Preoperative serum potassium predicts the clinical outcome after non-cardiac surgery

Abstract Background: Potassium disorders have been linked to adverse outcomes in various medical conditions. However, the association of preoperative serum potassium with postoperative outcome is not well established. We aimed to examine the association between preoperative potassium with a 30-day mortality and adverse cardiovascular event (MACE). Methods: We conducted a cohort study using a prospectively collected database of patients, undergoing surgical procedures from 1998 to 2013 in the VA Western New York Healthcare System, which are reported to the Veterans Affairs Surgical Quality Improvement Program (VASQIP). The patients were categorized into three groups based on their documented preoperative potassium concentrations. Hypokalemia was defined as serum potassium concentration <4 mmol/L and hyperkalemia was defined as serum potassium concentrations >5.5 mmol/L. The values within the range of 4.0–5.5 mmol/L were considered as normokalemia and used as the control group. Statistical analyses included Chi-square test, analysis of variance and multivariate logistic regression to estimate the risk of MACE within 30 days of surgery. Results: Study included 5959 veterans who underwent surgery between 1998 and 2013. The patients in the hyperkalemics group had lower kidney function compared to the other two groups. The frequency of MACE was 13.6% in hypokalemics and 21.9% in hyperkalemics that were both significantly higher than 4.9% in controls. In multivariate logistic regression the hazard risk (HR) ratios of MACE were (2.17, 95% CI 1.75–2.70) for hypokalemics and (3.23, 95% CI 2.10–4.95) for hyperkalemics when compared to normokalemic controls. Conclusions: Preoperative hypokalemia and hyperkalemia are both independent predictors of MACE within 30 days.

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Predictors of 30-Day Mortality Using Machine Learning Approach following Carotid Endarterectomy: An Insight from National Surgical Quality Database

10.21203/rs.3.rs-386972/v1 ◽

2021 ◽

Author(s):

Nida Fatima ◽

FR FAHA Ashfaq Shuaib MD ◽

F MPH Maher Saqqur MD

Keyword(s):

Machine Learning ◽

Logistic Regression ◽

Carotid Endarterectomy ◽

Machine Learning Algorithms ◽

Brier Score ◽

Chronic Obstructive Pulmonary Disorder ◽

Improvement Program ◽

Surgical Quality ◽

Preoperative Serum ◽

Selection Of Variables

Abstract BACKGROUND: Pre-operative prognostication of 30-day mortality in patients with carotid endarterectomy (CEA) can optimize surgical risk stratification and guide the decision-making process to improve survival. To develop and validate a set of predictive variables of 30-day mortality following CEA.METHODS: The patient cohort was identified from the American College of Surgeons National Surgical Quality Improvement Program (2005-2016). We performed logistic regression (enter, stepwise and forward) and least absolute shrinkage and selection operator (LASSO) method for selection of variables, which resulted in 28-candidate models. The final model was selected based upon clinical knowledge and numerical results.RESULTS: Statistical analysis included 65,807 patients with 30-day mortality in 0.7% (n=466) patients. The median age of our cohort was 71.0 years (range, 16-89 years). The model with 9-predictive factors which included: age, body mass index, functional health status, American society of anesthesiologist grade, chronic obstructive pulmonary disorder, preoperative serum albumin, preoperative hematocrit, preoperative serum creatinine and preoperative platelet count—performed best on discrimination, calibration, Brier score and decision analysis to develop a machine learning algorithm. Logistic regression showed higher AUCs than LASSO across these different models. The predictive probability derived from the best model was converted into an open-accessible scoring system.CONCLUSION: Machine learning algorithms show promising results for predicting 30-day mortality following CEA. These algorithms can be useful aids for counseling patients, assessing pre-operative medical risks, and predicting survival after surgery.

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Increased Serum Levels of Asymmetric Dimethylarginine and Symmetric Dimethylarginine and Decreased Levels of Arginine in Sudanese Patients with Essential Hypertension

Kidney & Blood Pressure Research ◽

10.1159/000508695 ◽

2020 ◽

Vol 45 (5) ◽

pp. 727-736

Author(s):

Sahar Gamil ◽

Jeanette Erdmann ◽

Edzard Schwedhelm ◽

Khalid Hussein Bakheit ◽

Ihab B.B. Abdalrahman ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Essential Hypertension ◽

Amino Acid ◽

Asymmetric Dimethylarginine ◽

Multivariate Logistic Regression Analysis ◽

Serum Levels ◽

Control Group ◽

Multivariate Logistic Regression ◽

Symmetric Dimethylarginine

Introduction: Essential hypertension (EH) is a disease caused by various environmental and genetic factors. Nitric oxide (NO) is important for the functional integrity of the endothelium. It is produced in endothelial cells by endothelial NO synthase (eNOS) that mediates the conversion of the amino acid arginine into NO and citrulline. Asymmetric dimethylarginine (ADMA) acts as an inhibitor of eNOS. In contrast, symmetric dimethylarginine (SDMA) has no direct effect on eNOS but plays an important role competing with arginine for transport across the amino acid transporter. ADMA and SDMA have been found to play a central role in the development of cardiovascular diseases. Serum ADMA levels may serve as a future diagnostic marker and a target of therapy in hypertensive patients in the Sudanese population. This study aimed to investigate the relation between serum arginine, ADMA, and SDMA levels with EH in the Sudanese population. Methods: Patients (n = 260) with established hypertension and controls (n = 144) with normal blood pressure were included in this case-control study. Serum blood samples were analyzed for arginine, ADMA, and SDMA, using high-performance liquid chromatography-tandem mass spectrometry. Other laboratory data were measured using routine methods. Mann-Whitney’s U test and χ2 tests were used for continuous and categorical data, respectively. A multivariate logistic regression analysis was conducted to investigate the independent effect of multiple variables on the development of hypertension. Results: Serum arginine levels were significantly lower in the patient group than in the control group (p < 0.001). ADMA and SDMA levels were significantly higher in the patient group than the control group (p < 0.001, p = 0.001, respectively). Multivariate logistic regression analysis showed that only older age, being a male, and arginine levels are independent factors controlling the development of hypertension (p < 0.001, p < 0.001, and p = 0.046, respectively). ADMA and SDMA levels were not independent factors for the development of hypertension. Conclusions: This study demonstrated increased serum levels of ADMA and SDMA and decreased arginine levels in Sudanese patients with EH. Lowering serum ADMA levels or increasing the arginine levels might be a novel therapeutic target in these individuals.

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Musculoskeletal Problems in Relation to Farming, Gender and Smoking

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/154193120004403052 ◽

2000 ◽

Vol 44 (30) ◽

pp. 5-588-5-590

Author(s):

M G Björkstén ◽

A. Rask-Andersen

Keyword(s):

Logistic Regression ◽

General Population ◽

Smoking Habits ◽

Control Group ◽

Regression Analyses ◽

Multivariate Logistic Regression ◽

Male And Female ◽

Musculoskeletal Problems ◽

Female Farmers ◽

Group Belonging

The aim of the present study was to investigate if smoking habits covariated with musculoskeletal problems among a group of male and female farmers and a control group from the general population. A questionnaire was sent to all farms and to a group of controls from the general population in the county of Uppsala. It comprised questions about smoking habits and musculoskeletal problems. Crosstabulations and multivariate logistic regression analyses were performed. In the analyses we included smoking habits, age, gender and group belonging, e g farmers or controls. Age did not give a higher risk for musculoskeletal problems in any of the groups. The results showed that problems were related both to gender and group combined or not combined with smoking habits.

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Characteristics Analysis, Clinical Outcome and Risk Factors for Fungal Peritonitis in Peritoneal Dialysis Patients: A 10-Year Case-Control Study

Frontiers in Medicine ◽

10.3389/fmed.2021.774946 ◽

2021 ◽

Vol 8 ◽

Author(s):

Rongrong Li ◽

Difei Zhang ◽

Jingwen He ◽

Jianjun Ou ◽

La Zhang ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Peritoneal Dialysis ◽

Serum Potassium ◽

Case Control Study ◽

Case Control ◽

Catheter Removal ◽

Multivariate Logistic Regression ◽

Fungal Peritonitis ◽

Control Study

Background: Fungal peritonitis (FP) is a rare but severe complication that can appear in patients receiving peritoneal dialysis (PD). This study aimed to investigate the incidence rate and clinical characteristics of FP, evaluate clinical outcomes between FP and bacterial peritonitis (BP) patients on PD, and especially estimate the risk factors for FP outbreak.Methods: All episodes of FP diagnosed in our hospital from January 1, 2011, to December 31, 2020, were reviewed in this single-center study. FP cases were analyzed and compared with patients diagnosed with BP in a 1:6 ratio matching for case-control study. Patient information, including clinical information, biochemical analysis, and outcomes, was recorded. Univariate and multivariate logistic regression model were used to analyze the risk factors for FP.Results: A total of 15 FP episodes were observed in 15 PD patients, with an FP rate of 0.0071 episodes per patient-year. Seventeen strains of fungi were isolated and identified. Candida was the most common pathogen (15 strains, 88.2%), followed by Aspergillus fumigatus (2 strains, 11.8%). Between the groups, FP group showed a higher rate of HD transfer and catheter removal, and a lower rate of PD resumption in the short-term outcome (all P < 0.01), while no significant difference in the mortality was noted during the whole study period. The multivariate logistic regression analysis showed that longer PD duration (odds ratio [OR] 1.042, 95% confidence interval [CI] 1.012–1.073, P < 0.01), higher serum potassium (OR 3.373, 95% CI 1.068–10.649, P < 0.05), elevated estimated glomerular filtration rate (eGFR) (OR 1.845, 95% CI 1.151–2.955, P < 0.05), reduced serum albumin level (OR 0.820, 95% CI 0.695–0.968, P < 0.05) and peritoneal effluent polymorphonuclear (PMN) count (OR 0.940, 95%CI 0.900–0.981, P < 0.01) were significantly increased the risk for FP.Conclusion: These results suggested that FP leads to higher rate of catheter removal and HD transfer, and a lower rate of PD resumption than BP, and that additional attention should be paid to hypoalbuminemia, increased serum potassium, long PD duration, and low peritoneal effluent PMN in PD patients.

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Factors associated with medial meniscal subluxation in knees with medial meniscus tears: a cross-sectional study

10.21203/rs.3.rs-35269/v2 ◽

2020 ◽

Author(s):

Xinguang Liu ◽

Ran Ding ◽

Chen Liu ◽

Bin Yang ◽

Weiguo Wang

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Medial Meniscus ◽

Multivariate Logistic Regression Analysis ◽

Control Group ◽

Independent Factor ◽

Multivariate Logistic Regression ◽

Factors Associated ◽

Meniscus Tears

Abstract Background Previous studies have indicated that medial meniscal subluxation (MMS) is associated with special types of medial meniscus tears (MMT) and chondral lesions. However, most of these studies lacked arthroscopic findings and did not adjust for possible confounders. The purpose of this study was to explore factors associated with MMS in patients with MMT using multivariate logistic regression analysis. Methods A retrospective analysis of 115 patients who underwent arthroscopic surgery for MMT was conducted. The medial meniscal extrusion (MME) distance was measured on a single mid-coronal magnetic resonance (MR) image, and the MMS group included patients with MME distance ≥3 mm (55 patients with 55 knees). Other patients were included as the control group (60 patients with 60 knees). Demographic and clinical data were collected as variates. A multivariate logistic regression analysis was performed to identify factors associated with MMS. Results In a univariate analysis, the Outerbridge classification (P=0.002) and the type of MMT (P<0.001) were significantly different between the MMS group and the control group. According to unadjusted and age- and body mass index (BMI)-adjusted multivariate logistic regression analysis, the type of MMT was an independent factor associated with MMS. Compared with horizontal tears, radial tears, posterior medial meniscus root tears (PMMRT) and complex tears had approximately 6-fold (adjusted OR 6.468, 95% CI 1.509–27.718, P=0.012), 10-fold (adjusted OR 10.324, 95% CI 1.719–61.989, P=0.011) and 4-fold (adjusted OR 4.458, 95% CI 1.602–12.408, P=0.004) higher associations with MMS, respectively. Conclusion The type of MMT was an independent factor associated with MMS in knees with MMT. Radial tears, PMMRT and complex tears were more likely than horizontal tears to result in MMS. The results suggest that MMT combined with MMS should be noted when managing MMT, especially radial tears, PMMRT and complex tears. Moreover, the results indicate that we must not only preserve the meniscus as much as possible but also restore its position to as close to normal as possible.

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Analysis of Risk Factors for Non-Union After Surgery for Limb Fractures: A Case-Control Study of 669 Subjects

10.21203/rs.3.rs-74785/v1 ◽

2020 ◽

Author(s):

Qiang Xu ◽

Bin Zhang ◽

Min Dai ◽

Xuqiang Liu

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Internal Fixation ◽

Weight Bearing ◽

Multivariate Logistic Regression Analysis ◽

Control Group ◽

Fracture Type ◽

Multivariate Logistic Regression ◽

Non Union ◽

Limb Fractures

Abstract Objective: Although a large number of clinical and animal experimental studies have explored factors affecting fracture healing, there are only a few examples of systematic research on these factors for limb fractures. The purpose of this study was to analyse the risk factors for limb fracture non-union in order to improve non-union prevention and early detection.Methods: A total of 223 patients with non-union after surgery for limb fractures performed at our institution from January 2005 to June 2017 were included as the case group, while a computer-generated random list was created to select 446 patients with successful bone healing who were treated during the same period as the control group, thus achieving a ratio of 1:2. The medical records of these patients were reviewed retrospectively. Age, sex, body mass index, obesity, smoking, alcohol, diabetes, hypertension, osteoporosis, fracture type, multiple fractures, non-steroidal anti-inflammatory drugs (NSAIDs) use, delayed weight bearing, internal fixation failure, and infection data were analysed and compared between the two groups. A multivariate logistic regression model was constructed to determine relevant factors associated with non-union.Results: The multivariate logistic regression analysis revealed that osteoporosis, open fractures, NSAIDs use, delayed weight bearing, failed internal fixation, and infection were independent risk factors for non-union after surgery for limb fractures.Conclusions: Osteoporosis, open fracture type, NSAIDs use, delayed weight bearing, failed internal fixation, and infection were found to be the main causes of bone non-union; clinicians should, therefore, take targeted measures to intervene in high-risk groups early.

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ASA Classification as a Risk Stratification Tool in Adult Spinal Deformity Surgery: A Study of 5805 Patients

Global Spine Journal ◽

10.1177/2192568217700106 ◽

2017 ◽

Vol 7 (8) ◽

pp. 719-726 ◽

Cited By ~ 15

Author(s):

Sulaiman Somani ◽

John Di Capua ◽

Jun S. Kim ◽

Kevin Phan ◽

Nathan J. Lee ◽

...

Keyword(s):

Logistic Regression ◽

Risk Stratification ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Wound Complications ◽

Complication Rates ◽

Multivariate Logistic Regression ◽

Improvement Program ◽

Asa Classification ◽

Increased Risk

Study Design: Retrospective analysis of prospectively collected data. Objectives: Adult spinal deformity (ASD) surgery is a highly complex procedure that has high complication rates. Risk stratification tools can improve patient management and may lower complication rates and associated costs. The goal of this study was to identify the independent association between American Society of Anesthesiologists (ASA) class and postoperative outcomes following ASD surgery. Methods: The 2010-2014 American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology and International Classification of Diseases, Ninth Revision, codes relevant to ASD surgery. Patients were divided based on their ASA classification. Bivariate and multivariate logistic regression analyses were employed to quantify the increased risk of 30-day postoperative complications for patients with increased ASA scores. Results: A total of 5805 patients met the inclusion criteria, 2718 (46.8%) of which were ASA class I-II and 3087 (53.2%) were ASA class III-IV. Multivariate logistic regression revealed ASA class to be a significant risk factor for mortality (odds ratio [OR] = 21.0), reoperation within 30 days (OR = 1.6), length of stay ≥5 days (OR = 1.7), overall morbidity (OR = 1.4), wound complications (OR = 1.8), pulmonary complications (OR = 2.3), cardiac complications (OR = 3.7), intra-/postoperative red blood cell transfusion (OR = 1.3), postoperative sepsis (OR = 2.7), and urinary tract infection (OR = 1.6). Conclusions: This is the first study evaluating the role of ASA class in ASD surgery with a large patient database. Use of ASA class as a metric for preoperative health was verified and the association of ASA class with postoperative morbidity and mortality in ASD surgery suggests its utility in refining the risk stratification profile and improving preoperative patient counseling for those individuals undergoing ASD surgery.

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Relationship between diverticulosis and nonalcoholic fatty liver disease in elderly patients

Journal of International Medical Research ◽

10.1177/0300060517751740 ◽

2018 ◽

Vol 46 (4) ◽

pp. 1545-1554 ◽

Cited By ~ 1

Author(s):

Abdurrahman Sahin ◽

Nurettin Tunc ◽

Ulvi Demirel ◽

Orhan Kursat Poyrazoglu ◽

Mehmet Yalniz ◽

...

Keyword(s):

Logistic Regression ◽

Liver Disease ◽

Elderly Patients ◽

Predictive Factors ◽

Fatty Liver Disease ◽

The Elderly ◽

Control Group ◽

Multivariate Logistic Regression ◽

Colonic Diverticulosis ◽

Nonalcoholic Fatty Liver

Objective To compare clinical and laboratory features of elderly patients with and without diverticulosis and assess factors related to hepatosteatosis. Method This retrospective case–control study analysed the clinical and laboratory data, colonoscopy and abdominal ultrasonography records of patients >65 years who underwent colonoscopies. Subjects were categorized according to the presence and absence of colonic diverticulosis. Univariate/multivariate logistic regression analyses were performed to evaluate the independent predictive factors of hepatosteatosis. Results A total of 355 patients were enrolled in the study: 169 had colonic diverticulosis; and 186 without colonic diverticulosis formed the control group. Age, sex and chronic disorders associated with the metabolic syndrome did not differ between the diverticulosis and control groups. The rate of hepatosteatosis was lower in patients with diverticulosis compared with the control group (27% versus 42%, respectively). Diabetes mellitus, hyperlipidaemia and hepatosteatosis were more common among patients aged <75 years. In the multivariate logistic regression analysis, diverticulosis remained an independent predictor of hepatosteatosis (odds ratio 0.529; 95% confidence interval 0.323, 0.866). Other independent predictive factors in the multivariate analysis were triglyceride and albumin. Conclusion Diverticulosis in the elderly was found to be a negative predictor of hepatosteatosis. Higher values of albumin and triglyceride in conjunction with the absence of diverticulosis may be suggestive of nonalcoholic fatty liver disease in the elderly.

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Lifestyle intervention to prevent gestational diabetes mellitus and adverse maternal outcomes among pregnant women at high risk for gestational diabetes mellitus

Journal of International Medical Research ◽

10.1177/0300060520979130 ◽

2020 ◽

Vol 48 (12) ◽

pp. 030006052097913

Author(s):

Xueyan Lin ◽

Ting Yang ◽

Xueqin Zhang ◽

Wei Wei

Keyword(s):

Diabetes Mellitus ◽

Logistic Regression ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Lifestyle Intervention ◽

Intervention Group ◽

Control Group ◽

Maternal Outcomes ◽

Multivariate Logistic Regression

Objective We assessed the effects of a lifestyle intervention on gestational diabetes mellitus (GDM) incidence and risk of adverse maternal outcomes among pregnant women at high risk for GDM. Methods From July to December 2018, we enrolled 1822 eligible pregnant women; of these, 304 had at least one risk factor for GDM. Participants were randomly allocated to the intervention or control group. Usual prenatal care was offered to both groups; the intervention group also received individually modified education on diet, physical activity, and weight control. The GDM diagnosis was based on an oral glucose tolerance test at 24–28 gestational weeks. Multivariate logistic regression was used to evaluate the effects of the lifestyle intervention on risk of GDM and adverse maternal outcomes. Results A total of 281 women (139 in the intervention group and 142 controls) were included. Incidences of GDM and adverse maternal outcomes were all significantly lower in the intervention than in the control group. Multivariate logistic regression indicated that women in the intervention group had a lower risk of GDM and adverse maternal outcomes, after adjusting potential confounding factors. Conclusion The present lifestyle intervention was associated with lower risks of GDM and adverse maternal outcomes.

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Correlation between OSAHS and Early Peripheral Atherosclerosis Indices in Patients with Type 2 Diabetes Mellitus in China: A Cross-Sectional Inpatient Study

Journal of Diabetes Research ◽

10.1155/2021/6630020 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Xin Zhao ◽

Xiaofeng Yu ◽

Sixu Xin ◽

Wei Zhang ◽

Xiaomei Zhang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Logistic Regression ◽

Risk Factor ◽

Lower Extremity ◽

Control Group ◽

Multivariate Logistic Regression ◽

Early Atherosclerosis

Objective: To analyze the differences of early atherosclerosis indices in type 2 diabetes mellitus (T2DM) patients with different degrees of obstructive sleep apnea-hypopnea syndrome (OSAHS) and explore the correlation between them, so as to provide a new clinical basis for the prevention and treatment of early atherosclerosis in patients with T2DM and OSAHS. Methods. A prospective study was conducted in 312 patients with T2DM and snoring who were hospitalized in the Department of Endocrinology, Peking University International Hospital from January 2017 to January 2020. According to the monitoring results, 312 patients were divided into 4 groups including the control group (208 cases), mild OSAHS group (18 cases), moderate OSAHS group (38 cases), and severe OSAHS group (48 cases). Multivariate logistic regression analysis was used to analyze the early atherosclerosis indices including brachial-ankle pulse wave velocity (PWV) and ankle-brachial index (ABI) in patients with T2DM coexistence with different degrees of OSAHS. Results. (1) As the degree of OSAHS increased, ABI decreased gradually and was lower than that in the control group, but PWV increased and was higher than that in the control group ( p < 0.05 , respectively). (2) The apnea-hypopnea index (AHI) positively correlated with PWV ( r = 0.36 , p < 0.05 ) and negatively correlated with ABI ( r = − 0.37 , p < 0.05 ). (3) Multivariate logistic regression showed that after adjusting for age, gender, duration, BMI, blood pressure, blood glucose, blood lipid, and other factors, OSAHS was a risk factor of lower extremity arterial disease (LEAD) in patients with T2DM. With the increase of degree of OSAHS, the risk of lower extremity atherosclerosis gradually increased. Conclusion. OSAHS is an independent risk factor of LEAD in patients with T2DM, and with the increase of AHI, the ABI and PWV have changed, which provides a new clinical basis for the prevention and the treatment of early atherosclerosis in patients with T2DM and OSAHS.

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