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Dai J, Guo Y, Zhou Q, Duan XJ, Shen J, Zhang X. The relationship between red cell distribution width, serum calcium ratio, and in-hospital mortality among patients with acute respiratory failure: A retrospective cohort study of the MIMIC-IV database. Medicine (Baltimore) 2024; 103:e37804. [PMID: 38608105 PMCID: PMC11018187 DOI: 10.1097/md.0000000000037804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/14/2024] [Indexed: 04/14/2024] Open
Abstract
To investigate the impact of RDW/CA (the ratio of red cell distribution width to calcium) on in-hospital mortality in patients with acute respiratory failure (ARF). This retrospective cohort study analyzed the data of 6981 ARF patients from the Medical Information Mart for Intensive Care (MIMIC-IV) database 2.0. Critically ill participants between 2008 and 2019 at the Beth Israel Deaconess Medical Center in Boston. The primary outcome of interest was in-hospital mortality. A Cox proportional hazards regression model was used to determine whether the RDW/CA ratio independently correlated with in-hospital mortality. The Kaplan-Meier method was used to plot the survival curves of the RDW/CA. Subgroup analyses were performed to measure the mortality across various subgroups. After adjusting for potential covariates, we found that a higher RDW/CA was associated with an increased risk of in-hospital mortality (HR = 1.17, 95% CI: 1.01-1.35, P = .0365) in ARF patients. A nonlinear relationship was observed between RDW/CA and in-hospital mortality, with an inflection point of 1.97. When RDW/CA ≥ 1.97 was positively correlated with in-hospital mortality in patients with ARF (HR = 1.554, 95% CI: 1.183-2.042, P = .0015). The Kaplan-Meier curve indicated the higher survival rates for RDW/CA < 1.97 and the lower for RDW/CA ≥ 1.97 after adjustment for age, gender, body mass index, and ethnicity. RDW/CA is an independent predictor of in-hospital mortality in patients with ARF. Furthermore, a nonlinear relationship was observed between RDW/CA and in-hospital mortality in patients with ARF.
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Affiliation(s)
- Jun Dai
- Department of Nursing, The First People’s Hospital of Changde City, Changde, Hunan Province, China
| | - Yafen Guo
- Department of Nursing, The First People’s Hospital of Changde City, Changde, Hunan Province, China
| | - Quan Zhou
- Department of Science and Education, The First People’s Hospital of Changde City, Changde, Hunan Province, China
| | - Xiang-Jie Duan
- Department of Infectious Diseases, The First People’s Hospital of Changde City, Changde, Hunan Province, China
| | - Jinhua Shen
- Department of Nursing, The First People’s Hospital of Changde City, Changde, Hunan Province, China
| | - Xueqing Zhang
- Department of Nursing, The First People’s Hospital of Changde City, Changde, Hunan Province, China
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Kwok WC, Tam TCC, Ho JCM, Lam DCL, Ip MSM, Yap DYH. Hospitalized acute exacerbation in chronic obstructive pulmonary disease - impact on long-term renal outcomes. Respir Res 2024; 25:36. [PMID: 38238804 PMCID: PMC10797933 DOI: 10.1186/s12931-023-02635-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common and preventable event in patients with chronic obstructive pulmonary disease (COPD). Data regarding the impact of AECOPD on short- and long-term renal outcomes are lacking. METHODS We included all COPD patients who were followed at Queen Mary Hospital (QMH) in year 2015 and reviewed their clinical/renal outcomes in subsequent five years. Relationships between AECOPD and adverse renal outcomes were evaluated. RESULTS 371 COPD patients were included. 169 patients had hospitalized AECOPD in past one year (HAE group) while 202 patients did not (non-HAE group). 285 patients (76.8%) had renal progression/death and 102 (27.5%) patients developed acute kidney injury (AKI). HAE group showed a more rapid eGFR decline than non-HAE group (-4.64 mL/min/1.73m2/year vs. -2.40 mL/min/1.73m2/year, p = 0.025). HAE group had significantly higher risk for renal progression/death at 5 years [adjusted OR (aOR) 2.380 (95% CI = 1.144-4.954), p = 0.020]. The frequency of hospitalized AECOPD in past 3 years, any AECOPD in past 3 years, hospitalized AECOPD in past 3 years were also predictive of renal progression/death at 5 years [aOR were 1.176 (95% CI = 1.038- 1.331), 2.998 (95% CI = 1.438-6.250) and 2.887 (95% CI = 1.409-5.917) respectively; p = 0.011, 0.003 and 0.004]. HAE group also showed significantly higher risk of AKI [adjusted HR (aHR) 2.430; 95% CI = 1.306-4.519, p = 0.005]. CONCLUSIONS AECOPD, in particular HAE, was associated with increased risk of renal progression/death and AKI. Prevention of AECOPD, especially HAE, may potentially improve short- and long-term renal outcomes in COPD patients.
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Affiliation(s)
- Wang Chun Kwok
- Division of Respiratory Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Terence C C Tam
- Division of Respiratory Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - James C M Ho
- Division of Respiratory Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - David C L Lam
- Division of Respiratory Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Mary S M Ip
- Division of Respiratory Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Desmond Y H Yap
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong SAR, People's Republic of China.
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Zhao X, Su R, Hu R, Chen Y, Xu X, Yuan Y, Zhang J, Zhang W, Yang Y, Chen M, Li D, Wu B, Huang D, Wu D. Sarcopenia index as a predictor of clinical outcomes among older adult patients with acute exacerbation of chronic obstructive pulmonary disease: a cross-sectional study. BMC Geriatr 2023; 23:89. [PMID: 36774462 PMCID: PMC9921248 DOI: 10.1186/s12877-023-03784-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/30/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Sarcopenia is a geriatric syndrome with progressive loss of skeletal muscle mass and function and has a negative impact on clinical outcomes associated with chronic obstructive pulmonary disease (COPD). Recently, the sarcopenia index (SI) was developed as a surrogate marker of sarcopenia based upon the serum creatinine to cystatin C ratio. We aimed to assess the value of SI for predicting clinically important outcomes among elderly patients with acute exacerbation of COPD (AECOPD). METHODS This cross-sectional study included elderly patients with AECOPD in China from 2017 to 2021. Clinical data were collected from medical records, and serum creatinine and cystatin C were measured. Outcomes included respiratory failure, heart failure, severe pneumonia, invasive mechanical ventilation, and mortality. Binary logistic regression was used to analyze the association between SI and clinical outcomes. RESULTS A total of 306 patients (260 men, 46 women, age range 60-88 years) were enrolled in this study. Among the total patients, the incidence of respiratory failure and severe pneumonia was negatively associated with SI values. After adjusting for potential confounding factors, binary logistic regression analyses showed that a higher SI was still independently associated with a lower risk of respiratory failure (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.13-0.56, P < 0.05). In subgroup analysis, the incidence of respiratory failure was negatively associated with SI values in groups with both frequent exacerbation and non-frequent exacerbation. After adjustment for potential confounders, binary logistic regression analyses showed that a higher SI was also independently associated with a lower risk of respiratory failure in both groups (OR: 0.19, 95% CI: 0.06-0.64 and OR: 0.31, 95% CI: 0.11-0.85). However, there were no significant differences in the correlations between SI and the risk of heart failure, invasive mechanical ventilation, and mortality in all groups. CONCLUSION The SI based on serum creatinine and cystatin C can predict respiratory failure in patients with AECOPD and either frequent or infrequent exacerbations. This indicator provides a convenient tool for clinicians when managing patients with AECOPD in daily clinical practice.
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Affiliation(s)
- Xuanna Zhao
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Ruoxin Su
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Rongwei Hu
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yujuan Chen
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiaoyong Xu
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yalian Yuan
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jinhong Zhang
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Wenchao Zhang
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yu Yang
- grid.410560.60000 0004 1760 3078Department of Geriatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Min Chen
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Dongming Li
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Bin Wu
- grid.410560.60000 0004 1760 3078Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Dan Huang
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
| | - Dong Wu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
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Ling M, Huiyin L, Shanglin C, Haiming L, Zhanyi D, Shuchun W, Meng B, Murong L. Relationship between human serum albumin and in-hospital mortality in critical care patients with chronic obstructive pulmonary disease. Front Med (Lausanne) 2023; 10:1109910. [PMID: 37181348 PMCID: PMC10174316 DOI: 10.3389/fmed.2023.1109910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
Background The relationship between human serum albumin levels and the prognosis of critical care patients with chronic obstructive pulmonary disease (COPD) remains controversial. Objective To investigate the relationship between serum albumin levels and in-hospital mortality in critical care patients with COPD. METHODS: This study used a retrospective observational cohort from the Medical Information in Intensive Care database (MIMIC-IV) in the United States. Multivariate Cox regression analysis was used to assess the relationship between serum albumin levels and in-hospital mortality. A restricted cubic spline line was also used to explore nonlinear relationship. Results A total of 3,398 critical care patients with COPD were included. The overall in-hospital mortality was 12.4%. We found a negative relationship between human serum albumin and in-hospital mortality (HR = 0.97, 95% CI 0.96-0.99, p = 0.002). Conclusion In critical care patients with COPD, there was a negative association between human serum albumin and in-hospital mortality.
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Affiliation(s)
- Ma Ling
- Department of Respiratory, Zhumadian Central Hospital, Zhumadian, China
| | - Li Huiyin
- Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chen Shanglin
- Department of Laboratory, The Fifth People’s Hospital of Panyu District, Guangzhou, China
| | - Li Haiming
- Department of Respiratory, Zhumadian Central Hospital, Zhumadian, China
| | - Di Zhanyi
- Department of Respiratory, Zhumadian Central Hospital, Zhumadian, China
| | - Wang Shuchun
- Department of Respiratory, Zhumadian Central Hospital, Zhumadian, China
| | - Bai Meng
- Department of Computer Center, Fujian Provincial Maternity Hospital, Fuzhou, Fujian, China
- *Correspondence: Bai Meng,
| | - Lu Murong
- Department of Critical Care, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Lu Murong,
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Hu T, Yao W, Li Y, Liu Y. Interaction of acute heart failure and acute kidney injury on in-hospital mortality of critically ill patients with sepsis: A retrospective observational study. PLoS One 2023; 18:e0282842. [PMID: 36888602 PMCID: PMC9994701 DOI: 10.1371/journal.pone.0282842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/23/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The present study aimed to evaluate the synergistic impact of acute heart failure (AHF) and acute kidney injury (AKI) on in-hospital mortality in critically ill patients with sepsis. METHODS We undertook a retrospective, observational analysis using data acquired from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and eICU Collaborative Research Database (eICU-CRD). The effects of AKI and AHF on in-hospital mortality were examined using a Cox proportional hazards model. Additive interactions were analyzed using the relative extra risk attributable to interaction. RESULTS A total of 33,184 patients were eventually included, comprising 20,626 patients in the training cohort collected from the MIMIC-IV database and 12,558 patients in the validation cohort extracted from the eICU-CRD database. After multivariate Cox analysis, the independent variables for in-hospital mortality included: AHF only (HR:1.20, 95% CI:1.02-1.41, P = 0.005), AKI only (HR:2.10, 95% CI:1.91-2.31, P < 0.001), and both AHF and AKI (HR:3.80, 95%CI:13.40-4.24, P < 0.001). The relative excess risk owing to interaction was 1.49 (95% CI:1.14-1.87), the attributable percentage due to interaction was 0.39 (95%CI:0.31-0.46), and the synergy index was 2.15 (95%CI:1.75-2.63), demonstrated AHF and AKI had a strong synergic impact on in-hospital mortality. And the findings in the validation cohort indicated identical conclusions to the training cohort. CONCLUSION Our data demonstrated a synergistic relationship of AHF and AKI on in-hospital mortality in critically unwell patients with sepsis.
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Affiliation(s)
- Tianyang Hu
- Precision Medicine Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wanjun Yao
- Department of Anesthesiology, Wuhan No.1 Hospital, 430030, Wuhan, Hubei, China
| | - Yu Li
- Department of Nephrology, Chongqing Bishan District People’s Hospital (Bishan Hospital Affiliated to Chongqing Medical University), Chongqing, China
| | - Yanan Liu
- Department of Nephrology, Rheumatology and Immunology, Jiulongpo District People’s Hospital, Chongqing, China
- * E-mail:
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Han H, Hu S, Du J. Predictive value of the hemoglobin-albumin-lymphocyte-platelet (HALP) index for ICU mortality in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Intern Emerg Med 2023; 18:85-96. [PMID: 36357607 DOI: 10.1007/s11739-022-03132-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
The combined index of hemoglobin, albumin, lymphocyte, and platelet (HALP) is a novel indicator reflecting systemic inflammation and nutritional status. To explore the relationship between HALP score and ICU mortality risk in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). A total of 1533 AECOPD patients from the eICU Collaborative Research Database (eICU-CRD) between 2014 and 2015 were included in this retrospective cohort study. Univariate and multivariate Cox proportional hazards models were utilized to investigate the association of HALP score, platelet-to-lymphocyte ratio (PLR) score, and lymphocyte-to-monocyte ratio (LMR) score with the ICU mortality risk in patients with AECOPD. Stratified analyses were performed based on patients' ICU admission type, body mass index (BMI), and Acute Physiology, Age and Chronic Health Evaluation IV (APACHE IV) score. Of these 1533 AECOPD patients, 123 (8.00%) patients died in the ICU. Low HALP score [hazard ratio (HR) = 1.69; 95% confidence interval (CI) 1.14-2.53] and low LMR score (HR = 1.60; 95% CI 1.07-2.39) were associated with an increased ICU mortality risk in patients with AECOPD after adjusting for all confounders. Stratified analyses indicated that low HALP score were still associated with a higher ICU mortality risk in patients admitted to ICU by emergency (HR = 1.81; 95% CI 1.11-2.96), obese patients (HR = 2.81; 95% CI 1.29-6.10), and patients with low APACHE scores (HR = 2.87; 95% CI 1.75-4.69). Low HALP score was associated with an increased risk of ICU mortality in patients with AECOPD, suggesting that the HALP score may be a novel prognostic predictor in patients with AECOPD.
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Affiliation(s)
- Huishan Han
- Department of General Practice, The First Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Siying Hu
- Department of General Practice, The First Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Juan Du
- Department of Respiratory, Guang'an People's Hospital, No.1 Mingkang Street, Guang'an District, Guang'an, 638000, China.
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