1
|
Sheikh MS, Thongprayoon C, Suppadungsuk S, Miao J, Qureshi F, Kashani K, Cheungpasitporn W. Evaluating ChatGPT's Accuracy in Responding to Patient Education Questions on Acute Kidney Injury and Continuous Renal Replacement Therapy. Blood Purif 2024:000539065. [PMID: 38679000 DOI: 10.1159/000539065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/19/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Acute Kidney Injury (AKI) and Continuous Renal Replacement Therapy (CRRT) are critical areas in nephrology. The effectiveness of ChatGPT in simpler, patient education-oriented questions has not been thoroughly assessed. This study evaluates the proficiency of ChatGPT 4.0 in responding to such questions, subjected to various linguistic alterations. METHODS Eighty-nine questions were sourced from the Mayo Clinic Handbook for educating patients on AKI and CRRT. These questions were categorized as original, paraphrased with different interrogative adverbs, paraphrased resulting in incomplete sentences, and paraphrased containing misspelled words. Two nephrologists verified the questions for medical accuracy. A chi-squared test was conducted to ascertain notable discrepancies in ChatGPT 4.0's performance across these formats. RESULTS ChatGPT provided notable accuracy in handling a variety of question formats for patient education in AKI and CRRT. Across all question types, ChatGPT demonstrated an accuracy of 97% for both original and adverb-altered questions and 98% for questions with incomplete sentences or misspellings. Specifically for AKI-related questions, the accuracy was consistently maintained at 97% for all versions. In the subset of CRRT-related questions, the tool achieved a 96% accuracy for original and adverb-altered questions, and this increased to 98% for questions with incomplete sentences or misspellings. The statistical analysis revealed no significant difference in performance across these varied question types (p-value: 1.00 for AKI and 1.00 for CRRT), and there was no notable disparity between the AI's responses to AKI and CRRT questions (p-value: 0.71). CONCLUSION ChatGPT 4.0 demonstrates consistent and high accuracy in interpreting and responding to queries related to AKI and CRRT, irrespective of linguistic modifications. These findings suggest that ChatGPT 4.0 has the potential to be a reliable support tool in the delivery of patient education, by accurately providing information across a range of question formats. Further research is needed to explore the direct impact of AI-generated responses on patient understanding and education outcomes.
Collapse
|
2
|
Singh SP, Qureshi U, Qureshi F, Qureshi F. Commentary: Eighteen cases of renal aneurysms: clinical retrospective analysis and experience of endovascular interventional treatment. Front Surg 2024; 11:1352880. [PMID: 38348468 PMCID: PMC10860334 DOI: 10.3389/fsurg.2024.1352880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/10/2024] [Indexed: 02/15/2024] Open
Affiliation(s)
- Som P. Singh
- Department of Biomedical Sciences, Kansas City School of Medicine, University of Missouri, Kansas City, MO, United States
| | - Ursula Qureshi
- College of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, Kansas City, MO, United States
| | - Farah Qureshi
- Lake Erie College of Osteopathic Medicine, Erie, PA, United States
| | - Fawad Qureshi
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
3
|
Aiumtrakul N, Thongprayoon C, Arayangkool C, Vo KB, Wannaphut C, Suppadungsuk S, Krisanapan P, Garcia Valencia OA, Qureshi F, Miao J, Cheungpasitporn W. Personalized Medicine in Urolithiasis: AI Chatbot-Assisted Dietary Management of Oxalate for Kidney Stone Prevention. J Pers Med 2024; 14:107. [PMID: 38248809 PMCID: PMC10817681 DOI: 10.3390/jpm14010107] [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: 12/23/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/23/2024] Open
Abstract
Accurate information regarding oxalate levels in foods is essential for managing patients with hyperoxaluria, oxalate nephropathy, or those susceptible to calcium oxalate stones. This study aimed to assess the reliability of chatbots in categorizing foods based on their oxalate content. We assessed the accuracy of ChatGPT-3.5, ChatGPT-4, Bard AI, and Bing Chat to classify dietary oxalate content per serving into low (<5 mg), moderate (5-8 mg), and high (>8 mg) oxalate content categories. A total of 539 food items were processed through each chatbot. The accuracy was compared between chatbots and stratified by dietary oxalate content categories. Bard AI had the highest accuracy of 84%, followed by Bing (60%), GPT-4 (52%), and GPT-3.5 (49%) (p < 0.001). There was a significant pairwise difference between chatbots, except between GPT-4 and GPT-3.5 (p = 0.30). The accuracy of all the chatbots decreased with a higher degree of dietary oxalate content categories but Bard remained having the highest accuracy, regardless of dietary oxalate content categories. There was considerable variation in the accuracy of AI chatbots for classifying dietary oxalate content. Bard AI consistently showed the highest accuracy, followed by Bing Chat, GPT-4, and GPT-3.5. These results underline the potential of AI in dietary management for at-risk patient groups and the need for enhancements in chatbot algorithms for clinical accuracy.
Collapse
Affiliation(s)
- Noppawit Aiumtrakul
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA; (N.A.); (C.A.); (K.B.V.); (C.W.)
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.S.); (O.A.G.V.); (F.Q.); (J.M.); (W.C.)
| | - Chinnawat Arayangkool
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA; (N.A.); (C.A.); (K.B.V.); (C.W.)
| | - Kristine B. Vo
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA; (N.A.); (C.A.); (K.B.V.); (C.W.)
| | - Chalothorn Wannaphut
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA; (N.A.); (C.A.); (K.B.V.); (C.W.)
| | - Supawadee Suppadungsuk
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.S.); (O.A.G.V.); (F.Q.); (J.M.); (W.C.)
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand
| | - Pajaree Krisanapan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.S.); (O.A.G.V.); (F.Q.); (J.M.); (W.C.)
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
| | - Oscar A. Garcia Valencia
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.S.); (O.A.G.V.); (F.Q.); (J.M.); (W.C.)
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.S.); (O.A.G.V.); (F.Q.); (J.M.); (W.C.)
| | - Jing Miao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.S.); (O.A.G.V.); (F.Q.); (J.M.); (W.C.)
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.S.); (O.A.G.V.); (F.Q.); (J.M.); (W.C.)
| |
Collapse
|
4
|
Ijaz R, Ali NM, Ramzan U, Qureshi F, Baloch SR, Khan MA, Mazhar B, chaudhry M. Phylo-geographic analysis of whitefly on the basis of mitochondrial cytochrome oxidase 1 gene. BRAZ J BIOL 2024. [DOI: 10.1590/1519-6984.252910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Bemisia tabaci is a species complex that causes damage to its broad range of plant hosts through serious feeding. It transmits plant viruses of different groups to important agricultural crops. Some important cash crops of Pakistan are sugar cane, rice, tobacco and seed oil. It shows high genetic variability and is differentiated as races or biotypes. Biotypes are, biotype Q, biotype B, biotype B2, biotype M, biotype L, biotype A, biotype H, biotype C, biotype K, biotype N, biotype R, biotype E, biotype P, biotype J, biotype S, biotype AN. Although the current report based on the Bayesian study of mitochondrial cytohrome oxidase gene1 (CO1) DNA sequences has classified the different populations of whiteflies into twelve genetic groups which are Mediterranean, Sub-Saharan Africa silverleafing, Indian Ocean, Asia II, Asia I, Australia, New World, Italy, China, Sub-Saharan Africa non-silverleafing, Mediterranean/Asia Minor/Africa and Uganda sweet potato. Begomoviruses is largest group of viruses transmitted by B. tabaci and cause major diseases of crops such as tomato and chili leaf curl disease, cassava mosaic disease; yellow mosaic disease of legumes and cotton leaf curl disease. The main objective of current study is to inculpate knowledge regarding genetic diversity of whitefly in cotton fields across Pakistan via analysis of partial DNA sequence of mitochondrial gene Cytochrom Oxidase I (mtCO1).
Collapse
Affiliation(s)
- R. Ijaz
- GC University Lahore, Pakistan
| | | | | | - F. Qureshi
- University of Veterinary and Animal Sciences, Pakistan
| | | | | | | | | |
Collapse
|
5
|
Miao J, Thongprayoon C, Suppadungsuk S, Garcia Valencia OA, Qureshi F, Cheungpasitporn W. Ethical Dilemmas in Using AI for Academic Writing and an Example Framework for Peer Review in Nephrology Academia: A Narrative Review. Clin Pract 2023; 14:89-105. [PMID: 38248432 PMCID: PMC10801601 DOI: 10.3390/clinpract14010008] [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: 11/15/2023] [Revised: 12/23/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
The emergence of artificial intelligence (AI) has greatly propelled progress across various sectors including the field of nephrology academia. However, this advancement has also given rise to ethical challenges, notably in scholarly writing. AI's capacity to automate labor-intensive tasks like literature reviews and data analysis has created opportunities for unethical practices, with scholars incorporating AI-generated text into their manuscripts, potentially undermining academic integrity. This situation gives rise to a range of ethical dilemmas that not only question the authenticity of contemporary academic endeavors but also challenge the credibility of the peer-review process and the integrity of editorial oversight. Instances of this misconduct are highlighted, spanning from lesser-known journals to reputable ones, and even infiltrating graduate theses and grant applications. This subtle AI intrusion hints at a systemic vulnerability within the academic publishing domain, exacerbated by the publish-or-perish mentality. The solutions aimed at mitigating the unethical employment of AI in academia include the adoption of sophisticated AI-driven plagiarism detection systems, a robust augmentation of the peer-review process with an "AI scrutiny" phase, comprehensive training for academics on ethical AI usage, and the promotion of a culture of transparency that acknowledges AI's role in research. This review underscores the pressing need for collaborative efforts among academic nephrology institutions to foster an environment of ethical AI application, thus preserving the esteemed academic integrity in the face of rapid technological advancements. It also makes a plea for rigorous research to assess the extent of AI's involvement in the academic literature, evaluate the effectiveness of AI-enhanced plagiarism detection tools, and understand the long-term consequences of AI utilization on academic integrity. An example framework has been proposed to outline a comprehensive approach to integrating AI into Nephrology academic writing and peer review. Using proactive initiatives and rigorous evaluations, a harmonious environment that harnesses AI's capabilities while upholding stringent academic standards can be envisioned.
Collapse
Affiliation(s)
- Jing Miao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (J.M.); (S.S.); (O.A.G.V.); (F.Q.); (W.C.)
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (J.M.); (S.S.); (O.A.G.V.); (F.Q.); (W.C.)
| | - Supawadee Suppadungsuk
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (J.M.); (S.S.); (O.A.G.V.); (F.Q.); (W.C.)
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bang Phli 10540, Samut Prakan, Thailand
| | - Oscar A. Garcia Valencia
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (J.M.); (S.S.); (O.A.G.V.); (F.Q.); (W.C.)
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (J.M.); (S.S.); (O.A.G.V.); (F.Q.); (W.C.)
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (J.M.); (S.S.); (O.A.G.V.); (F.Q.); (W.C.)
| |
Collapse
|
6
|
Miao J, Thongprayoon C, Suppadungsuk S, Garcia Valencia OA, Qureshi F, Cheungpasitporn W. Innovating Personalized Nephrology Care: Exploring the Potential Utilization of ChatGPT. J Pers Med 2023; 13:1681. [PMID: 38138908 PMCID: PMC10744377 DOI: 10.3390/jpm13121681] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/01/2023] [Revised: 12/02/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
The rapid advancement of artificial intelligence (AI) technologies, particularly machine learning, has brought substantial progress to the field of nephrology, enabling significant improvements in the management of kidney diseases. ChatGPT, a revolutionary language model developed by OpenAI, is a versatile AI model designed to engage in meaningful and informative conversations. Its applications in healthcare have been notable, with demonstrated proficiency in various medical knowledge assessments. However, ChatGPT's performance varies across different medical subfields, posing challenges in nephrology-related queries. At present, comprehensive reviews regarding ChatGPT's potential applications in nephrology remain lacking despite the surge of interest in its role in various domains. This article seeks to fill this gap by presenting an overview of the integration of ChatGPT in nephrology. It discusses the potential benefits of ChatGPT in nephrology, encompassing dataset management, diagnostics, treatment planning, and patient communication and education, as well as medical research and education. It also explores ethical and legal concerns regarding the utilization of AI in medical practice. The continuous development of AI models like ChatGPT holds promise for the healthcare realm but also underscores the necessity of thorough evaluation and validation before implementing AI in real-world medical scenarios. This review serves as a valuable resource for nephrologists and healthcare professionals interested in fully utilizing the potential of AI in innovating personalized nephrology care.
Collapse
Affiliation(s)
- Jing Miao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (J.M.); (C.T.); (S.S.); (O.A.G.V.); (F.Q.)
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (J.M.); (C.T.); (S.S.); (O.A.G.V.); (F.Q.)
| | - Supawadee Suppadungsuk
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (J.M.); (C.T.); (S.S.); (O.A.G.V.); (F.Q.)
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand
| | - Oscar A. Garcia Valencia
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (J.M.); (C.T.); (S.S.); (O.A.G.V.); (F.Q.)
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (J.M.); (C.T.); (S.S.); (O.A.G.V.); (F.Q.)
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (J.M.); (C.T.); (S.S.); (O.A.G.V.); (F.Q.)
| |
Collapse
|
7
|
Singh SP, Ramprasad A, Qureshi FM, Baig FA, Qureshi F. A Cross-Sectional Study of Graduate Medical Education in Radiological Fellowships using Accessible Content. Curr Probl Diagn Radiol 2023; 52:528-533. [PMID: 37246039 DOI: 10.1067/j.cpradiol.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/16/2023] [Accepted: 05/08/2023] [Indexed: 05/30/2023]
Abstract
Graduate medical education in radiology serves an imperative role in training the next generation of specialists. Given the regularity of virtual interviews, the website of a fellowship programs remains a critical first-line source of information of applicants. The aim of this study is to systematically evaluate 7 radiology fellowship programs utilizing a systematic process. A cross-sectional descriptive 286 graduate medical education fellowship programs in radiology were screened from the Fellowship and Residency Electronic Interactive Database (FREIDA). Extracted data was evaluated for comprehensiveness using 20 content criteria, and a readability score is calculated. The mean comprehensiveness among all fellowship program websites was 55.8% (n = 286), and the average FRE among the program overview sections was 11.9 (n = 214). ANOVA revealed no statistical significance in program website comprehensiveness between radiology fellowships (P = 0.33). The quality of a program's website data continues to serve an important role in an applicant's decision-making. Fellowship programs have improved in their content availability overtime, but content reevaluation needs to be continued for tangible improvement.
Collapse
Affiliation(s)
- Som P Singh
- University of Missouri Kansas City School of Medicine, Kansas City, MO..
| | - Aarya Ramprasad
- University of Missouri Kansas City School of Medicine, Kansas City, MO
| | - Fahad M Qureshi
- University of Missouri Kansas City School of Medicine, Kansas City, MO
| | - Farhan A Baig
- University of Missouri Kansas City School of Medicine, Kansas City, MO
| | | |
Collapse
|
8
|
Suppadungsuk S, Thongprayoon C, Miao J, Krisanapan P, Qureshi F, Kashani K, Cheungpasitporn W. Exploring the Potential of Chatbots in Critical Care Nephrology. Medicines (Basel) 2023; 10:58. [PMID: 37887265 PMCID: PMC10608511 DOI: 10.3390/medicines10100058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
The exponential growth of artificial intelligence (AI) has allowed for its integration into multiple sectors, including, notably, healthcare. Chatbots have emerged as a pivotal resource for improving patient outcomes and assisting healthcare practitioners through various AI-based technologies. In critical care, kidney-related conditions play a significant role in determining patient outcomes. This article examines the potential for integrating chatbots into the workflows of critical care nephrology to optimize patient care. We detail their specific applications in critical care nephrology, such as managing acute kidney injury, alert systems, and continuous renal replacement therapy (CRRT); facilitating discussions around palliative care; and bolstering collaboration within a multidisciplinary team. Chatbots have the potential to augment real-time data availability, evaluate renal health, identify potential risk factors, build predictive models, and monitor patient progress. Moreover, they provide a platform for enhancing communication and education for both patients and healthcare providers, paving the way for enriched knowledge and honed professional skills. However, it is vital to recognize the inherent challenges and limitations when using chatbots in this domain. Here, we provide an in-depth exploration of the concerns tied to chatbots' accuracy, dependability, data protection and security, transparency, potential algorithmic biases, and ethical implications in critical care nephrology. While human discernment and intervention are indispensable, especially in complex medical scenarios or intricate situations, the sustained advancements in AI signal that the integration of precision-engineered chatbot algorithms within critical care nephrology has considerable potential to elevate patient care and pivotal outcome metrics in the future.
Collapse
Affiliation(s)
- Supawadee Suppadungsuk
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Jing Miao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Pajaree Krisanapan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Division of Nephrology and Hypertension, Thammasat University Hospital, Pathum Thani 12120, Thailand
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Kianoush Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
9
|
Aiumtrakul N, Thongprayoon C, Suppadungsuk S, Krisanapan P, Miao J, Qureshi F, Cheungpasitporn W. Navigating the Landscape of Personalized Medicine: The Relevance of ChatGPT, BingChat, and Bard AI in Nephrology Literature Searches. J Pers Med 2023; 13:1457. [PMID: 37888068 PMCID: PMC10608326 DOI: 10.3390/jpm13101457] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 09/10/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Literature reviews are foundational to understanding medical evidence. With AI tools like ChatGPT, Bing Chat and Bard AI emerging as potential aids in this domain, this study aimed to individually assess their citation accuracy within Nephrology, comparing their performance in providing precise. MATERIALS AND METHODS We generated the prompt to solicit 20 references in Vancouver style in each 12 Nephrology topics, using ChatGPT, Bing Chat and Bard. We verified the existence and accuracy of the provided references using PubMed, Google Scholar, and Web of Science. We categorized the validity of the references from the AI chatbot into (1) incomplete, (2) fabricated, (3) inaccurate, and (4) accurate. RESULTS A total of 199 (83%), 158 (66%) and 112 (47%) unique references were provided from ChatGPT, Bing Chat and Bard, respectively. ChatGPT provided 76 (38%) accurate, 82 (41%) inaccurate, 32 (16%) fabricated and 9 (5%) incomplete references. Bing Chat provided 47 (30%) accurate, 77 (49%) inaccurate, 21 (13%) fabricated and 13 (8%) incomplete references. In contrast, Bard provided 3 (3%) accurate, 26 (23%) inaccurate, 71 (63%) fabricated and 12 (11%) incomplete references. The most common error type across platforms was incorrect DOIs. CONCLUSIONS In the field of medicine, the necessity for faultless adherence to research integrity is highlighted, asserting that even small errors cannot be tolerated. The outcomes of this investigation draw attention to inconsistent citation accuracy across the different AI tools evaluated. Despite some promising results, the discrepancies identified call for a cautious and rigorous vetting of AI-sourced references in medicine. Such chatbots, before becoming standard tools, need substantial refinements to assure unwavering precision in their outputs.
Collapse
Affiliation(s)
- Noppawit Aiumtrakul
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA;
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.S.); (P.K.); (J.M.); (F.Q.); (W.C.)
| | - Supawadee Suppadungsuk
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.S.); (P.K.); (J.M.); (F.Q.); (W.C.)
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand
| | - Pajaree Krisanapan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.S.); (P.K.); (J.M.); (F.Q.); (W.C.)
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
| | - Jing Miao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.S.); (P.K.); (J.M.); (F.Q.); (W.C.)
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.S.); (P.K.); (J.M.); (F.Q.); (W.C.)
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.S.); (P.K.); (J.M.); (F.Q.); (W.C.)
| |
Collapse
|
10
|
Varghese KJ, Singh SP, Qureshi FM, Shreekumar S, Ramprasad A, Qureshi F. Digital Patient Education on Xanthelasma Palpebrarum: A Content Analysis. Clin Pract 2023; 13:1207-1214. [PMID: 37887084 PMCID: PMC10605081 DOI: 10.3390/clinpract13050108] [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: 07/21/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
Patient education has been transformed using digital media and online repositories which disseminate information with greater efficiency. In dermatology, this transformation has allowed for patients to gain education on common cutaneous conditions and improve health literacy. Xanthelasma palpebrarum is one of the most common cutaneous conditions, yet there is a poor understanding of how digital materials affect health literacy on this condition. Our study aimed to address this paucity of literature utilizing Brief DISCERN, Rothwell's Classification of Questions, and six readability calculations. The findings of this study indicate a poor-quality profile (Brief DISCERN < 16) regarding digital materials and readability scores which do not meet grade-level recommendations in the United States. This indicates a need to improve the current body of educational materials used by clinicians for diagnosing and managing xanthelasma palpebrarum.
Collapse
Affiliation(s)
- Kevin J. Varghese
- Department of Biomedical Sciences, University of Missouri Kansas City School of Medicine, Kansas City, MO 64108, USA; (F.M.Q.); (S.S.); (A.R.)
| | - Som P. Singh
- Department of Biomedical Sciences, University of Missouri Kansas City School of Medicine, Kansas City, MO 64108, USA; (F.M.Q.); (S.S.); (A.R.)
| | - Fahad M. Qureshi
- Department of Biomedical Sciences, University of Missouri Kansas City School of Medicine, Kansas City, MO 64108, USA; (F.M.Q.); (S.S.); (A.R.)
| | - Shreevarsha Shreekumar
- Department of Biomedical Sciences, University of Missouri Kansas City School of Medicine, Kansas City, MO 64108, USA; (F.M.Q.); (S.S.); (A.R.)
| | - Aarya Ramprasad
- Department of Biomedical Sciences, University of Missouri Kansas City School of Medicine, Kansas City, MO 64108, USA; (F.M.Q.); (S.S.); (A.R.)
| | - Fawad Qureshi
- Department of Nephrology, Mayo Clinic Alix School of Medicine, Rochester, MN 55905, USA;
| |
Collapse
|
11
|
Qarajeh A, Tangpanithandee S, Thongprayoon C, Suppadungsuk S, Krisanapan P, Aiumtrakul N, Garcia Valencia OA, Miao J, Qureshi F, Cheungpasitporn W. AI-Powered Renal Diet Support: Performance of ChatGPT, Bard AI, and Bing Chat. Clin Pract 2023; 13:1160-1172. [PMID: 37887080 PMCID: PMC10605499 DOI: 10.3390/clinpract13050104] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 08/27/2023] [Revised: 09/15/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Patients with chronic kidney disease (CKD) necessitate specialized renal diets to prevent complications such as hyperkalemia and hyperphosphatemia. A comprehensive assessment of food components is pivotal, yet burdensome for healthcare providers. With evolving artificial intelligence (AI) technology, models such as ChatGPT, Bard AI, and Bing Chat can be instrumental in educating patients and assisting professionals. To gauge the efficacy of different AI models in discerning potassium and phosphorus content in foods, four AI models-ChatGPT 3.5, ChatGPT 4, Bard AI, and Bing Chat-were evaluated. A total of 240 food items, curated from the Mayo Clinic Renal Diet Handbook for CKD patients, were input into each model. These items were characterized by their potassium (149 items) and phosphorus (91 items) content. Each model was tasked to categorize the items into high or low potassium and high phosphorus content. The results were juxtaposed with the Mayo Clinic Renal Diet Handbook's recommendations. The concordance between repeated sessions was also evaluated to assess model consistency. Among the models tested, ChatGPT 4 displayed superior performance in identifying potassium content, correctly classifying 81% of the foods. It accurately discerned 60% of low potassium and 99% of high potassium foods. In comparison, ChatGPT 3.5 exhibited a 66% accuracy rate. Bard AI and Bing Chat models had an accuracy rate of 79% and 81%, respectively. Regarding phosphorus content, Bard AI stood out with a flawless 100% accuracy rate. ChatGPT 3.5 and Bing Chat recognized 85% and 89% of the high phosphorus foods correctly, while ChatGPT 4 registered a 77% accuracy rate. Emerging AI models manifest a diverse range of accuracy in discerning potassium and phosphorus content in foods suitable for CKD patients. ChatGPT 4, in particular, showed a marked improvement over its predecessor, especially in detecting potassium content. The Bard AI model exhibited exceptional precision for phosphorus identification. This study underscores the potential of AI models as efficient tools in renal dietary planning, though refinements are warranted for optimal utility.
Collapse
Affiliation(s)
- Ahmad Qarajeh
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.Q.); (C.T.); (S.S.); (P.K.); (O.A.G.V.); (J.M.); (F.Q.)
- Faculty of Medicine, University of Jordan, Amman 11942, Jordan
| | - Supawit Tangpanithandee
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.Q.); (C.T.); (S.S.); (P.K.); (O.A.G.V.); (J.M.); (F.Q.)
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.Q.); (C.T.); (S.S.); (P.K.); (O.A.G.V.); (J.M.); (F.Q.)
| | - Supawadee Suppadungsuk
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.Q.); (C.T.); (S.S.); (P.K.); (O.A.G.V.); (J.M.); (F.Q.)
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand
| | - Pajaree Krisanapan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.Q.); (C.T.); (S.S.); (P.K.); (O.A.G.V.); (J.M.); (F.Q.)
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
| | - Noppawit Aiumtrakul
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA;
| | - Oscar A. Garcia Valencia
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.Q.); (C.T.); (S.S.); (P.K.); (O.A.G.V.); (J.M.); (F.Q.)
| | - Jing Miao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.Q.); (C.T.); (S.S.); (P.K.); (O.A.G.V.); (J.M.); (F.Q.)
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.Q.); (C.T.); (S.S.); (P.K.); (O.A.G.V.); (J.M.); (F.Q.)
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.Q.); (C.T.); (S.S.); (P.K.); (O.A.G.V.); (J.M.); (F.Q.)
| |
Collapse
|
12
|
Thongprayoon C, Vaitla P, Jadlowiec CC, Leeaphorn N, Mao SA, Mao MA, Qureshi F, Kaewput W, Qureshi F, Tangpanithandee S, Krisanapan P, Pattharanitima P, Acharya PC, Nissaisorakarn P, Cooper M, Cheungpasitporn W. Distinct Phenotypes of Non-Citizen Kidney Transplant Recipients in the United States by Machine Learning Consensus Clustering. Medicines (Basel) 2023; 10:medicines10040025. [PMID: 37103780 PMCID: PMC10144541 DOI: 10.3390/medicines10040025] [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] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/24/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Better understanding of the different phenotypes/subgroups of non-U.S. citizen kidney transplant recipients may help the transplant community to identify strategies that improve outcomes among non-U.S. citizen kidney transplant recipients. This study aimed to cluster non-U.S. citizen kidney transplant recipients using an unsupervised machine learning approach; Methods: We conducted a consensus cluster analysis based on recipient-, donor-, and transplant- related characteristics in non-U.S. citizen kidney transplant recipients in the United States from 2010 to 2019 in the OPTN/UNOS database using recipient, donor, and transplant-related characteristics. Each cluster's key characteristics were identified using the standardized mean difference. Post-transplant outcomes were compared among the clusters; Results: Consensus cluster analysis was performed in 11,300 non-U.S. citizen kidney transplant recipients and identified two distinct clusters best representing clinical characteristics. Cluster 1 patients were notable for young age, preemptive kidney transplant or dialysis duration of less than 1 year, working income, private insurance, non-hypertensive donors, and Hispanic living donors with a low number of HLA mismatch. In contrast, cluster 2 patients were characterized by non-ECD deceased donors with KDPI <85%. Consequently, cluster 1 patients had reduced cold ischemia time, lower proportion of machine-perfused kidneys, and lower incidence of delayed graft function after kidney transplant. Cluster 2 had higher 5-year death-censored graft failure (5.2% vs. 9.8%; p < 0.001), patient death (3.4% vs. 11.4%; p < 0.001), but similar one-year acute rejection (4.7% vs. 4.9%; p = 0.63), compared to cluster 1; Conclusions: Machine learning clustering approach successfully identified two clusters among non-U.S. citizen kidney transplant recipients with distinct phenotypes that were associated with different outcomes, including allograft loss and patient survival. These findings underscore the need for individualized care for non-U.S. citizen kidney transplant recipients.
Collapse
Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Pradeep Vaitla
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | | | - Napat Leeaphorn
- Renal Transplant Program, University of Missouri-Kansas City School of Medicine/Saint Luke's Health System, Kansas City, MO 64108, USA
| | - Shennen A Mao
- Division of Transplant Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Michael A Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Fahad Qureshi
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Supawit Tangpanithandee
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Pajaree Krisanapan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - Pattharawin Pattharanitima
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine Thammasat University, Pathum Thani 12120, Thailand
| | - Prakrati C Acharya
- Division of Nephrology, Texas Tech Health Sciences Center El Paso, El Paso, TX 79905, USA
| | - Pitchaphon Nissaisorakarn
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, DC 21042, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
13
|
Thongprayoon C, Radhakrishnan Y, Cheungpasitporn W, Petnak T, Zabala Genovez J, Chewcharat A, Qureshi F, Mao MA, Kashani KB. Association of hypochloremia with mortality among patients requiring continuous renal replacement therapy. J Nephrol 2023; 36:161-170. [PMID: 35347649 DOI: 10.1007/s40620-022-01305-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/19/2021] [Accepted: 03/05/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Serum chloride derangement is common in critically ill patients requiring continuous renal replacement therapy (CRRT). We aimed to assess the association between serum chloride levels before and during CRRT with mortality. METHODS This is a retrospective cohort study of critically ill patients receiving CRRT for acute kidney injury from December 2006 through November 2015 in a tertiary referral hospital in the United States. We used logistic regression to assess serum chloride before and mean serum chloride during CRRT as predictors for 90 days mortality after CRRT initiation. The normal reference range for serum chloride was 99-108 mmol/L. RESULTS Of 1282 eligible patients, 25%, 50%, and 25% had hypochloremia, normochloremia, and hyperchloremia, respectively. The adjusted odds ratio for 90 days mortality in patients with hypochloremia before CRRT was 1.82 (95% CI 1.29-2.55). During CRRT, 4%, 70%, 26% of patients had mean serum chloride in the hypochloremia, normochloremia, and hyperchloremia range, respectively. The adjusted odds ratio for 90 days mortality in patients with mean serum chloride during CRRT in the hypochloremia range was 2.96 (95% CI 1.43-6.12). Hyperchloremia before and during CRRT was not associated with mortality. The greater serum chloride range during CRRT was associated with increased mortality (OR 1.29; 95% CI 1.13-1.47 per 5 mmol/L increase). CONCLUSION Hypochloremia before and during CRRT is associated with higher mortality.
Collapse
Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yeshwanter Radhakrishnan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tananchai Petnak
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jose Zabala Genovez
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Api Chewcharat
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael A Mao
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL, USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA. .,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
14
|
Thongprayoon C, Pattharanitima P, Kattah AG, Mao MA, Keddis MT, Dillon JJ, Kaewput W, Tangpanithandee S, Krisanapan P, Qureshi F, Cheungpasitporn W. Explainable Preoperative Automated Machine Learning Prediction Model for Cardiac Surgery-Associated Acute Kidney Injury. J Clin Med 2022; 11:6264. [PMID: 36362493 PMCID: PMC9656700 DOI: 10.3390/jcm11216264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/15/2022] [Accepted: 10/21/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND We aimed to develop and validate an automated machine learning (autoML) prediction model for cardiac surgery-associated acute kidney injury (CSA-AKI). METHODS Using 69 preoperative variables, we developed several models to predict post-operative AKI in adult patients undergoing cardiac surgery. Models included autoML and non-autoML types, including decision tree (DT), random forest (RF), extreme gradient boosting (XGBoost), and artificial neural network (ANN), as well as a logistic regression prediction model. We then compared model performance using area under the receiver operating characteristic curve (AUROC) and assessed model calibration using Brier score on the independent testing dataset. RESULTS The incidence of CSA-AKI was 36%. Stacked ensemble autoML had the highest predictive performance among autoML models, and was chosen for comparison with other non-autoML and multivariable logistic regression models. The autoML had the highest AUROC (0.79), followed by RF (0.78), XGBoost (0.77), multivariable logistic regression (0.77), ANN (0.75), and DT (0.64). The autoML had comparable AUROC with RF and outperformed the other models. The autoML was well-calibrated. The Brier score for autoML, RF, DT, XGBoost, ANN, and multivariable logistic regression was 0.18, 0.18, 0.21, 0.19, 0.19, and 0.18, respectively. We applied SHAP and LIME algorithms to our autoML prediction model to extract an explanation of the variables that drive patient-specific predictions of CSA-AKI. CONCLUSION We were able to present a preoperative autoML prediction model for CSA-AKI that provided high predictive performance that was comparable to RF and superior to other ML and multivariable logistic regression models. The novel approaches of the proposed explainable preoperative autoML prediction model for CSA-AKI may guide clinicians in advancing individualized medicine plans for patients under cardiac surgery.
Collapse
Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Pattharawin Pattharanitima
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
| | - Andrea G. Kattah
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Michael A. Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Mira T. Keddis
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | - John J. Dillon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - Supawit Tangpanithandee
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Faculty of Medicine, Chakri Naruebodindra Medical Institute, Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand
| | - Pajaree Krisanapan
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
15
|
Thongprayoon C, Mao SA, Jadlowiec CC, Mao MA, Leeaphorn N, Kaewput W, Vaitla P, Pattharanitima P, Tangpanithandee S, Krisanapan P, Qureshi F, Nissaisorakarn P, Cooper M, Cheungpasitporn W. Machine Learning Consensus Clustering of Morbidly Obese Kidney Transplant Recipients in the United States. J Clin Med 2022; 11:jcm11123288. [PMID: 35743357 PMCID: PMC9224965 DOI: 10.3390/jcm11123288] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/28/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background: This study aimed to better characterize morbidly obese kidney transplant recipients, their clinical characteristics, and outcomes by using an unsupervised machine learning approach. Methods: Consensus cluster analysis was applied to OPTN/UNOS data from 2010 to 2019 based on recipient, donor, and transplant characteristics in kidney transplant recipients with a pre-transplant BMI ≥ 40 kg/m2. Key cluster characteristics were identified using the standardized mean difference. Post-transplant outcomes, including death-censored graft failure, patient death, and acute allograft rejection, were compared among the clusters. Results: Consensus clustering analysis identified 3204 kidney transplant recipients with a BMI ≥ 40 kg/m2. In this cohort, five clinically distinct clusters were identified. Cluster 1 recipients were predominantly white and non-sensitized, had a short dialysis time or were preemptive, and were more likely to receive living donor kidney transplants. Cluster 2 recipients were older and diabetic. They were likely to have been on dialysis >3 years and receive a standard KDPI deceased donor kidney. Cluster 3 recipients were young, black, and had kidney disease secondary to hypertension or glomerular disease. Cluster 3 recipients had >3 years of dialysis and received non-ECD, young, deceased donor kidney transplants with a KDPI < 85%. Cluster 4 recipients were diabetic with variable dialysis duration who either received non-ECD standard KDPI kidneys or living donor kidney transplants. Cluster 5 recipients were young retransplants that were sensitized. One-year patient survival in clusters 1, 2, 3, 4, and 5 was 98.0%, 94.4%, 98.5%, 98.7%, and 97%, and one-year death-censored graft survival was 98.1%, 93.0%, 96.1%, 98.8%, and 93.0%, respectively. Cluster 2 had the worst one-year patient survival. Clusters 2 and 5 had the worst one-year death-censored graft survival. Conclusions: With the application of unsupervised machine learning, variable post-transplant outcomes are observed among morbidly obese kidney transplant recipients. Recipients with earlier access to transplant and living donation show superior outcomes. Unexpectedly, reduced graft survival in cluster 3 recipients perhaps underscores socioeconomic access to post-transplant support and minorities being disadvantaged in access to preemptive and living donor transplants. Despite obesity-related concerns, one-year patient and graft survival were favorable in all clusters, and obesity itself should be reconsidered as a hard barrier to kidney transplantation.
Collapse
Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA; (C.T.); (S.T.); (P.K.); (F.Q.)
| | - Shennen A. Mao
- Division of Transplant Surgery, Mayo Clinic, Jacksonville, FL 32224, USA;
| | | | - Michael A. Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Napat Leeaphorn
- Renal Transplant Program, University of Missouri-Kansas City School of Medicine/Saint Luke’s Health System, Kansas City, MO 64108, USA;
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
- Correspondence: (W.K.); (P.P.); (W.C.)
| | - Pradeep Vaitla
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS 39216, USA;
| | - Pattharawin Pattharanitima
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
- Correspondence: (W.K.); (P.P.); (W.C.)
| | - Supawit Tangpanithandee
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA; (C.T.); (S.T.); (P.K.); (F.Q.)
| | - Pajaree Krisanapan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA; (C.T.); (S.T.); (P.K.); (F.Q.)
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA; (C.T.); (S.T.); (P.K.); (F.Q.)
| | - Pitchaphon Nissaisorakarn
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, DC 20007, USA;
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55902, USA; (C.T.); (S.T.); (P.K.); (F.Q.)
- Correspondence: (W.K.); (P.P.); (W.C.)
| |
Collapse
|
16
|
Gibson L, Mittal A, Qureshi F, Neerumpa S, Hamidpour S, Mateescu V, Salzman G, Molteni A, Monaghan NP, Poisner A. Distinct Responses in the Brain Compared to Lung in a Rat Model of Fat Embolism Syndrome. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r4079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lilian Gibson
- Biomedical sciencesUniversity of MissouriKansas CityMO
| | - A. Mittal
- Biomedical sciencesUniversity of MissouriKansas CityMO
| | - F. Qureshi
- Biomedical sciencesUniversity of MissouriKansas CityMO
| | - S. Neerumpa
- Biomedical sciencesUniversity of MissouriKansas CityMO
| | - S. Hamidpour
- Biomedical sciencesUniversity of MissouriKansas CityMO
| | - V. Mateescu
- Biomedical sciencesUniversity of MissouriKansas CityMO
| | - G. Salzman
- Biomedical sciencesUniversity of MissouriKansas CityMO
| | - A. Molteni
- Biomedical sciencesUniversity of MissouriKansas CityMO
| | | | - A. Poisner
- University of Kansas Medical CenterKansas CityKS
| |
Collapse
|
17
|
Gossett CL, Kattah AG, Qureshi F. Unusual Ultrasound Findings in a Difficult to Cannulate Arteriovenous Graft. Kidney360 2022; 3:192-193. [PMID: 35368558 PMCID: PMC8967606 DOI: 10.34067/kid.0003952021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/02/2021] [Indexed: 01/10/2023]
Affiliation(s)
- Christy L. Gossett
- Department of Nephrology & Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Andrea G. Kattah
- Department of Nephrology & Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Fawad Qureshi
- Department of Nephrology & Hypertension, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
18
|
Thongprayoon C, Cheungpasitporn W, Radhakrishnan Y, Zabala Genovez JL, Petnak T, Shawwa K, Qureshi F, Mao MA, Kashani KB. Association of Serum Potassium Derangements with Mortality among Patients Requiring Continuous Renal Replacement Therapy. Ther Apher Dial 2022; 26:1098-1105. [PMID: 35067000 DOI: 10.1111/1744-9987.13804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/28/2021] [Revised: 01/05/2022] [Accepted: 01/19/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND We aimed to assess the association between serum potassium and mortality in patients receiving continuous renal replacement therapy (CRRT). METHODS We studied 1,279 acute kidney injury patients receiving CRRT in a tertiary referral hospital in the United States. We used logistic regression to assess the association of serum potassium before CRRT and mean serum potassium during CRRT with 90-day mortality after CRRT initiation, using serum potassium 4.0-4.4 mmol/L as reference group. RESULTS Before CRRT, there was a U-shaped association between serum potassium and 90-day mortality. There was a significant increase in mortality when serum potassium before CRRT was ≤3.4 and ≥4.5 mmol/L. During CRRT, progressively increased mortality was noted when mean serum potassium was ≥4.5 mmol/L. The odds ratio of 90-day mortality was significantly higher when mean serum potassium was ≥4.5 mmol/L. CONCLUSION Hypokalemia and hyperkalemia before CRRT and hyperkalemia during CRRT predicts 90-day mortality. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Jose L Zabala Genovez
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Tananchai Petnak
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.,Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Khaled Shawwa
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Michael A Mao
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL, USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
19
|
Thongprayoon C, Radhakrishnan Y, Cheungpasitporn W, Petnak T, Qureshi F, Mao MA, Kashani KB. Association of Serum Phosphate Derangement With Mortality in Patients on Continuous Renal Replacement Therapy. Can J Kidney Health Dis 2022; 9:20543581221114697. [PMID: 35923184 PMCID: PMC9340369 DOI: 10.1177/20543581221114697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background: There is limited evidence on the association of serum phosphate with
mortality in patients receiving continuous renal replacement therapy
(CRRT). Objective: To assess the association of serum phosphate with mortality in critically ill
patients requiring CRRT for acute kidney injury (AKI). Design: A cohort study. Setting: A tertiary referral hospital in the United States. Patients: Acute kidney injury patients receiving CRRT from 2006 through 2015 in
intensive care units. Measurements: (1) Serum phosphate before CRRT and (2) mean serum phosphate during CRRT were
categorized into 3 groups; ≤2.4 (hypophosphatemia), 2.5 to 4.5 (normal serum
phosphate group), and ≥4.6 (hyperphosphatemia) mg/dL. Methods: Multivariable logistic regression was used to assess the association between
serum phosphate and 90-day mortality. Results: A total of 1108 patients were included in this study. Of these, 55% died
within 90 days after CRRT initiation. Before CRRT, 3%, 30%, and 66% had
hypophosphatemia, normophosphatemia, and hyperphosphatemia, respectively.
Before CRRT, both hypophosphatemia and hyperphosphatemia were significantly
associated with higher 90-day mortality with the adjusted odds ratio (OR) of
2.22 (95% confidence interval [CI]: [1.03, 4.78]) and 1.62 (95% CI: [1.21,
2.18]), respectively. During CRRT, 3%, 85%, and 12% had mean serum phosphate
in hypophosphatemia, normophosphatemia, and hyperphosphatemia range. During
CRRT, hyperphosphatemia was significantly associated with higher 90-day
mortality with adjusted OR of 2.22 (95% CI: [1.45, 3.38]). Limitations: Single center, observational design, lack of information regarding causes of
serum phosphate derangement. Conclusion: Most CRRT patients had hyperphosphatemia before CRRT initiation but maintain
normal serum phosphate during CRRT. Before CRRT, hypo- and
hyperphosphatemia, and during CRRT, hyperphosphatemia predicted higher
mortality. Trial registration: Not registered.
Collapse
Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yeshwanter Radhakrishnan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tananchai Petnak
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael A. Mao
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL, USA
| | - Kianoush B. Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
20
|
Thongprayoon C, Cheungpasitporn W, Radhakrishnan Y, Petnak T, Qureshi F, Mao MA, Kashani KB. Impact of hypoalbuminemia on mortality in critically ill patients requiring continuous renal replacement therapy. J Crit Care 2021; 68:72-75. [PMID: 34929529 DOI: 10.1016/j.jcrc.2021.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/19/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aimed to assess the association of hypoalbuminemia with mortality in critically ill patients requiring continuous renal replacement therapy (CRRT). METHODS This is a retrospective cohort study of critically ill patients receiving CRRT from December 2006 through November 2015 in a tertiary referral hospital in the United States. We used logistic regression to assess serum albumin at CRRT initiation as predictors for 90-day mortality. RESULTS A total of 911 patients requiring CRRT were included in this study. The mean serum albumin at CRRT initiation was 3.0 ± 0.7 g/dL. The 90-day mortality was 57%. Serum albumin levels of ≤2.4, 2.5-2.9, 3.0-3.4, and ≥ 3.5 g/dL were noted in 24%, 29%, 24%, and 23% of patients, respectively. In adjusted analysis, serum albumin ≤2.4 g/dL compared with serum albumin of ≥3.5 g/dL was significantly associated with higher 90-day mortality with OR of 1.57 (95% CI 1.02-2.42). Serum albumin 2.5-2.9 and 3.0-3.4 g/dL were not associated with higher mortality. Sensitivity analysis in patients requiring CRRT in the setting of acute kidney injury showed consistent results. CONCLUSION Approximately three out of four patients had hypoalbuminemia (<3.5 g/dL) at CRRT initiation. However, only severe hypoalbuminemia <2.5 g/dL was significantly associated with higher mortality.
Collapse
Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Yeshwanter Radhakrishnan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tananchai Petnak
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael A Mao
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL, USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
21
|
Kaewput W, Thongprayoon C, Dumancas CY, Kanduri SR, Kovvuru K, Kaewput C, Pattharanitima P, Petnak T, Lertjitbanjong P, Boonpheng B, Wijarnpreecha K, Zabala Genovez JL, Vallabhajosyula S, Jadlowiec CC, Qureshi F, Cheungpasitporn W. In-hospital mortality of hepatorenal syndrome in the United States: Nationwide inpatient sample. World J Gastroenterol 2021; 27:7831-7843. [PMID: 34963745 PMCID: PMC8661379 DOI: 10.3748/wjg.v27.i45.7831] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/24/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatorenal syndrome (HRS) is a life-threatening condition among patients with advanced liver disease. Data trends specific to hospital mortality and hospital admission resource utilization for HRS remain limited.
AIM To assess the temporal trend in mortality and identify the predictors for mortality among hospital admissions for HRS in the United States.
METHODS We used the National Inpatient Sample database to identify an unweighted sample of 4938 hospital admissions for HRS from 2005 to 2014 (weighted sample of 23973 admissions). The primary outcomes were temporal trends in mortality as well as predictors for hospital mortality. We estimated odds ratios from multi-level mixed effect logistic regression to identify patient characteristics and treatments associated with hospital mortality.
RESULTS Overall hospital mortality was 32%. Hospital mortality decreased from 44% in 2005 to 24% in 2014 (P < 0.001), while there was an increase in the rate of liver transplantation (P = 0.02), renal replacement therapy (P < 0.001), length of hospital stay (P < 0.001), and hospitalization cost (P < 0.001). On multivariable analysis, older age, alcohol use, coagulopathy, neurological disorder, and need for mechanical ventilation predicted higher hospital mortality, whereas liver transplantation, transjugular intrahepatic portosystemic shunt, and abdominal paracentesis were associated with lower hospital mortality.
CONCLUSION Although there was an increase in resource utilizations, hospital mortality among patients admitted for HRS significantly improved. Several predictors for hospital mortality were identified.
Collapse
Affiliation(s)
- Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States
| | - Carissa Y Dumancas
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States
| | - Swetha R Kanduri
- Division of Nephrology, Department of Medicine, Ochsner Clinic Foundation, New Orleans, LA 70121, United States
| | - Karthik Kovvuru
- Division of Nephrology, Department of Medicine, Ochsner Clinic Foundation, New Orleans, LA 70121, United States
| | - Chalermrat Kaewput
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Pattharawin Pattharanitima
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12121, Thailand
| | - Tananchai Petnak
- Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Ploypin Lertjitbanjong
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, Memphis, TN 13326, United States
| | | | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jose L Zabala Genovez
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, United States
| | | | - Fawad Qureshi
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
| |
Collapse
|
22
|
Pattharanitima P, Thongprayoon C, Petnak T, Srivali N, Gembillo G, Kaewput W, Chesdachai S, Vallabhajosyula S, O’Corragain OA, Mao MA, Garovic VD, Qureshi F, Dillon JJ, Cheungpasitporn W. Machine Learning Consensus Clustering Approach for Patients with Lactic Acidosis in Intensive Care Units. J Pers Med 2021; 11:jpm11111132. [PMID: 34834484 PMCID: PMC8623582 DOI: 10.3390/jpm11111132] [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: 09/22/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Lactic acidosis is a heterogeneous condition with multiple underlying causes and associated outcomes. The use of multi-dimensional patient data to subtype lactic acidosis can personalize patient care. Machine learning consensus clustering may identify lactic acidosis subgroups with unique clinical profiles and outcomes. METHODS We used the Medical Information Mart for Intensive Care III database to abstract electronic medical record data from patients admitted to intensive care units (ICU) in a tertiary care hospital in the United States. We included patients who developed lactic acidosis (defined as serum lactate ≥ 4 mmol/L) within 48 h of ICU admission. We performed consensus clustering analysis based on patient characteristics, comorbidities, vital signs, organ supports, and laboratory data to identify clinically distinct lactic acidosis subgroups. We calculated standardized mean differences to show key subgroup features. We compared outcomes among subgroups. RESULTS We identified 1919 patients with lactic acidosis. The algorithm revealed three best unique lactic acidosis subgroups based on patient variables. Cluster 1 (n = 554) was characterized by old age, elective admission to cardiac surgery ICU, vasopressor use, mechanical ventilation use, and higher pH and serum bicarbonate. Cluster 2 (n = 815) was characterized by young age, admission to trauma/surgical ICU with higher blood pressure, lower comorbidity burden, lower severity index, and less vasopressor use. Cluster 3 (n = 550) was characterized by admission to medical ICU, history of liver disease and coagulopathy, acute kidney injury, lower blood pressure, higher comorbidity burden, higher severity index, higher serum lactate, and lower pH and serum bicarbonate. Cluster 3 had the worst outcomes, while cluster 1 had the most favorable outcomes in terms of persistent lactic acidosis and mortality. CONCLUSIONS Consensus clustering analysis synthesized the pattern of clinical and laboratory data to reveal clinically distinct lactic acidosis subgroups with different outcomes.
Collapse
Affiliation(s)
- Pattharawin Pattharanitima
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12121, Thailand
- Correspondence: (P.P.); (C.T.); (W.C.)
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
- Correspondence: (P.P.); (C.T.); (W.C.)
| | - Tananchai Petnak
- Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Narat Srivali
- Division of Pulmonary Medicine, St. Agnes Hosipital, Baltimore, MD 21229, USA;
| | - Guido Gembillo
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy;
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand;
| | - Supavit Chesdachai
- Division of Infectious Disease, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA;
| | - Oisin A. O’Corragain
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA 19140, USA;
| | - Michael A. Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Vesna D. Garovic
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
| | - John J. Dillon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
- Correspondence: (P.P.); (C.T.); (W.C.)
| |
Collapse
|
23
|
Sy-Go JPT, Androga LA, Saini JS, Qureshi F, Kattah AG. Peritoneal-mediastinal communication complication in peritoneal dialysis. Semin Dial 2021; 34:384-387. [PMID: 34378248 DOI: 10.1111/sdi.13008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/01/2021] [Accepted: 07/14/2021] [Indexed: 12/01/2022]
Abstract
Peritoneal-mediastinal communication is a rare complication of peritoneal dialysis (PD). We report the first case of peritoneal-mediastinal communication complication in a 36-year-old Caucasian man on continuous cycler peritoneal dialysis (CCPD) after undergoing cardiac surgery. He developed end-stage kidney disease (ESKD) due to calcineurin inhibitor nephrotoxicity and BK virus nephropathy in the setting of prior heart transplantation. He was initially started on intermittent hemodialysis (iHD) and was switched to CCPD 1 year later. He presented with increased drainage from his sternal incision site and reduced ultrafiltration. A contrast-enhanced chest computed tomography scan revealed an anterior chest wall subcutaneous fluid collection. He was found to have a peritoneal-mediastinal communication intraoperatively. He was successfully managed with "low-volume" PD by using reduced fill volumes for all his exchanges and did not require transition to iHD. He also had no vascular access options because of multiple prior thromboses, which would have made transitioning to iHD not feasible. This case further highlights the complex management of an ESKD patient who cannot do iHD and only do low-volume PD because of a surgical complication and the need for a multidisciplinary approach to ensure appropriate patient care.
Collapse
Affiliation(s)
- Janina Paula T Sy-Go
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lagu A Androga
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jaskaran S Saini
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrea G Kattah
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
24
|
Thongprayoon C, Hansrivijit P, Petnak T, Mao MA, Bathini T, Duriseti P, Vallabhajosyula S, Qureshi F, Erickson SB, Cheungpasitporn W. Impact of serum magnesium levels at hospital discharge and one-year mortality. Postgrad Med 2021; 134:47-51. [PMID: 33998391 DOI: 10.1080/00325481.2021.1931369] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: We aimed to determine the optimal range of discharge serum magnesium in hospitalized patients by evaluating one-year mortality risk according to discharge serum magnesium.Methods: This was a single-center cohort study of hospitalized adult patients who survived until hospital discharge. We classified discharge serum magnesium, defined as the last serum magnesium within 48 hours of hospital discharge, into ≤1.6, 1.7-1.8, 1.9-2.0, 2.1-2.2, and ≥2.3 mg/dL. We assessed one-year mortality risk after hospital discharge based on discharge serum magnesium, using discharge magnesium of 2.1-2.2 mg/dL as the reference group.Results: Of 39,193 eligible patients, 8%, 23%, 34%, 23%, and 12% had a serum magnesium of ≤1.6, 1.7-1.8, 1.9-2.0, 2.1-2.2, and ≥2.3 mg/dL, respectively, at hospital discharge. After the adjustment for several confounders, discharge serum magnesium of ≤1.6, 1.7-1.8, and ≥2.3 mg/dL were associated with higher one-year mortality with hazard ratio of 1.35 (95% CI 1.21-1.50), 1.14 (95% CI 1.06-1.24), and 1.17 (95% CI 1.07-1.28), respectively, compared to discharge serum magnesium of 2.1-2.2 mg/dL. There was no significant difference in one-year mortality between patients with discharge serum magnesium of 1.9-2.0 and 2.1-2.2 mg/dL.Conclusion: The optimal range of serum magnesium at discharge was 1.9-2.2 mg/dL. Both hypomagnesemia and hypermagnesemia at discharge were associated with higher one-year mortality.
Collapse
Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Panupong Hansrivijit
- Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA, USA
| | - Tananchai Petnak
- Division of Pulmonary and Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael A Mao
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL, USA
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | - Parikshit Duriseti
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stephen B Erickson
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
25
|
Thongprayoon C, Lapumnuaypol K, Kaewput W, Petnak T, Qureshi F, Mao MA, Boonpheng B, Bathini T, Choudhury A, Vallabhajosyula S, Cheungpasitporn W. Gastrointestinal bleeding among hospitalizations for salicylate poisoning in the United States. QJM 2021; 114:190-195. [PMID: 33599273 DOI: 10.1093/qjmed/hcab034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/01/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND This study aimed to determine the incidence, as well as evaluate risk factors, and impact of gastrointestinal bleeding on outcomes and resource use in patients admitted for salicylate poisoning. METHODS We used the National Inpatient Sample to construct a cohort of patients hospitalized primarily for salicylate poisoning from 2003 to 2014. We compared clinical characteristics, in-hospital treatments, outcomes and resource use between salicylate poisoning patients with and without gastrointestinal bleeding. RESULTS Of 13 805 hospital admissions for salicylate poisoning, gastrointestinal bleeding occurred in 482 (3.5%) admissions. The risk factors for gastrointestinal bleeding included older age, history of atrial fibrillation and cirrhosis. After adjusting for difference in baseline characteristics, patients with gastrointestinal bleeding required more gastric lavage, gastrointestinal endoscopy, invasive mechanical ventilation and red blood cell transfusion. Gastrointestinal bleeding was significantly associated with increased risk of anemia, circulatory, liver and hematological failure but was not significantly associated with increased in-hospital mortality. The length of hospital stay and hospitalization cost was significantly higher in patients with gastrointestinal bleeding. CONCLUSION Gastrointestinal bleeding occurred in about 4% of patients admitted for salicylate poisoning. Gastrointestinal bleeding was associated with higher morbidity and resource use but not mortality.
Collapse
Affiliation(s)
- C Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - K Lapumnuaypol
- Division of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC 20007, USA
| | - W Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
| | - T Petnak
- Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - F Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - M A Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - B Boonpheng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - T Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - A Choudhury
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ 07030, USA
| | - S Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - W Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
26
|
Thongprayoon C, Kaewput W, Petnak T, O’Corragain OA, Boonpheng B, Bathini T, Vallabhajosyula S, Pattharanitima P, Lertjitbanjong P, Qureshi F, Cheungpasitporn W. Impact of Palliative Care Services on Treatment and Resource Utilization for Hepatorenal Syndrome in the United States. Medicines (Basel) 2021; 8:medicines8050021. [PMID: 34065828 PMCID: PMC8150700 DOI: 10.3390/medicines8050021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/01/2021] [Accepted: 05/11/2021] [Indexed: 12/16/2022]
Abstract
Background: This study aimed to determine the rates of inpatient palliative care service use and assess the impact of palliative care service use on in-hospital treatments and resource utilization in hospital admissions for hepatorenal syndrome. Methods: Using the National Inpatient Sample, hospital admissions with a primary diagnosis of hepatorenal syndrome were identified from 2003 through 2014. The primary outcome of interest was the temporal trend and predictors of inpatient palliative care service use. Logistic and linear regression was performed to assess the impact of inpatient palliative care service on in-hospital treatments and resource use. Results: Of 5571 hospital admissions for hepatorenal syndrome, palliative care services were used in 748 (13.4%) admissions. There was an increasing trend in the rate of palliative care service use, from 3.3% in 2003 to 21.1% in 2014 (p < 0.001). Older age, more recent year of hospitalization, acute liver failure, alcoholic cirrhosis, and hepatocellular carcinoma were predictive of increased palliative care service use, whereas race other than Caucasian, African American, and Hispanic and chronic kidney disease were predictive of decreased palliative care service use. Although hospital admission with palliative care service use had higher mortality, palliative care service was associated with lower use of invasive mechanical ventilation, blood product transfusion, paracentesis, renal replacement, vasopressor but higher DNR status. Palliative care services reduced mean length of hospital stay and hospitalization cost. Conclusion: Although there was a substantial increase in the use of palliative care service in hospitalizations for hepatorenal syndrome, inpatient palliative care service was still underutilized. The use of palliative care service was associated with reduced resource use.
Collapse
Affiliation(s)
- Charat Thongprayoon
- Department of Medicine, Mayo Clinic, Division of Nephrology and Hypertension, Rochester, MN 55905, USA;
- Correspondence: (C.T.); (W.K.); (T.P.); (P.P.); (W.C.)
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
- Correspondence: (C.T.); (W.K.); (T.P.); (P.P.); (W.C.)
| | - Tananchai Petnak
- Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Correspondence: (C.T.); (W.K.); (T.P.); (P.P.); (W.C.)
| | - Oisin A. O’Corragain
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA 19140, USA;
| | - Boonphiphop Boonpheng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85719, USA;
| | - Saraschandra Vallabhajosyula
- Section of Interventional Cardiology, Department of Medicine, Division of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Pattharawin Pattharanitima
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
- Correspondence: (C.T.); (W.K.); (T.P.); (P.P.); (W.C.)
| | - Ploypin Lertjitbanjong
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA;
| | - Fawad Qureshi
- Department of Medicine, Mayo Clinic, Division of Nephrology and Hypertension, Rochester, MN 55905, USA;
| | - Wisit Cheungpasitporn
- Department of Medicine, Mayo Clinic, Division of Nephrology and Hypertension, Rochester, MN 55905, USA;
- Correspondence: (C.T.); (W.K.); (T.P.); (P.P.); (W.C.)
| |
Collapse
|
27
|
Thongprayoon C, Petnak T, Kaewput W, Qureshi F, Mao MA, Pivovarova AI, Boonpheng B, Bathini T, Vallabhajosyula S, Medaura J, Cheungpasitporn W. Acute kidney injury among salicylate intoxication hospitalisations in the United States. Int J Clin Pract 2021; 75:e13745. [PMID: 32991024 DOI: 10.1111/ijcp.13745] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/12/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the risk factors and the association of acute kidney injury (AKI) with outcomes, and resource utilisation in patients hospitalised because of salicylate intoxication in the United States. METHODS Hospitalised patients with a primary diagnosis of salicylate intoxication from 2003 to 2014 were identified in the National Inpatient Sample (NIS) database. End-stage kidney disease patients were excluded. The occurrence of AKI was identified using hospital diagnosis code. Clinical characteristics, in-hospital treatment, outcomes and resource utilisation were compared between patients with and without AKI. RESULTS A total of 13 787 eligible hospital admissions were included in the analysis. AKI occurred in 1279 (9.3%) admissions. Older age, male sex, more recent year of hospitalisation, anaemia, hypertension, congestive heart failure, chronic kidney disease, volume depletion, sepsis and ventricular arrhythmia/cardiac arrest were significantly associated with increased risk of AKI, whereas Hispanic race was associated with decreased risk. AKI was significantly associated with increased risk of organ failure, and in-hospital mortality. In addition, the need for ventilation support, blood component transfusion, renal replacement therapy, length of hospital stay and hospitalisation cost were higher in AKI patients. CONCLUSION Approximately one tenth of salicylate intoxication patients developed AKI during hospitalisation. AKI was associated with higher morbidity, mortality and resource utilisations.
Collapse
Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tananchai Petnak
- Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael A Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Aleksandra I Pivovarova
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Boonphiphop Boonpheng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | - Saraschandra Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Juan Medaura
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| |
Collapse
|
28
|
Thongprayoon C, Petnak T, Kaewput W, Mao MA, Boonpheng B, Bathini T, Vallabhajosyula S, Lertjitbanjong P, Qureshi F, Cheungpasitporn W. Acute kidney injury in hospitalized patients with methanol intoxication: National Inpatient Sample 2003-2014. Hosp Pract (1995) 2021; 49:203-208. [PMID: 33496631 DOI: 10.1080/21548331.2021.1882239] [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] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study aimed to 1) determine the incidence of acute kidney injury (AKI), 2) identify risk factors for AKI, and 3) evaluate the impact of AKI on in-hospital outcomes in hospitalized patients for methanol intoxication. METHODS We searched the National Inpatient Sample Database for hospitalized patients from 2003 to 2014 with a primary diagnosis of methanol intoxication. We excluded patients with end-stage kidney disease. We identified the AKI using a discharge diagnosis code. We compared clinical characteristics, in-hospital treatment, outcomes, and resource use between AKI and non-AKI patients. RESULTS A total of 603 hospital admissions for methanol intoxication were analyzed. AKI developed in 135 (22.4%) admissions. Anemia (OR 3.43 p < 0.001), hypertension (OR 1.86; p = 0.02), volume depletion (OR 3.46; p = 0.001), sepsis (OR 6.91; p < 0.001), rhabdomyolysis (OR 6.25; p = 0.003), and acute pancreatitis (OR 5.30; p = 0.004) were independent risk factors for AKI development. AKI was significantly associated with increased risk of in-hospital mortality and organ failure. AKI patients needed more mechanical ventilation, and extracorporeal therapy, had longer length of hospital stay, and higher hospitalization costs. CONCLUSION Over one-fifth of methanol intoxication patients developed AKI during hospitalization. AKI was associated with higher morbidity, mortality, and resource utilization.
Collapse
Affiliation(s)
- Charat Thongprayoon
- Department of Medicine, Division of Nephrology and Hypertension, Rochester, MN, USA
| | - Tananchai Petnak
- Division of Pulmonary and Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, Rochester, MN, USA
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Michael A Mao
- Department of Medicine, Division of Nephrology and Hypertension, Jacksonville, FL, USA
| | - Boonphiphop Boonpheng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | - Saraschandra Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ploypin Lertjitbanjong
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Fawad Qureshi
- Department of Medicine, Division of Nephrology and Hypertension, Rochester, MN, USA
| | | |
Collapse
|
29
|
Petnak T, Thongprayoon C, Kaewput W, Qureshi F, Boonpheng B, Vallabhajosyula S, Bathini T, Mao MA, Lertjitbanjong P, Cheungpasitporn W. Circulatory Shock among Hospitalized Patients for Salicylate Intoxication. Diseases 2021; 9:diseases9010007. [PMID: 33445533 PMCID: PMC7839009 DOI: 10.3390/diseases9010007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/23/2020] [Revised: 01/01/2021] [Accepted: 01/09/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the risk factors for circulatory shock and its impact on outcomes in patients hospitalized for salicylate intoxication. METHODS We used the National Inpatient Sample to identify patients hospitalized primarily for salicylate intoxication from 2003-2014. Circulatory shock was identified based on hospital diagnosis code for any type of shock or hypotension. We compared clinical characteristics, in-hospital treatments, outcomes, and resource use between patients with and without circulatory shock associated with salicylate intoxication. RESULTS Of 13,805 hospital admissions for salicylate intoxication, circulatory shock developed in 484 (4%) admissions. Risk factors for development of circulatory shock included older age, female sex, concurrent psychotropic medication overdose, anemia, congestive heart failure, volume depletion, rhabdomyolysis, seizure, gastrointestinal bleeding, and sepsis. Circulatory shock was significantly associated with increased odds of any organ failure and in-hospital mortality. Length of hospital stay and hospitalization cost was significantly higher in patients with circulatory shock. CONCLUSION Approximately 4% of patients admitted for salicylate intoxication developed circulatory shock. Circulatory shock was associated with worse clinical outcomes and increased resource use.
Collapse
Affiliation(s)
- Tananchai Petnak
- Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA;
- Correspondence: (C.T.); (W.K.); (W.C.)
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
- Correspondence: (C.T.); (W.K.); (W.C.)
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA;
| | - Boonphiphop Boonpheng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
| | - Saraschandra Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85724, USA;
| | - Michael A. Mao
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Ploypin Lertjitbanjong
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA;
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA;
- Correspondence: (C.T.); (W.K.); (W.C.)
| |
Collapse
|
30
|
Roy KD, Sharma GM, Qureshi F, Wadia F. Analysis of Reasons for Orthopaedic Walkouts from the Emergency Department in a Private Tertiary Care Centre. Malays Orthop J 2021; 14:137-142. [PMID: 33403074 PMCID: PMC7752024 DOI: 10.5704/moj.2011.021] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: A small proportion of patients presenting to the Emergency department (ED) of any hospital tend to take discharge against medical advice (DAMA) due to several patient related or hospital/service related reasons. Amongst these, orthopaedic patients are a special group due to their inability to mobilise independently due to injuries and have treatment needs which involve higher costs. The aim of the current study was to ascertain and analyse the reasons for orthopaedic walkouts at a tertiary care new private hospital. Materials and Methods: This retrospective telephonic structured interview-based study was carried out on all orthopaedic patients taking DAMA during a one-year period from July 2016 to June 2017. They were telephonically interviewed with a structured questionnaire. Hospital and ED records were analysed for demographic as well as temporal characteristics. Results: A total of 68 orthopaedic patients walked out of casualty against medical advice out of a total 775 (8.77%) orthopaedic patients presenting during the period as against 6.4% overall rate of DAMA for all specialties. The main reasons for DAMA were financial unaffordability of treatment (36.7%), preference for another orthopaedic surgeon (22%) and on advice of the patient’s General Practitioner (16.1%). Conclusion: Unaffordability of treatment is a significant cause for walkouts amongst orthopaedic patients. Private hospitals need to recognise and implement processes by which these patients can be treated at affordable costs and with coverage either by medical insurance or robust charity programs. Patient education and awareness are important to encourage them to have insurance coverage.
Collapse
Affiliation(s)
- K D Roy
- Department of Trauma and Orthopaedics, Royal Gwent Hospital, Newport, United Kingdom
| | - G M Sharma
- Department of Orthopaedics, MGM Medical College Kamothe, Kamothe, India
| | - F Qureshi
- Department of Trauma and Orthopaedics, Royal Gwent Hospital, Newport, United Kingdom
| | - F Wadia
- Department of Orthopaedics, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| |
Collapse
|
31
|
Thongprayoon C, Cheungpasitporn W, Chewcharat A, Petnak T, Mao MA, Srivali N, Bathini T, Vallabhajosyula S, Qureshi F, Kashani K. Hospital-acquired serum phosphate derangements and their associated in-hospital mortality. Postgrad Med J 2020; 98:43-47. [PMID: 33087530 DOI: 10.1136/postgradmedj-2020-138872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/15/2020] [Revised: 09/08/2020] [Accepted: 09/30/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND We aimed to report the incidence of hospital-acquired hypophosphataemia and hyperphosphataemia along with their associated in-hospital mortality. METHODS We included 15 869 adult patients hospitalised at a tertiary medical referral centre from January 2009 to December 2013, who had normal serum phosphate levels at admission and at least two serum phosphate measurements during their hospitalisation. The normal range of serum phosphate was defined as 2.5-4.2 mg/dL. In-hospital serum phosphate levels were categorised based on the occurrence of hospital-acquired hypophosphataemia and hyperphosphataemia. We analysed the association of hospital-acquired hypophosphataemia and hyperphosphataemia with in-hospital mortality using multivariable logistic regression. RESULTS Fifty-three per cent (n=8464) of the patients developed new serum phosphate derangements during their hospitalisation. The incidence of hospital-acquired hypophosphataemia and hyperphosphataemia was 35% and 27%, respectively. Hospital-acquired hypophosphataemia and hyperphosphataemia were associated with odds ratio (OR) of 1.56 and 2.60 for in-hospital mortality, respectively (p value<0.001 for both). Compared with patients with persistently normal in-hospital phosphate levels, patients with hospital-acquired hypophosphataemia only (OR 1.64), hospital-acquired hyperphosphataemia only (OR 2.74) and both hospital-acquired hypophosphataemia and hyperphosphataemia (ie, phosphate fluctuations; OR 4.00) were significantly associated with increased in-hospital mortality (all p values <0.001). CONCLUSION Hospital-acquired serum phosphate derangements affect approximately half of the hospitalised patients and are associated with increased in-hospital mortality rate.
Collapse
Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Api Chewcharat
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tananchai Petnak
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael A Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Narat Srivali
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Saint Agnes Hospital, Baltimore, Maryland, USA
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona Medical Center, Tucson, Arizona, USA
| | | | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kianoush Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
32
|
Cheungpasitporn W, Thongprayoon C, Chewcharat A, Petnak T, Mao MA, Davis PW, Bathini T, Vallabhajosyula S, Qureshi F, Erickson SB. Hospital-Acquired Dysmagnesemia and In-Hospital Mortality. Med Sci (Basel) 2020; 8:E37. [PMID: 32882826 PMCID: PMC7565056 DOI: 10.3390/medsci8030037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/10/2020] [Accepted: 08/19/2020] [Indexed: 01/01/2023] Open
Abstract
Background and Objectives: This study aimed to report the incidence of hospital-acquired dysmagnesemia and its association with in-hospital mortality in adult general hospitalized patients. Materials and Methods: We studied 26,020 adult hospitalized patients from 2009 to 2013 who had normal admission serum magnesium levels and at least two serum magnesium measurements during hospitalization. The normal range of serum magnesium was 1.7-2.3 mg/dL. We categorized in-hospital serum magnesium levels based on the occurrence of hospital-acquired hypomagnesemia and/or hypermagnesemia. We assessed the association between hospital-acquired dysmagnesemia and in-hospital mortality using multivariable logistic regression. Results: 28% of patients developed hospital-acquired dysmagnesemia. Fifteen per cent had hospital-acquired hypomagnesemia only, 10% had hospital-acquired hypermagnesemia only, and 3% had both hospital-acquired hypomagnesemia and hypermagnesemia. Compared with patients with persistently normal serum magnesium levels in hospital, those with hospital-acquired hypomagnesemia only (OR 1.77; p < 0.001), hospital-acquired hypermagnesemia only (OR 2.31; p < 0.001), and both hospital-acquired hypomagnesemia and hypermagnesemia (OR 2.14; p < 0.001) were significantly associated with higher in-hospital mortality. Conclusions: Hospital-acquired dysmagnesemia affected approximately one-fourth of hospitalized patients. Hospital-acquired hypomagnesemia and hypermagnesemia were significantly associated with increased in-hospital mortality.
Collapse
Affiliation(s)
- Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.C.); (F.Q.); (S.B.E.)
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA;
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.C.); (F.Q.); (S.B.E.)
| | - Api Chewcharat
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.C.); (F.Q.); (S.B.E.)
| | - Tananchai Petnak
- Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Michael A. Mao
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Paul W. Davis
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA;
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA;
| | - Saraschandra Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.C.); (F.Q.); (S.B.E.)
| | - Stephen B. Erickson
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.C.); (F.Q.); (S.B.E.)
| |
Collapse
|
33
|
Thongprayoon C, Cheungpasitporn W, Petnak T, Mao MA, Chewcharat A, Qureshi F, Medaura J, Bathini T, Vallabhajosyula S, Kashani KB. Hospital-Acquired Serum Chloride Derangements and Associated In-Hospital Mortality. Medicines (Basel) 2020; 7:medicines7070038. [PMID: 32610534 PMCID: PMC7400070 DOI: 10.3390/medicines7070038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/27/2020] [Accepted: 06/28/2020] [Indexed: 01/28/2023]
Abstract
Background: We aimed to describe the incidence of hospital-acquired dyschloremia and its association with in-hospital mortality in general hospitalized patients. Methods: All hospitalized patients from 2009 to 2013 who had normal admission serum chloride and at least two serum chloride measurements in the hospital were studied. The normal range of serum chloride was defined as 100–108 mmol/L. Hospital serum chloride levels were grouped based on the occurrence of hospital-acquired hypochloremia and hyperchloremia. The association of hospital-acquired hypochloremia and hyperchloremia with in-hospital mortality was analyzed using logistic regression. Results: Among the total of 39,298 hospitalized patients, 59% had persistently normal hospital serum chloride levels, 21% had hospital-acquired hypochloremia only, 15% had hospital-acquired hyperchloremia only, and 5% had both hypochloremia and hyperchloremia. Compared with patients with persistently normal hospital serum chloride levels, hospital-acquired hyperchloremia only (odds ratio or OR 2.84; p < 0.001) and both hospital-acquired hypochloremia and hyperchloremia (OR 1.72; p = 0.004) were associated with increased in-hospital mortality, whereas hospital-acquired hypochloremia only was not (OR 0.91; p = 0.54). Conclusions: Approximately 40% of hospitalized patients developed serum chloride derangements. Hospital-acquired hyperchloremia, but not hypochloremia, was associated with increased in-hospital mortality.
Collapse
Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.C.); (F.Q.); (K.B.K.)
- Correspondence: (C.T.); (W.C.)
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA;
- Correspondence: (C.T.); (W.C.)
| | - Tananchai Petnak
- Division of Pulmonary and Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Michael A. Mao
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Api Chewcharat
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.C.); (F.Q.); (K.B.K.)
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.C.); (F.Q.); (K.B.K.)
| | - Juan Medaura
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA;
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85719, USA;
| | | | - Kianoush B. Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (A.C.); (F.Q.); (K.B.K.)
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
34
|
Boyd TA, Eastman PS, Huynh DH, Qureshi F, Sasso EH, Bolce R, Temple J, Hillman J, Boyle DL, Kavanaugh A. Correlation of serum protein biomarkers with disease activity in psoriatic arthritis. Expert Rev Clin Immunol 2020; 16:335-341. [DOI: 10.1080/1744666x.2020.1729129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- T. A. Boyd
- Division of Rheumatology, Department of Medicine, University of California, San Diego, CA, USA
| | | | - D. H. Huynh
- Division of Rheumatology, Department of Medicine, University of California, San Diego, CA, USA
| | - F. Qureshi
- Crescendo Bioscience, South San Francisco, CA, USA
| | - E. H. Sasso
- Crescendo Bioscience, South San Francisco, CA, USA
| | - R. Bolce
- Crescendo Bioscience, South San Francisco, CA, USA
| | - J. Temple
- Division of Rheumatology, Department of Medicine, University of California, San Diego, CA, USA
| | - J. Hillman
- Division of Rheumatology, Department of Medicine, University of California, San Diego, CA, USA
| | - D. L. Boyle
- Division of Rheumatology, Department of Medicine, University of California, San Diego, CA, USA
| | - A. Kavanaugh
- Division of Rheumatology, Department of Medicine, University of California, San Diego, CA, USA
| |
Collapse
|
35
|
Affiliation(s)
- F. Qureshi
- Department of Dermatology Kingston Hospital NHS Foundation Trust London UK
| | - A. J. Hughes
- Department of Dermatology Kingston Hospital NHS Foundation Trust London UK
| | - J. Natkunarajah
- Department of Dermatology Kingston Hospital NHS Foundation Trust London UK
| |
Collapse
|
36
|
Qureshi F. 350P Single center experience of diffuse large b-cell lymphoma patients with central nervous system relapse. Ann Oncol 2016. [DOI: 10.1016/s0923-7534(21)00508-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
37
|
Qureshi F. 350P Single center experience of diffuse large b-cell lymphoma patients with central nervous system relapse. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw586.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
38
|
Qureshi F, Shafi A, Ali S, Siddiqui N. Clinical predictors of anticipatory emesis in patients treated with chemotherapy at a tertiary care cancer hospital. Pak J Med Sci 2016; 32:337-40. [PMID: 27182235 PMCID: PMC4859018 DOI: 10.12669/pjms.322.9493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine the clinical predictors of anticipatory emesis in patients treated with chemotherapy at a tertiary care cancer hospital. Methods: This was a cross-sectional study conducted on 200 patients undergoing first line chemotherapy with minimum of two cycles at inpatient department and chemotherapy bay of Shaukat Khanum Memorial Cancer Hospital and Research Centre Pakistan. Anticipatory nausea and vomiting develops before administration of chemotherapy. Clinical signs and symptoms in patients with or without anticipatory emesis were compared using chi square test statistics. Results: The mean age of the study participants was 36.68 years (SD±12.23). The mean numbers of chemotherapy cycles administered were 3.23 (SD±1.2). Chemotherapy related nausea and vomiting was experienced by 188 (94%) patients and anticipatory nausea vomiting was reported in 90 (45%) of patients. Greater proportions of patients with anticipatory emesis were females. Fourteen (15.5%) p-value=0.031 patients with anticipatory emesis had history of anxiety and depression. Fifty nine (65.5%) p-value =< 0.0001 patients with anticipatory emesis had severe nausea after last chemotherapy cycle. Forty six (51.11%) p=<0.0001 patients had motion sickness. Conclusion: Female gender, history of motion sickness, anxiety and depression, severe nausea and vomiting experienced in pervious cycle of chemotherapy were clinical predictors of anticipatory nausea and vomiting.
Collapse
Affiliation(s)
- Fawad Qureshi
- Dr. Fawad Qureshi, MBBS, FCPS (Medicine). Fellow Medical Oncology, Department Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan. Department Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Azhar Shafi
- Dr. Azhar Shafi, MBBS, FCPS (Medicine). Fellow Medical Oncology, Department Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Sheeraz Ali
- Dr. Sheeraz Ali, MBBS, FCPS (Medicine). Fellow Medical Oncology, Department Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Neelam Siddiqui
- Dr. Neelam Siddiqui, MBBS, FRCP. Department Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| |
Collapse
|
39
|
Ness B, Qureshi F, Harris AA. Introduction to Kidney Patients. Physician Assistant Clinics 2016. [DOI: 10.1016/j.cpha.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
40
|
van der Helm-van Mil A, Knevel R, Qureshi F, Manning W, Cavet G, Huizinga T, Haney D. SAT0082 Evaluation of definitions of rheumatoid arthritis remission by assessing radiographic progression in the leiden early arthritis cohort. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.3029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
41
|
Hong JS, Romero R, Kusanovic JP, Kim JS, Lee J, Jin M, El Azzamy H, Lee DC, Topping V, Ahn S, Jacques S, Qureshi F, Chaiworapongsa T, Hassan SS, Korzeniewski SJ, Than NG, Kim CJ. "Trophoblast islands of the chorionic connective tissue" (TICCT): a novel placental histologic feature. Placenta 2013; 34:360-8. [PMID: 23453248 DOI: 10.1016/j.placenta.2013.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 01/25/2013] [Indexed: 12/25/2022]
Abstract
INTRODUCTION We found isolated or clustered trophoblasts in the chorionic connective tissue of the extraplacental membranes, and defined this novel histologic feature as the "trophoblast islands of the chorionic connective tissue" (TICCT). This study was conducted to determine the clinical significance of TICCT. METHODS Immunohistochemistry for cytokeratin-7 was performed on the chorioamniotic membranes (N = 2155) obtained from singleton pregnancies of 1199 uncomplicated term and 956 preterm deliveries. The study groups comprised 1236 African-American and 919 Hispanic women. Gestational age ranged from 24(+0) weeks to 41(+6) weeks. Multiple logistic regression analysis was performed to investigate the magnitude of association between patient characteristics and the presence of TICCT. RESULTS The likelihood of TICCT was significantly associated with advancing gestational age both in term (OR: 1.29, 95% CI: 1.16-1.45, p < 0.001) and preterm deliveries (OR: 1.19, 95% CI: 1.07-1.32, p = 0.001) . Hispanic women were less likely than African-American women to have TICCT across gestation in term (OR: 0.23, 95% CI: 0.18-0.31, p < 0.001) and preterm pregnancies (OR: 0.41, 95% CI: 0.29-0.58, p < 0.001). Women with a female fetus were significantly more likely to have TICCT than women with a male fetus, in both term (OR: 1.64, 95% CI: 1.28-2.11, p < 0.001) and preterm gestations (OR: 2.04, 95% CI: 1.46-2.85, p < 0.001). TICCT was 40% less frequent in the presence of chronic placental inflammation [term (OR: 0.60, 95% CI: 0.45-0.81, p = 0.001) and preterm gestations (OR: 0.58, 95% CI: 0.40-0.84, p = 0.003)] and in parous women at term (OR: 0.60, 95% CI: 0.44-0.81, p = 0.001). CONCLUSIONS Our findings suggest that the duration of pregnancy, fetal sex, and parity may influence the behavior of extravillous trophoblast and placental mesenchymal cells.
Collapse
Affiliation(s)
- J-S Hong
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Qureshi F, Maddula S, Hardman-Lea S. Recurrent Metastatic Breast Carcinoma Presenting with Pansinusitis and Choroidal Metastases and Subsequent Bilateral Simultaneous Orbital Cellulitis. Semin Ophthalmol 2012; 27:33-4. [DOI: 10.3109/08820538.2011.622332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
43
|
Masoodi I, Sheikh T, Qureshi F, Rather A, Malik S. Sister Mary Joseph’s nodule as the first presentation of gallbladder carcinoma: <i>A case report and literature review. Sahel Med J 2011. [DOI: 10.4314/smj2.v13i1.67503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
44
|
Abstract
Between September 1993 and September 1996, we performed 34 Kudo 5 total elbow replacements in 31 rheumatoid patients. All 22 surviving patients were reviewed at a mean of 11.9 years (10 to 14). Their mean age was 56 years (37 to 78) at the time of operation. All had Larsen grade IV or V rheumatoid changes on X-ray. Nine (three bilateral replacements and six unilateral) had died from unrelated causes. One who had died before ten years underwent revision for dislocation. Of the 22 total elbow replacements reviewed six had required revision, four for aseptic loosening (one humeral and three ulnar) and two for infection. Post-operatively, one patient had neuropraxia of the ulnar nerve and one of the radial nerve. Two patients had valgus tilting of the ulnar component. With revision as the endpoint, the mean survival time for the prosthesis was 11.3 years (95% confidence interval (10 to 13) and the estimated survival of the prosthesis at 12 years according to Kaplan-Meier survival analysis was 74% (95% confidence interval 0.53 to 0.91). Of the 16 surviving implants, ten were free from pain, four had mild pain and two moderate. The mean arc of flexion/extension of the elbow was 106° (65° to 130°) with pronation/supination of 90° (30° to 150°) with the joint at 90° of flexion. The mean Mayo elbow performance score was 82 (60 to 100) with five excellent, ten good and one fair result. Good long-term results can be expected using the Kudo 5 total elbow replacement in patients with rheumatoid disease, with a low incidence of loosening of the components.
Collapse
Affiliation(s)
- F. Qureshi
- Doncaster Royal Infirmary, Armthorpe Road, Doncaster DN2 5LT, UK
| | - K. P. Draviaraj
- The Shoulder and Elbow Unit, The Northern General Hospital, Sheffield Teaching Hospital, NHS Trust, Herries Road, Sheffield S5 7AU, UK
| | - D. Stanley
- The Shoulder and Elbow Unit, The Northern General Hospital, Sheffield Teaching Hospital, NHS Trust, Herries Road, Sheffield S5 7AU, UK
| |
Collapse
|
45
|
Arayne MS, Sultana N, Siddiqui FA, Mirza AZ, Qureshi F, Zuberi MH. Simultaneous Determination of Piracetam and its Four Impurities by RP-HPLC with UV Detection. J Chromatogr Sci 2010; 48:589-94. [DOI: 10.1093/chromsci/48.7.589] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
46
|
Bendon RW, Faye-Petersen O, Pavlova Z, Qureshi F, Elder N, Das A, Hauth J, McNellis D, Mercer B, Miodovnik M. Histologic Features of Chorioamnion Membrane Rupture: Development of Methodology. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/15513819709168344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
47
|
Rabbani F, Qureshi F, Rizvi N. Perspectives on domestic violence: case study from Karachi, Pakistan. East Mediterr Health J 2008; 14:415-426. [PMID: 18561735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
There is no adequate profile of domestic violence in Pakistan although this issue is frequently highlighted by the media. This case study used qualitative and quantitative methods to explore the nature and forms of domestic violence, circumstances, impact and coping mechanisms amongst selected women victims in Karachi. Violence was a continuum: all the women reported verbal abuse, often escalating into physical, emotional, sexual and economic abuse. The husband was the most common perpetrator. Women suffered in silence due to sociocultural norms, misinterpretation of religious beliefs, subordinate status, economic dependence and lack of legal redress. Besides short-term local measures, public policy informed by correct interpretation of religion can bring about a change in prevailing societal norms.
Collapse
Affiliation(s)
- F Rabbani
- Department of Community Health Sciences, Aga Khan University Karachi, Pakistan.
| | | | | |
Collapse
|
48
|
Soong V, Qureshi F. Response to Ross et al. Clin Otolaryngol 2007. [DOI: 10.1111/j.1365-2273.2007.01446.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
49
|
Jeanty C, Nien JK, Espinoza J, Kusanovic JP, Gonçalves LF, Qureshi F, Jacques S, Lee W, Romero R. Pleural and pericardial effusion: a potential ultrasonographic marker for the prenatal differential diagnosis between congenital diaphragmatic eventration and congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2007; 29:378-87. [PMID: 17366518 PMCID: PMC2391071 DOI: 10.1002/uog.3958] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVES To determine whether or not the presence of pleural and/or pericardial effusion can be used prenatally as an ultrasonographic marker for the differential diagnosis between diaphragmatic eventration and diaphragmatic hernia. METHODS We present two case reports of non-isolated diaphragmatic eventration associated with pleural and/or pericardial effusion. Additionally, we reviewed the literature for all cases of congenital diaphragmatic hernia (CDH) and diaphragmatic eventration that met the following criteria: (1) prenatal diagnosis of a diaphragmatic defect and (2) definitive diagnosis by autopsy or surgery. The frequencies of pleural effusion, pericardial effusion and hydrops were compared between the two conditions using Fisher's exact test. A subanalysis was conducted of cases with isolated diaphragmatic defects (i.e. diaphragmatic defects not associated with hydrops and other major structural or chromosomal anomalies). RESULTS A higher proportion of fetuses with diaphragmatic eventration had associated pleural and pericardial effusions compared with fetuses with diaphragmatic hernia (58% (7/12) vs. 3.7% (14/382), respectively, P < 0.001). This observation remained true when only cases of diaphragmatic defects not associated with hydrops and other major structural or chromosomal anomalies were compared (29% (2/7) with eventration vs. 2.2% (4/178) with CDH, P < 0.02). CONCLUSIONS The presence of pleural and/or pericardial effusion in patients with diaphragmatic defects should raise the possibility of a congenital diaphragmatic eventration. This information is clinically important for management and counseling because the prognosis and treatment for CDH and congenital diaphragmatic eventration are different. Published by John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- C Jeanty
- Perinatology Research Branch, National Institute of Child Health and Human Development, NIH/DHHS, Bethesda, MD, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
|