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Zhang L, Zhao X, Wang Z, Deng H, Zhang X, Wang X, Lao J, Gao M, Hou Y, Han Y. Preadmission metformin use increased the incidence of hyperlactatemia at admission and 30-day in-hospital mortality among T2D patients with heart disease at high risk of hypoxia. Int J Cardiol 2024; 412:132338. [PMID: 38964551 DOI: 10.1016/j.ijcard.2024.132338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Surprisingly, despite the high prevalence of metformin use in type 2 diabetes (T2D) patients with heart disease, limited safety data is available regarding metformin use in patients with acute and critical heart disease. METHODS In this single-center retrospective study, patients admitted to the cardiology department for heart failure (HF) or acute coronary syndrome (ACS) between December 2013 and December 2021 and who underwent arterial blood gas analysis at admission with an estimated glomerular clearance rate of ≥45 ml/min/1.73 m2 were identified. The incidences of hyperlactatemia, acidosis, and 30-day in-hospital mortality were compared between preadmission metformin users and nonusers. RESULTS Of 526 admissions, 193/193 metformin users/nonusers were selected in a propensity score-matched model. Metformin users had greater lactate levels (2.55 ± 2.07 mmol/l vs. 2.00 ± 1.80 mmol/l P < 0.01), a greater incidence of hyperlactatemia [odds ratio (OR) = 2.55; 95% confidence interval (CI), 1.63-3.98; P < 0.01] and acidosis (OR = 1.78; 95% CI, 1.00-3.16; P < 0.05) at admission and a greater incidence of in-hospital mortality (OR = 3.83; 95% CI, 1.05-13.94; P < 0.05), especially those with HF/acute myocardial infarction, elderly age, or without preadmission insulin use. CONCLUSIONS Our results suggest that, compared to metformin nonusers, preadmission use of metformin may be associated with a greater incidence of hyperlactatemia and acidosis at admission and greater 30-day in-hospital mortality among T2D patients with HF or ACS at high risk of hypoxia, particularly those without preadmission insulin use. The safety of metformin in this population needs to be confirmed in prospective controlled trials.
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Affiliation(s)
- Le Zhang
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, Shandong Province, PR China
| | - Xia Zhao
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, Shandong Province, PR China
| | - Zhongsu Wang
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, Shandong Province, PR China
| | - Hao Deng
- School of Pharmacy, Shandong University, Jinan, Shandong Province, PR China
| | - Xue Zhang
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, Shandong Province, PR China
| | - Xuan Wang
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, Shandong Province, PR China
| | - Jiahui Lao
- Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, PR China
| | - Mei Gao
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia, Jinan, Shandong Province, PR China
| | - Yinglong Hou
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia, Jinan, Shandong Province, PR China
| | - Yi Han
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, Shandong Province, PR China.
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Chen Y, Ba J, Peng C, Peng H, Li S, Lai W. Impact of lactate/albumin ratio on prognostic outcomes in patients with concomitant heart failure and chronic kidney disease. Intern Emerg Med 2024; 19:1625-1636. [PMID: 38795274 DOI: 10.1007/s11739-024-03656-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/18/2024] [Indexed: 05/27/2024]
Abstract
Previous studies have linked the lactate/albumin (L/A) ratio to poor outcomes in various conditions, but its connection to mortality in patients with both heart failure (HF) and chronic kidney disease (CKD) remains unclear. Using data from 1537 patients in MIMIC-IV, this study examined the relationship between L/A ratio and in-hospital and one-year mortality, employing Cox models, Kaplan-Meier (KM) analysis, and restricted cubic splines (RCS). The non-survivor group showed higher L/A ratios than survivors (1.04 ± 0.78 vs. 0.58 ± 0.29, p < 0.001), indicating a significant link between higher L/A ratios and mortality. Cox analysis identified the L/A ratio was significantly related to all-cause mortality both in-hospital (HR 2.033; 95% CI 1.576-2.624; p < 0.001) and one-year (HR 1.723; 95% CI 1.428-2.078; p < 0.001). The association between L/A ratio and mortality was non-linear and increasing. The KM survival curves demonstrated significantly poorer survival outcomes for the high L/A group compared to the low L/A group, a difference that was statistically validated by a significant log-rank test (log-rank p < 0.001). L/A ratio has a significant association with poor prognosis in patients with HF and CKD patients in a critical condition. This finding demonstrates that L/A ratio might be useful in identifying patients with HF and CKD at high risk of all-cause death. Further large-scale prospective studies are needed to verify these results and inform clinical decisions.
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Affiliation(s)
- Yang Chen
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Junhui Ba
- Department of Medical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chaoquan Peng
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hui Peng
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road, Guangzhou, 510630, China
| | - Shaomin Li
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road, Guangzhou, 510630, China.
| | - Weiyan Lai
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road, Guangzhou, 510630, China.
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Zhou X, Tan W, Liu M, Liu N. Predicting the mortality of patients with cardiogenic shock after coronary artery bypass grafting. Perfusion 2024; 39:807-815. [PMID: 36935559 DOI: 10.1177/02676591231161275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Cardiogenic shock (CS) is a critical condition and the leading cause of mortality after coronary artery bypass grafting (CABG). To define the risk factors for CS in patients who undergo CABG and create a risk-predictive model is crucial. METHODS In this observational study, we retrospectively evaluated consecutive patients who underwent CABG between January 2018 and October 2022 at Beijing Anzhen Hospital. A total of 496 patients were enrolled and categorized into the training (396 cases) and internal test (100 cases) sets. The variables significantly associated with mortality (p < 0.05) were analyzed using logistic regression analyses. RESULTS The E/A ratio at admission, postoperative brain natriuretic peptide, postoperative arterial lactate, two or more arrhythmias at the same time after CABG, and carotid artery stenosis at admission were identified as independent prognostic factors for in-hospital mortality after multivariate logistic regression analysis. The CS after CABG score (ACCS) was established and three classes of ACCS, named classes I (ACCS, <20), II (ACCS, 20-30), and III (ACCS, >30), made up the risk model. The ACCS showed better discrimination with an AUROC of 0.937 (95% confidence interval, 0.982-0.892) and calibration with the Hosmer-Lemeshow test (X2 = 5.854 with 8 df; p = 0.664). In addition, tenfold cross-validation demonstrated that the mean misdiagnosis rate was 5.56% and the lowest misdiagnosis rate was 6.38%. CONCLUSION The ACCS score represents a risk-predictive model for in-hospital mortality of patients with CS after CABG in acute care settings. Patients identified as class III may have a worse prognosis.
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Affiliation(s)
- Xiaozheng Zhou
- Center for Cardiac Intensive, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wen Tan
- Center for Cardiac Intensive, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Maomao Liu
- Center for Cardiac Intensive, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Nan Liu
- Center for Cardiac Intensive, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Fountoulaki K, Ventoulis I, Drokou A, Georgarakou K, Parissis J, Polyzogopoulou E. Emergency department risk assessment and disposition of acute heart failure patients: existing evidence and ongoing challenges. Heart Fail Rev 2023; 28:781-793. [PMID: 36123519 PMCID: PMC9485013 DOI: 10.1007/s10741-022-10272-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 12/02/2022]
Abstract
Heart failure (HF) is a global public health burden, characterized by frequent emergency department (ED) visits and hospitalizations. Identifying successful strategies to avoid admissions is crucial for the management of acutely decompensated HF, let alone resource utilization. The primary challenge for ED management of patients with acute heart failure (AHF) lies in the identification of those who can be safely discharged home instead of being admitted. This is an elaborate decision, based on limited objective evidence. Thus far, current biomarkers and risk stratification tools have had little impact on ED disposition decision-making. A reliable definition of a low-risk patient profile is warranted in order to accurately identify patients who could be appropriate for early discharge. A brief period of observation can facilitate risk stratification and allow for close monitoring, aggressive treatment, continuous assessment of response to initial therapy and patient education. Lung ultrasound may represent a valid bedside tool to monitor cardiogenic pulmonary oedema and determine the extent of achieved cardiac unloading after treatment in the observation unit setting. Safe discharge mandates multidisciplinary collaboration and thoughtful assessment of socioeconomic and behavioural factors, along with a clear post-discharge plan put forward and a close follow-up in an outpatient setting. Ongoing research to improve ED risk stratification and disposition of AHF patients may mitigate the tremendous public health challenge imposed by the HF epidemic.
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Affiliation(s)
- Katerina Fountoulaki
- 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, 12462, Athens, Greece.
| | - Ioannis Ventoulis
- Department of Occupational Therapy, University of Western Macedonia, 50200, Ptolemaida, Greece
| | - Anna Drokou
- University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, 12462, Athens, Greece
| | - Kyriaki Georgarakou
- University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, 12462, Athens, Greece
| | - John Parissis
- University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, 12462, Athens, Greece
| | - Effie Polyzogopoulou
- University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, 12462, Athens, Greece
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Chen Y, Yang K, Wu B, Lin W, Chen S, Xu X, Peng C, Xie D. Association between lactate/albumin ratio and mortality in patients with heart failure after myocardial infarction. ESC Heart Fail 2023; 10:1928-1936. [PMID: 36987543 PMCID: PMC10192240 DOI: 10.1002/ehf2.14359] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/02/2022] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
Abstract
AIMS Lactate/albumin ratio (L/A) is a recognized prognostic index of patients with heart failure (HF) after myocardial infarction (MI). We aim to evaluate the prognostic value of L/A ratio in predicting in-hospital mortality for those patients. METHODS AND RESULTS We enrolled qualified patients from Medical Information Mart for Intensive Care IV database for retrospective study. A receiver operating characteristic (ROC) curve of the subjects was applied to determine the predicted value and the best cut-off value of L/A on admission. Univariate/multivariate Cox regression analysis and restricted cubic splines (RCS) were performed to identify the association between hospital admission and hospital mortality. The Kaplan-Meier (KM) method was used to draw the survival curve of the two groups with different L/A levels at admission. L/A values at admission were significantly higher in the death groups than the survival groups [1.36 (1.20) vs. 0.62 (0.36), P < 0.05], and area under the ROC curve [0.780 (95% confidence interval, 0.772-0.827)] was better than other indicators, and the best the cut-off value was 0.671. Data of Cox regression analysis showed that higher L/A value supposed to be an independent risk factor for in-hospital mortality. RCS analysis showed evidence of an increasing trend and a non-linear relationship between L/A and in-hospital mortality (P value was non-linear <0.05). KM survival curves were significantly lower in the high L/A group than the low L/A group (P < 0.001), and the former group had an increased risk of in-hospital mortality compared with the latter one (log rank P < 0.001). CONCLUSIONS Elevated L/A ratio on admission is an independent predictor of high in-hospital mortality in post-MI heart failure patients, which proved to be better than lactate, Sequential Organ Failure Assessment score and other related indicators.
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Affiliation(s)
- Yang Chen
- Department of Cardiology, Third Affiliated HospitalSun Yat‐sen UniversityTianhe RoadGuangzhouGuangdong510630China
| | - Ke Yang
- Department of Cardiology, Third Affiliated HospitalSun Yat‐sen UniversityTianhe RoadGuangzhouGuangdong510630China
| | - Bingyuan Wu
- Department of Cardiology, Third Affiliated HospitalSun Yat‐sen UniversityTianhe RoadGuangzhouGuangdong510630China
| | - Wanwen Lin
- Department of Cardiology, Third Affiliated HospitalSun Yat‐sen UniversityTianhe RoadGuangzhouGuangdong510630China
| | - Simin Chen
- Department of Cardiology, Third Affiliated HospitalSun Yat‐sen UniversityTianhe RoadGuangzhouGuangdong510630China
| | - Xiaochun Xu
- Department of Cardiology, Third Affiliated HospitalSun Yat‐sen UniversityTianhe RoadGuangzhouGuangdong510630China
| | - Chaoquan Peng
- Department of Cardiology, Third Affiliated HospitalSun Yat‐sen UniversityTianhe RoadGuangzhouGuangdong510630China
| | - Dongmei Xie
- Department of Cardiology, Third Affiliated HospitalSun Yat‐sen UniversityTianhe RoadGuangzhouGuangdong510630China
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Hu W, Yuan L, Wang X, Zang B, Zhang Y, Yan X, Zhao W, Chao Y. Predictive Value of Arterial Blood Lactic Acid Concentration on the Risk of in-Hospital All-Cause Death in Patients with Acute Heart Failure. Int J Clin Pract 2022; 2022:7644535. [PMID: 36474546 PMCID: PMC9683964 DOI: 10.1155/2022/7644535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/15/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
Abstract
The study aims to examine the predictive value of arterial blood lactic acid concentration for in-hospital all-cause mortality in the intensive care unit (ICU) for patients with acute heart failure (AHF). We retrospectively analyzed the clinical data of 7558 AHF patients in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The exposure variable of the present study was arterial blood lactic acid concentration and the outcome variable was in-hospital all-cause death. The patients were divided into those who survived (n = 6792) and those who died (n = 766). The multivariate logistic regression model, restricted cubic spline (RCS) plot, and subgroup analysis were used to evaluate the association between lactic acid and in-hospital all-cause mortality. In addition, receiver operating curve (ROC) analysis also was performed. Finally, we further explore the association between NT-proBNP and lactic acid and in-hospital all-cause mortality. Compared with the lowest quartiles, the odds ratios with 95% confidence intervals for in-hospital all-cause mortality across the quartiles were 1.46 (1.07-2.00), 1.48 (1.09-2.00), and 2.36 (1.73-3.22) for lactic acid, and in-hospital all-cause mortality was gradually increased with lactic acid levels increasing (P for trend <0.05). The RCS plot revealed a positive and linear connection between lactic acid and in-hospital all-cause mortality. A combination of lactic acid concentration and the Simplified Acute Physiology Score (SAPS) II may improve the predictive value of in-hospital all-cause mortality in patients with AHF (AUC = 0.696). Among subgroups, respiratory failure interacted with an association between lactic acid and in-hospital all-cause mortality (P for interaction <0.05). The correlation heatmap revealed that NT-proBNP was positively correlated with lactic acid (r = 0.07) and positively correlated with in-hospital all-cause mortality (r = 0.18). There was an inverse L-shaped curve relationship between NT-proBNP and in-hospital all-cause mortality, respectively. Mediation analysis suggested that a positive relationship between lactic acid and in-hospital all-cause death was mediated by NT-proBNP. For AHF patients in the ICU, the arterial blood lactic acid concentration during hospitalization was a significant independent predictor of in-hospital all-cause mortality. The combination of lactic acid and SAPS II can improve the predictive value of the risk of in-hospital all-cause mortality in patients with AHF.
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Affiliation(s)
- Weiwei Hu
- Department of Critical Care Medicine, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu, China
| | - Lei Yuan
- Department of Interventional Vascular Surgery, Xuzhou Cancer Hospital, Xuzhou 221005, Jiangsu, China
| | - Xiaotong Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu, China
| | - Baohe Zang
- Department of Critical Care Medicine, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu, China
| | - Yang Zhang
- Department of Critical Care Medicine, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu, China
| | - Xianliang Yan
- Department of Emergency Medicine, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu, China
| | - Wenjing Zhao
- Department of Critical Care Medicine, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu, China
| | - Yali Chao
- Department of Critical Care Medicine, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu, China
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Guo W, Zhao L, Zhao H, Zeng F, Peng C, Guo W, Yan H. The value of lactate/albumin ratio for predicting the clinical outcomes of critically ill patients with heart failure. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:118. [PMID: 33569420 PMCID: PMC7867948 DOI: 10.21037/atm-20-4519] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Previous studies have shown that the lactate/albumin (L/A) ratio plays a role in predicting the outcomes of septic shock or severe sepsis. However, the role of the L/A ratio in predicting the outcomes of critically ill patients with heart failure remains unclear. We therefore performed a retrospective study to clarify this issue. Methods The study was based on the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III) database and included critically ill adult patients with heart failure. The primary endpoints were 28-day and 1-year all-cause mortality after admission at the intensive care unit. Results We analyzed 4,562 patients in this study. We divided the participants into five groups according to the L/A ratio: quintile (Q)1 (L/A ratio ≤0.40, n=913), Q2 (0.40< L/A ratio ≤0.51, n=912), Q3 (0.51< L/A ratio ≤0.66, n=912), Q4 (0.66< L/A ratio ≤0.92, n=912), and Q5 (L/A ratio >0.92, n=913). After stratifying by L/A ratio, the risk of 28-day and 1-year mortality were significantly different between the groups (log-rank P<0.001). Compared with the first quintile, the second, third, fourth, and fifth quintiles of the L/A ratio were associated with higher 28-day [hazard ratio (HR) 1.57, 95% confidence interval (CI): 1.21-2.03 for Q3, HR 1.72, 95% CI: 1.34-2.21 for Q4, and HR 3.15, 95% CI: 2.47-4.01 for Q5) and 1-year mortality (HR 1.19, 95% CI: 1.00-1.41 for Q2, HR 1.36, 95% CI: 1.15-1.60 for Q3, HR 1.42, 95% CI: 1.20-1.67 for Q4, and HR 2.46, 95% CI: 2.09-2.89 for Q5). The restricted cubic spline showed that the L/A ratio positively correlated with both 28-day and 1-year all-cause mortality. Conclusions The L/A ratio could serve as a predictor of short and long-term mortality in critically ill patients with heart failure.
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Affiliation(s)
- Wenqin Guo
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Shenzhen, China
| | - Lingyue Zhao
- Department of Ambulatory Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Shenzhen, China
| | - Fanfang Zeng
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Shenzhen, China
| | - Changnong Peng
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Shenzhen, China
| | - Wenyu Guo
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Shenzhen, China
| | - Hongbing Yan
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Shenzhen, China
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Early prediction model for coronary heart disease using genetic algorithms, hyper-parameter optimization and machine learning techniques. HEALTH AND TECHNOLOGY 2021. [DOI: 10.1007/s12553-020-00508-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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