ObjectiveTo assesse the association of an insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme gene (ACE) with the risk and the mortality of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). MethodsWe searched electronic databases through April 2014 for the terms "angiotensin-converting enzyme gene", "acute lung injury" and "acute respiratory distress syndrome", and reviewed all studies that reported the relationship of the I/D polymorphism in ACE with ALI/ARDS in adults. Eight studies met the inclusion criteria, comprising 498 ALI/ARDS patients, 3220 healthy controls and 1137 patients without ALI/ARDS. Three genetic models were used: the allele, dominant and recessive models. The meta-analysis was performed with RevMan 5.2 software. ResultsThe ACE I/D polymorphism was not associated with susceptibility to ALI/ARDS compared with the healthy controls and the patient controls for any genetic model. The ACE I/D polymorphism was associated with the mortality risk of ALI/ARDS in Asian subjects, and OR was 2.99 (95% CI 1.87-4.76, P < 0.05), 0.36 (95% CI 0.20-0.67, P < 0.05), 4.62 (95% CI 1.71-12.45, P < 0.05) for allele I/D, genotype II/II+ID and genotype DD/II+ID, respectively. ConclusionThere is a possible association between the ACE I/D polymorphism genotype and the mortality risk of ALI/ARDS in Asians.
Objective To evaluate the effects and safety of procalcitonin(PCT)-guided algorithms of antibiotic therapy in critically ill patients in intensive care unit (ICU). Methods Literatures in English and Chinese concerning randomized controlled trials(RCTs) on PCT-guided algorithms of antibiotic therapy in critically ill patients was retrieved by electronic and manual search. All related data were extracted. Meta-analysis was conducted using the statistical software RevMan 5.3 on the basis of strict quality evaluation. Results Eight RCTs involving 2708 ICU patients were included, with 1360 patients in the PCT-guided group and 1348 patients in the control group. Compared with the control group, PCT-guided algorithms were associated with a significant reduction in the duration of antibiotic therapy (MD -2.44 days, 95%CI -3.25 to -1.62, P < 0.00001), and the occurrence of adverse reaction of antibiotics was also lower (RR=0.74, 95%CI 0.56 to 0.97, P=0.03), however the mortality exhibited no difference between the PCT-guided group and the control group (RR=1.00, 95%CI 0.89 to 1.13, P=0.99). Conclusion PCT-guided algorithms can shorten the duration of antibiotic therapy and reduce the occurrence of adverse reaction in critically ill patients without significant effect on mortality.
ObjectiveTo evaluate the effects and safety of statins in patients with acute respiratory distress syndrome (ARDS). MethodsLiteratures in English and Chinese concerning randomized controlled trials (RCTs) on statins in ARDS patients were retrieved by electronic and manual search. All related data were extracted. Meta-analysis was conducted using the statistical software RevMan 5.3 on the basis of strict quality evaluation. ResultsFive RCTs involving 1489 ARDS patients were included, with 709 patients in the statins group and 780 patients in the placebo control group. Compared with the control group, statins did not improve the survival of ARDS patients[risk ratio (RR) 1.01, 95% confidence interval (CI) 0.86 to 1.18, P=0.91), while the improvement of oxygenation[mean difference (MD) 3.92, 95%CI-14.10 to 21.94, P=0.67], ventilator-free days (MD 0.65, 95%CI-0.20 to 1.50, P=0.13) and non-pulmonary organ failure-free days (MD 1.20, 95%CI-1.46 to 3.87, P=0.38) exhibited no differences between the statins group and the control group. However statins were associated with significant elevation of creatine kinase (MD 6.92, 95%CI 5.77 to 8.07, P < 0.000 01). ConclusionThis study demonstrates that statins can not improve outcomes of ARDS patients, and the safety of statins still needs further evaluation.