Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Dec 9, 2024; 13(4): 99564
Published online Dec 9, 2024. doi: 10.5492/wjccm.v13.i4.99564
Impact of diabetes mellitus on mortality in pulmonary hypertension: A systematic review and meta-analysis
Smitesh Padte, Priyal Mehta, Vikas Bansal, Niti singh, Rayyan Sunasra, Vidhi Goyal, Raunaq B Chaudhary, Yash Junnarkar, Vidhi Shah, Zara Arshad, Faisal A Nawaz, Salim Surani, Rahul Kashyap
Smitesh Padte, Priyal Mehta, Zara Arshad, Faisal A Nawaz, Salim Surani, Rahul Kashyap, Department of Research, Global Remote Research Scholar Program, Princeton Junction, Princeton, NJ 08550, United States
Smitesh Padte, Department of Internal Medicine, WellSpan York Hospital, York, PA 17403, United States
Priyal Mehta, Department of Internal Medicine, St. Vincent Hospital, Worchester, MA 01608, United States
Vikas Bansal, Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55902, United States
Niti singh, Department of Anesthesiology and Critical Care, Seth G. S. Medical College and K.E.M. Hospital, Mumbai 400012, Mahārāshtra, India
Rayyan Sunasra, Department of Medicine, Hinduhridaysamrat Balasaheb Thackeray Medical College and Dr. R. N Cooper Hospital, Mumbai 400056, India
Vidhi Goyal, Raunaq B Chaudhary, Yash Junnarkar, Vidhi Shah, Department of Medicine, HBT Medical College and Dr. RN Cooper Hospital, Mumbai 400056, Mahārāshtra, India
Faisal A Nawaz, Department of Psychiatry, Al Amal Psychiatry Hospital, Dubai 50262, Dubayy, United Arab Emirates
Salim Surani, Department of Medicine & Pharmacology, Texas A&M University, College Station, TX 77843, United States
Rahul Kashyap, Department of Research, Wellspan Health, York, PA 17403, United States
Author contributions: Padte S, Mehta P, and Kashyap R designed the research; Padte S, Mehta P, Singh N, Sunasra R, Goyal V, Chaudhary R, Junnarkar Y, Shah V, Arshad Z, Nawaz F, Surani S and Kashyap R performed the research; Padte S and Bansal V analyzed the data; Padte S, Mehta P, Singh N, and Sunasra R wrote the paper. All authors revised the paper.
Conflict-of-interest statement: None of the authors have any conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Salim Surani, FACP, FCCP, MD, MHSc, Professor, Department of Medicine & Pharmacology, Texas A&M University, 40 Bizzell Street, College Station, TX 77843, United States. srsurani@hotmail.com
Received: July 25, 2024
Revised: September 5, 2024
Accepted: September 23, 2024
Published online: December 9, 2024
Processing time: 98 Days and 6.9 Hours
Abstract
BACKGROUND

Pulmonary hypertension (PH) is a progressive disease characterized by endothelial dysfunction and vascular remodeling and is a leading cause of mortality worldwide. Although it is independently associated with multiple comorbidities, the impact of diabetes mellitus (DM) on mortality in patients with PH remains uncertain. To address this issue, we conducted a systematic review and meta-analysis to investigate the effect of DM on survival in patients with pulmonary hypertension.

AIM

To investigate the impact of diabetes mellitus on mortality in pulmonary hypertension patients.

METHODS

We conducted a comprehensive search of four major electronic bibliographic databases like PubMed, Google Scholar, Scopus, and Embase, and identified 106 relevant studies, out of 1561 articles, published since the year 2000 for full-text review. Fourteen retrospective and prospective cohort studies that compared survival between patients with DM and those without DM in the context of PH were deemed eligible for inclusion in our meta-analysis. The study was registered on PROSPERO with the identifier CRD42023390232.

RESULTS

A total of 116455 patients with PH were included in the meta-analysis, of whom 41228 suffered from DM and 75227 did not. The results of our meta-analysis indicate an elevated mortality rate among PH patients with diabetes mellitus in comparison to those without DM [odds ratio (OR) = 1.40, 95%CI: 1.15–1.70, P = 0.0006]. The meta-regression analysis unveiled a statistically significant negative association between mean age and effect size (coefficient = -0.036, P value = 0.018). Conversely, a statistically significant positive association was detected between female proportion and effect size (coefficient = 0.000, P value < 0.001).

CONCLUSION

Our meta-analysis, which included approximately 116500 PH patients, revealed that the presence of diabetes mellitus was associated with increased odds of mortality when compared to non-diabetic patients. The meta-regression analysis indicates that studies with older participants and lower proportions of females tend to exhibit smaller effect sizes. Clinically, these findings underscore the importance of incorporating diabetes status into the risk stratification of patients with PH with more aggressive monitoring and early intervention to improve prognosis potentially.

Keywords: Pulmonary hypertension; Diabetes mellitus; Mortality; Systematic review; Meta-analysis

Core Tip: The high prevalence of comorbidities among pulmonary hypertension (PH) patients significantly complicates disease management and amplifies mortality risk. The presence of diabetes mellitus in PH patients is known to decrease survival rates, although the exact level of risk remains uncertain. Our study showed that in patients suffering from pulmonary hypertension, the presence of diabetes mellitus was significantly associated with decreased odds of survival when compared to nondiabetic patients from the same group. The sample's mean age and female proportion were also determined to moderate the effect size.