Frontiers in Medicine最新文献

{"title":"Ovarian sensitivity index-based nomogram for predicting clinical pregnancy outcomes in patients with diminished ovarian reserve undergoing <i>in vitro</i> fertilization or intracytoplasmic sperm injection.","authors":"Feng-Xia Liu, Ka-Li Huang, Shan-Jia Yi, Hui Huang, Ming-Hua Shi, Xue-Fei Liang","doi":"10.3389/fmed.2025.1618552","DOIUrl":"10.3389/fmed.2025.1618552","url":null,"abstract":"<p><strong>Background: </strong>Predicting clinical pregnancy outcomes in patients with diminished ovarian reserve (DOR) undergoing <i>in vitro</i> fertilization/intracytoplasmic sperm injection (IVF/ICSI) remains challenging owing to the unique characteristics of this patient group. Therefore, this study aimed to leverage existing predictive models for pregnancy outcomes while integrating innovative strategies to develop and validate a visualization-based predictive model specifically designed for patients with DOR undergoing IVF/ICSI treatment.</p><p><strong>Methods: </strong>This retrospective study analyzed data from 448 patients with DOR who underwent IVF/ICSI at Guangxi Zhuang Autonomous Region Reproductive Hospital from January 2019 to August 2023. We developed and internally validated a nomogram incorporating the ovarian sensitivity index (OSI), age, and controlled ovarian hyperstimulation (COH) protocol to predict clinical pregnancy outcomes. Receiver operating characteristic (ROC) analysis, univariate and least absolute shrinkage and selection operator (LASSO) regression analyses, and multivariate logistic regression were used to construct the model. The optimal cut-off value of the OSI for predicting clinical pregnancy was 1.135.</p><p><strong>Results: </strong>Through multivariate analysis, age, OSI, and COH protocol were identified as independent predictors. The developed nomogram demonstrated good discrimination with an area under the ROC curve of 0.744, along with satisfactory calibration and clinical utility.</p><p><strong>Conclusion: </strong>The developed nomogram can accurately predict clinical pregnancy outcomes in patients with DOR undergoing IVF/ICSI, potentially assisting clinicians in personalized counselling and improving outcomes in this challenging patient population.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1618552"},"PeriodicalIF":3.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety analysis of montelukast sodium added on azithromycin in the treatment of <i>Mycoplasma pneumoniae</i> pneumonia in children.","authors":"Ying Liang, Wei Li","doi":"10.3389/fmed.2025.1506621","DOIUrl":"10.3389/fmed.2025.1506621","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the safety and effectiveness of using montelukast sodium added on azithromycin for the treatment of pediatric <i>Mycoplasma pneumoniae</i> pneumonia (MPP).</p><p><strong>Methods: </strong>Retrospective analysis showed that 122 children with MPP were divided into a control group (61 cases received azithromycin treatment) and a study group (61 cases received azithromycin combined with montelukast sodium treatment) according to different treatment plans. Both groups were treated for 7 days, and lung function, lung compliance, chest CT signal, inflammatory immune status, and side effects were compared before and after treatment.</p><p><strong>Result: </strong>After a month of treatment, positive end expiratory pressure (PEEP) levels were lower in the research group compared to the control group's kids, whereas forced vital capacity (FVC), tidal volume (TV), peak expiratory flow rate (PEF), pulmonary ventilation per minute (MVV), and pulmonary dynamic compliance (Cdyn) levels were greater (<i>p</i> < 0.05). After a month of treatment, the detection rates of lung CT signs such as bronchial wall thickening, pleural effusion (PE), ground glass density shadow (GGO), gravel sign, lymphadenopathy, consolidation of lung (LC) and bronchogenic sign in the research group were all lower than those in the control group (<i>p</i> < 0.05). Compared to the control group, serum levels of amyloid A (SAA), procalcitonin (PCT), lactate dehydrogenase (LDH), TOll-like receptor 4 (TLR4), and CD8 + were all lower in the research group.</p><p><strong>Conclusion: </strong>Azithromycin plus montelukast sodium can effectively improve the lung function and lung compliance of children with MPP, reduce the detection rate of chest CT signs of disease symptoms, and improve the inflammatory and immune state of the body, without increasing adverse reactions, and the clinical application is safe.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1506621"},"PeriodicalIF":3.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and determinants of anemia in chronic kidney disease patients in Ethiopia: a systematic review and meta-analysis.","authors":"Eshetu Elfios Endrias, Temesgen Geta, Eskinder Israel, Melesse Belayneh Yayeh, Beker Ahmed, Abdulkerim Hassen Moloro","doi":"10.3389/fmed.2025.1529280","DOIUrl":"10.3389/fmed.2025.1529280","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a progressive and devastating condition affecting over 10% of the global population, with more than 800 million individuals impacted worldwide. Anemia, a critical and debilitating complication of CKD, accelerates disease progression and exacerbates its overall burden. Despite numerous studies exploring the prevalence and determinants of anemia in CKD in Ethiopia, the pooled prevalence remains undefined, highlighting a critical gap in evidence.</p><p><strong>Objectives: </strong>To determine the pooled prevalence of anemia and identify its associated factors among CKD patients in Ethiopia through a systematic review and meta-analysis.</p><p><strong>Methods: </strong>A comprehensive search was carried out for studies with full document and written in English language through an electronic web-based search strategy from databases of PubMed, CINAHL, Cochrane Library, Embase, Google Scholar and Ethiopian University Repository online. The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) checklist. Statistical analyses were performed using STATA version 17. Meta-analysis was conducted with a random-effects model. Heterogeneity among the primary studies was evaluated using Cochran's Q test and the I-squared statistic. To explore potential sources of heterogeneity, subgroup and sensitivity analyses were performed.</p><p><strong>Results: </strong>This systematic review and meta-analysis included seven studies, involving a total of 1,714 CKD patients. The pooled prevalence of anemia among CKD patients was 60.93% (95% CI: 50.05, 71.80), with substantial heterogeneity observed across studies (I² = 97.0, <i>P</i> < 0.000). A significant association was found between anemia in CKD patients and diabetes comorbidity, with those having diabetes experiencing significantly higher odds of developing anemia (OR: 4.52, 95% CI: 1.18-7.28). Additionally, patients in stage 3 or more advanced stages of CKD had an increased risk of anemia (OR: 4.36, 95% CI: 3.15-5.57).</p><p><strong>Conclusion and recommendations: </strong>This systematic review and meta-analysis revealed a high pooled prevalence of anemia among CKD patients, with significant associations with diabetes mellitus comorbidity, and advanced CKD stages. Regional differences were also noted, with Oromia region showing the highest prevalence. We recommend regular anemia screening in CKD patients and the identification and management of risk factors such as diabetes and advanced CKD stages.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD42024608561, identifier CRD42024608561.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1529280"},"PeriodicalIF":3.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilizing SS-OCT and 3D parametric modeling to enhance IOL position prediction in cataract patients with long axial length.","authors":"Chuang Li, Bin Luo, Xiaoling Luo, Liying Zhang, Qiang Li, Wei Peng","doi":"10.3389/fmed.2025.1604224","DOIUrl":"10.3389/fmed.2025.1604224","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the biological characteristics of the lens and explore the factors influencing the postoperative position of intraocular lens (IOL) using swept-source optical coherence tomography (SS-OCT) in cataract patients with long axial length (AL).</p><p><strong>Methods: </strong>This retrospective study enrolled 110 cataract patients who underwent uneventful cataract surgeries. The preoperative and postoperative biometric parameters were obtained using IOLMaster 700. The average lens density (ALD) was analyzed using Fiji ImageJ. The biological characteristics of cataracts were analyzed using three-dimension (3D) parametric modeling software, Pro/Engineer Wildfire 5.0.</p><p><strong>Results: </strong>The lens equator position (LEP) showed positive correlation with the preoperative anterior chamber depth (ACD), lens equatorial diameter (LED), and lens vaulting (LV). The postoperative position of the IOL showed positive correlation with the preoperative ACD and LEP (<i>r</i> = 0.432, <i>p</i> < 0.05; <i>r</i> = 0.657, <i>p</i> < 0.05). The LEP demonstrated a higher correlation with the postoperative position of the IOL than with the preoperative ACD (<i>p</i> < 0.05). The LEP displayed the highest correlation with the postoperative position of the IOL (<i>r</i> = 0.686, <i>p</i> < 0.05) in the subgroup of ultra-long eyes (AL ≥ 28.0 mm).</p><p><strong>Conclusion: </strong>The LEP, derived from the SS-OCT and 3D parametric modeling, was a better predictor of postoperative IOL position than the preoperative ACD. This methodology provides a robust basis for accurately predicting the effective lens position in cataract patients with long AL.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1604224"},"PeriodicalIF":3.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The rising burden of Alzheimer's and other dementias: role of high fasting plasma glucose from 1990 to 2021.","authors":"Shuhua Liu, Yuxuan Wu, Fangying Chen, Luying Han, Yu Zhang, Enqiang Chang","doi":"10.3389/fmed.2025.1592620","DOIUrl":"10.3389/fmed.2025.1592620","url":null,"abstract":"<p><strong>Background: </strong>Dementia, one of the top 10 causes of death globally, imposes significant health and socioeconomic/socioeconomic burdens, with prevalence projected to reach 82 million by 2030. High fasting plasma glucose (HFPG) is a prominent modifiable risk factor for dementia in 2021. This study aims first to examine the global trend in dementia burden and the disability-adjusted life years and death attributable to HFPG from 1990 to 2021 and second to define age-specific disparities in dementia burden among older populations.</p><p><strong>Methods: </strong>Using data from the Global Burden of Diseases Study (GBD) 2021, this research evaluated the incidence, prevalence, deaths, disability-adjusted life years (DALYs), and HFPG-attributable burden related to Alzheimer's disease and other dementias (ADOD). The estimated annual percentage change was calculated to qualify the burden change of ADOD.</p><p><strong>Results: </strong>There was a significant rise in the ADOD burden globally, with over 56.9 million prevalent cases and 2.0 million deaths in 2021. the incidence and prevalence were positively correlated with HFPG-related summary exposure value. The HFPG-attributable ADOD burden has increased worldwide over time. Globally, the 60 to 74 age groups suffered a prominent rise in the burden and HFPG-attributable burden of ADOD.</p><p><strong>Conclusion: </strong>The global burden and HFPG-attributable ADOD burden have remained prominent and have increased increase over the past 32 years. The ASIR and ASPR showed positive correlations with the SEV related to HFPG. Notably, the 60 to 74 age groups suffered a prominent rise in burden and HFPG attributable to the DALYs rate of ADOD over time. Moreover, a prominent positive correlation was observed between the incidence and prevalence rate with the SEVs related to HFPG occurred in the population aged 60 to 74 years old. Therefore, HFPG should be emphasized in strategic priorities for controlling the ADOD burden.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1592620"},"PeriodicalIF":3.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explainable AI for time series prediction in economic mental health analysis.","authors":"Ying Yang, Lifen Wen, Li Li","doi":"10.3389/fmed.2025.1591793","DOIUrl":"10.3389/fmed.2025.1591793","url":null,"abstract":"<p><strong>Introduction: </strong>The integration of Explainable Artificial Intelligence (XAI) into time series prediction plays a pivotal role in advancing economic mental health analysis, ensuring both transparency and interpretability in predictive models. Traditional deep learning approaches, while highly accurate, often operate as black boxes, making them less suitable for high-stakes domains such as mental health forecasting, where explainability is critical for trust and decision-making. Existing <i>post-hoc</i> explainability methods provide only partial insights, limiting their practical application in sensitive domains like mental health analytics.</p><p><strong>Methods: </strong>To address these challenges, we propose a novel framework that integrates explainability directly within the time series prediction process, combining both intrinsic and post-hoc interpretability techniques. Our approach systematically incorporates feature attribution, causal reasoning, and human-centric explanation generation using an interpretable model architecture.</p><p><strong>Results: </strong>Experimental results demonstrate that our method maintains competitive accuracy while significantly improving interpretability. The proposed framework supports more informed decision-making for policymakers and mental health professionals.</p><p><strong>Discussion: </strong>This framework ensures that AI-driven mental health screening tools remain not only highly accurate but also trustworthy, interpretable, and aligned with domain-specific knowledge, ultimately bridging the gap between predictive performance and human understanding.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1591793"},"PeriodicalIF":3.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of Levi's Muscle Index in frailty assessment: comparison of bioimpedance measures among older adults.","authors":"Kworweinski Lafontant, David H Fukuda, Estefania Zamarripa, Abigail L Tice, Jethro Raphael M Suarez, Chitra Banarjee, Dahee Kim, Jeffrey R Stout, Joon-Hyuk Park, Rui Xie, Ladda Thiamwong","doi":"10.3389/fmed.2025.1525569","DOIUrl":"10.3389/fmed.2025.1525569","url":null,"abstract":"<p><strong>Introduction: </strong>Frailty is prevalent among older adults and is characterized by reductions in physical function and muscle quality. Despite the emerging clinical utility of bioelectrical impedance analysis (BIA) and phase angle (PhA) as a bioimpedance index, little is known about how bioimpedance indices such as Levi's Muscle Index (LMI), reactance/height (Xc/Height), and resistance/height (R/Height), relate to physical function and frailty.</p><p><strong>Methods: </strong>This cross-sectional study examined 208 community-dwelling older adults (female, <i>n</i> = 183; age = 74.2 ± 6.9 years; BMI = 30.4 ± 6.4 kg/m²) to compare physical function measures and bioimpedance indices across frailty categories determined by the FRAIL questionnaire. PhA, LMI, Xc/Height, and R/Height were all assessed at 50 kHz using a direct segmental multi-frequency InBody s10 BIA device. Physical function was assessed using handgrip strength, postural sway, Timed-Up-and-Go, and the Short Physical Performance Battery. Data were analyzed using Spearman rho (ρ) and Pearson r correlation coefficients, and group differences were examined using Kruskal-Wallis H tests and one-way ANOVA.</p><p><strong>Results: </strong>PhA (<i>r</i> = -0.18, <i>p</i> = 0.01) and Xc/Height (<i>r</i> = -0.24, <i>p</i> < 0.001) were significantly associated with FRAIL scores. LMI and PhA were well correlated with each other (ρ = 0.76, <i>p</i> < 0.001), yet Xc/Height was the only bioimpedance index to significantly differ between frailty categories (<i>F</i> = 6.39, <i>p</i> = 0.002, ηp² = 0.06).</p><p><strong>Conclusion: </strong>Results suggest Xc/Height may be the only bioimpedance index indicative of frailty among older adults. Given the variety of assessments used to categorize frailty, these conclusions may be limited to the use of the FRAIL questionnaire; future research should compare LMI and PhA using multiple frailty indices.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1525569"},"PeriodicalIF":3.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12243873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RaNet: a residual attention network for accurate prostate segmentation in T2-weighted MRI.","authors":"Muhammad Arshad, Chengliang Wang, Muhammad Wajeeh Us Sima, Jamshed Ali Shaikh, Salem Alkhalaf, Fahad Alturise","doi":"10.3389/fmed.2025.1589707","DOIUrl":"10.3389/fmed.2025.1589707","url":null,"abstract":"<p><p>Accurate segmentation of the prostate in T2-weighted MRI is critical for effective prostate diagnosis and treatment planning. Existing methods often struggle with the complex textures and subtle variations in the prostate. To address these challenges, we propose RaNet (Residual Attention Network), a novel framework based on ResNet50, incorporating three key modules: the DilatedContextNet (DCNet) encoder, the Multi-Scale Attention Fusion (MSAF), and the Feature Fusion Module (FFM). The encoder leverages residual connections to extract hierarchical features, capturing both fine-grained details and multi-scale patterns in the prostate. The MSAF enhances segmentation by dynamically focusing on key regions, refining feature selection and minimizing errors, while the FFM optimizes the handling of spatial hierarchies and varying object sizes, improving boundary delineation. The decoder mirrors the encoder's structure, using deconvolutional layers and skip connections to retain essential spatial details. We evaluated RaNet on a prostate MRI dataset PROMISE12 and ProstateX , achieving a DSC of 98.61 and 96.57 respectively. RaNet also demonstrated robustness to imaging artifacts and MRI protocol variability, confirming its applicability across diverse clinical scenarios. With a balance of segmentation accuracy and computational efficiency, RaNet is well suited for real-time clinical use, offering a powerful tool for precise delineation and enhanced prostate diagnostics.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1589707"},"PeriodicalIF":3.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Bronchoalveolar lavage cell percentages as diagnostic markers of immune checkpoint inhibitor pneumonitis.","authors":"Mahnoor Mir, Felipe Soto, Pedro Antonio Amezcua Gomez, Rodrigo Del Rio Arroyo, Adarsh Suresh, Amber Su, Qiong Gan, John Stewart, Roberto Adachi, Diwakar D Balachandran, Lara Bashoura, Roberto F Casal, Burton F Dickey, George A Eapen, Scott E Evans, Horiana Grosu, Carlos A Jimenez, Julie Lin, David E Ost, Bruce F Sabath, Vickie R Shannon, Aung Naing, Jianjun Gao, Jia Wu, Karthik Suresh, Saadia A Faiz, Mehmet Altan, Ajay Sheshadri","doi":"10.3389/fmed.2025.1646108","DOIUrl":"https://doi.org/10.3389/fmed.2025.1646108","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.3389/fmed.2025.1582714.].</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1646108"},"PeriodicalIF":3.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review and meta-analysis of current guidelines, and their evidence base, on risk of renal function after administration of contrast medium for diabetic patients receiving metformin.","authors":"Qinhui Xu, Weixing Huang, Qianyun Li, Tongan Bao, Hua Luo, Xiao Luo","doi":"10.3389/fmed.2025.1547725","DOIUrl":"10.3389/fmed.2025.1547725","url":null,"abstract":"<p><strong>Purpose: </strong>Our study aimed to determine through a meta-analysis whether continuing metformin use in diabetic patients receiving contrast agents would increase the risk of renal impairment and metabolic abnormalities.</p><p><strong>Methods: </strong>We searched the PubMed, EBSCO, Medline, and the Cochrane Central Register of Controlled Trials from the inception dates to March 2024. The included studies comparing metformin users and non-users during contrast agent administration in diabetic patients. Outcome measures included contrast-induced acute kidney injury (CI-AKI), serum creatinine, estimated glomerular filtration rate (eGFR), lactate level, and incidence of metabolic acidosis. We used odds ratio (OR) for dichotomous outcomes and weighted or standardized mean difference (WMD or SMD) for continuous outcomes, depending on scale consistency across studies.</p><p><strong>Results: </strong>Analysis involved 2 randomized controlled trials and 5 retrospective cohorts comprising 2020 patients. There were no significant differences between the metformin and non-metformin groups in CI-AKI incidence (OR: 0.87, 95% CI: 0.63-1.20), changes in renal function (serum creatinine: SMD: -0.15, 95% CI: -0.64-0.35; eGFR: WMD: 3.35, 95% CI: -1.60-8.29), incidence of metabolic acidosis (OR: 0.90, 95% CI: 0.57-1.43), and lactate levels (SMD: 0.29, 95% CI: -0.53-1.11). Sensitivity analysis excluding one study revealed a significant reduction in creatinine with metformin. Logistic regression meta-analysis showed that metformin use was not significantly associated with CI-AKI or metabolic acidosis, while contrast volume was the only consistent predictor of CI-AKI. Lower baseline CO₂ was independently associated with increased risk of metabolic acidosis.</p><p><strong>Conclusions: </strong>Our analysis indicates that continuing metformin during contrast agent administration does not increase the risk of CI-AKI, acidosis, or eGFR compared to discontinuation or non-use of metformin. Additionally, continuation of metformin may be associated with a modest reduction in serum creatinine levels after contrast exposure. However, the limited quality of included studies may weaken the strength of these conclusions.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD42023459602, identifier: CRD42023459602.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1547725"},"PeriodicalIF":3.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12241009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}