Association of serum osmolality with all-cause and cardiovascular mortality in US adults: A prospective cohort study

The J-shaped relationship between serum osmolality and all-cause mortality in critically ill patients with myocardial infarction: a retrospective cohort study

Background

Serum osmolality (SOSM) is an indicator of hydration status and is associated with the prognosis of various cardiovascular diseases. This study investigated the association between SOSM and all-cause mortality in critically ill patients with myocardial infarction (MI).

Methods

This retrospective cohort study utilized data from the Medical Information for Intensive Care-IV (MIMIC-IV) database, including critically ill patients with a primary diagnosis of MI. Patients were categorized into tertile groups based on the SOSM levels. Kaplan-Meier (K-M) survival analysis, multiple Cox regression models, restricted cubic spline (RCS) analysis, and threshold effect analysis were used to investigate the nonlinear relationship between all-cause mortality in critically ill patients with MI and SOSM.

Results

A total of 5354 patients with MI were included. K-M survival analysis showed that the survival rate of the high SOSM group was significantly lower than that of the other groups, which was consistent with the results after IPTW correction (log-rank P<0.05). Multiple Cox regression confirmed that patients with high SOSM had significantly increased risk of death at 30-day [HR, 1.45 (95% CI 1.21-1.73) P<0.001], 180-day [HR, 1.32 (95% CI 1.15-1.53) P<0.001], and 365-day [HR, 1.31(95% CI1.15-1.49) P<0.001]. RCS analysis and threshold effect analysis showed a J-shaped relationship between SOSM and mortality risk, and the minimum threshold of SOSM was 286.28 mmol/L.

Conclusions

This study revealed a J-shaped relationship between SOSM and all-cause mortality in critically ill MI patients, suggesting its potential as a prognostic marker for risk stratification.

The U-shaped association between serum osmolality and 28-day mortality in patients with sepsis: a retrospective cohort study

BACKGROUND

Sepsis is a recognized global health challenge that places a considerable disease burden on countries. Although there has been some progress in the study of sepsis, the mortality rate of sepsis remains high. The relationship between serum osmolality and the prognosis of patients with sepsis is unclear.

METHOD

Patients with sepsis who met the criteria in the Medical Information Mart for Intensive Care IV database were included in the study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were determined using multivariable Cox regression. The relationship between serum osmolality and the 28-day mortality risk in patients with sepsis was investigated using curve fitting, and inflection points were calculated.

RESULTS

A total of 13,219 patients with sepsis were enrolled in the study; the mean age was 65.1 years, 56.9 % were male, and the 28-day mortality rate was 18.8 %. After adjusting for covariates, the risk of 28-day mortality was elevated by 99% (HR 1.99, 95%CI 1.74-2.28) in the highest quintile of serum osmolality (Q5 >303.21) and by 59% (HR 1.59, 95%CI 1.39-1.83) in the lowest quintile (Q1 ≤285.80), as compared to the reference quintile (Q3 291.38-296.29). The results of the curve fitting showed a U-shaped relationship between serum osmolality and the risk of 28-day mortality, with an inflection point of 286.9 mmol/L.

CONCLUSION

There is a U-shaped relationship between serum osmolality and the 28-day mortality risk in patients with sepsis. Higher or lower serum osmolality is associated with an increased risk of mortality in patients with sepsis. Patients with sepsis have a lower risk of mortality when their osmolality is 285.80-296.29 mmol/L.

Association between Urine Specific Gravity as a Measure of Hydration Status and Risk of Type 2 Diabetes: The Kailuan Prospective Cohort Study

Diabetes, especially type 2 diabetes (T2D), poses an unprecedented challenge to global public health. Hydration status also plays a fundamental role in human health, especially in people with T2D, which is often overlooked. This study aimed to explore the longitudinal associations between hydration status and the risk of T2D among the Chinese population. This study used data from the large community-based Kailuan cohort, which included adults who attended physical examinations from 2006 to 2007 and were followed until 2020. A total of 71,526 participants who eventually met the standards were divided into five hydration-status groups based on their levels of urine specific gravity (USG). Multivariable and time-dependent Cox proportional hazards models were employed to evaluate the associations of baseline and time-dependent hydration status with T2D incidence. Restricted cubic splines (RCS) analysis was used to examine the dose-response relationship between hydration status and the risk of T2D. Over a median 12.22-year follow-up time, 11,804 of the participants developed T2D. Compared with the optimal hydration-status group, participants with dehydration and severe dehydration had a significantly increased risk of diabetes, with adjusted hazard ratios (95% CI) of 1.30 (1.04-1.63) and 1.38 (1.10-1.74). Time-dependent analyses further confirmed the adverse effects of impending dehydration, dehydration, and severe dehydration on T2D incidence by 16%, 26%, and 33% compared with the reference group. Inadequate hydration is significantly associated with increased risks of T2D among Chinese adults. Our findings provided new epidemiological evidence and highlighted the potential role of adequate hydration status in the early prevention of T2D development.

Association between the dietary inflammatory index and all-cause and cardiovascular mortality in patients with atherosclerotic cardiovascular disease

BACKGROUND AND AIMS

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide. Inflammation is pivotal in atherosclerosis development. The dietary inflammatory index (DII) is a tool to quantify the overall inflammatory potential of diet. The association between DII and all-cause and cardiovascular mortality in ASCVD patients remains undetermined.

METHODS AND RESULTS

Participants included individuals with ASCVD from the National Health and Nutrition Examination Survey from 1999 to 2018. A total of 5006 participants were included, during a median of 6.6 years of follow-up, of which 2220 (44.4 %) were dead. The Cox proportional hazard model evaluated the association between DII and all-cause and cardiovascular mortality. Participants in the higher DII quartile exhibited a higher mortality of ASCVD. Compared with the patients in quartile 1, those in quartile 4 had a 34 % increased risk for all-cause mortality (HR = 1.34, 95 % CI = 1.21-1.61, p = 0.001). Cardiovascular mortality showed a similar trend, however the correlation is not significant. The restricted cubic spline (RCS) showed that the relationship between DII and all-cause and cardiovascular mortality was linear. Subgroup analysis revealed a persistently positive association between DII and all-causemortality across population subgroups. However, an interaction was detected between DII and alcohol history in relation to cardiovascular mortality.

CONCLUSION

DII was positively correlated with the all-cause mortality of ASCVD patients. The intake of a pro-inflammatory diet may increase mortality in ASCVD patients.