Abstract
BackgroundThe impact of pre-existing diabetes on the development of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) in critically ill patients remains unclear. We performed a meta-analysis of cohort studies to evaluate the risk of ALI/ARDS in critically ill patients with and without pre-existing diabetes.Materials and MethodsWe searched PubMed and Embase from the inception to September 2013 for cohort studies assessing the effect of pre-existing diabetes on ALI/ARDS occurrence. Pooled odds ratio (OR) with 95% confidence interval (CI) was calculated using random- or fixed-effect models when appropriate.ResultsSeven cohort studies with a total of 12,794 participants and 2,937 cases of pre-existing diabetes, and 2,457 cases of ALI/ARDS were included in the meta-analysis. A fixed-effects model meta-analysis showed that pre-existing diabetes was associated with a reduced risk of ALI/ARDS (OR 0.66; 95% CI, 0.55–0.80; p<0.001), with low heterogeneity among the studies (I2 = 18.9%; p = 0.286). However, the asymmetric funnel plot and Egger's test (p = 0.007) suggested publication bias may exist.ConclusionsOur meta-analysis suggests that pre-existing diabetes was associated with a decreased risk of ALI/ARDS in critically ill adult patients. However, the result should be interpreted with caution because of the potential bias and confounding in the included studies.
Highlights
Acute lung injury (ALI) is a syndrome characterized by hypoxemia, noncardiogenic pulmonary edema, low lung compliance and widespread capillary leakage
Seven cohort studies with a total of 12,794 participants and 2,937 cases of pre-existing diabetes, and 2,457 cases of ALI/acute respiratory distress syndrome (ARDS) were included in the meta-analysis
A fixed-effects model meta-analysis showed that pre-existing diabetes was associated with a reduced risk of ALI/ARDS, with low heterogeneity among the studies (I2 = 18.9%; p = 0.286)
Summary
Acute lung injury (ALI) is a syndrome characterized by hypoxemia, noncardiogenic pulmonary edema, low lung compliance and widespread capillary leakage. The proportion of critically ill patients with diabetes is growing as a result of the worldwide increase in diabetes. Pre-existing diabetes has been a risk factor of acute kidney injury in critically ill patients [3,4], and has been associated with an increased mortality of surgical ICU [5], but in some other studies, diabetes does not alter mortality in ICU patients [6,7,8]. The impact of pre-existing diabetes on the development of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) in critically ill patients remains unclear. We performed a meta-analysis of cohort studies to evaluate the risk of ALI/ARDS in critically ill patients with and without pre-existing diabetes
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