Living bio-drug therapies using mesenchymal stem cells and exosomes for mechanically ventilated patients with acute respiratory distress syndrome: A systematic review and meta-analysis

Table 2 Summary of outcomes analyzed by conventional pairwise meta-analysis and network meta-analysis, including pooled effect estimates with 95% confidence intervals and P values

Outcome	Analysis	Comparison(s)	Effect estimate (95%CI), P value	Notes
Duration of MV	CMA	MSCs vs control	WMD: -2.73 (-8.00 to 2.53), P = 0.31	Not significant; sensitivity analysis showed -4.84 days
MV-free days	CMA	MSCs vs control	WMD: -0.84 (-4.33 to 2.65), P = 0.64	No difference
	NMA	MSCs vs control	WMD: -0.59 (-5.23 to 4.04)
	NMA	Exosomes vs control	WMD: 2.78 (-6.69 to 12.26)
	NMA	MSCs vs exosomes	WMD: 3.38 (-7.17 to 13.93)
Length of hospital stay	CMA	MSCs vs control	WMD: 2.11 (-7.82 to 12.04), P = 0.68	No difference; heterogeneity reduced after sensitivity analysis
Length of ICU stay	CMA	MSCs vs control	WMD: 0.97 (-3.84 to 5.78), P = 0.69	No difference
6-MWD	CMA	MSCs vs control	WMD: 0.08 (-27.08 to 27.08), P = 1.00	No difference; heterogeneity reduced after sensitivity analysis
Mortality	CMA	MSCs/exosomes vs control	OR: 0.77 (0.56-1.06), P = 0.11	Trend toward reduction, not significant
	NMA	MSCs vs control	OR: 0.84 (0.58-1.22)
	NMA	Exosomes vs control	OR: 0.62 (0.30-1.28)
	NMA	Exosomes vs MSCs	OR: 0.74 (0.33-1.66)
Adverse events	CMA	MSCs/exosomes vs control	OR: 1.04 (0.75-1.44), P = 0.80	No difference
	NMA	MSCs vs control	OR: 1.02 (0.72-1.45)
	NMA	Exosomes vs control	OR: 1.34 (0.56-3.20)
	NMA	Exosomes vs MSCs	OR: 1.31 (0.52-3.34)

CI: Confidence interval; MV: Mechanical ventilation; CMA: Conventional meta-analysis; MSCs: Mesenchymal stem cells; WMD: Weighted mean difference; NMA: Network meta-analysis; ICU: Intensive care unit; 6-MWD: Six-minute walk distance; OR: Odds ratio.