Relationship between tracheal intubation and the drugs used by patients with drug overdose due to self-harm

Abstract Background Tracheal intubation may be performed in patients with drug overdose due to self-harm; however, the details of the causative drug are unknown. The purpose of this study was to clarify the relationship between drugs or its blood levels of patients with drug overdose and the need for tracheal intubation based on the actual measurement results. Methods From October 2018 to March 2020, 132 patients with drug overdose due to self-harm who were transported to the emergency department (ED) were studied. Patient drugs were measured using gas chromatography–mass spectrometry (GC-MS) and were analyzed on the basis of the GC/MS Forensic Toxicological Database. Logistic analysis was performed by combining patient information and GC-MS information. Results The Glasgow Coma Scale (GCS) and Japan Coma Scale (JCS) efficiently predicted tracheal intubation in patients with drug overdose during transport triage; GCS (cut-off value: 12, area under the curve (AUC): 0.81, 95% confidence interval (CI): 0.71–0.88, sensitivity: 0.85, specificity: 0.71, P < 0.05) and JCS (cut-off value: 3, AUC: 0.74, 95% CI: 0.60–0.84, sensitivity: 0.60, specificity: 0.84, P < 0.05). The drugs detected in all patients with drug overdose in order were benzodiazepine receptor agonists (BZs; 43.9%), anticonvulsants (38.6%), antipsychotics (25.0%), and antidepressants (9.8%). In univariate logistic analysis, antipsychotics (odds ratio (OR) 2.46, 95% CI 1.19–5.20, P < 0.05), anticonvulsants (OR 2.71, 95% CI 1.26–5.98, P < 0.05), and anticonvulsants above alert blood levels (OR 27.8, 95% CI 2.92–264.1, P < 0.05) were significantly associated with tracheal intubation in patients with drug overdose, but not BZs and antidepressants. Also, in multivariate logistic analysis, antipsychotics (OR 2.27, 95% CI 1.07–4.83, P < 0.05), anticonvulsants (OR 2.50, 95% CI 1.14–5.64, P < 0.05) and in multivariate logistic analysis of blood levels, anticonvulsants above the alert blood levels (OR 24.9, 95% CI 2.56–241.6, P < 0.05) were significantly associated with tracheal intubation in patients with drug overdose respectively. Conclusions Logistic analysis revealed that the use of anticonvulsants and antipsychotics were significantly associated with an increased OR in the tracheal intubation of patients with drug overdose due to self-harm.

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AB0132 THE STUDY OF SUBCLINICAL SYNOVITIS DETECTED BY ULTRASONOGRAPHY AND MRI IN RA PATIENTS AFTER REACHING CLINICAL REMISSION ON PATIENT’S SUBJECTIVE SYMPTOMS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2830 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1094.2-1094

Author(s):

M. Nawata ◽

K. Someya ◽

T. Aritomi ◽

M. Funada ◽

K. Nakamura ◽

...

Keyword(s):

Clinical Remission ◽

Research Funding ◽

Morning Stiffness ◽

Univariate Analysis ◽

P Value ◽

Research Support ◽

Residual Symptoms ◽

Logistic Analysis ◽

Significant Difference ◽

Multivariate Logistic Analysis

Background:The goal of treatment in rheumatoid arthritis (RA) is to achieve remission. There is the patient with residual symptoms in the Japanese RA patient who achieved clinical remission. There are not many studies to examine the relation between everyday life, social activity and evaluation of disease activities using high-sensitivity image examinations (musculoskeletal ultrasound (MSKUS) and MRI).Objectives:To examine the relationship between subjective residual symptoms and imaging examinations in RA patients who have achieved clinical remission.Methods:30 RA patients who achieved SDAI remission during RA treatment. Age, sex, disease duration, physical findings, serological markers, disease activity, HAQ, EQ-5D-5L, FACIT-F, Patient Reported Outcomes (PROs), EGA and medications were evaluated. 44 joints were assessed by MSKUS with gray scale (GS) and power doppler (PD) and contrast-enhanced bilateral joint MRI scoring with OMERACT-RAMRIS scoring.Results:1. The mean SDAI of the 30 RA patients was 1.3. 2.In the analysis of the presence or absence of subjective residual symptoms that led to remission of SDAI (Table 1).Table 1.Subjective residual symptoms/presence (N=17)Subjective residual symptoms/absence (N=13)Univariate analysisp valueMultivariate logistic analysisp valueTJC0.0±0.00.3±0.50.0173HAQ0.4±0.40.05±0.10.00950.00181EQ5D-5L0.8±0.10.9±0.00.0001FACIT-F14.5±9.84.6±4.30.0233Morning stiffness (min)256.5±564.80.0±0.00.0210Pain (VAS) (mm)9.2±9.50.9±1.50.00440.0455PGA (mm)7.7±9.00.5±1.10.0013(1). In the univariate analysis, the number of tender joints, HAQ, EQ-5D-5L, FACIT-F, morning stiffness, and pain VAS were extracted with significant differences.(2). In multivariate logistic analysis, HAQ and pain VAS were extracted as independent factors with significant differences. 3.In univariate analysis of the association between HAQ and pain VAS extracted in multivariate logistic analysis and imaging examinations (MSKUS/MRI), MRI-synovitis was extracted with a significant difference in HAQ.Conclusion:1. It was suggested that Pain VAS and HAQ due to RA could be identified in patients reaching SDAI remission. 2. In patients reaching SDAI remission, Pain VAS ≤10 or HAQ ≤0.5 suggested that subjective residual symptoms may be eliminated. 3. HAQ ≤ 0.5 suggests that synovitis is less likely to be detected on MRI. 4. In patients who have reached SDAI remission, little residual inflammation was observed on US, suggesting that induction of remission is important not only to prevent joint destruction, but also to improve and maintain long-term QoL.Disclosure of Interests:MASAO NAWATA Grant/research support from: I have received research funding from Eli Lilly Japan K.K., Kazuki Someya: None declared, Takafumi Aritomi: None declared, Masashi funada: None declared, Katsumi Nakamura: None declared, SAITO KAZUYOSHI Grant/research support from: I have received research funding from Eli Lilly Japan K.K., Yoshiya Tanaka Speakers bureau: I have received speaking fees from Abbvie, Daiichi-Sankyo, Chugai, Takeda, Mitsubishi-Tanabe, Bristol-Myers, Astellas, Eisai, Janssen, Pfizer, Asahi-kasei, Eli Lilly, GlaxoSmithKline, UCB, Teijin, MSD, and Santen, Consultant of: I have received consulting fees from Abbvie, Daiichi-Sankyo, Chugai, Takeda, Mitsubishi-Tanabe, Bristol-Myers, Astellas, Eisai, Janssen, Pfizer, Asahi-kasei, Eli Lilly, GlaxoSmithKline, UCB, Teijin, MSD, and Santen, Grant/research support from: I have received research grants from Mitsubishi-Tanabe, Takeda, Chugai, Astellas, Eisai, Taisho-Toyama, Kyowa-Kirin, Abbvie, and Bristol-Myers

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Factors associated with the development of ocular candidiasis and ocular prognosis with echinocandin therapy for candidemia

Journal of Ophthalmic Inflammation and Infection ◽

10.1186/s12348-021-00248-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Daiki Sakai ◽

Wataru Matsumiya ◽

Sentaro Kusuhara ◽

Makoto Nakamura

Keyword(s):

Candida Albicans ◽

Medical Records ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Patient Characteristics ◽

Antifungal Drugs ◽

Factors Associated ◽

Logistic Analysis ◽

Multivariate Logistic Analysis ◽

Systemic Antifungal Therapy

Abstract Purpose To evaluate the factors associated with the development of ocular candidiasis (OC) and ocular prognosis with echinocandin therapy for candidemia. Methods The medical records of 56 consecutive patients with a positive blood culture for Candida species between November 2016 and October 2019 were retrospectively reviewed. Information on patient characteristics, isolated Candida species, treatment details for candidemia, and ocular findings were extracted to identify factors associated with OC development. Results The leading pathogen of candidemia was Candida albicans (C.albicans) (41.1%). Of 56 patients, 18 (32.1%) were diagnosed with chorioretinitis, categorized as either probable (8 patients) or possible OC (10 patients). There was no case of endophthalmitis with vitritis. The incidence of probable OC was not significantly different between the groups treated with echinocandins and other antifungal drugs (15.2% vs. 11.1%, p = 1.00). In all probable OC cases, systemic antifungal therapy was switched from echinocandins to azoles, and no case progressed to endophthalmitis. A multivariate logistic analysis revealed that female sex (adjusted odds ratio [aOR], 8.93; 95% confidence interval [CI], 1.09–72.9) and C. albicans (aOR, 23.6; 95% CI, 1.8–281) were independent factors associated with the development of probable OC. Conclusion One-seventh of patients with candidemia developed probable OC. Given the evidence of female and C. albicans as the factors associated with OC development, careful ophthalmologic management is required with these factors, especially in candidemia. Although echinocandins had no correlation with OC development and did not lead to the deterioration of ocular prognosis, further investigation is required.

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B-Type Natriuretic Peptides Help in Cardioembolic Stroke Diagnosis

Stroke ◽

10.1161/strokeaha.114.008311 ◽

2015 ◽

Vol 46 (5) ◽

pp. 1187-1195 ◽

Cited By ~ 78

Author(s):

Víctor Llombart ◽

Albert Antolin-Fontes ◽

Alejandro Bustamante ◽

Dolors Giralt ◽

Natalia S. Rost ◽

...

Keyword(s):

Natriuretic Peptides ◽

Meta Analysis ◽

Area Under The Curve ◽

Cardioembolic Stroke ◽

Blood Levels ◽

Clinical Value ◽

Predictive Values ◽

Pubmed Database ◽

Integrated Discrimination Improvement ◽

Improvement Index

Background and Purpose— Determining the underlying cause of stroke is important to optimize secondary prevention treatment. Increased blood levels of natriuretic peptides (B-type natriuretic peptide/N-terminal pro-BNP [BNP/NT-proBNP]) have been repeatedly associated with cardioembolic stroke. Here, we evaluate their clinical value as pathogenic biomarkers for stroke through a literature systematic review and individual participants’ data meta-analysis. Methods— We searched publications in PubMed database until November 2013 that compared BNP and NT-proBNP circulating levels among stroke causes. Standardized individual participants’ data were collected to estimate predictive values of BNP/NT-proBNP for cardioembolic stroke. Dichotomized BNP/NT-proBNP levels were included in logistic regression models together with clinical variables to assess the sensitivity and specificity to identify cardioembolic strokes and the additional value of biomarkers using area under the curve and integrated discrimination improvement index. Results— From 23 selected articles, we collected information of 2834 patients with a defined cause. BNP/NT-proBNP levels were significantly elevated in cardioembolic stroke until 72 hours from symptoms onset. Predictive models showed a sensitivity >90% and specificity >80% when BNP/NT-proBNP were added considering the lowest and the highest quartile, respectively. Both peptides also increased significantly the area under the curve and integrated discrimination improvement index compared with clinical models. Sensitivity, specificity, and precision of the models were validated in 197 patients with initially undetermined stroke with final pathogenic diagnosis after ancillary follow-up. Conclusions— Natriuretic peptides are strongly increased in cardioembolic strokes. Future multicentre prospective studies comparing BNP and NT-proBNP might aid in finding the optimal biomarker, the best time point, and the optimal cutoff points for cardioembolic stroke identification.

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Development and Validation of a Nomogram for Renal Involvement in Primary Sjögren Syndrome Patients: A Retrospective Analysis

Modern Rheumatology ◽

10.1093/mr/roab123 ◽

2021 ◽

Author(s):

Xinshi Huang ◽

Xiaobing Wang ◽

Dinglai Yu

Keyword(s):

Risk Factors ◽

Prediction Model ◽

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Renal Involvement ◽

Calibration Plot ◽

Receiver Operating Characteristic Curves ◽

Logistic Analysis ◽

Validation Set ◽

Multivariate Logistic Analysis

Abstract Objective To establish and validate a nomogram for individualized prediction of renal involvement in pSS patients. Methods A total of 1293 patients with pSS from the First Affiliated Hospital of Wenzhou Medical University between January 2008 to January 2020 were recruited and further analyzed retrospectively. The patients were randomly divided into a development set (70%, n = 910) and a validation set (30%, n = 383). The univariable and multivariate logistic regression were performed to analyze the risk factors of renal involvement in pSS. Based on the regression β coefficients derived from multivariate logistic analysis, an individualized nomogram prediction model was developed. The prediction model of discrimination and calibration was evaluated with the area under the receiver operating characteristic curves and Calibration plot. Results Multivariate logistic analysis showed that hypertension, anemia, albumin, uric acid, anti-Ro52, hematuria and Chisholm-Mason grade were independent risk factors of renal involvement in pSS. The area under the receiver operating characteristic curves were 0.797 and 0.750 respectively in development set and validation set, indicating the nomogram had a good discrimination capacity. The Calibration plot showed nomogram had a strong concordance performance between the prediction probability and the actual probability. Conclusion The individualized nomogram for pSS patients those who had renal involvement could be used by clinicians to predict the risk of pSS patients developing into renal involvement and improve early screening and intervention.

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A Salmonella Typhimurium phage type (PT) U320 outbreak in England, 2008: continuation of a trend involving ready-to-eat products

Epidemiology and Infection ◽

10.1017/s0950268810003080 ◽

2011 ◽

Vol 139 (12) ◽

pp. 1936-1944 ◽

Cited By ~ 6

Author(s):

N. S. BOXALL ◽

G. K. ADAK ◽

E. DE PINNA ◽

I. A. GILLESPIE

Keyword(s):

Case Control Study ◽

Phage Type ◽

Case Control ◽

Protection Agency ◽

Retrospective Case ◽

Retail Chain ◽

Logistic Analysis ◽

Multivariate Logistic Analysis ◽

Epidemiological Link ◽

Control Study

SUMMARYIn March 2008, the Health Protection Agency in England conducted a retrospective case-control study to investigate the cause of 179 cases of the newly recognized, fully antimicrobial-sensitive Salmonella Typhimurium PT U320. Forty-three symptomatic laboratory-confirmed case-patients and 84 asymptomatic location-matched controls were interviewed by telephone about exposures in the 3 days prior to illness or interview. Multivariate logistic analysis indicated consumption of pre-packaged egg sandwiches (odds ratio 3·29, 95% confidence interval 1·19–9·09) was independently associated with illness. Eight of the 15 case-patients who consumed egg sandwiches did so from retail chain A (53·3%) whereas none of the eight controls consumed similar sandwiches (χ2=7·20, P⩽0·01). A review of the pre-packaged egg sandwich ingredients suggested this outbreak was probably caused by exposure to an ingredient common to pre-packaged sandwiches and prepared salads but we established a definitive epidemiological link with only the former. Short shelf-life, product diversity and investigation lag hinder epidemiological investigations of such popular products, providing continued challenges for food safety enforcement of freshly prepared produce.

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Sleep deprivation reduces LH secretion in men independently of melatonin

Acta Endocrinologica ◽

10.1530/acta.0.1240646 ◽

1991 ◽

Vol 124 (6) ◽

pp. 646-651 ◽

Cited By ~ 5

Author(s):

RickJ. Strassman ◽

Clifford R. Qualls ◽

E.Jonathan Lisansky ◽

Glenn T. Peake

Keyword(s):

Sleep Deprivation ◽

Hormone Secretion ◽

Area Under The Curve ◽

Bright Light ◽

Pulse Frequency ◽

Blood Levels ◽

Luteinizing Hormone Secretion ◽

Normal Man ◽

Normal Men ◽

Lh Secretion

Abstract. Melatonin affects gonadal function in nonprimate mammals. Confirmatory data in man are not available. We assessed melatonin's acute effects on luteinizing hormone secretion in 17 normal men. We studied these men in conditions of sleep in the dark, and sleep deprivation in bright light, dim light, and bright light combined with a physiologically relevant infusion of melatonin, while measuring blood levels of immunoreactive LH every 20 min for 7 h. We compared overnight LH secretion, and LH pulse frequency, amplitude, length, interval and area under the curve using a modification of the PULSAR peak identification program, among the four treatments. Areas under the curve for peaks in all three conditions of sleep deprivation were lower than in normal sleep. The presence or absence of melatonin had no additional effect. We conclude that acute suppression of melatonin does not affect LH pulse parameters in normal man, but that sleep deprivation may reduce the amount of LH secreted per pulse.

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Predictive accuracy of risk scales following self-harm: Multicentre, prospective cohort study

The British Journal of Psychiatry ◽

10.1192/bjp.bp.116.189993 ◽

2017 ◽

Vol 210 (6) ◽

pp. 429-436 ◽

Cited By ~ 35

Author(s):

Leah Quinlivan ◽

Jayne Cooper ◽

Declan Meehan ◽

Damien Longson ◽

John Potokar ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Predictive Accuracy ◽

Area Under The Curve ◽

Global Scale ◽

National Guidelines ◽

Liaison Psychiatry ◽

Predictive Values ◽

Self Harm

BackgroundScales are widely used in psychiatric assessments following self-harm. Robust evidence for their diagnostic use is lacking.AimsTo evaluate the performance of risk scales (Manchester Self-Harm Rule, ReACT Self-Harm Rule, SAD PERSONS scale, Modified SAD PERSONS scale, Barratt Impulsiveness Scale); and patient and clinician estimates of risk in identifying patients who repeat self-harm within 6 months.MethodA multisite prospective cohort study was conducted of adults aged 18 years and over referred to liaison psychiatry services following self-harm. Scale a priori cut-offs were evaluated using diagnostic accuracy statistics. The area under the curve (AUC) was used to determine optimal cut-offs and compare global accuracy.ResultsIn total, 483 episodes of self-harm were included in the study. The episode-based 6-month repetition rate was 30% (n = 145). Sensitivity ranged from 1% (95% CI 0–5) for the SAD PERSONS scale, to 97% (95% CI 93–99) for the Manchester Self-Harm Rule. Positive predictive values ranged from 13% (95% CI 2–47) for the Modified SAD PERSONS Scale to 47% (95% CI 41–53) for the clinician assessment of risk. The AUC ranged from 0.55 (95% CI 0.50–0.61) for the SAD PERSONS scale to 0.74 (95% CI 0.69–0.79) for the clinician global scale. The remaining scales performed significantly worse than clinician and patient estimates of risk (P < 0.001).ConclusionsRisk scales following self-harm have limited clinical utility and may waste valuable resources. Most scales performed no better than clinician or patient ratings of risk. Some performed considerably worse. Positive predictive values were modest. In line with national guidelines, risk scales should not be used to determine patient management or predict self-harm.

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Radiomics Nomogram Based on Radiomics Score from Multiregional Diffusion-Weighted MRI and Clinical Factors for Evaluating HER-2 2+ Status of Breast Cancer

Diagnostics ◽

10.3390/diagnostics11081491 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1491

Author(s):

Chunli Li ◽

Jiandong Yin

Keyword(s):

Breast Cancer ◽

Characteristic Curve ◽

Receiver Operator Characteristic Curve ◽

Clinical Factors ◽

Clinical Value ◽

Logistic Analysis ◽

Diffusion Weighted ◽

Apparent Diffusion ◽

Her 2 ◽

Multivariate Logistic Analysis

This study aimed to establish and validate a radiomics nomogram using the radiomics score (rad-score) based on multiregional diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) features combined with clinical factors for evaluating HER-2 2+ status of breast cancer. A total of 223 patients were retrospectively included. Radiomic features were extracted from multiregional DWI and ADC images. Based on the intratumoral, peritumoral, and combined regions, three rad-scores were calculated using the logistic regression model. Independent parameters were selected among clinical factors and combined rad-score (com-rad-score) using multivariate logistic analysis and used to construct a radiomics nomogram. The performance of the nomogram was evaluated using calibration, discrimination, and clinical usefulness. The areas under the receiver operator characteristic curve (AUCs) of intratumoral and peritumoral rad-scores were 0.824/0.763 and 0.794/0.731 in the training and validation cohorts, respectively. Com-rad-score achieved the highest AUC (0.860/0.790) among three rad-scores. ER status and com-rad-score were selected to establish the nomogram, which yielded good discrimination (AUC: 0.883/0.848) and calibration. Decision curve analysis demonstrated the clinical value of the nomogram in the validation cohort. In conclusion, radiomics nomogram, including clinical factors and com-rad-score, showed favorable performance for evaluating HER-2 2+ status in breast cancer.

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The use of perioperative serial blood lactate levels, the APACHE II and the postoperative MELD as predictors of early mortality after liver transplantation

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502011000600021 ◽

2011 ◽

Vol 26 (6) ◽

pp. 535-540 ◽

Cited By ~ 13

Author(s):

Anibal Basile-Filho ◽

Edson Antonio Nicolini ◽

Maria Auxiliadora-Martins ◽

Orlando de Castro e Silva Jr

Keyword(s):

Liver Transplantation ◽

Blood Lactate ◽

Area Under The Curve ◽

Roc Curves ◽

Tertiary Hospital ◽

Early Mortality ◽

Apache Ii ◽

Blood Levels ◽

Lactate Levels ◽

Blood Lactate Levels

PURPOSE: To evaluate the accuracy of different parameters in predicting early (one-month) mortality of patients submitted to orthotopic liver transplantation (OLT). METHODS: This is a retrospective study of forty-four patients (38 males and 10 females, mean age of 52.2 ± 8.9 years) admitted to the Intensive Care Unit of a tertiary hospital. Serial lactate blood levels, APACHE II, MELD post-OLT, creatinine, bilirubin and INR parameters were analyzed by receiver-operator characteristic (ROC) curves as evidenced by the area under the curve (AUC). The level of significance was set at 0.05. RESULTS: The mortality of OLT patients within one month was 17.3%. Differences in blood lactate levels became statistically significant between survivors and nonsurvivors at the end of the surgery (p<0.05). The AUC was 0.726 (95%CI = 0.593-0.835) for APACHE II (p = 0.02); 0.770 (95%CI = 0.596-0.849) for blood lactate levels (L7-L8) (p = 0.03); 0.814 (95%CI = 0.690-0.904) for MELD post-OLT (p < 0.01); 0.550 (95%CI = 0.414-0.651) for creatinine (p = 0.64); 0.705 (95%CI = 0.571-0.818) for bilirubin (p = 0.05) and 0.774 (95%CI = 0.654-0.873) for INR (p = 0.02). CONCLUSION: Among the studied parameters, MELD post-OLT was more effective in predicting early mortality after OLT.

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Association of Carboxyhemoglobin Levels with Peripheral Arterial Disease in Chronic Smokers Managed at Dr George Mukhari Academic Hospital

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17155581 ◽

2020 ◽

Vol 17 (15) ◽

pp. 5581

Author(s):

Mashudu Nemukula ◽

Motetelo Alfred Mogale ◽

Honey Bridget Mkhondo ◽

Lizette Bekker

Keyword(s):

Nitric Oxide ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Academic Hospital ◽

Convenience Sample ◽

Logistic Analysis ◽

Arterial Dilation ◽

Peripheral Arterial ◽

Arterial Damage ◽

Multivariate Logistic Analysis

Chronic cigarette smokers (CCS) are known to have elevated levels of carboxyhemoglobin (COHb). However, it is not known whether increased levels of COHb are associated with endothelial dysfunction (ED), and therefore the development of peripheral arterial disease (PAD). The aim of the study was to investigate the association of blood COHb and plasma nitric oxide (NO) levels, and whether it is an independent risk factor in the development of PAD among CCS at Dr George Mukhari Academic Hospital (DGMAH). A sample of 120 CCS with PAD and a convenience sample of 100 CCS without PAD were recruited into the study. Blood COHb levels were measured using the ABL 90 FLEX CO-oximeter automated spectroscopy. Plasma nitric oxide (NO) levels were measure using ELISA. Logistic regression analysis was used to investigate the association of blood COHb and plasma NO with PAD. Blood COHb levels of CCS with PAD were significantly higher than those of CCS without PAD, and the NO levels of CCS with PAD were significantly lower than those of CCS without PAD. Although both the blood COHb and plasma NO in CCS were significantly associated with PAD in bivariate logistic analysis, only plasma NO was independently associated with PAD in multivariate logistic analysis. This finding is consistent with the hypothesis that COHb is a cause of arterial damage in PAD, leading to reduced NO, and therefore reduced arterial dilation.

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