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Wang H, Liu Y, Yuan J, Wang Y, Yuan Y, Liu Y, Ren X, Zhou J. Development and validation of a nomogram for predicting mortality in patients with acute severe traumatic brain injury: A retrospective analysis. Neurol Sci 2024; 45:4931-4956. [PMID: 38722502 DOI: 10.1007/s10072-024-07572-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/29/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Recent evidence links the prognosis of traumatic brain injury (TBI) to various factors, including baseline clinical characteristics, TBI specifics, and neuroimaging outcomes. This study focuses on identifying risk factors for short-term survival in severe traumatic brain injury (sTBI) cases and developing a prognostic model. METHODS Analyzing 430 acute sTBI patients from January 2018 to December 2023 at the 904th Hospital's Neurosurgery Department, this retrospective case-control study separated patients into survival outcomes: 288 deceased and 142 survivors. It evaluated baseline, clinical, hematological, and radiological data to identify risk and protective factors through univariate and Lasso regression. A multivariate model was then formulated to pinpoint independent prognostic factors, assessing their relationships via Spearman's correlation. The model's accuracy was gauged using the Receiver Operating Characteristic (ROC) curve, with additional statistical analyses for quantitative factors and model effectiveness. Internal validation employed ROC, calibration curves, Decision Curve Analysis (DCA), and Clinical Impact Curves (CIC) to assess model discrimination, utility, and accuracy. The International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) and Corticosteroid Randomization After Significant Head injury (CRASH) models were also compared through multivariate regression. RESULTS Factors like unilateral and bilateral pupillary non-reactivity at admission, the derived neutrophil to lymphocyte ratio (dNLR), platelet to lymphocyte ratio (PLR), D-dimer to fibrinogen ratio (DFR), infratentorial hematoma, and Helsinki CT score were identified as independent risk factors (OR > 1), whereas serum albumin emerged as a protective factor (OR < 1). The model showed superior predictive performance with an AUC of 0.955 and surpassed both IMPACT and CRASH models in predictive accuracy. Internal validation confirmed the model's high discriminative capability, clinical relevance, and effectiveness. CONCLUSIONS Short-term survival in sTBI is significantly influenced by factors such as pupillary response, dNLR, PLR, DFR, serum albumin levels, infratentorial hematoma occurrence, and Helsinki CT scores at admission. The developed nomogram accurately predicts sTBI outcomes, offering significant clinical utility.
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Affiliation(s)
- Haosheng Wang
- Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu Province, 214000, China
- The Fifth Clinical Medical College of Anhui Medical University, Wuxi, Jiangsu Province, 214000, China
- Department of Neurosurgery, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, Jiangsu Province, 214000, China
| | - Yehong Liu
- Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, Jiangsu Province, 214000, China
| | - Jun Yuan
- Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu Province, 214000, China
- The Fifth Clinical Medical College of Anhui Medical University, Wuxi, Jiangsu Province, 214000, China
- Department of Neurosurgery, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, Jiangsu Province, 214000, China
| | - Yuhai Wang
- Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu Province, 214000, China
- The Fifth Clinical Medical College of Anhui Medical University, Wuxi, Jiangsu Province, 214000, China
- Department of Neurosurgery, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, Jiangsu Province, 214000, China
| | - Ying Yuan
- Institute of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, 230022, China
| | - Yuanyuan Liu
- Department of Neurosurgery, The Lu' an Hospital Affiliated to Anhui Medical University, Lu'an, Anhui Province, 237000, China
| | - Xu Ren
- Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu Province, 214000, China
- The Fifth Clinical Medical College of Anhui Medical University, Wuxi, Jiangsu Province, 214000, China
- Department of Neurosurgery, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, Jiangsu Province, 214000, China
| | - Jinxu Zhou
- Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu Province, 214000, China.
- The Fifth Clinical Medical College of Anhui Medical University, Wuxi, Jiangsu Province, 214000, China.
- Department of Neurosurgery, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, Jiangsu Province, 214000, China.
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Wiedermann CJ. Albumin in Normovolemic Fluid Management for Severe Traumatic Brain Injury: Controversies and Research Gaps. J Clin Med 2024; 13:5452. [PMID: 39336939 PMCID: PMC11432589 DOI: 10.3390/jcm13185452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 08/22/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024] Open
Abstract
Traumatic brain injury (TBI) is a significant public health issue characterized by high mortality rates and long-term complications. This commentary examines the controversial role of the use of albumin in the fluid management of patients with severe TBI. Despite its physiological benefits, the clinical use of albumin remains controversial due to the fact that various studies have yielded mixed results. Serum albumin is important for maintaining normovolemia, primarily through its contribution to colloid osmotic pressure, which helps to retain fluid in the circulatory system. This review highlights the existing evidence, examines inconsistencies in guideline recommendations, and suggests future research directions to clarify the efficacy and safety of the use of albumin in maintaining normovolemia in patients with TBI. The review also discusses the potential benefits of small-volume resuscitation strategies for the management of acute kidney injury in TBI patients, drawing parallels with the management of septic acute kidney injury. The need for further well-designed randomized controlled trials and ethical considerations in studies regarding the use of hyperoncotic albumin in TBI management is emphasized.
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Affiliation(s)
- Christian J. Wiedermann
- Institute of General Practice and Public Health, Claudiana—College of Health Professions, 39100 Bolzano, Italy;
- Department of Public Health, Medical Decision Making and Health Technology Assessment, UMIT TIROL—Private University for Health Sciences and Health Technology, 6060 Hall, Austria
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Liu Y, Tan Y, Wan J, Chen Q, Zheng Y, Xu W, Wang P, Chong W, Yu X, Zhang Y. Association of C-reactive protein/albumin ratio with mortality in patients with Traumatic Brain Injury: A systematic review and meta-analysis. Heliyon 2024; 10:e33460. [PMID: 39035503 PMCID: PMC11259862 DOI: 10.1016/j.heliyon.2024.e33460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/21/2024] [Accepted: 06/21/2024] [Indexed: 07/23/2024] Open
Abstract
Objective This study examines the C-reactive protein (CRP)/albumin ratio (CAR) as an inflammation-based prognostic score for predicting mortality in patients with Traumatic Brain Injury (TBI). Methods We systematically searched the electronic databases PubMed, Embase, and Cochrane up to February 2024. Our inclusion criteria encompassed studies investigating CAR-predicted mortality in patients with TBI. We calculated the Odds Ratio (OR) and associated 95 % confidence intervals (95 % CI) using a random-effects model. Quality assessment of the included studies was appraised using a Newcastle-Ottawa scale. Results A total of five studies comprising 1040 patients were included in this meta-analysis. The pooled results indicated that CAR was associated with mortality in patients with TBI (OR = 1.88, 95 % CI: 1.05-3.36, P < 0.0001). The findings of subgroup analysis indicated that the relationship between CAR and mortality in patients with TBI did not vary with the severity of the condition. Conclusions CAR emerges as a valuable prognostic tool for mortality in patients with TBI, underscoring its potential role in early risk stratification and management strategies.
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Affiliation(s)
- Yuyang Liu
- Center for Evidence-based Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yaheng Tan
- Public Health Clinical Center of Chengdu, Chengdu, Sichuan, China
| | - Jun Wan
- Center for Evidence-based Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Qiwen Chen
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yuxin Zheng
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Wenhao Xu
- Center for Evidence-based Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Peng Wang
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weelic Chong
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Xueying Yu
- Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yu Zhang
- Center for Evidence-based Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
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Sun M, Gu L, Li Y, Luo F, Tao Y, Shen W, Xie Z. Procalcitonin/Albumin Ratio Predicts the Outcome After Severe Traumatic Brain Injury: A Propensity Score-Matched Analysis. Neurocrit Care 2024; 40:664-673. [PMID: 37523109 DOI: 10.1007/s12028-023-01792-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The procalcitonin/albumin ratio (PAR), a novel inflammation-based index, has been reported to predict the prognosis following cardiopulmonary bypass surgery and bacterial infection. However, whether PAR can predict the outcome of patients with severe traumatic brain injury (STBI) has not been fully elucidated. This study aimed to investigate the relationship between serum PAR levels and prognosis at 6 months after STBI. METHODS We retrospectively enrolled 129 patients diagnosed with STBI and collected relevant clinical and laboratory data. Logistic regression analysis was used to estimate the association of PAR with the prognosis of STBI. The receiver operating characteristics curve was performed to examine the predictive use of PAR for prognosis. Propensity score matching (PSM) analysis was also performed to improve the reliability of the results. The primary outcome measures were expressed as a score on the modified Rankin Scale at 6 months. RESULTS The unfavorable prognosis group had advanced age, lower Glasgow Coma Scale score, higher rate of cerebral hernia and intracranial infection, higher neutrophil/lymphocyte ratio (NLR) and C-reactive protein/albumin ratio (CAR), elevated PAR, and higher rate of pneumonia. Multivariate analysis showed that PAR (before PSM: odds ratio 3.473, 95% confidence interval 2.983-4.043, P < 0.001; after PSM: odds ratio 5.358, 95% confidence interval 3.689-6.491, P < 0.001) was independently associated with unfavorable outcome. The area under the curve of the PAR for predicting an unfavorable outcome was higher than that of the CAR and NLR. CONCLUSIONS The PAR might be a novel independent risk factor of the outcome after STBI. Moreover, PAR was a better biomarker in predicting the outcome of patients with STBI than CAR and NLR.
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Affiliation(s)
- Mingjiang Sun
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lingui Gu
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma Multi-disciplinary Team Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuanyou Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Fushu Luo
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yihao Tao
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China
| | - Weiwei Shen
- Department of Endocrinology, The First Affiliated Hospital, Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Zongyi Xie
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China.
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Kumar M, Jain K, Chauhan R, Meena SC, Luthra A, Thakur H, Singh A, Nair R, Gupta R. Hypoalbuminemia: incidence and its impact on acute respiratory distress syndrome and 28-day outcome in trauma patients. Eur J Trauma Emerg Surg 2023; 49:2305-2314. [PMID: 37402792 DOI: 10.1007/s00068-023-02318-5] [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: 02/25/2023] [Accepted: 06/25/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE This prospective observational study explored the effect of early onset hypoalbuminemia (EOH) on the development of adult respiratory distress syndrome (ARDS) in orthopedic trauma victims. METHODS Serum albumin levels were measured for the initial 7 days of injury for adult trauma patients (18-65 years). Patients were recruited into group A (any serum albumin value < 3.5 mg/dl) and group B (all serum albumin ≥ 3.5 mg/dl), based on serum albumin values. Patients were followed for the development of ARDS and outcome until 28 days. The primary outcome of the study was to explore the effects of EOH on ARDS. RESULTS EOH (any serum albumin value < 3.5 g/dl within 7 days of injury) was present in 205/386 (53.1%) patients. The majority of 174/205 (84.9%) patients had EOH by the fourth day after the injury, with the mean time for development of EOH being 2.15 ± 1.87 days. ARDS manifested in 87/205 (42.4%) and 15/181 (8.3%) patients in group A and group B, respectively (p < 0.001). EOH had 8.2 times greater odds of ARDS (OD 8.2 95% CL 4.7-14.0, p = 0.000). The mean time for the onset of ARDS was 5.63 ± 2.62 days. No statistically significant causal relationship occurred between the onset of EOH and the development of ARDS (Pearson's correlation coefficient = 0.14, p = 0.16). At serum albumin cutoff concentrations of 3.4 gm/dl on D1 (AUC 0.68, 95% CI: 0.61-0.74, p = 0.000), ARDS may be anticipated in 62.8% of patients. The commencement of ARDS was independently correlated with EOH (p = 0.000), Respiratory rate on admission (p = 0.000), inotrope use (p = 0.000), and soft tissue injury (p = 0.000) (R2 = 0.466). The odds of 28-day all-cause death were 7.7 times higher in EOH (OD 7.7 95% CL 3.5-16.7, p = 0.00) and 9 times higher in ARDS (OD 9 95% CL 4.9-16.16, p = 0.00). CONCLUSION EOH is a frequent occurrence and has a strong influence development of ARDS and 28-day mortality in trauma patients.
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Affiliation(s)
- Mandeep Kumar
- PGIMER: Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Kajal Jain
- PGIMER: Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Rajeev Chauhan
- PGIMER: Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Shyam Charan Meena
- PGIMER: Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India.
| | - Ankur Luthra
- PGIMER: Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Haneesh Thakur
- PGIMER: Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Ajay Singh
- PGIMER: Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Revathi Nair
- PGIMER: Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Rekha Gupta
- PGIMER: Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
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Castellani GB, Maietti E, Leonardi G, Bertoletti E, Trapani F, Battistini A, Tedeschi S, Piperno R, Viale P. Healthcare-associated infections and antimicrobial resistance in severe acquired brain injury: a retrospective multicenter study. Front Neurol 2023; 14:1219862. [PMID: 37662048 PMCID: PMC10469002 DOI: 10.3389/fneur.2023.1219862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/24/2023] [Indexed: 09/05/2023] Open
Abstract
Background Recent studies underscore that healthcare-associated infections (HAIs) and multidrug-resistant (MDR) HAIs affect rehabilitation outcomes and hospital length of stay (LOS) for severe acquired brain injury (sABI). Objective This study aimed to estimate HAI incidence in different sABI rehabilitation settings and determine risk factors and HAI impact on neuromotor and cognitive recovery. Methods We conducted a retrospective multicenter study in two semi-intensive units (SICUs), two high-specialty post-acute units (PAUs), and one long-term care (LTC) rehabilitation facility. Data extraction was performed by experienced clinicians, using a structured Excel file and they agreed upon criteria for case definitions of healthcare. The main outcome measures were the HAI and MDR HAI incidence and the LOS, the functional recovery was measured using the Level of Cognitive Functioning and Disability Rating Scale. Results There were 134 sABI participants. The calculation of the probability level was adjusted for three pairwise comparisons among settings (0.05/3 = 0.017). The HAI and MDR HAI incidences were significantly higher in SICU (3.7 and 1.3 per 100 person-days) than in other settings (LTC: 1.9, p = 0.034 and 0.5, p = 0.026; PAU: 1.2, p < 0.001 and 0.3, p < 0.001). HAI and MDR HAI risk variables included older age, an increased number of devices, and carbapenemase-producing Enterobacteriaceae (CPE) colonization, while a high prealbumin plasma value seemed to have a protective effect. Conclusion HAIs are related to longer LOS, and colonization is associated with poor prognosis and poor functional outcomes with reduced ability to achieve the cognitive capacity of self-care, employability, and independent living. The need to ensure the protection of non-colonized patients, especially those with severe disabilities on admission, is highlighted.
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Affiliation(s)
| | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Gloria Leonardi
- Department of Long-Term Care Rehabilitation, Santa Viola Hospital Colibrì Consortium, Bologna, Italy
| | - Erik Bertoletti
- Department of Long-Term Care Rehabilitation, Santa Viola Hospital Colibrì Consortium, Bologna, Italy
| | - Filippo Trapani
- Infectious Disease Unit, Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alberto Battistini
- Rehabilitation Medicine and Neurorehabilitation Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Sara Tedeschi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Roberto Piperno
- Rehabilitation Medicine and Neurorehabilitation Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Ginstman F, Ghafouri B, Zsigmond P. Altered levels of transthyretin in human cerebral microdialysate after subarachnoid haemorrhage using proteomics; a descriptive pilot study. Proteome Sci 2023; 21:10. [PMID: 37420193 DOI: 10.1186/s12953-023-00210-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 06/19/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Subarachnoid haemorrhage (SAH) is one of the most severe forms of stroke in which delayed cerebral ischemia is one of the major complications. Neurointensive care aims at preventing and treating such complications and identification of biomarkers of early signs of ischemia might therefore be helpful. METHODS We aimed at describing proteome profile in cerebral microdialysate in four patients with aneurysmal SAH using two dimensional gel electrophoresis in combination with mass spectrometry in search for new biomarkers for delayed cerebral ischemia and to investigate if there were temporal fluctuations in those biomarkers over time after aneurysmal bleed. RESULTS The results showed transthyretin in nine different proteoforms (1001, 1102, 2101, 3101, 4101, 4102, 5001, 5101, 6101) in cerebral microdialysate samples from four patients having sustained SAH. Several proteoforms show highly differing levels and pooled analysis of all samples showed varying optical density related to time from aneurysmal bleed, indicating a temporal evolution. CONCLUSIONS Transthyretin proteoforms have not earlier been shown in cerebral microdialysate after SAH and we describe differing levels based on proteoform as well as time from subarachnoid bleed. Transthyretin is well known to be synthetized in choroid plexus, whilst intraparenchymal synthesis remains controversial. The results need to be confirmed in larger studies in order to further describe transthyretin.
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Affiliation(s)
- Fredrik Ginstman
- Department of Neurosurgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Bijar Ghafouri
- Pain and Rehabilitation Center and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Zsigmond
- Department of Neurosurgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Lee JH, Lee D, Lee BK, Cho YS, Kim DK, JUNG YH, Ryu SJ, No E. The association between lactate to albumin ratio and outcomes at early phase in patients with traumatic brain injury. ULUS TRAVMA ACIL CER 2023; 29:752-757. [PMID: 37409915 PMCID: PMC10405036 DOI: 10.14744/tjtes.2023.40033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/17/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The majority of traumatic brain injury (TBI) cases result in death in the early phase; predicting short-term progno-sis of affected patients is necessary to prevent this. This study aimed to examine the association between the lactate-to-albumin ratio (LAR) on admission and outcomes in the early phase of TBI. METHODS This retrospective observational study included patients with TBI who visited our emergency department between January 2018 and December 2020. TBI was considered as an head abbreviated injury scale (AIS) score of 3 or higher and other AIS of 2 or lower. The primary and secondary outcomes were 24-h mortality and massive transfusion (MT), respectively. RESULTS In total, 460 patients were included. The 24-h mortality was 12.6% (n=28) and MT was performed in 31 (6.7%) patients. In the multivariable analysis, LAR was associated with 24-h mortality (odds ratio [OR], 2.021; 95% confidence interval [CI], 1.301-3.139) and MT (OR, 1.898; 95% CI, 1.288-2.797). The areas under the curve of LAR for 24-h mortality and MT were 0.805 (95% CI, 0.766-0.841) and 0.735 (95% CI, 0.693-0.775), respectively. CONCLUSION LAR was associated with early-phase outcomes in patients with TBI, including 24-h mortality and MT. LAR may help predict these outcomes within 24 h in patients with TBI.
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Affiliation(s)
- Ji Ho Lee
- Department of Emergency Medicine Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - DongHun Lee
- Department of Emergency Medicine Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Byung Kook Lee
- Department of Emergency Medicine Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Soo Cho
- Department of Emergency Medicine Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Dong Ki Kim
- Department of Emergency Medicine Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Hun JUNG
- Department of Emergency Medicine Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Seok Jin Ryu
- Department of Emergency Medicine Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Eul No
- Department of Emergency Medicine Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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9
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Wang Y, Gong Y, Chen D, Xu F, Yang P. C-Reactive Protein/Albumin Ratio Is Associated with Mortality in Patients with Moderate to Severe Traumatic Brain Injury. World Neurosurg 2023; 173:e234-e240. [PMID: 36796630 DOI: 10.1016/j.wneu.2023.02.037] [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: 11/15/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND The C-reactive protein/albumin ratio (CAR), Glasgow coma scale score, and blood glucose level serve as reference values to evaluate the prognosis of critically ill patients. However, the prognostic significance of the admission serum CAR for patients with moderate to severe traumatic brain injury (TBI) has remained unclear. We examined the effect of the admission CAR on the outcomes of patients with moderate to severe TBI. METHODS The clinical data from 163 patients with moderate to severe TBI were collected. Before analysis, the patients' records were anonymized and de-identified. Multivariate logistic regression analyses were used to investigate the risk factors and construct a prognostic model of in-hospital mortality. The predictive value of different models was compared by evaluating the areas under the receiver operating characteristic curve. RESULTS Of the 163 patients, those who had not survived (nonsurvivors, n = 34) had had a higher CAR than that of the survivors (3.8 vs. 2.6; P < 0.001). The results of multivariate logistic regression analysis indicated that the Glasgow coma scale score (odds ratio [OR], 0.430; P = 0.001), blood glucose (OR, 1.290; P = 0.017), and CAR (OR, 1.609; P = 0.036) were independent risk factors for mortality and were used to construct the prognostic model. The area under the receiver operating characteristic curve of the prognostic model was 0.922 (95% confidence interval, 0.875-0.970), higher than that for the CAR (P = 0.0409). We had screened 195 patients for inclusion in the present study and excluded 32 patients. CONCLUSIONS The CAR can serve as an independent risk factor of mortality for patients with moderate to severe TBI. Incorporating CAR into a predictive model could contribute to efficiently predicting the prognosis of adults with moderate to severe TBI.
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Affiliation(s)
- Yifei Wang
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yue Gong
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Du Chen
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Feng Xu
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Peng Yang
- The First Affiliated Hospital of Soochow University, Suzhou, China.
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10
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Xiong Q, Le K, Wang Y, Tang Y, Dong X, Zhong Y, Zhou Y, Feng Z. A prediction model of clinical outcomes in prolonged disorders of consciousness: A prospective cohort study. Front Neurosci 2023; 16:1076259. [PMID: 36817098 PMCID: PMC9936154 DOI: 10.3389/fnins.2022.1076259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/31/2022] [Indexed: 02/05/2023] Open
Abstract
Objective This study aimed to establish and validate a prediction model for clinical outcomes in patients with prolonged disorders of consciousness (pDOC). Methods A total of 170 patients with pDOC enrolled in our rehabilitation unit were included and divided into training (n = 119) and validation sets (n = 51). Independent predictors for improved clinical outcomes were identified by univariate and multivariate logistic regression analyses, and a nomogram model was established. The nomogram performance was quantified using receiver operating curve (ROC) and calibration curves in the training and validated sets. A decision curve analysis (DCA) was performed to evaluate the clinical usefulness of this nomogram model. Results Univariate and multivariate logistic regression analyses indicated that age, diagnosis at entry, serum albumin (g/L), and pupillary reflex were the independent prognostic factors that were used to construct the nomogram. The area under the curve in the training and validation sets was 0.845 and 0.801, respectively. This nomogram model showed good calibration with good consistency between the actual and predicted probabilities of improved outcomes. The DCA demonstrated a higher net benefit in clinical decision-making compared to treating all or none. Conclusion Several feasible, cost-effective prognostic variables that are widely available in hospitals can provide an efficient and accurate prediction model for improved clinical outcomes and support clinicians to offer suitable clinical care and decision-making to patients with pDOC and their family members.
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Affiliation(s)
- Qi Xiong
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Kai Le
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yong Wang
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yunliang Tang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaoyang Dong
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yuan Zhong
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yao Zhou
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhen Feng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China,*Correspondence: Zhen Feng ✉
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11
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Qin Y, Liu M, Guo F, Chen D, Yang P, Chen X, Xu F. The Efficacy of Parenteral Nutrition and Enteral Nutrition Supports in Traumatic Brain Injury: A Systemic Review and Network Meta-Analysis. Emerg Med Int 2023; 2023:8867614. [PMID: 37125379 PMCID: PMC10139805 DOI: 10.1155/2023/8867614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/05/2023] [Accepted: 03/11/2023] [Indexed: 05/02/2023] Open
Abstract
Background Enteral nutrition (EN) is often used in patients with traumatic brain injury (TBI), but some studies have shown that EN has its disadvantages. However, it is not clear which nutritional support is appropriate to reduce mortality, improve prognosis, and improve nutritional status in patients with TBI. We performed this Bayesian network meta-analysis to evaluate the improvement of nutritional indicators and the clinical outcomes of patients with TBI. Methods We systematically searched PubMed, Embase, Cochrane Library, and Web of Science from inception until December 2021. All randomized controlled trials (RCTs) which compared the effects of different nutritional supports on clinical outcomes and nutritional indicators in patients with TBI were included. The co-primary outcomes included mortality and the value of serum albumin. The secondary outcomes were nitrogen balance, the length of study (LOS) in the ICU, and feeding-related complications. The network meta-analysis was performed to adjust for indirect comparison and mixed treatment analysis. Results 7 studies enroll a total of 456 patients who received different nutritional supports including parenteral nutrition (PN), enteral nutrition (EN), and PN + EN. No effects on in-hospital mortality (Median RR = 1.06, 95% Crl = 0.12 to 1.77) and the value of 0-1 days of serum albumin were found between the included regimens. However, the value of 11-13 days of serum albumin of EN was better than that of PN (WMD = -4.95, 95% CI = -7.18 to -2.72, P < 0.0001, I 2 = 0%), and 16-20 days of serum albumin of EN + PN was better than that of EN (WMD = -7.42, 95% CI = -14.51 to -0.34, P=0.04, I 2 = 90%). No effects on the 5-7 day nitrogen balance were found between the included regimens. In addition, the complications including pneumonia and sepsis have no statistical difference between EN and PN. EN was superior to PN in terms of LOS in the ICU and the incidence rate of stress ulcers. Although the difference in indirect comparisons between the included regimens was not statistically significant, the results showed that PN seemed to rank behind other regimens, and the difference between them was extremely small. Conclusion Available evidence suggests that EN + PN appears to be the most effective strategy for patients with TBI in improving clinical outcomes and nutritional support compared with other nutritional supports. Further trials are required.
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Affiliation(s)
- Yan Qin
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Maoxia Liu
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Fengbao Guo
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Du Chen
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Peng Yang
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xionghui Chen
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Feng Xu
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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12
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Detection of factors affecting kidney function using machine learning methods. Sci Rep 2022; 12:21740. [PMID: 36526702 PMCID: PMC9758148 DOI: 10.1038/s41598-022-26160-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Due to the increasing prevalence of chronic kidney disease and its high mortality rate, study of risk factors affecting the progression of the disease is of great importance. Here in this work, we aim to develop a framework for using machine learning methods to identify factors affecting kidney function. To this end classification methods are trained to predict the serum creatinine level based on numerical values of other blood test parameters in one of the three classes representing different ranges of the variable values. Models are trained using the data from blood test results of healthy and patient subjects including 46 different blood test parameters. The best developed models are random forest and LightGBM. Interpretation of the resulting model reveals a direct relationship between vitamin D and blood creatinine level. The detected analogy between these two parameters is reliable, regarding the relatively high predictive accuracy of the random forest model reaching the AUC of 0.90 and the accuracy of 0.74. Moreover, in this paper we develop a Bayesian network to infer the direct relationships between blood test parameters which have consistent results with the classification models. The proposed framework uses an inclusive set of advanced imputation methods to deal with the main challenge of working with electronic health data, missing values. Hence it can be applied to similar clinical studies to investigate and discover the relationships between the factors under study.
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13
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Jung E, Ryu HH, Ko CW, Lim YD. Elevated C-reactive protein-to-albumin ratio with fever is a predictor of poor functional outcome in patients with mild traumatic brain injury. Heliyon 2022; 8:e12153. [PMID: 36568655 PMCID: PMC9768302 DOI: 10.1016/j.heliyon.2022.e12153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/07/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction The C-reactive protein -to-albumin ratio (CAR), a novel inflammation-based prognostic score, is useful in predicting clinical outcomes, including those in central nervous system diseases. However, no report has identified the relationship between CAR and long-term clinical outcomes in patients with mild traumatic brain injury (mTBI). We aimed to evaluate the relationship between CAR and long-term functional outcomes in patients with mTBI and analyze whether CAR is associated with the presence of fever. Methods This was a retrospective observational study includes 387 adult patients with mTBI who were treated at a level-1 trauma center between 2017 and 2021. The main exposure variable was an elevated CAR, and the main outcomes were degrees of disability and quality of life measured using the modified Rankin Scale (mRS). A multivariable logistic regression analysis was performed to estimate the effect size of CAR on study outcomes. An interaction analysis was performed between CAR and fever on study outcomes. Results Elevated CAR had no significant association with poor functional outcomes (aOR [95% CI]: 1.35 [0.39-4.69]) in patients with mTBI. In the interaction analysis, elevated CAR was not associated with increased poor functional outcomes in the absence of fever (1.08 [0.55-2.13]), but a significant increase in poor functional outcomes was observed when elevated CAR was accompanied by fever (1.32 [1.14-2.56)). Conclusions Elevated CAR with fever increased the risk of poor functional recovery at 6 months after hospital discharge in patients with mTBI. Our study findings suggest the need for strategies for the prevention of long-term poor functional recovery in the presence of high CAR and fever in patients with mTBI.
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Affiliation(s)
- Eujene Jung
- Chonnam National University Hospital, Gwangju, South Korea
| | - Hyun Ho Ryu
- Chonnam National University Hospital, Gwangju, South Korea,Chonnam National University College of Medicine,Corresponding author.
| | - Cha won Ko
- Chonnam National University Hospital, Gwangju, South Korea
| | - Yong Deok Lim
- Chonnam National University Hospital, Gwangju, South Korea
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Wang R, He M, Qu F, Zhang J, Xu J. Lactate Albumin Ratio Is Associated With Mortality in Patients With Moderate to Severe Traumatic Brain Injury. Front Neurol 2022; 13:662385. [PMID: 35432157 PMCID: PMC9011050 DOI: 10.3389/fneur.2022.662385] [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: 02/01/2021] [Accepted: 02/03/2022] [Indexed: 11/28/2022] Open
Abstract
Background Traumatic brain injury (TBI) is a serious public health issue all over the world. This study was designed to evaluate the prognostic value of lactate to albumin ratio (LAR) on patients with moderate to severe TBI. Methods Clinical data of 273 moderate to severe TBI patients hospitalized in West China Hospital between May 2015 and January 2018 were collected. Multivariate logistic regression analyses were used to explore risk factors and construct a prognostic model of in-hospital mortality in this cohort. A receiver operating characteristic (ROC) curve was drawn to evaluate the discriminative ability of this model. Results Non-survivors had higher LAR than survivors (1.09 vs. 0.53, p < 0.001). Results of multivariate logistic regression analysis showed that Glasgow Coma Scale (GCS; odds ratio [OR] = 0.743, p = 0.001), blood glucose (OR = 1.132, p = 0.005), LAR (OR = 1.698, p = 0.022), subdural hematoma (SDH; OR = 2.889, p = 0.006), intraparenchymal hemorrhage (IPH; OR = 2.395, p = 0.014), and diffuse axonal injury (DAI; OR = 2.183, p = 0.041) were independent risk factors of in-hospital mortality in included patients. These six factors were utilized to construct the prognostic model. The area under the ROC curve (AUC) values of single lactate, albumin, and LAR were 0.733 (95% Cl; 0.673–0.794), 0.740 (95% Cl; 0.683–0.797), and 0.780 (95% Cl; 0.725–0.835), respectively. The AUC value of the prognostic model was 0.857 (95%Cl; 0.812–0.901), which was higher than that of LAR (Z = 2.1250, p < 0.05). Conclusions Lactate to albumin ratio is a readily available prognostic marker of moderate to severe TBI patients. A prognostic model incorporating LAR is beneficial for clinicians to evaluate possible progression and make treatment decisions in TBI patients.
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Affiliation(s)
- Ruoran Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Min He
| | - Fengyi Qu
- Department of Radiation Oncolygy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jing Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Jianguo Xu
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15
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Ha JW, Pyo JY, Ahn SS, Song JJ, Park YB, Lee SW. Nutrition Risk Index Score at Diagnosis Can Effectively Predict Poor Prognosis in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. J Ren Nutr 2021; 32:423-431. [PMID: 34294554 DOI: 10.1053/j.jrn.2021.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/08/2021] [Accepted: 06/06/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES This study investigated whether the nutritional risk index (NRI) score at diagnosis might be useful for anticipating poor prognosis, in particular, all-cause mortality and end-stage renal disease (ESRD) in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). METHODS The medical records of 242 immunosuppressive drug-naïve patients with AAV were retrospectively reviewed. Data at diagnosis and poor prognosis and medications during follow-up were assessed. The NRI score was calculated by 1.519 × serum albumin (g/L) + 41.7 × present (kg)/ideal body weight (kg). RESULTS The median age at diagnosis of patients with AAV (131 microscopic polyangiitis, 62 granulomatosis with polyangiitis, and 49 eosinophilic granulomatosis with polyangiitis) was 60 years (85 male). During follow-up, twenty-nine patients (12.0%) died after a period of 35.9 months, and 42 patients (17.4%) had ESRD for a period of 30.0 months. Using the receiver operator characteristic curve, the cutoffs of the NRI scores for all-cause mortality and ESRD were calculated as NRI ≤ 101.95 (sensitivity, 46.5%; specificity, 89.7%) and NRI ≤ 99.85 (sensitivity, 57.0%; specificity, 83.3%). In the multivariable Cox hazard model analyses, age (hazard ratio [HR], 1.035), five-factor score (HR, 1.623), and the NRI score ≤ 101.95 (HR, 4.262) were independent predictors of all-cause mortality, whereas, five-factor score (HR, 1.516), hypertension (HR, 1.906), and the NRI score ≤ 99.85 (HR, 3.623) were independent predictors of ESRD occurrence during follow-up in patients with AAV. CONCLUSIONS The NRI score at diagnosis may be a useful index to anticipate all-cause mortality and ESRD occurrence during follow-up in patients with AAV.
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Affiliation(s)
- Jang Woo Ha
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Yoon Pyo
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Soo Ahn
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jason Jungsik Song
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Lu Y, Ren C, Jiang J. The Relationship Between Prognostic Nutritional Index and All-Cause Mortality in Critically Ill Patients: A Retrospective Study. Int J Gen Med 2021; 14:3619-3626. [PMID: 34305408 PMCID: PMC8296707 DOI: 10.2147/ijgm.s318896] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/02/2021] [Indexed: 01/21/2023] Open
Abstract
Purpose The effectiveness and prognostic value of the prognostic nutritional index (PNI) in critically ill patients are unknown. Hence, this study aimed to analyze the relationship between the PNI and all-cause mortality in critically ill patients. Patients and Methods Patient data were obtained from the Multiparameter Intelligent Monitoring in Intensive Care III database. The relationship between the PNI and in-hospital mortality was analyzed using receiver operating characteristic curve analysis and a logistic regression model. Propensity score matching (PSM) was used to eliminate the bias caused by confounding factors. The Kaplan-Meier curve and Cox regression model were used to test the effect of the PNI on 30-, 90-, 180-, and 365-day mortality. Results A low PNI score is an independent risk factor for in-hospital mortality in critically ill patients. A total of 3644 cases were successfully matched using PSM. The PSM group with balanced covariates obtained similar results in the three models, which were statistically significant. The Kaplan-Meier curve and Cox regression model showed that the PNI was negatively correlated with 30-, 90-, 180-, and 365-day all-cause mortality. Conclusion The PNI score is an independent risk factor for all-cause mortality in critically ill patients, where a low PNI score is associated with increased mortality.
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Affiliation(s)
- Yan Lu
- Clinical Laboratory, DongYang People's Hospital, Dongyang, 322100, Zhejiang, People's Republic of China
| | - Chaoxiang Ren
- Clinical Laboratory, DongYang People's Hospital, Dongyang, 322100, Zhejiang, People's Republic of China
| | - Jinwen Jiang
- Clinical Laboratory, DongYang People's Hospital, Dongyang, 322100, Zhejiang, People's Republic of China
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Mismatch between Tissue Partial Oxygen Pressure and Near-Infrared Spectroscopy Neuromonitoring of Tissue Respiration in Acute Brain Trauma: The Rationale for Implementing a Multimodal Monitoring Strategy. Int J Mol Sci 2021; 22:ijms22031122. [PMID: 33498736 PMCID: PMC7865258 DOI: 10.3390/ijms22031122] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/21/2022] Open
Abstract
The brain tissue partial oxygen pressure (PbtO2) and near-infrared spectroscopy (NIRS) neuromonitoring are frequently compared in the management of acute moderate and severe traumatic brain injury patients; however, the relationship between their respective output parameters flows from the complex pathogenesis of tissue respiration after brain trauma. NIRS neuromonitoring overcomes certain limitations related to the heterogeneity of the pathology across the brain that cannot be adequately addressed by local-sample invasive neuromonitoring (e.g., PbtO2 neuromonitoring, microdialysis), and it allows clinicians to assess parameters that cannot otherwise be scanned. The anatomical co-registration of an NIRS signal with axial imaging (e.g., computerized tomography scan) enhances the optical signal, which can be changed by the anatomy of the lesions and the significance of the radiological assessment. These arguments led us to conclude that rather than aiming to substitute PbtO2 with tissue saturation, multiple types of NIRS should be included via multimodal systemic- and neuro-monitoring, whose values then are incorporated into biosignatures linked to patient status and prognosis. Discussion on the abnormalities in tissue respiration due to brain trauma and how they affect the PbtO2 and NIRS neuromonitoring is given.
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18
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Nayak R, Jagdhane N, Attry S, Ghosh S. Serum Albumin Levels in Severe Traumatic Brain Injury: Role as a Predictor of Outcome. INDIAN JOURNAL OF NEUROTRAUMA 2020. [DOI: 10.1055/s-0039-1698714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Background Serum albumin has long been considered as an outcome marker in various critical illnesses. The aim of our study is to ascertain the role of serum albumin as a predictor of outcome in severe head injury patients.
Materials and Methods This is a prospective observational study of patients with severe traumatic brain injury (TBI). Depending on the serum albumin level at admission, patients were dichotomized into two groups: one with normal serum albumin and other with hypoalbuminemia. Their outcomes at 6-month follow-up were assessed by the modified Glasgow Outcome Score.
Result Eighty patients (57 males and 23 females) with severe TBI were included in the study. The mean age of the study patients was 39.6 + 13.1 years and the mean serum albumin level at admission was 3.7 + 1.2 g/dL with lowest being 2.2 mmol/L and highest being 6.1 mmol/L. Thirty-four patients (42.5%) had low serum albumin level (< 3.5 g/dL) at admission. At 6-month follow-up, 58 (72.5%) patients had a good neurological outcome and 22 (27.5%) had a poor outcome. The group with normal serum albumin levels showed a significantly better outcome compared with the hypoalbuminemia group (p = 0.01). On multiple regression analysis, low serum albumin emerged as the only predictor of the poor outcome in severe head injury patients.
Conclusion Serum albumin at admission is an independent predictor of outcome in severe TBI patients. Larger prospective studies are required to confirm these findings.
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Affiliation(s)
- Raghavendra Nayak
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Nitin Jagdhane
- Department of Neurosurgery, SevenHills Hospital, Mumbai, Maharashtra, India
| | - Sanjeev Attry
- Department of Neurosurgery, Bangur Institute of Neuroscience, Kolkata, West Bengal, India
| | - Samarendranath Ghosh
- Department of Neurosurgery, Bangur Institute of Neuroscience, Kolkata, West Bengal, India
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Li Y, Liu C, Luo X, He Q, Cheng Y, Shen W, Xie Z. Controlling nutritional status score and prognostic nutrition index predict the outcome after severe traumatic brain injury. Nutr Neurosci 2020; 25:690-697. [PMID: 32778001 DOI: 10.1080/1028415x.2020.1804097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Immune-nutritional status is correlated with a clinical outcome in critical illness. Recently, controlling nutritional status (CONUT) score and prognostic nutrition index (PNI) has been reported to predict prognosis following cancer and other diseases. The aim of this study was to explore the relationship between the CONUT score and PNI and 6-month outcome in patients with severe traumatic brain injury (STBI). METHODS We retrospectively analyzed the clinical data of 78 patients with STBI, including the CONUT score and PNI. Patients were divided into high CONUT group and low CONUT group. Patients were also divided into high PNI and low PNI group respectively. The 6-month outcome was evaluated by the modified Rankin scale (mRS). The unfavorable outcome was defined as mRS score ≥3. RESULTS The unfavorable outcome group had lower Glasgow coma scale (GCS) scores, serum albumin, total cholesterol, PNI, and higher CONUT scores (P < 0.05). Both CONUT scores and PNI were strongly correlated with mRS (r = 0.429, P < 0.05; r = -0.590, P < 0.05, respectively). After adjustment for confounding factors, the odds ratios of CONUT scores and PNI for predicting unfavorable outcome were 10.478 (95% CI: 2.793-39.301) and -0.039 (95% CI: 0.008-0.204), respectively. The area under the curve (AUC) of CONUT scores for predicting unfavorable outcome was 0.777 (95% CI: 0.674-0.880, P < 0.01), which was similar to PNI (0.764, 95% CI: 0.657-0.87, P < 0.01). CONCLUSION Both CONUT scores and PNI might be novel independent predictors of the poor outcome in STBI.
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Affiliation(s)
- Yuanyou Li
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Chang Liu
- Department of Neurology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Xu Luo
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Qiuguang He
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Yuan Cheng
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Weiwei Shen
- Department of Endocrinology, The First Affiliated Hospital, Chongqing Medical and Pharmaceutical College, Chongqing, People's Republic of China
| | - Zongyi Xie
- Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, People's Republic of China
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Wang R, He M, Ou X, Xie X, Kang Y. CRP Albumin ratio is positively associated with poor outcome in patients with traumatic brain injury. Clin Neurol Neurosurg 2020; 195:106051. [PMID: 32650209 DOI: 10.1016/j.clineuro.2020.106051] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/31/2020] [Accepted: 06/27/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The C-reactive protein/albumin ratio (CAR), a novel inflammation-based index, has been proved useful in predicting outcome of various diseases. We designed this study to explore the prognostic value of CAR in patients with traumatic brain injury (TBI). PATIENTS AND METHODS We retrospectively included 151 patients diagnosed with TBI and collected related clinical and laboratory data. Univariate and multivariate logistic regression were conducted to find independent risk factors of mortality. Then, we incorporated CAR into prognostic model and drew receiver operating characteristic (ROC) curve of models. Finally, we compared the predictive value of different models by evaluating the area under the receiver operating characteristic curves (AUC). RESULTS In this study, a total of 54 patients had poor survival outcome with mortality rate of 35.8 %. Results of multivariate analysis showed that GCS score in admission (OR 0.700, 95 %Cl 0.570-0.860, p=0.001), acute kidney injury (AKI) (OR 3.952, 95Cl 1.631-9.577, p=0.002) and CAR (OR 1.202, 95Cl 1.039-1.390, p=0.013) were independently associated with in-hospital mortality. The AUC value of predictive model composed of the above three factors was higher than GCS or CAR alone. CONCLUSION CAR is an independent risk factor of mortality in patients with TBI. Incorporating CAR into predictive model could increase the value in predicting outcome of TBI patients.
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Affiliation(s)
- Ruoran Wang
- Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Min He
- Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaofeng Ou
- Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaoqi Xie
- Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yan Kang
- Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Controlling nutritional status (CONUT) score is a predictive marker for patients with traumatic brain injury. Clin Neurol Neurosurg 2020; 195:105909. [PMID: 32652392 DOI: 10.1016/j.clineuro.2020.105909] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/09/2020] [Accepted: 05/09/2020] [Indexed: 02/08/2023]
Abstract
OBJECT We designed this study to evaluate whether controlling nutritional status (CONUT) score was valuable in predicting outcome of patients with traumatic brain injury (TBI). METHODS Clinical and laboratory data of patients admitted with TBI in our hospital between January 2015 and January 2018 was retrospectively collected. We divided patients into two groups according to in-hospital and 90-day outcome respectively and compared baseline characteristics of two groups. Multivariate analyses were conducted to evaluate whether CONUT score was associated with outcome of included patients. Receiver operating characteristics (ROC) curves were drawn to compare the predictive value of CONUT score and constructed models. RESULTS A total of 365 patients were included in our study. Multivariate logistic regression analyses showed that CONUT score was independently associated with in-hospital mortality (OR = 1.244, 95% CI: 1.099-1.408, p = 0.001) and 90-day outcome (OR = 1.441, 95% CI: 1.193-1.741, p < 0.001). ROC curve showed that area under the ROC curve (AUC) of CONUT score for predicting in-hospital mortality and 90-day outcome were 0.790 (95% CI: 0.745-0.836, p < 0.001) and 0.839 (95% CI: 0.792-0.886, p < 0.001), respectively. CONCLUSION CONUT score is independently associated with in-hospital mortality and 90-day outcome of patients with TBI.
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Luo HC, Fu YQ, You CY, Liu CJ, Xu F. Comparison of admission serum albumin and hemoglobin as predictors of outcome in children with moderate to severe traumatic brain injury: A retrospective study. Medicine (Baltimore) 2019; 98:e17806. [PMID: 31689863 PMCID: PMC6946495 DOI: 10.1097/md.0000000000017806] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Hypoalbuminemia and anemia are frequent among in patients with traumatic brain injury (TBI). We assess whether serum albumin and hemoglobin at admission can predict outcome in children with moderate to severe TBI.This retrospective study was conducted in a tertiary pediatric hospital between May 2012 and Jun 2018 included children with an admission Glasgow Coma Scale of ≤13.A total of 213 patients were included of whom 45 died in hospital. Multivariate logistic regression showed that hypoalbuminemia (serum albumin <30 g/L) was independently associated with mortality (adjusted odds ratio [OR] = 3.059; 95% confidence interval [CI]: 1.118-8.371; P = .030) in children with moderate to severe TBI, while anemia (hemoglobin <90 g/L) was not independently associated with mortality (adjusted OR = 1.742; 95% CI: 0.617-4.916; P = .295). Serum albumin was significantly superior to hemoglobin (area under the curve [AUC] 0.738 vs AUC 0.689, P < .05) under receiver operating characteristic curve analysis. Hypoalbuminemia was also associated with reduced 14-day ventilation-free days, 14-day intensive care unit (ICU)-free days, and 28-day hospital-free days.Serum albumin at admission was superior to hemoglobin in predicting the mortality in children with moderate to severe TBI and also associated with reduced ventilator-free, ICU-free, and hospital-free days.
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Affiliation(s)
- Hong-chun Luo
- Department of Infectious Diseases, The First Affiliated Hospital
| | - Yue-qiang Fu
- Department of Critical Care Medicine, Children's Hospital, Chongqing Medical University
- Ministry of Education Key Laboratory of Child Development and Disorders
- National Clinical Research Center for Child Health and Disorders (Chongqing)
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Cheng-yan You
- Department of Critical Care Medicine, Children's Hospital, Chongqing Medical University
- Ministry of Education Key Laboratory of Child Development and Disorders
- National Clinical Research Center for Child Health and Disorders (Chongqing)
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Cheng-jun Liu
- Department of Critical Care Medicine, Children's Hospital, Chongqing Medical University
- Ministry of Education Key Laboratory of Child Development and Disorders
- National Clinical Research Center for Child Health and Disorders (Chongqing)
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Feng Xu
- Department of Critical Care Medicine, Children's Hospital, Chongqing Medical University
- Ministry of Education Key Laboratory of Child Development and Disorders
- National Clinical Research Center for Child Health and Disorders (Chongqing)
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Lavery LA, Crisologo PA, Yavuz M. What is the most durable construct for a forefoot amputation, traditional transmetatarsal amputation or a medial ray sparing procedure? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S47. [PMID: 31032326 DOI: 10.21037/atm.2019.02.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Peter A Crisologo
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Metin Yavuz
- Department of Physical Therapy, UNT Health Science Center, Ft Worth, Texas, USA
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Krishnan A, Suarez-Pierre A, Zhou X, Lin CT, Fraser CD, Crawford TC, Hsu J, Hasan RK, Resar J, Chacko M, Baumgartner WA, Conte JV, Mandal K. Comparing Frailty Markers in Predicting Poor Outcomes after Transcatheter Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:43-54. [PMID: 30848712 DOI: 10.1177/1556984519827698] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Frailty is an important component of risk prognostication in transcatheter aortic valve replacement (TAVR). Objective markers of frailty, including sarcopenia, the modified Frailty Index (mFI), and albumin levels, have emerged, but little is known how such markers compare to each other in predicting outcomes after TAVR. We sought to define and compare these markers in predicting long-term outcomes after TAVR. METHODS Patients who underwent TAVR at our institution from 2011 to 2016 were included. Indexed cross-sectional areas of the lumbosacral muscles on preoperative computed tomography scans were used to assess sarcopenia. Optimal cutoffs for sarcopenia were defined using a statistically validated method. mFI was calculated using an 11-point scale of clinical characteristics. The primary outcome was 2-year all-cause mortality. Adjusted survival analysis was used to analyze outcomes. RESULTS A total of 381 patients were included in this study. Sarcopenia of the psoas muscles was associated with an increased risk of mortality on univariate (HR: 2.3, P = 0.01) and multivariate (HR: 2.5, P = 0.01) analysis. Sarcopenia of the paravertebral muscles was associated with increased risk of mortality only on univariate analysis (HR: 2.1, P = 0.03). Increased preoperative albumin levels were associated with decreased risk of mortality on univariate (HR: 0.3, P < 0.01) and multivariate analysis (HR: 0.3, P < 0.01). The (mFI) was not associated with mortality on univariate or multivariate analysis. DISCUSSION Novel cutoffs for sarcopenia of the psoas muscles were determined and associated with decreased survival after TAVR. Sarcopenia and albumin levels may be better tools for risk prediction than mFI in TAVR.
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Affiliation(s)
- Aravind Krishnan
- 1 Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alejandro Suarez-Pierre
- 1 Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xun Zhou
- 1 Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cheng T Lin
- 2 Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles D Fraser
- 1 Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Todd C Crawford
- 1 Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joshua Hsu
- 1 Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rani K Hasan
- 3 Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jon Resar
- 3 Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthews Chacko
- 3 Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William A Baumgartner
- 1 Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John V Conte
- 4 Division of Cardiac Surgery, Department of Surgery, Penn State College of Medicine, Hershey, PA, USA
| | - Kaushik Mandal
- 4 Division of Cardiac Surgery, Department of Surgery, Penn State College of Medicine, Hershey, PA, USA
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Kendall H, Abreu E, Cheng AL. Serum Albumin Trend Is a Predictor of Mortality in ICU Patients With Sepsis. Biol Res Nurs 2019; 21:237-244. [PMID: 30722677 DOI: 10.1177/1099800419827600] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Patients admitted to the hospital with sepsis are 8 times more likely to die than patients with other diagnoses. There is no diagnostic test that clearly identifies the presence of the dysregulated host response that is central to sepsis. Researchers have identified serum albumin as a possible predictor of mortality in a number of critically ill patient populations. However, these studies primarily focus on the levels on admission, neglecting the clinically significant decrease that occurs subsequently. The purpose of this study was to examine the relationship between the trend of serum albumin over time and mortality in adults admitted to the intensive care unit (ICU) with sepsis. METHODS This retrospective, correlational study used existing medical record data. All patients admitted to the ICU at a Midwestern regional medical center with a primary sepsis diagnosis were included in the initial sample. Logistic regression analysis was used to assess the ability of serum albumin to predict mortality. RESULTS Serum albumin trend, admission serum albumin level, and lowest serum albumin level were significant unique predictors of mortality. The probability of survival decreases by 70.6% when there is a strong negative trend in serum albumin level, by 63.4% when admission serum albumin is ≤2.45 g/dl, and by 76.4% when the lowest serum albumin is ≤1.45 g/dl. CONCLUSION Clinicians are encouraged to measure serum albumin levels in patients with sepsis. Low serum albumin levels and a strong negative trend in serial measurements should instigate aggressive monitoring and treatment in this population.
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Affiliation(s)
- Heather Kendall
- 1 University of Missouri-Kansas City School of Nursing and Health Studies, Kansas City, MO, USA
| | - Eduardo Abreu
- 1 University of Missouri-Kansas City School of Nursing and Health Studies, Kansas City, MO, USA
| | - An-Lin Cheng
- 2 Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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Exploring Pharmacological Mechanisms of Xuefu Zhuyu Decoction in the Treatment of Traumatic Brain Injury via a Network Pharmacology Approach. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:8916938. [PMID: 30402137 PMCID: PMC6193325 DOI: 10.1155/2018/8916938] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/17/2018] [Indexed: 12/21/2022]
Abstract
Objectives Xuefu Zhuyu decoction (XFZYD), a traditional Chinese medicine (TCM) formula, has been demonstrated to be effective for the treatment of traumatic brain injury (TBI). However, the underlying pharmacological mechanisms remain unclear. This study aims to explore the potential action mechanisms of XFZYD in the treatment of TBI and to elucidate the combination principle of this herbal formula. Methods A network pharmacology approach including ADME (absorption, distribution, metabolism, and excretion) evaluation, target prediction, known therapeutic targets collection, network construction, and molecule docking was used in this study. Results A total of 119 bioactive ingredients from XFZYD were predicted to act on 47 TBI associated specific proteins which intervened in several crucial pathological processes including apoptosis, inflammation, antioxidant, and axon genesis. Almost each of the bioactive ingredients targeted more than one protein. The molecular docking simulation showed that 91 pairs of chemical components and candidate targets had strong binding efficiencies. The “Jun”, “Chen”, and “Zuo-Shi” herbs from XFZYD triggered their specific targets regulation, respectively. Conclusion Our work successfully illuminates the “multicompounds, multitargets” therapeutic action of XFZYD in the treatment of TBI by network pharmacology with molecule docking method. The present work may provide valuable evidence for further clinical application of XFZYD as therapeutic strategy for TBI treatment.
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Cho J, Kim HM, Song M, Park JS, Lee SM. Application of an early oral feeding protocol after pylorus-preserving pancreaticoduodenectomy. Support Care Cancer 2018; 27:981-990. [PMID: 30112720 DOI: 10.1007/s00520-018-4387-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/27/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE This study evaluates the effect of an enhanced recovery after surgery (ERAS)-based nutrition support protocol on oral intake and weight change in patients who underwent pylorus-preserving pancreaticoduodenectomy (PPPD). METHODS A 14-day postoperative nutrition support protocol was developed to initiate oral intake after 1 week of enteral tube feeding and parenteral nutrition (early oral feeding, EOF). Forty-eight patients who underwent PPPD participated in the study (non-EOF, n = 23; EOF, n = 25). General information, nutrition supply route and amount, blood chemistry, and weight changes were tracked. RESULTS The enteral tube feeding duration was 2.7 days shorter in the EOF group than in the non-EOF group. Furthermore, the EOF group started oral liquid and soft diets 1.1 and 2.5 days earlier than the non-EOF group, respectively. Compared with the non-EOF group, the EOF group reported a higher energy intake (22.1%; p = 0.001) and protein intake (17.4%; p = 0.000) via oral route. Although cumulative energy and protein intakes were similar in both groups, weight reduction in the EOF group (3.6 ± 0.1%, 2.2 ± 0.7 kg) was significantly less than the non-EOF group (8.2 ± 0.9%, 5.2 ± 0.5 kg). The blood levels of total protein and transferrin increased and prealbumin decreased, regardless of the EOF application. Serum albumin increased significantly only in the EOF group. CONCLUSION The EOF protocol developed for post-PPPD patients enables the early initiation and increase in the amount of oral intake while significantly alleviating weight loss.
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Affiliation(s)
- Jungmin Cho
- Clinical Nutrition Program, Graduate School of Human Environmental Sciences, Yonsei University, Seoul, South Korea
| | - Hyung Mi Kim
- Department of Nutrition, Gangnam Severance Hospital, Yonsei University Health System, Seoul, South Korea
| | - Mina Song
- Department of Food and Nutritional Science, College of Human Ecology, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Joon Seong Park
- Pancreatobiliary Cancer Clinic, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
| | - Seung-Min Lee
- Department of Food and Nutritional Science, College of Human Ecology, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Mkhize BT, Mabaso MHL, Madurai S, Mkhize-Kwitshana ZL. The Investigation of the Use of Prealbumin as a Tool for Nutritional Assessment in Adults Coinfected with HIV and Intestinal Helminth Parasites in KwaZulu-Natal, South Africa. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7805857. [PMID: 30065944 PMCID: PMC6051331 DOI: 10.1155/2018/7805857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/14/2018] [Indexed: 12/17/2022]
Abstract
Serum prealbumin is considered to be as important as albumin in the nutritional status assessment. However, there is relatively little evidence of its advantage over the commonly used albumin. This study investigated the use of prealbumin compared to albumin as a marker of nutritional status in adults singly and dually infected with human immunodeficiency virus (HIV) and intestinal helminths, with or without inflammatory conditions, in different body mass index (BMI) categories. This cross-sectional study was conducted in a periurban setting in KwaZulu-Natal, South Africa. Multivariate multinomial logistic regression models were fitted to investigate the effect of prealbumin and albumin in nutritional assessment among HIV and helminth individuals with or without inflammation, indicated by elevated and normal C-reactive protein (CRP) levels. In normal CRP, albumin was significantly lower in unadjusted BMI [RRR = 0.8, p = 0.001] and in normal weight [RRR = 0.7, p = 0.003] and overweight [RRR = 0.5, p = 0.001] participants. In elevated CRP, albumin was significantly lower [RRR = 0.8, p = 0.050] and prealbumin was significantly higher in unadjusted BMI [RRR = 1.2, p = 0.034] and overweight [RRR = 1.4, p = 0.052] individuals. The current study found that prealbumin can differentiate between inflammation-induced reduction of albumin and true malnutrition in adults singly or coinfected with HIV and intestinal helminths in the presence or absence of inflammation in various BMI categories.
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Affiliation(s)
- B. T. Mkhize
- Department of Biomedical and Clinical Technology, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - M. H. L. Mabaso
- Epidemiology and Strategic Information Unit, HIV/AIDS, STI and TB (HAST), Human Sciences Research Council, Durban, South Africa
| | - S. Madurai
- Global Clinical and Viral Laboratory, Durban, South Africa
| | - Z. L. Mkhize-Kwitshana
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Biomedical Sciences, Faculty of Natural Sciences, Mangosuthu University of Technology, Durban, South Africa
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Tong B, Jutzeler CR, Cragg JJ, Grassner L, Schwab JM, Casha S, Geisler F, Kramer JLK. Serum Albumin Predicts Long-Term Neurological Outcomes After Acute Spinal Cord Injury. Neurorehabil Neural Repair 2017; 32:7-17. [DOI: 10.1177/1545968317746781] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background. There is a need to identify reliable biomarkers of spinal cord injury recovery for clinical practice and clinical trials. Objective. Our objective was to correlate serum albumin levels with spinal cord injury neurological outcomes. Methods. We performed a secondary analysis of patients with traumatic spinal cord injury (n = 591) participating in the Sygen clinical trial. Serum albumin concentrations were obtained as part of routine blood chemistry analysis, at trial entry (24-72 hours), 1, 2, and 4 weeks after injury. The primary outcomes were “marked recovery” and lower extremity motor scores, derived from the International Standards for the Neurological Classification of Spinal Cord Injury. Data were analyzed with multivariable logistic and linear regression to adjust for potential confounders. Results. Serum albumin was significantly associated with spinal cord injury neurological outcomes. Higher serum albumin concentrations at 1, 2, and 4 weeks were associated with higher 52-week lower extremity motor score. Similarly, the odds of achieving “marked neurological recovery” was greater for individuals with higher serum albumin concentrations. The association between serum albumin concentrations and neurological outcomes was independent of initial injury severity, treatment with GM-1, and polytrauma. Conclusions. In spinal cord injury, serum albumin is an independent marker of long-term neurological outcomes. Serum albumin could serve as a feasible biomarker for prognosis at the time of injury and stratification in clinical trials.
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Affiliation(s)
- Bobo Tong
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine R. Jutzeler
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacquelyn J. Cragg
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Lukas Grassner
- Center for Spinal Cord Injuries and Department of Neurosurgery, Trauma Center, Murnau, Germany
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Jan M. Schwab
- Wexner Medical Center, The Ohio State University, Spinal Cord Injury Medicine, Columbus, OH, USA
| | - Steve Casha
- University of Calgary, Calgary, Alberta, Canada
| | - Fred Geisler
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John L. K. Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
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Pretreatment Serum Prealbumin as an Independent Prognostic Indicator in Patients With Metastatic Renal Cell Carcinoma Using Tyrosine Kinase Inhibitors as First-Line Target Therapy. Clin Genitourin Cancer 2017; 15:e437-e446. [DOI: 10.1016/j.clgc.2017.01.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 12/27/2022]
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Kim K, Bang JY, Kim SO, Kim S, Kim JU, Song JG. Association of preoperative hypoalbuminemia with postoperative acute kidney injury in patients undergoing brain tumor surgery: a retrospective study. J Neurosurg 2017; 128:1115-1122. [PMID: 28474996 DOI: 10.3171/2016.11.jns162237] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Hypoalbuminemia is known to be independently associated with postoperative acute kidney injury (AKI). However, little is known about the association between the preoperative serum albumin level and postoperative AKI in patients undergoing brain tumor surgery. The authors investigated the incidence of AKI, impact of preoperative serum albumin level on postoperative AKI, and death in patients undergoing brain tumor surgery. METHODS The authors retrospectively reviewed the electronic medical records and laboratory results of 2363 patients who underwent brain tumor surgery between January 2008 and December 2014. Postoperative AKI was defined according to Kidney Disease: Improving Global Outcomes Definition and Staging (KDIGO). Multivariate logistic regression analysis was used to identify demographic, preoperative laboratory, and intraoperative factors associated with AKI development. Cox proportional hazards models were used to investigate the adjusted odds ratio and hazard ratio for the association between preoperative serum albumin level and outcome variables. RESULTS The incidence of AKI was 1.8% (n = 43) using KDIGO criteria. The incidence of AKI was higher in patients with a preoperative serum albumin level < 3.8 g/dl (3.5%) than in those with a preoperative serum albumin level ≥ 3.8 g/dl (1.2%, p < 0.001). The overall mortality was also higher in the former than in the latter group (5.0% vs 1.8%, p < 0.001). After inverse probability of treatment-weighting adjustment, a preoperative serum albumin level < 3.8 g/dl was also found to be associated with postoperative AKI (OR 1.981, 95% CI 1.022-3.841; p = 0.043) and death (HR 2.726, 95% CI 1.522-4.880; p = 0.001). CONCLUSIONS The authors' results demonstrated that a preoperative serum albumin level of < 3.8 g/dl was independently associated with AKI and mortality in patients undergoing brain tumor surgery.
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Affiliation(s)
- Kyungmi Kim
- Departments of1Anesthesiology and Pain Medicine and Laboratory for Cardiovascular Dynamics, and
| | - Ji-Yeon Bang
- Departments of1Anesthesiology and Pain Medicine and Laboratory for Cardiovascular Dynamics, and
| | - Seon-Ok Kim
- 2Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Saegyeol Kim
- Departments of1Anesthesiology and Pain Medicine and Laboratory for Cardiovascular Dynamics, and
| | - Joung Uk Kim
- Departments of1Anesthesiology and Pain Medicine and Laboratory for Cardiovascular Dynamics, and
| | - Jun-Gol Song
- Departments of1Anesthesiology and Pain Medicine and Laboratory for Cardiovascular Dynamics, and
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Zhang SQ, Peng B, Stary CM, Jian ZH, Xiong XX, Chen QX. Serum prealbumin as an effective prognostic indicator for determining clinical status and prognosis in patients with hemorrhagic stroke. Neural Regen Res 2017; 12:1097-1102. [PMID: 28852391 PMCID: PMC5558488 DOI: 10.4103/1673-5374.211188] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Serum prealbumin is a recognized marker of malnutrition, but its prognostic role in patients with hemorrhagic stroke remains unclear. In this study, we retrospectively reviewed the records of 105 patients with hemorrhagic stroke admitted to Renmin Hospital of Wuhan University, China, from January to December 2015. We collected demographic and radiological data, and recorded serum prealbumin levels at admission and on days 1, 3, 6, 9, and 14–21. The existence of infections and gastrointestinal hemorrhage, and clinical condition at discharge were also recorded. Serum prealbumin levels during hospitalization were significantly lower in patients with infections compared with those without infections, and also significantly lower in patients with gastrointestinal hemorrhage compared with those without. Serum prealbumin levels at discharge were significantly higher in patients with good recovery than in those with poor recovery. We conclude that regular serum prealbumin measurements in patients with hemorrhagic stroke may be a useful indicator for determining clinical status and prognosis, which may therefore help to guide clinical decision-making.
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Affiliation(s)
- Shen-Qi Zhang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Bin Peng
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Creed M Stary
- Department of Anesthesiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Zhi-Hong Jian
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xiao-Xing Xiong
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Qian-Xue Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
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Nedić O, Miljuš G, Malenković V. Regulation of Insulin and Insulin-Like Activity in Malnourished Patients with Carcinoma Ventriculi Subjected to Total Gastrectomy and Personalized Nutritional Support. J Med Biochem 2016; 35:17-25. [PMID: 28356860 PMCID: PMC5346797 DOI: 10.1515/jomb-2015-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/03/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Insulin and insulin-like growth factor (IGF) activities are disturbed during critical illness. Time-course changes in the concentrations of insulin, IGF-I and IGF-binding proteins (IGFBPs) were monitored in this study and their correlation with interleukin (IL)-6 was assessed in patients subjected to total gastrectomy and specific nutritional regime. METHODS Patients were fed post-operatively according to the following scheme: parenteral nutrition on day 1, enteral nutrition combined with parenteral form from day 2 to 7, peroral nutrition from day 8 and full oral nutrition from day 14. Blood samples were taken periodically and the levels of IL-6, insulin, IGF-I and IGFBP-1 to -4 were determined. RESULTS On day 1 post-operatively, the concentration of IL-6 reached its maximum and decreased afterwards. The concentration of insulin increased until day 3 and then started to fall. The concentration of IGF-I, already low preoperatively, continued to decrease. The concentration of IGFBP-1 peaked on day 1 post-operatively, whereas the concentration of IGFBP-3 decreased on that day. The concentration of IL-6 correlated positively with the concentration of IGFBP-1 and negatively with IGFBP-3. On day 14, the concentrations of IL-6, insulin and IGFBP-1 returned to or were close to their basal levels, whereas the concentrations of IGF-I and IGFBP-3 remained reduced. CONCLUSIONS A 14-day post-operative recovery, which included specific nutritional support, was suitable to restore insulin concentration and re-establish IGFBP-1 regulation primarily by nutrition. Very low IGF-I level on day 14 after surgery and IGFBP-3 concentration still lower than before surgery indicated that the catabolic condition was not compensated.
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Affiliation(s)
- Olgica Nedić
- Institute for the Application of Nuclear Energy (INEP), University of Belgrade, Belgrade, Serbia
| | - Goran Miljuš
- Institute for the Application of Nuclear Energy (INEP), University of Belgrade, Belgrade, Serbia
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Garwe T, Albrecht RM, Stoner JA, Mitchell S, Motghare P. Hypoalbuminemia at admission is associated with increased incidence of in-hospital complications in geriatric trauma patients. Am J Surg 2015; 212:109-15. [PMID: 26414690 DOI: 10.1016/j.amjsurg.2015.06.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 06/21/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Elderly patients are at an increased risk of protein-energy malnutrition (PEM) which increases the risk of morbidity/mortality. We evaluated the association between hypoalbuminemia at the time of emergency department (ED) admission and in-hospital complications among geriatric trauma patients. METHODS This was an ambidirectional cohort study of geriatric (≥55 years) trauma patients treated at a Level I trauma center between May 2013 and March 2014. The exposure of interest was albumin level at ED admission (<3.6 g/dL [PEM] or ≥3.6 g/dL (No PEM)]. The outcome of interest was 30-day incidence of complications. RESULTS A total of 130 patients met study eligibility. Of these, 85 (65%) patients were in the PEM group. After adjusting for tube feeding and injury severity score, PEM at admission was associated with a 2-fold increase in the risk of 30-day overall hospital complications (hazard ratio 2.1, 95% confidence interval 1.1 to 3.8). CONCLUSION Serum albumin level at ED admission, but not prealbumin level, is a significant predictor of in-hospital complications in geriatric trauma patients.
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Affiliation(s)
- Tabitha Garwe
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA.
| | - Roxie M Albrecht
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA
| | - Stephanie Mitchell
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Prasenjeet Motghare
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK 73104, USA
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