scholarly journals Prediction of Vancomycin Levels Using Cystatin C in Overweight and Obese Patients: a Retrospective Cohort Study of Hospitalized Patients

2020 ◽  
Vol 65 (1) ◽  
pp. e01487-20
Author(s):  
Hilary R. Teaford ◽  
Ryan W. Stevens ◽  
Andrew D. Rule ◽  
Kristin C. Mara ◽  
Kianoush B. Kashani ◽  
...  
Keyword(s):  
Kidney Function ◽  
Cystatin C ◽  
Regression Models ◽  
Fold Increase ◽  
Obese Patients ◽  
Linear Regression Models ◽  
Stable Renal Function ◽  
The Mean ◽  
Nonobese Patients

ABSTRACTThe use of the kidney function biomarker cystatin C (cysC) can improve the accuracy of vancomycin dosing for target trough attainment in nonobese patients. It is unknown whether cysC can also improve vancomycin target trough attainment in overweight and obese patients. We conducted a retrospective observational study of overweight or obese hospitalized adults with stable renal function administered intravenous vancomycin between January 2011 and July 2019. Linear regression models were used to predict initial steady-state vancomycin troughs using several factors, including various cysC- and serum creatinine (SCr)-based estimates of kidney function. We compared the predicted proportion of patients within the target trough range (10 to 20 mg/liter) using the derived models to that observed from usual care. Of the 200 included patients, the mean trough level was 15 ± 6.3 mg/liter. The optimal model to predict the initial trough included both cysC and SCr (R2 = 0.48) rather than either biomarker alone. This model predicted that 79% (95% confidence interval [CI], 73% to 85%) of troughs could be between 10 and 20 mg/liter compared to the 62% observed in clinical practice (P < 0.001), a 1.3-fold increase. This study is the first to examine the role of cysC in predicting vancomycin levels in an exclusively overweight or obese population. While dosing models based on cysC appear promising in this setting, prospective validation is needed.

scholarly journals Cystatin C predicts renal function impairment after partial or radical tumor nephrectomy

2021 ◽  
Author(s):  
Mike Wenzel ◽  
Hang Yu ◽  
Annemarie Uhlig ◽  
Christoph Würnschimmel ◽  
Manuel Wallbach ◽  
...  
Keyword(s):  
Renal Function ◽  
Linear Regression ◽  
Kidney Function ◽  
Cystatin C ◽  
Regression Models ◽  
Linear Regression Models ◽  
Renal Function Impairment ◽  
Blind Area ◽  
Function Impairment

Abstract Purpose To test the value of preoperative and postoperative cystatin C (CysC) as a predictor on kidney function after partial (PN) or radical nephrectomy (RN) in renal cell carcinoma (RCC) patients with normal preoperative renal function. Methods From 01/2011 to 12/2014, 195 consecutive RCC patients with a preoperative estimated glomerular filtration rate (eGFR) > 60 ml/min/1.73m2 underwent surgical RCC treatment with either PN or RN. Logistic and linear regression models tested for the effect of CysC as a predictor of new-onset chronic kidney disease in follow-up (eGFR < 60 ml/min/1.73m2). Moreover, postoperative CysC and creatinine values were compared for kidney function estimation. Results Of 195 patients, 129 (66.2%) underwent PN. In postoperative and in follow-up setting (median 14 months, IQR 10–20), rates of eGFR < 60 ml/min/1.73m2 were 55.9 and 30.2%. In multivariable logistic regression models, preoperative CysC [odds ratio (OR): 18.3] and RN (OR: 13.5) were independent predictors for a reduced eGFR < 60 ml/min/1.73m2 in follow-up (both p < 0.01), while creatinine was not. In multivariable linear regression models, a difference of the preoperative CysC level of 0.1 mg/dl estimated an eGFR decline in follow-up of about 5.8 ml/min/1.73m2. Finally, we observed a plateau of postoperative creatinine values in the range of 1.2–1.3 mg/dl, when graphically depicted vs. postoperative CysC values (‘creatinine blind area’). Conclusion Preoperative CysC predicts renal function impairment following RCC surgery. Furthermore, CysC might be superior to creatinine for renal function monitoring in the early postoperative setting.

scholarly journals Assessing Early Heterogeneity in Doubling Times of the COVID-19 Epidemic across Prefectures in Mainland China, January–February, 2020

Epidemiologia ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 95-113 ◽  
Author(s):  
Isaac Chun-Hai Fung ◽  
Xiaolu Zhou ◽  
Chi-Ngai Cheung ◽  
Sylvia K. Ofori ◽  
Kamalich Muniz-Rodriguez ◽  
...  
Keyword(s):  
Regression Models ◽  
Doubling Time ◽  
Metropolitan Areas ◽  
Mainland China ◽  
Linear Regression Models ◽  
Case Count ◽  
Daily Time Series ◽  
The Mean ◽  
Doubling Times ◽  
Daily Time

To describe the geographical heterogeneity of COVID-19 across prefectures in mainland China, we estimated doubling times from daily time series of the cumulative case count between 24 January and 24 February 2020. We analyzed the prefecture-level COVID-19 case burden using linear regression models and used the local Moran’s I to test for spatial autocorrelation and clustering. Four hundred prefectures (~98% population) had at least one COVID-19 case and 39 prefectures had zero cases by 24 February 2020. Excluding Wuhan and those prefectures where there was only one case or none, 76 (17.3% of 439) prefectures had an arithmetic mean of the epidemic doubling time <2 d. Low-population prefectures had a higher per capita cumulative incidence than high-population prefectures during the study period. An increase in population size was associated with a very small reduction in the mean doubling time (−0.012, 95% CI, −0.017, −0.006) where the cumulative case count doubled ≥3 times. Spatial analysis revealed high case count clusters in Hubei and Heilongjiang and fast epidemic growth in several metropolitan areas by mid-February 2020. Prefectures in Hubei and neighboring provinces and several metropolitan areas in coastal and northeastern China experienced rapid growth with cumulative case count doubling multiple times with a small mean doubling time.

Abstract WMP14: Association of Systolic Blood Pressure, LDL Cholesterol, and Hgb A1c With White Matter Hyperintensity on MRI in the ACCORDION MIND Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Tanya Turan ◽  
Rebecca Gottesman ◽  
Sharon Yeatts ◽  
Shyam Prabhakaran ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Factor ◽  
Regression Models ◽  
Ldl Cholesterol ◽  
Vascular Risk Factor ◽  
White Matter Hyperintensity ◽  
Vascular Risk ◽  
Linear Regression Models ◽  
Risk Factor Profile ◽  
The Mean

Introduction: While retrospective studies have shown that poor control of vascular risk factors is associated with progression of white matter hyperintensity (WMH), it has not been studied prospectively. Hypothesis: We hypothesize that higher systolic blood pressure (SBP) mean, LDL cholesterol, and Hgb A1c will be correlated with WMH progression in diabetics. Methods: This is a secondary analysis of the Memory in Diabetes (MIND) substudy of the Action to Control Cardiovascular Risk in Diabetes Follow-on Study (ACCORDION). The primary outcome was WMH progression, evaluated by fitting linear regression models to the WMH volume on the month 80 MRI and adjusting for the WMH volume on the baseline MRI. The primary predictors were the mean values of SBP, LDL, and A1c from baseline to month 80. We defined a good vascular risk factor profile as mean SBP <120 mm Hg and mean LDL <120 mg/dL. Results: We included 292 patients, with a mean (SD) age of 62.6 (5.3) years and 55.8% male. The mean number of SBP, LDL, and A1c measurements per patient was 17, 5, and 12. We identified 86 (29.4%) patients with good vascular risk factor profile. In the linear regression models, mean SBP and LDL were associated with WMH progression and in a second fully adjusted model they both remained associated with WMH progression (Table). Those with a good vascular risk factor profile had less WMH progression (β Coefficient -0.80, 95% CI -1.42, -0.18, p=0.012). Conclusions: Our data reinforce prior research showing that higher SBP and LDL is associated with progression of WMH in diabetics, likely secondary to chronic microvascular ischemia, and suggest that control of these factors may have protective effects. This study has unique strengths, including prospective serial measurement of the exposures, validated algorithmic measurement methodology for WMH, and rigorous adjudication of study data. Clinical trials are needed to investigate the effect of vascular risk factor reduction on WMH progression.

Use of Metformin for Weight Management in Children and Adolescents With Obesity in the Clinical Setting

2018 ◽  
Vol 57 (14) ◽  
pp. 1677-1685 ◽  
Author(s):  
Kathryn E. Kyler ◽  
Rachel B. Kadakia ◽  
Hannah L. Palac ◽  
Soyang Kwon ◽  
Adolfo J. Ariza ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Weight Loss ◽  
Linear Regression ◽  
Weight Management ◽  
Clinical Setting ◽  
Regression Models ◽  
Obese Patients ◽  
Z Score ◽  
Linear Regression Models ◽  
Anthropometric Measures

Use of metformin for weight loss for children in a clinical setting has not been well described; therefore, we aimed to identify characteristics of obese patients prescribed metformin in a clinical setting and evaluate changes in anthropometric measures. Records of obese patients aged 10 to 18 years without diabetes attending an academic endocrinology practice from 2009 to 2013 were reviewed. Analyses assessed changes in anthropometric measures (weight, body mass index [BMI], and BMI z-score) over 12 months between those prescribed metformin (n = 49) and those not prescribed metformin (n = 142). Outcomes were standardized before using multivariable linear regression models. Patients prescribed metformin were significantly older, more often female, and had larger baseline anthropometric measures (all P < .05). In the models, subjects prescribed metformin had significantly less gain in standardized weight, BMI, and BMI z-score over 6 and 12 months (all P < .05). Metformin may be a useful weight management aid in children in a clinical setting.

scholarly journals Differential Profile of OSA in Obese Kashmiri Patients of Northern India

JMS SKIMS ◽  
2016 ◽  
Vol 19 (2) ◽  
pp. 65-74
Author(s):  
Javid Ahmad Malik ◽  
Sheikh Shoib ◽  
Bashir Ahmad Naikoo ◽  
Shabir Ahmad Lone ◽  
Ramees Mohi Ud Din Mir ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Daytime Sleepiness ◽  
Sleep Latency ◽  
Obese Patients ◽  
Nocturnal Sleep ◽  
Presenting Symptoms ◽  
Northern India ◽  
Obstructive Sleep ◽  
The Mean ◽  
Nonobese Patients

Obstructive sleep apnea (OSA) and obesity are two interacting global epidemics both with high prevalence and morbidity. Both epidemiologic and clinical studies suggest that majority of patients with obesity also have OSA and untreated OSA in these patients results in significant cardiovascular and metabolic complications.Objectives: To evaluate the profile of OSAin obese patients of Kashmir.Methods: We performed polysomnography studies in obese patients that were referred from various sub-specialty clinics from July 2011 to August 2013.Results: Out of 182 patients who underwent polysomnography (PSG), 11O (60.4%) were obese (BMI > 30 kg/m2). In 110 obese patients, 104 (94.5%) had OSA. Hypertension, diabetes and dyslipidemia were more prevalent among obese (p<0.05). The mean neck circumference and mean BMI of obese patients was significantly more than that of non-obese (33.9 kg/m2 vs. 26.8 kg/m2) (p <0.000). Presenting symptoms of obese were snoring (97.3%), daytime sleepiness (87.3%) with a mean ESS of 15.3, disturbed nocturnal sleep (70.0%), nocturia (62.7%) and witnessed apneas (45.5%). OSA was significantly (p=0.002) more common among obese compared to non-obese (93% vs 76%). Most were clinically suspected to have OSAby internists (29%), cardiologists (20%), endocrinologists (15%) and psychiatrists (13%). Sleep efficiency was significantly less (p< 0.03) in obese patients but sleep latency and REM sleep latency did not significantly differ between obese and non-obese. Unlike awake oxygen saturation the average nocturnal oxygen saturation of obese patients was significantly less [p=0.001] than that of nonobese patients (84.7% vs. 88.1%). The mean AHI of obese patients was significantly more than non-obese i.e 24.3 vs. 18.0 (p = 0.001) and so was the mean ODI i.e 24.6 vs. 17.2 (p = 0.001). Variables that significantly correlated with presence of OSA include age, gender, BMI, hypertension, diabetes and cardiovascular disease (p< 0.05), however on logistic regression only BMI, hypertension, and nocturia correlated with OSA. CPAPtherapy improved snoring, nocturia, nocturnal sleep and daytime sleepiness more in obese than non-obese OSApatients.Conclusions: OSA which is highly prevalent among obese Kashmiri patients, is largely unrecognized in the primary care setting. It is associated with significant comorbidities and most of these improve with CPAPtherapy. JMS 2016; 19(2):65-74.

scholarly journals Cystatin C-Based Evaluation of Kidney Function of HIV-Infected Children in Benin City, Southern Nigeria

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Moses Temidayo Abiodun ◽  
Nosakhare J. Iduoriyekemwen ◽  
Phillip O. Abiodun
Keyword(s):  
Kidney Disease ◽  
Hiv Infection ◽  
Kidney Function ◽  
Cystatin C ◽  
Mean Value ◽  
Control Group ◽  
Healthy Children ◽  
Serum Cystatin C ◽  
Serum Cystatin ◽  
The Mean

Background. Human immunodeficiency virus (HIV) is now a confirmed risk factor for kidney disease with an increased burden in persons of African descent.Method. We measured the serum cystatin C levels of 205 ART-naive, HIV-infected children by an ELISA technique and compared them with the levels of apparently healthy children.Result. The mean ± SD serum cystatin C level of children with HIV infection was 1.01 ± 0.44 mg/L, significantly higher than the mean value in the control group, that is, 0.72 ± 0.20 mg/L (P=0.000). The mean ± SD cystatin C-based estimated GFR of children with HIV infection was 102.7 ± 31.0 mL/min/1.73 m2, significantly lower than 126.9 ± 28.5 mL/min/1.73 m2in the control group, (P=0.014). A significantly higher proportion of HIV-infected children compared to controls had eGFR < 90 mL/min/1.73 m2(21.5% versus 5.4%;P=0.00). The prevalence of chronic kidney disease (CKD) among the HIV-infected children was 10.7%. The cystatin C-based eGFR of the HIV-infected children ≥5 years old correlated positively with their CD4 count (r=0.23;  P=0.022).Conclusion. There is a high prevalence of CKD among HIV-infected children, requiring regular monitoring of their kidney function using a cystatin C-based method.

scholarly journals Face mask wearing rate predicts country’s COVID-19 death rates

2020 ◽  
Author(s):  
Daisuke Miyazawa ◽  
Gen Kaneko
Keyword(s):  
Multiple Regression ◽  
Regression Models ◽  
Face Mask ◽  
Lasso Regression ◽  
Regression Analyses ◽  
Linear Regression Models ◽  
National Differences ◽  
Regression Approach ◽  
Independent Risk Factors

AbstractIdentification of biomedical and socioeconomic predictors for the number of deaths by COVID-19 among countries will lead to the development of effective intervention. While previous multiple regression studies have identified several predictors, little is known for the effect of mask non-wearing rate on the number of COVID-19-related deaths possibly because the data is available for limited number of countries, which constricts the application of traditional multiple regression approach to screen a large number of potential predictors. In this study, we used the hypothesis-driven regression to test the effect of limited number of predictors based on the hypothesis that the mask non-wearing rate can predict the number of deaths to a large extent together with age and BMI, other relatively independent risk factors for hospitalized patients of COVID-19. The mask non-wearing rate, percentage of age ≥ 80 (male), and male BMI showed Spearman’s correlations up to about 0.8, 0.7, and 0.6 with the number of deaths per million from 22 countries from mid-March to mid-June, respectively. The observed number of deaths per million were significantly correlated with the numbers predicted by the lasso regression model including four predictors, age ≥ 80 (male), male BMI, and mask non-wearing rates from mid-March and late April to early May (Pearson’s coefficient = 0.918). The multiple linear regression models including the mask non-wearing rates, age, and obesity-related predictors explained up to 79% variation of the number of deaths per million. Furthermore, 56.8% of the variation of mask non-wearing rate in mid-March, the strongest predictor of the number of deaths per million, was predicted by age ≥ 80 (male) and male BMI, suggesting the confounding role of these predictors. Although further verification is needed to identify causes of the national differences in COVID-19 mortality rates, these results highlight the importance of the mask, age, and BMI in predicting the COVID-19-related deaths, providing a useful strategy for future regression analyses that attempt to contribute to the mechanistic understanding of COVID-19.

scholarly journals Serum uromodulin is a novel predictive marker of renal function in the Japanese population

2020 ◽  
Author(s):  
Ryosuke Usui ◽  
Tetsuya Ogawa ◽  
Hideo Takahashi ◽  
Chihiro Iwasaki ◽  
Minako Koike ◽  
...  
Keyword(s):  
Clinical Study ◽  
Kidney Function ◽  
Cystatin C ◽  
Japanese Population ◽  
Estimated Glomerular Filtration Rate ◽  
Predictive Marker ◽  
Enzyme Linked Immunosorbent Assay ◽  
Serum Concentrations ◽  
Specific Enzyme ◽  
The Mean

Abstract Background Uromodulin, also known as Tamm-Horsfall protein, is the most abundant protein in urine. It has recently been reported that uromodulin exists in a small amount in blood and that its concentration correlates with the estimated glomerular filtration rate (eGFR). However, its clinical significance has not been clarified and there are no relevant data for the Japanese population. Method First, we generated anti-human uromodulin mouse monoclonal antibodies and established a specific enzyme-linked immunosorbent assay for uromodulin. We then performed an observational clinical study to determine if there was a correlation between serum uromodulin concentration and estimates of kidney function and whether the serum uromodulin value could be a biomarker in clinical nephrology. The clinical study included 308 patients with and without chronic kidney disease and healthy volunteers. Serum concentrations of creatinine, cystatin C, and uromodulin were measured and correlations were sought between the eGFR calculated from the creatinine and cystatin C levels and the serum uromodulin concentration. Results There was a good correlation between the serum uromodulin concentration and the eGFR value calculated from the creatinine (r=0.76) and cystatin C (r=0.79) levels. The mean serum uromodulin level in the group with an eGFR >90 mL/min/1.73 m 2 calculated using cystatin C was significantly higher than that in the group with an eGFR of 80–89 mL/min/1.73 m 2 . Conclusions The serum uromodulin measurement could be a useful biomarker for identification of patients with early deterioration of kidney function.

scholarly journals The Influence of Sitting, Standing, and Stepping Bouts on Cardiometabolic Health Markers in Older Adults

2021 ◽  
pp. 1-9
Author(s):  
Simone J.J.M. Verswijveren ◽  
Cormac Powell ◽  
Stephanie E. Chappel ◽  
Nicola D. Ridgers ◽  
Brian P. Carson ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Body Composition ◽  
Linear Regression ◽  
Regression Models ◽  
Fasting Glucose ◽  
Cardiometabolic Health ◽  
Linear Regression Models ◽  
Cross Sectional

Aside from total time spent in physical activity behaviors, how time is accumulated is important for health. This study examined associations between sitting, standing, and stepping bouts, with cardiometabolic health markers in older adults. Participants from the Mitchelstown Cohort Rescreen Study (N = 221) provided cross-sectional data on activity behaviors (assessed via an activPAL3 Micro) and cardiometabolic health. Bouts of ≥10-, ≥30-, and ≥60-min sitting, standing, and stepping were calculated. Linear regression models were fitted to examine the associations between bouts and cardiometabolic health markers. Sitting (≥10, ≥30, and ≥60 min) and standing (≥10 and ≥30 min) bouts were detrimentally associated with body composition measures, lipid markers, and fasting glucose. The effect for time spent in ≥60-min sitting and ≥30-min standing bouts was larger than shorter bouts. Fragmenting sitting with bouts of stepping may be targeted to benefit cardiometabolic health. Further insights for the role of standing need to be elicited.

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