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Puri A, Giri M, Huang H, Zhao Q. Blood urea nitrogen to creatinine ratio is associated with in-hospital mortality in critically ill patients with venous thromboembolism: a retrospective cohort study. Front Cardiovasc Med 2024; 11:1400915. [PMID: 38938654 PMCID: PMC11208632 DOI: 10.3389/fcvm.2024.1400915] [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: 03/14/2024] [Accepted: 06/03/2024] [Indexed: 06/29/2024] Open
Abstract
Background The relationship between the blood urea nitrogen to creatinine ratio (BCR) and the risk of in-hospital mortality among intensive care unit (ICU) patients diagnosed with venous thromboembolism (VTE) remains unclear. This study aimed to assess the relationship between BCR upon admission to the ICU and in-hospital mortality in critically ill patients with VTE. Methods This retrospective cohort study included patients diagnosed with VTE from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The primary endpoint was in-hospital mortality. Univariate and multivariate logistic regression analyses were conducted to evaluate the prognostic significance of the BCR. Receiver operating characteristic (ROC) curve analysis was utilized to determine the optimal cut-off value of BCR. Additionally, survival analysis using a Kaplan-Meier curve was performed. Results A total of 2,560 patients were included, with a median age of 64.5 years, and 55.5% were male. Overall, the in-hospital mortality rate was 14.6%. The optimal cut-off value of the BCR for predicting in-hospital mortality in critically ill VTE patients was 26.84. The rate of in-hospital mortality among patients categorized in the high BCR group was significantly higher compared to those in the low BCR group (22.6% vs. 12.2%, P < 0.001). The multivariable logistic regression analysis results indicated that, even after accounting for potential confounding factors, patients with elevated BCR demonstrated a notably increased in-hospital mortality rate compared to those with lower BCR levels (all P < 0.05), regardless of the model used. Patients in the high BCR group exhibited a 77.77% higher risk of in-hospital mortality than those in the low BCR group [hazard ratio (HR): 1.7777; 95% CI: 1.4016-2.2547]. Conclusion An elevated BCR level was independently linked with an increased risk of in-hospital mortality among critically ill patients diagnosed with VTE. Given its widespread availability and ease of measurement, BCR could be a valuable tool for risk stratification and prognostic prediction in VTE patients.
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Affiliation(s)
- Anju Puri
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mohan Giri
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huanhuan Huang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Gairola S, Solanki SL, Patkar S, Goel M. Artificial Intelligence in Perioperative Planning and Management of Liver Resection. Indian J Surg Oncol 2024; 15:186-195. [PMID: 38818006 PMCID: PMC11133260 DOI: 10.1007/s13193-024-01883-4] [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: 09/18/2023] [Accepted: 01/16/2024] [Indexed: 06/01/2024] Open
Abstract
Artificial intelligence (AI) is a speciality within computer science that deals with creating systems that can replicate the intelligence of a human mind and has problem-solving abilities. AI includes a diverse array of techniques and approaches such as machine learning, neural networks, natural language processing, robotics, and expert systems. An electronic literature search was conducted using the databases of "PubMed" and "Google Scholar". The period for the search was from 2000 to June 2023. The search terms included "artificial intelligence", "machine learning", "liver cancers", "liver tumors", "hepatectomy", "perioperative" and their synonyms in various combinations. The search also included all MeSH terms. The extracted articles were further reviewed in a step-wise manner for identification of relevant studies. A total of 148 articles were identified after the initial literature search. Initial review included screening of article titles for relevance and identifying duplicates. Finally, 65 articles were reviewed for this review article. The future of AI in liver cancer planning and management holds immense promise. AI-driven advancements will increasingly enable precise tumour detection, location, and characterisation through enhanced image analysis. ML algorithms will predict patient-specific treatment responses and complications, allowing for tailored therapies. Surgical robots and AI-guided procedures will enhance the precision of liver resections, reducing risks and improving outcomes. AI will also streamline patient monitoring, better hemodynamic management, enabling early detection of recurrence or complications. Moreover, AI will facilitate data-driven research, accelerating the development of novel treatments and therapies. Ultimately, AI's integration will revolutionise liver cancer care, offering personalised, efficient and effective solutions, improving patients' quality of life and survival rates.
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Affiliation(s)
- Shruti Gairola
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra India
| | - Sohan Lal Solanki
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra India
| | - Shraddha Patkar
- Division of Hepatobiliary Surgical Oncology, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra India
| | - Mahesh Goel
- Division of Hepatobiliary Surgical Oncology, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra India
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Ogundeji SP, Fasola FA, Kotila TR. HYPERTENSION AND DIABETES MELLITUS ARE ASSOCIATED WITH DEEP VENOUS THROMBOEMBOLISM: A CASE CONTROL STUDY. Ann Ib Postgrad Med 2024; 22:34-38. [PMID: 38939895 PMCID: PMC11205718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/01/2024] [Indexed: 06/29/2024] Open
Abstract
Introduction Identifying risk factors for venous thromboembolism (VTE) is useful in deciding thromboprophylaxis for VTE. A retrospective study had shown an association between hypertension and diabetes mellitus with VTE in our population. The objective of this study was to confirm these findings and to determine if the complete blood count and coagulation tests can also be useful parameters in stratifying VTE patients for prophylaxis. Methods This is a gender and age matched prospective case-control study of 45 Doppler's confirmed DVT and 43 apparently healthy controls. Results Identified risk factors included history of hypertension, diabetes mellitus, previous DVT, recent surgery, recent trauma, malignancy, sepsis, and immobility. The cases had a significantly lower mean haematocrit (33±7.4% vs 38±4.6%, p<0.001). Though no differences were observed in leucocyte and platelet counts between cases and controls but stratification as leucocytosis vs leucopaenia (P=0.003) and thrombocytosis vs thrombocytopaenia (P=0.045) differed between both groups. Also, the International normalized ratio (INR) was higher in cases (1.1±0.2 vs 1.0±0.1;P=0.001), hypercoagulable state (INR<0.9) and hypocoagulable state (INR>1.2) were observed in 4.4% and 28.9% of cases respectively but not in controls (P <0.001). Also, aPTT>40 seconds was seen in 4.4% vs 4.7% of cases and controls respectively and aPTT< 30 seconds in 22% of cases but not in controls (P =0.004). Conclusion Hypertension and diabetes mellitus are identified risk factors not traditionally associated with DVT. These in addition to a complete blood count and coagulation tests can be useful in stratifying patients for prophylaxis in our population and other similar communities.
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Affiliation(s)
- S P Ogundeji
- Department of Haematology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - F A Fasola
- Department of Haematology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - T R Kotila
- Department of Haematology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Trabulsi N, Khafagy AM, Alhazmi LS, Alghamdi AM, Alzahrani AA, Banaamah MM, Farsi A, Shabkah A, Samkari A, Al-Hajeili M, Abduljabbar A, Wazzan M. Caprini versus Padua venous thromboembolism risk assessment scores: A comparative study in hospitalized patients at a tertiary center. Saudi Med J 2024; 45:362-368. [PMID: 38657986 PMCID: PMC11147578 DOI: 10.15537/smj.2024.45.4.20230954] [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: 12/07/2023] [Accepted: 02/16/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES To assess and compare the Caprini and Padua risk assessment models (RAMs) for predicting venous thromboembolism (VTE) in hospitalized patients. METHODS We retrospectively reviewed 28 VTE and 450 non-VTE patients hospitalized at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, in 2019. Their baseline medical, demographic, and radiological reports were recorded. We compared Caprini scores (defined at admission) and Padua scores (calculated retrospectively) for their ability to predict VTE. A cumulative risk score was created by adding the individual scores for each risk factor. We also analyzed the sensitivity, specificity, and diagnostic accuracy of the RAM scores. RESULTS Major differences in risk factors were shown between patients with and without VTE. Previous VTE was significantly associated with a higher risk of VTE (28.6%), as was reduced mobility (57.1%), acute infection (25%), high Caprini score (50%), and high Padua score (64.3%, p<0.05). The sensitivity of the Caprini score (96%) was higher than that of the Padua score (64.3%), as was the specificity (92.1% vs. 46.9%), positive predictive value (93% vs. 7%), and accuracy (94.1% vs. 47.9%). The specificity of the Caprini score was higher than that of the Padua score in Critical Care, Gynecology/Obstetrics, and Surgical departments. The Caprini RAM showed the lowest level of specificity in the medical department. CONCLUSION The Caprini RAM demonstrated higher sensitivity, specificity, and predictive accuracy than did the Padua RAM and thus distinguished low and high VTE risk in hospitalized patients.
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Affiliation(s)
- Nora Trabulsi
- From the Department of Surgery (Trabulsi, Alhazmi, Alzahrani, Samkari, Farsi); from the Department of Internal Medicine (Khafagy, Al-Hajeili); from the Department of Radiology (Banaamah, Abduljabbar, Wazzan), Faculty of Medicine, King Abdulaziz University, from the Department of Internal Medicine (Alghamdi), King Abdulaziz University Hospital, and from the Department of Surgery (Shabkah), International Medical Center, Jeddah, Kingdom of Saudi Arabia.
| | - Abdulmajeed M. Khafagy
- From the Department of Surgery (Trabulsi, Alhazmi, Alzahrani, Samkari, Farsi); from the Department of Internal Medicine (Khafagy, Al-Hajeili); from the Department of Radiology (Banaamah, Abduljabbar, Wazzan), Faculty of Medicine, King Abdulaziz University, from the Department of Internal Medicine (Alghamdi), King Abdulaziz University Hospital, and from the Department of Surgery (Shabkah), International Medical Center, Jeddah, Kingdom of Saudi Arabia.
| | - Lenah S. Alhazmi
- From the Department of Surgery (Trabulsi, Alhazmi, Alzahrani, Samkari, Farsi); from the Department of Internal Medicine (Khafagy, Al-Hajeili); from the Department of Radiology (Banaamah, Abduljabbar, Wazzan), Faculty of Medicine, King Abdulaziz University, from the Department of Internal Medicine (Alghamdi), King Abdulaziz University Hospital, and from the Department of Surgery (Shabkah), International Medical Center, Jeddah, Kingdom of Saudi Arabia.
| | - Abdullah M. Alghamdi
- From the Department of Surgery (Trabulsi, Alhazmi, Alzahrani, Samkari, Farsi); from the Department of Internal Medicine (Khafagy, Al-Hajeili); from the Department of Radiology (Banaamah, Abduljabbar, Wazzan), Faculty of Medicine, King Abdulaziz University, from the Department of Internal Medicine (Alghamdi), King Abdulaziz University Hospital, and from the Department of Surgery (Shabkah), International Medical Center, Jeddah, Kingdom of Saudi Arabia.
| | - Abdulmajeed A. Alzahrani
- From the Department of Surgery (Trabulsi, Alhazmi, Alzahrani, Samkari, Farsi); from the Department of Internal Medicine (Khafagy, Al-Hajeili); from the Department of Radiology (Banaamah, Abduljabbar, Wazzan), Faculty of Medicine, King Abdulaziz University, from the Department of Internal Medicine (Alghamdi), King Abdulaziz University Hospital, and from the Department of Surgery (Shabkah), International Medical Center, Jeddah, Kingdom of Saudi Arabia.
| | - Mohanned M. Banaamah
- From the Department of Surgery (Trabulsi, Alhazmi, Alzahrani, Samkari, Farsi); from the Department of Internal Medicine (Khafagy, Al-Hajeili); from the Department of Radiology (Banaamah, Abduljabbar, Wazzan), Faculty of Medicine, King Abdulaziz University, from the Department of Internal Medicine (Alghamdi), King Abdulaziz University Hospital, and from the Department of Surgery (Shabkah), International Medical Center, Jeddah, Kingdom of Saudi Arabia.
| | - Ali Farsi
- From the Department of Surgery (Trabulsi, Alhazmi, Alzahrani, Samkari, Farsi); from the Department of Internal Medicine (Khafagy, Al-Hajeili); from the Department of Radiology (Banaamah, Abduljabbar, Wazzan), Faculty of Medicine, King Abdulaziz University, from the Department of Internal Medicine (Alghamdi), King Abdulaziz University Hospital, and from the Department of Surgery (Shabkah), International Medical Center, Jeddah, Kingdom of Saudi Arabia.
| | - Alaa Shabkah
- From the Department of Surgery (Trabulsi, Alhazmi, Alzahrani, Samkari, Farsi); from the Department of Internal Medicine (Khafagy, Al-Hajeili); from the Department of Radiology (Banaamah, Abduljabbar, Wazzan), Faculty of Medicine, King Abdulaziz University, from the Department of Internal Medicine (Alghamdi), King Abdulaziz University Hospital, and from the Department of Surgery (Shabkah), International Medical Center, Jeddah, Kingdom of Saudi Arabia.
| | - Ali Samkari
- From the Department of Surgery (Trabulsi, Alhazmi, Alzahrani, Samkari, Farsi); from the Department of Internal Medicine (Khafagy, Al-Hajeili); from the Department of Radiology (Banaamah, Abduljabbar, Wazzan), Faculty of Medicine, King Abdulaziz University, from the Department of Internal Medicine (Alghamdi), King Abdulaziz University Hospital, and from the Department of Surgery (Shabkah), International Medical Center, Jeddah, Kingdom of Saudi Arabia.
| | - Marwan Al-Hajeili
- From the Department of Surgery (Trabulsi, Alhazmi, Alzahrani, Samkari, Farsi); from the Department of Internal Medicine (Khafagy, Al-Hajeili); from the Department of Radiology (Banaamah, Abduljabbar, Wazzan), Faculty of Medicine, King Abdulaziz University, from the Department of Internal Medicine (Alghamdi), King Abdulaziz University Hospital, and from the Department of Surgery (Shabkah), International Medical Center, Jeddah, Kingdom of Saudi Arabia.
| | - Ahmed Abduljabbar
- From the Department of Surgery (Trabulsi, Alhazmi, Alzahrani, Samkari, Farsi); from the Department of Internal Medicine (Khafagy, Al-Hajeili); from the Department of Radiology (Banaamah, Abduljabbar, Wazzan), Faculty of Medicine, King Abdulaziz University, from the Department of Internal Medicine (Alghamdi), King Abdulaziz University Hospital, and from the Department of Surgery (Shabkah), International Medical Center, Jeddah, Kingdom of Saudi Arabia.
| | - Mohammad Wazzan
- From the Department of Surgery (Trabulsi, Alhazmi, Alzahrani, Samkari, Farsi); from the Department of Internal Medicine (Khafagy, Al-Hajeili); from the Department of Radiology (Banaamah, Abduljabbar, Wazzan), Faculty of Medicine, King Abdulaziz University, from the Department of Internal Medicine (Alghamdi), King Abdulaziz University Hospital, and from the Department of Surgery (Shabkah), International Medical Center, Jeddah, Kingdom of Saudi Arabia.
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Harindranath S, Varghese J, Afzalpurkar S, Giri S. Standard and Extended Thromboprophylaxis in Patients with Inflammatory Bowel Disease: A Literature Review. Euroasian J Hepatogastroenterol 2023; 13:133-141. [PMID: 38222957 PMCID: PMC10785145 DOI: 10.5005/jp-journals-10018-1401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 10/04/2023] [Indexed: 01/16/2024] Open
Abstract
Patients with inflammatory bowel disease (IBD), both Crohn's disease and ulcerative colitis, frequently experience venous thromboembolism (VTE), a potentially fatal consequence. The pathophysiological mechanisms contributing to VTE include inflammation, modifications in coagulation factors, endothelial dysfunction, and platelet activation. Numerous pro-inflammatory cytokines and markers, such as tumor necrosis factor-alpha and interleukin-6, have a significant impact on the thrombotic cascade. Patients with IBD are more likely to suffer VTE for a variety of causes. Exacerbations of preexisting conditions, admission to the hospital, surgical intervention, immobilization, corticosteroid usage, central venous catheterization, and hereditary susceptibility all fit into this category. The mainstay of therapy for VTE in IBD patients includes anticoagulation that is individualized for each patient depending on the thrombosis site, severity, bleeding risk, and interaction with other drugs. In some high-risk IBD patients, such as those having major surgery or hospitalized with severe flare, preventive anticoagulation may play a role. However, the acceptance rate for this recommendation is low. Additionally, there is a subset of patients who would require extended thromboprophylaxis. The majority of the studies that looked into this question consisted of patients in the surgical setting. Emerging data suggest that risk factors other than surgery can also dictate the duration of anticoagulation. While extending anticoagulation in all patients may help reduce VTE-related mortality, identifying these risk factors is important. Hence, the decision to initiate prophylaxis should be individualized, considering the overall thrombotic and bleeding risks. This review explores the relationship between IBD and VTE, including risk factors, epidemiology, and prevention. A multifactorial approach involving aggressive management of underlying inflammation, identification of modifiable risk factors, and judicious use of anticoagulant therapy is essential for reducing the burden of VTE in this vulnerable population. How to cite this article Harindranath S, Varghese J, Afzalpurkar S, et al. Standard and Extended Thromboprophylaxis in Patients with Inflammatory Bowel Disease: A Literature Review. Euroasian J Hepato-Gastroenterol 2023;13(2):133-141.
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Affiliation(s)
- Sidharth Harindranath
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Jijo Varghese
- Department of Gastroenterology, NS Hospital, Kollam, Kerala, India
| | - Shivaraj Afzalpurkar
- Department of Gastroenterology, Nanjappa Multispecialty Hospital, Davangere, Karnataka, India
| | - Suprabhat Giri
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Bakhsh E, Shaban M, Al Subaie S, Al Moshary M, AlSheef M. Exploring the Clinical Efficacy of Venous Thromboembolism Management in Saudi Arabian Hospitals: An Insight into Patient Outcomes. J Pers Med 2023; 13:jpm13040612. [PMID: 37108998 PMCID: PMC10141716 DOI: 10.3390/jpm13040612] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/24/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Venous thromboembolism (VTE) is a common condition that can recur, leading to multiple therapeutic strategies to prevent it. The aim of this study was to explore the clinical efficacy of VTE management in Saudi Arabian hospitals and to gain insights into patient outcomes. A retrospective single-center study was conducted that retrieved the data of all patients with VTE registered from January 2015 to December 2017. Patients of all age groups were included if they attended the thrombosis clinic at KFMC during the data collection period. The study analyzed the various therapeutic strategies used for VTE and their effect on patient outcomes. The results showed that 14.6% of the patients had provoked VTE, with a higher incidence among females and younger patients. The most commonly prescribed treatment was combination therapy, followed by warfarin, oral anticoagulants, and factor Xa inhibitor. Despite being prescribed treatment, 74.9% of the patients experienced recurrence of VTE. There was no associated risk factor for recurrence in 79.9% of the patients. Thrombolytic therapy and catheter-directed thrombolysis were found to be associated with a lower risk of VTE recurrence, while anticoagulation therapy, including oral anticoagulants, was associated with a higher risk. Vitamin K antagonist (warfarin) and factor Xa inhibitor (rivaroxaban) had a significant positive association with VTE recurrence, while the use of a direct thrombin inhibitor (dabigatran) showed a lower risk, but it was not statistically significant. The results of the study highlight the need for further research to determine the most effective therapeutic strategy for VTE management in Saudi Arabian hospitals. The findings also suggest that anticoagulation therapy, including oral anticoagulants, may increase the risk of VTE recurrence, while thrombolytic therapy and catheter-directed thrombolysis may lower the risk.
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Affiliation(s)
- Ebtisam Bakhsh
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh 11564, Saudi Arabia
| | - Mostafa Shaban
- Community Health Nursing Department, College of Nursing, Jouf University, Sakaka 72388, Saudi Arabia
| | - Sarah Al Subaie
- Medical Laboratory Scientific Officer, Ministry of Health, Riyadh 11671, Saudi Arabia
| | - May Al Moshary
- Department of Basic Science, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Mohammed AlSheef
- Department of Medical Specialties, King Fahad Medical City, Riyadh 11671, Saudi Arabia
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