title: A meta-analysis of potential risks of low levels of protein Z for diseases related to vascular thrombosis.
abstract: The relationship between protein Z levels and thrombosis is controversial. We performed a systematic review and meta-analysis of the available studies to assess the association between protein Z and vascular thrombotic diseases. We conducted an electronic literature search through MedLine, Embase, Google Scholar, Web of Science, The Cochrane Library, bibliographies of retrieved articles and abstracts of congresses up to October, 2009. Studies were included if they analysed protein Z levels in patients with vascular thrombotic diseases. After the review process, 28 case-control studies (33 patient cohorts), including 4,218 patients with thrombotic diseases and 4,778 controls, were selected for analysis. The overall analysis using a random-effects model showed that low protein Z levels were associated with an increased risk of thrombosis (odds ratio [OR] 2.90, 95% confidence interval [CI] 2.05-4.12; p<0.00001). On subgroup analysis, a significant association was found between low protein Z levels and arterial vascular diseases (OR 2.67, 95%CI 1.60-4.48; p=0.0002), pregnancy complications (OR 4.17, 95%CI 2.31-7.52; p<0.00001), and venous thromboembolic diseases (OR 2.18, 95%CI 1.19-4.00; p=0.01). The results of this meta-analysis are consistent with a role for protein Z deficiency in thrombotic diseases, including arterial thrombosis, pregnancy complications and venous thromboembolism.
authors.affiliation: Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Florence, Italy. francescosofi@gmail.com
authors.forename: Francesco
authors.initials: F
authors.lastname: Sofi
authors.forename: Francesca
authors.initials: F
authors.lastname: Cesari
authors.forename: Rosanna
authors.initials: R
authors.lastname: Abbate
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.forename: George
authors.initials: G
authors.lastname: Broze
authors.forename: Sandra
authors.initials: S
authors.lastname: Fedi
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D001798:Blood Proteins / Q000378:metabolism*; D015536:Down-Regulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011247:Pregnancy; D017594:Publication Bias; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000097:blood* / Q000209:etiology*
chemical_list: D015415:Biomarkers; D001798:Blood Proteins; C026080:plasma protein Z