A Novel Prediction Model of Acute Kidney Injury Based on Combined Blood Variables in STEMI

BACKGROUND

Development of acute kidney injury (AKI) is associated with poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI).

OBJECTIVE

This study sought to investigate whether a combination of pre-procedural blood tests could predict the incidence of AKI in patients with STEMI.

METHODS

A total of 908 consecutive Japanese patients with STEMI who underwent primary percutaneous coronary intervention within 48 hours of symptom onset were recruited and divided into derivation (n = 617) and validation (n = 291) cohorts. A risk score model was created based on a combination of parameters assessed on routine blood tests on admission.

RESULTS

In the derivation cohort, multivariate analysis showed that the following 4 variables were significantly associated with AKI: blood sugar ≥200 mg/dL (odds ratio [OR]: 2.07), high-sensitivity troponin I >1.6 ng/mL (upper limit of normal ×50) (OR: 2.43), albumin ≤3.5 mg/dL (OR: 2.85), and estimated glomerular filtration rate <45 mL/min/1.73 m² (OR: 2.64). Zero to 4 points were given according to the number of those factors. Incremental risk scores were significantly associated with a higher incidence of AKI in both cohorts (P < 0.001). Receiver-operating characteristic curve analysis of risk models showed adequate discrimination between patients with and without AKI (derivation cohort, area under the curve: 0.754; 95% confidence interval: 0.733-0.846; validation cohort, area under the curve: 0.754; 95% confidence interval: 0.644-0.839).

CONCLUSIONS

Our novel laboratory-based model might be useful for early prediction of the post-procedural risk of AKI in patients with STEMI.

Patients' Perspective About the Cost of Diabetes Management: An Analysis of Online Health Communities

Objective

To understand the perspectives of persons' living with diabetes about the increasing cost of diabetes management through an analysis of online health communities (OHCs) and the impact of persons' participation in OHCs on their capacity and treatment burden.

Patients and Methods

A qualitative study of 556 blog posts submitted between January 1, 2007 and December 31, 2017 to 4 diabetes social networking sites was conducted between March 2018 and July 2019. All posts were coded inductively using thematic analysis procedures. Eton's Burden of Treatment Framework and Boehmer's Theory of Patient Capacity directed triangulation of themes with existing theory.

Results

Three themes were identified: (1) cost barriers to care: participants describe individual and systemic cost barriers that inhibit prescribed therapy goals; (2) impact of financial cost on health: participants describe the financial effects of care on their physical and emotional health; and (3) saving strategies to overcome cost impact: participants discuss practical strategies that help them achieve therapy goals. Finally, we also identify that the use of OHCs serves to increase persons' capacity with the potential to decrease treatment burden, ultimately improving mental and physical health.

Conclusion

High cost for diabetes care generated barriers that negatively affected physical health and emotional states. Participant-shared experiences in OHCs increased participants' capacity to manage the burden. Potential solutions include cost-based shared decision-making tools and advocacy for policy change.

Study of chemical composition and nutritional values of vegetable wastes in Bangladesh

The present study was conducted with the objectives of determining the chemical composition and nutritional value of vegetable waste (VW) of households and the marketplace for their suitability as ruminant feed. The crude protein, total digestible nutrients and extent of rumen degradability of dry matter (DM) of VW of households were 140.0 g kg-1, 0.668 and 0.855, respectively; while those of the marketplace were 169.0 g kg-1, 0.633 and 0.80, respectively. The levels of chromium and lead in each respectively, was 13.27 and 1.53 ng kg-1DM; and 31.01 and 5.71 ng kg-1DM. The total aflatoxins in VW of households was 3.08 µg kg-1DM, and undetectable in VW from the marketplace. Considering the chemical composition and safety parameters studied, VW could preliminary be considered as animal feed. The feeding of processed marketplace VW (VWP) at 275 g kg-1DM of a diet or 0.76% of live weight (LW) to growing bulls, replacing 50% of a concentrate mixture as supplement to a Napier silage diet for a period of 34 days reduced the total DM intake (0.0276 vs 0.0343 LW) without any significant (P > 0.05) changes in DM or protein digestibility. Blood urea levels (19.5 vs 23.67 mg dl-1), and serum creatinine levels (1.37 vs 1.08 mg dl-1) differed significantly (P > 0.05) between the two groups but were within normal physiological ranges. Therefore, it may be concluded that the level of incorporation of VWP would be less than 50% replacement of the concentrate in the diet. Further research is required to determine optimum inclusion levels in ruminant diets.