Iron metabolism-related indicators as predictors of the incidence of acute kidney injury after cardiac surgery: a meta-analysis

Some studies have found that ferroptosis plays an important role in the incidence of acute kidney injury (AKI) after cardiac surgery. However, whether iron metabolism-related indicators can be used as predictors of the incidence of AKI after cardiac surgery remains unclear. We aimed to systematically evaluate whether iron metabolism-related indicators can be used as predictors of the incidence of AKI after cardiac surgery via meta-analysis. Search methods: The PubMed, Embase, Web of Science, and Cochrane Library databases were searched from January 1971 to February 2023 to identify prospective observational and retrospective observational studies examining iron metabolism-related indicators and the incidence of AKI after cardiac surgery among adults. Data Extraction and Synthesis: The following data were extracted by two independent authors (ZLM and YXY): date of publication, first author, country, age, sex, number of included patients, iron metabolism-related indicators, outcomes of patients, patient types, study types, sample, and specimen sampling time. The level of agreement between authors was determined using Cohen’s κ value. The Newcastle–Ottawa Scale (NOS) was used to evaluate the quality of studies. Statistical heterogeneity across the studies was measured by the I2 statistic. The standardized mean difference (SMD) and 95% confidence interval (CI) were used as effect size measures. Meta-analysis was performed using Stata 15. After applying the inclusion and exclusion criteria, 9 articles on iron metabolism-related indicators and the incidence of AKI after cardiac surgery were included in this study. Meta-analysis revealed that after cardiac surgery, baseline serum ferritin (μg/L) (I2 = 43%, fixed effects model, SMD = −0.3, 95% CI:-0.54 to −0.07, p = 0.010), preoperative and 6-hour postoperative fractional excretion (FE) of hepcidin (%) (I2 = 0.0%, fixed effects model, SMD = −0.41, 95% CI: −0.79 to −0.02, p = 0.038; I2 = 27.0%, fixed effects model, SMD = −0.49, 95% CI: −0.88 to −0.11, p = 0.012), 24-hour postoperative urinary hepcidin (μg/L) (I2 = 0.0%, fixed effects model, SMD = −0.60, 95% CI: −0.82 to −0.37, p 2 = 0.0%, fixed effects model, SMD = −0.65, 95% CI: −0.86 to −0.43, p  After cardiac surgery, patients with lower baseline serum ferritin levels (μg/L), lower preoperative and 6-hour postoperative FE of hepcidin (%), lower 24-hour postoperative hepcidin/urine creatinine ratios (μg/mmol) and lower 24-hour postoperative urinary hepcidin levels (μg/L) are more likely to develop AKI. Therefore, these parameters have the potential to be predictors for AKI after cardiac surgery in the future. In addition, there is a need for relevant clinical research of larger scale and with multiple centers to further test these parameters and prove our conclusion. Trial Registration: PROSPERO identifier: CRD42022369380.</p

Socio-demographic information of the participants and association with satisfaction with the gatekeeper policy.

Socio-demographic information of the participants and association with satisfaction with the gatekeeper policy.</p

Patient Satisfaction with Community Health Service Centers as Gatekeepers and the Influencing Factors: A Cross-Sectional Study in Shenzhen, China

<div><p>Purpose</p><p>Shenzhen is the first pilot city in China implementing the gatekeeper policy, with community health service (CHS) centers as the gatekeepers. We aim to investigate patient satisfaction with this policy and its influencing factors in Shenzhen.</p><p>Methods</p><p>3,848 patients visiting eight CHS centers in Shenzhen of China between May 1 and July 28, 2013 were recruited. We interviewed them using a structured questionnaire to investigate their satisfaction with the gatekeeper policy of CHS. Multivariable logistic regression models were used to identify influencing factors.</p><p>Results</p><p>Of the respondents, 28.17%, 47.27% and 24.56% were satisfied with, neutral to, and not satisfied with the gatekeeper policy respectively. Patient satisfaction with this policy was found to be associated with education level, familiarity with the policy, referral experience, satisfaction with convenience of seeing a doctor, satisfaction with waiting time, satisfaction with medical facility, satisfaction with general medical practitioners’ professional skill, and proportion of expense reimbursed.</p><p>Conclusions</p><p>Our investigation shows that patient satisfaction with the gatekeeper policy was low. To improve patient satisfaction, efforts should be made to increase the convenience of seeing a doctor in community, shorten waiting time, improve general medical practitioners’ professional skill, and increase proportion of expense reimbursement.</p></div

Health status and health-seeking behavior, awareness and understanding of the gatekeeper policy, and satisfaction with CHS.

<p>Health status and health-seeking behavior, awareness and understanding of the gatekeeper policy, and satisfaction with CHS.</p

The relationship between BMI, WC, NC and the prevalence of new hypertension, diabetes and dyslipidemia.

The relationship between BMI, WC, NC and the prevalence of new hypertension, diabetes and dyslipidemia.</p

Characteristics of the study participants stratified by gender.

Characteristics of the study participants stratified by gender.</p

Minimal data set.

(SAV)</p

Logistic regression analysis on potential influence factors of being satisfied with the gatekeeper policy.

Logistic regression analysis on potential influence factors of being satisfied with the gatekeeper policy.</p

The distribution of blood pressure, plasma glucose and blood lipid levels among different BMI and WC (Mean ± SD).

The distribution of blood pressure, plasma glucose and blood lipid levels among different BMI and WC (Mean ± SD).</p

Association of BMI, WC and NC every change of 1 SD with the prevalence of hypertension, diabetes and dyslipidemia.

Association of BMI, WC and NC every change of 1 SD with the prevalence of hypertension, diabetes and dyslipidemia.</p