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Utsumi M, Inagaki M, Kitada K, Tokunaga N, Yunoki K, Sakurai Y, Okabayashi H, Hamano R, Miyasou H, Tsunemitsu Y, Otsuka S. Predictive values of sarcopenia and systemic inflammation-based markers in advanced hepatocellular carcinoma after hepatectomy. Asian J Surg 2024; 47:3039-3047. [PMID: 38388270 DOI: 10.1016/j.asjsur.2024.02.004] [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] [Received: 10/16/2023] [Revised: 01/05/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Sarcopenia accompanied by systemic inflammation is associated with poor prognosis in patients with advanced hepatocellular carcinoma (HCC). However, the effect of sarcopenia combined with systemic inflammation on the prognosis of patients with advanced HCC who underwent hepatectomy is unclear. This study aimed to evaluate the effect of sarcopenia and inflammation on the prognosis of patients with advanced HCC. METHODS This retrospective study included 151 patients recruited between July 2010 and December 2022. We defined advanced HCC as that presenting with vascular invasion or tumor size ≥2 cm or multiple tumors. Sarcopenia was assessed using the psoas muscle index. Preoperative inflammatory markers were used by calculating the prognostic nutritional index, albumin-globulin ratio (AGR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio. Cox regression analysis was performed to determine the prognostic factors for overall survival. RESULTS Of 151 patients, sarcopenia occurred in 84 (55.6 %). Sarcopenia was significantly associated with male sex, older age, body mass index (<25 kg/m2), and a higher NLR. In the multivariate analysis, AGR <1.25 (hazard ratio [HR], 2.504; 95% confidence interval [CI]: 1.325-4.820; p < 0.05); alpha-fetoprotein levels ≥25 ng/mL (HR, 1.891; 95% CI: 1.016-3.480; p = 0.04); and sarcopenia (HR, 1.908; 95% CI: 1.009-3.776; p < 0.05) were independent predictors of overall survival. The sarcopenia and low AGR groups had significantly worse overall survival than either the non-sarcopenia and high AGR or sarcopenia and low AGR groups. CONCLUSION Sarcopenia and AGR are independent prognostic factors in patients with advanced HCC. Thus, sarcopenia may achieve a better prognostic value when combined with AGR.
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Affiliation(s)
- Masashi Utsumi
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan.
| | - Masaru Inagaki
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
| | - Koji Kitada
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
| | - Naoyuki Tokunaga
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
| | - Kosuke Yunoki
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
| | - Yuya Sakurai
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
| | - Hiroki Okabayashi
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
| | - Ryosuke Hamano
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
| | - Hideaki Miyasou
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
| | - Yousuke Tsunemitsu
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
| | - Shinya Otsuka
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
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Utsumi M, Inagaki M, Kitada K, Tokunaga N, Yunoki K, Okabayashi H, Hamano R, Miyasou H, Tsunemitsu Y, Otsuka S. Combination of sarcopenia and systemic inflammation-based markers for predicting the prognosis of patients undergoing pancreaticoduodenectomy for pancreatic cancer. PLoS One 2024; 19:e0305844. [PMID: 38913646 PMCID: PMC11195994 DOI: 10.1371/journal.pone.0305844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/04/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the effects of sarcopenia and inflammation on the prognosis of patients with pancreatic cancer after pancreaticoduodenectomy. METHODS Eighty patients who had undergone pancreaticoduodenectomy for pancreatic cancer between July 2010 and December 2023 were included in this study. The psoas muscle index was used to assess sarcopenia. The C-reactive protein-to-albumin ratio, prognostic nutritional index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were used to calculate the preoperative inflammatory marker levels. The prognostic factors for overall survival were determined using Cox regression analysis. RESULTS Twenty-four patients were diagnosed with sarcopenia. Sarcopenia showed a significant association with advanced tumor stage. Univariate analysis revealed a significant reduction in overall survival in patients with a prognostic nutritional index of <45, C-reactive protein-to-albumin ratio of ≥0.047, cancer antigen 19-9 levels of ≥130 U/mL, sarcopenia, lymph node metastasis, and vascular invasion. Multivariate analysis revealed that a C-reactive protein-to-albumin ratio of ≥0.047 (hazards ratio, 3.383; 95% confidence interval: 1.384-8.689; p< 0.001), cancer antigen 19-9 levels of ≥130 U/mL (hazards ratio, 2.720; 95% confidence interval: 1.291-6.060; p = 0.008), sarcopenia (hazards ratio, 3.256; 95% confidence interval: 1.535-7.072; p = 0.002) and vascular invasion (hazards ratio, 2.092; 95% confidence interval: 1.057-4.170; p = 0.034) were independent predictors of overall survival. Overall survival in the sarcopenia and high C-reactive protein-to-albumin ratio groups was significantly poorer than that in the non-sarcopenia and low C-reactive protein-to-albumin ratio and sarcopenia or high C-reactive protein-to-albumin ratio groups. CONCLUSION Sarcopenia and a high C-reactive protein-to-albumin ratio are independent prognostic factors in patients with pancreatic cancer after pancreaticoduodenectomy. Thus, sarcopenia may have a better prognostic value when combined with the C-reactive protein-to-albumin ratio.
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Affiliation(s)
- Masashi Utsumi
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
| | - Masaru Inagaki
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
| | - Koji Kitada
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
| | - Naoyuki Tokunaga
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
| | - Kosuke Yunoki
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
| | - Hiroki Okabayashi
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
| | - Ryosuke Hamano
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
| | - Hideaki Miyasou
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
| | - Yousuke Tsunemitsu
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
| | - Shinya Otsuka
- Department of Surgery, NHO Fukuyama Medical Center, Fukuyama City, Hiroshima, Japan
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Utsumi M, Kitada K, Tokunaga N, Narusaka T, Hamano R, Miyasou H, Tsunemitsu Y, Otsuka S, Inagaki M. Preoperative Albumin-to-Globulin Ratio Predicts Prognosis in Hepatocellular Carcinoma: A Cohort Study Including Non-Hepatitis Virus-Infected Patients. Dig Surg 2021; 38:307-315. [PMID: 34515102 DOI: 10.1159/000518307] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/02/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION We evaluated the prognostic significance of the preoperative albumin-to-globulin ratio (AGR) in patients with hepatocellular carcinoma (HCC) with various liver etiologies. METHODS We retrospectively analyzed 157 patients with HCC between July 2010 and February 2021. The relationship between clinicopathological variables was investigated using univariate and multivariate analyses. Statistical significance was set at p < 0.05. RESULTS The mean overall survival (OS) was 24.5 months. The 1-, 3-, and 5-year OS rates were 90.4%, 81.2%, and 68.7%, respectively. Patients were classified into 2 groups: AGR <1.16 (low-AGR group; n = 43) and AGR ≥1.16 (high-AGR group; n = 114). In univariate analysis, OS was significantly reduced in patients with a low AGR (AGR <1.16), an alpha-fetoprotein level ≥25 ng/mL, a tumor size ≥3.5 cm, microvascular invasion, and poor tumor differentiation. In multivariate analysis, a low AGR (hazard ratio [95% confidence interval]) (2.394 [1.092-5.213]; p = 0.030) and microvascular invasion (2.268 [1.019-5.169]; p = 0.045) were independent predictors of OS. DISCUSSION/CONCLUSION A low AGR was significantly associated with poor OS in patients with HCC, regardless of liver etiology. This may assist in treatment stratification and better management of patients with HCC.
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Affiliation(s)
- Masashi Utsumi
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Koji Kitada
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Naoyuki Tokunaga
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Toru Narusaka
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Ryosuke Hamano
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Hideaki Miyasou
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Yousuke Tsunemitsu
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Shinya Otsuka
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Masaru Inagaki
- Department of Surgery, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
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Zhao C, Wei Y, Chen D, Jin J, Chen H. Prognostic value of an inflammatory biomarker-based clinical algorithm in septic patients in the emergency department: An observational study. Int Immunopharmacol 2020; 80:106145. [PMID: 31955067 DOI: 10.1016/j.intimp.2019.106145] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/02/2019] [Accepted: 12/20/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND To develop an inflammatory biomarker-based, simple-to-use nomogram for the early identification of septic patients at high risk of mortality in the emergency department (ED). METHODS All patients diagnosed with sepsis admitted to the intensive care unit (ICU) from the ED were screened from the Medical Information Mart for Intensive Care III database and divided into two cohorts: the primary cohort and the validation cohort. We used bivariate logistic regression analysis to determine independent risk factors and to construct a predictive nomogram and subsequently evaluated the calibration, discrimination and clinical usefulness of the nomogram. The gradient boosting machine (GBM) model was used to more accurately evaluate these variables. RESULTS A total of 5663 admissions were enrolled, of which 3964 comprised the primary cohort and 1699 comprised the validation group, with 28-day mortality rates of 21.2% and 20.4%, respectively. Age > 69, neutrophil-to-lymphocyte ratio (NLR) > 9.8, platelet-to-lymphocyte ratio (PLR) > 249.89, lymphocyte-to-monocyte ratio (LMR) ≤ 2.18, and red cell distribution width (RDW) were detected as important determinants of 28-day mortality and included in the nomogram. The calibration plot revealed an adequate fit of the nomogram for predicting the risk of 28-day mortality. Regarding discriminative ability, receiver operating characteristic curve analysis showed that the nomogram had an area under the curve (AUC) of 0.826 (95% CI: 0.811-0.841, P < 0.001) in the primary cohort, which was greater than that of all individual parameters and other scores. Decision curve analysis also indicated that our nomogram was feasible in clinical practice, as the threshold probabilities were 0-0.62 for the primary cohort. The GBM model yielded a significantly greater AUC of up to 0.867. CONCLUSIONS This proposed simple-to-use nomogram based on age, NLR, PLR, LMR and RDW provides a relatively accurate mortality prediction for septic patients in the ED.
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Affiliation(s)
- Chenyan Zhao
- Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu, China
| | - Yao Wei
- Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu, China
| | - Dongyu Chen
- Department of Intensive Care Medicine, Yancheng City No. 1 People's Hospital, Yancheng 224000, Jiangsu, China
| | - Jun Jin
- Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu, China
| | - Hui Chen
- Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu, China.
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Siregar GA, Irwansyah D. Comparison of Platelet to Lymphocyte Ratio between Degrees of the Barcelona Clinic Liver Cancer on Hepatocellular Carcinoma Patients at Haji Adam Malik General Hospital. Open Access Maced J Med Sci 2019; 7:3451-3454. [PMID: 32002072 PMCID: PMC6980812 DOI: 10.3889/oamjms.2019.444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND: Hepatocellular carcinoma (HCC) is the fifth most common malignancy. The Barcelona Clinical Liver Cancer System (BCLC), guides the treatment of patients with HCC. Platelet to lymphocyte ratio (PLR) is an inflammatory marker used as a prognostic factor disease of HCC. An increase in PLR indicates higher host’s inflammatory response and is associated with aggressive HCC behaviour, according to BCLC. AIM: This study aims to determine the PLRs between among the degrees of BCLC (The Barcelona Clinic Liver Cancer) in HCC patients at Haji Adam Malik General Hospital in Medan during 2015-2016. METHODS: This retrospective study involved 166 patients with HCC who were then classified by the BCLC guidelines. PLRs among the patient’s degrees of BCLC were compared using Kruskal Wallis test. RESULTS: A total of 166 HCC patients, 129 (77.7%) were men and 37 (22.3%) were women. The PLR value has a median value of 17841with the lowest value of 1776 and the highest value of 223684. There were differences in PLR levels with various BCLC stages in patients with HCC at Haji Adam Malik Hospital during 2015-2016 (p = 0.026). CONCLUSION: There were differences in PLR levels with various BCLC stages in patients with HCC at Haji Adam Malik Hospital during 2015-2016.
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Affiliation(s)
- Gontar Alamsyah Siregar
- Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Dedi Irwansyah
- Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
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Prognostic value of platelet-to-lymphocyte ratios among critically ill patients with acute kidney injury. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:238. [PMID: 28882170 PMCID: PMC5590135 DOI: 10.1186/s13054-017-1821-z] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 08/22/2017] [Indexed: 12/21/2022]
Abstract
Background Inflammation plays an important role in the initiation and progression of acute kidney injury (AKI). However, evidence regarding the prognostic effect of the platelet-to-lymphocyte ratio (PLR), a novel systemic inflammation marker, among patients with AKI is scarce. In this study, we investigated the value of the PLR in predicting the outcomes of critically ill patients with AKI. Methods Patient data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.3. PLR cutoff values were determined using smooth curve fitting or quintiles and were used to categorize the subjects into groups. The clinical outcomes were 30-day and 90-day mortality in the intensive care unit (ICU). Cox proportional hazards models were used to evaluate the association between the PLR and survival. Results A total of 10,859 ICU patients with AKI were enrolled. A total of 2277 thirty-day and 3112 ninety-day deaths occurred. A U-shaped relationship was observed between the PLR and both 90-day and 30-day mortality, with the lowest risk being at values ranging from 90 to 311. The adjusted HR (95% CI) values for 90-day mortality given risk values < 90 and > 311 were 1.25 (1.12–1.39) and 1.19 (1.08–1.31), respectively. Similar trends were observed for 30-day mortality or when quintiles were used to group patients according to the PLR. Statistically significant interactions were found between the PLR and both age and heart rate. Younger patients (aged < 65 years) and those with more rapid heart rates (≥89.4 beats per minute) tended to have poorer prognoses only when the PLR was < 90, whereas older patients (aged ≥ 65 years) and those with slower heart rates (<89.4 beats per minute) had higher risk only when the PLR was > 311 (P < 0.001 for age and P < 0.001 for heart rate). Conclusions The preoperative PLR was associated in a U-shaped pattern with survival among patients with AKI. The PLR appears to be a novel, independent prognostic marker of outcomes in critically ill patients with AKI.
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Białas AJ, Pedone C, Piotrowski WJ, Antonelli Incalzi R. Platelet distribution width as a prognostic factor in patients with COPD - pilot study. Int J Chron Obstruct Pulmon Dis 2017; 12:2261-2267. [PMID: 28814854 PMCID: PMC5546588 DOI: 10.2147/copd.s131868] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Platelets may actively participate in inflammation in COPD. Platelet distribution width (PDW), a measure of platelets’ volume heterogeneity, may increase in platelets’ activation. We hypothesized that PDW may be a marker of hypercoagulation, which plays a significant role in conditions associated with worse survival of patients with COPD, eg, acute myocardial infarction and other forms of ischemic heart disease. Methods Retrospective analysis of 79 patients. Variables were compared after grouping patients according to the upper normal limit of PDW, using Welch’s t-tests or Mann–Whitney U, and chi-square tests. Survival in the two groups was compared using the Kaplan–Meier method and Cox proportional hazards regression. Results Ten patients presented values of PDW above 16 fL, which was the upper limit of normality for our laboratory. Compared to patients with normal PDW, they had lower forced expiratory flow between 25% and 75% of vital capacity (FEF 25–75) – 35% of reference value vs 57% (P=0.003) and peak expiratory flow – 39% vs 54% (P<0.001). The median survival of patients with elevated PDW was 743 days compared to those with normal PDW (1,305 days) (P=0.025). The adjusted HR was 4.59 (95% CI: 1.1, 19.19; P=0.04). Conclusion Our analysis indicates that elevated PDW is associated with reduced survival of patients with COPD. If our data are to be confirmed, PDW may be used as an inexpensive and repeatable prognostic tool in COPD.
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Affiliation(s)
- Adam J Białas
- Department of Pneumology and Allergy, Medical University of Lodz, Łódź, Poland.,Healthy Aging Research Centre (HARC), Medical University of Lodz, Łódź, Poland
| | - Claudio Pedone
- Department of Geriatrics, Campus Bio-Medico University of Rome, Rome, Italy
| | - Wojciech J Piotrowski
- Department of Pneumology and Allergy, Medical University of Lodz, Łódź, Poland.,Healthy Aging Research Centre (HARC), Medical University of Lodz, Łódź, Poland
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Liu WY, Lin SG, Wang LR, Fang CC, Lin YQ, Braddock M, Zhu GQ, Zhang Z, Zheng MH, Shen FX. Platelet-to-Lymphocyte Ratio: A Novel Prognostic Factor for Prediction of 90-day Outcomes in Critically Ill Patients With Diabetic Ketoacidosis. Medicine (Baltimore) 2016; 95:e2596. [PMID: 26825908 PMCID: PMC5291578 DOI: 10.1097/md.0000000000002596] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Diabetic ketoacidosis (DKA) is a life-threatening acute complication of diabetes mellitus and the novel systemic inflammation marker platelet-to-lymphocyte ratio (PLR) may be associated with clinical outcome in patients with DKA. This study aimed to investigate the utility of PLR in predicting 90-day clinical outcomes in patients with DKA. Patient data exacted from the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC II) database was analyzed. A cutoff value for PLR of 267.67 was determined using Youden index (P < 0.05) and used to categorize subjects into a high PLR group and a low PLR group. The hazard ratios (HRs) and 95% confidence intervals (CIs) for DKA were calculated across PLR. Clinical outcomes in our study were defined as intensive care unit (ICU) 90-day readmission and all-cause mortality. A total of 278 ICU admissions were enrolled and stratified by cutoff value of PLR. The incidence of readmission and mortality was 17.8% in the high PLR group, significantly higher than 7.4% in the low PLR group. In the multivariable model, after adjusting for known confounding variables including clinical parameters, comorbidities, laboratory parameters, the HRs for DKA were 2.573 (95% CI 1.239-5.345; P = 0.011), 2.648 (95% CI 1.269-5.527; P = 0.009), and 2.650 (95% CI 1.114-6.306; P = 0.028), respectively. The Kaplan-Meier survival curve showed that a high PLR level was associated with a higher risk for 90-day outcomes in patients with DKA. The authors report that higher PLR presents a higher risk for 90-day incidence of readmission and mortality in patients with DKA. It appears to be a novel independent predictor of 90-day outcomes in critically ill DKA patients in ICU units.
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Affiliation(s)
- Wen-Yue Liu
- From the Department of Endocrinology, the First Affiliated Hospital of Wenzhou Medical University (W-YL, C-CF, F-XS); School of the First Clinical Medical Sciences (S-GL, L-RW, G-QZ); Department of Infection and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University (L-RW, Y-QL, G-QZ, M-HZ); Renji School of Wenzhou Medical University, Wenzhou, China (Y-QL); Global Medicines Development, AstraZeneca R&D, Loughborough, United Kingdom (MB); Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua (ZZ); and Institute of Hepatology, Wenzhou Medical University, Wenzhou, China (M-HZ)
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