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Wu J, Li X, Zhang H, Lin L, Li M, Chen G, Wang C. Development and validation of a prediction model for all-cause mortality in maintenance dialysis patients: a multicenter retrospective cohort study. Ren Fail 2024; 46:2322039. [PMID: 38415296 PMCID: PMC10903750 DOI: 10.1080/0886022x.2024.2322039] [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: 10/24/2023] [Accepted: 02/17/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The mortality risk varies considerably among individual dialysis patients. This study aimed to develop a user-friendly predictive model for predicting all-cause mortality among dialysis patients. METHODS Retrospective data regarding dialysis patients were obtained from two hospitals. Patients in training cohort (N = 1421) were recruited from the Fifth Affiliated Hospital of Sun Yat-sen University, and patients in external validation cohort (N = 429) were recruited from the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine. The follow-up endpoint event was all-cause death. Variables were selected by LASSO-Cox regression, and the model was constructed by Cox regression, which was presented in the form of nomogram and web-based tool. The discrimination and accuracy of the prediction model were assessed using C-indexes and calibration curves, while the clinical value was assessed by decision curve analysis (DCA). RESULTS The best predictors of 1-, 3-, and 5-year all-cause mortality contained nine independent factors, including age, body mass index (BMI), diabetes mellitus (DM), cardiovascular disease (CVD), cancer, urine volume, hemoglobin (HGB), albumin (ALB), and pleural effusion (PE). The 1-, 3-, and 5-year C-indexes in the training set (0.840, 0.866, and 0.846, respectively) and validation set (0.746, 0.783, and 0.741, respectively) were consistent with comparable performance. According to the calibration curve, the nomogram predicted survival accurately matched the actual survival rate. The DCA showed the nomogram got more clinical net benefit in both the training and validation sets. CONCLUSIONS The effective and convenient nomogram may help clinicians quantify the risk of mortality in maintenance dialysis patients.
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Affiliation(s)
- Jingcan Wu
- Department of Nephrology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Xuehong Li
- Department of Nephrology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Hong Zhang
- Department of Nephrology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Lin Lin
- Department of Nephrology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Man Li
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Gangyi Chen
- Department of Nephrology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Cheng Wang
- Department of Nephrology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
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Wang D, Niu Y, Ma Y, Tang L, Zhang Q, Zhang L, Sun X, Mei Y, Cai G, Chen X, Li P. Clinical characteristics and prognostic factors of non-malignant pleural effusions in hospitalised patients: a retrospective cohort study. BMJ Open 2024; 14:e077980. [PMID: 39079916 PMCID: PMC11293410 DOI: 10.1136/bmjopen-2023-077980] [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: 07/26/2023] [Accepted: 07/16/2024] [Indexed: 08/03/2024] Open
Abstract
OBJECTIVE Non-malignant pleural effusions (NMPE) are common in hospitalised patients. Data on NMPE inpatients are scarce and the factors influencing the prognosis are unknown. DESIGN This was a retrospective cohort study. SETTING AND PARTICIPANTS We conducted a retrospective cohort of inpatients (n=86 645) admitted to the Chinese PLA General Hospital from 2018 to 2021, based on electronic medical records. The observations of 4934 subjects with effusions confirmed by chest radiological tests (CT or X-ray) without a diagnosis of malignancy were followed during admission. Logistic regression was used to analyse organ damage and other factors associated with in-hospital death. Patients were clustered according to their laboratory indicators, and the association between the clustering results and outcomes was studied. OUTCOME The outcome of this study was in-hospital mortality. RESULTS Among 4934 patients, heart failure + pneumonia + renal dysfunction was the most common (15.12%) among 100 different diagnostic groups. 318 (6.4%) patients died during hospitalisation. Lung (OR 3.70, 95% CI 2.42 to 5.89), kidney (OR 2.88, 95% CI 2.14 to 3.90) and heart (1.80, 95% CI 1.29 to 2.55) damage were associated with in-hospital mortality. Hierarchical clustering of laboratory indicators (estimated glomerular filtration rate, white blood cell count, platelet count, haemoglobin, N-terminal pro-B-type natriuretic peptide, serum albumin) demonstrated the ability to discriminate patients at high risk of in-hospital death. CONCLUSION Comorbidities and multiorgan failure are the prominent characteristics of NMPE patients, which increase the risk of in-hospital mortality, and comprehensive intervention for specific comorbidity patterns is suggested.
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Affiliation(s)
- Danni Wang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney, Beijing, China
| | - Yue Niu
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney, Beijing, China
| | - Yangyang Ma
- Department of Medical information, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Li Tang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney, Beijing, China
| | - Qingtao Zhang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney, Beijing, China
| | - Li Zhang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney, Beijing, China
| | - Xuefeng Sun
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney, Beijing, China
| | - Yan Mei
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney, Beijing, China
| | - Guangyan Cai
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney, Beijing, China
| | - Xiangmei Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney, Beijing, China
| | - Ping Li
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney, Beijing, China
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Zhang F, Xiang T, Feng X, Zhang G, Liu Y, Li L. Pleural effusion portends a poor prognosis in patients on continuous ambulatory peritoneal dialysis. PLoS One 2024; 19:e0297343. [PMID: 38241413 PMCID: PMC10798541 DOI: 10.1371/journal.pone.0297343] [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: 08/04/2023] [Accepted: 01/02/2024] [Indexed: 01/21/2024] Open
Abstract
AIMS Pleural effusion is not an infrequent complication in patients undergoing continuous ambulatory peritoneal dialysis. However, there is not adequate data to evaluate pleural effusion and prognosis in clinical practice. In this study, we validated this potential association by a multicenter cohort. METHODS We screened 1,162 patients who met the inclusion criteria with PD. According to the existence of pleural effusion on stable dialysis (4-8 weeks after dialysis initiation), the participants were divided into pleural effusion and non-pleural effusion groups. The hazard ratios (HRs) of all-cause and cause-specific death were estimated with adjustment for demographic characteristics and multiple potential clinical confounders. Subgroup analysis and propensity score matching (PSM) were used to further verify the robustness of the correlation between hydrothorax and prognosis. RESULTS Pleural effusion was found in 8.9% (104/1162) of PD individuals. After adjusting for the confounding factors, patients with pleural effusion had significantly increased HRs for all-cause death was 3.06 (2.36-3.96) and cardiovascular death was 3.78 (2.67-5.35) compared to those without pleural effusion. However, it was not associated with infectious and other causes of death. After PSM, the HR of all-cause mortality was 3.56 (2.28-5.56). The association trends were consistent in the subgroup sensitivity analysis. CONCLUSION Pleural effusion is not rare in PD, and is significantly associated with overall and cardiovascular mortality, which is independent of underlying diseases and clinically relevant indicators.
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Affiliation(s)
- Fengping Zhang
- Department of Nephrology, Jiujiang NO.1 People’s Hospital, Jiujiang, China
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Ting Xiang
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoran Feng
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Guilin Zhang
- Department of Nephrology, The NO.1 Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yu Liu
- Department of Nephrology, Pingxiang People’s Hospital, Pingxiang, China
| | - Luohua Li
- Department of Nephrology, Jiujiang NO.1 People’s Hospital, Jiujiang, China
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Matta A. Indwelling pleural catheters for benign pleural effusions: a concise review. Curr Opin Pulm Med 2023; 29:37-42. [PMID: 36336912 DOI: 10.1097/mcp.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE OF REVIEW Benign pleural effusions (BPEs) are more common than malignant effusions and their treatment involves treating the underlying disease process. However, in cases refractory to medical management, pleural interventions might be necessary. Use of indwelling pleural catheters (IPCs) has been gaining popularity for patients with refractory effusion. In this review, we will focus on reviewing the data assessing safety and efficacy of IPC in patients with BPE related to congestive heart failure (CHF), hepatic hydrothorax, end-stage renal disease (ESRD) and chylothorax. RECENT FINDINGS Several small studies including the most recent randomized control trial have looked into the efficacy and safety of IPC in BPE. Majority of data come from patients having CHF and hepatic hydrothorax as the underlying cause of the effusion. Limited data are available in patients with ESRD and chylothorax. Time to pleurodesis varies but is relatively higher in this patient population. Caution must be addressed in patients with immunocompromised status given a high risk of infection. SUMMARY IPCs are increasingly being used in patients with BPE refractory to medical management. They can be used both for palliation and to achieve pleurodesis in some cases. Further data in the form of randomized control trials are still needed to evaluate the efficacy and safety of its use in this patient population.
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Affiliation(s)
- Atul Matta
- Division of Pulmonary, Critical Care and Sleep Medicine - University of Texas Medical Branch (UTMB), Galveston, Texas, USA
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Park S, Kim WY, Baek MS. Risk Factors for Mortality Among Mechanically Ventilated Patients Requiring Pleural Drainage. Int J Gen Med 2022; 15:1637-1646. [PMID: 35210834 PMCID: PMC8858769 DOI: 10.2147/ijgm.s349249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/09/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Pleural effusions are common in mechanically ventilated patients. However, the risk factors for poor outcomes after pleural drainage are poorly understood. This study aimed to identify factors that were associated with in-hospital mortality among mechanically ventilated patients who underwent pleural drainage. Methods This retrospective study evaluated 82 consecutive patients who required chest tubes during mechanical ventilation at two university-affiliated hospitals in Korea between January 2015 and June 2020. Results The median age was 76 years (interquartile range [IQR]: 64–84 years), and the median SOFA score was 11 (IQR: 7–13). Intensive care unit admission was most commonly because of pneumonia (n = 44, 53.7%) and 60 patients (77.9%) had exudative pleural effusions. During pleural drainage, the PaO2/FiO2 was 210 (IQR: 153–253); 45 patients (54.9%) were receiving vasopressors, and 31 patients (37.8%) were receiving continuous renal replacement therapy (CRRT). The multivariable regression analysis revealed that poor overall survival was independently associated with receiving vasopressors (adjusted hazard ratio [aHR]: 3.81, 95% confidence interval [CI]: 1.65–8.81, p = 0.002) and receiving CRRT (aHR: 5.48, 95% CI: 2.29–13.12, p < 0.001). The PaO2/FiO2 ratio was relatively stable through the third day of pleural drainage among survivors but decreased among non-survivors. The vasopressor dose decreased among survivors but remained relatively stable among non-survivors. Conclusion Among mechanically ventilated patients who required pleural drainage, use of vasopressors and CRRT was significantly associated with in-hospital mortality. On the third day of pleural drainage, the changes in PaO2/FiO2 and vasopressor dose were associated with in-hospital mortality.
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Affiliation(s)
- Sojung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Won-Young Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Moon Seong Baek
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
- Correspondence: Moon Seong Baek, Email
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