1
|
Wren J, Goodacre S, Pandor A, Essat M, Clowes M, Cooper G, Hinchliffe R, Reed MJ, Thomas S, Wilson S. Diagnostic accuracy of alternative biomarkers for acute aortic syndrome: a systematic review. Emerg Med J 2024:emermed-2023-213772. [PMID: 39107052 DOI: 10.1136/emermed-2023-213772] [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: 11/16/2023] [Accepted: 07/21/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND D-dimer is the only biomarker currently recommended in guidelines for the diagnosis of acute aortic syndrome (AAS). We undertook a systematic review to determine whether any alternative biomarkers could be useful in AAS diagnosis. METHODS We searched electronic databases (including MEDLINE, EMBASE and the Cochrane Library) from inception to February 2024. Diagnostic studies were eligible if they examined biomarkers other than D-dimer for diagnosing AAS compared with a reference standard test in people presenting to the ED with symptoms of AAS. Case-control studies were identified but excluded due to high risk of bias. Selection of studies, data extraction and risk of bias assessments using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool were undertaken independently by at least two reviewers. We used narrative synthesis to summarise the findings. RESULTS We identified 2017 citations, included 13 cohort studies (n=76-999), and excluded 38 case-control studies. Methodological quality was variable, with most included studies having unclear or high risk of bias and applicability concerns in at least one item of the QUADAS-2 tool. Only two studies reported biomarkers with sensitivity and specificity comparable to D-dimer (ie, >90% and >50%, respectively). Wang et al reported 99.1% sensitivity and 84.9% specificity for soluble ST2; however, these findings conflicted with estimates of 58% sensitivity and 70.8% specificity reported in another study. Chun and Siu reported 95.6% sensitivity and 56.1% specificity for neutrophil count, but this has not been confirmed elsewhere. CONCLUSION There are many potential alternative biomarkers for AAS but few have been evaluated in more than one study, study designs are often weak and reported biomarker accuracy is modest or inconsistent between studies. Alternative biomarkers to D-dimer are not ready for routine clinical use. PROSPERO REGISTRATION NUMBER CRD42022252121.
Collapse
Affiliation(s)
- Joshua Wren
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | | | | | - Graham Cooper
- Aortic Dissection Charitable Trust, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robert Hinchliffe
- Department of Vascular Surgery, North Bristol NHS Trust, Westbury on Trym, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Matthew J Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), NHS Lothian, Edinburgh, UK
- Acute Care Group, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Steven Thomas
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sarah Wilson
- Emergency Department, Wexham Park Hospital, Slough, UK
| |
Collapse
|
2
|
Zeng Y, Zhao Y, Dai S, Liu Y, Zhang R, Yan H, Zhao M, Wang Y. Impact of lactate dehydrogenase on prognosis of patients undergoing cardiac surgery. BMC Cardiovasc Disord 2022; 22:404. [PMID: 36088306 PMCID: PMC9463775 DOI: 10.1186/s12872-022-02848-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Lactate dehydrogenase (LDH) has been reported in multiple heart diseases. Herein, we explored the prognostic effects of preoperative LDH on adverse outcomes in cardiac surgery patients. Methods Retrospective data analysis was conducted from two large medical databases: Medical Information Mart for Intensive Care (MIMIC) III and MIMIC IV databases. The primary outcome was in-hospital mortality, whereas the secondary outcomes were 1-year mortality, continuous renal replacement therapy, prolonged ventilation, and prolonged length of intensive care unit and hospital stay. Results Patients with a primary endpoint had significantly higher levels of LDH (p < 0.001). Multivariate regression analysis presented that elevated LDH was independently correlated with increased risk of primary and secondary endpoints (all p < 0.001). Subgroup analyses showed that high LDH was consistently associated with primary endpoint. Moreover, LDH exhibited the highest area under the curve (0.768) for the prediction of primary endpoint compared to the other indicators, including neutrophil–lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet–lymphocyte ratio (PLR), lactate, and simplified acute physiology score (SAPS) II. The above results were further confirmed in the MIMIC IV dataset. Conclusions Elevated preoperative LDH may be a robust predictor of poor prognosis in cardiac surgery patients, and its predictive ability is superior to NLR, LMR, PLR, lactate, and SAPS II. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02848-7.
Collapse
|
3
|
Ke J, Chen Y, Wang X, Wu Z, Zhang Q, Lian Y, Chen F. Machine learning-based in-hospital mortality prediction models for patients with acute coronary syndrome. Am J Emerg Med 2022; 53:127-134. [PMID: 35033770 DOI: 10.1016/j.ajem.2021.12.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 12/13/2021] [Accepted: 12/31/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The purpose of this study is to identify the risk factors of in-hospital mortality in patients with acute coronary syndrome (ACS) and to evaluate the performance of traditional regression and machine learning prediction models. METHODS The data of ACS patients who entered the emergency department of Fujian Provincial Hospital from January 1, 2017 to March 31, 2020 for chest pain were retrospectively collected. The study used univariate and multivariate logistic regression analysis to identify risk factors for in-hospital mortality of ACS patients. The traditional regression and machine learning algorithms were used to develop predictive models, and the sensitivity, specificity, and receiver operating characteristic curve were used to evaluate the performance of each model. RESULTS A total of 6482 ACS patients were included in the study, and the in-hospital mortality rate was 1.88%. Multivariate logistic regression analysis found that age, NSTEMI, Killip III, Killip IV, and levels of D-dimer, cardiac troponin I, CK, N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-density lipoprotein (HDL) cholesterol, and Stains were independent predictors of in-hospital mortality. The study found that the area under the receiver operating characteristic curve of the models developed by logistic regression, gradient boosting decision tree (GBDT), random forest, and support vector machine (SVM) for predicting the risk of in-hospital mortality were 0.884, 0.918, 0.913, and 0.896, respectively. Feature importance evaluation found that NT-proBNP, D-dimer, and Killip were top three variables that contribute the most to the prediction performance of the GBDT model and random forest model. CONCLUSIONS The predictive model developed using logistic regression, GBDT, random forest, and SVM algorithms can be used to predict the risk of in-hospital death of ACS patients. Based on our findings, we recommend that clinicians focus on monitoring the changes of NT-proBNP, D-dimer, Killip, cTnI, and LDH as this may improve the clinical outcomes of ACS patients.
Collapse
Affiliation(s)
- Jun Ke
- Department of Emergency, Fujian Provincial Hospital, Fuzhou 350001, Provincial College of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China; Fujian Provincial Institute of Emergency Medicine, Fuzhou 350001, China; Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou 350001, China
| | - Yiwei Chen
- Shanghai Synyi Medical Technology Co., Ltd, Shanghai 201203, China
| | - Xiaoping Wang
- Department of Emergency, Fujian Provincial Hospital, Fuzhou 350001, Provincial College of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China; Fujian Provincial Institute of Emergency Medicine, Fuzhou 350001, China; Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou 350001, China
| | - Zhiyong Wu
- Department of Cardiology, Fujian Provincial Hospital, Fuzhou 350001, Provincial College of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China
| | - Qiongyao Zhang
- Center for information management, Fujian Provincial Hospital, Fuzhou 350001, Fujian Provincial, China
| | - Yangpeng Lian
- Center for information management, Fujian Provincial Hospital, Fuzhou 350001, Fujian Provincial, China
| | - Feng Chen
- Department of Emergency, Fujian Provincial Hospital, Fuzhou 350001, Provincial College of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China; Fujian Provincial Institute of Emergency Medicine, Fuzhou 350001, China; Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou 350001, China.
| |
Collapse
|
4
|
Gotta V, Tancev G, Marsenic O, Vogt JE, Pfister M. Identifying key predictors of mortality in young patients on chronic haemodialysis-a machine learning approach. Nephrol Dial Transplant 2021; 36:519-528. [PMID: 32510143 DOI: 10.1093/ndt/gfaa128] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/28/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The mortality risk remains significant in paediatric and adult patients on chronic haemodialysis (HD) treatment. We aimed to identify factors associated with mortality in patients who started HD as children and continued HD as adults. METHODS The data originated from a cohort of patients <30 years of age who started HD in childhood (≤19 years) on thrice-weekly HD in outpatient DaVita dialysis centres between 2004 and 2016. Patients with at least 5 years of follow-up since the initiation of HD or death within 5 years were included; 105 variables relating to demographics, HD treatment and laboratory measurements were evaluated as predictors of 5-year mortality utilizing a machine learning approach (random forest). RESULTS A total of 363 patients were included in the analysis, with 84 patients having started HD at <12 years of age. Low albumin and elevated lactate dehydrogenase (LDH) were the two most important predictors of 5-year mortality. Other predictors included elevated red blood cell distribution width or blood pressure and decreased red blood cell count, haemoglobin, albumin:globulin ratio, ultrafiltration rate, z-score weight for age or single-pool Kt/V (below target). Mortality was predicted with an accuracy of 81%. CONCLUSIONS Mortality in paediatric and young adult patients on chronic HD is associated with multifactorial markers of nutrition, inflammation, anaemia and dialysis dose. This highlights the importance of multimodal intervention strategies besides adequate HD treatment as determined by Kt/V alone. The association with elevated LDH was not previously reported and may indicate the relevance of blood-membrane interactions, organ malperfusion or haematologic and metabolic changes during maintenance HD in this population.
Collapse
Affiliation(s)
- Verena Gotta
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - Georgi Tancev
- Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - Olivera Marsenic
- Pediatric Nephrology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Julia E Vogt
- Department of Computer Science, ETH Zurich, Zurich, Switzerland
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland.,Certara, Princeton, NJ, USA
| |
Collapse
|
5
|
Sun Z, Zhang Z, Wei S. Comparison between Different Tricuspid Valve Procedures through Postoperative Inflammation and Myocardial Enzymes. Braz J Cardiovasc Surg 2021; 36:212-218. [PMID: 33113321 PMCID: PMC8163275 DOI: 10.21470/1678-9741-2020-0158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction The thoracoscopic procedure for tricuspid valve (TV) diseases is a minimally invasive method of treatment. This study focuses on comparing the changes in postoperative inflammatory reaction and myocardial injury markers after thoracoscopic and sternotomy/thoracotomy TV procedures. Methods We retrospectively analyzed 88 patients (53 males, aged 50.9±16.2 years) with TV diseases (single-valve disease) (72 cases of TV plasty) between January 2018 and April 2019. A total of 56 patients underwent thoracoscopic procedure (50 cases of TV plasty). The leukocyte and C-reactive protein (CRP) levels were monitored as indicators of systemic inflammatory reaction. The lactate dehydrogenase, creatine kinase, creatine kinase myocardial band, aspartate aminotransferase, and troponin-T levels were recorded as markers of myocardial injury. Results The CRP and white blood cells levels of patients in the sternotomy approach group were continuously higher than those in patients in the thoracoscopic approach group. And the levels of myocardial enzymes in patients in the thoracoscopic approach group were significantly lower than those in patients in the sternotomy approach group. Conclusion Compared with sternotomy/thoracotomy procedures on TV, the thoracoscopic procedure can reduce postoperative myocardial injury significantly and systemic inflammatory reaction to a certain extent. It is technically feasible, safe, effective, and worthy of widespread adoption in clinical practice.
Collapse
Affiliation(s)
- Zuoyong Sun
- Department of Cardiothoracic Surgery, Binzhou People's Hospital, Binzhou, Shandong, People's Republic of China
| | - Zhigang Zhang
- Department of Infectious Diseases, Binzhou People's Hospital, Binzhou, Shandong, People's Republic of China
| | - Shixiong Wei
- Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| |
Collapse
|
6
|
Morello F, Santoro M, Fargion AT, Grifoni S, Nazerian P. Diagnosis and management of acute aortic syndromes in the emergency department. Intern Emerg Med 2021; 16:171-181. [PMID: 32358680 DOI: 10.1007/s11739-020-02354-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/21/2020] [Indexed: 12/12/2022]
Abstract
Acute aortic syndromes (AASs) are deadly cardiovascular emergencies involving the thoracic aorta. AASs are relatively rare conditions, have unspecific signs and symptoms (including truncal pain, syncope, neurologic deficit and limb ischemia) and require contrast-enhanced tomography angiography (CTA) of the chest and abdomen for conclusive diagnosis and subsequent therapeutic planning. In the Emergency Department (ED), most patients with potential signs/symptoms of AASs are finally found affected by other alternative diagnoses. Hence, misdiagnosis and delayed diagnosis of AASs are major concerns. In critically ill patients, decision to perform CTA is usually straightforward, as exam benefits largely outweigh risks. In patients with ST-tract elevation on ECG, suspected primary ischemic stroke and in stable patients (representing the most prevalent ED scenarios), proper selection of patients necessitating CTA is cumbersome, due to concurrent risks of misdiagnosis and over-testing. Available studies support an algorithm integrating clinical probability assessment, bedside echocardiography and D-dimer (if the clinical probability is not high). Therapeutic management includes medical therapy for all patients including an opioid and anti-impulse drugs (a beta-blocker and a vasodilator), targeting a heart rate of 60 bpm and systolic blood pressure of 100-120 mmHg. Patients with AASs involving the ascending aorta are likely candidate for urgent surgery, and complicated type B AASs (severe aortic dilatation, impending or frank rupture, organ malperfusion, refractory pain, severe hypertension) necessitate evaluation for urgent endovascular treatment. For uncomplicated type B AASs, optimal medical therapy is the current standard of care.
Collapse
Affiliation(s)
- Fulvio Morello
- S.C.U. Medicina d'Urgenza, Ospedale Molinette, A.O.U. Città della Salute e della Scienza, Torino, Italy
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, Torino, Italy
| | - Marco Santoro
- S.C.U. Medicina d'Urgenza, Ospedale Molinette, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | | | - Stefano Grifoni
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla, 3, 50134, Firenze, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla, 3, 50134, Firenze, Italy.
| |
Collapse
|
7
|
Shaher F, Wang S, Qiu H, Hu Y, Zhang Y, Wang W, AL-Ward H, Abdulghani MAM, Baldi S, Zhou S. Effect and Mechanism of Ganoderma lucidum Spores on Alleviation of Diabetic Cardiomyopathy in a Pilot in vivo Study. Diabetes Metab Syndr Obes 2020; 13:4809-4822. [PMID: 33335409 PMCID: PMC7736836 DOI: 10.2147/dmso.s281527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Ganoderma lucidum spores (GLS) exhibit disease prevention properties, but no study has been carried out on the anti-diabetic cardiomyopathy property of GLS. The aim of this study was to evaluate the hyperglycemia-mediated cardiomyopathy protection and mechanisms of GLS in streptozotocin (STZ)induced diabetic rats. METHODS Male SD rats were randomly divided into three groups. Two groups were given STZ (50 mg/kg, i.p.) treatment and when their fasting plasma glucose was above 16.7 mmol/L, among them, one group was given placebo, as diabetic group, and another group was given GLS (300 mg/kg) treatment. The group without STZ treatment was given placebo as a control group. The experiment lasted 70 days. The histology of myocardium and biomarkers of antioxidants, myocardial injury, pro-inflammatory cytokines, pro-apoptotic proteins and phosphorylation of key proteins in PI3K/AKT pathway were assessed. RESULTS Biochemical analysis showed that GLS treatment significantly reduced the blood glucose (-20.3%) and triglyceride (-20.4%) levels compared to diabetic group without treatment. GLS treatment decreased the content of MDA (-25.6%) and activity of lactate dehydrogenase (-18.9%) but increased the activity of GSH-Px (65.4%). Western blot analysis showed that GLS treatment reduced the expression of both alpha-smooth muscle actin and brain natriuretic peptide. Histological analysis on the cardiac tissue micrographs showed that GLS treatment reduced collagen fibrosis and glycogen reactivity in myocardium. Both Western blot and immunohistochemistry analyses showed that GLS treatment decreased the expression levels of pro-inflammatory factors (cytokines IL-1β, and TNF-α) as well as apoptosis regulatory proteins (Bax, caspase-3 and -9), but increased Bcl-2. Moreover, GLS treatment significantly increased the phosphorylation of key proteins involved in PI3K/AKT pathway, eg, p-AKT p-PI3K and mTOR. CONCLUSION The results indicated that GLS treatment alleviates diabetic cardiomyopathy by reducing hyperglycemia, oxidative stress, inflammation, apoptosis and further attenuating the fibrosis and myocardial dysfunction induced by STZ through stimulation of the PI3K/Akt/mTOR signaling pathway.
Collapse
Affiliation(s)
- Fahmi Shaher
- Department of Pathophysiology, College of Basic Medicine, Jiamusi University, Jiamusi, People’s Republic of China
| | - Shuqiu Wang
- Department of Pathophysiology, College of Basic Medicine, Jiamusi University, Jiamusi, People’s Republic of China
| | - Hongbin Qiu
- Department of Pathophysiology, College of Basic Medicine, Jiamusi University, Jiamusi, People’s Republic of China
| | - Yu Hu
- Department of Pathophysiology, College of Basic Medicine, Jiamusi University, Jiamusi, People’s Republic of China
| | - Yu Zhang
- Department of Pharmacology, College of Pharmacy, Jiamusi University, Jiamusi, People’s Republic of China
| | - Weiqun Wang
- Department of Physiology, College of Basic Medicine, Jiamusi University, Jiamusi, People’s Republic of China
| | - Hisham AL-Ward
- Department of Biochemistry and Molecular Biology, College of Basic Medicine, Jiamusi University, Jiamusi, People’s Republic of China
| | - Mahfoudh A M Abdulghani
- Department of Pharmacology and Toxicology, Unaizah College Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Salem Baldi
- Department of Clinical Laboratory Diagnostics, College of Basic Medicine, Dalian Medical University, Dalian, People’s Republic of China
| | - Shaobo Zhou
- School of Life Sciences, Institute of Biomedical and Environmental Science and Technology (iBEST), University of Bedfordshire, LutonLU1 3JU, UK
| |
Collapse
|
8
|
Theologou T, Harky A, Shaw M, Eltyeb H, Elbakbak W, Snosi M, Harrington D, Kuduvalli M, Oo A, Field M. Management of Lower Limb Ischemia During Operative Repair of Acute Type A Aortic Dissection by Distal Crossover Grafts: a Case Series. Braz J Cardiovasc Surg 2020; 35:607-613. [PMID: 33118723 PMCID: PMC7598955 DOI: 10.21470/1678-9741-2019-0259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective To describe our experience of nine patients with extra-anatomical bypass for clinically ischemic distal limb during repair of acute Type A aortic dissection (ATAAD). Methods We retrospectively examined a series of nine patients who underwent surgery for ATAAD. We identified a subset of the patients who presented with concomitant radiographic and clinical signs of lower limb ischemia. All but one patient (axillobifemoral bypass) underwent femorofemoral crossover grafting by the cardiac surgeon during cooling. Results One hundred eighty-one cases of ATAAD underwent surgery during the study period with a mortality of 19.3%. Nine patients had persistent clinical evidence of lower limb ischemia (4.9%) and underwent extra-anatomical bypass during cooling. Two patients underwent additional fasciotomies. Mean delay from symptoms to surgery in these nine patients was 9.5 hours. Two patients had bilateral amputations despite revascularisation and, of note, had long delays in presentation for surgery (> 12 hours). There were no mortalities during these inpatient episodes. Outpatient radiographic follow-up at the first opportunity demonstrated 100% patency. Conclusion Our experience suggests that, during complicated aortic dissection, limb ischemia may have a devastating outcome including amputation when diagnosis and referral are delayed. Early diagnosis and surgery are crucial in preventing this potentially devastating complication.
Collapse
Affiliation(s)
- Thomas Theologou
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Amer Harky
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Shaw
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Hazim Eltyeb
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Walid Elbakbak
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mostafa Snosi
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Deborah Harrington
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Manoj Kuduvalli
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Aung Oo
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark Field
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool United Kingdom Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| |
Collapse
|
9
|
Oliveira VC, Oliveira P, Moreira M, Correia M, Lima P, Silva JC, Pereira RV, Fonseca M. Impact of Total Psoas Area and Lean Muscular Area on Mortality after Endovascular Aortic Aneurysm Repair. Ann Vasc Surg 2020; 72:479-487. [PMID: 32949746 DOI: 10.1016/j.avsg.2020.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/06/2020] [Accepted: 09/09/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Sarcopenia has assumed growing relevance as a morbimortality predictor after major abdominal surgery. The aim of this study is to access total psoas muscle area (TPA) and lean muscle area (LMA) impact in morbimortality after elective endovascular abdominal aortic aneurysm repair (EVAR). METHODS Asymptomatic patients submitted to aortic endoprosthesis implantation between January 1, 2014 and December 31, 2018 at our vascular surgery department were retrospectively evaluated. After exclusion criteria were applied, 105 patients were included in the study; preoperative computed tomography scans were evaluated using OSIRIX software (Bernex, Switzerland). Two observers independently calculated TPA at the most caudal level of the L3 vertebra and respective density, therefore calculating LMA. Patients were separated by tertiles with the lowest being considered sarcopenic and with higher muscle steatosis and compared with the higher tertiles. Patient demographics and intraoperative and postoperative period variables were collected. Charlson comorbidity index was calculated and surgical complications classified according to Clavien-Dindo. The intraclass correlation coefficient and Bland-Altman plot were made to characterize interobserver variability. Survival analysis was performed with the Kaplan-Meier method, and differences between survival curves were tested with the log-rank test. The effect of sarcopenia on patient survival was assessed using Cox proportional hazard models. RESULTS Considering TPA, univariate analyses revealed that patients in the lower tertile had inferior survival (P = 0.03), whereas multivariate analyses showed increased likelihood of mortality (P = 0.039, hazard ratio (HR) 3.829). For LMA, univariate analyses revealed that patients in the lower tertile had inferior survival (P = 0.013), whereas multivariate analyses showed increased likelihood of mortality (P = 0.026, HR 4.153). When analyzing patients in the lowest tertile of both TPA and LMA, both univariate (P = 0.002) and multivariate (P = 0.018, HR 4.166) analyses reveled inferior survival. CONCLUSIONS Our study reveals reduced survival in patients with low TPA and low LMA submitted to elective EVAR; these factors should probably be taken into consideration in the future for preoperative risk evaluation and surgical planning.
Collapse
Affiliation(s)
- Vânia Constâncio Oliveira
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, EPE, Praceta Professor Mota Pinto, Coimbra, Portugal.
| | - Pedro Oliveira
- Liver Transplantation Department, Centro Hospitalar e Universitário de Coimbra, EPE, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Mário Moreira
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, EPE, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Mafalda Correia
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, EPE, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Pedro Lima
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, EPE, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Joana Cruz Silva
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, EPE, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Ricardo Vale Pereira
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, EPE, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Manuel Fonseca
- Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, EPE, Praceta Professor Mota Pinto, Coimbra, Portugal
| |
Collapse
|
10
|
Kayaalti S, Kayaalti O, Hakan Aksebzeci B. A decision support system for the prediction of mortality in patients with acute kidney injury admitted in intensive care unit. J Appl Biomed 2020; 18:26-32. [PMID: 34907705 DOI: 10.32725/jab.2020.004] [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: 11/06/2018] [Accepted: 02/19/2020] [Indexed: 11/05/2022] Open
Abstract
Intensive care unit (ICU) is a very special unit of a hospital, where healthcare professionals provide treatment and, later, close follow-up to the patients. It is crucial to estimate mortality in ICU patients from many viewpoints. The purpose of this study is to classify the status of patients with acute kidney injury (AKI) in ICU as early mortality, late mortality, and survival by the application of Classification and Regression Trees (CART) algorithm to the patients' attributes such as blood urea nitrogen, creatinine, serum and urine neutrophil gelatinase-associated lipocalin (NGAL), alkaline phosphatase, lactate dehydrogenase (LDH), gamma-glutamyl transferase, laboratory electrolytes, blood gas, mean arterial pressure, central venous pressure and demographic details of patients. This study was conducted 50 patients with AKI who were followed up in the ICU. The study also aims to determine the significance of relationship between the attributes used in the prediction of mortality in CART and patients' status by employing the Kruskal-Wallis H test. The classification accuracy, sensitivity, and specificity of CART for the tested attributes for the prediction of early mortality, late mortality, and survival of patients were 90.00%, 83.33%, and 91.67%, respectively. The values of both urine NGAL and LDH on day 7 showed a considerable difference according to the patients' status after being examined by the Kruskal-Wallis H test.
Collapse
Affiliation(s)
- Selda Kayaalti
- Develi Hatice-Muammer Kocaturk Public Hospital, Department of Anesthesiology and Reanimation, Develi, Kayseri, Turkey
| | - Omer Kayaalti
- Kayseri University, Develi Huseyin Sahin Vocational College, Department of Computer Technologies, Kayseri, Turkey
| | - Bekir Hakan Aksebzeci
- Abdullah Gul University, Faculty of Engineering, Department of Biomedical Engineering, Kayseri, Turkey
| |
Collapse
|
11
|
Association of Lactate Dehydrogenase with In-Hospital Mortality in Patients with Acute Aortic Dissection: A Retrospective Observational Study. Int J Hypertens 2020; 2020:1347165. [PMID: 31969993 PMCID: PMC6969996 DOI: 10.1155/2020/1347165] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
Background Evidence regarding the relationship between serum lactate dehydrogenase (LDH) levels and in-hospital mortality in acute aortic dissection (AAD) patients is extremely limited. We aimed to investigate the relationship between LDH and in-hospital mortality in AAD patients. Methods The present study was a retrospective observational study. A total of 1526 participants with acute aortic dissection were involved in a hospital in China from January 2014 to December 2018. The target-independent variable was LDH measured at baseline, and the dependent was all-cause mortality during hospitalization. Covariates involved in this study included age, gender, body mass index (BMI), hypertension, diabetes, smoking, stroke, atherosclerosis, systolic blood pressure (SBP), diastolic blood pressure (DBP), white blood cell (WBC), hemoglobin (Hb), alanine transaminase (ALT), aspartate aminotransferase (AST), albumin (ALB), creatinine (Cr), symptom, type of AAD (Stanford), and management. Results The average age of 1526 selected participants was 52.72 ± 11.94 years old, and about 80.41% of them were male. The result of the fully adjusted model showed LDH was positively associated with in-hospital mortality in AAD patients after adjusting confounders (OR = 1.09, 95% CI 1.05 to 1.13). A nonlinear relationship was detected between LDH and in-hospital mortality in AAD patients after adjusting for potential confounders (age, gender, BMI, hypertension, diabetes, stroke, atherosclerosis, smoking, symptom, SBP, DBP, WBC, Hb, ALT, AST, ALB, Cr, type of AAD (Stanford), and management), whose point was 557. The effect sizes and the confidence intervals of the left and right sides of the inflection point were 0.90 (0.74–1.10) and 1.12 (1.06–1.19), respectively. Subgroup analysis in participants showed that the relationship between LDH and in-hospital mortality was stable, and all of the P value for the interaction in different subgroup were more than 0.05. Conclusions The relationship between LDH and in-hospital mortality in AAD patients is nonlinear. LDH was positively related with in-hospital mortality when LDH is more than 557.
Collapse
|
12
|
Mahmoodpoor A, Hamishehkar H, Fattahi V, Sanaie S, Arora P, Nader ND. Urinary versus plasma neutrophil gelatinase-associated lipocalin (NGAL) as a predictor of mortality for acute kidney injury in intensive care unit patients. J Clin Anesth 2019; 44:12-17. [PMID: 29100016 DOI: 10.1016/j.jclinane.2017.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/29/2017] [Accepted: 10/20/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To examine urinary and plasma neutrophil gelatinase-associated lipocalin (NGAL) levels in predicting ICU mortality. DESIGN Prospective observational. SETTING University Critical Care setting. PARTICIPANTS 50 patients with acute kidney injury (AKI). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Serial urinary and plasma concentrations of NGAL were measured. Twenty-five patients had early progression (EP) and 25 patients had early improvement (EI) of AKI. Plasma concentrations of NGAL in the EP group (N=25) were significantly higher than those in the EI group (129 [IQR; 20] vs. 111 [IQR; 32] ng/mL; P=0.009), while urine NGAL levels on admission were similar in both groups (61 [IQR; 20] vs. 65 [IQR; 20] ng/mL; P=0.767). Plasma NGAL concentrations rapidly decreased to 87 [32] ng/mL in the EI group (P<0.001) and while it remained elevated in the EP group (138 [21] ng/mL). Within 28-days, 50% of the patients died in the EP group, whereas no patient died in the EI group (P<0.001). Plasma NGAL was a fair predictor for progression of AKI (AUC; 0.719±0.063; P=0.006). 48-hour changes in plasma NGAL levels predicted death within 28-days of ICU admission (AUC; 0.874±0.048; P<0.001). CONCLUSION Early progression of AKI was associated with more death within 28 and 90days. While one time measurement of plasma NGAL levels at the time ICU admission may represent the kidney health status in critical care settings, it does not reliably predict mortality. On the other hand, changes in plasma NGAL within 48h of admission improve the value of this biomarker in predicting ICU mortality.
Collapse
Affiliation(s)
- Ata Mahmoodpoor
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Hamishehkar
- Applied Drug Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Fattahi
- Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sarvin Sanaie
- Lung & Tuberculosis Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Pradeep Arora
- Clinical Professor of Medicine, University at Buffalo, Buffalo, NY, USA.
| | - Nader D Nader
- Department of Anesthesiology, University at Buffalo, 77 Goodell Street, Suite #510, Buffalo, NY 14203, USA.
| |
Collapse
|
13
|
Cardoso AL, Fernandes A, Aguilar-Pimentel JA, de Angelis MH, Guedes JR, Brito MA, Ortolano S, Pani G, Athanasopoulou S, Gonos ES, Schosserer M, Grillari J, Peterson P, Tuna BG, Dogan S, Meyer A, van Os R, Trendelenburg AU. Towards frailty biomarkers: Candidates from genes and pathways regulated in aging and age-related diseases. Ageing Res Rev 2018; 47:214-277. [PMID: 30071357 DOI: 10.1016/j.arr.2018.07.004] [Citation(s) in RCA: 288] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/08/2018] [Accepted: 07/10/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Use of the frailty index to measure an accumulation of deficits has been proven a valuable method for identifying elderly people at risk for increased vulnerability, disease, injury, and mortality. However, complementary molecular frailty biomarkers or ideally biomarker panels have not yet been identified. We conducted a systematic search to identify biomarker candidates for a frailty biomarker panel. METHODS Gene expression databases were searched (http://genomics.senescence.info/genes including GenAge, AnAge, LongevityMap, CellAge, DrugAge, Digital Aging Atlas) to identify genes regulated in aging, longevity, and age-related diseases with a focus on secreted factors or molecules detectable in body fluids as potential frailty biomarkers. Factors broadly expressed, related to several "hallmark of aging" pathways as well as used or predicted as biomarkers in other disease settings, particularly age-related pathologies, were identified. This set of biomarkers was further expanded according to the expertise and experience of the authors. In the next step, biomarkers were assigned to six "hallmark of aging" pathways, namely (1) inflammation, (2) mitochondria and apoptosis, (3) calcium homeostasis, (4) fibrosis, (5) NMJ (neuromuscular junction) and neurons, (6) cytoskeleton and hormones, or (7) other principles and an extensive literature search was performed for each candidate to explore their potential and priority as frailty biomarkers. RESULTS A total of 44 markers were evaluated in the seven categories listed above, and 19 were awarded a high priority score, 22 identified as medium priority and three were low priority. In each category high and medium priority markers were identified. CONCLUSION Biomarker panels for frailty would be of high value and better than single markers. Based on our search we would propose a core panel of frailty biomarkers consisting of (1) CXCL10 (C-X-C motif chemokine ligand 10), IL-6 (interleukin 6), CX3CL1 (C-X3-C motif chemokine ligand 1), (2) GDF15 (growth differentiation factor 15), FNDC5 (fibronectin type III domain containing 5), vimentin (VIM), (3) regucalcin (RGN/SMP30), calreticulin, (4) PLAU (plasminogen activator, urokinase), AGT (angiotensinogen), (5) BDNF (brain derived neurotrophic factor), progranulin (PGRN), (6) α-klotho (KL), FGF23 (fibroblast growth factor 23), FGF21, leptin (LEP), (7) miRNA (micro Ribonucleic acid) panel (to be further defined), AHCY (adenosylhomocysteinase) and KRT18 (keratin 18). An expanded panel would also include (1) pentraxin (PTX3), sVCAM/ICAM (soluble vascular cell adhesion molecule 1/Intercellular adhesion molecule 1), defensin α, (2) APP (amyloid beta precursor protein), LDH (lactate dehydrogenase), (3) S100B (S100 calcium binding protein B), (4) TGFβ (transforming growth factor beta), PAI-1 (plasminogen activator inhibitor 1), TGM2 (transglutaminase 2), (5) sRAGE (soluble receptor for advanced glycosylation end products), HMGB1 (high mobility group box 1), C3/C1Q (complement factor 3/1Q), ST2 (Interleukin 1 receptor like 1), agrin (AGRN), (6) IGF-1 (insulin-like growth factor 1), resistin (RETN), adiponectin (ADIPOQ), ghrelin (GHRL), growth hormone (GH), (7) microparticle panel (to be further defined), GpnmB (glycoprotein nonmetastatic melanoma protein B) and lactoferrin (LTF). We believe that these predicted panels need to be experimentally explored in animal models and frail cohorts in order to ascertain their diagnostic, prognostic and therapeutic potential.
Collapse
|
14
|
Cui J, Xiong J, Zhang Y, Peng T, Huang M, Lin Y, Guo Y, Wu H, Wang C. Serum lactate dehydrogenase is predictive of persistent organ failure in acute pancreatitis. J Crit Care 2017; 41:161-165. [PMID: 28554094 DOI: 10.1016/j.jcrc.2017.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/27/2017] [Accepted: 05/03/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE Elevated serum lactate dehydrogenase (LDH) has been reported in a serious of clinical diseases. However, the relationship between LDH and the incidence of persistent organ failure (POF) in acute pancreatitis (AP) has not been characterized. MATERIALS AND METHODS A total of 105 patients with AP who presented within 72h from symptom onset between 2014 and 2015 were included in this retrospective study. Demographic parameters and laboratory data on admission were compared between patients with and without POF. Multivariable logistic regression analyses were utilized to evaluate the prognostic value of LDH for predicting POF. RESULTS 21 patients were diagnosed with POF. Compared to non-POF, patients with POF showed a significantly higher value of serum LDH on admission (741.57±331.72 vs. 296.08±135.73U/L, P<0.001). After multivariate logistic analysis, LDH remained an independent risk factor for POF (Hazard ratio 4.38, 95%CI: 1.42-13.47; P=0.010). A LDH value of 647U/L predicted POF with an area under the curve (AUC) of 0.876, a sensitivity with 76.2% and specificity with 98.8%, respectively. CONCLUSIONS Our results indicate that serum LDH on admission is independently associated with POF in AP and may serve as a potential prognostic factor.
Collapse
Affiliation(s)
- Jing Cui
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Jiongxin Xiong
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yushun Zhang
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Tao Peng
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Min Huang
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yan Lin
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yao Guo
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Heshui Wu
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Chunyou Wang
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| |
Collapse
|