Prediction of hemodynamic tolerance of intermittent hemodialysis in critically ill patients: a cohort study

AbstractThe evaluation and management of fluid balance are key challenges when caring for critically ill patients requiring renal replacement therapy. The aim of this study was to assess the ability of clinical judgment and other variables to predict the occurrence of hypotension during intermittent hemodialysis (IHD) in critically ill patients. This was a prospective, observational, single-center study involving critically ill patients undergoing IHD. The clinical judgment of hypervolemia was determined by the managing nephrologists and critical care physicians in charge of the patients on the basis of the clinical data used to calculate the ultrafiltration volume and rate for each dialysis treatment. Seventy-nine (31.9%) patients presented with hypotension during IHD. Patients were perceived as being hypervolemic in 109 (43.9%) of the cases by nephrologists and in 107 (43.1%) by intensivists. The agreement between nephrologists and intensivists was weak (kappa = 0.561). Receiver operating characteristic curve analysis yielded an AUC of 0.81 (95% CI 0.75 to 0.84; P < 0.0001), and a cutoff value of 70 mm for the vascular pedicle width (VPW) had the highest accuracy for the prediction of the absence of hypotension. The clinical judgment of hypervolemia did not predict hypotension during IHD. The high predictive ability of the VPW may assist clinicians with critical thinking.

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Prediction of Hemodynamic Tolerance of Intermittent Hemodialysis in Critically Ill Patients: A Cohort Study

10.21203/rs.3.rs-496960/v2 ◽

2021 ◽

Author(s):

Rogerio da Hora Passos ◽

Juliana Caldas ◽

Joao Gabriel Ramos ◽

Erica de Melo ◽

Marcelo Augusto Duarte Silveira ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Clinical Judgment ◽

Operating Characteristic ◽

Predictive Ability ◽

Intermittent Hemodialysis ◽

Roc Curve Analysis ◽

Dialysis Treatment ◽

Single Center Study ◽

Pedicle Width

Abstract Background: The evaluation and management of fluid balance are key challenges when caring for critically ill patients requiring renal replacement therapy (RRT). The aim of this study was to assess the ability of clinical judgment and other variables to predict the occurrence of hypotension during intermittent hemodialysis (IHD) in critically ill patients.Methods: This was a prospective, observational, single-center study involving critically ill patients undergoing IHD. The clinical judgment of hypervolemia was determined by the managing nephrologists and critical care physicians in charge of the patients on the basis of the clinical data used to calculate the ultrafiltration volume and rate for each dialysis treatment.Results: Seventy-nine (31.9%) patients presented with hypotension during IHD. Patients were perceived as being hypervolemic in 109 (43.9%) of the cases by nephrologists and in 107 (43.1%) by intensivists. The agreement between nephrologists and intensivists was weak (kappa =0.561). Receiver operating characteristic (ROC) curve analysis yielded an AUC of 0.81 (95% CI 0.75 to 0.84; P < 0.0001), and a cutoff value of 70 mm for the vascular pedicle width (VPW) had the highest accuracy for the prediction of the absence of hypotension.Conclusions: The clinical judgment of hypervolemia did not predict hypotension during IHD. The high predictive ability of the VPW may assist clinicians with critical thinking.

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Prediction of Hemodynamic Tolerance of Intermittent Hemodialysis in Critically Ill Patients: A Cohort Study

10.21203/rs.3.rs-496960/v1 ◽

2021 ◽

Author(s):

Rogerio da Hora Passos ◽

Juliana Caldas Ribeiro ◽

Joao Gabriel Rosa Ramos ◽

Erica Batista dos Santos Galvão de Melo ◽

Marcelo Augusto Duarte Silveira ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Clinical Judgment ◽

Operating Characteristic ◽

Predictive Ability ◽

Intermittent Hemodialysis ◽

Roc Curve Analysis ◽

Dialysis Treatment ◽

Single Center Study ◽

Pedicle Width

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A Comparison of Eosinopenia and C-Reactive Protein as a Marker of Bloodstream Infections in Critically Ill Patients: A Case Control Study

Anaesthesia and Intensive Care ◽

10.1177/0310057x0903700319 ◽

2009 ◽

Vol 37 (3) ◽

pp. 450-456 ◽

Cited By ~ 10

Author(s):

K. M. Ho ◽

S. C. Towler

Keyword(s):

Receiver Operating Characteristic Curve ◽

Receiver Operating Characteristic ◽

Critically Ill ◽

Critically Ill Patients ◽

Operating Characteristic ◽

Characteristic Curve ◽

Bloodstream Infections ◽

C Reactive Protein ◽

Reactive Protein ◽

Receiver Operating

Diagnosis of bloodstream infections in critically ill patients is difficult. This case control study involved a total of 22 patients with confirmed bloodstream infections and 44 concurrent controls from an intensive care unit in Western Australia. We aimed to assess whether eosinopenia and C-reactive protein are useful markers of bloodstream infections in critically ill patients. The patients with bloodstream infections had a more severe disease and a longer length of intensive care unit (10.7 vs 4.0 days, P=0.001) and hospital stay (40.9 vs 17.9 days, P=0.015) than the controls. Univariate analyses showed that C-reactive protein (area under the receiver operating characteristic curve 0.847, 95% confidence internal (CI) 0.721 to 0.973), eosinophil counts (area under the receiver operating characteristic curve 0.849, 95% CI 0.738 to 0.961) and fibrinogen concentrations (area under the receiver operating characteristic curve 0.730, 95% CI 0.578 to 0.882) were significant markers of bloodstream infections. C-reactive protein concentration was, however, the only significant predictor in the multivariate analysis (odds ratio 1.21 per 10 mgH increment, 95% CI 1.01 to 1.39, P=0.007). C-reactive protein concentration appears to be a better marker of bloodstream infections than eosinopenia in critically ill patients. A large prospective cohort study is needed to assess whether eosinopenia is useful in addition to C-reactive protein concentrations as a marker of bloodstream infections.

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P1076HEMODYNAMIC TOLERANCE TO INTERMITTENT DIALYSIS IN CRITICALLY ILL PATIENTS: THE CLINICAL JUDGMENT OF HIPERVOLEMIA IS ABLE TO PREDICATIT?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1076 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Erica Melo ◽

Marcelo Silveira ◽

Fábio Dutra ◽

Ana Baptista ◽

Filipe Miranda ◽

...

Keyword(s):

Logistic Regression ◽

Critical Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Judgment ◽

Multiple Logistic Regression Analysis ◽

Intermittent Hemodialysis ◽

Intradialytic Hypotension ◽

X Rays ◽

Multiple Logistic Regression

Abstract Background and Aims Evaluation and management of fluid balance are a key challenge in caring for the critically ill requiring renal replacement therapy. As intradialytic hypotension is a common complication and can be associated ultrafiltration rate. Usually the nephrologist and critical care physician have relied in their subjective clinical judgment and clinical data to calculate ultrafiltration. The aim of this study was to assess the prediction of clinical judgment of fluid overload and other clinical and dialysis data as predictors of hemodynamic tolerance to intermittent dialysis. Method This prospective observational single-center study was performed in critically ill patients with acute kidney injury undergoing intermittent hemodialysis. Before hemodialysis, clinical judgement of Hypervolemia from nephrologists and intensivists were assessed and posterior-anterior views of chest-X-rays done within three hour before of beginning of dialysis were collected for measurement of vascular pedicle width (VPW). Factors predicting intradialytic hypotension were identified by multiple logistic regression analysis. Results 248 AKI patients requiring intermittent dialysis were considered eligible. The clinician judgement of hypervolemia was not different between hypotensive and non hypotensive sessions. Multiple logistic regression showed that the size of VPW was independently associated with the development of hypotension during IHD session. A VPW value of > 70 mm had an 86.1 % sensitivity, 55 % specificity for identifying non hypotensive sessions with an area under the curve (AUC) = 0.81, 95 % CI 0.75–0.84, p < 0.001. Conclusion Clinical judgment of hypervolemia and other clinical and demographic variables that are used by nephrologists and critical care physicians at bedside did not predict hypotensive hemodialysis sessions. The high predictive ability of VPW measurement can help physicians to avoid inductive and deductive thinking and may assist critical thinking.

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Therapeutic drug monitoring and receiver operating characteristic curve prediction may reduce the development of linezolid-associated thrombocytopenia in critically ill patients

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-013-2041-3 ◽

2014 ◽

Vol 33 (6) ◽

pp. 1029-1035 ◽

Cited By ~ 26

Author(s):

H.-Y. Dong ◽

J. Xie ◽

L.-H. Chen ◽

T.-T. Wang ◽

Y.-R. Zhao ◽

...

Keyword(s):

Therapeutic Drug Monitoring ◽

Receiver Operating Characteristic Curve ◽

Receiver Operating Characteristic ◽

Critically Ill ◽

Drug Monitoring ◽

Critically Ill Patients ◽

Operating Characteristic ◽

Characteristic Curve ◽

Therapeutic Drug ◽

Operating Characteristic Curve

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MicroRNAs-1299, -126-3p and -30e-3p as Potential Diagnostic Biomarkers for Prediabetes

Diagnostics ◽

10.3390/diagnostics11060949 ◽

2021 ◽

Vol 11 (6) ◽

pp. 949

Author(s):

Cecil J. Weale ◽

Don M. Matshazi ◽

Saarah F. G. Davids ◽

Shanel Raghubeer ◽

Rajiv T. Erasmus ◽

...

Keyword(s):

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Characteristic Curve ◽

Predictive Ability ◽

Roc Curves ◽

Tolerance Test ◽

Cross Sectional Study ◽

Oral Glucose ◽

Cross Sectional ◽

Receiver Operating

This cross-sectional study investigated the association of miR-1299, -126-3p and -30e-3p with and their diagnostic capability for dysglycaemia in 1273 (men, n = 345) South Africans, aged >20 years. Glycaemic status was assessed by oral glucose tolerance test (OGTT). Whole blood microRNA (miRNA) expressions were assessed using TaqMan-based reverse transcription quantitative-PCR (RT-qPCR). Receiver operating characteristic (ROC) curves assessed the ability of each miRNA to discriminate dysglycaemia, while multivariable logistic regression analyses linked expression with dysglycaemia. In all, 207 (16.2%) and 94 (7.4%) participants had prediabetes and type 2 diabetes mellitus (T2DM), respectively. All three miRNAs were significantly highly expressed in individuals with prediabetes compared to normotolerant patients, p < 0.001. miR-30e-3p and miR-126-3p were also significantly more expressed in T2DM versus normotolerant patients, p < 0.001. In multivariable logistic regressions, the three miRNAs were consistently and continuously associated with prediabetes, while only miR-126-3p was associated with T2DM. The ROC analysis indicated all three miRNAs had a significant overall predictive ability to diagnose prediabetes, diabetes and the combination of both (dysglycaemia), with the area under the receiver operating characteristic curve (AUC) being significantly higher for miR-126-3p in prediabetes. For prediabetes diagnosis, miR-126-3p (AUC = 0.760) outperformed HbA1c (AUC = 0.695), p = 0.042. These results suggest that miR-1299, -126-3p and -30e-3p are associated with prediabetes, and measuring miR-126-3p could potentially contribute to diabetes risk screening strategies.

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Evaluation of factors that predict the success rate of trial of labor after the cesarean section

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04004-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yang Mi ◽

Pengfei Qu ◽

Na Guo ◽

Ruimiao Bai ◽

Jiayi Gao ◽

...

Keyword(s):

Logistic Regression ◽

Cesarean Section ◽

Receiver Operating Characteristic Curve ◽

Success Rate ◽

Operating Characteristic ◽

Characteristic Curve ◽

Predictive Ability ◽

Training Set ◽

History Of ◽

Operating Characteristic Curve

Abstract Background For most women who have had a previous cesarean section, vaginal birth after cesarean section (VBAC) is a reasonable and safe choice, but which will increase the risk of adverse outcomes such as uterine rupture. In order to reduce the risk, we evaluated the factors that may affect VBAC and and established a model for predicting the success rate of trial of the labor after cesarean section (TOLAC). Methods All patients who gave birth at Northwest Women’s and Children’s Hospital from January 2016 to December 2018, had a history of cesarean section and voluntarily chose the TOLAC were recruited. Among them, 80% of the population was randomly assigned to the training set, while the remaining 20% were assigned to the external validation set. In the training set, univariate and multivariate logistic regression models were used to identify indicators related to successful TOLAC. A nomogram was constructed based on the results of multiple logistic regression analysis, and the selected variables included in the nomogram were used to predict the probability of successfully obtaining TOLAC. The area under the receiver operating characteristic curve was used to judge the predictive ability of the model. Results A total of 778 pregnant women were included in this study. Among them, 595 (76.48%) successfully underwent TOLAC, whereas 183 (23.52%) failed and switched to cesarean section. In multi-factor logistic regression, parity = 1, pre-pregnancy BMI < 24 kg/m2, cervical score ≥ 5, a history of previous vaginal delivery and neonatal birthweight < 3300 g were associated with the success of TOLAC. The area under the receiver operating characteristic curve in the prediction and validation models was 0.815 (95% CI: 0.762–0.854) and 0.730 (95% CI: 0.652–0.808), respectively, indicating that the nomogram prediction model had medium discriminative power. Conclusion The TOLAC was useful to reducing the cesarean section rate. Being primiparous, not overweight or obese, having a cervical score ≥ 5, a history of previous vaginal delivery or neonatal birthweight < 3300 g were protective indicators. In this study, the validated model had an approving predictive ability.

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Usefulness of sialic acid for diagnosis of sepsis in critically ill patients: a retrospective study

BMC Anesthesiology ◽

10.1186/s12871-020-01197-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Bo Yao ◽

Wen-juan Liu ◽

Di Liu ◽

Jin-yan Xing ◽

Li-juan Zhang

Keyword(s):

Sialic Acid ◽

Critically Ill ◽

Critically Ill Patients ◽

Incomplete Data ◽

Acid Level ◽

Operating Characteristic ◽

Area Under The Curve ◽

Diagnostic Efficacy ◽

Receiver Operating Characteristic Curves ◽

Sensitivity Specificity

Abstract Background Early diagnosis of sepsis is very important. It is necessary to find effective and adequate biomarkers in order to diagnose sepsis. In this study, we compared the value of sialic acid and procalcitonin for diagnosing sepsis. Methods Newly admitted intensive care unit patients were enrolled from January 2019 to June 2019. We retrospectively collected patient data, including presence of sepsis or not, procalcitonin level and sialic acid level. Receiver operating characteristic curves for the ability of sialic acid, procalcitonin and combination of sialic acid and procalcitonin to diagnose sepsis were carried out. Results A total of 644 patients were admitted to our department from January 2019 to June 2019. The incomplete data were found in 147 patients. Finally, 497 patients data were analyzed. The sensitivity, specificity and area under the curve for the diagnosis of sepsis with sialic acid, procalcitonin and combination of sialic acid and procalcitonin were 64.2, 78.3%, 0.763; 67.9, 84.0%, 0.816 and 75.2, 84.6%, 0.854. Moreover, sialic acid had good values for diagnosing septic patients with viral infection, with 87.5% sensitivity, 82.2% specificity, and 0.882 the area under the curve. Conclusions Compared to procalcitonin, sialic acid had a lower diagnostic efficacy for diagnosing sepsis in critically ill patients. However, the combination of sialic acid and procalcitonin had a higher diagnostic efficacy for sepsis. Moreover, sialic acid had good value for diagnosing virus-induced sepsis.

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Predictors of thermal increase in magnetic resonance–guided focused ultrasound treatment for essential tremor: histogram analysis of skull density ratio values for 1024 elements

Journal of Neurosurgery ◽

10.3171/2021.5.jns21669 ◽

2021 ◽

pp. 1-6

Author(s):

Ken Iijima ◽

Hajime Yokota ◽

Toshio Yamaguchi ◽

Masayuki Nakano ◽

Takahiro Ouchi ◽

...

Keyword(s):

Logistic Regression ◽

Operating Characteristic ◽

Focused Ultrasound ◽

Characteristic Curve ◽

Density Ratio ◽

Predictive Ability ◽

Curve Analysis ◽

Regression Analyses ◽

Multivariate Logistic Regression ◽

Operating Characteristic Curve

OBJECTIVE Sufficient thermal increase capable of generating thermocoagulation is indispensable for an effective clinical outcome in patients undergoing magnetic resonance–guided focused ultrasound (MRgFUS). The skull density ratio (SDR) is one of the most dominant predictors of thermal increase prior to treatment. However, users currently rely only on the average SDR value (SDRmean) as a screening criterion, although some patients with low SDRmean values can achieve sufficient thermal increase. The present study aimed to examine the numerical distribution of SDR values across 1024 elements to identify more precise predictors of thermal increase during MRgFUS. METHODS The authors retrospectively analyzed the correlations between the skull parameters and the maximum temperature achieved during unilateral ventral intermediate nucleus thalamotomy with MRgFUS in a cohort of 55 patients. In addition, the numerical distribution of SDR values was quantified across 1024 elements by using the skewness, kurtosis, entropy, and uniformity of the SDR histogram. Next, the authors evaluated the correlation between the aforementioned indices and a peak temperature > 55°C by using univariate and multivariate logistic regression analyses. Receiver operating characteristic curve analysis was performed to compare the predictive ability of the indices. The diagnostic performance of significant factors was also assessed. RESULTS The SDR skewness (SDRskewness) was identified as a significant predictor of thermal increase in the univariate and multivariate logistic regression analyses (p < 0.001, p = 0.013). Moreover, the receiver operating characteristic curve analysis indicated that the SDRskewness exhibited a better predictive ability than the SDRmean, with area under the curve values of 0.847 and 0.784, respectively. CONCLUSIONS The SDRskewness is a more accurate predictor of thermal increase than the conventional SDRmean. The authors suggest setting the SDRskewness cutoff value to 0.68. SDRskewness may allow for the inclusion of treatable patients with essential tremor who would have been screened out based on the SDRmean exclusion criterion.

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