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Zhang X, He C, Lu S, Yu H, Li G, Zhang P, Sun Y. Construction and validation of a nomogram to predict left ventricular hypertrophy in low-risk patients with hypertension. J Clin Hypertens (Greenwich) 2024; 26:274-285. [PMID: 38341620 PMCID: PMC10918740 DOI: 10.1111/jch.14780] [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: 12/14/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024]
Abstract
Electrocardiography (ECG) is an accessible diagnostic tool for screening patients with hypertensive left ventricular hypertrophy (LVH). However, its diagnostic sensitivity is low, with a high probability of false-negatives. Thus, this study aimed to establish a clinically useful nomogram to supplement the assessment of LVH in patients with hypertension and without ECG-LVH based on Cornell product criteria (low-risk hypertensive population). A cross-sectional dataset was used for model construction and divided into development (n = 2906) and verification (n = 1447) datasets. A multivariable logistic regression risk model and nomogram were developed after screening for risk factors. Of the 4353 low-risk hypertensive patients, 673 (15.4%) had LVH diagnosed by echocardiography (Echo-LVH). Eleven risk factors were identified: hypertension awareness, duration of hypertension, age, sex, high waist-hip ratio, education level, tea consumption, hypochloremia, and other ECG-LVH diagnostic criteria (including Sokolow-Lyon, Sokolow-Lyon products, and Peguero-Lo Presti). For the development and validation datasets, the areas under the curve were 0.724 (sensitivity = 0.606) and 0.700 (sensitivity = 0.663), respectively. After including blood pressure, the areas under the curve were 0.735 (sensitivity = 0.734) and 0.716 (sensitivity = 0.718), respectively. This novel nomogram had a good predictive ability and may be used to assess the Echo-LVH risk in patients with hypertension and without ECG-LVH based on Cornell product criteria.
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Affiliation(s)
- Xueyao Zhang
- Department of CardiologyFirst Hospital of China Medical UniversityShenyangChina
| | - Chuan He
- Department of Laboratory MedicineFirst Hospital of China Medical UniversityShenyangChina
- National Clinical Research Center for Laboratory Medicine CenterFirst Hospital of China Medical UniversityShenyangChina
| | - Saien Lu
- Department of CardiologyFirst Hospital of China Medical UniversityShenyangChina
| | - Haijie Yu
- Department of CardiologyFirst Hospital of China Medical UniversityShenyangChina
| | - Guangxiao Li
- Department of Medical Record Management CenterFirst Hospital of China Medical UniversityShenyangChina
| | - Pengyu Zhang
- Department of CardiologyFirst Hospital of China Medical UniversityShenyangChina
| | - Yingxian Sun
- Department of CardiologyFirst Hospital of China Medical UniversityShenyangChina
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Valga F, Monzon T, Vega-Diaz N, Santana A, Moscol G, Ruiz-Santana S, Rodriguez-Perez JC. Serum chloride as a marker of cardiovascular and all-cause mortality in chronic hemodialysis patients: 5-Year follow-up study. Nefrologia 2023; 43 Suppl 2:47-56. [PMID: 38245440 DOI: 10.1016/j.nefroe.2023.05.009] [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: 08/23/2022] [Accepted: 02/20/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Hypochloremia has been associated with increased mortality in patients with hypertension, heart failure, sepsis, and chronic kidney disease (CKD). The pathophysiological mechanisms of this finding are not clear. There are no studies describing an association between serum chloride levels (Cl-) and mortality in incident chronic hemodialysis (HD) patients. METHOD Retrospective cohort study of the incident population in our chronic outpatient hemodialysis program between January 1, 2016, and January 1, 2021 (N=374). Survival time was collected in all patients and analyzed using the Kaplan-Meyer method. A multivariate Cox regression model was performed to predict the probability of survival, applying a stepwise procedure. RESULTS During the median follow-up period of 20 months, 83 patients died. The 5-year overall survival rate for our patients was 45%. Both natremia and chloremia had no significant differences when compared by sex, vascular access, or etiology. There was an inverse correlation between Cl- and interdialytic weight gain (r=-0.15) (p=0.0038). Patients belonging to the quartile with lower Cl- levels had less probability of survival than patients in the quartile with higher Cl- levels (27% and 68%, respectively, p=0.019). On the other hand, in the multivariate Cox regression model, variables significantly associated with higher mortality were being older, having higher baseline comorbidity by modified Charlson index, not taking diuretics and having lower albumin and chloride levels. Particularly, higher Cl- levels was independently associated with both lower all-cause mortality (adjusted hazard ratio [HR]=0.84; 95% confidence interval [CI], 0.77-0.92; p=0.0001) and cardiovascular mortality (HR 0.9; 95% CI, 0.83-0.97; p<0.0057). CONCLUSIONS Lower Cl- levels were associated with higher all-cause and cardiovascular mortality in incident patients on chronic hemodialysis in our health area.
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Affiliation(s)
- Francisco Valga
- Nephrology Department, Doctor Negrin University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain; Doctoral School, Biomedicine Research Program, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - Tania Monzon
- Nephrology Department, Doctor Negrin University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain; Doctoral School, Biomedicine Research Program, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Nicanor Vega-Diaz
- Doctoral School, Biomedicine Research Program, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain; Avericum S.L Hemodialysis Centers, Las Palmas de Gran Canaria, Spain
| | - Angelo Santana
- Mathematics Department, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Giancarlo Moscol
- Oncology Department, MD Anderson Cancer Center, Houston, TX, USA
| | - Sergio Ruiz-Santana
- Doctoral School, Biomedicine Research Program, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain; Intensive Care Unit, Doctor Negrin University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Jose Carlos Rodriguez-Perez
- Nephrology Department, Doctor Negrin University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain; University Fernando Pessoa-Canarias, Las Palmas, Spain
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Bossel D, Bourgeat M, Pantet O, Zingg T. Effect of Pre-Hospital Intravenous Fluids on Initial Metabolic Acid-Base Status in Trauma Patients: A Retrospective Cohort Study. Metabolites 2023; 13:937. [PMID: 37623880 PMCID: PMC10456668 DOI: 10.3390/metabo13080937] [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: 06/29/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
Despite its known harmful effects, normal saline is still commonly used in the treatment of hypovolemia in polytrauma patients. Given the lack of pre-hospital research on this topic, the current study aims to assess the current practice of fluid administration during the pre-hospital phase of care and its effects on initial metabolic acid-base status in trauma patients. We extracted and completed data from patients recorded in the Lausanne University Hospital (CHUV) trauma registry between 2008 and 2019. Patients were selected according to their age, the availability of a blood gas analysis after arrival at the emergency room, data availability in the trauma registry, and the modality of arrival in the ED. The dominantly administered pre-hospital fluid was normal saline. No association between the type of fluid administered during the pre-hospital phase and the presence of hyperchloremic acidosis in the ED was observed.
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Affiliation(s)
- Damien Bossel
- Faculty of Biology and Medicine, Lausanne University, 1011 Lausanne, Switzerland
| | - Mylène Bourgeat
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois—CHUV, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Olivier Pantet
- Service of Adult Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois—CHUV, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Tobias Zingg
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois—CHUV, Lausanne University Hospital, 1011 Lausanne, Switzerland
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Pierscianek D, Oppong MD, Ahmadipour Y, Rauschenbach L, Michel A, Kebir S, Dammann P, H Wrede K, Glas M, Hense J, Pöttgen C, Sure U, Jabbarli R. Electrolyte and renal disorders in patients with newly diagnosed glioblastoma. Future Oncol 2021; 17:4711-4719. [PMID: 34672208 DOI: 10.2217/fon-2020-1312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: Disturbances of electrolytes and renal function have been linked to the prognosis of critically ill patients and recently also of cancer patients. This study aimed to assess electrolyte and renal disorders in glioblastoma patients and evaluate their prognostic effect. Methods: Medical records of patients with newly diagnosed glioblastoma between 2005 and 2018 were retrospectively reviewed for electrolyte and renal function parameters and for demographic, clinical and outcome parameters. Results: Electrolyte and renal function disorders were associated with poorer survival in univariate and Kaplan-Meier analysis. Multivariate analysis revealed hypochloremia as an independent prognostic factor for overall and 1-year survival. Conclusion: Only hypochloremia showed an association with glioblastoma prognosis, independent of other known prognostic factors, as age or molecular status.
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Affiliation(s)
- Daniela Pierscianek
- Department of Neurosurgery & Spine Surgery, University Hospital Essen, Essen, 45147, Germany.,German Cancer Consortium, Partner Site University Hospital Essen, Essen, 45147, Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery & Spine Surgery, University Hospital Essen, Essen, 45147, Germany.,German Cancer Consortium, Partner Site University Hospital Essen, Essen, 45147, Germany
| | - Yahya Ahmadipour
- Department of Neurosurgery & Spine Surgery, University Hospital Essen, Essen, 45147, Germany.,German Cancer Consortium, Partner Site University Hospital Essen, Essen, 45147, Germany
| | - Laurèl Rauschenbach
- Department of Neurosurgery & Spine Surgery, University Hospital Essen, Essen, 45147, Germany.,German Cancer Consortium, Partner Site University Hospital Essen, Essen, 45147, Germany
| | - Anna Michel
- Department of Neurosurgery & Spine Surgery, University Hospital Essen, Essen, 45147, Germany.,German Cancer Consortium, Partner Site University Hospital Essen, Essen, 45147, Germany
| | - Sied Kebir
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, 45147, Germany.,Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, Essen, 45147, German
| | - Philipp Dammann
- Department of Neurosurgery & Spine Surgery, University Hospital Essen, Essen, 45147, Germany.,German Cancer Consortium, Partner Site University Hospital Essen, Essen, 45147, Germany
| | - Karsten H Wrede
- Department of Neurosurgery & Spine Surgery, University Hospital Essen, Essen, 45147, Germany.,German Cancer Consortium, Partner Site University Hospital Essen, Essen, 45147, Germany
| | - Martin Glas
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, 45147, Germany.,Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, Essen, 45147, German
| | - Jörg Hense
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, 45147, Germany.,Department of Medical Oncology, University Hospital Essen, Essen, 45147, Germany
| | - Christoph Pöttgen
- German Cancer Consortium, Partner Site University Hospital Essen, Essen, 45147, Germany.,Department of Radiotherapy, University Hospital Essen, Essen, 45147, Germany
| | - Ulrich Sure
- Department of Neurosurgery & Spine Surgery, University Hospital Essen, Essen, 45147, Germany.,German Cancer Consortium, Partner Site University Hospital Essen, Essen, 45147, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery & Spine Surgery, University Hospital Essen, Essen, 45147, Germany.,German Cancer Consortium, Partner Site University Hospital Essen, Essen, 45147, Germany
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