A novel and simple risk model predicts the prognosis for patients with paraquat poisoning

Abstract Background: Acute paraquat (PQ) poisoning is characterized by multi-organ failure and lacking effective therapies. Therefore, identifying risk factors and developing model that could predict early prognosis for patients with PQ poisoning is of great importance. Methods: This was a retrospective cohort study employed with patients suffered from acute PQ poisoning (n=1199). Patients (n=913) with PQ poisoning from 2011 to 2018 were randomly divided into 2 mutually exclusive groups: training (609 patients) and test (304 patients). Another 2 external cohorts containing 207 cases from Zhengzhou 2019 were used as validation from different time and 79 from Shenyang as validation from different site. Risk factors were identified by a logistic model with Markov Chain Monte Carlo (MCMC) simulation and further evaluated by a latent class analysis. The prediction score of this model was developed based on the training sample and was further evaluated using the testing and validation samples. Results: Eight risk factors including age, ingestion volume, CK-MB, platelet (PLT), white blood cell (WBC), neutrophil counts (N), gamma-glutamyl transferase (GGT) and serum creatinine (Cr) were identified as in dependent risk indicators of in-hospital death events. The risk model had a C statistic of 0.895 (95% CI 0.855-0.928), 0.891 (95% CI 0.848-0.932) and 0.829 (95% CI 0.455-1.000) and a predictive range of 4.6%-98.2%, 2.3%-94.9% and 0%-12.5% for the test, validation_time and validation_site group, respectively. In the training group, the risk model classified 18.4%, 59.9% and 21.7% of patients into the high, average and low-risk groups, with corresponding probabilities of 0.985, 0.365, and 0.03 for in-hospital death events. Conclusion: Eight risk factors were identified in this study. And we developed and evaluated a simple risk model to predict the prognosis of patients with acute PQ poisoning. This simple and reliable risk score system could be helpful in recognizing high-risk patients and reducing in-hospital death rate due to PQ poisoning.

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A novel simple risk model to predict the prognosis of patients with paraquat poisoning

Scientific Reports ◽

10.1038/s41598-020-80371-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yanxia Gao ◽

Liwen Liu ◽

Tiegang Li ◽

Ding Yuan ◽

Yibo Wang ◽

...

Keyword(s):

Risk Factors ◽

Latent Class ◽

Risk Model ◽

Risk Groups ◽

Training Sample ◽

Risk Indicators ◽

Hospital Death ◽

Gamma Glutamyl Transferase ◽

Creatine Kinase Mb ◽

Glutamyl Transferase

AbstractTo identify risk factors and develop a simple model to predict early prognosis of acute paraquat (PQ) poisoning patients, we performed a retrospective cohort study of acute PQ poisoning patients (n = 1199). Patients (n = 913) with PQ poisoning from 2011 to 2018 were randomly divided into training (n = 609) and test (n = 304) samples. Another two independent cohorts were used as validation samples for a different time (n = 207) and site (n = 79). Risk factors were identified using a logistic model with Markov Chain Monte Carlo (MCMC) simulation and further evaluated using a latent class analysis. The prediction score was developed based on the training sample and was evaluated using the testing and validation samples. Eight factors, including age, ingestion volume, creatine kinase-MB [CK-MB], platelet [PLT], white blood cell [WBC], neutrophil counts [N], gamma-glutamyl transferase [GGT], and serum creatinine [Cr] were identified as independent risk indicators of in-hospital death events. The risk model had C statistics of 0.895 (95% CI 0.855–0.928), 0.891 (95% CI 0.848–0.932), and 0.829 (95% CI 0.455–1.000), and predictive ranges of 4.6–98.2%, 2.3–94.9%, and 0–12.5% for the test, validation_time, and validation_site samples, respectively. In the training sample, the risk model classified 18.4%, 59.9%, and 21.7% of patients into the high-, average-, and low-risk groups, with corresponding probabilities of 0.985, 0.365, and 0.03 for in-hospital death events. We developed and evaluated a simple risk model to predict the prognosis of patients with acute PQ poisoning. This risk scoring system could be helpful for identifying high-risk patients and reducing mortality due to PQ poisoning.

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Correlation of Gamma Glutamyl Transferase with Traditional Risk Markers of Cardiovascular Disease in Different Obesity Phenotypes

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/48020.14801 ◽

2021 ◽

Author(s):

Amit Kumar Meena ◽

Sonali Sharma ◽

Barkha Gupta ◽

Asrar Ahmed

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Lipid Profile ◽

Liver Enzymes ◽

Tertiary Care ◽

Gamma Glutamyl Transferase ◽

Strong Positive Correlation ◽

Positive Correlation ◽

Gamma Glutamyl ◽

Glutamyl Transferase

Introduction: The increased prevalence of overweight, obesity, and metabolic syndrome has revealed that liver enzymes have a potential role as determinants of metabolic conditions such as, hyperlipidemia, and Cardiovascular Disease (CVD). Aim: The study aimed to investigate the correlation between liver enzymes with anthropometric indices of obesity and lipid profile in different obese phenotypes at a tertiary care. Materials and Methods: The present observational study was conducted on a total of 180 obese participants of either gender in the age group 18-59 years from December 2018 to May 2019. These were further divided into two phenotypic groups viz., Metabolically Healthy Obese (MHO group; n=90) and Metabolically Unhealthy Obese (MUHO group; n=90) according to NCEP ATP III criteria.Traditional cardiovascular risk factors were evaluated in the study participants through anthropometric viz., Body Mass Index (BMI), Waist Circumference (WC), Hip Circumference (HC), waist–hip ratio (WHR), blood pressure and biochemical investigations i.e., serum glucose, lipid profile and liver enzymes. Data was analysed by using Microsoft excel software. Results: Among 180 obese participants, 76 were males and 104 females with mean age 40.42±10.84 years. In MUHO phenotype, Gamma Glutamyl Transferase (GGT) showed a strong positive correlation with BMI (r=0.413, p=0.00001), lipid parameters viz., LDL-C (r=0.3785, p=0.0001), TC (r=0.2953, p=0.0023), TG (r=0.2623, p=0.006) and negative correlation with HDL-C (-r=0.3167, p=0.001). No significant correlation was found in MHO phenotype between liver enzymes, BMI and lipid profile parameters. Conclusion: The results of this study indicated that GGT shows a strong positive correlation with traditional risk factors in MUHO participants. Thus, raised GGT may be considered as a risk marker of CVD in MUHO phenotype.

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Serum gamma-glutamyl transferase to alanine aminotransferase ratio predict the vascular invasion and outcome in hepatitis B virus related hepatocellular carcinoma

10.21203/rs.3.rs-439544/v1 ◽

2021 ◽

Author(s):

Zhifeng Zhao ◽

Jiayun Lin ◽

Xiaochun Ni ◽

Hongjie Li ◽

Lei Zheng ◽

...

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Subgroup Analysis ◽

Alanine Aminotransferase ◽

Vascular Invasion ◽

Gamma Glutamyl Transferase ◽

B Virus ◽

Glutamyl Transferase

Abstract Backgrounds: The ratio of gamma-glutamyl transferase (GGT) to alanine aminotransferase (ALT) is a predictive biomarker for hepatitis and hepatocellular carcinoma (HCC). In this study, the relationship between GGT/ALT ratio and vascular invasion was explored in hepatitis B virus (HBV)-related HCC and tumor prognosis. Methods: Totally 558 patients were involved in this study. Univariate and multivariate logistic analysis were used to evaluate GGT/ALT as the risk factor of vascular invasion. Prognostic value of GGT/ALT was investigated by univariate and multivariate Cox analysis combined with Kaplan Meier curves. In order to reduce confounding bias, subgroup analysis and propensity score matching (PSM) were performed. Results: Patients were divided into high and low GGT/ALT groups with an optimal cut-off value of 2.95 in predicting vascular invasion. In univariate and multivariate logistic regression, high GGT/ALT group was listed as the independent risk factors for vascular invasion(P=0.03), the other risk factors included age (P=0.001), α-fetoprotein (AFP) (P=0.026), tumor size (P<0.001), tumor capsule (P=0.018), pathological differentiation (P<0.001) and Barcelona Clinic Liver Cancer (BCLC) classification (P<0.001). In survival analysis, high GGT/ALT ratio was associated with decreased overall survival (OS) (HR: 1.38; 95% CI: 1.03, 1.87; P<0.0001) and disease-free survival (DFS) rates (HR: 1.32; 95% CI: 1.03, 1.87; P<0.0001). In sensitivity analysis, comparable results were furtherly confirmed by subgroup analysis. In PSM analysis, GGT/ALT was still associated with vascular invasion independently (OR, 186; 95% CI, 1.23, 3.33). Conclusion: Preoperative GGT/ALT has good predictive value for vascular invasion, tumor severity and outcome in HBV-related HCC patients.

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Abstract P027: Gamma-Glutamyl Transferase is More Strongly Associated with Diabetes Risk Than Alanine and Aspartate Aminotransferase: Results from the Atherosclerosis Risk in Communities (ARIC) StudyStudy

Circulation ◽

10.1161/circ.125.suppl_10.ap027 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Andrea L Christman ◽

Mariana Lazo ◽

Chiadi E Ndumele ◽

James Pankow ◽

Josef Coresh ◽

...

Keyword(s):

Risk Factors ◽

Liver Disease ◽

Aspartate Aminotransferase ◽

Liver Enzymes ◽

Gamma Glutamyl Transferase ◽

Community Based ◽

Gamma Glutamyl ◽

Spline Models ◽

Glutamyl Transferase ◽

Diagnosed Diabetes

Introduction: Liver disease and diabetes often co-occur and have shared risk factors. We undertook this study to investigate which liver enzyme (alanine aminotransferase (ALT), aspartate aminotransferase (AST), or gamma-glutamyl transferase (GGT)) would be most strongly associated with incident diabetes in a large, community-based population. Hypothesis: We hypothesized that ALT, AST, and GGT would be independently associated with diabetes and that ALT would be most strongly associated with diabetes due to its liver specificity. Methods: We conducted a prospective analysis of 9,524 participants in the ARIC Study without diagnosed diabetes or a history of high alcohol consumption (>14 [women] and >21 [men] drinks/week). Enzymes were measured from stored plasma samples. We examined the association of sex-specific quartiles of liver enzymes with incident diagnosed diabetes using Cox proportional hazards models adjusted for demographic, lifestyle, and behavioral risk factors. Restricted cubic spline models were fit to model the continuous associations. Results: Median ALT, AST, and GGT were 13, 18, and 22 U/L, respectively. During a median follow-up of 11 years, there were 1,905 self-reported cases of diabetes. All three liver enzymes were significantly associated with diabetes, even after adjustment for all covariates (HRs (95% CIs): ALT, 1.63 (1.44, 1.85); AST, 1.23 (1.09, 1.40); GGT, 1.99 (1.71, 2.30) comparing Q4 versus Q1). The restricted cubic spline models show similar patterns (Figure). After simultaneously adjustment for the other liver enzymes, only ALT and GGT remained significantly associated with diabetes. In analyses further restricted to participants who reported never consuming alcohol only GGT remained significant. Conclusion: In this community-based population, GGT was more strongly associated with diabetes risk than ALT and AST. Although ALT and AST are considered to be more specific markers of liver disease, higher levels of GGT may be a more important risk factor for diabetes.

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Elevated gamma-glutamyl transferase is associated with subclinical inflammation independent of cardiometabolic risk factors in an asymptomatic population: a cross-sectional study

Nutrition & Metabolism ◽

10.1186/s12986-016-0097-7 ◽

2016 ◽

Vol 13 (1) ◽

Cited By ~ 9

Author(s):

Shozab S. Ali ◽

Ebenezer T. Oni ◽

Michael J. Blaha ◽

Emir Veledar ◽

Hamid R. Feiz ◽

...

Keyword(s):

Risk Factors ◽

Cardiometabolic Risk ◽

Cross Sectional Study ◽

Cardiometabolic Risk Factors ◽

Gamma Glutamyl Transferase ◽

Subclinical Inflammation ◽

Sectional Study ◽

Cross Sectional ◽

Gamma Glutamyl ◽

Glutamyl Transferase

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Feline obesity: risk factors and clinical and metabolic findings

Semina Ciências Agrárias ◽

10.5433/1679-0359.2021v42n6p3305 ◽

2021 ◽

Vol 42 (6) ◽

pp. 3305-3320

Author(s):

Camila Moura de Lima ◽

◽

Gustavo Antônio Boff ◽

Sergiane Baes Pereira ◽

Alexsander Ferraz ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Environmental Management ◽

Body Fat ◽

Body Condition Score ◽

Serum Biochemistry ◽

The Body ◽

Gamma Glutamyl Transferase ◽

Glutamyl Transferase

Excess body fat can cause a series of metabolic and mechanical effects on the body. Therefore, this study aimed to verify the clinical, metabolic, and risk factors of overweight (OW) cats. For the acceptance of participation in the research, the tutors were asked to answer a questionnaire containing 34 questions and to point out the body condition score (BCS) on a sheet containing nine images of different scores (1 to 9 on a 9-point scale). Thereafter, the body evaluations were performed as a classification of the BCS on a scale from 1 to 9, with an ideal score (IS) of BCS 5 and OW for BCS > 5. Further, the lean mass index and morphometric measurements (thoracic and abdominal circumferences and height and length of the patella to calcaneal tuberosity) were performed to estimate the percentage of body fat. Systolic blood pressure was measured using the non-invasive Doppler method and blood was collected for hemogram and serum biochemistry (creatinine, urea, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, glucose, triglycerides, and cholesterol). After these analyses, we sought to guide and raise the awareness of the tutors to promote the correct nutritional and environmental management of the animals. Thirty adult cats were divided into two groups, based on the classification of the BCS, with eight having an IS and 22 being OW. The OW group was found to have a low level of physical activity, hypercholesterolemia, and higher values of body characteristics. Additionally, there was a median agreement between the perceptions of the clinician and the tutors. Therefore, it was concluded that the main laboratory alteration found in the obese cats was hypercholesterolemia, which was a critical parameter. It was observed that a low degree of physical activity could cause excess weight gain. It was found that the guardians of the cats with ideal weight underestimated the BCS, which could contribute to the supply of excess food and consequently, obesity. Thus, this study was sought to guide and raise the awareness of tutors, to promote the correct nutritional and environmental management thereby providing welfare and quality of life to the animals.

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Commonly used clinical chemistry tests as mortality predictors: Results from two large cohort studies

PLoS ONE ◽

10.1371/journal.pone.0241558 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241558

Author(s):

Lars Lind ◽

Daniela Zanetti ◽

Marieann Högman ◽

Lars Sundman ◽

Erik Ingelsson

Keyword(s):

Risk Factors ◽

Clinical Chemistry ◽

Mortality Prediction ◽

Gamma Glutamyl Transferase ◽

Normal Range ◽

Normal Ranges ◽

All Cause Mortality ◽

Glutamyl Transferase ◽

Clinical Chemistry Tests

Background The normal ranges for clinical chemistry tests are usually defined by cut-offs given by the distribution in healthy individuals. This approach does however not indicate if individuals outside the normal range are more prone to disease. Methods We studied the associations and risk prediction of 11 plasma and serum biomarkers with all-cause mortality in two population-based cohorts: a Swedish cohort (X69) initiated in 1969, and the UK Biobank (UKB) initiated in 2006–2010, with up to 48- and 9-years follow-up, respectively. Results In X69 and in UKB, 18,529 and 425,264 individuals were investigated, respectively. During the follow-up time, 14,475 deaths occurred in X69 and 17,116 in UKB. All evaluated tests were associated with mortality in X69 (P<0.0001, except bilirubin P<0.005). For calcium, blood urea nitrogen, bilirubin, hematocrit, uric acid, and iron, U-shaped associations were seen (P<0.0001). For leukocyte count, gamma-glutamyl transferase, alkaline phosphatases and lactate dehydrogenase, linear positive associations were seen, while for albumin the association was negative. Similar associations were seen in UKB. Addition of all biomarkers to a model with classical risk factors improved mortality prediction (delta C-statistics: +0.009 in X69 and +0.023 in UKB, P<0.00001 in both cohorts). Conclusions Commonly used clinical chemistry tests were associated with all-cause mortality both in the medium- and long-term perspective, and improved mortality prediction beyond classical risk factors. Since both linear and U-shaped relationships were found, we propose to define the normal range of a clinical chemistry test based on its association with mortality, rather than from the distribution.

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Seroepidemiology of human fascioliasis and its relationship with anti-Fasciola IgG and liver enzymes as biomarkers of pathogenicity

African Health Sciences ◽

10.4314/ahs.v20i1.26 ◽

2020 ◽

Vol 20 (1) ◽

pp. 208-218

Author(s):

Kiran Afshan ◽

Saman Kabeer ◽

Sabika Firasat ◽

Sarwat Jahan ◽

Mazhar Qayyum

Keyword(s):

Risk Factors ◽

Liver Enzymes ◽

Multiple Logistic Regression Analysis ◽

Health Concern ◽

Enzyme Linked Immunosorbent Assay ◽

Gamma Glutamyl Transferase ◽

Socioeconomic Condition ◽

Human Fascioliasis ◽

Associated Risk Factors ◽

Glutamyl Transferase

Background: Fascioliasis has never been considered a public health concern in Pakistan, although the increasing numbers of human cases reported in south Asia need a re-consideration in the country. The current study aimed to find the seroprevalence of human fascioliasis, associated risk factors and its relationship with liver enzymes as biomarkers of pathogenicity. Methods: The cross-sectional study was conducted in different districts of Punjab region from May 2014 to August 2016. A total of 546 respondents were screened by using enzyme-linked immunosorbent assay (ELISA) and serum biochemical tests. Results: Higher seroprevalence was recorded in Muzaffargarh (6.2%) and Bhara kahu (5.9%), while low infection rate in Gu- jranwala (1.1%) and Islamabad (1.5%). The results of multiple logistic regression analysis showed rural inhabitants (OR=7.9, 95%CI: 2.5-24.8), females (OR=3.5, 95%CI: 1.7-7.1), family size 3-7 (OR=1.7, 95%CI: 1.0-2.9) and socioeconomic condition (OR=3.9, 95%CI: 1.5-10.4) were the significantly (p<0.005) associated risk factors with disease. The results of liver enzymes i.e. aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transferase and cholesterol levels were significantly (p=0.001) elevated and associated with fascioliasis pathogenicity. Conclusion: The higher prevalence recorded may explain with Fasciola IgG antibodies for both active and past infections and cross reactivity of the assay with other helminthes. Keywords: Human fascioliasis; immunodiagnosis; liver enzymes; Pakistan.

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A survey of feline leukaemia virus infection of domestic cats from selected areas in Harare, Zimbabwe

Journal of the South African Veterinary Association ◽

10.4102/jsava.v85i1.1126 ◽

2014 ◽

Vol 85 (1) ◽

Cited By ~ 3

Author(s):

Francis Muchaamba ◽

Takudzwa H. Mutiringindi ◽

Musavenga T. Tivapasi ◽

Solomon Dhliwayo ◽

Gift Matope

Keyword(s):

Risk Factors ◽

Control Measures ◽

Enzyme Linked Immunosorbent Assay ◽

Gamma Glutamyl Transferase ◽

Domestic Cats ◽

Cross Sectional ◽

Leukaemia Virus ◽

Test Kit ◽

Feline Leukaemia Virus ◽

Glutamyl Transferase

A cross-sectional study was conducted to detect the feline leukaemia virus (FeLV) p27 antigen and to determine risk factors and the haematological changes associated with infection in domestic cats in Zimbabwe. Sera were collected for detection of the p27 antigen, urea, creatinine, alanine aminotransferase and gamma-glutamyl transferase levels, whilst whole blood was collected for haematology. FeLV p27 antigen was detected using a rapid enzyme-linked immunosorbent assay (ELISA) test kit. Data on risk factors were analysed using a logistic regression model. Of the 100 cats tested, 41% (95% CI: 31.19% – 50.81%) (41/100) were positive for the FeLV p27 antigen. Sex and health status of cats were not significantly (p > 0.05) associated with infection. Intact cats (OR = 9.73), those living in multicat housing (OR = 5.23) and cats that had access to outdoor life (OR = 35.5) were found to have higher odds of infection compared with neutered cats, those living in single-cat housing, and without access to outdoor life, respectively. Biochemistry and haematology revealed no specific changes. The results showed that FeLV infection was high in sampled cats, providing evidence of active infection. Thus, it would be prudent to introduce specific control measures for FeLV infection in Zimbabwe.

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