Gu Wan-Jie, Wan You-Dong, Tie Hong-Tao, Kan Quan-Cheng, Sun Tong-Wen
Department of Anaesthesiology, the First Affiliated Hospital, Guangxi Medical University, Nanning, China ; Department of Integrated Intensive Care Unit, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, China.
Department of Integrated Intensive Care Unit, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, China.
PLoS One. 2014 Feb 27;9(2):e90426. doi: 10.1371/journal.pone.0090426. eCollection 2014.
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.
We 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.
Seven 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 (I(2)=18.9%; p=0.286). However, the asymmetric funnel plot and Egger's test (p=0.007) suggested publication bias may exist.
Our 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.
既往糖尿病对危重症患者急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）发生发展的影响尚不清楚。我们进行了一项队列研究的荟萃分析，以评估有和无既往糖尿病的危重症患者发生ALI/ARDS的风险。
我们检索了从数据库建库至2013年9月的PubMed和Embase数据库，查找评估既往糖尿病对ALI/ARDS发生影响的队列研究。适当情况下，使用随机或固定效应模型计算合并比值比（OR）及95%置信区间（CI）。
荟萃分析纳入了7项队列研究，共12,794名参与者，其中2,937例有既往糖尿病，2,457例发生ALI/ARDS。固定效应模型荟萃分析显示，既往糖尿病与ALI/ARDS风险降低相关（OR 0.66；95%CI，0.55 - 0.80；p<0.001），各研究间异质性较低（I(2)=18.9%；p=0.286）。然而，漏斗图不对称及Egger检验（p=0.007）提示可能存在发表偏倚。
我们的荟萃分析表明，既往糖尿病与成年危重症患者ALI/ARDS风险降低相关。然而，由于纳入研究中存在潜在偏倚和混杂因素，对该结果的解释应谨慎。
