Soluble ST2 and Galectin-3 as Predictors of Chronic Kidney Disease Progression and Outcomes

2021 ◽  
Vol 52 (2) ◽  
pp. 119-130
Author(s):  
Ae Jin Kim ◽  
Han Ro ◽  
Hyunsook Kim ◽  
Jae Hyun Chang ◽  
Hyun Hee Lee ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Proportional Hazards Model ◽  
Cox Regression ◽  
Adverse Outcomes ◽  
Cox Proportional Hazards Model ◽  
Secondary Outcome ◽  
Composite Outcome ◽  
Ckd Progression ◽  
Cox Regression Analysis ◽  
Galectin 3

<b><i>Background:</i></b> Soluble suppression of tumorigenicity-2 (sST2) and galectin-3, novel biomarkers of heart failure and cardiovascular stress, predict cardiovascular events (CVEs) and mortality. However, their relationship with kidney function and adverse outcomes in CKD are uncertain. The purpose of this study was to determine the association between sST2 and galectin-3 with CKD progression and adverse clinical outcomes. <b><i>Methods:</i></b> We measured baseline sST2 and galectin-3 levels in the CKD patient cohort at our institution between October 2013 and December 2014. The primary outcome was CKD progression (kidney failure with replacement therapy or ≥50% reduction in estimated glomerular filtration rate from the baseline). The secondary outcome was the composite of CVEs and death. We used a Cox proportional hazards model to evaluate the associations between sST2 and galectin-3 levels, with kidney and clinical outcomes. <b><i>Results:</i></b> In total, 352 patients were enrolled in this study. At baseline, log sST2 and galectin-3 were directly associated with the serum creatinine (Cr) and urine protein-to-Cr ratio. Cox regression analysis showed that the baseline log sST2 level independently predicted CKD progression and composite outcome after adjustment for age, sex, smoking, diabetes mellitus, hypertension, cardiovascular disease, renin-angiotensin system blocker, calcium channel blocker, β-blocker, diuretics, antiplatelet agents, anemia, and hypoalbuminemia. The baseline log galectin-3 level was independently associated with CKD progression, but not with the composite outcome after adjustment for confounding variables. <b><i>Conclusions:</i></b> Elevated levels of sST2 and galectin-3 are significantly associated with CKD progression, but only sST2 is associated with adverse clinical outcomes.

scholarly journals Improving Prognostic and Fibrotic Evaluation of Chronic Kidney Disease with Contrast‐Enhanced Ultrasound Index Derived Peak Intensity: an observational study

2019 ◽  
Author(s):  
Yao Xu ◽  
Hongli Li ◽  
Chunlin Wang ◽  
Minfang Zhang ◽  
Qin Wang ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Proportional Hazards Model ◽  
Cox Regression ◽  
Cox Proportional Hazards Model ◽  
High Morbidity ◽  
Ckd Progression ◽  
Cox Regression Analysis ◽  
Peak Intensity ◽  
Contrast Enhanced

Abstract Background Chronic kidney disease (CKD) is a progressive disease with high morbidity and mortality. Contrast-enhanced ultrasonography (CEUS) has emerged as a cost-effective novel non-invasive imaging technique to improve the diagnosis and predict CKD progression. Methods Patients diagnosed with CKD who underwent CEUS with intravenous bolus contrast 1.5 ml SonoVue during 2014 to December 2014 at Ren Ji hospital, Shanghai, China, were enrolled in this study. Time-intensity curves and quantitative indexes were created using QLAB quantification software. Kidney biopsies were analyzed with α-SMA immunohistochemistry. The Cox proportional hazards model was used to investigate the risk factors for kidney survival. Results Out of 167 CKD patients followed for a median of 23.6±11.3 months, 29 (17.4%) exhibited CKD progression with decline in glomerular filtration rate of more than 25% or end-stage renal disease. Multivariate Cox regression analysis revealed lower derived peak intensity (DPI) was independently associated with progression of kidney disease. Patients with DPI≤11.98db had more severe renal fibrosis and less likely to recover from CKD progression. Conclusions This study demonstrated that the DPI is a reliable CEUS parameter for the evaluation of renal function and independent predictor for the prognosis of CKD patients.

scholarly journals Systemic Immune-Inflammatory Index predicts prognosis of patients with COVID-19: a retrospective study

2020 ◽  
Author(s):  
Hong Li ◽  
Jia-bao Huang ◽  
Wen Pan ◽  
Cun-tai Zhang ◽  
Xiao-yan Chang ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Roc Curve ◽  
Cox Regression ◽  
Invasive Mechanical Ventilation ◽  
Adverse Outcomes ◽  
Secondary Outcome ◽  
Cox Regression Analysis ◽  
Inflammatory Index

Abstract Background Our study aimed to investigate the prognostic value of a novel inflammatory index, systemic immune-inflammation index (SII), with the clinical outcomes of patients infected with coronavirus disease 2019 (COVID-19).Methods We evaluated a cohort study of COVID-19 patients (18–95 years old) in Tongji Hospital of Huazhong University of Science and Technology from January 28th 2020 to February 29th 2020. The enrolled patients were divided into two groups (including low-SII group and high-SII group) according to the cut-off point which is analyzed by receiver operating characteristic (ROC) curve. Univariate and multivariate COX regression analysis were performed to identify the factors associated with the outcomes of patients with COVID-19 infection. The primary and secondary outcome were in-hospital mortality and the development of acute respiratory distress syndrome (ARDS), respectively.Results A number of 326 adult patients (43.87% males, 61.22 ± 0.86 years) were enrolled in the final analyses. There were 147 cases (45.09%) died in hospital and 116 patients (35.58%) developed ARDS. ROC curve analysis indicated that the SII had a greater prediction accuracy in predicting the in-hospital mortality (area under the curve [AUC] = 0.789, sensitivity = 69.90%, specificity = 70.80%) and the development of ARDS (AUC = 0.736, sensitivity = 67.80%, specificity = 71.10%). Kaplan-Meier analysis revealed that patients in high-SII group had a greater risk of adverse clinical outcomes (all P < 0.001). The multivariate Cox regression analysis indicated that elevated SII was found as the risk predictor of in-hospital mortality (hazard ratio [HR] = 2.839, 95% confidence interval [CI] = 1.116–7.222, P = 0.028) and the developed ARDS (HR = 6.832, 95%CI = 2.583–18.074, P < 0.001). Additional significant independent predictor for adverse outcomes was the lymphocyte proportion. What’s more, it suggests that the invasive mechanical ventilation performed in the early stage of the disease progression may be beneficial for patients.Conclusion SII, a novel biomarker, might be a remarkable prognostic indicator to assess the in-hospital mortality and the development of ARDS in patients with COVID-19 and help for clinical risk assessment.

scholarly journals Trajectories of Mediterranean Diet Adherence and Risk of Hypertension in China: Results from the CHNS Study, 1997–2011

Nutrients ◽  
2018 ◽  
Vol 10 (12) ◽  
pp. 2014 ◽  
Author(s):  
Min Gao ◽  
Fengbin Wang ◽  
Ying Shen ◽  
Xiaorou Zhu ◽  
Xing Zhang ◽  
...  
Keyword(s):  
Mediterranean Diet ◽  
Proportional Hazards Model ◽  
Cox Regression ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Nutrition Survey ◽  
Cox Regression Analysis ◽  
Incident Hypertension ◽  
Diet Adherence ◽  
Mediterranean Diet Adherence

Evidence indicates that longitudinal changes in dietary patterns may predict variations in blood pressure (BP) and risk of incident hypertension. We aimed to identify distinct trajectories in the levels of Mediterranean diet adherence (MDA) in China and explore their association with BP levels and hypertension risk using the China Health and Nutrition Survey 1997–2011 data. Three levels of MDA were constructed. The trajectories in these levels were constructed using group-based trajectory modeling. A Cox proportional hazards model was used to measure the association between MDA trajectory groups and the risk of incident hypertension after adjusting for covariates. Finally, 6586 individuals were included. Six distinct MDA trajectory groups were identified: persistently low and gradual decline; rapidly increasing and stabilized; persistently moderate; slightly increasing, steady, and acutely descending; slightly decreasing and acutely elevated; and persistently high. The systolic BP and diastolic BP were significantly lower in trajectory groups with rapidly increasing and stabilized MDA; slightly increasing, steady, and acutely descending MDA; and persistently high MDA. Cox regression analysis showed that the risks of developing hypertension were relatively lower in the group with slightly increasing, steady, and acutely descending MDA (hazard ratio (HR) = 0.17, 95% confidence interval (CI): 0.09–0.32) and the group with rapidly increasing and stabilized MDA (HR = 0.32, 95% CI: 0.23–0.42), but the risk was the highest in the trajectory with persistently moderate MDA (HR = 0.96, 95% CI: 0.84–1.08). In conclusion, MDA in China was categorized into six distinct trajectory groups. BP was relatively lower in trajectory groups with initially high or increasing MDA levels. Greater MDA was significantly associated with a lower risk of developing hypertension.

Coexpression of PDGFR-Alpha, PDGFR-Beta and VEGF as a Prognostic Factor in Patients with Hepatocellular Carcinoma

2011 ◽  
Vol 26 (2) ◽  
pp. 108-116 ◽  
Author(s):  
Li Chen ◽  
Yan Shi ◽  
Cheng-ying Jiang ◽  
Li-xin Wei ◽  
Ya-li Lv ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Growth Factor ◽  
Proportional Hazards Model ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Prognostic Significance ◽  
Disease Free Survival ◽  
Hazard Ratio ◽  
Cox Proportional Hazards Model ◽  
Cox Regression Analysis

Aims To evaluate the prognostic value of vascular endothelial growth factor (VEGF), platelet-derived growth factor receptor-alpha (PDGFR-α) and beta (PDGFR-β) expression in patients with hepatocellular carcinoma (HCC). Methods The expression of PDGFR-α, PDGFR-β and VEGF in 63 HCC patients who underwent curative resection was examined by immunohistochemistry (IHC). The correlations between the expression of these biomarkers and the clinicopathological characteristics were analyzed. Patient survival was analyzed by univariate analysis and Cox proportional hazards model. Results Univariate survival analysis showed that PDGFR-α or PDGFR-β overexpression was of no prognostic significance in predicting disease-free survival (DFS) and overall survival (OS) (p>0.05), while VEGF overexpression and PDGFR-α/PDGFR-β/VEGF coexpression were significantly correlated with worse DFS and poorer OS in HCC patients (P<0.05). More importantly, PDGFR-α/PDGFR-β/VEGF coexpression was an independent prognostic marker for poor survival as indicated by multivariate Cox regression analysis (DFS, hazard ratio 3.122, p=0.001; OS, hazard ratio 4.260, p=0.000). Conclusions Coexpression of PDGFR-α, PDGFR-β and VEGF could be considered an independent prognostic biomarker for predicting DFS and OS in HCC patients. This result could be used to identify patients at a higher risk of tumor recurrence and poor prognosis, and help to select therapeutic schemes for the treatment of HCC.

Genetic and nongenetic factors for contralateral progression of unilateral moyamoya disease: the first report from the SUPRA Japan Study Group

2021 ◽  
pp. 1-10
Author(s):  
Yohei Mineharu ◽  
Yasushi Takagi ◽  
Akio Koizumi ◽  
Takaaki Morimoto ◽  
Takeshi Funaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Moyamoya Disease ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Regression ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Multicenter Cohort Study ◽  
Cox Regression Analysis ◽  
Unilateral Moyamoya Disease

OBJECTIVE Although many studies have analyzed risk factors for contralateral progression in unilateral moyamoya disease, they have not been fully elucidated. The aim of this study was to examine whether genetic factors as well as nongenetic factors are involved in the contralateral progression. METHODS The authors performed a multicenter cohort study in which 93 cases with unilateral moyamoya disease were retrospectively reviewed. The demographic features, RNF213 R4810K mutation, lifestyle factors such as smoking and drinking, past medical history, and angiographic findings were analyzed. A Cox proportional hazards model was used to find risk factors for contralateral progression. RESULTS Contralateral progression was observed in 24.7% of cases during a mean follow-up period of 72.2 months. Clinical characteristics were not significantly different between 63 patients with the R4810K mutation and those without it. Cox regression analysis showed that the R4810K mutation (hazard ratio [HR] 4.64, p = 0.044), childhood onset (HR 7.21, p < 0.001), male sex (HR 2.85, p = 0.023), and daily alcohol drinking (HR 4.25, p = 0.034) were independent risk factors for contralateral progression. CONCLUSIONS These results indicate that both genetic and nongenetic factors are associated with contralateral progression of unilateral moyamoya disease. The findings would serve to help us better understand the pathophysiology of moyamoya disease and to manage patients more appropriately.

scholarly journals Simulation Extrapolation Method for Cox Regression Model with a Mixture of Berkson and Classical Errors in the Covariates using Calibration Data

2019 ◽  
Vol 15 (2) ◽  
Author(s):  
Jean de Dieu Tapsoba ◽  
Edward C. Chao ◽  
Ching-Yun Wang
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Regression ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Classical Type ◽  
Calibration Data ◽  
Finite Sample ◽  
Cox Regression Analysis ◽  
Simulation Extrapolation

Abstract Many biomedical or epidemiological studies often aim to assess the association between the time to an event of interest and some covariates under the Cox proportional hazards model. However, a problem is that the covariate data routinely involve measurement error, which may be of classical type, Berkson type or a combination of both types. The issue of Cox regression with error-prone covariates has been well-discussed in the statistical literature, which has focused mainly on classical error so far. This paper considers Cox regression analysis when some covariates are possibly contaminated with a mixture of Berkson and classical errors. We propose a simulation extrapolation-based method to address this problem when two replicates of the mismeasured covariates are available along with calibration data for some subjects in a subsample only. The proposed method places no assumption on the mixture percentage. Its finite-sample performance is assessed through a simulation study. It is applied to the analysis of data from an AIDS clinical trial study.

scholarly journals Unplanned Reoperation After Trapeziometacarpal Arthroplasty: Rate, Reasons, and Risk Factors

Hand ◽  
2016 ◽  
Vol 12 (5) ◽  
pp. 446-452 ◽  
Author(s):  
Suzanne C. Wilkens ◽  
Zichao Xue ◽  
Jos J. Mellema ◽  
David Ring ◽  
Neal Chen
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Regression ◽  
Persistent Pain ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Cox Regression Analysis ◽  
Factors Associated ◽  
Hazards Model ◽  
Kaplan Meier

Background: Trapeziometacarpal (TMC) arthritis is an expected part of ageing to which most patients adapt well. Patients who do not adapt to TMC arthritis may be offered operative treatment. The factors associated with reoperation after TMC arthroplasty are incompletely understood. The purpose of this study was to determine the rate of, the underlying reasons for, and the factors associated with unplanned reoperation after TMC arthroplasty. Methods: In this retrospective study, we included all adult patients who had TMC arthroplasty for TMC arthritis at 1 of 3 large urban area hospitals between January 2000 and December 2009. Variables were inserted into a multivariable Cox proportional hazards model to determine factors associated with unplanned reoperation, and the Kaplan-Meier curve was used to estimate and describe the probability of unplanned reoperation over time. Results: Among 458 TMC arthroplasties, 19 (4%) had an unplanned reoperation; 16 of 19 (84%) for persistent pain and two-thirds within the first year. The multivariate Cox regression analysis showed that unplanned reoperation was independently associated with younger age, surgeon inexperience, and index procedure type. Conclusions: Surgeons should be aware as well as patients should be informed that as many as 4% are offered or request a second surgery, usually for persistent pain and often within the 1-year window when additional improvement is anticipated.

scholarly journals FOXD1 Promotes Cell Growth and Metastasis by Activation of Vimentin in NSCLC

2018 ◽  
Vol 51 (6) ◽  
pp. 2716-2731 ◽  
Author(s):  
Dan Li ◽  
Suyun Fan ◽  
Fei Yu ◽  
Xuchao Zhu ◽  
Yingchun Song ◽  
...  
Keyword(s):  
Proportional Hazards Model ◽  
Cox Regression ◽  
Disease Free Survival ◽  
Cox Proportional Hazards Model ◽  
Migration And Invasion ◽  
Rank Test ◽  
Cox Regression Analysis ◽  
Nsclc Patients

Background/Aims: Forkhead box D1 (FOXD1) has a well-established role in early embryonic development and organogenesis and functions as an oncogene in several cancers. However, the clinical significance and biological roles of FOXD1 in non-small cell lung cancer (NSCLC) remain largely unknown. Methods: A total of 264 primary NSCLC tissue samples were collected. The expression levels of FOXD1 in these samples were examined by immunohistochemical staining. The expression of FOXD1 was knocked down by lentiviral shRNA. The relative expression of FOXD1 was determined by qRT-PCR, Western blotting and immunofluorescence image. The functional roles of FOXD1 in NSCLC were demonstrated cell viability CCK-8 assay, colony formation, cell invasion and migration assays, and cell apoptosis assay in vitro. In vivo mouse xenograft and metastasis models were used to assess tumorigenicity and metastatic ability. The Chi-square test was used to assess the correlation between FOXD1 expression and the clinicopathological characteristics. Survival curves were estimated by Kaplan-Meier method and compared using the log-rank test. The Cox proportional hazards model was used for univariate and multivariate analyses. Results: We determined that higher levels of FOXD1 were present in NSCLC tissues, especially in metastatic NSCLC tissues. FOXD1 was also higher in all NSCLC cells compared with normal human bronchial epithelial cells. A higher expression level of FOXD1 was associated with malignant behavior and poor prognosis in NSCLC patients. Knockdown of FOXD1 significantly inhibited proliferation, migration, and invasion in vitro and tumor growth and metastasis in vivo, and it increased the apoptosis rates of NSCLC cells. Mechanistic analyses revealed that FOXD1 expressed its oncogenic characteristics through activating Vimentin in NSCLC. Multivariate Cox regression analysis indicated that FOXD1 was an independent prognostic factor both for overall survival (OS) and disease-free survival (DFS) in NSCLC patients. Conclusion: Our results indicated that FOXD1 might be involved in the development and progression of NSCLC as an oncogene, and thereby might be a potential therapeutic target for NSCLC patients.

scholarly journals Intraocular Lens Power, Myopia, and the Risk of Nd:YAG Capsulotomy after 15,375 Cataract Surgeries

2020 ◽  
Vol 9 (10) ◽  
pp. 3071
Author(s):  
Juha-Matti Lindholm ◽  
Ilkka Laine ◽  
Raimo Tuuminen
Keyword(s):  
Cataract Surgery ◽  
Proportional Hazards Model ◽  
Cox Regression ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Intraocular Lenses ◽  
Cumulative Probability ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
Hydrophobic Acrylic

The present study estimated the 5-year cumulative probability of Nd:YAG laser posterior capsulotomy according to the diopter power of implanted hydrophobic acrylic intraocular lenses (IOLs). Data were retrospectively collected of 15,375 eyes having cataract surgery and in-the-bag implantation of hydrophobic acrylic monofocal IOLs at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland between the years 2007 and 2016. The cumulative probability of Nd:YAG capsulotomy was calculated by Kaplan–Meier estimates, and potential risk factors were analyzed using the Cox proportional hazards model. The 5-year cumulative probability of Nd:YAG capsulotomy after cataract surgery was 27.4% (95% confidence interval (CI) 22.9–32.6%) for low-diopter (5–16.5 D) IOLs, 14.6% (13.8–15.5%) for mid-diopter (17–24.5 D) IOLs, and 13.6% (11.7–15.6%) for high-diopter (25–30 D) IOLs. A multivariate Cox regression analysis showed that low-diopter IOLs (HR 1.76; 95% CI 1.38–2.25; p < 0.001) were associated with an increased risk of Nd:YAG capsulotomy compared to mid-diopter IOLs over the follow-up period after accounting for other predictors. Real-world evidence shows that low-diopter IOLs are associated with significantly higher risk of Nd:YAG capsulotomy within five years following implantation. Estimation should help in evaluating the risks of cataract surgery in myopic eyes.

Abstract 283: Variation In Ticagrelor Utilization And Outcomes In Patients With Acute Coronary Syndrome

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Aya Ozaki ◽  
Cynthia JACKEVICIUS ◽  
Alice Chong ◽  
Maria Koh ◽  
Maneesh Sud ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Proportional Hazards Model ◽  
Temporal Trends ◽  
Cox Proportional Hazards Model ◽  
Secondary Outcome ◽  
Administrative Claims ◽  
Factors Associated ◽  
Coronary Syndrome ◽  
Hospital Variation ◽  
Significant Difference

Background: Ticagrelor is a P2Y12 inhibitor with better cardiovascular outcomes than clopidogrel in clinical trials for acute coronary syndromes. However, the adoption of ticagrelor into clinical practice has been understudied. Therefore, we evaluated: 1) temporal trends in ticagrelor use, 2) factors associated with its use, and 3) hospital variation in its adoption and clinical outcomes. Methods: We conducted a population-based cohort study using administrative claims data in Ontario, Canada between 4/2014 and 3/2018. We identified individuals >65 years of age who were admitted for myocardial infarction (MI) or unstable angina (UA) and filled a prescription for ticagrelor or clopidogrel at or within 7 days of discharge. We categorized hospitals into quartiles based on ticagrelor utilization rates. The primary composite outcome was 1-year death or hospitalization for MI/UA, and 1-year bleeding hospitalization was a secondary outcome. Outcomes were evaluated using a Cox proportional hazards model to compare high vs. low utilization groups. Further, we quantified the between-hospital variability of ticagrelor utilization using multi-level logistic regression analysis, expressed as median odds ratios (MOR). Results: Among 23 962 patients in our cohort, 42.5% were prescribed ticagrelor ≤7 days post-hospital discharge. Ticagrelor utilization increased from 32.6% in 2014 to 51.8% in 2017. Hospitals at the lowest quartile of ticagrelor utilization (<8.8%) had a higher hazard of the primary outcome (adjusted hazard ratio: 1.27 95%CI: 1.11-1.46, p<0.001) compared with high ticagrelor utilization hospitals (>40%). No significant difference in bleeding hospitalization across hospital quartiles was observed. Some factors associated with higher ticagrelor use were cardiologist as most responsible physician during index hospitalization and urban hospital. After adjusting for patient-, prescriber- and hospital-level characteristics, substantial variation remained between hospitals in the likelihood of patients receiving ticagrelor at discharge (MOR: 2.54). Conclusion: Increasing trends of ticagrelor utilization were observed. Ticagrelor utilization rates varied across hospitals, and hospitals with higher ticagrelor adoption were associated with better clinical outcomes.

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