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Tan X, Wu Y, Li F, Wei Q, Lu X, Huang X, He D, Huang X, Deng S, Hu L, Song F, Su Y. Development and validation of a prediction model for hypoproteinemia after traumatic spinal cord injury: A multicenter retrospective clinical study. Medicine (Baltimore) 2024; 103:e38081. [PMID: 38905385 PMCID: PMC11191892 DOI: 10.1097/md.0000000000038081] [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: 10/16/2023] [Accepted: 04/11/2024] [Indexed: 06/23/2024] Open
Abstract
A multicenter retrospective analysis of conventionally collected data. To identify the potential causes of hypoproteinemia after traumatic spinal cord injury (TSCI) and provide a diagnostic model for predicting an individual likelihood of developing hypoproteinemia. Hypoproteinemia is a complication of spinal cord injury (SCI), an independent risk factor for respiratory failure in elderly patients with SCI, and a predictor of outcomes in patients with cervical SCI. Few nomogram-based studies have used clinical indicators to predict the likelihood of hypoproteinemia following TSCI. This multicenter retrospective clinical analysis included patients with TSCI admitted to the First Affiliated Hospital of Guangxi Medical University, Wuzhou GongRen Hospital, and Dahua Yao Autonomous County People Hospital between 2016 and 2020. The data of patients from the First Affiliated Hospital of Guangxi Medical University were used as the training set, and those from the other 2 hospitals were used as the validation set. All patient histories, diagnostic procedures, and imaging findings were recorded. To predict whether patients with TSCI may develop hypoproteinemia, a least absolute shrinkage and selection operator regression analysis was conducted to create a nomogram. The model was validated by analyzing the consequences using decision curve analysis, calibration curves, the C-index, and receiver operating characteristic curves. After excluding patients with missing data, 534 patients were included in this study. Male/female sex, age ≥ 60 years, cervical SCI, pneumonia, pleural effusion, urinary tract infection (UTI), hyponatremia, fever, hypotension, and tracheostomy were identified as independent risk factors of hypoalbuminemia. A simple and easy-to-replicate clinical prediction nomogram was constructed using these factors. The area under the curve was 0.728 in the training set and 0.881 in the validation set. The predictive power of the nomogram was satisfactory. Hypoalbuminemia after TSCI may be predicted using the risk factors of male/female sex, age ≥ 60 years, cervical SCI, pneumonia, pleural effusion, UTI, hyponatremia, fever, hypotension, and tracheostomy.
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Affiliation(s)
- Xiuwei Tan
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yanlan Wu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fengxin Li
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qian Wei
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xuefeng Lu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaoxi Huang
- The People’s Hospital of Dahua Yao Autonomus County, Hechi, China
| | - Deshen He
- Wuzhou GongRen Hospital, Wuzhou, China
| | | | | | - Linting Hu
- Guangxi Medical University, Nanning, China
| | | | - Yiji Su
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Aday AW, Bagheri M, Vaitinadin NS, Mosley JD, Wang TJ. Polygenic risk score in comparison with C-reactive protein for predicting incident coronary heart disease. Atherosclerosis 2023; 379:117194. [PMID: 37536150 PMCID: PMC10529589 DOI: 10.1016/j.atherosclerosis.2023.117194] [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: 03/30/2023] [Revised: 07/11/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND AIMS Despite interest in the use of polygenic risk scores (PRS) for predicting coronary heart disease (CHD) risk, the clinical utility of PRS compared to conventional risk factors has not been demonstrated. We compared the performance of PRS with that of high-sensitivity C-reactive protein (hsCRP) in two well-established cohorts. METHODS The study population included individuals of European ancestry free of baseline CHD from ARIC (N = 13,113) and the Framingham Offspring Study (FHS) (N = 2,696). The primary predictors included a validated PRS consisting of >6.6 million single nucleotide polymorphisms and hsCRP. The outcome was incident CHD, defined as non-fatal or fatal myocardial infarction. We compared the performance of both predictors after adjusting for the Pooled Cohort Equations in multivariable-adjusted Cox regression models. We assessed discrimination and reclassification using c-statistics and net reclassification improvement. RESULTS Incident CHD occurred in 565 ARIC and 153 FHS participants. In multivariable-adjusted models, both PRS and hsCRP were associated with incident CHD (p < 0.05 in both cohorts). In models incorporating both predictors, strengths of association were similar. For instance, in ARIC, the hazard ratio per SD increment was 1.38 (95% CI, 1.27-1.50, p = 2.94 × 10-14) for PRS and 1.41 (1.30-1.55, p = 3.10 × 10-15) for hsCRP. Neither predictor significantly increased model discrimination or net reclassification when compared with models containing the Pooled Cohort Equations alone. CONCLUSIONS In two independent cohorts, PRS performed similarly to hsCRP for the prediction of CHD risk. These findings suggest PRS does not have unique clinical utility beyond this widely-available, inexpensive measure of risk in unselected middle-aged populations.
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Affiliation(s)
- Aaron W Aday
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Minoo Bagheri
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nataraja Sarma Vaitinadin
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan D Mosley
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas J Wang
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Higher levels of neutrophil percentage-to-albumin ratio predict increased mortality risk in patients with liver cirrhosis: a retrospective cohort study. Eur J Gastroenterol Hepatol 2023; 35:198-203. [PMID: 36472501 PMCID: PMC9770107 DOI: 10.1097/meg.0000000000002470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Recent studies indicated that the neutrophil percentage-to-albumin ratio (NPAR) was a predictor of mortality in several diseases. There has been no evidence to prove the predictive function of NPAR in patients with liver cirrhosis. Therefore, this study aimed to investigate the association between NPAR and clinical outcomes in cirrhotic patients. METHODS We retrospectively recruited hospitalized decompensated cirrhotic patients from the tertiary grade-A hospital. Patients with malignancy or severe cardiac, respiratory and kidney diseases were excluded. Demographical data, liver functions, complications and outcomes of cirrhosis were recorded. NPAR was calculated through the ratio of neutrophil percentage (%)/serum albumin concentration (g/dL) at admission to the hospital. Cox proportional hazards models were performed to evaluate the prognostic values of NPAR, and subgroup analyses were utilized to ensure stable results. RESULTS A total of 376 patients with decompensated liver cirrhosis at baseline were enrolled. The liver dysfunction, cirrhosis-related complications and mortality rate increased along with the tertiles of NPAR. In multivariate analysis, higher NPARs were independently associated with increased risk of mortality in patients with liver cirrhosis after adjustments for confounding factors (tertile 3 versus tertile 1: adjusted HR = 1.92; 95% CI, 1.04-3.56; P trend = 0.008) and each unit increase of NPAR implicated a 4% increase risk of mortality. Subgroup analysis demonstrated no significant interactions in most subgroups. CONCLUSION Increased NPAR was independently correlated with a higher risk of mortality in patients with liver cirrhosis.
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Manolis AS, Manolis AA. High C-Reactive Protein/Low Serum Albumin: A Hidden Villain in Cardiovascular Disease. Angiology 2022; 73:797-799. [PMID: 35941139 DOI: 10.1177/00033197221120135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Antonis S Manolis
- First Department of Cardiology, Athens University School of Medicine, Athens, Greece
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Manolis AA, Manolis TA, Melita H, Mikhailidis DP, Manolis AS. Low serum albumin: A neglected predictor in patients with cardiovascular disease. Eur J Intern Med 2022; 102:24-39. [PMID: 35537999 DOI: 10.1016/j.ejim.2022.05.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 01/02/2023]
Abstract
Albumin, the most abundant circulating protein in blood, is an essential protein which binds and transports various drugs and substances, maintains the oncotic pressure of blood and influences the physiological function of the circulatory system. Albumin also has anti-inflammatory, antioxidant, and antithrombotic properties. Evidence supports albumin's role as a strong predictor of cardiovascular (CV) risk in several patient groups. Its protective role extends to those with coronary artery disease, heart failure, hypertension, atrial fibrillation, peripheral artery disease or ischemic stroke, as well as those undergoing revascularization procedures or with aortic stenosis undergoing transcatheter aortic valve replacement, and patients with congenital heart disease and/or endocarditis. Hypoalbuminemia is a strong prognosticator of increased all-cause and CV mortality according to several cohort studies and meta-analyses in hospitalized and non-hospitalized patients with or without comorbidities. Normalization of albumin levels before discharge lowers mortality risk, compared with hypoalbuminemia before discharge. Modified forms of albumin, such as ischemia modified albumin, also has prognostic value in patients with coronary or peripheral artery disease. When albumin is combined with other risk factors, such as uric acid or C-reactive protein, the prognostic value is enhanced. Although albumin supplementation may be a plausible approach, its efficacy has not been established and in patients with hypoalbuminemia, priority is focused on diagnosing and managing the underlying condition. The CV effects of hypoalbuminemia and relevant issues are considered in this review. Large cohort studies and meta-analyses are tabulated and the physiologic effects of albumin and the deleterious effects of low albumin are pictorially illustrated.
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Affiliation(s)
| | - Theodora A Manolis
- Aiginiteio University Hospital, Athens University School of Medicine, Athens, Greece
| | - Helen Melita
- Central Laboratories, Onassis Cardiac Surgery Center, Athens, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Antonis S Manolis
- First Department of Cardiology, Athens University School of Medicine, Athens, Greece.
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Yao YF, Chen ZY, Luo TY, Dou XY, Chen HB. Cholesterol affects the relationship between albumin and major adverse cardiac events in patients with coronary artery disease: a secondary analysis. Sci Rep 2022; 12:12634. [PMID: 35879423 PMCID: PMC9314340 DOI: 10.1038/s41598-022-16963-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/19/2022] [Indexed: 02/05/2023] Open
Abstract
We aimed to examine whether the efficacy of the risk of poor prognosis in patients with coronary artery disease is jointly affected by total cholesterol and baseline serum albumin in a secondary analysis of previous study. We analyzed the data of 204 patients from October 2014 to October 2017 for newly diagnosed stable CAD. The outcome was major adverse cardiac events (MACE; defined as all cause mortality, non fatal myocardial infarction, and non fatal stroke). The median duration of follow-up was 783 days. Multivariable COX model was performed to revalidate the relationship between the sALB and MACE and interaction tests were conducted to find the effects of total cholesterol on their association. A total of 28 MACE occurred among the 204 participants. The risk of MACE varied by baseline serum albumin and total cholesterol. Specifically, lower serum albumin indicated higher risk of MACE (HR 3.52, 95% CI 1.30-9.54), and a test for interaction between baseline serum albumin and total cholesterol on MACE was significant (P = 0.0005). We suggested that baseline serum albumin and total cholesterol could interactively affect the risk of poor prognosis of patients with coronary artery diseases. Our findings need to be confirmed by further randomized trials.
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Affiliation(s)
- Yu-Feng Yao
- Department of Ophthalmology, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong Province, China
- Shantou University Medical College, No. 22 Xinling Road, 15724172356, Shantou, 515031, Guangdong Province, China
| | - Zhen-Yu Chen
- Department of Cardiovascular Medicine, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong Province, China
- Shantou University Medical College, No. 22 Xinling Road, 15724172356, Shantou, 515031, Guangdong Province, China
| | - Tian-Yi Luo
- Department of Ophthalmology, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong Province, China
- Shenzhen University, Shenzhen, 518037, Guangdong Province, China
| | - Xiao-Yan Dou
- Department of Ophthalmology, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong Province, China.
| | - Hai-Bo Chen
- Department of Cardiovascular Medicine, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong Province, China.
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