scholarly journals Utility of routine non-gated CT chest in detection of subclinical atherosclerotic calcifications of coronary arteries in hospitalised HIV patients

2020 ◽  
Vol 93 (1109) ◽  
pp. 20190462 ◽  
Author(s):  
Mayil Krishnam ◽  
Eun Jin Chae ◽  
Eduardo Hernandez-Rangel ◽  
Edgar Karangiah ◽  
Geeta Gupta ◽  
...  

Objectives: To evaluate coronary artery calcification (CAC) on routine CT chest in hospitalised HIV patients and to assess individual risk factors. Methods: Routine CT chests, May 2010–November 2015, of 143 hospitalised HIV-positive patients were reviewed for qualitative assessment of calcification in major coronary arteries by two radiologists. Presence, location and burden of calcification were evaluated on 3 mm axial images of CT chest. Cardiovascular risk factors and HIV lab parameters such as CD4 count, viral load and duration, and status of antiretroviral treatment were collected. Statistical analysis including multivariate logistic regression was performed. Results: Forty-one patients (28.7%) showed CAC, left anterior descending (n = 38, 92.7%), circumflex (n = 18, 43.9%) and Right Coronary Artery (n = 13, 31.7%); mostly mild CAC burden and mostly proximal left coronary arteries with excellent interobserver and intraobserver agreements (K = 0.9, and 1). Age of CAC+ group (53.9 years) was significantly higher than CAC− group (43.4, p < 0.001, minimum age of CAC+, 27 years). No significant difference between two groups in sex, ethnicity and risk factors and HAART status. CAC+ group showed significantly longer HIV duration (12.3 years vs 8.6, p < 0.0344) and higher CD4 cell counts (mean = 355.9 vs 175.3, p = 0.0053) and significantly lower viral load (76 vs 414K, p = 0.02) than CAC− group. On multivariate logistic regression, age, HIV duration and CD4 were significantly associated with CAC+ (p-values < .05). Conclusions: One-third of hospitalised HIV patients showed subclinical CAC on CT chest. HIV duration and age of patients were independent risk factors for developing CAC. Higher CD4 cell count was strongly associated with CAC+. Advances in knowledge: Routine CT chest with or without contrast performed for non-cardiac indications is helpful in identification of subclinical CAC in HIV patients and radiologists should be encouraged to report CAC. CAC is seen in younger age group in HIV, and awareness of this finding on routine CT chest would help guiding clinicians to assess risk stratification for primary prevention of ischemic heart disease in this population at an earlier stage when compared to normal population. Duration of HIV infection and age of patients were independent risk factors for developing CAC in our study and CD4 count was strongly associated with presence of CAC.

2021 ◽  
Author(s):  
Tao Chang ◽  
Xigang Yan ◽  
Chao Zhao ◽  
Yufu Zhang ◽  
Bao Wang ◽  
...  

Abstract Background There are few studies on the development and effect of coagulopathy in patients with a traumatic brain injury (TBI) during the early post-operative period. We determined the risk factors and neurologic outcomes of in patients with a TBI and coagulopathy diagnosed by routine laboratory tests within 72 hours post-operatively. Methods The baseline characteristics, intra-operative management, and follow-up results of 462 patients with TBIs were obtained and retrospectively analyzed by multivariate logistic regression from January 2015 to June 2019. Coagulopathy was defined as an activated partial thromboplastin time > 40 seconds, international normalized ratio >1.4, or a platelet count < 100×109 /L.Results Multivariate logistic regression analysis revealed that the Glasgow Coma Scale (GCS) at the time of admission, Injury Severity Score (ISS) at the time of admission, pupil mydriasis, duration of surgery, intra-operative blood loss, and intra-operative crystalloid resuscitation were independent risk factors for patients who developed a coagulopathy post-operatively. There were statistical differences in mortality (p = 0.049), the Glasgow Outcome Scale-Extended (GCS-E; p = 0.024), and the modified Rankin Scale (p = 0.043) between patients with and without coagulopathy 1 week after surgery. Coagulopathy within 72 h after surgery revealed a trend for higher mortality at 1 week (66.7%), 3 months (71.4%), and 6 months (76.2%). Furthermore, coagulopathy and contusion expansion in the early post-operative period were independent risk factors for TBI mortality after surgery. Intra-operative crystalloid resuscitation had a substantial diagnostic accuracy in predicting coagulopathy within 72 h post-operatively (area under the curve [AUC] = 0.972).Conclusion Coagulopathy within 72 h post-operatively in patients with a TBI predicted worse disease progression and unfavorable neurologic outcomes. Hence, we should take practical and reasonable measures to manage these risk factors, which may protect patients with a TBI from post-operative coagulopathy.


2020 ◽  
Author(s):  
Sufen Zhou ◽  
Hongyan Guo ◽  
Heng Liu ◽  
Mingqun Li

Abstract Background: This study aimed to investigate potential predictors, including cerebroplacental ratio (CPR), middle cerebral artery (MCA)/uterine artery pulsatility index (PI) ratio, for adverse perinatal outcome in pregnancies at term.Methods: This was an observational, prospective study of recruited pregnancies at term. An adverse perinatal outcome was set as the primary observational endpoint. The receiver operating characteristic (ROC) curve was plotted to investigate the predictive and cut-off values of risk factors for adverse perinatal outcome. Independent risk factors (maternal, neonatal, prenatal ultrasound and Doppler variables) for adverse perinatal outcome were evaluated by the univariate and multivariate logistic regression analyses.Results: A total of 392 pregnancies at term were included and 19.4% of them had suffered adverse perinatal outcome. CPR (OR: 0.42, 95%CI: 0.20-0.93, P=0.032) and MCA/uterine artery PI ratio (OR: 0.25, 95%CI: 0.16-0.42, P=0.032) were two independent risk factors for adverse perinatal outcome by univariate and multivariate logistic regression analyses.Conclusions: MCA/uterine artery PI ratio is a good predictor of adverse perinatal outcome in pregnancies at term.


BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e044117
Author(s):  
Wence Shi ◽  
Xiaoxue Fan ◽  
Jingang Yang ◽  
Lin Ni ◽  
Shuhong Su ◽  
...  

ObjectiveTo investigate the incidence of gastrointestinal bleeding (GIB) in patients with acute myocardial infarction (AMI), clarify the association between adverse clinical outcomes and GIB and identify risk factors for in-hospital GIB after AMI.DesignRetrospective cohort study.Setting108 hospitals across three levels in China.ParticipantsFrom 1 January 2013 to 31 August 2014, after excluding 2659 patients because of incorrect age and missing GIB data, 23 794 patients with AMI from 108 hospitals enrolled in the China Acute Myocardial Infarction Registry were divided into GIB-positive (n=282) and GIB-negative (n=23 512) groups and were compared.Primary and secondary outcome measuresMajor adverse cardiovascular and cerebrovascular events (MACCEs) are a composite of all-cause death, reinfarction and stroke. The association between GIB and endpoints was examined using multivariate logistic regression and Cox proportional hazards models. Independent risk factors associated with GIB were identified using multivariate logistic regression analysis.ResultsThe incidence of in-hospital GIB in patients with AMI was 1.19%. GIB was significantly associated with an increased risk of MACCEs both in-hospital (OR 2.314; p<0.001) and at 2-year follow-up (HR 1.407; p=0.0008). Glycoprotein IIb/IIIa (GPIIb/IIIa) receptor inhibitor, percutaneous coronary intervention (PCI) and thrombolysis were novel independent risk factors for GIB identified in the Chinese AMI population (p<0.05).ConclusionsGIB is associated with both in-hospital and follow-up MACCEs. Gastrointestinal prophylactic treatment should be administered to patients with AMI who receive primary PCI, thrombolytic therapy or GPIIb/IIIa receptor inhibitor.Trial registration numberNCT01874691.


2022 ◽  
Author(s):  
Chengcheng Sheng ◽  
Zongxu Xu ◽  
Jun Wang

Abstract Background: Acute pancreatitis in pregnancy (APIP) with persistent organ failure (POF) poses a high risk of death for mother and fetus. This study sought to create a nomogram model for early prediction of POF with APIP patients.Methods: We conducted a cross-sectional study on APIP patients with organ failure (OF) between January 2012 and March 2021 in a university hospital. 131 patients were collected. Their clinical courses and pregnancy outcomes were obtained. Risk factors for POF were identified by univariate and multivariate logistic regression analysis. Prediction models with POF were built and nomogram was plotted. The performance of the nomogram was evaluated by using a bootstrapped-concordance index and calibration plots.Results: Hypertriglyceridemia was the most common etiology in this group of APIP patients, which accounted for 50% of transient organ failure (TOF) and 72.3% of POF. All in-hospital maternal death was in the POF group (P<0.05), which also had a significantly higher perinatal mortality rate than the TOF group (P<0.05). Univariate and multivariate logistic regression analysis determined that lactate dehydrogenase, triglycerides, serum creatinine, and procalcitonin were independent risk factors for predicting POF in APIP. A nomogram for POF was created by using the four indicators. The area under the curve was 0.875 (95% confidence interval 0.80–0.95). The nomogram had a bootstrapped-concordance index of 0.85 and was well-calibrated.Conclusions: Hypertriglyceridemia was the leading cause of organ failure-related APIP. Lactate dehydrogenase, triglycerides, serum creatinine, and procalcitonin were the independent risk factors of POF in APIP. Our nomogram model showed an effective prediction of POF with the four indicators in APIP patients.


2020 ◽  
pp. 014556132097260
Author(s):  
Shuliang Zhou ◽  
Sulin Mi ◽  
Shuilian Luo ◽  
Ying Wang ◽  
Bin Ren ◽  
...  

Background: An outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 infection occurred in Wuhan, China, in December 2019. To date, the analysis of fatal cases and the risk factors for death have rarely been reported. Methods: In this study, 220 adult patients with confirmed and suspected COVID-19 were enrolled. Clinical characteristics, laboratory data, treatments, and complications were compared between 168 survivors and 52 nonsurvivors. Univariable analysis and multivariable logistic regression were used to investigate the risk factors for mortality. Results: A total of 220 patients (168 were discharged and 52 died in the hospital) were enrolled in the study. The median age of all patients was 59.5 (47.0-69.0) years, and the median age of patients who died was significantly older than that of patients who survived (70.5 vs 56.0 years, respectively; P < .001). According to multivariate logistic regression, older age (odds ratio: 1.09, 95% CI: 1.03-1.15; P = .001), initial Sequential Organ Failure Assessment (SOFA) score >2 (37.4, 9.4-148.0; P = .011), and respiratory rate >24 per minute (10.89, 1.47-80.67; P = .019) were independent risk factors for mortality. Conclusion: Clinical and laboratory parameters predicting poor prognosis including older age, baseline SOFA score >2, and respiratory rate >24 per minute were identified.


2019 ◽  
Vol 67 (6) ◽  
pp. 957-963 ◽  
Author(s):  
Xia Ling ◽  
Bo Shen ◽  
Kangzhi Li ◽  
Lihong Si ◽  
Xu Yang

The goals of this study were to develop a new prediction model to predict 1-year poor prognosis (death or modified Rankin scale score of ≥3) in patients with acute ischemic stroke (AIS) and to compare the performance of the new prediction model with other prediction scales. Baseline data of 772 patients with AIS were collected, and univariate and multivariate logistic regression analyses were performed to identify independent risk factors for 1-year poor prognosis in patients with AIS. The area under the receiver operating characteristics curve (AUC) value of the new prediction model and the THRIVE, iScore and ASTRAL scores was compared. The Hosmer-Lemeshow test was used to assess the goodness of fit of the model. We identified 196 (25.4%) patients with poor prognosis at 1-year follow-up, and of these 68 (68/196, 34.7%) had died. Multivariate logistic regression and receiver operating characteristic curve analyses showed that age ≥70 years, consciousness (lethargy or coma), history of stroke or transient ischemic attack, cancer, abnormal fasting blood glucose levels ≥7.0 mmol/L, and National Institutes of Health Stroke Scale score were independent risk factors for 1-year poor prognosis in patients with AIS. Scores were assigned for each variable by rounding off β coefficient to the integer score, and a new prediction model with a maximum total score of 9 points was developed. The AUC value of the new prediction model was higher than the THRIVE score (p<0.05). The χ2 value for the Hosmer-Lemeshow test was 7.337 (p>0.05), suggesting that the prediction model had a good fit. The new prediction model can accurately predict 1-year poor prognosis in Chinese patients with AIS.


2021 ◽  
Vol 8 ◽  
Author(s):  
Zhaoli Meng ◽  
Wei Fang ◽  
Mei Meng ◽  
Jicheng Zhang ◽  
Qizhi Wang ◽  
...  

Acute fatty liver of pregnancy (AFLP) is a rare but potentially life-threatening hepatic disorder that leads to considerable maternal and fetal mortality. To explore the risk factors for maternal and fetal mortality in AFLP and develop new predictive models, through this retrospective study, we analyzed the demographic characteristics, clinical symptoms, and laboratory findings of 106 patients with AFLP who were admitted to Shandong Provincial Hospital. Risk factors for maternal and fetal mortality were analyzed by univariate and multivariate logistic regression analysis. The new models based on the multivariate logistic regression analysis and the model for end-stage liver disease (MELD) were tested in AFLP. The receiver operating characteristic curve (ROC) was applied to compare the predictive efficiency, sensitivity, and specificity of the two models. Prenatal nausea (p = 0.037), prolonged prothrombin time (p = 0.003), and elevated serum creatinine (p = 0.003) were independent risk factors for maternal mortality. The ROC curve showed that the area under the curve (AUC) of the MELD was 0.948, with a sensitivity of 100% and a specificity of 83.3%. The AUC of the new model for maternal mortality was 0.926, with a sensitivity of 90% and a specificity of 94.8%. Hepatic encephalopathy (p = 0.016) and thrombocytopenia (p = 0.001) were independent risk factors for fetal mortality. Using the ROC curve, the AUC of the MELD was 0.694, yielding a sensitivity of 68.8% and a specificity of 64.4%. The AUC of the new model for fetal mortality was 0.893, yielding a sensitivity of 100% and a specificity of 73.3%. Both the new predictive model for maternal mortality and the MELD showed good predictive efficacy for maternal mortality in patients with AFLP (AUC = 0.926 and 0.948, respectively), and the new predictive model for fetal mortality was superior to the MELD in predicting fetal mortality (AUC = 0.893 and 0.694, respectively). The two new predictive models were more readily available, less expensive, and easier to implement clinically, especially in low-income countries.


2020 ◽  
Author(s):  
Gizachew Ayele Manaye ◽  
Dejene Derseh Abateneh ◽  
Wondwossen Niguse Asmare

Abstract Background In developing countries, both opportunistic infections and chronic diseases account a high HIV associated mortality and morbidity. Chronic kidney diseases (CKD) associated with HIV infection has got increased attention in sub-Saharan Africa as a result of the high HIV prevalence and due to the late diagnosis and initiation of HAART. Thus, this study was conducted to assess CKD and associated factors among HIV patients on HARRT in Northwest Ethiopia. Methods A hospital-based cross-sectional study with a secondary data review was conducted from February 01 to April 30, 2017, at the University of Gondar Referral Hospital, Northwest Ethiopia. The study participants were selected using a systematic random sampling technique. Socio-demographic and clinical data were collected using a semi-structured questionnaire by trained nurses. Venous blood and urine specimen was collected for serum creatinine and urine protein determination respectively. Glomerular filtration rate was estimated using the CKD–EPI estimator. Data were entered into SPSS version 20 for analysis. Bivariate and multivariate logistic regression was employed and p-value < 0.05 was considered statistically significant. Results A total of 336 HIV patients on HARRT participated in the study. The mean (SD) age of the participants was 39.7 ( + 9.7) years. The study participants were on HAART with an average of 7.5 ( + 3) years. Before ART initiation, the majority of patients had WHO clinical stage II and III, 251 (74.7%), CD4+T cell count < 200 cells/mm 3 , 221 (65.8%).The overall prevalence of CKD was 16.1%. About 27 (8.0%), 16 (4.8%), 11 (3.3%) of the participants had stage 1 and stage 2 CKD and chronic renal failure (stage 3a-5) respectively. With multivariate logistic regression analysis being male (AOR=2.05 (1.03-4.09), p=0.04, occupation merchant (AOR=2.91(1.00-8.48),p=0.049)and viral load > 1000 copies/mm 3 (AOR=3.1 (1.38-7.00), P<0.01) were significantly associated with CKD. Conclusions The prevalence of CKD among HIV patients on HARRT is high. Being male, merchant and viral load > 1000 copies/mm 3 were associated factors of CKD. Patients should be regularly monitored and screened for early diagnosis and management of CKD. Those patients with high viral load and male patients should be closely followed.


2020 ◽  
Author(s):  
Xiao-Xue Zhang ◽  
Meng Wei ◽  
Lu-Xiang Shang ◽  
Yan-Mei Lu ◽  
Ling Zhang ◽  
...  

Abstract Background: This study explored the relationships between the low-/high-density lipoprotein cholesterol ratio (LDL-C/HDL-C) and other clinical indicators and ischaemic stroke (IS) in patients with non-valvular atrial fibrillation (NVAF) in Xinjiang. The findings could provide a theoretical and therapeutic basis for NVAF patients.Methods: NVAF patients who were admitted to 10 medical centres across Xinjiang were divided into stroke (798 patients) and control (2671 patients) groups according to the occurrence of first acute IS occurred. Univariate and multivariate logistic regression analysis were used to examine the independent risk factors for IS in NVAF patients. Factor analysis and principal component regression analysis were used to analyse the main factors influencing IS. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminatory ability of LDL-C/HDL-C for predicting the occurrence of IS.Results: The stroke group had an average age of 71.64 ± 9.96 years and included 305 females (38.22%). The control group had a mean age of 67.30 ± 12.01 years and included 825 females (30.89%). Multivariate logistic regression showed that the risk of IS in the highest LDL-C/HDL-C quartile ( ≥2.73) was 16.23-fold that of the lowest quartile ( < 1.22); IS risk was 2.27-fold higher in obese patients than in normal-weight subjects; IS risk was 3.15-fold higher in smoking patients than in non-smoking patients. The area under the ROC curve of LDL-C/HDL-C was 0.76, the optimal critical value was 2.33, the sensitivity was 63.53%, and the specificity was 76.34%. Principal component regression analysis showed that LDL-C/HDL-C, age, smoking, drinking, LDL-C and hypertension were risk factors for IS in NVAF patients.Conclusions: LDL-C/HDL-C >1.22, smoking, BMI ≥24 kg/m2 and CHA2DS2-VASc score were independent risk factors for IS in NVAF patients; LDL-C/HDL-C was the main risk factor.


2020 ◽  
Author(s):  
Xiao-Xue Zhang ◽  
Meng Wei ◽  
Lu-Xiang Shang ◽  
Yan-Mei Lu ◽  
Ling Zhang ◽  
...  

Abstract Background: This study explored the relationships between the low-/high-density lipoprotein cholesterol ratio (LDL-C/HDL-C) and other clinical indicators and ischaemic stroke (IS) in patients with non-valvular atrial fibrillation (NVAF) in Xinjiang. The findings could provide a theoretical and therapeutic basis for NVAF patients.Methods: NVAF patients who were admitted to 10 medical centres across Xinjiang were divided into stroke (798 patients) and control (2671 patients) groups according to the occurrence of first acute IS. Univariate and multivariate logistic regression analysis were used to examine the independent risk factors for IS in NVAF patients. Factor analysis and principal component regression analysis were used to analyse the main factors influencing IS. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminatory ability of LDL-C/HDL-C for predicting the occurrence of IS.Results: The stroke group had an average age of 71.64 ± 9.96 years and included 305 females (38.22%). The control group had a mean age of 67.30 ± 12.01 years and included 825 females (30.89%). Multivariate logistic regression showed that the risk of IS in the highest LDL-C/HDL-C quartile ( ≥2.73) was 16.23-fold that of the lowest quartile ( < 1.22); IS risk was 2.27-fold higher in obese patients than in normal-weight subjects; IS risk was 3.15-fold higher in smoking patients than in non-smoking patients. The area under the ROC curve of LDL-C/HDL-C was 0.76, the optimal critical value was 2.33, the sensitivity was 63.53%, and the specificity was 76.34%. Principal component regression analysis showed that LDL-C/HDL-C, age, smoking, drinking, LDL-C and hypertension were risk factors for IS in NVAF patients.Conclusions: LDL-C/HDL-C >1.22, smoking, BMI ≥24 kg/m2 and CHA2DS2-VASc score were independent risk factors for IS in NVAF patients; LDL-C/HDL-C was the main risk factor.


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