scholarly journals Evolution of SARS-CoV-2-Neutralizing Antibodies after Two Standard Dose Vaccinations, Risk Factors for Non-Response and Effect of a Third Dose Booster Vaccination in Non-Responders on Hemodialysis. A Prospective Multi-Centre Cohort Study

2021 ◽  
Vol 10 (21) ◽  
pp. 5113
Author(s):  
Frank-Peter Tillmann ◽  
Lars Figiel ◽  
Johannes Ricken ◽  
Hermann Still ◽  
Christoph Korte ◽  
...  
Keyword(s):  
Risk Factors ◽  
Immunosuppressive Therapy ◽  
Booster Vaccination ◽  
Binary Logistic Regression ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Control Group ◽  
Binary Logistic Regression Analysis ◽  
Healthy Control ◽  
Antibody Titers

The aim of this investigation was to determine the effect of SARS-Cov-2 vaccination in hemodialysis patients, search for risk factors for non- or low-response, and to measure the effect of a third booster vaccination in non- or low-responders. Methods SARS-CoV-2 IgG antibodies and the virus-neutralizing capacity were measured 4–5 weeks after a full standard vaccination in 95 chronic hemodialysis patients and 60 controls. IgG titers > 30 AU/mL served to classify participants as responders. Multivariable binary logistic regression analysis was used to search for risk factors of reduced vaccination success. Patients with vaccination failure were offered a third booster dosage. Results 82.1% of the patient cohort as compared to 98.3% of the healthy control group were able to mount SARS-CoV-2 titers above 30 AU/mL after two standard vaccine doses. Mean IgG antibody titers were lower in hemodialysis patients than controls (78 ± 35 vs. 90 ± 20 AU/mL, p = 0.002). Multivariable binary logistic regression analysis showed age and immunosuppressive medication as major risk factors for vaccination failure with a decreased probability of successful vaccination of −6.1% (95% CI −1.2 to −10.9) per increase in age of one year and −87.4% (95% CI −98.0 to −21.5) in patients on immunosuppressive therapy (crude odds ratio for vaccination failure for immunosuppressive therapy 6.4). Ten out of 17 patients with non-response to vaccination were offered a third dose. Booster vaccination after the second dose induced an increase in effective antibody titers of >30 AU/mL in seven out of ten patients 4–5 weeks later (70%). Conclusion Standard SARS-CoV-2 vaccination schemes are highly effective in mounting protective neutralizing IgG antibodies in chronic hemodialysis patients. Nevertheless, response to vaccination is diminished as compared to a healthy control group. Major risk factors for vaccination failure are older age and immunosuppressive therapy. In non- or low-responders to standard vaccination a third booster vaccination was able to induce effective antibody titers in about 70% of patients, indicating that a third booster vaccination might be preferable to decreasing immunosuppressive therapy.

scholarly journals Correlation of Lipid Ratios With the Severity of Pulmonary Alveolar Proteinosis: A Cross-Sectional Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Xin Yan ◽  
Yujuan Gao ◽  
Qi Zhao ◽  
Xiaohua Qiu ◽  
Mi Tian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Alveolar Proteinosis ◽  
Pulmonary Function Tests ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Control Group ◽  
Binary Logistic Regression Analysis ◽  
Cross Sectional ◽  
Lipid Ratios ◽  
Alveolar Proteinosis

Background: Lipids are known to accumulate abnormally in the alveoli and circulate during pulmonary alveolar proteinosis (PAP). However, the relationship between lipid ratios and PAP is not clear. In this study, we investigated the lipid ratios in PAP patients and explored the relationships between lipid ratios and the severity of PAP.Methods: A total of 122 PAP patients were diagnosed and divided the mild- moderate PAP group (n = 61) and the severe PAP group (n = 61) according to the value of disease severity score (DSS). One hundred thirty healthy volunteers were classified as the control group. Routine blood examination and pulmonary function tests were performed and lipid profile were measured.Results: Compared with the control group, patients with PAP had significantly higher TG, TC/HDL-C, TG/HDL-C, and non-HDL-C, while lower HDL-C (all P < 0.05). Patients with the severe PAP had higher TC, TG, LDL-C, TC/HDL-C, and non-HDL-C, while lower HDL-C than patients with the mild- moderate PAP (all P < 0.05). Binary logistic regression analysis indicated that TC/HDL-C (OR = 2.322, 95% CI 1.621–3.713, P = 0.024) and non-HDL-C (OR = 1.797, 95% CI 1.239–3.109, P = 0.036) were all significantly correlated with the severity of PAP after adjustment for other risk factors. The AUC value of TC/HDL-C for predicting the severity of PAP was larger than that of non-HDL-C. The AUROC for TC/HDL-C was 0.741 (0.654–0.828), and the optimal cut-off point for TC/HDL-C was 5.05 (sensitivity: 73.6%, specificity: 68.1%).Conclusions: Lipid ratios, including TC-HDL-C and non-HDL-C, were independent risk factors for the severity of PAP. TC/HDL-C is a promising biomarker for the severity of PAP.

scholarly journals Prevalence and Risk Factors of Hyperuricemia in Guangming District, Shenzhen: An Observational Study from a District Hospital in 2020

2021 ◽  
Vol 3 (3) ◽  
pp. 33-38
Author(s):  
Kaiyin CHEN ◽  
Ping XIAO ◽  
Tingwei WANG ◽  
Shaofang LI
Keyword(s):  
Risk Factors ◽  
Prevalence Rate ◽  
Adult Population ◽  
Age Groups ◽  
Binary Logistic Regression ◽  
The Body ◽  
Control Group ◽  
Binary Logistic Regression Analysis ◽  
General Adult Population ◽  
Potential Risk Factors

Objective This study aimed to explore the prevalence of hyperuricemia among the general adult population in Shenzhen and to determine the risk factors of hyperuricemia. Methods A total of 9337 cases who underwent physical examination in The Seventh Affiliated Hospital of Sun Yat-Sen University in 2020 were enrolled in this study. The binary logistic regression analysis was performed to determine potential risk factors of hyperuricemia. Result The overall prevalence rate of hyperuricemia in the studied population was 40.5% (3783/9337). Subgroup analysis showed that the prevalence of males was 52.8% (3046/5769) and the prevalence of females was 20.7% (737/3568). Moreover, among different age groups (≤29 years old, 30-39 years old, 40-49 years old, 50-59 years old, and ≥60 years old), the prevalence rate of males was significantly higher than that of females (P<0.05). To further determine the relationship between the body mass index (BMI) and hyperuricemia, the population with normal BMI was set as the control group. After controlling for gender and age, the prevalence rate of hyperuricemia in the overweight population increased by 1.799 times; and the prevalence rate in the obese and very obese population increased by 3.283 times and 3.830 times, respectively. Conclusion The data presented in this study demonstrated that the prevalence rate of hyperuricemia is high in Shenzhen, espeially in males. Moreover, the level of BMI is significantly linked to the prevalence of hyperuricemia. Therefore, early interventions should be carried out to address the high prevalence of hyperuricemia in male and obese populations.

scholarly journals Age and multimorbidities as poor prognostic factors for COVID-19 in hemodialysis: a Lebanese national study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mabel Aoun ◽  
Rabab Khalil ◽  
Walid Mahfoud ◽  
Haytham Fatfat ◽  
Line Bou Khalil ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Coronary Artery Disease ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Death Rate ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
National Study ◽  
Artery Disease

Abstract Background Hemodialysis patients with COVID-19 have been reported to be at higher risk for death than the general population. Several prognostic factors have been identified in the studies from Asian, European or American countries. This is the first national Lebanese study assessing the factors associated with SARS-CoV-2 mortality in hemodialysis patients. Methods This is an observational study that included all chronic hemodialysis patients in Lebanon who were tested positive for SARS-CoV-2 from 31st March to 1st November 2020. Data on demographics, comorbidities, admission to hospital and outcome were collected retrospectively from the patients’ medical records. A binary logistic regression analysis was performed to assess risk factors for mortality. Results A total of 231 patients were included. Mean age was 61.46 ± 13.99 years with a sex ratio of 128 males to 103 females. Around half of the patients were diabetics, 79.2% presented with fever. A total of 115 patients were admitted to the hospital, 59% of them within the first day of diagnosis. Hypoxia was the major reason for hospitalization. Death rate was 23.8% after a median duration of 6 (IQR, 2 to 10) days. Adjusted regression analysis showed a higher risk for death among older patients (odds ratio = 1.038; 95% confidence interval: 1.013, 1.065), patients with heart failure (odds ratio = 4.42; 95% confidence interval: 2.06, 9.49), coronary artery disease (odds ratio = 3.27; 95% confidence interval: 1.69, 6.30), multimorbidities (odds ratio = 1.593; 95% confidence interval: 1.247, 2.036), fever (odds ratio = 6.66; 95% confidence interval: 1.94, 27.81), CRP above 100 mg/L (odds ratio = 4.76; 95% confidence interval: 1.48, 15.30), and pneumonia (odds ratio = 19.18; 95% confidence interval: 6.47, 56.83). Conclusions This national study identified older age, coronary artery disease, heart failure, multimorbidities, fever and pneumonia as risk factors for death in patients with COVID-19 on chronic hemodialysis. The death rate was comparable to other countries and estimated at 23.8%.

scholarly journals Raised TSH is associated with endothelial dysfunction in Metabolic Syndrome: A case control study

2017 ◽  
Vol 55 (4) ◽  
pp. 212-221 ◽  
Author(s):  
Ashok Kumar Ahirwar ◽  
Archana Singh ◽  
Anju Jain ◽  
Surajeet Kumar Patra ◽  
Binita Goswami ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Endothelial Dysfunction ◽  
Subclinical Hypothyroidism ◽  
Serum Insulin ◽  
Binary Logistic Regression ◽  
Binary Logistic Regression Analysis ◽  
Healthy Controls ◽  
Healthy Control ◽  
Study Population ◽  
Serum Tsh

AbstractIntroduction. Endothelial dysfunction has been considered as one of the important factors in pathogenesis of Metabolic Syndrome (Met S). Subclinical hypothyroidism (SCH) has also been reported to be associated with Met S. The aim of our study is to evaluate the association of raised TSH with mediators of endothelial dysfunction in Met S with Subclinical hypothyroidism as compared to healthy controls.Methods. Study population consisted of 100 subjects, out of which 50 were cases of Met S and 50 were healthy controls. Met S group were further divided into two, based on the presence & absence of SCH. Serum insulin, T3, T4, TSH were measured by chemiluminescence based immunoassay (CLIA). Serum nitric oxide (NO) levels were measured by Modified Griess’s method and serum endothelin-1 (ET-1) levels were measured by ELISA.Results. Out of 50 cases of Met S, SCH was diagnosed in 22. The mean serum TSH levels were significantly higher in Met S cases as compared to healthy controls (5.7 ± 1.2 μIU/mL vs. 2.3 ± 1.6 μIU/mL, P <0.0001). Mean serum NO levels were significantly lower in Met S cases as compared to healthy control (15.4 ± 10 μM vs. 21 ± 10 μM, p = 0.009). Mean serum ET-1 levels were significantly higher in Met S cases as compared to healthy controls (2.68 ± 1.7 fmol/mL vs. 2.1 ± 0.84 fmol/mL, p = 0.011). On Pearson’s correlation analysis, TSH showed positive correlation with ET-1 (r = 0.341, p = 0.001) and negative correlation with NO (r = −0.331, p = 0.001). Binary logistic regression analysis showed that TSH, NO and ET-1 has significant odd’s ratio for predicting Met S.Conclusion. Met S cases were screened for thyroid abnormalities and found to have 44% of SCH along with co-existing endothelial dysfunction. Raised TSH in SCH could cause endothelial dysfunction which may lead to Met S and associated co-morbidities. Present study gives new insight in linking endothelial dysfunction and raised TSH in Met S. Therefore, Met S cases should be screened for SCH and treated appropriately to attenuate endothelial dysfunction and associated comorbidities in Met S.

Use of neutrophil/lymphocyte ratio as a marker in patients with suspicious diaphragmatic attenuation artifact

2021 ◽  
Vol 8 (12) ◽  
pp. 706-710
Author(s):  
Kemal Göçer ◽  
Ahmet Çağrı Aykan ◽  
Bayram Öztürk ◽  
Alihan Erdoğan
Keyword(s):  
Risk Factors ◽  
Binary Logistic Regression ◽  
Myocardial Perfusion Spect ◽  
Binary Logistic Regression Analysis ◽  
Inferior Wall ◽  
Roc Curve Analysis ◽  
Neutrophil Lymphocyte Ratio ◽  
Significant Difference ◽  
Attenuation Artifact ◽  
Artery Disease

Objective: This study aimed to evaluate whether neutrophil/lymphocyte (N/L) ratio assists in the diagnosis of coronary artery disease (CAD) in patients with suspected diaphragmatic attenuation artifact (DAA) on myocardial perfusion SPECT (MP-SPECT). Material and Methods: A total of 255 patients undergoing coronary angiography between 2015-2020 due to unclear DAA of the inferior wall on MP-SPECT were included in this retrospective study. Patients were divided into two groups (CAD and non-CAD) according to angiographic images. Significant CAD was defined as ≥50% stenosis of coronary arteries feeding the inferior wall. White blood cell count, biochemical parameters, and risk factors for CAD were compared between the two groups. Results: There was no statistically significant difference between the two groups in terms of age (p = 0.055), gender (p = 0.482), and body mass index (p = 0.305). N/L ratio (OR = 1.397 p = 0.002 95% Cl = 1.128-1.732) and left ventricle ejection fraction (OR = 0.896 p = 0.023 95% Cl = 0.815-0.985) were independent risk factors for CAD in multivariate binary logistic regression analysis. Receiver Operating Characteristic (ROC) curve analysis showed that a cut-off value of ≥2 for N/L ratio predicted the presence of CAD (sensitivity=63.5%, specificity=60.7%, AUC=0.668, 95% CI=0.596 – 0.740, p<0.001). Conclusion: N/L ratio is a simple and accessible test and may increase the diagnostic accuracy of MP-SPECT for CAD in patients with suspicious diaphragmatic attenuation on MP-SPECT.

Risk factors for post-polypectomy bleeding; a retrospective case-control study of a high-volume colonoscopy center

2021 ◽  
Author(s):  
Dimitrios Eleftheriadis ◽  
Christina Imalis ◽  
Guido Gerken ◽  
Heiner Wedemeyer ◽  
Jan Duerig
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Ileocecal Valve ◽  
Binary Logistic Regression ◽  
High Volume ◽  
Binary Logistic Regression Analysis ◽  
Care Hospital ◽  
Retrospective Case ◽  
Polyp Size ◽  
Epinephrine Injection

Abstract Background and aim Post-polypectomy bleeding (PPB) remains an uncommon although serious complication of colonoscopy. The aim of this study is to determine the PPB-prevalence in a secondary care hospital and its associated risk factors. Patients and methods We collected data from 581 patients, with the removal of 1593 polyps between August 2017 and August 2019. A univariate binary logistic regression analysis was conducted retrospectively. Results PPB occurred in only 10 cases, representing 1.7% of patients: immediate in 1.2% and delayed in 0.5%. The number of removed polyps per patient [4.5 (SD 2.59) for hemorrhagic vs. 2.74 (SD 1.98) for non-hemorrhagic group] and the propofol dose [232 mg (SD 93.07) for hemorrhagic vs. 133 mg (SD 57.28) for non-hemorrhagic group] were relevant patient-related risk factors. The polyp-based analysis showed the polyp size [18.4 mm (SD 10.44) for hemorrhagic vs. 4.42 mm (SD 4.29) for non-hemorrhagic group], the morphology [wide-based: OR 24.83 (95 % CI 2.76 – 223.44), pedunculated: OR 56.67 (95 % CI 5.03 – 638.29)], the location at ileocecal valve [OR 20.48, 95 % CI 1.81 – 231.97)], and the polypectomy method [hot snare piecemeal with epinephrine injection: OR 75.38 (95 % CI 7.67 – 741.21)] as significant risk factors for PPB, too. Conclusions The low rate of PPB confirms the safety of the procedure in non-tertiary, high-volume colonoscopy centers. The number of polyps removed per patient, the polyp size, morphology and location, as well as the sedation dose and the method of polypectomy were shown as relevant risk factors.

Risk of Retinal Toxicity in Longterm Users of Hydroxychloroquine

2017 ◽  
Vol 44 (11) ◽  
pp. 1674-1679 ◽  
Author(s):  
Ji-Won Kim ◽  
Yoon Young Kim ◽  
Hwajeong Lee ◽  
Sung-Hoon Park ◽  
Seong-Kyu Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Disease ◽  
Fundus Autofluorescence ◽  
Binary Logistic Regression ◽  
Field Testing ◽  
Retinal Toxicity ◽  
Binary Logistic Regression Analysis ◽  
Visual Field Testing ◽  
Daily Dose ◽  
Study Participants

Objective.Several studies have reported risk factors for hydroxychloroquine (HCQ) retinal toxicity, but data are limited for patients of Asian ancestry. The aim of this study was to investigate the rate of and factors for HCQ retinal toxicity in the Korean population.Methods.There were 123 patients enrolled in this study who were using or had used HCQ. Retinal toxicity was detected using spectral domain optical coherence tomography, fundus autofluorescence, multifocal electroretinography, and automated visual field testing. Binary logistic regression analysis was performed to identify factors associated with HCQ retinal toxicity.Results.Mean duration of HCQ use and mean HCQ dose in study participants was 10.1 years and 6.4 mg/kg, respectively. We found 17 patients (13.8%) with HCQ retinal toxicity among 123 patients. Patients with retinal toxicity took HCQ ranging from 6.7–21.9 years and daily dosage ranging from 4.9–9.1 mg/kg. Only 1 patient had retinal toxicity among patients with daily dose < 5.0 mg/kg. These factors increased the risk of HCQ retinal toxicity: longer duration of HCQ use [adjusted OR (aOR) = 4.71, 95% CI 2.18–10.15 for duration of HCQ use in 5-yr increments], higher daily HCQ dose (aOR = 3.34, 95% CI 1.03–10.80 for daily HCQ dose in 100-mg increments), and the presence of kidney disease (aOR = 8.56, 95% CI 1.15–64.00).Conclusion.HCQ retinal toxicity is associated with duration of HCQ use, daily HCQ dose, and presence of kidney disease. Proper dosing of maximum 5 mg/kg and regular screening according to risk factors are important in HCQ use.

scholarly journals Risk factors for extended length of stay following hip fracture surgery: A retrospective cohort study of patients aged 90 years and over in China

2019 ◽  
Author(s):  
Ling Lan ◽  
Li-jian Pei ◽  
Feifei Zhai ◽  
Yuelun Zhang ◽  
Jun Jing ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Retrospective Cohort ◽  
Binary Logistic Regression ◽  
Postoperative Pneumonia ◽  
Binary Logistic Regression Analysis ◽  
Hip Fracture Surgery ◽  
Extended Length ◽  
Potential Risk Factors ◽  
Fracture Surgery

Abstract Background Hip fractures are typical fractures in geriatric patients and are associated with a high risk of postoperative complications and extended length of stay (LOS) compared with other osteoporotic fractures, particularly among patients over age 90. We aimed to identify the risk factors for extended LOS (more than 14 days) in patients older than 90 years. Methods A single-centre retrospective cohort study was performed in 50 patients (over age 90) who experienced hip fracture between June 1, 2013, and August 31, 2017. Their medical records were retrospectively reviewed from the hospital’s electronic database. The baseline characteristics of the patients, intraoperative data and postoperative complications were collected for the assessment of potential risk factors. Univariate analysis and multivariate binary logistic regression analysis were performed to determine potential risk factors for extended LOS. Results The age of the patients in the cohort ranged from 90 to 101 years, and the analysis demonstrated that 70% (n = 35) of the patients experienced a complicated course of treatment with an in-hospital mortality rate of 4% (n = 2). The most common complication was the occurrence of postoperative pneumonia (38%). The median duration of hospital stay was 18 (IQR 11, 21) days. Multivariate binary logistic regression analysis showed that a LOS of more than 14 days was significantly associated with a lower mean diastolic blood pressure during surgery [odds ratio (OR) =0.86, 95% confidence interval (CI)=0.76-0.98, P = 0.018] and the occurrence of postoperative pneumonia (OR=8.95, 95% CI=1.45-55.3, P = 0.018). The occurrence of postoperative pneumonia was significantly associated with the neutrophil-to-lymphocyte ratio (NLR) at admission (D0) [odds ratio (OR) =1.20, 95% confidence interval (CI)=1.02-1.41, P = 0.029]. Neither the LOS nor postoperative pneumonia was found to be associated with the anaesthesia technique. Conclusions A lower mean diastolic blood pressure during surgery and the occurrence of postoperative pneumonia may extend the LOS in patients aged 90 years and over who undergo hip fracture surgery. The use of regional anaesthesia was not associated with a shorter LOS.

scholarly journals Associations of Cardiovascular and All-Cause Mortality with Metabolic Syndrome in Hemodialysis Patients: A Prospective Single-Center Study

Medicina ◽  
2019 ◽  
Vol 55 (10) ◽  
pp. 694
Author(s):  
Zorica Dimitrijevic ◽  
Andriana Jovanovic ◽  
Mina Cvetkovic ◽  
Tamara Vrecic ◽  
Emina Kostic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Metabolic Disorders ◽  
Cardiometabolic Risk ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Single Center Study ◽  
All Cause Mortality

Background and objectives: Metabolic syndrome (MetS) is a cluster of risk factors, such as abdominal obesity, insulin resistance, dyslipidemia and hypertension, that together increase the risk of cardiovascular disease. Chronic hemodialysis (HD) patients have multiple comorbidities and many metabolic disorders, causing the frequent occurrence of metabolic syndrome. The goal of this study was to assess the prevalence of MetS in HD patients, and its association with all-cause and cardiovascular (CV) mortality. Patients and methods: A total of 138 HD patients were included in this prospective study. We analyzed demographic, anthropometric and biochemical data. Outcome measures were all-cause and CV mortality during the three-year follow-up. Results: MetS was diagnosed in 57.24% of enrolled patients. During the 36 months of follow-up, 33 patients died. MetS patients showed a significantly higher mortality rate than non-MetS (30.4% versus 16.36%, p < 0.001). The association of different MetS components with cardiovascular mortality reached significance when a minimum of three components were present (1.81 (95% confidence interval CI = 1.21–2.33)), with a grouped increase in effect size for subjects with four or five MetS components. Subjects with MetS exhibited nearly twice as high risk for all-cause (hazard ratio HR = 1.99 (95%CI) = 1.42–2.97) and 2.5 times for CV (HR = 2.51 (95%CI) = 1.25–3.83) mortality compared with those without MetS, after adjustment for age, gender, and cardiovascular disease. Conclusions: The study demonstrates that MetS is widespread in HD patients. In future, the focus must be on an active screening approach, and treatment of cardiometabolic risk factors, aiming to reduce mortality.

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