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Zhou P, Guo QQ, Wang FX, Zhou L, Hu HF, Deng Z. Nonlinear relationship between platelet count and 30-day in-hospital mortality in ICU acute respiratory failure patients: a multicenter retrospective cohort study. Eur J Med Res 2024; 29:312. [PMID: 38849948 PMCID: PMC11161993 DOI: 10.1186/s40001-024-01909-1] [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: 02/05/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Limited evidence exists regarding the link between platelet count and 30-day in-hospital mortality in acute respiratory failure (ARF) patients. Thus, this study aims to investigate this association among ICU patients experiencing acute respiratory failure. METHODS We conducted a retrospective cohort study across multiple centers, utilizing data from the US eICU-CRD v2.0 database covering 22,262 patients with ARF in the ICU from 2014 to 2015. Our aim was to investigate the correlation between platelet count and 30-day in-hospital mortality using binary logistic regression, subgroup analyses, and smooth curve fitting. RESULTS The 30-day in-hospital mortality rate was 19.73% (4393 out of 22,262), with a median platelet count of 213 × 109/L. After adjusting for covariates, our analysis revealed an inverse association between platelet count and 30-day in-hospital mortality (OR = 0.99, 95% CI 0.99, 0.99). Subgroup analyses supported the robustness of these findings. Furthermore, a nonlinear relationship was identified between platelet count and 30-day in-hospital mortality, with the inflection point at 120 × 109/L. Below the inflection point, the effect size (OR) was 0.89 (0.87, 0.91), indicating a significant association. However, beyond this point, the relationship was not statistically significant. CONCLUSION This study establishes a clear negative association between platelet count and 30-day in-hospital mortality among ICU patients with ARF. Furthermore, we have identified a nonlinear relationship with saturation effects, indicating that among ICU patients with acute respiratory failure, the lowest 30-day in-hospital mortality rate occurs when the baseline platelet count is approximately 120 × 109/L.
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Affiliation(s)
- Pan Zhou
- Department of Emergency Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China
| | - Qin-Qin Guo
- Department of Emergency Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China
| | - Fang-Xi Wang
- Department of Emergency Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China
| | - Li Zhou
- Department of Emergency Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China
| | - Hao-Fei Hu
- Department of Nephrology, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China.
| | - Zhe Deng
- Department of Emergency Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China.
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Cao C, Han Y, Hu H, He Y, Luo J. Non-linear relationship between pulse pressure and the risk of pre-diabetes: a secondary retrospective Chinese cohort study. BMJ Open 2024; 14:e080018. [PMID: 38521517 PMCID: PMC10961532 DOI: 10.1136/bmjopen-2023-080018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/01/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVE Previous research has shown that pulse pressure (PP) has a significant role in the start and development of type 2 diabetes mellitus. However, there is little proof that PP and pre-diabetes mellitus (Pre-DM) are related. Our study aimed to investigate the relationship between PP and incident pre-DM in a substantial cohort of Chinese participants. DESIGN The 'DATADRYAD' database (www.Datadryad.org) was used to retrieve the data for this secondary retrospective cohort analysis. PARTICIPANTS Data from 182 672 Chinese individuals who participated in the medical examination programme were recorded in this retrospective cohort study between 2010 and 2016 across 32 sites and 11 cities in China. SETTING PP assessed at baseline and incident pre-DM during follow-up were the target-independent and dependent variables. The association between PP and pre-DM was investigated using Cox proportional hazards regression. PRIMARY OUTCOME MEASURES The outcome was incident pre-DM. Impaired fasting glucose levels (fasting blood glucose between 5.6 and 6.9 mmol/L) were used to define pre-DM. RESULTS After controlling for confounding variables, PP was positively correlated with incident pre-DM among Chinese adults (HR 1.009, 95% CI 1.007 to 1.010). Additionally, at a PP inflection point of 29 mm Hg, a non-linear connection between the PP and incident pre-DM was discovered. Increased PP was an independent risk factor for developing pre-DM when PP was greater than 29 mm Hg. However, their association was not significant when PP was less than 29 mm Hg. According to subgroup analyses, females, never-smokers and non-obesity correlated more significantly with PP and pre-DM. CONCLUSION We discovered that higher PP independently correlated with pre-DM risk in this study of Chinese participants. The connection between PP and incident pre-DM was also non-linear. High PP levels were related to a higher risk of pre-DM when PP was above 29 mm Hg. ARTICLE FOCUS Our study investigated the relationship between PP and incident pre-DM in a secondary retrospective cohort of Chinese participants.
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Affiliation(s)
- Changchun Cao
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, Guangdong, China
| | - Yong Han
- Department of Emergency, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China
| | - Haofei Hu
- Department of Nephrology, Shenzhen University First Affiliated Hospital, Shenzhen, Guangdong, China
| | - Yongcheng He
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, China
- Department of Nephrology, Shenzhen Hengsheng Hospital, Shenzhen, Guangdong Province, China
| | - Jiao Luo
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Dapeng New District, Guangdong Province, China
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Tu L, Hu H, Zhou X, Zhang H, Liu X, Yang D, He Y. Association between estimated glomerular filtration rate and reversion to normoglycemia in people with impaired fasting glucose: a 5-year retrospective cohort study. Eur J Med Res 2024; 29:140. [PMID: 38388456 PMCID: PMC10882936 DOI: 10.1186/s40001-024-01669-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: 07/24/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES The present body of evidence regarding the correlation between the estimated glomerular filtration rate (eGFR) and the reversal of impaired fasting glucose (IFG) to normoglycemia remains constrained. Consequently, the objective of our study is to examine the relationship between eGFR and the restoration of normoglycemia in individuals with IFG. METHODS This retrospective cohort study consecutively collected data from 24,541 non-selective participants with IFG at Rich Healthcare Group in China from January 2010 to 2016. We aimed to investigate the association between baseline eGFR and reversion to normoglycemia using the Cox proportional-hazards regression model. Through the utilization of a Cox proportional hazards regression model featuring cubical spline smoothing, we were able to ascertain the non-linear correlation between eGFR and the return to normoglycemia. Furthermore, various sensitivity and subgroup analyses were carried out, and a competing risk multivariate Cox regression was employed to examine the progression to diabetes as a competing risk for the reversal of normoglycemic events. RESULTS In our study, comprising 24,541 participants, the average age was 49.25 ± 13.77 years, with 66.28% being male. The baseline eGFR mean was 104.16 ± 15.78 ml/min per 1.73 m2. During a median follow-up period of 2.89 years, we observed a reversion rate to normoglycemia of 45.50%. Upon controlling for covariates, our findings indicated a positive correlation between eGFR and the probability of returning to normoglycemia (HR = 1.008, 95% CI 1.006-1.009). In addition, a non-linear association was observed between eGFR and the likelihood of transitioning from IFG to normoglycemia. The inflection point of eGFR was found to be 111.962 ml/min per 1.73 m2, with HRs of 1.003 (95% CI 1.001, 1.005) on the left side of the point and 1.019 (95% CI 1.015, 1.022) on the right side. Our robust results were supported by competing risks multivariate Cox's regression and sensitivity analysis. CONCLUSIONS The findings of our investigation indicate a favorable and non-linear correlation between eGFR and the restoration of normoglycemia in Chinese individuals with IFG. Specifically, a reduction in renal function at an early stage in these patients may considerably diminish the likelihood of attaining normoglycemia.
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Affiliation(s)
- Lirong Tu
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Rd, Nanchong, 637000, Sichuan Province, China
| | - Haofei Hu
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518000, Guangdong Province, China
- Department of Nephrology, Shenzhen Second People's Hospital, Shenzhen, 518000, Guangdong Province, China
| | - Xinglei Zhou
- Department of Nephrology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu Province, China
| | - Heping Zhang
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Rd, Nanchong, 637000, Sichuan Province, China
| | - Xiaohui Liu
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Rd, Nanchong, 637000, Sichuan Province, China.
| | - Dehua Yang
- Department of Pediatrics, Shenzhen Hengsheng Hospital, No. 20 Yintian Road, Baoan District, Shenzhen, 518103, Guangdong Province, China.
| | - Yongcheng He
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, No.1 Maoyuan South Rd, Nanchong, 637000, Sichuan Province, China.
- Department of Nephrology, Shenzhen Hengsheng Hospital, Shenzhen, 518103, Guangdong Province, China.
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Guan M, Wu L, Cheng Y, Qi D, Chen J, Song H, Hu H, Wan Q. Defining the threshold: triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio's non-linear impact on tubular atrophy in primary membranous nephropathy. Front Endocrinol (Lausanne) 2024; 15:1322646. [PMID: 38327562 PMCID: PMC10847559 DOI: 10.3389/fendo.2024.1322646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024] Open
Abstract
Background Hyperlipidemia is common in primary membranous nephropathy (PMN) patients, and tubular atrophy (TA) is an unfavorable prognostic factor. However, the correlation between the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and TA is controversial. Therefore, our study aimed to investigate the association between the TG/HDL-C ratio and TA in PMN patients. Methods We conducted a cross-sectional study and collected data from 363 PMN patients at Shenzhen Second People's Hospital from January 2008 to April 2023. The primary objective was to evaluate the independent correlation between the TG/HDL-C ratio and TA using binary logistic regression model. We used a generalized additive model along with smooth curve fitting and multiple sensitivity analyses to explore the relationship between these variables. Additionally, subgroup analyses were conducted to delve deeper into the results. Results Of the 363 PMN patients, 75 had TA (20.66%). The study population had a mean age of 46.598 ± 14.462 years, with 217 (59.78%) being male. After adjusting for sex, age, BMI, hypertension, history of diabetes, smoking, alcohol consumption, UPRO, eGFR, HB, FPG, and ALB, we found that the TG/HDL-C ratio was an independent risk factor for TA in PMN patients (OR=1.29, 95% CI: 1.04, 1.61, P=0.0213). A non-linear correlation was observed between the TG/HDL-C ratio and TA, with an inflection point at 4.25. The odds ratios (OR) on the left and right sides of this inflection point were 1.56 (95% CI: 1.17, 2.07) and 0.25 (95% CI: 0.04, 1.54), respectively. Sensitivity analysis confirmed these results. Subgroup analysis showed a consistent association between the TG/HDL-C ratio and TA, implying that factors such as gender, BMI, age, UPRO, ALB, hypertension and severe nephrotic syndrome had negligible effects on the link between the TG/HDL-C ratio and TA. Conclusion Our study demonstrates a non-linear positive correlation between the TG/HDL-C ratio and the risk of TA in PMN patients, independent of other factors. Specifically, the association is more pronounced when the ratio falls below 4.25. Based on our findings, it would be advisable to decrease the TG/HDL-C ratio below the inflection point in PMN patients as part of treatment strategies.
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Affiliation(s)
- Mijie Guan
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Liling Wu
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Yuan Cheng
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Dongli Qi
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Jia Chen
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Haiying Song
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Haofei Hu
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Qijun Wan
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
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Mo Z, Han Y, Cao C, Huang Q, Hu Y, Yu Z, Hu H. Association between non-high-density lipoprotein to high-density lipoprotein ratio and reversion to normoglycemia in people with impaired fasting glucose: a 5-year retrospective cohort study. Diabetol Metab Syndr 2023; 15:259. [PMID: 38105214 PMCID: PMC10726583 DOI: 10.1186/s13098-023-01237-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVE The relationship between the non-high-density lipoprotein to high-density lipoprotein ratio (non-HDL-c/HDL-c ratio) and changes in glycemic status as well as the development of type 2 diabetes mellitus (T2DM) has been well established. However, there is a lack of evidence concerning the association between the non-HDL-c/HDL-c ratio and the reversal of normoglycemia in individuals with impaired fasting glucose (IFG). Therefore, this study aimed to examine the connection between the non-HDL-c/HDL-c ratio and the likelihood of reverting to normoglycemia among people with IFG. METHODS This retrospective cohort study examined data collected from 15,524 non-selective participants with IFG at the Rich Healthcare Group in China between January 2010 and 2016. The Cox proportional-hazards regression model was used to investigate the connection between the baseline non-HDL-c/HDL-c ratio and the probability of reverting to normoglycemia. We were able to discover the non-linear association between the non-HDL-c/HDL-c ratio and reversion to normoglycemia using a Cox proportional hazards regression model with cubical spline smoothing. We also performed several sensitivity and subgroup analyses. A competing risk multivariate Cox regression was utilized as well to examine the development to diabetes as a competing risk for the reversal of normoglycemic events. RESULTS In our study, a total of 15,524 individuals participated, with a mean age of 50.9 ± 13.5 years, and 64.7% were male. The average baseline non-HDL-c/HDL-c ratio was 2.9 ± 0.9. Over a median follow-up period of 2.9 years, we observed a reversion rate to normoglycemia of 41.8%. After adjusting for covariates, our findings revealed a negative association between the non-HDL-c/HDL-c ratio and the likelihood of reverting to normoglycemia (HR = 0.71, 95% CI 0.69-0.74). Notably, we identified a non-linear relationship between the non-HDL-c/HDL-c ratio and the probability of transitioning from IFG to normoglycemia. We found an inflection point at a non-HDL-c/HDL-c ratio of 3.1, with HRs of 0.63 (95% CI 0.69, 0.74) on the left side and 0.78 (95% CI 0.74, 0.83) on the right side of the point. Competing risks multivariate Cox's regression, sensitivity analysis, and subgroup analysis consistently supported our robust results. CONCLUSION Our study has revealed a negative and non-linear relationship between the non-HDL-c/HDL-c ratio and reversion to normoglycemia in Chinese people with IFG. Specifically, when the non-HDL-c/HDL-c ratio was below 3.1, a significant and negative association with reversion to normoglycemia was observed. Furthermore, keeping the non-HDL-c/HDL-c ratio below 3.1 significantly elevated the probability of returning to normoglycemia.
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Affiliation(s)
- Zihe Mo
- Department of Physical Examination, Dongguan Tungwah Hospital, No. 1 Dongcheng Road, Dongcheng Street, Dongguan, 523000, Guangdong, China
| | - Yong Han
- Department of Emergency, Shenzhen Second People's Hospital, Shenzhen, 518000, Guangdong, China
- Department of Emergency, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518000, Guangdong, China
| | - Changchun Cao
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, 518000, Guangdong, China
| | - Qingli Huang
- Department of Physical Examination, Dongguan Tungwah Hospital, No. 1 Dongcheng Road, Dongcheng Street, Dongguan, 523000, Guangdong, China
| | - Yanhua Hu
- College of Information Science and Engineering, Liuzhou Institute of Technology, No. 99, Xinliu Avenue, Yufeng District, Liuzhou, 545616, Guangxi Zhuang Autonomous Region, China.
| | - Zhiqun Yu
- Department of Physical Examination, Dongguan Tungwah Hospital, No. 1 Dongcheng Road, Dongcheng Street, Dongguan, 523000, Guangdong, China.
| | - Haofei Hu
- Department of Nephrology, Shenzhen Second People's Hospital, No.3002 Sungang Road, Futian District, Shenzhen, 518000, Guangdong, China.
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518000, Guangdong, China.
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Li T, Cao C, Xuan X, Liu W, Xiao X, Wei C. The association between creatinine to body weight ratio and the risk of progression to diabetes from pre-diabetes: a 5-year cohort study in Chinese adults. BMC Endocr Disord 2023; 23:266. [PMID: 38044422 PMCID: PMC10694873 DOI: 10.1186/s12902-023-01518-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 11/21/2023] [Indexed: 12/05/2023] Open
Abstract
OBJECTIVE Evidence on the association between the creatinine to body weight (Cre/BW) ratio and the risk of pre-diabetes to diabetes development remains limited. Our study aimed to examine the association between the Cre/BW ratio and incident diabetes in pre-diabetic patients. METHODS This retrospective cohort study included 24,506 pre-diabetic participants who underwent health checks from 2010 to 2016 in China. We used the Cox proportional-hazards regression model to explore the relationship between baseline Cre/BW ratio and diabetes risk in pre-diabetes patients. Using a Cox proportional hazards regression with cubic spline function and smooth curve fitting (cubical spline smoothing), we were able to determine the non-linear relationship between them. We also carried out a number of subgroup and sensitivity analyses. RESULTS The age range of the participants included in this study was 20-99 years, with a majority of 16,232 individuals (66.24%) being men. The mean baseline Cre/BW ratio was 1.06 (SD 0.22) umol/L/kg. 2512 (10.25%) participants received a diabetes final diagnosis over a median follow-up period of 2.89 years. After adjusting for covariates, the Cre/BW ratio had a negative association with incident diabetes in participants with pre-diabetes, per umol/L/kg increase in Cre/BM ratio was accompanied by a 55.5% decrease in diabetes risk (HR = 0.445, 95%CI 0.361 to 0.548). The Cre/BW ratio and risk of diabetes had a non-linear connection, with 1.072 umol/L/kg serving as the ratio's inflection point. The HR were 0.294 (95%CI:0.208-0.414) and 0.712 (95%CI:0.492-1.029), respectively, on the left and right sides of the inflection point. The sensitivity analysis demonstrated the robustness of these results. Subgroup analyses indicated that the Cre/BW ratio was strongly associated with the risk of diabetes among participants who were younger than 50 years, as well as among those with diastolic blood pressure (DBP) < 90 mmHg and triglyceride (TG) < 1.7 mmol/L. In contrast, among participants 50 years of age or older, those with DBP ≥ 90 mmHg, and those with TG ≥ 1.7 mmol/L, the relationship between the Cre/BW ratio and the risk of diabetes was attenuated. CONCLUSION This study demonstrates a negative, non-linear relationship between the Cre/BW ratio and the risk of diabetes among the Chinese population with pre-diabetes. From a therapeutic standpoint, it is clinically meaningful to maintain the Cre/BW ratio levels above the inflection point of 1.072 umol/L/kg.
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Affiliation(s)
- Tong Li
- Department of Nephrology, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, 518000, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, 518000, China
| | - Changchun Cao
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, Guangdong Province, 518000, China
| | - Xuan Xuan
- Department of Rheumatology, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, 518000, China
- Department of Rheumatology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, 518000, China
| | - Wenjing Liu
- Department of Geriatrics, Shenzhen Second People's Hospital, No.3002 Sungang Road, Futian District, Shenzhen, Guangdong Province, 518000, China
- Department of Geriatrics, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, 518000, China
| | - Xiaohua Xiao
- Department of Geriatrics, Shenzhen Second People's Hospital, No.3002 Sungang Road, Futian District, Shenzhen, Guangdong Province, 518000, China.
- Department of Geriatrics, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, 518000, China.
| | - Cuimei Wei
- Department of Geriatrics, Shenzhen Second People's Hospital, No.3002 Sungang Road, Futian District, Shenzhen, Guangdong Province, 518000, China.
- Department of Geriatrics, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, 518000, China.
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Liu Y, Hu H, Li Z, Yang Y, Chen F, Li W, Zhang L, Huang G. Association between preoperative serum sodium and postoperative 30-day mortality in adult patients with tumor craniotomy. BMC Neurol 2023; 23:355. [PMID: 37794369 PMCID: PMC10548693 DOI: 10.1186/s12883-023-03412-2] [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: 02/19/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Limited data exist regarding preoperative serum sodium (Na) and 30-day mortality in adult patients with tumor craniotomy. Therefore, this study investigates their relationship. METHODS A secondary retrospective analysis was performed using data from the ACS NSQIP database (2012-2015). The principal exposure was preoperative Na. The outcome measure was 30-day postoperative mortality. Binary logistic regression modeling was conducted to explore the link between them, and a generalized additive model and smooth curve fitting were applied to evaluate the potential association and its explicit curve shape. We also conducted sensitivity analyses and subgroup analyses. RESULTS A total of 17,844 patients (47.59% male) were included in our analysis. The mean preoperative Na was 138.63 ± 3.23 mmol/L. The 30-day mortality was 2.54% (455/17,844). After adjusting for covariates, we found that preoperative Na was negative associated with 30-day mortality. (OR = 0.967, 95% CI:0.941, 0.994). For patients with Na ≤ 140, each increase Na was related to a 7.1% decreased 30-day mortality (OR = 0.929, 95% CI:0.898, 0.961); for cases with Na > 140, each increased Na unit was related to a 8.8% increase 30-day mortality (OR = 1.088, 95% CI:1.019, 1.162). The sensitivity analysis and subgroup analysis indicated that the results were robust. CONCLUSIONS This study shows a positive and nonlinear association between preoperative Na and postoperative 30-day mortality in adult patients with tumor craniotomy. Appropriate preoperative Na management and maintenance of serum Na near the inflection point (140) may reduce 30-day mortality.
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Affiliation(s)
- Yufei Liu
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, No. 3002 Sungang west Road, Futian District, Shenzhen, Guangdong Province, 518035, China
- Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
- Shenzhen University Health Science Center, Shenzhen city, Guangdong Province, 518000, China
| | - Haofei Hu
- Shenzhen University Health Science Center, Shenzhen city, Guangdong Province, 518000, China
- Nephrological Department, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, 518035, China
| | - Zongyang Li
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, No. 3002 Sungang west Road, Futian District, Shenzhen, Guangdong Province, 518035, China
- Shenzhen University Health Science Center, Shenzhen city, Guangdong Province, 518000, China
| | - Yuandi Yang
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, No. 3002 Sungang west Road, Futian District, Shenzhen, Guangdong Province, 518035, China
- Shenzhen University Health Science Center, Shenzhen city, Guangdong Province, 518000, China
| | - Fanfan Chen
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, No. 3002 Sungang west Road, Futian District, Shenzhen, Guangdong Province, 518035, China
- Shenzhen University Health Science Center, Shenzhen city, Guangdong Province, 518000, China
| | - Weiping Li
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, No. 3002 Sungang west Road, Futian District, Shenzhen, Guangdong Province, 518035, China
- Shenzhen University Health Science Center, Shenzhen city, Guangdong Province, 518000, China
| | - Liwei Zhang
- Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, No. 119, South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Guodong Huang
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, No. 3002 Sungang west Road, Futian District, Shenzhen, Guangdong Province, 518035, China.
- Shenzhen University Health Science Center, Shenzhen city, Guangdong Province, 518000, China.
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Correa-Agudelo E, Ding L, Beck AF, Mendy A, Mersha TB. Multilevel Analysis of Racial and Ethnic Disparities in COVID-19 Hospitalization among Children with Allergies. Ann Am Thorac Soc 2023; 20:843-853. [PMID: 36622831 PMCID: PMC10257024 DOI: 10.1513/annalsats.202207-580oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/09/2023] [Indexed: 01/10/2023] Open
Abstract
Rationale: Previous studies have identified risk factors for coronavirus disease (COVID-19) hospitalization in children. However, these studies have been limited in their ability to disentangle the contribution of racial disparities, allergic comorbidities, and environmental exposures to the development of severe COVID-19 in at-risk children with allergies. Objectives: To examine racial and ethnic disparities in COVID-19 hospitalization and their links to potentially underlying allergic comorbidities and individual and place-based factors in children with allergies. Methods: This is an electronic health record-based retrospective study of children in 2020. The outcome was COVID-19 hospitalization categorized as no hospital care for patients with asymptomatic/mild illness, short stay for patients admitted and discharged within 24 hours, and prolonged stay for patients requiring additional time to discharge (more than 24 h). Mixed-effects and mediation models were used to determine relationships among independent variables, mediators, and COVID-19 hospitalization. Results: Among the 5,258 children with COVID-19 positive test or diagnosis, 10% required a short stay, and 3.7% required a prolonged stay. Black and Hispanic children had higher odds of longer stays than non-Hispanic White children (both P < 0.001). Children with obesity and eosinophilic esophagitis diagnoses had higher odds of short and prolonged stay (all P < 0.05). Area-level deprivation was associated with short stay (adjusted odds ratio [AOR], 15.49; 95% confidence interval [CI], 5.16-45.47 for every 0.1-unit increase) and prolonged stay (AOR, 11.82; 95% CI, 2.25-62.01 for every 0.1-unit increase). Associations between race/ethnicity and COVID-19 hospitalization were primarily mediated by insurance and area-level deprivation, altogether accounting for 99% of the variation in COVID-19 hospitalization. Conclusions: There were racial and ethnic differences in children with allergies and individual and place-based factors related to COVID-19 hospitalization. Differences were primarily mediated by insurance and area-level deprivation, altogether accounting for 99% of the variation in COVID-19 hospitalization. A better understanding of COVID-related morbidity in children and the link to place-based factors is key to developing prevention strategies capable of equitably improving outcomes.
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Affiliation(s)
| | - Lili Ding
- Division of Biostatistics and Epidemiology
| | - Andrew F. Beck
- Division of General & Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, and
| | - Angelico Mendy
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio
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9
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Zhu Y, Hu H, Wu Y, Rao Y, Li Q, Duan X, Yao G, Yin H, Luo Z. The association between fatty liver index and onset of diabetes: secondary analysis of a population-based cohort study. BMC Public Health 2023; 23:679. [PMID: 37041534 PMCID: PMC10091632 DOI: 10.1186/s12889-023-15442-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: 08/21/2022] [Accepted: 03/14/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND According to research, the fatty liver index (FLI) is associated with diabetes. However, few studies have been conducted to investigate the relationship between FLI and diabetes risk from various perspectives. This study comprehensively investigated the relationship between FLI and incident diabetes in a large Japanese population. METHODS This retrospective cohort study included 14,280 participants from Murakami Memorial Hospital in Japan from 2004 to 2015. The independent and dependent variables are FLI and risk of type 2 diabetes mellitus (T2DM), respectively. To examine the link between FLI and incident T2DM, Cox proportional-hazards regression was employed. In addition, we performed a number of sensitivity studies to guarantee the validity of the results. Moreover, we conducted subgroup analyses. RESULTS After adjusting covariates, the results showed that FLI was positively associated with the risk of T2DM (HR = 1.019, 95%CI: 1.012, 1.025). Additionally, the sensitivity analysis showed how reliable the outcomes were. And a stronger association between FLI and incident T2DM was observed in the regular exercisers (HR = 1.036, 95%CI: 1.019-1.053, P < 0.0001) and the population without ethanol consumption (HR = 1.028, 95%CI: 1.017-1.039, P < 0.0001). Besides, receiver operating characteristic (ROC) curve analysis showed that FLI was better than waist circumference, triglycerides, body mass index, and gamma-glutamyl transferase in predicting incident T2DM. CONCLUSION FLI is positively associated with incident T2DM.
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Affiliation(s)
- Yanqiong Zhu
- Department of Gastroenterology, Jiangmen Central Hospital, No.23 Haibang Street, Pengjiang District, Jiangmen, 529030, Guangdong Province, China
| | - Haofei Hu
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518000, Guangdong Province, China
- Department of Nephrology, Shenzhen Second People's Hospital, Shenzhen, 518000, Guangdong Province, China
- Shenzhen University Health Science Center, Shenzhen, 518000, Guangdong Province, China
| | - Yumei Wu
- Department of Gastroenterology, Shenzhen Third People's Hospital, No.29 Bulan Road, Longgang District, Shenzhen, 518000, Guangdong Province, China
| | - Yinhua Rao
- Department of Gastroenterology, Shenzhen People's Hospital Longhua Branch, Guangdong Province, 518000, China
| | - Qixiang Li
- Department of Gastroenterology, Jiangmen Central Hospital, No.23 Haibang Street, Pengjiang District, Jiangmen, 529030, Guangdong Province, China
| | - Xuehui Duan
- Department of Gastroenterology, Jiangmen Central Hospital, No.23 Haibang Street, Pengjiang District, Jiangmen, 529030, Guangdong Province, China
| | - Guopeng Yao
- Department of Gastroenterology, Jiangmen Central Hospital, No.23 Haibang Street, Pengjiang District, Jiangmen, 529030, Guangdong Province, China
| | - Hekun Yin
- Department of Gastroenterology, Jiangmen Central Hospital, No.23 Haibang Street, Pengjiang District, Jiangmen, 529030, Guangdong Province, China.
| | - Ziyi Luo
- Department of Gastroenterology, Shenzhen Third People's Hospital, No.29 Bulan Road, Longgang District, Shenzhen, 518000, Guangdong Province, China.
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10
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Cheng T, Wang X, Han Y, Hao J, Hu H, Hao L. The level of serum albumin is associated with renal prognosis and renal function decline in patients with chronic kidney disease. BMC Nephrol 2023; 24:57. [PMID: 36922779 PMCID: PMC10018824 DOI: 10.1186/s12882-023-03110-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/07/2023] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVE The study's purpose is to explore the link of serum albumin on renal progression in patients with chronic kidney disease (CKD). METHODS This study was a secondary analysis of a prospective cohort study in which a total of 954 participants were non-selectively and consecutively collected from the research of CKD-ROUTE in Japan between November 2010 and December 2011. We evaluated the association between baseline ALB and renal prognosis (initiation of dialysis or 50% decline in eGFR from baseline) and renal function decline (annual eGFR decline) using the Cox proportional-hazards and linear regression models, respectively. We performed a number of sensitivity analyses to ensure the validity of the results. In addition, we performed subgroup analyses. RESULTS The included patients had a mean age of (66.86 ± 13.41) years, and 522 (69.23%) were male. The mean baseline ALB and eGFR were (3.89 ± 0.59) g/dL and (33.43 ± 17.97) ml/min/1.73 m2. The annual decline in eGFR was 2.65 mL/min/1.73 m2/year. 218 (28.9%) individuals experienced renal prognosis during a median follow-up period of 36.0 months. The baseline ALB was inversely linked with renal prognosis (HR = 0.61, 95%CI: 0.45, 0.81) and renal function decline (β = -1.41, 95%CI: -2.11, -0.72) after controlling for covariates. The renal prognosis and ALB had a non-linear connection, with ALB's inflection point occurring at 4.3 g/dL. Effect sizes (HR) were 0.42 (0.32, 0.56) and 6.11 (0.98, 38.22) on the left and right sides of the inflection point, respectively. There was also a non-linear relationship between ALB and renal function decline, and the inflection point of ALB was 4.1 g/dL. The effect sizes(β) on the left and right sides of the inflection point were -2.79(-3.62, -1.96) and 0.02 (-1.97, 1.84), respectively. CONCLUSION This study shows a negative and non-linear association between ALB and renal function decline as well as renal prognosis in Japanese CKD patients. When ALB is lower than 4.1 g/dL, ALB decline was closely related to poor renal prognosis and renal function decline. From a therapeutic point of view, reducing the decline in ALB makes sense for delaying CKD progression.
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Affiliation(s)
- Tong Cheng
- Department of Nephrology, Southern University of Science and Technology Hospital, No. 6019 Liuxian Street, Xili Avenue, Nanshan District, Shenzhen, Guangdong Province, 518000, China
| | - Xiaoyu Wang
- Department of Nephrology, Hechi People's Hospital, Hechi, Guangxi Zhuang Autonomous Region, 547000, China
| | - Yong Han
- Department of Emergency, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, 518000, China
| | - Jianbing Hao
- Department of Nephrology, Southern University of Science and Technology Hospital, No. 6019 Liuxian Street, Xili Avenue, Nanshan District, Shenzhen, Guangdong Province, 518000, China
| | - Haofei Hu
- Department of Nephrology, Shenzhen Second People's Hospital, No. 3002 Sungang Road, Futian District, Shenzhen, Guangdong Province, 518000, China.
| | - Lirong Hao
- Department of Nephrology, Southern University of Science and Technology Hospital, No. 6019 Liuxian Street, Xili Avenue, Nanshan District, Shenzhen, Guangdong Province, 518000, China.
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11
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Liu Y, Li L, Hu H, Yang J, Zhang X, Chen L, Chen F, Hao S, Li W, Huang G. Association between preoperative hematocrit and postoperative 30-day mortality in adult patients with tumor craniotomy. Front Neurol 2023; 14:1059401. [PMID: 36895901 PMCID: PMC9990837 DOI: 10.3389/fneur.2023.1059401] [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: 10/07/2022] [Accepted: 02/01/2023] [Indexed: 02/23/2023] Open
Abstract
Background The purpose of this research was to synthesize the American College of Surgeons National Surgical Quality Improvement Program database to investigate the link between preoperative hematocrit and postoperative 30-day mortality in patients with tumor craniotomy. Methods A secondary retrospective analysis of electronic medical records of 18,642 patients with tumor craniotomy between 2012 and 2015 was performed. The principal exposure was preoperative hematocrit. The outcome measure was postoperative 30-day mortality. We used the binary logistic regression model to explore the link between them and conducted a generalized additive model and smooth curve fitting to investigate the link and its explicit curve shape. We conducted sensitivity analyses by converting a continuous HCT into a categorical variable and calculated an E-value. Results A total of 18,202 patients (47.37% male participants) were included in our analysis. The postoperative 30-day mortality was 2.5% (455/18,202). After adjusting for covariates, we found that preoperative hematocrit was positively associated with postoperative 30-day mortality (OR = 0.945, 95% CI: 0.928, 0.963). A non-linear relationship was also discovered between them, with an inflection point at a hematocrit of 41.6. The effect sizes (OR) on the left and right sides of the inflection point were 0.918 (0.897, 0.939) and 1.045 (0.993, 1.099), respectively. The sensitivity analysis proved that our findings were robust. The subgroup analysis demonstrated that a weaker association between preoperative hematocrit and postoperative 30-day mortality was found for patients who did not use steroids for chronic conditions (OR = 0.963, 95% CI: 0.941-0.986), and a stronger association was discovered in participants who used steroids (OR = 0.914, 95% CI: 0.883-0.946). In addition, there were 3,841 (21.1%) cases in the anemic group (anemia is defined as a hematocrit (HCT) <36% in female participants and <39% in male participants). In the fully adjusted model, compared with the non-anemic group, patients in the anemic group had a 57.6% increased risk of postoperative 30-day mortality (OR = 1.576; 95% CI: 1.266, 1.961). Conclusion This study confirms that a positive and nonlinear association exists between preoperative hematocrit and postoperative 30-day mortality in adult patients undergoing tumor craniotomy. Preoperative hematocrit was significantly associated with postoperative 30-day mortality when the preoperative hematocrit was <41.6.
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Affiliation(s)
- Yufei Liu
- Shenzhen Key Laboratory of Neurosurgery, Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Lunzou Li
- Department of Neurosurgery, Hechi People's Hospital, Hechi, Guangxi, China
| | - Haofei Hu
- Shenzhen University Health Science Center, Shenzhen, Guangdong, China.,Department of Nephrology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Jihu Yang
- Shenzhen Key Laboratory of Neurosurgery, Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.,Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Xiejun Zhang
- Shenzhen Key Laboratory of Neurosurgery, Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.,Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Lei Chen
- Shenzhen Key Laboratory of Neurosurgery, Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.,Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Fanfan Chen
- Shenzhen Key Laboratory of Neurosurgery, Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.,Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Shuyu Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Weiping Li
- Shenzhen Key Laboratory of Neurosurgery, Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.,Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Guodong Huang
- Shenzhen Key Laboratory of Neurosurgery, Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.,Shenzhen University Health Science Center, Shenzhen, Guangdong, China
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12
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Liu Y, Hu H, Li Z, Yang J, Zhang X, Chen L, Chen F, Li W, Ji N, Huang G. Association between preoperative platelet and 30-day postoperative mortality of adult patients undergoing craniotomy for brain tumors: data from the American College of Surgeons National Surgical Quality Improvement Program database. BMC Neurol 2022; 22:465. [PMID: 36494643 PMCID: PMC9733164 DOI: 10.1186/s12883-022-03005-5] [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: 05/26/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Evidence regarding the relationship between preoperative platelet and 30-day postoperative mortality of intracranial tumor patients undergoing craniotomy is still limited. Therefore, the present research was conducted to explore the link of the platelet and 30-day postoperative mortality. METHODS Electronic medical records of 18,642 adult patients undergoing craniotomy for brain tumors from 2012 to 2015 in the American College of Surgeons National Surgical Quality Improvement Program, were subject to secondary retrospective analysis. A binary logistic regression model evaluated the independent association between preoperative platelet and 30-day postoperative mortality. A generalized additive model and smooth curve fitting was conducted to explore the exact shape of the curve between them. Additionally, We also conducted sensitivity analyses to test the robustness of the results, and performed subgroup analyses. RESULTS Eighteen thousand sixty-three patients were included in this study analysis. Of these, 47.49% were male. The mean preoperative platelet value was (244.12 ± 76.77) × 109/L. The 30-day postoperative mortality of included participants was 2.5% (452/18,063). After adjusting covariates, the results showed that preoperative platelet was positively associated with 30-day postoperative mortality (OR = 0.999, 95%CI: 0.997, 1.000). There was also a nonlinear relationship between preoperative platelet and 30-day postoperative mortality, and the inflection point of the platelet was 236. The effect sizes (OR) on the right and left sides of the inflection point were 1.002 (1.000, 1.004) and 0.993 (0.990, 0.995), respectively. And sensitive analysis demonstrated the robustness of the results. Subgroup analysis showed a stronger association between preoperative platelet and 30-day postoperative mortality in non-emergency surgery patients when preoperative platelet value is less than 235 × 109/L. CONCLUSIONS This research demonstrates a positive and non-linear relationship between preoperative platelet and 30-day postoperative mortality in U.S. adult brain tumor patients undergoing craniotomy. Preoperative platelet is strongly related to 30-day postoperative mortality when the platelet is less than 235 × 109/L. Proper preoperative management of platelet and maintenance of platelet near inflection point (235) could reduce risk of 30-day postoperative mortality in these cases.
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Affiliation(s)
- Yufei Liu
- grid.452847.80000 0004 6068 028XPresent Address: Neurosurgical Department, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, No.3002 Sungang Road, Futian District, Shenzhen, 518035 Guangdong Province China ,grid.411617.40000 0004 0642 1244Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China ,grid.508211.f0000 0004 6004 3854Shenzhen University Health Science Center, Shenzhen, 518000 Guangdong Province China
| | - Haofei Hu
- grid.508211.f0000 0004 6004 3854Shenzhen University Health Science Center, Shenzhen, 518000 Guangdong Province China ,grid.452847.80000 0004 6068 028XNephrological Department, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035 Guangdong Province China
| | - Zongyang Li
- grid.452847.80000 0004 6068 028XPresent Address: Neurosurgical Department, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, No.3002 Sungang Road, Futian District, Shenzhen, 518035 Guangdong Province China ,grid.508211.f0000 0004 6004 3854Shenzhen University Health Science Center, Shenzhen, 518000 Guangdong Province China
| | - Jihu Yang
- grid.452847.80000 0004 6068 028XPresent Address: Neurosurgical Department, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, No.3002 Sungang Road, Futian District, Shenzhen, 518035 Guangdong Province China ,grid.508211.f0000 0004 6004 3854Shenzhen University Health Science Center, Shenzhen, 518000 Guangdong Province China
| | - Xiejun Zhang
- grid.452847.80000 0004 6068 028XPresent Address: Neurosurgical Department, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, No.3002 Sungang Road, Futian District, Shenzhen, 518035 Guangdong Province China ,grid.508211.f0000 0004 6004 3854Shenzhen University Health Science Center, Shenzhen, 518000 Guangdong Province China
| | - Lei Chen
- grid.452847.80000 0004 6068 028XPresent Address: Neurosurgical Department, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, No.3002 Sungang Road, Futian District, Shenzhen, 518035 Guangdong Province China ,grid.508211.f0000 0004 6004 3854Shenzhen University Health Science Center, Shenzhen, 518000 Guangdong Province China
| | - Fanfan Chen
- grid.452847.80000 0004 6068 028XPresent Address: Neurosurgical Department, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, No.3002 Sungang Road, Futian District, Shenzhen, 518035 Guangdong Province China ,grid.508211.f0000 0004 6004 3854Shenzhen University Health Science Center, Shenzhen, 518000 Guangdong Province China
| | - Weiping Li
- grid.452847.80000 0004 6068 028XPresent Address: Neurosurgical Department, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, No.3002 Sungang Road, Futian District, Shenzhen, 518035 Guangdong Province China ,grid.508211.f0000 0004 6004 3854Shenzhen University Health Science Center, Shenzhen, 518000 Guangdong Province China
| | - Nan Ji
- grid.411617.40000 0004 0642 1244Neurosurgical Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070 China ,grid.411617.40000 0004 0642 1244China National Clinical Research Center for Neurological Diseases, Beijing, China ,Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing, China
| | - Guodong Huang
- grid.452847.80000 0004 6068 028XPresent Address: Neurosurgical Department, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University, No.3002 Sungang Road, Futian District, Shenzhen, 518035 Guangdong Province China ,grid.508211.f0000 0004 6004 3854Shenzhen University Health Science Center, Shenzhen, 518000 Guangdong Province China
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Salimi F, Stasinska A, Morgan GG, Hankey GJ, Almeida O, Yeap B, Flicker L, Heyworth J. Long-term exposure to low air pollutant concentrations and hospitalisation for respiratory diseases in older men: A prospective cohort study in Perth, Australia. Heliyon 2022; 8:e10905. [PMID: 36276719 PMCID: PMC9578981 DOI: 10.1016/j.heliyon.2022.e10905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/22/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background Acute exposure to ambient air pollution even at low concentrations has been associated with increased hospitalisation for respiratory diseases but the effects of long-term exposure are less certain. In this study, we investigated the associations between long-term exposures to PM2.5, PM2.5 absorbance and NO2 and hospitalisation for asthma, chronic obstructive pulmonary disease and pneumonia in a cohort of older men living in Perth, Western Australia, a city where the levels of air pollutants are well below the world standards. Materials and methods The study population of 11,156 men with no prior hospitalisation for respiratory disease was drawn from the Health in Men Study (HIMS) cohort of men aged >65 years living in Perth, Western Australia between 1996-1999. PM2.5, PM2.5 absorbance (PM2.5a) and NO2 were measured across the Perth metropolitan area over three seasons in 2012. Land use regression (LUR) models were used to estimate annual concentrations of PM2.5, PM2.5 absorbance and NO2 at the residential address of each participant from inception (1996) to 2015. Hospitalisation for respiratory disease between inception and 2015 was ascertained using the Western Australian Data Linkage System. The association between exposure to air pollution with hospitalisation for respiratory disease was examined using Cox regression analysis. Results No statistically significant associations were observed in the fully adjusted models. However, positive associations were observed with first hospitalisation for pneumonia (HR 1.08, 95% CI: 1.01–1.16) when adjusted for age, year of enrolment, smoking status, education, BMI and physical activity. Conclusions In this longitudinal study of older men we found no evidence of associations between increased long-term exposure to low-level air pollution with increased risk of hospitalisation for respiratory diseases in Perth, Australia. More studies on respiratory morbidity associated with exposure to low levels of air pollution are needed for more comprehensive understanding of the overall risk.
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Affiliation(s)
- Farhad Salimi
- University Centre for Rural Health, Faculty of Medicine and Health, The University of Sydney, Australia Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia,Occupational and Environmental Health Sciences, Public Health and Preventive Medicine, Monash University, Australia,Corresponding author.
| | - Ania Stasinska
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Geoffrey G. Morgan
- University Centre for Rural Health, Faculty of Medicine and Health, The University of Sydney, Australia Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Graeme J. Hankey
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Osvaldo Almeida
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Bu Yeap
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Leon Flicker
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Jane Heyworth
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Hu H, Cao C, Han Y, He Y. Triglyceride affects the association between estimated glomerular filtration rate and the onset of non-alcoholic fatty liver disease: A second analysis of a Chinese cohort study. Front Med (Lausanne) 2022; 9:984241. [PMID: 36237544 PMCID: PMC9551029 DOI: 10.3389/fmed.2022.984241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/12/2022] [Indexed: 11/20/2022] Open
Abstract
Objective The role of triglyceride (TG) and estimated glomerular filtration rate (eGFR) effect modifiers on the risk of non-alcoholic fatty liver disease (NAFLD) is unknown. This study examined whether TG modifies the relationship between eGFR and incident NAFLD. Methods In a Chinese hospital from January 2010 to December 2014, 15,555 non-obese subjects were collected systematically for this retrospective cohort study. The target-independent and dependent variables were eGFR measured at baseline and NAFLD appearing during follow-up. The modified variable was TG measured at baseline. The multivariate Cox proportional hazards model was used to explore eGFR and TG’s association with NAFLD risk. We explored a priori interaction between eGFR and TG, and performed subgroup analyses to further assess whether the relationship between eGFR and incident NAFLD was modified by TG. We also explored the effect of TG and eGFR interaction on the risk of NAFLD. Results The mean age was 43.09 ± 14.92 years, and 8,131 (52.27%) were males. During a median follow-up time of 35.8 months, 2,077 (13.35%) individuals developed NAFLD. In the adjusted model, eGFR was negatively associated with incident NAFLD (HR = 0.984, 95% CI: 0.982, 0.987), while TG was positively related to NAFLD (HR = 1.582, 95% CI: 1.490, 1.681). TG could modify the relationship between eGFR and incident NAFLD. A stronger association between eGFR and NAFLD could be found in the participants without hypertriglyceridemia (HTG) (HR = 0.981, 95% CI: 0.978–0.984, P for interaction = 0.0139). In contrast, the weaker association was probed in the population with HTG (HR = 0.986, 95% CI: 0.983–0.989). At the same time, we also found an interaction between eGFR and TG in influencing NAFLD risk. In participants with decreased eGFR and HTG, the risk of NAFLD was significantly increased. Further, compared to non-HTG subjects with eGFR ≥ 116.56 ml/min/1.73 m2, participants with HTG and eGFR < 82.88 ml/min/1.73 m2 had about a fourfold increase in the risk (HR = 4.852 95% CI: 3.943–5.970) of NAFLD. Conclusion eGFR and TG is independently associated with NAFLD risk. The association of eGFR with incident NAFLD is likely to be modified by TG in the Chinese non-obese population. There was an interactive effect between eGFR and TG in affecting NAFLD risk. In participants with decreased eGFR and hypertriglyceridemia, the risk of NAFLD is significantly increased.
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Affiliation(s)
- Haofei Hu
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Shenzhen University Health Science Center, Shenzhen, Guangdong, China
| | - Changchun Cao
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, Guangdong, China
| | - Yong Han
- Shenzhen University Health Science Center, Shenzhen, Guangdong, China
- Department of Emergency, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Emergency, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Yong Han,
| | - Yongcheng He
- Department of Nephrology, Shenzhen Hengsheng Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
- Yongcheng He,
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Wang X, Han Y, Liu Y, Hu H. Association between serum uric acid-to-creatinine ratio and non-alcoholic fatty liver disease: a cross-sectional study in Chinese non-obese people with a normal range of low-density lipoprotein cholesterol. BMC Gastroenterol 2022; 22:419. [PMID: 36104672 PMCID: PMC9472393 DOI: 10.1186/s12876-022-02500-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Evidence regarding the relationship between serum uric acid-to-creatinine (SUA/Scr) ratio and non-alcoholic fatty liver disease (NAFLD) in Chinese non-obese people is still limited. Therefore, the present study was undertaken to analyze the association between the SUA/Scr ratio and NAFLD.
Methods This study was a cross-sectional study that non-selectively and consecutively collected 182,320 non-obese individuals with a normal range of low-density lipoprotein cholesterol in a Chinese hospital from January 2010 to December 2014. A binary logistic regression model was used to evaluate the independent association between the SUA/Scr ratio and NAFLD. A generalized additive model (GAM) and smooth curve fitting (penalized spline method) was conducted to explore the exact shape of the curve between them. A series of sensitivity analyses were used to ensure the robustness of the results. Moreover, subgroup analyses were conducted. In addition, the diagnostic value of the SUA/Scr ratio for NAFLD was evaluated based on the area under the receiver-operating characteristic curve (AUROC). It was stated that the data had been uploaded to the DATADRYAD website. Results The average participants' age was 40.96 ± 14.05 years old, and 90,305 (49.5%) were male. The prevalence of NAFLD was 13.7%, and the mean SUA/Scr was 3.62 ± 0.92. After adjusting covariates, the results showed that SUA/Scr ratio was positively associated with NAFLD (OR = 1.424, 95%CI: 1.396, 1.454). There was also a non-linear relationship between SUA/Scr ratio and NAFLD in participants with normal kidney function, and the inflection point of the SUA/Scr ratio was 4.425. The effect sizes (OR) on the left and right sides of the inflection point were 1.551 (1.504, 1.599) and 1.234 (1.179, 1.291), respectively. And the sensitive analysis demonstrated the robustness of the results. Subgroup analysis showed a stronger association between SUA/Scr ratio and NAFLD in females and the population with age < 50 years, FPG ≤ 6.1 mmol/L, BMI < 24 kg/m2, and HDL-c ≥ 1 mmol/L. In contrast, the weaker association was probed in males and the population with age ≥ 50 years, BMI ≥ 24 kg/m2, FPG > 6.1 mmol/L, and HDL-c < 1 mmol/L. The SUA/Scr ratio had an AUC of 0.6624 (95% CI 0.6589, 0.6660) for diagnosing NAFLD. Based on the best cut-off value of 3.776, the negative predictive value of the SUA/Scr ratio for identifying NAFLD was 91.0%. Conclusion This study demonstrates an independent positive association between SUA/Scr ratio and NAFLD in Chinese non-obese people with a normal range of low-density lipoprotein cholesterol. There is also a non-linear relationship between the SUA/Scr ratio and NAFLD in participants with normal kidney function, and the SUA/Scr ratio is strongly related to NAFLD when SUA/Scr ratio is less than 4.425. The SUA/Scr ratio has a certain reference value for determining NAFLD. When the SUA/Scr ratio is lower than 3.776, identifying NAFLD patients with low risk is a great reference. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02500-w.
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Pan W, Han Y, Hu H, He Y. Association between hemoglobin and chronic kidney disease progression: a secondary analysis of a prospective cohort study in Japanese patients. BMC Nephrol 2022; 23:295. [PMID: 35999502 PMCID: PMC9400271 DOI: 10.1186/s12882-022-02920-6] [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: 03/31/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Anemia has been reported as a risk factor for chronic kidney disease (CKD) progression. However, there are still few studies examining the relationship between specific hemoglobin (Hb) levels and renal prognosis and renal function decline simultaneously. Meanwhile, the possible non-linear relationship between Hb and CKD progression also deserves further exploration. On that account, our primary goal is to explore the link of Hb on renal prognosis and renal function decline in patients with CKD. METHODS This study was a secondary analysis of a prospective cohort study, which consecutively and non-selectively collected 962 participants from the research of CKD-ROUTE in Japan from November 2010 to December 2011. We used the Cox proportional-hazards and linear regression models to evaluate the independent association between baseline Hb and renal prognosis (renal composite endpoint, initiation of dialysis during follow-up or 50% decline in eGFR from baseline) and renal function decline(annual eGFR decline), respectively. A multivariate Cox proportional hazards regression analysis with cubic spline functions model and smooth curve fitting (penalized spline method) were conducted to address Hb and CKD prognosis's non-linearity. At the same time, a generalized additive model (GAM) and smooth curve fitting (penalized spline method) was conducted to explore the exact shape of the curve between Hb and renal function decline. Additionally, we did a series of sensitivity analyses to ensure the robustness of the results. Moreover, we conducted subgroup analyses. RESULTS The mean age of the included patients was 67.35 ± 13.56 years old, and 69.65% were male. The mean baseline Hb and estimated glomerular filtration rate (eGFR) was 12.06 ± 2.21 g/dL and 33.04 ± 18.01 ml/min per 1.73 m2. The annual decline in eGFR was 2.09 mL/min/1.73 m2/year. During a median follow-up time of 33.5 months, 252(26.2%) people experienced renal composite endpoint. After adjusting covariates, the results showed that Hb was negatively associated with renal composite endpoint (HR = 0.836, 95%CI: 0.770, 0.907) and renal function decline (β = -0.436, 95%CI: -0.778, -0.093). There was also a non-linear relationship between Hb and renal composite endpoint, and the inflection point of Hb was 8.6 g/dL. The effect sizes(HR) on the left and right sides of the inflection point were 1.257 (0.841, 1.878) and 0.789 (0.715, 0.870), respectively. And the sensitive analysis demonstrated the robustness of the results. Subgroup analysis showed that Hb was more strongly associated with the renal composite endpoint in non-hypertensive, SBP < 140 mmHg, urine protein-to-creatinine ratio (UPCR) < 0.5 g/gCr, and diuretic use patients. In contrast, the weaker association was probed in hypertensive and non-diuretic use patients and the patients with SBP ≥ 140 mmHg, and UPCR ≥ 0.5 g/gCr. CONCLUSION This study demonstrates a negative and non-linear relationship between Hb and renal prognosis and renal function decline in Japanese CKD patients. Hb is strongly related to renal prognosis when Hb is above 8.6 g/dL.
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Affiliation(s)
- Wushan Pan
- Department of Nephrology, Kaifeng Central Hospital, Kaifeng, 475000, Henan Province, China
| | - Yong Han
- Department of Emergency, Shenzhen Second People's Hospital, Shenzhen, 518000, Guangdong Province, China.,Department of Emergency, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518000, Guangdong Province, China
| | - Haofei Hu
- Department of Nephrology, Shenzhen Second People's Hospital, Futian District, No.3002 Sungang Road, Shenzhen, 518000, Guangdong Province, China. .,Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518000, Guangdong Province, China.
| | - Yongcheng He
- Department of Nephrology, Shenzhen Hengsheng Hospital, Baoan District, No. 20 Yintian Road, Shenzhen, 518000, Guangdong Province, China.
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Cao C, Hu H, Zheng X, Zhang X, Wang Y, He Y. Association between central obesity and incident diabetes mellitus among Japanese: a retrospective cohort study using propensity score matching. Sci Rep 2022; 12:13445. [PMID: 35927472 PMCID: PMC9352654 DOI: 10.1038/s41598-022-17837-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
Previous evidence revealed that central obesity played a vital role in the development of diabetes mellitus (DM). However, because of imbalanced confounding variables, some studies have not wholly established the association between central obesity and diabetes. Propensity score matching (PSM) analysis can minimize the impact of potential confounding variables. Therefore, the aim of the present study was to explore the relationship between central obesity and diabetes in the Japanese population by using PSM analysis. This retrospective cohort study included 15,453 Japanese adults who were free of diabetes at baseline between 2004 and 2015, which provided all medical records for individuals participating in the physical exam. Central obesity at baseline was an independent variable, and incident diabetes during follow-up was an outcome variable. Using a 1:1 PSM analysis, the present retrospective cohort study included 1639 adults with and without central obesity. Additionally, we employed a doubly robust estimation method to identify the association between central obesity and diabetes. Subjects with central obesity were 92% more likely to develop DM (HR = 1.65, 95%CI 1.12, 2.41). After adjusting for covariates, subjects with central obesity had a 72% increased risk of developing DM compared with subjects with non-central obesity in the PSM cohort (HR = 1.72, 95% CI 1.16, 2.56). Central obesity individuals had a 91% higher risk of DM than non-central obesity individuals, after adjustment for propensity score (HR = 1.91, 95% CI 1.29, 2.81). In sensitivity analysis, the central obesity group had a 44% (HR = 1.44, 95% CI 1.09, 1.90) and 59% (HR = 1.59, 95% CI1.35, 1.88) higher risk of DM than the non-central obesity group in the original and weighted cohorts after adjusting for confounding variables, respectively. Central obesity was independently associated with an increased risk of developing diabetes. After adjustment for confounding covariates, central obesity participants had a 72% higher risk of development of diabetes than non-central obesity individuals in the PSM cohort.
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Affiliation(s)
- Changchun Cao
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, No. 6, Renmin Road, Dapeng New District, Shenzhen, 518000, Guangdong, China
| | - Haofei Hu
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518000, Guangdong, China
| | - Xiaodan Zheng
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, 518000, Guangdong, China
| | - Xiaohua Zhang
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, No. 6, Renmin Road, Dapeng New District, Shenzhen, 518000, Guangdong, China
| | - Yulong Wang
- Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, No. 6, Renmin Road, Dapeng New District, Shenzhen, 518000, Guangdong, China.
| | - Yongcheng He
- Department of Nephrology, Shenzhen Hengsheng Hospital, No. 20 Yintian Road, Xixiang Street, Baoan District, Shenzhen, 518000, Guangdong, China. .,Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Nanchong, 637000, Sichuan, China.
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Jermihov A, Chen L, Echavarria MF, Ng EP, Velez FO, Moodie CC, Garrett JR, Fontaine JP, Toloza EM. Effect of Socio-Economic Status on Perioperative Outcomes After Robotic-Assisted Pulmonary Lobectomy. Cureus 2022; 14:e26201. [PMID: 35754434 PMCID: PMC9224841 DOI: 10.7759/cureus.26201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Lower socioeconomic status (SES) has been correlated with poor survival rates and surgical outcomes following lung cancer resection. This study sought to determine whether this disparity exists perioperatively in lung cancer patients following robotic-assisted video-thoracoscopic pulmonary lobectomy. Methods: We retrospectively reviewed 447 consecutive patients who underwent robotic-assisted pulmonary lobectomy by one surgeon for known or suspected lung cancer. Ten patients were excluded due to incomplete data. We used median income by residential ZIP code as a surrogate for SES status and grouped patients based on whether ZIP-based median income was less than (Group 1) or greater than (Group 2) 300% of the federal poverty income level. The effects of SES status groups on incidence of postoperative complications, chest tube duration, hospital length of stay (LOS), and in-hospital mortality were evaluated by the logistic regression model and Inverse Gaussian regression model, respectively. Results: Without adjustment, Group 1 tended to have a higher rate of postoperative complications, with 54% of patients experiencing complications compared to 34% of patients in Group 2 (p=0.007). Median chest tube duration and hospital LOS were also significantly longer in Group 1 than in Group 2 (p=0.034). In multivariable logistical regression analysis, while controlling for covariates and considering effect modifications, lower SES was significantly and positively associated with postoperative complications (odds ratio (OR)=1.98, p=0.039). Preoperative chronic obstructive pulmonary disease (COPD) was also a positive and significant predictor of postoperative complications (OR=1.89, p=0.017), chest tube duration (p=0.020), and LOS (p=0.010). Conclusions: Lower median income is associated with a greater number of postoperative complications following pulmonary resection for lung cancer when controlling for covariates.
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Cen J, Han Y, Liu Y, Hu H. Evaluated Glomerular Filtration Rate Is Associated With Non-alcoholic Fatty Liver Disease: A 5-Year Longitudinal Cohort Study in Chinese Non-obese People. Front Nutr 2022; 9:916704. [PMID: 35782950 PMCID: PMC9244698 DOI: 10.3389/fnut.2022.916704] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/30/2022] [Indexed: 12/12/2022] Open
Abstract
ObjectiveEvidence regarding the association between evaluated glomerular filtration rate (eGFR) and non-alcoholic fatty liver disease (NAFLD) is still limited. On that account, the purpose of our research is to survey the link of evaluated eGFR on NAFLD.MethodsThis study is a retrospective cohort study. Which consecutively and non-selectively collected a total of 16,138 non-obese participants in a Chinese hospital from January 2010 to December 2014. We then used the Cox proportional-hazards regression model to explore the relationship between baseline eGFR and NAFLD risk. A Cox proportional hazards regression with cubic spline functions and smooth curve fitting (the cubic spline smoothing) was used to identify the non-linear relationship between eGFR and NAFLD. Additionally, we also performed a series of sensitivity analyses and subgroup analyses. Data had been uploaded to the DATADRYAD website.ResultsThe mean age of the included individuals was 43.21 ± 14.95 years old, and 8,467 (52.47%) were male. The mean baseline eGFR was 98.83 ± 22.80 mL/min per 1.73m2. During a median follow-up time of 35.8 months, 2,317 (14.36%) people experienced NAFLD. After adjusting covariates, the results showed that eGFR was negatively associated with incident NAFLD (HR = 0.983, 95%CI: 0.980, 0.985). There was also a non-linear relationship between eGFR and NAFLD, and the inflection point of eGFR was 103.489 mL/min per 1.73 m2. The effect sizes (HR) on the left and right sides of the inflection point were 0.988 (0.984, 0.991) and 0.971 (0.963, 0.979), respectively. And the sensitive analysis demonstrated the robustness of our results. Subgroup analysis showed that eGFR was more strongly associated with incident NAFLD in diastolic blood pressure (DBP) < 90 mmHg, fasting plasma glucose (FPG) ≤ 6.1 mmol/L, high-density lipoprotein cholesterol (HDL-c) < 1 mmol/L, and alanine aminotransferase (ALT) ≥ 40 U/L participants. In contrast, the weaker association was probed in those with DBP ≥ 90 mmHg, ALT < 40 U/L, FPG > 6.1 mmol/L, and HDL-c ≥ 1 mmol/L.ConclusionThis study demonstrates a negative and non-linear association between eGFR and incident NAFLD in the Chinese non-obese population. eGFR is strongly related to NAFLD when eGFR is above 103 mL/min per 1.73 m2. From a therapeutic perspective, it makes sense to maintain eGFR levels within the inflection point to 130 mL/min/1.73 m2.
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Affiliation(s)
- Ji Cen
- Department of Nephrology, Hechi People’s Hospital, Hechi, China
| | - Yong Han
- Department of Emergency, Shenzhen Second People’s Hospital, Shenzhen, China
- Department of Emergency, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Shenzhen University Health Science Center, Shenzhen, China
| | - Yufei Liu
- Shenzhen University Health Science Center, Shenzhen, China
- Department of Neurosurgery, Shenzhen Second People’s Hospital, Shenzhen, China
- Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Haofei Hu
- Shenzhen University Health Science Center, Shenzhen, China
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- *Correspondence: Haofei Hu,
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Mo Z, Hu H, Du X, Huang Q, Chen P, Lai L, Yu Z. Association of Evaluated Glomerular Filtration Rate and Incident Diabetes Mellitus: A Secondary Retrospective Analysis Based on a Chinese Cohort Study. Front Med (Lausanne) 2022; 8:724582. [PMID: 35174179 PMCID: PMC8841619 DOI: 10.3389/fmed.2021.724582] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/24/2021] [Indexed: 02/04/2023] Open
Abstract
BackgroundPrevious studies have revealed that chronic kidney disease (CKD) is a significant risk factor for insulin resistance and diabetes. However, few studies are on the association between estimated glomerular filtration rate (eGFR) and incident diabetes, especially in the Chinese population with eGFR>60 mL/min·1.73 m2. This study explored the relationship between eGFR and incident diabetes in a large cohort in the Chinese community.MethodsThis study was a retrospective cohort study. A total of 1,99,435 adults from Rich Healthcare Group in China were studied, including all medical records for participants who received a health check from 2010 to 2016. The target-independent and target-dependent variables were eGFR measured at baseline, and incident diabetes mellitus appeared during the follow-up. After testing the proportion hypothesis, Cox proportional hazards regression was used to investigate the association between eGFR and incident diabetes. A Cox proportional hazards regression with cubic spline functions and smooth curve fitting (the cubic spline smoothing) was used to identify non-linear relationships between eGFR and the risk of diabetes. Additionally, we also performed subgroup analysis and a series sensitivity analysis. It was stated that the data had been uploaded to the DATADRYAD website.ResultAfter adjusting gender, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), alanine aminotransferase (ALT), aspartate aminotransferase (AST), smoking and drinking status, and family history of diabetes, the result showed that eGFR was negatively associated with incident diabetes [HR = 0.986, 95% CI (0.984, 0.988)]. A non-linear relationship was detected between eGFR and incident diabetes, with an inflection point of eGFR of 98.034 mL/min·1.73 m2. The effect sizes and the confidence intervals (Cis) on the left and right sides of the inflection point were 0.998 (0.993, 1.003) and 0.976 (0.972, 0.980), respectively. Subgroup analysis showed a stronger association in the population with FPG <6.1 mmol/L, BMI <24 kg/m2, SBP <140 mmHg, DBP <90 mmHg and family history without diabetes. The same trend was also seen in women and the population who never smoke.ConclusionEstimated glomerular filtration rate is independently associated with incident diabetes. The relationship between eGFR and incident diabetes is also non-linear. eGFR is strongly related to incident diabetes when eGFR was above 98.034 mL/min·1.73 m2.
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Affiliation(s)
- Zihe Mo
- Department of Physical Examination, DongGuan Tungwah Hospital, Dongguan, China
| | - Haofei Hu
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Department of Nephrology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xiaoqing Du
- Department of Physical Examination, DongGuan Tungwah Hospital, Dongguan, China
| | - Qingli Huang
- Department of Physical Examination, DongGuan Tungwah Hospital, Dongguan, China
| | - Ping Chen
- Department of Physical Examination, DongGuan Tungwah Hospital, Dongguan, China
| | - Linjing Lai
- Department of Physical Examination, DongGuan Tungwah Hospital, Dongguan, China
| | - Zhiqun Yu
- Department of Physical Examination, DongGuan Tungwah Hospital, Dongguan, China
- *Correspondence: Zhiqun Yu
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Cao C, Zhang X, Yuan J, Zan Y, Zhang X, Xue C, Wang Y, Zheng X. Nonlinear relationship between aspartate aminotransferase to alanine aminotransferase ratio and the risk of prediabetes: A retrospective study based on chinese adults. Front Endocrinol (Lausanne) 2022; 13:1041616. [PMID: 36387912 PMCID: PMC9640919 DOI: 10.3389/fendo.2022.1041616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Recent evidence has revealed that the aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT ratio) may be closely associated with metabolic syndrome and insulin resistance. However, it is unclear whether the AST/ALT ratio correlates with prediabetes risk. The aim of our study was to examine the association between AST/ALT ratios and the risk of prediabetes among a large cohort of Chinese subjects. METHODS This retrospective cohort study recruited 75204 Chinese adults with normoglycemia at baseline who underwent physical examinations at the Rich Healthcare Group from 2010 to 2016. The AST/ALT ratio at baseline was the target independent variable, and the risk of developing prediabetes during follow-up was the dependent variable. Cox proportional-hazards regression was used to evaluate the independent association between the AST/ALT ratio and prediabetes. This study identified nonlinear relationships by applying a generalized additive model (GAM) and smooth curve fitting. In order to assess the robustness of this study, we performed a series of sensitivity analyses. Moreover, we performed a subgroup analysis to evaluate the consistency of the association in different subgroups. Data from this study have been updated on the DATADRYAD website. RESULTS The AST/ALT ratio was negatively and independently related to the prediabetes risk among Chinese adults (HR: 0.76, 95% CI: 0.75-0.84, P<0.0001) after adjusting demographic and biochemical covariates. Furthermore, a nonlinear relationship between the AST/ALT ratio and the risk of developing prediabetes was found at an inflection point of 1.50 for the AST/ALT ratio. When the AST/ALT ratio was to the left of the inflection point (AST/ALT ratio ≤ 1.50), the AST/ALT ratio was negatively related to the prediabetes risk (HR:0.70, 95%CI: 0.65-0.76, P<0.0001). In contrast, the relationship tended to be saturated when the AST/ALT ratio was more than 1.50 (HR: 1.01, 95%CI: 0.89-1.15, P=0.8976). Our findings remained robust across a range of sensitivity analyses. Subgroup analysis revealed that other variables did not alter the relationship between the AST/ALT ratio and prediabetes risk. CONCLUSION This study revealed that AST/ALT ratio was negatively and independently associated with prediabetes risk among Chinese participants. The relationship between the AST/ALT ratio and prediabetes risk was nonlinear, and AST/ALT ratio ≤ 1.50 was strongly inversely correlated with prediabetes risk.
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Affiliation(s)
- Changchun Cao
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, Guangdong, China
| | - Xiaohua Zhang
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, Guangdong, China
| | - Junhu Yuan
- Department of Orthopedics, Foshan First People’s Hospital, Foshan, Guangdong, China
| | - Yibing Zan
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, Guangdong, China
| | - Xin Zhang
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, Guangdong, China
| | - Chao Xue
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, Guangdong, China
| | - Yulong Wang
- Department of Rehabilitation, Shenzhen Dapeng New District Nan’ao People’s Hospital, Shenzhen, Guangdong, China
- *Correspondence: Yulong Wang, ; Xiaodan Zheng,
| | - Xiaodan Zheng
- Department of Neurology, Shenzhen Samii International Medical Center (The Fourth People’s Hospital of Shenzhen), Shenzhen, Guangdong, China
- *Correspondence: Yulong Wang, ; Xiaodan Zheng,
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Wang X, Huang C, Liu Y, Han Y, Hu H. Association of estimated glomerular filtration rate and incident pre-diabetes: A secondary 5-year longitudinal cohort study in Chinese people. Front Endocrinol (Lausanne) 2022; 13:965545. [PMID: 36387884 PMCID: PMC9648615 DOI: 10.3389/fendo.2022.965545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/14/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE There is still limited evidence regarding the relationship between the estimated glomerular filtration rate (eGFR) and pre-diabetes. For that reason, our research aims to survey the association of eGFR with pre-diabetes. METHODS This study was a retrospective cohort study, which consecutively and non-selectively collected a total of 173301 participants from Rich Healthcare Group in China from January 2010 to 2016. We then used the Cox proportional-hazards regression model to explore the relationship between baseline eGFR and pre-diabetes risk. Using a Cox proportional hazards regression with cubic spline function and smooth curve fitting (cubical spline smoothing), we were able to determine the non-linear relationship between eGFR and pre-diabetes. Additionally, we also conducted a series of sensitivity analyses and subgroup analyses. The DATADRYAD website was updated with data. RESULTS The mean age of the included individuals was 40.95 ± 11.94 years old, and 92318 (53.27%) were male. The mean baseline eGFR was 111.40 ± 14.77 ml/min per 1.73 m2. During a median follow-up time of 3.0 years, 18333 (10.58%) people experienced pre-diabetes. As a result of adjusting for covariates, eGFR had a negative association with incident pre-diabetes (HR=0.993, 95%CI: 0.992-0.995). There was also a U-shaped curve relationship between eGFR and pre-diabetes, and the inflection point of eGFR was 129.793 ml/min per 1.73 m2. HRs on the left and right sides of the inflection point were respectively 0.993 (0.991-0.994) and 1.023 (1.010- 1.037). Our results were robust in the sensitivity analysis. Subgroup analyses indicated that eGFR was strongly associated with the risk of pre-diabetes among participants who were younger than 30 years and 40-70 years, as well as among those who had never smoked. In contrast, the association of eGFR with the risk of pre-diabetes was attenuated among participants who were 30-40 years of age and 70 years of age or older, and among those who currently smoked. CONCLUSION This study demonstrates a negative and U-shaped curve association between eGFR and the risk of pre-diabetes among the general Chinese population. Either reduced renal function or glomerular hyperperfusion status may be associated with an increased risk of prediabetes.
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Affiliation(s)
- Xiaoyu Wang
- Department of Nephrology, Hechi People’s Hospital, Hechi, Guangxi Zhuang Autonomous Region, China
| | - Cheng Huang
- Department of Nephrology, Hechi People’s Hospital, Hechi, Guangxi Zhuang Autonomous Region, China
| | - Yufei Liu
- Department of Neurosurgery, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- Shenzhen University Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
| | - Yong Han
- Shenzhen University Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
- Department of Emergency, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Emergency, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Yong Han, ; Haofei Hu,
| | - Haofei Hu
- Shenzhen University Health Science Center, Shenzhen University, Shenzhen, Guangdong, China
- Department of Nephrology, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
- *Correspondence: Yong Han, ; Haofei Hu,
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Liu Y, Hu H, Han Y, Li L, Li Z, Zhang L, Luo Z, Huang G, Lan Z. Body Mass Index Has a Nonlinear Association With Postoperative 30-Day Mortality in Patients Undergoing Craniotomy for Tumors in Men: An Analysis of Data From the ACS NSQIP Database. Front Endocrinol (Lausanne) 2022; 13:868968. [PMID: 35518931 PMCID: PMC9065251 DOI: 10.3389/fendo.2022.868968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The association between body mass index (BMI) and mortality is controversial. Thus, the purpose of our research was to survey the association between BMI and postoperative 30-day mortality in brain tumor patients undergoing craniotomy. METHODS This study analyzed data collected in a multicenter, cross-sectional study that consecutively and nonselectively collected data from a total of 18,642 patients undergoing craniotomy for tumors in the ACS NSQIP from 2012 to 2015. We constructed three linear and non-linear binomial logistic models (the inflection point was set at 18.5) to evaluate the association between BMI and postoperative 30-day mortality, respectively. We also conducted subgroup analyses. Additionally, we compared non-linear models with vs. without interaction with sex. RESULTS A total of 17,713 patients were included in this analysis. Of these, 47.38% were male. The postoperative 30-day mortality of the included cases was 2.39% (423/17,713), and the mean BMI was 28.41 ± 6.05 kg/m2. The linear logistic models suggested that after adjusting for the covariates, BMI was not associated with postoperative 30-day mortality (OR=0.999; 95% CI: 0.981, 1.017). The non-linear binomial logistic models suggested a nonlinear relationship between BMI and postoperative 30-day mortality. When BMI was < 18.5, we observed a stronger negative association between them after adjusting for covariates; the OR and 95% CI were 0.719, 0.576-0.896. When BMI was > 18.5, the relationship between them was not significant. We also found that a one-unit decrease in BMI for male patients with BMI < 18.5 kg/m2 was related to a 34.6% increase in the risk of postoperative 30-day mortality (OR=0.654, 95% CI (0.472, 0.907). There was no significant association between them in male patients with BMI > 18.5 kg/m2 or female patients. CONCLUSIONS This study demonstrates a non-linear relationship between BMI and the risk of postoperative death. Preoperative underweight (BMI < 18.5 kg/m2) would increase the risk of postoperative death in male patients (> 18 years old) undergoing craniotomy for brain tumors. Appropriate nutritional management prior to craniotomy for brain tumors may reduce the risk of postoperative 30-day mortality in underweight men.
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Affiliation(s)
- Yufei Liu
- Neurosurgical Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Shenzhen University Health Science Center, Shenzhen, China
| | - Haofei Hu
- Shenzhen University Health Science Center, Shenzhen, China
- Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Yong Han
- Shenzhen University Health Science Center, Shenzhen, China
- Department of Emergency, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Lunzou Li
- Neurosurgical Department, Hechi People’s Hospital, Hechi, China
| | - Zongyang Li
- Neurosurgical Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
- Shenzhen University Health Science Center, Shenzhen, China
| | - Liwei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhu Luo
- Neurosurgical Department, Hechi People’s Hospital, Hechi, China
- *Correspondence: Zhu Luo, ; Guodong Huang, ; Zhan Lan,
| | - Guodong Huang
- Neurosurgical Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, China
- Shenzhen University Health Science Center, Shenzhen, China
- *Correspondence: Zhu Luo, ; Guodong Huang, ; Zhan Lan,
| | - Zhan Lan
- Neurosurgical Department, Hechi People’s Hospital, Hechi, China
- *Correspondence: Zhu Luo, ; Guodong Huang, ; Zhan Lan,
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Mendy A, Wu X, Keller JL, Fassler CS, Apewokin S, Mersha TB, Xie C, Pinney SM. Air pollution and the pandemic: Long-term PM 2.5 exposure and disease severity in COVID-19 patients. Respirology 2021; 26:1181-1187. [PMID: 34459069 PMCID: PMC8662216 DOI: 10.1111/resp.14140] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/09/2021] [Accepted: 08/09/2021] [Indexed: 12/23/2022]
Abstract
Background and objective Ecological studies have suggested an association between exposure to particulate matter ≤2.5 μm (PM2.5) and coronavirus disease 2019 (COVID‐19) severity. However, these findings are yet to be validated in individual‐level studies. We aimed to determine the association of long‐term PM2.5 exposure with hospitalization among individual patients infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Methods We estimated the 10‐year (2009–2018) PM2.5 exposure at the residential zip code of COVID‐19 patients diagnosed at the University of Cincinnati healthcare system between 13 March 2020 and 30 September 2020. Logistic regression was used to determine the odds ratio (OR) and 95% CI for COVID‐19 hospitalizations associated with PM2.5, adjusting for socioeconomic characteristics and comorbidities. Results Among the 14,783 COVID‐19 patients included in our study, 13.6% were hospitalized; the geometric mean (SD) PM2.5 was 10.48 (1.12) μg/m3. In adjusted analysis, 1 μg/m3 increase in 10‐year annual average PM2.5 was associated with 18% higher hospitalization (OR: 1.18, 95% CI: 1.11–1.26). Likewise, 1 μg/m3 increase in PM2.5 estimated for the year 2018 was associated with 14% higher hospitalization (OR: 1.14, 95% CI: 1.08–1.21). Conclusion Long‐term PM2.5 exposure is associated with increased hospitalization in COVID‐19. Therefore, more stringent COVID‐19 prevention measures may be needed in areas with higher PM2.5 exposure to reduce the disease morbidity and healthcare burden.
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Affiliation(s)
- Angelico Mendy
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Xiao Wu
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jason L Keller
- Center for Health Informatics, Department of Biomedical Informatics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Cecily S Fassler
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Senu Apewokin
- Division of Infectious Diseases, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Tesfaye B Mersha
- Division of Asthma Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Changchun Xie
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Susan M Pinney
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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