Association between Diabetes Mellitus and Contrast-Associated Acute Kidney Injury: A Systematic Review and Meta-Analysis of 1.1 Million Contrast Exposure Patients.

BACKGROUND: Although diabetes mellitus (DM) has been a common risk factor of contrast-associated acute kidney injury (CA-AKI) for a long time, several current studies showed that DM is not an independent risk factor. Due to this diverse finding, we aim to conduct a systematic review assessing the effect of DM on CA-AKI. METHODS: We searched Ovid Medline, Embase, and Cochrane Database of Systematic Reviews (to June 1, 2020) for studies assessing the association between DM and CA-AKI. Random meta-analysis was performed to derive the pooled estimates of the adjusted odds ratio (OR) and corresponding 95% confidence intervals (CIs). RESULTS: A total of 84 studies involving 1,136,827 participants were included in this meta-analysis. The presence of DM was associated with an higher risk of CA-AKI (pooled OR: 1.58, 95% CI: 1.48-1.70, I2 = 64%). Furthermore, the predictive effect of elevated CA-AKI for was stronger in the subgroup of DM patients with chronic kidney disease (CKD) (OR: 2.33, 95% CI: 1.21-4.51), while the relationship between DM and CA-AKI was not significant in subgroup patients without CKD (OR: 1.12, 95% CI: 0.73-1.72). CONCLUSION: This is the first meta-analysis to prove that DM is an independent risk factor of CA-AKI in patients. While the predictive value of DM for CA-AKI in patients with normal kidney function was weakened, more protective treatments are needed in diabetic patients with kidney dysfunction to avoid the occurrence of CA-AKI.

The U-Shape Relationship Between Glycated Hemoglobin Level and Long-Term All-Cause Mortality Among Patients With Coronary Artery Disease.

Background: Although glycated hemoglobin (HbA1c) was considered as a prognostic factor in some subgroup of coronary artery disease (CAD), the specific relationship between HbA1c and the long-term all-cause death remains controversial in patients with CAD. Methods: The study enrolled 37,596 CAD patients and measured HbAlc at admission in Guangdong Provincial People's Hospital. The patients were divided into 4 groups according to HbAlc level (Quartile 1: HbA1c ≤ 5.7%; Quartile 2: 5.7% < HbA1c ≤ 6.1%; Quartile 3: 6.1% < HbA1c ≤ 6.7%; Quartile 4: HbA1c > 6.7%). The study endpoint was all-cause death. The restricted cubic splines and cox proportional hazards models were used to investigate the association between baseline HbAlc levels and long-term all-cause mortality. Results: The median follow-up was 4 years. The cox proportional hazards models revealed that HbAlc is an independent risk factor in the long-term all-cause mortality. We also found an approximate U-shape association between HbA1c and the risk of mortality, including increased risk of mortality when HbA1c ≤ 5.7% and HbA1c > 6.7% [Compared with Quartile 2, Quartile 1 (HbA1c ≤ 5.7), aHR = 1.13, 95% CI:1.01-1.26, P < 0.05; Quartile 3 (6.1% < HbA1c ≤ 6.7%), aHR = 1.04, 95% CI:0.93-1.17, P =0.49; Quartile 4 (HbA1c > 6.7%), aHR = 1.32, 95% CI:1.19-1.47, P < 0.05]. Conclusions: Our study indicated a U-shape relationship between HbA1c and long-term all-cause mortality in CAD patients.

Effect of hemocoagulase for prevention of pulmonary hemorrhage in critical newborns on mechanical ventilation: a randomized controlled trial.

OBJECTIVE: To investigate the role of hemocoagulase to prevent pulmonary hemorrhage in critical newborns on mechanical ventilation. DESIGN: Randomized controlled trial. SETTING: Neonatal Intensive Care Unit of an affiliated hospital of a Medical University. CHILDREN: Seventy-two critical newborn infants on mechanical ventilation. INTERVENTION: The involved neonates were divided randomly into two groups. Forty-one patients were treated with prophylactic hemocoagulase(dripped through the endotracheal tube), and other 31 neonates served as controls. OUTCOME MEASURES: Incidence of pulmonary hemorrhage, time of ceasing pulmonary hemorrhage if occurred, time of withdrawing of mechanical ventilation in the survivors, and mortality. RESULTS: The incidence of pulmonary hemorrhage (12% vs 42%) and the time of ceasing pulmonary hemorrhage (1.36 +/- 0.65 vs 3.58 +/- 0.82, days), were significantly less in infants treated with prophylactic hemocoagulase as compared with the controls (P<0.05). The time to withdrawal of mechanical ventilation was less in the intervention group (3.20 +/- 0.45 vs 5.04 +/- 1.51 days) (P < 0.05). The mortality in children who received hemocoagulase was 22.0%, which was significantly less than controls (41.9 %) (P < 0.05). CONCLUSION: Prophylactic use of hemocoagulase in mechanically ventilated neonates is effective against pulmonary hemorrhage.

New treatment of neonatal pulmonary hemorrhage with hemocoagulase in addition to mechanical ventilation.

OBJECTIVE: To investigate the effect of a new treatment for neonatal pulmonary hemorrhage with hemocoagulase in addition to mechanical ventilation. METHODS: Forty-eight newborn infants with pulmonary hemorrhage were included and divided randomly into 2 groups. Among them, 28 patients were treated with hemocoagulase in addition to mechanical ventilation, and the other 20 neonates served as controls and were treated with mechanical ventilation only. RESULTS: Both the length of pulmonary hemorrhage and the duration of mechanical ventilation in the survivors were significantly shortened in the infants treated with hemocoagulase in addition to mechanical ventilation as compared to controls (p < 0.05). Moreover, all infants that were unable to remain in the neonatal intensive care unit died after discharge, and when their outcome was estimated as non-survivors, the mortality in the patients with this new treatment was 39.3% (11/28), which was significantly lower than in controls (75.0%, 15/20; p < 0.05). When the discharged infants were not included in the statistics, the mortality in the hemocoagulase group was 10.7% (3/28), which was also significantly lower than in controls (40.0%, 8/20; p < 0.05). CONCLUSIONS: The new treatment with hemocoagulase in addition to mechanical ventilation is effective in newborn infants with pulmonary hemorrhage.