scholarly journals Disease burden and prognostic factors for clinical failure in elderly community acquired pneumonia patients

2020 ◽  
Author(s):  
Xiudi Han ◽  
Xuedong Liu ◽  
Liang Chen ◽  
Yimin Wang ◽  
Hui Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Pleural Effusion ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Logistic Regression Analysis ◽  
Community Acquired Pneumonia ◽  
Multivariable Logistic Regression Analysis ◽  
Clinical Failure

Abstract Background: The study was to evaluate initial antimicrobial regimen and clinical outcomes and to explore risk factors for clinical failure (CF) in elderly patients with community-acquired pneumonia (CAP).Methods: 3,011 hospitalized elderly patients were enrolled from 13 national teaching hospitals between January 1, 2014 and December 31, 2014 initiated by the CAP-China network. Risk factors for CF were screened by multivariable logistic regression analysis.Results: The incidence of CF in elderly CAP patients was 13.1%. CF patients were older, longer hospital stays and higher treatment costs than clinical success (CS) patients. The CF patients were more prone to present hyperglycemia, hyponatremia, hypoproteinemia, pleural effusion, respiratory failure and cardiovascular events. Inappropriate initial antimicrobial regimens in CF group were significantly higher than CS group. Undertreatment, CURB-65, PH<7.3, PaO2/FiO2 < 200 mmHg, sodium <130 mmol/L, healthcare-associated pneumonia, white blood cells >10000/mm3, pleural effusion and congestive heart failure were independent risk factors for CF in multivariable logistic regression analysis. Male and bronchiectasis were protective factors.Conclusions: Discordant therapy was a cause of CF. Early accurate detection and management of prevention to potential causes is likely to improve clinical outcomes in elderly patients CAP.Trial registration: A Retrospective Study on Hospitalized Patients With Community-acquired Pneumonia in China (CAP-China) (RSCAP-China), NCT02489578. Registered 16 March 2015, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0005E5S&selectaction=Edit&uid=U0000GWC&ts=2&cx=1bnotb

scholarly journals Disease burden and prognostic factors for clinical failure in elderly community acquired pneumonia patients

2020 ◽  
Author(s):  
Xiudi Han ◽  
Xuedong Liu ◽  
Liang Chen ◽  
Yimin Wang ◽  
Hui Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Pleural Effusion ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Logistic Regression Analysis ◽  
Community Acquired Pneumonia ◽  
Multivariable Logistic Regression Analysis ◽  
Clinical Failure

Abstract Background: The study was to evaluate initial antimicrobial regimen and clinical outcomes and to explore risk factors for clinical failure (CF) in elderly patients with community-acquired pneumonia (CAP). Methods: 3,011 hospitalized elderly patients were enrolled from 13 national teaching hospitals between January 1, 2014 and December 31, 2014 initiated by the CAP-China network. Risk factors for CF were screened by multivariable logistic regression analysis. Results: The incidence of CF in elderly CAP patients was 13.1%. CF patients were older, longer hospital stays and higher treatment costs than clinical success (CS) patients. The CF patients were more prone to present hyperglycemia, hyponatremia, hypoproteinemia, pleural effusion, respiratory failure and cardiovascular events. Inappropriate initial antimicrobial regimens in CF group were significantly higher than CS group. Undertreatment, CURB-65, PH<7.3, PaO 2 /FiO 2 < 200 mmHg, sodium <130 mmol/L, healthcare-associated pneumonia, white blood cells >10000/mm 3 , pleural effusion and congestive heart failure were independent risk factors for CF in multivariable logistic regression analysis. Male and bronchiectasis were protective factors. Conclusions: Discordant therapy was a cause of CF. Early accurate detection and management of prevention to potential causes is likely to improve clinical outcomes in elderly patients CAP. Trial registration : A Retrospective Study on Hospitalized Patients With Community-acquired Pneumonia in China (CAP-China) (RSCAP-China), NCT02489578. Registered 16 March 2015, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0005E5S&selectaction=Edit&uid=U0000GWC&ts=2&cx=1bnotb

scholarly journals Disease burden and prognostic factors for clinical failure in elderly community acquired pneumonia patients

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Xiudi Han ◽  
◽  
Xuedong Liu ◽  
Liang Chen ◽  
Yimin Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Pleural Effusion ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Logistic Regression Analysis ◽  
Community Acquired Pneumonia ◽  
Multivariable Logistic Regression Analysis ◽  
Clinical Failure

Abstract Background The study was to evaluate initial antimicrobial regimen and clinical outcomes and to explore risk factors for clinical failure (CF) in elderly patients with community-acquired pneumonia (CAP). Methods 3011 hospitalized elderly patients were enrolled from 13 national teaching hospitals between January 1, 2014 and December 31, 2014 initiated by the CAP-China network. Risk factors for CF were screened by multivariable logistic regression analysis. Results The incidence of CF in elderly CAP patients was 13.1%. CF patients were older, longer hospital stays and higher treatment costs than clinical success (CS) patients. The CF patients were more prone to present hyperglycemia, hyponatremia, hypoproteinemia, pleural effusion, respiratory failure and cardiovascular events. Inappropriate initial antimicrobial regimens in CF group were significantly higher than CS group. Undertreatment, CURB-65, PH < 7.3, PaO2/FiO2 < 200 mmHg, sodium < 130 mmol/L, healthcare-associated pneumonia, white blood cells > 10,000/mm3, pleural effusion and congestive heart failure were independent risk factors for CF in multivariable logistic regression analysis. Male and bronchiectasis were protective factors. Conclusions Discordant therapy was a cause of CF. Early accurate detection and management of prevention to potential causes is likely to improve clinical outcomes in elderly patients CAP. Trial registration A Retrospective Study on Hospitalized Patients With Community-acquired Pneumonia in China (CAP-China) (RSCAP-China), NCT02489578. Registered 16 March 2015, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0005E5S&selectaction=Edit&uid=U0000GWC&ts=2&cx=1bnotb

The Impact of Discrepancy between Measured versus Stated Weight on Hemorrhagic Transformation and Clinical Outcomes after Intravenous Alteplase Thrombolysis

2017 ◽  
Vol 44 (5-6) ◽  
pp. 241-247 ◽  
Author(s):  
Dong Hoon Shin ◽  
Min-Ju Kang ◽  
Jin Wook Kim ◽  
Dong-Jin Shin ◽  
Hyeon-Mi Park ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Clinical Outcomes ◽  
Logistic Regression Analysis ◽  
Hemorrhagic Transformation ◽  
Multivariable Logistic Regression Analysis ◽  
Laboratory Findings ◽  
Actual Weight ◽  
Measured Weight ◽  
Intravenous Alteplase

Background: An accurate measurement of patient weight is important in determining the dosage for intravenous alteplase thrombolysis. In most emergency rooms, however, weight is not measured. We investigated the difference between stated and measured weight and its effect on hemorrhagic transformation and clinical outcomes. Methods: We enrolled 128 consecutive patients who had hyperacute stroke and were treated by alteplase. Alteplase dose was calculated using the weight provided by patient or guardian/caregiver, and the actual weight was measured after administration. Patients were classified into 2 groups: overused group (stated weight >measured weight) and underused group (measured weight ≥stated weight). The prevalence of hemorrhagic transformation on follow-up, determined by gradient-recalled echo MRI or non-enhanced CT, was compared between the 2 groups. The predictors for hemorrhage with progression, defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) by a value of 4 or more accompanied by hemorrhage, were determined using multivariable logistic regression analysis and included the overused or underused alteplase and baseline clinical and laboratory findings. Results: Sixty-six (51.6%) of 128 patients were in the underused group and 62 patients (48.4%) in the overused group. The median difference between the stated and measured weights was 1.5 (interquartile range 0.56-3.81) kg, with the largest difference being 25.6 kg. Although there were no significant difference in baseline clinical and laboratory findings between the 2 groups, the overused group showed a significantly higher prevalence of hemorrhagic transformation (p = 0.012) and hemorrhage with progression (p = 0.025). The multivariable logistic regression analysis demonstrated that overused alteplase (OR 7.26; 95% CI 1.24-42.45; p = 0.028), baseline glucose (>144 mg/dL; OR 5.03; 95% CI 1.00-25.26; p = 0.050), and initial NIHSS (OR 1.13 per 1-point NIHSS increase; 95% CI 1.00-1.27; p = 0.047) in model 1 that use alteplase overdose as a categorical variable and overused alteplase (OR 1.67 1-mg increase; 95% CI 1.05-2.66; p = 0.027) in model 2 that use an overused alteplase dose as numerical variable were significant predictors for hemorrhage with progression. Conclusion: More alteplase usage than actual weight led to higher hemorrhagic transformation. As one of the predictors for clinical deterioration, it is important to administrate alteplase based on an accurately measured weight.

scholarly journals Use  of T-SPOT.TB for the diagnosis of unconventional pleural tuberculosis is superior to ADA in high prevalence areas: A prospective analysis of 601 cases

2020 ◽  
Author(s):  
Xinting Yang ◽  
jing zhang ◽  
Qingtao Liang ◽  
Liping Pan ◽  
Hongfei Duan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Pleural Effusion ◽  
Logistic Regression Analysis ◽  
Mononuclear Cells ◽  
Multivariate Logistic Regression Analysis ◽  
Interferon Gamma Release Assay ◽  
Diagnostic Efficiency ◽  
Diagnostic Efficacy

Abstract BACKGROUND: Tuberculous pleural effusion (TPE) is the most common extrapulmonary manifestation which still has lasting effect on lung function, however conventional diagnostic tests for TPE register multiple limitations. OBJECTIVES: This study aims to investigate diagnostic efficacy of the interferon gamma release assay (IGRA: T-SPOT.TB) in TPE patients of different characteristics comparing to adenosine deaminase (ADA), in order to clarify its appropriate setting in clinical diagnosis.METHODS: We performed a prospective, single-centre study including all suspected pleural effusion patients consecutively from June 2015 to October 2018. By using receiver operating characteristic (ROC) curves, technical cut-offs for all enrolled participants were determined, and the utility of IGRA for pleural fluid (PF) was analysed. We obtained the independent risk factors using logistic regression analysis for TPE and evaluated the performance of the T-SPOT assay stratified by risk factors in comparison to ADA.RESULTS: A total of 601 individuals was consecutively recruited. The maximum of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) in the PF T-SPOT assay had the best diagnostic efficiency in our study, with a sensitivity of 83.0% and a specificity of 83.1%. The corresponding cut-off value was 466 SFCs/106 mononuclear cells, which was equal to ADA (0.885 vs 0.887, P=0.957) and superior to PB. Among the TPE patients with low ADA (<40 IU/L), the sensitivity and specificity of PF T-SPOT were still 87.9% and 90.5%, respectively. The utility of ADA was negatively related to increasing age, but the PF T-SPOT test had a steady performance at all ages. Age (<45 yrs; odds ratio (OR) = 5.61, 95% confidence interval (CI) 3.59-8.78; P<0.001), gender (male; OR = 2.68, 95% CI 1.75-2.88; P<0.001) and body mass index (BMI) (<22; OR = 1.93, 95% CI 1.30-2.88; P=0.001) were independently associated with the risk of TB by multivariate logistic regression analysis. Notably, when stratified by risk factor, the sensitivity of PF T-SPOT was superior to the sensitivity (76.5% vs. 23.5%, P=0.016) for ADA and had noninferior specificity (84.4% vs. 96.9%, P=0.370).CONCLUSIONS: In conclusion, the overall potency of the PF T-SPOT assay is equal to that of ADA for diagnosing TPE. In addition, the PF T-SPOT assay can effectively discriminate TPE patients whose ADA is lower than 40 IU/L and is extremely superior to ADA in unconventional TPE patients (age≥45 yrs, female or BMI≥22). The PF T-SPOT assay is an excellent choice to supplement ADA to diagnose TPE.

scholarly journals Use of T-SPOT.TB for the diagnosis of unconventional pleural tuberculosis is superior to ADA in high prevalence areas: A prospective analysis of 601 cases

2020 ◽  
Author(s):  
Xinting Yang ◽  
jing zhang ◽  
Qingtao Liang ◽  
Liping Pan ◽  
Hongfei Duan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Pleural Effusion ◽  
Logistic Regression Analysis ◽  
Mononuclear Cells ◽  
Multivariate Logistic Regression Analysis ◽  
Interferon Gamma Release Assay ◽  
Diagnostic Efficiency ◽  
Diagnostic Efficacy

Abstract BACKGROUND: Tuberculous pleural effusion (TPE) is the most common extrapulmonary manifestation and may have lasting effect on lung function. However conventional diagnostic tests for TPE register multiple limitations. This study estimates diagnostic efficacy of the interferon gamma release assay (IGRA: T-SPOT.TB) in TPE patients of different characteristics.METHODS: We performed a prospective, single-centre study including all suspected pleural effusion patients consecutively enrolled from June 2015 to October 2018. Through receiver operating characteristic (ROC) curves, technical cut-offs and the utility of T-SPOT on pleural fluid (PF) were determined and analysed. Logistic regression analysis was performed to obtain the independent risk factors for TPE, and evaluated the performance of the T-SPOT assay stratified by risk factors in comparison to ADA.RESULTS: A total of 601 individuals were consecutively recruited. The maximum spot-forming cells (SFCs) of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) in the PF T-SPOT assay had the best diagnostic efficiency in our study, which was equal to ADA (0.885 vs 0.887, P=0.957) and superior to peripheral blood (PB), with a sensitivity of 83.0% and a specificity of 83.1% (The cut-off value was 466 SFCs/106 mononuclear cells). Among the TPE patients with low ADA (<40 IU/L), the sensitivity and specificity of PF T-SPOT were still 87.9% and 90.5%, respectively. The utility of ADA was negatively related to increasing age, but the PF T-SPOT test had a steady performance at all ages. Age (<45 yrs; odds ratio (OR) = 5.61, 95% confidence interval (CI) 3.59-8.78; P<0.001), gender (male; OR = 2.68, 95% CI 1.75-2.88; P<0.001) and body mass index (BMI) (<22; OR = 1.93, 95% CI 1.30-2.88; P=0.001) were independently associated with the risk of TB by multivariate logistic regression analysis. Notably, when stratified by risk factor, the sensitivity of PF T-SPOT was superior to the sensitivity for ADA (76.5% vs. 23.5%, P=0.016) and had noninferior specificity (84.4% vs. 96.9%, P=0.370).CONCLUSIONS: In conclusion, the PF T-SPOT assay can effectively discriminate TPE patients whose ADA is lower than 40 IU/L and is superior to ADA in unconventional TPE patients (age≥45 yrs, female or BMI≥22). The PF T-SPOT assay is an excellent choice to supplement ADA to diagnose TPE.

scholarly journals The utility of T-SPOT.TB for the diagnosis unconventional pleural tuberculosis is superior to ADA in high prevalence: A perspective analysis of 601 cases

2020 ◽  
Author(s):  
Xinting Yang ◽  
jing zhang ◽  
Qingtao Liang ◽  
Liping Pan ◽  
Hongfei Duan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Pleural Effusion ◽  
Logistic Regression Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
World Health ◽  
Interferon Gamma Release Assay ◽  
Diagnostic Efficiency ◽  
Diagnostic Efficacy

Abstract BACKGROUND Recently, Interferon Gamma Release Assay (IGRA) is still controversial in differentiating tuberculous pleural effusion (TPE), through recommended by World Health Organization (WHO )for identification of latent tuberculosis infection. OBJECTIVES Aim to qualify the diagnostic efficacy for TPE by IGRA in comparison to Adenosine deaminase(ADA), to clarify its appropriate scene in clinical diagnosis. METHODS A prospective, single-centre study including all suspected pleural effusion patients consecutively from June 2015 to October 2018. Through receiver operating characteristic (ROC) curves, all enrolled participants were determined technical cut-off and the utility of IGRA(T-SPOT)for pleural fluid(PF). Obtain the independent risk factors by logistic regression analysis for TPE, and evaluate the performance of T-SPOT stratified by risk factors, in comparison to ADA. RESULTS A total of 601 individuals were consecutively recruited. The maximum of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) in PF T-SPOT had the best diagnostic efficiency in our study, with a sensitivity of 83.0% and a specificity of 83.1%, corresponding cut-off value is 466, which was equal to ADA(0.885 vs 0.887, P=0.957) and superior than in PB; Among the TPE patients with low ADA(<40 IU/L), the sensitivity and specificity of PF T-SPOT was still 87.9%, 90.5% respectively. The utility of ADA was negative related to age ascents, but PF T-SPOT had steady performance at any age-stage. The age (<45 yrs; odds ratio (OR) 5.61), gender (male; OR 2.7) and body mass index (BMI)(<22; OR 1.93) was independently associated with the risk of TB by multivariate logistic regression analysis. Stratified by risk factors, notably the PF T-SPOT had superior sensitivity(76.5% vs. 23.5%,P=0.016) than ADA meanwhile had the non-inferior specificity(84.4% vs. 96.9%, P=0.370). CONCLUSIONS In conclusion, the overall potency of PF T-SPOT assay is equal to ADA for diagnosing TPE. In addition, PF T-SPOT can effectively discriminate the TPE patients whose ADA lower than 40IU/L, and extremely superior to ADA in unconventional TPE patients(age>45yrs, female or BMI<22). PF T-SPOT assay is an extremely good choice to supplement ADA to diagnose TPE.

Outcomes of cancer patients with takotsubo cardiomyopathy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18101-e18101
Author(s):  
Achuta Kumar Guddati ◽  
Gagan Kumar ◽  
Iuliana Shapira ◽  
Parijat Saurav Joy
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cancer Patients ◽  
Logistic Regression Analysis ◽  
Takotsubo Cardiomyopathy ◽  
Primary Diagnosis ◽  
Multivariable Logistic Regression Analysis ◽  
Solid Organ ◽  
Multivariable Logistic Regression

e18101 Background: Chemotherapy induced cardiomyopathy is an important complication of some chemotherapeutic agents. The stress of a cancer diagnosis and ongoing chemotherapy may contribute to cardiac morbidity in these patients. The burden of Takotsubo Cardiomyopathy (TCP) in cancer patients is unknown. The incidence of TCP and related outcomes in cancer patients was investigated in this study. Methods: The 2007-2013 National Inpatient Sample (NIS) was analyzed for patients with a prior and new diagnosis of TCP with and without malignancy. Risk factors for mortality were adjusted for associated conditions by multivariable logistic regression analysis. Results: From 2007 through 2013, an estimated 122,750 adults were admitted with a diagnosis of TCP. In 2013, the incidence of admissions in US of patients with coexisting TCP and malignancy was 1.13%. Admissions in 34,957 patients were for a primary diagnosis of TCP with 91.7% females; overall, 665 (2.1%) had solid organ cancer, 237 (0.74%) had hematological malignancy and 354 (1.11%) had metastatic cancer. Patients admitted for TCP with coexisting malignancy had a significantly higher mortality (13.8% vs. 2.9%, p < 0.0001), length of stay (7 vs. 4 days, p < 0.0001) and total charges ($29291 vs. $ 36231, p < 0.0001), compared to those with no malignancy. In patients with a primary diagnosis of TCP and without any underlying malignancy, males had a higher mortality (4.02% vs. 1.03%, p < 0.0001) whereas there was no gender difference in mortality in those with coexisting malignancy (6.25% vs 6.45%, p = 0.965). On multivariable logistic regression analysis, risk factors associated with mortality were solid cancer (OR 3.43, p = 0.008), stroke (OR 18.33, p < 0.0001), venous thromboembolic disease (OR 4.52, p = 0.004), malnutrition (OR 2.41, p = 0.006) and heart failure (OR 1.918, p = 0.004). Conclusions: Outcomes are significantly worse in patients with TCP and solid malignancy. Hence, this patient population must be regarded as high-risk and early diagnostic consideration for TCP is warranted. Early intervention may help lower mortality, decrease resource utilization and reduce the health care costs in these patients.

scholarly journals Use of T-SPOT.TB for the diagnosis of unconventional pleural tuberculosis is superior to ADA in high prevalence areas: a prospective analysis of 601 cases

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xinting Yang ◽  
Jing Zhang ◽  
Qingtao Liang ◽  
Liping Pan ◽  
Hongfei Duan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Pleural Effusion ◽  
Logistic Regression Analysis ◽  
Mononuclear Cells ◽  
Multivariate Logistic Regression Analysis ◽  
Interferon Gamma Release Assay ◽  
Diagnostic Efficiency ◽  
Diagnostic Efficacy

Abstract Background Tuberculous pleural effusion (TPE) is the most common extrapulmonary manifestation and may have lasting effect on lung function. However conventional diagnostic tests for TPE register multiple limitations. This study estimates diagnostic efficacy of the interferon gamma release assay (IGRA: T-SPOT.TB) in TPE patients of different characteristics. Methods We performed a prospective, single-centre study including all suspected pleural effusion patients consecutively enrolled from June 2015 to October 2018. Through receiver operating characteristic (ROC) curves, technical cut-offs and the utility of T-SPOT on pleural fluid (PF) were determined and analysed. Logistic regression analysis was performed to obtain the independent risk factors for TPE, and evaluated the performance of the T-SPOT assay stratified by risk factors in comparison to ADA. Results A total of 601 individuals were consecutively recruited. The maximum spot-forming cells (SFCs) of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) in the PF T-SPOT assay had the best diagnostic efficiency in our study, which was equal to ADA (0.885 vs 0.887, P = 0.957) and superior to peripheral blood (PB), with a sensitivity of 83.0% and a specificity of 83.1% (The cut-off value was 466 SFCs/106 mononuclear cells). Among the TPE patients with low ADA (< 40 IU/L), the sensitivity and specificity of PF T-SPOT were still 87.9 and 90.5%, respectively. The utility of ADA was negatively related to increasing age, but the PF T-SPOT test had a steady performance at all ages. Age (< 45 yrs.; odds ratio (OR) = 5.61, 95% confidence interval (CI) 3.59–8.78; P < 0.001), gender (male; OR = 2.68, 95% CI 1.75–2.88; P < 0.001) and body mass index (BMI) (< 22; OR = 1.93, 95% CI 1.30–2.88; P = 0.001) were independently associated with the risk of TB by multivariate logistic regression analysis. Notably, when stratified by risk factor, the sensitivity of PF T-SPOT was superior to the sensitivity for ADA (76.5% vs. 23.5%, P = 0.016) and had noninferior specificity (84.4% vs. 96.9%, P = 0.370). Conclusions In conclusion, the PF T-SPOT assay can effectively discriminate TPE patients whose ADA is lower than 40 IU/L and is superior to ADA in unconventional TPE patients (age ≥ 45 yrs., female or BMI ≥ 22). The PF T-SPOT assay is an excellent choice to supplement ADA to diagnose TPE.

scholarly journals Elevated De Ritis Ratio as a Predictor for Acute Kidney Injury after Radical Retropubic Prostatectomy

2021 ◽  
Vol 11 (9) ◽  
pp. 836
Author(s):  
Jun-Young Park ◽  
Jihion Yu ◽  
Jun Hyuk Hong ◽  
Bumjin Lim ◽  
Youngdo Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Roc Curve ◽  
Kidney Injury ◽  
Radical Retropubic Prostatectomy ◽  
Multivariable Logistic Regression Analysis ◽  
Retropubic Prostatectomy

Acute kidney injury (AKI) is related to mortality and morbidity. The De Ritis ratio, calculated by dividing the aspartate aminotransferase by the alanine aminotransferase, is used as a prognostic indicator. We evaluated risk factors for AKI after radical retropubic prostatectomy (RRP). This retrospective study included patients who performed RRP. Multivariable logistic regression analysis and a receiver operating characteristic (ROC) curve analysis were conducted. Other postoperative outcomes were also evaluated. Among the 1415 patients, 77 (5.4%) had AKI postoperatively. The multivariable logistic regression analysis showed that estimated glomerular filtration rate, albumin level, and the De Ritis ratio at postoperative day 1 were risk factors for AKI. The area under the ROC curve of the De Ritis ratio at postoperative day 1 was 0.801 (cutoff = 1.2). Multivariable-adjusted analysis revealed that the De Ritis ratio at ≥1.2 was significantly related to AKI (odds ratio = 8.637, p < 0.001). Postoperative AKI was associated with longer hospitalization duration (11 ± 5 days vs. 10 ± 4 days, p = 0.002). These results collectively show that an elevated De Ritis ratio at postoperative day 1 is associated with AKI after RRP in patients with prostate cancer.

scholarly journals The utility of T-SPOT.TB for the diagnosis unconventional pleural tuberculosis is superior to ADA in high prevalence: A perspective analysis of 601 cases

2020 ◽  
Author(s):  
Xinting Yang ◽  
jing zhang ◽  
Qingtao Liang ◽  
Liping Pan ◽  
Hongfei Duan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Pleural Effusion ◽  
Logistic Regression Analysis ◽  
Mononuclear Cells ◽  
Multivariate Logistic Regression Analysis ◽  
World Health ◽  
Interferon Gamma Release Assay ◽  
Diagnostic Efficiency

Abstract BACKGROUND: Interferon Gamma Release Assay (IGRA) is still controversial in differentiating tuberculous pleural effusion (TPE), through recommended by World Health Organization (WHO) for identification of latent tuberculosis infection. OBJECTIVES: Aim to in comparison to Adenosine deaminase (ADA), evaluate the IGRA (T-SPOT.TB) diagnostic efficacy for TPE patients of different characteristics, to clarify its appropriate scene in clinical diagnosis. METHODS: A prospective, single-centre study including all suspected pleural effusion patients consecutively from June 2015 to October 2018. Through receiver operating characteristic (ROC) curves, all enrolled participants were determined technical cut-off and the utility of IGRA for pleural fluid (PF). Obtain the independent risk factors by logistic regression analysis for TPE, and evaluate the performance of T-SPOT stratified by risk factors, in comparison to ADA. RESULTS: A total of 601 individuals were consecutively recruited. The maximum of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) in PF T-SPOT had the best diagnostic efficiency in our study, with a sensitivity of 83.0% and a specificity of 83.1%, corresponding cut-off value is 466 SFCs/10 6 mononuclear cells, which was equal to ADA (0.885 vs 0.887, P=0.957) and superior than in PB; Among the TPE patients with low ADA(<40 IU/L), the sensitivity and specificity of PF T-SPOT was still 87.9%, 90.5% respectively. The utility of ADA was negative related to age ascents, but PF T-SPOT had steady performance at any age-stage. The age (<45 yrs; odds ratio (OR) = 5.61), gender (male; OR = 2.7) and body mass index (BMI) (<22; OR = 1.93) was independently associated with the risk of TB by multivariate logistic regression analysis. Stratified by risk factors, notably the PF T-SPOT had superior sensitivity (76.5% vs. 23.5%, P =0.016) than ADA meanwhile had the non-inferior specificity (84.4% vs. 96.9%, P =0.370). CONCLUSIONS: In conclusion, the overall potency of PF T-SPOT assay is equal to ADA for diagnosing TPE. In addition, PF T-SPOT can effectively discriminate the TPE patients whose ADA lower than 40 IU/L, extremely superior to ADA in unconventional TPE patients (age>45yrs, female or BMI≧22). PF T-SPOT assay is an extremely good choice to supplement ADA to diagnose TPE.

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