing
business
Peptide Hydrolases
Subjects
Details
- ISSN :
- 1524475X and 10671927
- Volume :
- 28
- Database :
- OpenAIRE
- Journal :
- Wound Repair and Regeneration
- Accession number :
- edsair.doi.dedup.....d1a5174fd0729bbec7fb6f842e8c4635