scholarly journals Influence of transfusions, hemodialysis and extracorporeal life support on hyperferritinemia in critically ill patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254345
Author(s):  
Cornelia Knaak ◽  
Friederike S. Schuster ◽  
Peter Nyvlt ◽  
Patrick Heeren ◽  
Claudia Spies ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Linear Regression ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Linear Regression Analysis ◽  
Iron Storage ◽  
Multivariable Linear Regression Analysis

Background Ferritin is the major iron storage protein and an acute phase reactant. Hyperferritinemia is frequently seen in the critically ill where it has been hypothesized that not only underlying conditions but also factors such as transfusions, hemodialysis and extracorporeal life support (ECLS) lead to hyperferritinemia. This study aims to investigate the influence of transfusions, hemodialysis, and ECLS on hyperferritinemia in a multidisciplinary ICU cohort. Methods This is a post-hoc analysis of a retrospective observational study including patients aged ≥ 18 years who were admitted to at least one adult ICU between January 2006 and August 2018 with hyperferritinemia ≥ 500 μg/L and of ≥ 14 days between two ICU ferritin measurements. Patients with hemophagocytic lymphohistiocytosis (HLH) were excluded. To identify the influence of transfusions, hemodialysis, and ECLS on ferritin change, multivariable linear regression analysis with ferritin change between two measurements as dependent variable was performed. Results A total of 268 patients was analyzed. Median duration between measurements was 36 days (22–57). Over all patients, ferritin significantly increased between the first and last measurement (p = 0.006). Multivariable linear regression analysis showed no effect of transfusions, hemodialysis, or ECLS on ferritin change. Changes in aspartate aminotransferase (ASAT) and sequential organ failure assessment (SOFA) score were identified as influencing factors on ferritin change [unstandardized regression coefficient (B) = 2.6; (95% confidence interval (CI) 1.9, 3.3); p < 0.001 and B = 376.5; (95% CI 113.8, 639.1); p = 0.005, respectively]. Using the same model for subgroups of SOFA score, we found SOFA platelet count to be associated with ferritin change [B = 1729.3; (95% CI 466.8, 2991.9); p = 0.007]. No association of ferritin change and in-hospital mortality was seen in multivariable analysis. Conclusions The present study demonstrates that transfusions, hemodialysis, and ECLS had no influence on ferritin increases in critically ill patients. Hyperferritinemia appears to be less the result of iatrogenic influences in the ICU thereby underscoring its unskewed diagnostic value. Trial registration The study was registered with www.ClinicalTrials.gov (NCT02854943) on August 1, 2016.

Hyperkalemia of the blood-primed ECLS circuit does not result in post-initiation hyperkalemia in infants < 10 kg

Perfusion ◽  
2006 ◽  
Vol 21 (3) ◽  
pp. 173-177 ◽  
Author(s):  
Geoffrey M Fleming ◽  
Robert T Remenapp ◽  
Robert H Bartlett ◽  
Gail M Annich
Keyword(s):  
Regression Analysis ◽  
Cohort Study ◽  
Linear Regression ◽  
Retrospective Cohort ◽  
Potassium Level ◽  
Pediatric Patients ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Linear Regression Analysis ◽  
Multivariate Linear Regression Analysis

Objective: To assess the risk of hyperkalemia with blood-primed extracorporeal life support (ECLS) circuits in infants < 10 kg. Design: Retrospective cohort study of all neonatal and pediatric patients <10 kg placed on ECLS from May 1998 to April 2001. Measurements and main results: Data collection including patient weight, patient potassium levels pre- and post-initiation of ECLS, potassium level of the primed ECLS circuit, age of the packed red blood cell (PRBC) unit, type of preservative, and preservative reduction status. Seventy-six circuits were available for the analysis. The age of the PRBC unit and preservative reduction status significantly affected the potassium level of the primed ECLS circuit. Multivariate linear regression analysis showed no significant effect on the post-ECLS initiation patient potassium level with respect to the PRBC age, the preservative reduction status, the patient potassium level prior to ECLS initiation, and the potassium level of the primed ECLS circuit. Conclusions: Initiation of ECLS in infants <10 kg should not be delayed unnecessarily to perform preservative reduction or to utilize PRBC units of a specific age, as hyperkalemia of the primed ECLS circuit is not associated with systemic hyperkalemia in the patient post-initiation of ECLS.

scholarly journals Effect of Number of Clinics and Panel Size on Patient Continuity for Medical Residents

2009 ◽  
Vol 1 (2) ◽  
pp. 310-315 ◽  
Author(s):  
Maureen D. Francis ◽  
Whitney E. Zahnd ◽  
Andrew Varney ◽  
Steven L. Scaife ◽  
Mark L. Francis
Keyword(s):  
Regression Analysis ◽  
Linear Regression ◽  
Linear Regression Analysis ◽  
Medical Residents ◽  
Panel Size ◽  
Medical Education Program ◽  
Internal Medicine Residency Training ◽  
Multivariable Linear Regression Analysis ◽  
Linear Regression Modeling ◽  
Attending Physician

Abstract Background Accreditation Council for Graduate Medical Education program requirements for internal medicine residency training include a longitudinal, continuity experience with a panel of patients. Objective To determine whether the number of resident clinics, the resident panel size, and the supervising attending physician affect patient continuity. To determine the number of clinics and the panel size necessary to maximize patient continuity. Design We used linear regression modeling to assess the effect of number of attended clinics, the panel size, and the attending physician on patient continuity. Participants Forty medicine residents in an academic medicine clinic. Measurements Percent patient continuity by the usual provider of care method. Results Unadjusted linear regression analysis showed that patient continuity increased 2.3% ± 0.7% for each additional clinic per 9 weeks or 0.4% ± 0.1% for each additional clinic per year (P  =  .003). Conversely, patient continuity decreased 0.7% ± 0.4% for every additional 10 patients in the panel (P  =  .04). When simultaneously controlling for number of clinics, panel size, and attending physician, multivariable linear regression analysis showed that patient continuity increased 3.3% ± 0.5% for each additional clinic per 9 weeks or 0.6% ± 0.1% for each additional clinic per year (P &lt; .001). Conversely, patient continuity decreased 2.2% ± 0.4% for every additional 10 patients in the panel (P &lt; .001). Thus, residents who actually attend at least 1 clinic per week with a panel size less than 106 patients can achieve 50% patient continuity. Interestingly, the attending physician accounted for most of the variability in patient continuity (51%). Conclusions Patient continuity for residents significantly increased with increasing numbers of clinics and decreasing panel size and was significantly influenced by the attending physician.

Using the health belief model to analyse nurses’ perception towards their behaviours for keeping surgical instruments moist

2020 ◽  
Author(s):  
Yanhua Chen ◽  
Juan Hu ◽  
Yan Huang ◽  
Liangying Yi ◽  
Ruixue Hu
Keyword(s):  
Regression Analysis ◽  
Linear Regression ◽  
Health Belief Model ◽  
Linear Regression Analysis ◽  
Health Belief ◽  
Surgical Instruments ◽  
Length Of Service ◽  
Multivariable Linear Regression Analysis ◽  
Belief Model ◽  
The Health Belief Model

Abstract Background Because of conflicts with work schedule of central sterile supply department (CSSD), surgical instruments might not be immediately cleaned or sterilized by CSSD staff members after use. If surgical instruments are not kept appropriately moist, tarnish or rusting may occur on the instruments, which will not only affect cleaning quality, but also shorten the normal service life of the instruments. Nurses’ perception towards their behaviours for keeping surgical instruments moist has been rarely studied. We aimed to use the health belief model to analyse nurses’ perception towards their behaviours for keeping surgical instruments moist. Methods The survey which utilised a questionnaire regarding respondent’s general information and a self-designed nurses’ perception-behaviour scale for keeping surgical instruments moist was conducted with 360 nurses from the West China Second University Hospital, Sichuan University. Data was gathered with cluster sampling, and analysed in SPSS20.0. T-test, variance analysis and multivariable linear regression analysis were performed. Results Total score of nurses’ perception-behaviour scale for keeping surgical instruments moist was 139.93 ± 15.145, among which mean score for perceived severity, perceived susceptibility, perceived benefits, perceived barriers, and self-efficacy was 4.49 ± 0.57, 4.62 ± 0.48, 4.57 ± 0.52, 3.47 ± 0.94 and 4.16 ± 0.66, respectively. Single factor analysis showed that score of nurses’ perception-behaviour scale for keeping surgical instruments moist varied with age, length of service, and job title, with a statistically significant difference (P < 0.05). Multivariable linear regression analysis showed that length of service was the main factor affecting nurses’ perception towards their behaviours for keeping surgical instruments moist. Conclusion Nurses should be offered intensive training on keeping surgical instruments moist due to their inadequate perception on it. However, an increase in knowledge does not necessarily bring behavior change. The nurses’ change in health beliefs and behaviours must be based upon developing the right attitude. As a result, they could realise the benefits of keeping surgical instruments moist, identify the barriers, and finally obtain the solutions.

scholarly journals Patient Characteristics and Medical Provider Factors Are Associated With Length of Stay in Total Hip Arthroplasty Patients: a Retrospective Chinese Cohort Study

2020 ◽  
Author(s):  
Hui Zeng ◽  
Guoqing Li ◽  
Fei Yu ◽  
Jian Weng ◽  
Ao Xiong ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Total Hip Arthroplasty ◽  
Linear Regression ◽  
Length Of Stay ◽  
Hip Arthroplasty ◽  
Linear Regression Analysis ◽  
Patient Characteristics ◽  
Medical Provider ◽  
Multivariable Linear Regression Analysis ◽  
The Relationship

Abstract Background Total hip arthroplasty (THA) is a successful treatment in the improvement of quality of life. Diagnosis-related groups (DRGs) payment has a significant impact on the hospital market in China and length of stay (LOS) is one of its crucial manifestations. Patient characteristics and medical provider factors can affect LOS but the relationship is uncertain. We intent to explore the relationship between patient characteristics and medical provider factors and LOS of primary THA patients. Methods We reviewed the database containing 461 patients who underwent primary THA between January 2014 to January 2019 and regressed the LOS against a variety of perioperative factors. A multivariable linear regression model was performed to assess the difference. Results For parts of patient characteristics, multivariable linear regression analysis revealed that comorbidities, pre-operation albumin < 30 g/L, and pre-operation CRP ≥ 5 mg/L were all significantly associated with LOS (p < 0.05). For parts of medical provider factors, multivariable linear regression analysis revealed that date of surgery, urinary catheter, and incision drainage were all significantly associated with LOS (p < 0.05). Conclusions Patient characteristics and medical provider factors are associated with LOS of THA patients. Evaluation and identification of risk factors are beneficial in patients' education, perioperative discussion and surgery decisions in the different primary THA patient populations.

Abstract P269: Circulating Fatty Acids, Determinants and Use as Biomarkers for Dietary Intake: The CoDAM and Hoorn Study

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Anne J Wanders ◽  
Sabine E De Hoon ◽  
Marjan Alssema ◽  
Edith J Feskens ◽  
Geertruida J Van Woudenbergh ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Regression Analysis ◽  
Waist Circumference ◽  
Linear Regression ◽  
Dietary Intake ◽  
Alcohol Intake ◽  
Linear Regression Analysis ◽  
Epa And Dha ◽  
Health Factors ◽  
Multivariable Linear Regression Analysis

Objective: To increase the understanding of circulating fatty acids (FA) as biomarkers of FA intake, we investigated (1) determinants of circulating proportions of linoleic acid (LA), alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA); and (2) the effect of demographic, lifestyle, and health factors on the relation between circulating and self-reported intake of LA, ALA, EPA, and DHA. Hypothesis: We hypothesized that demographic, lifestyle, and health factors influence the relation between circulating and self-reported intake of FA. Methods: Cross-sectional analysis in combined data from the CoDAM (n=472) and Hoorn study (n=708). Dietary FA intakes (% of total FA) were calculated from a validated 79-item semi-quantitative food frequency questionnaire. Fasting total fatty acids (% of total FA) in plasma (CoDAM) or serum (Hoorn) were measured by gas liquid chromatography. The variation in circulating proportions of FA explained by demographic, lifestyle and health factors was calculated by multivariable linear regression analysis. Correlation coefficients between circulating proportions of FA and self-reported FA intakes were calculated by standardized multivariable linear regression analysis adjusted for demographic, lifestyle, and health factors. To assess the influence of specific factors on correlations, stratified analyses were performed and interactions were calculated. Results: Self-reported intakes were the primary determinants of circulating proportions of LA (partial R2: 7%), ALA (2%), EPA (9%) and DHA (16%). Standardized regression coefficients between circulating and self-reported FA were: LA β=0.280 (95% Confidence Interval: 0.227-0.333), ALA β=0.130 (0.071-0.188), EPA β=0.338 (0.281-0.395), and DHA β=0.450 (0.397-0.503). Other determinants of circulating FA were the use of lipid lowering drugs, waist circumference and sex for LA; prevalence of type 2 diabetes mellitus, age, sex, and alcohol intake for EPA; and age for DHA. The correlation between circulating and dietary LA was stronger among people with a lower vs higher waist circumference and higher vs lower alcohol intake (interaction: p<0.05). In women, the correlation between circulating and dietary EPA and DHA was weaker than in men, and the correlation between circulating and dietary DHA was higher with higher alcohol intake. Underreporting of energy intake did not affect the correlations. Conclusion: Self-reported intake of FA is the primary, but not the only determinant of circulating proportions of LA, ALA, EPA and DHA. This analysis indicates that demographic, lifestyle, and health characteristics may influence the relation between circulating proportions and self-reported intake of FA. Improved understanding is needed of factors determining circulating FA and the implication for their use as biomarkers of dietary intake in different subgroups.

scholarly journals Delayed Antibiotic Therapy and Organ Dysfunction in Critically Ill Septic Patients in the Emergency Department

2019 ◽  
Vol 8 (2) ◽  
pp. 222 ◽  
Author(s):  
Sung Yeon Hwang ◽  
Jikyoung Shin ◽  
Ik Joon Jo ◽  
Jong Eun Park ◽  
Hee Yoon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Platelet Count ◽  
Linear Regression ◽  
Serum Creatinine ◽  
Antibiotic Therapy ◽  
Critically Ill ◽  
Standard Error ◽  
Serum Bilirubin ◽  
Linear Regression Analysis ◽  
Multivariable Linear Regression Analysis

Background: We investigated the effect of antibiotic timing on outcomes based on changes in surrogate markers of organ failure, including platelet, serum bilirubin, serum creatinine levels, and the PaO2/FiO2 (P/F) ratio. Methods: This was a single-center, retrospective observational study of critically ill septic patients who presented to the emergency department (ED). The study period extended from August 2008 to September 2016. The primary outcomes included changes in platelet, serum bilirubin, serum creatinine levels, and the P/F ratio (δ-platelet, δ-serum bilirubin, δ-serum creatinine, and δ-P/F ratio were calculated as values measured on Day 3; values measured at ED enrollment). A multivariable linear regression model was developed to assess variables related to outcomes (δ-platelet, δ-serum bilirubin, δ-serum creatinine, and δ-P/F ratio). Results: We analyzed 1784 patients who met the inclusion criteria. The overall 28-day mortality was 14% (n = 256/1784). On multivariable linear regression analysis, the hourly delay in antibiotic therapy was significantly associated with a decrease in δ-platelet count (coefficient, −1.741; standard error, 0.740; p = 0.019), and an increase in δ-serum bilirubin (coefficient, 0.054; standard error, 0.021; p = 0.009). In contrast, it was not associated with δ-creatinine (coefficient, 0.008; standard error, 0.010; p = 0.434) or the δ-P/F ratio (coefficient, −0.797; standard error, 1.858; p = 0.668). Conclusion: The hourly delay of antibiotic therapy was associated with decreased platelet count and increased serum bilirubin concentration in critically ill septic patients during the first three days of ED admission.

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