Difference in hematocrit and plasma albumin levels as an additional biomarker in the diagnosis of infectious disease

A U shaped association between the HCT-ALB and hospital mortality in patients with sepsis

The difference between hematocrit and serum albumin (HCT-ALB) demonstrates diagnostic significance in infectious diseases, yet the nonlinear relationship between HCT-ALB and hospital mortality in ICU patients with sepsis remains unexplored. This retrospective multicenter cohort study analyzed 7,546 ICU sepsis patients (mean age 66 ± 16 years) to elucidate the HCT-ALB-mortality relationship. Using Cox proportional hazards models with smooth curve fitting, we identified a U-shaped association: Threshold analysis revealed an inflection point at 6.1. Below this threshold, each unit HCT-ALB increase corresponded to reduced mortality risk (adjusted HR 0.986, 95%CI 0.972-0.999; P = 0.036). Conversely, values ≥ 6.1 predicted escalating risk (adjusted HR 1.048 per unit increase, 95%CI 1.037-1.060; P < 0.0001). Significant age interaction was observed (P for interaction < 0.05), with heightened mortality risk in elderly patients (≥ 65 years: HR 1.022, 95%CI 1.014-1.031). These findings establish HCT-ALB as a non-linear predictor of sepsis outcomes, emphasizing its critical threshold dynamics and age-dependent prognostic implications.

A 5-transcript signature for discriminating viral and bacterial etiology in pediatric pneumonia

Pneumonia stands as the primary cause of death among children under five, yet current diagnosis methods often result in inadequate or unnecessary treatments. Our research seeks to address this gap by identifying host transcriptomic biomarkers in the blood of children with definitive viral and bacterial pneumonia. We performed RNA sequencing on 192 prospectively collected whole blood samples, including 38 controls and 154 pneumonia cases, uncovering a 5-transcript signature (genes FAM20A, BAG3, TDRD9, MXRA7, and KLF14) that effectively distinguishes bacterial from viral pneumonia (area under the curve (AUC): 0.95 [0.88-1.00]). Initial validation using combined definitive and probable cases yielded an AUC of 0.87 [0.77-0.97], while full validation in a new prospective cohort of 32 patients achieved an AUC of 0.92 [0.83-1.00]. This robust signature holds significant potential to enhance diagnostics accuracy for pediatric pneumonia, reducing diagnostic delays and unnecessary treatments and potentially transforming clinical practice.

Correlation of HCT-ALB, SmtO2, CRT and LAC with renal impairment and prognosis in patients with septic shock

Background

This study investigates the correlation between the difference in hematocrit (HCT) and serum albumin (ALB) levels (HCT-ALB), muscle tissue oxygen saturation (SmtO2), capillary refill time (CRT), and blood lactate (Lac) with the severity of renal function damage and prognosis in patients with septic shock.

Methods

Conducted from February 2022 to February 2024, this study included 116 septic shock patients treated at the First Affiliated Hospital of Anhui Medical University. Patients were divided into groups based on whether they developed acute kidney injury: 40 patients were included in the acute kidney injury group, and the remaining 76 were placed in the non-kidney injury group. The levels of HCT-ALB, SmtO2, CRT, and Lac were compared between the groups. Patients were followed up to assess their 28day survival outcomes; 75 surviving patients were placed in the survival group, and 41 deceased patients were in the death group. Differences in clinical data and levels of HCTALB, SmtO2, CRT, and Lac between the two groups were analyzed to explore the relationship of these indicators with patient prognosis.

Results

Levels of HCT-ALB, CRT, and Lac were higher, while SmtO2 was lower in the acute kidney injury group compared to the non-kidney injury group (P<0.05). Similarly, the death group exhibited higher levels of HCTALB, CRT, and Lac and lower SmtO2 levels compared to the survival group (P<0.05). Univariate and multivariate analyses revealed that HCT-ALB, SmtO2, CRT, and Lac significantly impact patient survival outcomes, demonstrating high predictive value for patient mortality with respective AUC values of 0.834, 0.782, 0.903, and 0.918. The combined application of these indicators for predicting patient mortality had an AUC value of 0.985, which is higher than when the indicators were used individually.

Conclusions

HCT-ALB, SmtO2, CRT, and Lac are significantly elevated in patients with acute kidney injury and deceased patients, closely correlating with the severity and prognosis of septic shock. These indicators can serve as essential biomarkers for assessing the condition and prognosis of these patients.

Association between hematocrit-to-albumin ratio and acute kidney injury in patients with acute pancreatitis: a retrospective cohort study

Acute pancreatitis (AP) can result in acute kidney injury (AKI), which is linked to poor outcomes. We aimed to assess the relationship between the hematocrit-to-albumin ratio (HAR) and AKI in this population. This retrospective cohort study included consecutive patients diagnosed with AP and admitted to hospital. Data were systematically extracted from electronic medical records, covering baseline demographic and clinical characteristics. Total 1514 AP patients were enrolled, with 17% (257/1514) developing AKI. Multivariable-adjusted regression analysis, curve fitting, threshold effects analyses, and subgroup analyses were conducted to evaluate the relationship between HAR and AKI incidence in AP patients. Compared to the reference tertile of HAR, the adjusted OR values for the lower and higher tertiles of HAR were 1.25 (95% CI, 0.82-1.91, P = 0.297) and 1.50 (95% CI, 1.03-2.20, P = 0.037), respectively, after adjusting for covariates. The curve fitting results showed a J-shaped relationship between HAR and AKI (non-linear, p = 0.001), with an inflection point of 8.969. Furthermore, validation using the Medical Information Mart for Intensive Care (MIMIC-IV) database AP population revealed a similar relationship with an inflection point at 10.257. Our findings suggest a J-shaped relationship between HAR and AKI in AP patients, indicating higher risk of AKI when HAR exceeds 8.969.

Hematocrit and Albumin Levels at Admission Predict in-Hospital Mortality in Pediatric COVID-19 Omicron Variant Patients

Introduction

The Omicron variant is the present predominant COVID-19 strain worldwide. Accurate mortality prediction can facilitate risk stratification and targeted therapies. The study aimed to evaluate the feasibility of the difference in hematocrit and albumin (HCT-ALB) levels, alone or combined with the pediatric Sequential Organ Failure Assessment (pSOFA) score and lactate level, to predict the in-hospital mortality of COVID-19 Omicron variant-infected pediatric patients.

Methods

A multicenter retrospective cohort study was performed for children with COVID-19 Omicron variant infection between December 2021 and January 2022. The demographics, clinical characteristics, hospital admission laboratory test results, and treatments were recorded. The in-hospital mortality was documented. The associations between HCT-ALB levels and mortality, and between HCT-ALB+pSOFA+lactate and mortality were analyzed.

Results

A total of 119 children were included. The median age was 1.6 (interquartile range: 0.5-6.2) years old. There were 70 boys and 49 girls. The mortality rate was 14.3% (17/119). The univariate and multivariate Cox regression analysis revealed that HCT-ALB was associated to in-hospital mortality (hazard ratio: 1.500, 95% confidence interval: 1.235-1.822, p<0.001). The receiver operating characteristic curve analysis revealed that HCT-ALB can be used to accurately predict in-hospital mortality at a cut-off value of -0.7 (area under the curve: 0.888, sensitivity: 0.882, specificity: 0.225, Youden index: 0.657, p<0.001). These patients were assigned into three groups based on the HCT-ALB level, pSOFA score, and lactate level (low-, medium-, and high-risk groups). The Kaplan-Meier analysis revealed that the mortality increased in the high-risk group, when compared to the medium-risk group (p<0.01). The latter group had a higher mortality, when compared to the low-risk group (p<0.01).

Conclusion

The HCT-ALB level can be applied to predict the in-hospital mortality of children infected with the COVID-19 Omicron variant. Its combination with other variables can improve prediction performance.

Hybrid Endometrial-Derived Hydrogels: Human Organoid Culture Models and In Vivo Perspectives

The endometrium plays a vital role in fertility, providing a receptive environment for embryo implantation and development. Understanding the endometrial physiology is essential for developing new strategies to improve reproductive healthcare. Human endometrial organoids (hEOs) are emerging as powerful models for translational research and personalized medicine. However, most hEOs are cultured in a 3D microenvironment that significantly differs from the human endometrium, limiting their applicability in bioengineering. This study presents a hybrid endometrial-derived hydrogel that combines the rigidity of PuraMatrix (PM) with the natural scaffold components and interactions of a porcine decellularized endometrial extracellular matrix (EndoECM) hydrogel. This hydrogel provides outstanding support for hEO culture, enhances hEO differentiation efficiency due to its biochemical similarity with the native tissue, exhibits superior in vivo stability, and demonstrates xenogeneic biocompatibility in mice over a 2-week period. Taken together, these attributes position this hybrid endometrial-derived hydrogel as a promising biomaterial for regenerative treatments in reproductive medicine.

The relationship between hematocrit and serum albumin levels difference and mortality in elderly sepsis patients in intensive care units-a retrospective study based on two large database

BACKGROUND

Sepsis still threatens the lives of more than 300 million patients annually and elderly patients with sepsis usually have a more complicated condition and a worse prognosis. Existing studies have shown that both Hematocrit (HCT) and albumin (ALB) can be used as potential predictors of sepsis, and their difference HCT-ALB has a significant capacity to diagnose infectious diseases. Currently, there is no relevant research on the relationship between HCT-ALB and the prognosis of elderly sepsis patients. Therefore, this study aims to explore the association between HCT-ALB and mortality in elderly patients with sepsis.

METHODS

This study was a multi-center retrospective study based on the Medical Information Mart for Intensive Care (MIMIC-IV) database and the eICU Collaborative Research Database (eICU-CRD) in elderly patients with sepsis. The optimal HCT-ALB cut-off point for ICU mortality was calculated by the Youden Index based on the eICU-CRD dataset, and multivariate logistic regressions were conducted to explore the association between HCT-ALB and ICU/hospital mortality in the two databases. Subgroup analyses were performed for different parameters and comorbidity status.

RESULTS

The number of 16,127 and 3043 elderly sepsis patients were selected from two large intensive care databases (eICU-CRD and MIMIC-IV, respectively) in this study. Depending on the optimal cut-off point, patients in both eICU-CRD and MIMIC-IV were independently divided into low HCT-ALB (< 6.7) and high HCT-ALB (≥ 6.7) groups. The odds ratio (95%confidence interval) [OR (95CI%)] of the high HCT-ALB group were 1.50 (1.36,1.65) and 1.71 (1.58,1.87) for ICU and hospital mortality in the eICU-CRD database after multivariable adjustment. Similar trends in the ICU and hospital mortality [OR (95%CI) 1.41 (1.15,1.72) and 1.27 (1.07,1.51)] were observed in MIMIC-IV database. Subgroup analysis showed an interaction effect with SOFA score in the eICU-CRD database however not in MIMIC-IV dataset.

CONCLUSIONS

High HCT-ALB (≥ 6.7) is associated with 1.41 and 1.27 times ICU and hospital mortality risk in elderly patients with sepsis. HCT-ALB is simple and easy to obtain and is a promising clinical predictor of early risk stratification for elderly sepsis patients in ICU.

The Pharmacokinetics of Gefitinib in a Chinese Cancer Population Group: A Virtual Clinical Trials Population Study

Gefitinib, a selective inhibitor of the epidermal growth factor receptor (EGFR) tyrosine kinase, is used to treat non-small-cell lung cancer (NSCLC). Lung cancer rates are high in China and are expected to increase over the next decade. CYP 2D6 intermediate metaboliser (IM) phenotypes are more prevalent in the Chinese population compared to Caucasians; the increased risk of drug-drug interactions (DDI) with chemotherapy polypharmacy may lead to different clinical pharmacokinetics outcomes for Chinese patients. This study developed and validated a virtual Chinese cancer population for the pragmatic assessment of gefitinib DDI as a victim drug in Chinese and Caucasian cancer populations. When assessing the impact of 2D6 phenotypes on bupropion mediated CYP 2D6 DDI in Chinese cancer population, we found that AUC increased by at least 60% in extensive metabolizers (EM) and 30% in IM. As a result, fmCYP2D6 was reduced by 15% in IM in the presence of bupropion, translating into > 70% of EM subjects and > 48% of IM subjects with trough concentrations at steady state (Ctrough,ss) below the gefitinib target trough level. The PBPK model predicted that a 500 mg once daily dose in both EM and IM subjects successfully reduced the percent of subjects below the Ctrough,ss. Such changes in Ctrough,ss warrant further investigation and highlight the ability of pharmacokinetic modelling to investigate populations that may be difficult to recruit for traditional clinical studies.