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Shi X, Zhong L, Lu J, Hu B, Shen Q, Gao P. Clinical significance of the lactate-to-albumin ratio on prognosis in critically ill patients with acute kidney injury. Ren Fail 2024; 46:2350238. [PMID: 38721940 DOI: 10.1080/0886022x.2024.2350238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/27/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE To explore the relationship between lactate-to-albumin ratio (LAR) at ICU admission and prognosis in critically ill patients with acute kidney injury (AKI). METHODS A retrospective analysis was conducted. Patients were divided into low (<0.659) LAR and high LAR (≥0.659) groups. Least absolute shrinkage and selection operator regression analysis was conducted to select variables associated with the 30-day prognosis. Cox regression analyses were performed to assess the association between LAR and mortality. Kaplan-Meier curves were plotted to compare cumulative survival rates between high and low LAR groups. Subgroup analysis was employed to assess the stability of the results. ROC curve was used to determine the diagnostic efficacy of LAR on prognosis. RESULTS A nonlinear relationship was observed between LAR and the risk of 30-day and 360-day all-cause mortality in AKI patients (p < 0.001). Cox regulation showed that high LAR (≥ 0.659) was an independent risk factor for 30-day and 360-day all-cause mortality in patients with AKI (p < 0.001). The Kaplan-Meier survival curves demonstrated a noteworthy decrease in cumulative survival rates at both 30 and 360 days for the high LAR group in comparison to the low LAR group (p < 0.001). Subgroup analyses demonstrated the stability of the results. ROC curves showed that LAR had a diagnostic advantage when compared with lactate or albumin alone (p < 0.001). CONCLUSION High LAR (≥0.659) at ICU admission was an independent risk factor for both short-term (30-day) and long-term (360-day) all-cause mortality in patients with AKI.
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Affiliation(s)
- Xiaoyun Shi
- Department of Emergency, The Second Hospital of Shandong University, Jinan, China
| | - Lei Zhong
- Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
- The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
| | - Jianhong Lu
- Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
- The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
| | - Beiping Hu
- Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
- The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
| | - Qikai Shen
- Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, China
- The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University, Huzhou, China
| | - Penghui Gao
- Department of Emergency, The Second Hospital of Shandong University, Jinan, China
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Yang D, He Y, Wang Q, Yu Y. Association between statin use and acute pulmonary embolism in intensive care unit patients with sepsis: a retrospective cohort study. Front Med (Lausanne) 2024; 11:1369967. [PMID: 38651067 PMCID: PMC11033833 DOI: 10.3389/fmed.2024.1369967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction Acute pulmonary embolism (APE) is a life-threatening medical condition that is frequently encountered and associated with significant incidence and mortality rates, posing a substantial threat to patients' well-being and quality of life. Sepsis is prominent independent risk factor for the development of APE. Despite recent investigations indicating a reduced APE risk through statin therapy, its impact on patients with sepsis and APE remains unresolved. Methods The Medical Information Mart for Intensive Care (MIMIC)-IV database was utilized to identify patients diagnosed with sepsis and APE, irrespective of statin treatment status, as part of this study. The primary study aim was to assess the risk of APE, which was analyzed using multivariate logistic regression models. Results The study encompassed a total of 16,633 participants, with an average age of 64.8 ± 16.2 years. Multivariate logistic regression revealed that septic patients receiving statin therapy in the intensive care unit (ICU) exhibited a 33% reduction in the risk of developing APE (OR = 0.67, 95% CI: 0.52-0.86, p < 0.001). The findings of further analyses, including stratification based on statin usage, dosage, and propensity score matching, consistently reinforced the hypothesis that administering statins to patients with sepsis effectively mitigates their potential APE risk. Discussion The results of the study provide compelling evidence in favor of administering statins to septic patients as a prophylactic measure against APE, given that statins may reduce the risk of developing APE, and their anti-APE effect appears to be dose-dependent. Nonetheless, future randomized controlled trials are needed to validate these results.
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Affiliation(s)
- Dengcang Yang
- Anesthesiology Department, The Central Hospital of Shaoyang, Shaoyang, Hunan, China
| | - Yanyan He
- Department of Geriatric Medicine, The Second Affiliated Hospital of Shaoyang University, Shaoyang, Hunan, China
| | - Qianqian Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Department of Pulmonary and Critical Care Medicine, Guangxi Hospital Division of The First Hospital, Sun Yat-Sen University, Nanning, Guangxi Zhuang, China
| | - Yi Yu
- Department of Critical Care Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Zhang XS, Cai WK, Wang P, Xu R, Yin SJ, Huang YH, Guo Y, Jiang FF, Pan JM, Li YH, He GH. Histamine H2 receptor antagonist exhibited comparable all-cause mortality-decreasing effect as β-blockers in critically ill patients with heart failure: a cohort study. Front Pharmacol 2023; 14:1273640. [PMID: 38035020 PMCID: PMC10683642 DOI: 10.3389/fphar.2023.1273640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
Background: Our previous study reported that histamine H2 receptor antagonists (H2RAs) exposure was associated with decreased mortality in critically ill patients with heart failure (HF) through the same pharmacological mechanism as β-blockers. However, population-based clinical study directly comparing the efficacy of H2RAs and β-blockers on mortality of HF patients are still lacking. This study aims to compare the association difference of H2RAs and β-blockers on mortality in critically ill patients with HF using the Medical Information Mart for Intensive Care III database (MIMIC-III). Methods: Study population was divided into 4 groups: β-blockers + H2RAs group, β-blockers group, H2RAs group, and Non-β-blockers + Non-H2RAs group. Kaplan-Meier curves and multivariable Cox regression models were employed to evaluate the differences of all-cause mortalities among the 4 groups. Propensity score matching (PSM) was used to increase comparability of four groups. Results: A total of 5593 patients were included. After PSM, multivariate analyses showed that patients in H2RAs group had close all-cause mortality with patients in β-blockers group. Furthermore, 30-day, 1-year, 5-year and 10-year all-mortality of patients in β-blockers + H2RAs group were significantly lower than those of patients in β-blockers group, respectively (HR: 0.64, 95%CI: 0.50-0.82 for 30-day; HR: 0.80, 95%CI: 0.69-0.93 for 1-year mortality; HR: 0.83, 95%CI: 0.74-0.93 for 5-year mortality; and HR: 0.85, 95%CI: 0.76-0.94 for 10-year mortality, respectively). Conclusion: H2RAs exposure exhibited comparable all-cause mortality-decreasing effect as β-blockers; and, furthermore, H2RAs and β-blockers had additive or synergistic interactions to improve survival in critically ill patients with HF.
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Affiliation(s)
- Xue-Sha Zhang
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
- College of Pharmacy, Dali University, Dali, China
| | - Wen-Ke Cai
- Department of Cardiothoracic Surgery, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Ping Wang
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Ran Xu
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Sun-Jun Yin
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Yan-Hua Huang
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
| | - Yu Guo
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
- College of Pharmacy, Dali University, Dali, China
| | - Fang-Fang Jiang
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
- College of Pharmacy, Dali University, Dali, China
| | - Jian-Mei Pan
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
- College of Pharmacy, Dali University, Dali, China
| | - Yi-Hua Li
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
- College of Pharmacy, Dali University, Dali, China
| | - Gong-Hao He
- Department of Clinical Pharmacy, 920th Hospital of Joint Logistics Support Force, Kunming, China
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Williams E, Kienast M, Medawar E, Reinelt J, Merola A, Klopfenstein SAI, Flint AR, Heeren P, Poncette AS, Balzer F, Beimes J, von Bünau P, Chromik J, Arnrich B, Scherf N, Niehaus S. A Standardized Clinical Data Harmonization Pipeline for Scalable AI Application Deployment (FHIR-DHP): Validation and Usability Study. JMIR Med Inform 2023; 11:e43847. [PMID: 36943344 PMCID: PMC10131740 DOI: 10.2196/43847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Increasing digitalization in the medical domain gives rise to large amounts of health care data, which has the potential to expand clinical knowledge and transform patient care if leveraged through artificial intelligence (AI). Yet, big data and AI oftentimes cannot unlock their full potential at scale, owing to nonstandardized data formats, lack of technical and semantic data interoperability, and limited cooperation between stakeholders in the health care system. Despite the existence of standardized data formats for the medical domain, such as Fast Healthcare Interoperability Resources (FHIR), their prevalence and usability for AI remain limited. OBJECTIVE In this paper, we developed a data harmonization pipeline (DHP) for clinical data sets relying on the common FHIR data standard. METHODS We validated the performance and usability of our FHIR-DHP with data from the Medical Information Mart for Intensive Care IV database. RESULTS We present the FHIR-DHP workflow in respect of the transformation of "raw" hospital records into a harmonized, AI-friendly data representation. The pipeline consists of the following 5 key preprocessing steps: querying of data from hospital database, FHIR mapping, syntactic validation, transfer of harmonized data into the patient-model database, and export of data in an AI-friendly format for further medical applications. A detailed example of FHIR-DHP execution was presented for clinical diagnoses records. CONCLUSIONS Our approach enables the scalable and needs-driven data modeling of large and heterogenous clinical data sets. The FHIR-DHP is a pivotal step toward increasing cooperation, interoperability, and quality of patient care in the clinical routine and for medical research.
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Affiliation(s)
| | | | | | | | | | | | - Anne Rike Flint
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Patrick Heeren
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Jonas Chromik
- Digital Health - Connected Healthcare, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Bert Arnrich
- Digital Health - Connected Healthcare, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | - Nico Scherf
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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Hu Y, Zhou J, Cao Q, Wang H, Yang Y, Xiong Y, Zhou Q. Utilization of Echocardiography After Acute Kidney Injury Was Associated with Improved Outcomes in Patients in Intensive Care Unit. Int J Gen Med 2021; 14:2205-2213. [PMID: 34113152 PMCID: PMC8183456 DOI: 10.2147/ijgm.s310445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/30/2021] [Indexed: 12/13/2022] Open
Abstract
Background We aimed to investigate the association between usage of transthoracic echocardiography (TTE) within 24 hours after acute kidney injury (AKI) and the prognosis of patients in intensive care unit (ICU). Methods The Medical Information Mart for Intensive Care III (MIMIC-III) database was used to identify AKI patients with and without TTE administration. The primary outcome was 28-day mortality. Multivariable regression was used to clarify the association between TTE and clinical outcomes and propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were utilized to validate our findings. Results Among 23,945 eligible AKI patients, 3361 patients who received TTE and 3361 who did not conduct TTE had similar propensity scores which were included in this study. After matching, the TTE group had a significantly lower 28-day mortality (OR 0.80, 95% CI 0.72–0.88, P<0.001). Patients in the TTE group received more fluid on day 1 and day 2 and had a more urine volume on day 1 and day 3, and the reduction in serum creatinine was greater than that in the no TTE group. The mediating effect of creatinine reduction was remarkable for the whole cohort (P=0.02 for the average causal mediation effect). Conclusion TTE utilization was associated with decreased risk-adjusted 28-day mortality for AKI patients in ICU and was proportionally mediated through creatinine reduction.
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Affiliation(s)
- Yugang Hu
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430061, People's Republic of China
| | - Jia Zhou
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430061, People's Republic of China
| | - Quan Cao
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430061, People's Republic of China
| | - Hao Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430061, People's Republic of China
| | - Yuanting Yang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430061, People's Republic of China
| | - Ye Xiong
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430061, People's Republic of China
| | - Qing Zhou
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430061, People's Republic of China
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