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Background  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.    Materials and Methods  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.    Results  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.    Conclusions  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.

Risk of Acute Lung Injury/Acute Respiratory Distress Syndrome in Critically Ill Adult Patients with Pre-Existing Diabetes: A Meta-Analysis