[show abstract][hide abstract] ABSTRACT: 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.
PLoS ONE 01/2014; 9(2):e90426. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study was designed to evaluate the value of plasma cystatin C in predicting adverse cardiac events after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS).
A total of 605 patients (404 male, mean age 60.4 ± 10.6 years) with ACS underwent successful PCI. Patients were divided into 4 groups according to the level of cystatin C, which was measured before the PCI: Q1 (<1.02 mg/L), Q2 (1.02-1.16 mg/L), Q3 (1.17-1.34 mg/L), and Q4 (≥1.35 mg/L).
After a follow-up of 14.3 ± 1.7 months, the incidence of mortality, nonfatal myocardial infarction, and target lesion revascularization in the Q2, Q3, and Q4 groups was higher than in the Q1 group (P < .001). The incidence of heart failure in the Q3 and Q4 groups was higher than in the Q1 group (P < .05). Multivariate Cox regression analysis showed that cystatin C elevation was an independent predictor of major adverse cardiac events. The cumulative survival rate of the Q3 and Q4 groups was lower than in the Q1 group (P < .001).
High plasma cystatin C concentration is an independent predictor of major adverse cardiac events in patients with ACS treated with PCI.
Heart & lung: the journal of critical care 05/2012; 41(5):456-62. · 1.04 Impact Factor
[show abstract][hide abstract] ABSTRACT: To describe the clinical features and management of thallium poisoning in patients with delayed hospital admission.
Fourteen patients (median age 36 years) were admitted 9-19 days after ingesting food poisoned with thallium. Clinical and laboratory data, including blood and urine thallium concentrations, were collected. Patients were treated with oral Prussian blue, a chelating agent sodium dimercaptosulfonate, and hemodialysis.
All patients experienced a triad of symptoms of acute gastrointestinal upset, painful combined polyneuropathy, and hair loss after consuming poisoned food. Fatigue and skin pigmentation were observed in all patients. Abnormal liver function tests were found in 6 (42.9%) and delirium and coma were identified in 4 (28.6%). Two weeks after the poisoning, the blood and urine thallium concentration ranged from 219.0 to 1414.4 μg/L (median: 535.3) and 956.5 to 11285.0 μg/L (median: 7460.0), respectively. One patient (7.1%) with a previous history of pulmonary fibrosis died of respiratory failure in hospital. Symptoms were improved and blood or urine thallium levels were normalized in the remaining 13 patients before discharge. After a 6.5 ± 1-month follow-up, 1 patient (7.1%) developed deep venous thrombosis in the left lower limb. In another patient (7.1%), numbness in the lower limbs remained.
Acute thallium poisoning is commonly manifested by gastrointestinal upset, painful polyneuropathy, and significant hair loss. Treatment strategies included Prussian blue and hemodialysis, which were associated with a good outcome in this case series.