Abu-Ashour Waseem, Twells Laurie, Valcour James, Randell Amy, Donnan Jennifer, Howse Patricia, Gamble John-Michael
School of Pharmacy, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
BMJ Open Diabetes Res Care. 2017 May 27;5(1):e000336. doi: 10.1136/bmjdrc-2016-000336. eCollection 2017.
To quantify the association between diabetes and the risk of incident infections by conducting a systematic review and meta-analysis.
Two reviewers independently screened articles identified from PubMed, EMBASE, Cochrane Library, IPA, and Web of Science databases. Cohort studies (CS) or case-control studies (CCS) evaluating the incidence of infections in adults with diabetes were included. Infections were classified as: skin and soft tissue, respiratory, blood, genitourinary, head and neck, gastrointestinal, bone, viral, and non-specified infections. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Summary crude and adjusted OR with 95% CIs were calculated using random effects models, stratified by study design. Heterogeneity was measured using the Istatistic and explored using subgroup analyses.
A total of 345 (243 CS and 102 CCS) studies were included. Combining adjusted results from all CS, diabetes was associated with an increased incidence of skin (OR 1.94, 95% CI 1.78 to 2.12), respiratory (OR 1.35, 95% CI 1.28 to 1.43), blood (OR 1.72, 95% CI 1.48 to 2.00), genitourinary (OR 1.61, 95% CI 1.42 to 1.82), head and neck (OR 1.17, 95% CI 1.13 to 1.22), gastrointestinal (OR 1.48, 95% CI 1.40 to 1.57), viral (OR 1.29, 95% CI 1.13 to 1.46), and non-specified (OR 1.84, 95% CI 1.66 to 2.04) infections. A stronger association was observed among CCS: skin (OR 2.64, 95% CI 2.20 to 3.17), respiratory (OR 1.62, 95% CI 1.37 to 1.92), blood (OR 2.40, 95% CI 1.68 to 3.42), genitourinary (OR 2.59, 95% CI 1.60 to 4.17), gastrointestinal (OR 3.61, 95% CI 2.94 to 4.43), and non-specified (OR 3.53, 95% CI 2.62 to 4.75).
Diabetes is associated with an increased risk of multiple types of infections. A high degree of heterogeneity was observed; however, subgroup analysis decreased the amount of heterogeneity within most groups. Results were generally consistent across types of infections.
通过进行系统评价和荟萃分析，量化糖尿病与感染发生风险之间的关联。
两名评审员独立筛选从PubMed、EMBASE、Cochrane图书馆、IPA和科学网数据库中识别出的文章。纳入评估糖尿病成人感染发生率的队列研究（CS）或病例对照研究（CCS）。感染分为：皮肤和软组织、呼吸道、血液、泌尿生殖系统、头颈部、胃肠道、骨骼、病毒感染和未明确分类的感染。使用纽卡斯尔-渥太华质量评估量表评估研究质量。采用随机效应模型计算汇总粗OR和调整后的OR以及95%可信区间，并按研究设计进行分层。使用I统计量测量异质性，并通过亚组分析进行探讨。
共纳入345项研究（243项CS和102项CCS）。综合所有CS的调整结果，糖尿病与皮肤感染（OR 1.94，95%可信区间1.78至2.12）、呼吸道感染（OR 1.35，95%可信区间1.28至1.43）、血液感染（OR 1.72，95%可信区间1.48至2.00）、泌尿生殖系统感染（OR 1.61，95%可信区间1.42至1.82）、头颈部感染（OR 1.17，95%可信区间1.13至1.22）、胃肠道感染（OR 1.48，95%可信区间1.40至1.57）、病毒感染（OR 1.29，95%可信区间1.13至1.46）和未明确分类的感染（OR 1.84，95%可信区间1.66至2.04）的发生率增加相关。在CCS中观察到更强的关联：皮肤感染（OR 2.64，95%可信区间2.20至3.17）、呼吸道感染（OR 1.62，95%可信区间1.37至1.92）、血液感染（OR 2.40，95%可信区间1.68至3.42）、泌尿生殖系统感染（OR 2.59，95%可信区间1.60至4.17）、胃肠道感染（OR 3.61，95%可信区间2.94至4.43）和未明确分类的感染（OR 3.53，95%可信区间2.62至4.75）。
糖尿病与多种类型感染的风险增加相关。观察到高度异质性；然而，亚组分析减少了大多数组内的异质性量。不同类型感染的结果总体一致。
