[Predictive value of D-dimer for deep venous thrombosis of lower extremity in adult burn patients]

Objective: To investigate the predictive value of D-dimer for deep venous thrombosis (DVT) of lower extremity in adult burn patients. Methods: A retrospective case series study was conducted. The clinical data of 3 861 adult burn patients who met the inclusion criteria and were admitted to the Department of Burns of Zhengzhou First People's Hospital from January 1, 2015 to December 31, 2019 were collected. The patients were divided into DVT group (n=77) and non-DVT group (n=3 784) according to whether DVT of lower extremity occurred during hospitalization or not. Data of patients in the two groups were collected and compared, including the gender, age, total burn area, D-dimer level, with lower limb burn and inhalation injury or not on admission, with sepsis/septic shock, femoral vein indwelling central venous catheter (CVC), history of surgery, and infusion of concentrated red blood cells or not during hospitalization. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, and chi-square test. The indicators with statistically significant differences between the two groups were analyzed with multivariate logistic regression analysis to screen the independent risk factors for DVT of lower extremity in 3 861 adult burn patients. The receiver operating characteristic (ROC) curve of the independent risk factors predicting DVT of lower extremity in 3 861 adult burn patients were drawn, and the area under the curve (AUC), the optimal threshold value, and the sensitivity and specificity under the optimal threshold value were calculated. The quality of the AUC was compared by Delong test, and the sensitivity and specificity under the optimal threshold value were compared using chi-square test. Results: There were no statistically significant differences in gender, occurrence of sepsis/septic shock or history of surgery during hospitalization between patients in the two groups (P>0.05), while there were statistically significant differences in age, total burn area, D-dimer level, lower limb burn and inhalation injury on admission, and femoral vein indwelling CVC and infusion of concentrated red blood cells during hospitalization between patients in the two groups (t=-8.17, with Z values of -5.04 and -10.83, respectively, χ2 values of 21.83, 5.37, 7.75, and 4.52, respectively, P<0.05 or P<0.01). Multivariate logistic regression analysis showed that age, total burn area, and D-dimer level were the independent risk factors for DVT of lower extremity in 3 861 adult burn patients (with odds ratios of 1.05, 1.02, and 1.14, respectively, 95% confidence intervals of 1.04-1.06, 1.00-1.03, and 1.10-1.20, respectively, P<0.05 or P<0.01). The AUCs of ROC of age, total burn area, and D-dimer level for predicting DVT of lower extremity in 3 861 adult burn patients were 0.74, 0.67, and 0.86, respectively (with 95% confidence intervals of 0.68-0.80, 0.60-0.74, and 0.83-0.89, respectively, P values<0.01), the optimal threshold values were 50.5 years old, 10.5% total body surface area, and 1.845 mg/L, respectively, the sensitivity under the optimal threshold values were 71.4%, 70.1%, and 87.0%, respectively, and the specificity under the optimal threshold values were 66.8%, 67.2%, and 72.9%, respectively. The AUC quality and sensitivity and specificity under the optimal threshold value of D-dimer level were significantly better than those of age (z=3.29, with χ2 values of 284.91 and 34.25, respectively, P<0.01) and total burn area (z=4.98, with χ2 values of 326.79 and 29.88, respectively, P<0.01), while the AUC quality and sensitivity and specificity under the optimal threshold values were similar between age and total burn area (P>0.05). Conclusions: D-dimer level is an independent risk factor for DVT of lower extremity in adult burn patients, its AUC quality and sensitivity and specificity under the optimal threshold value are better than those of age and total burn area, and it has good predictive value for DVT of lower extremity in adult burn patients.

[National experts consensus on tracheotomy and intubation for burn patients (2018 version)]

Airway edema, stenosis, obstruction and even asphyxia are easy to occur in patients with extensive burn, deep burn of head, face, and neck area, inhalation injuries, etc., which threaten life. Timely tracheotomy and intubation is an important treatment measure, but lack of knowledge and improper handling in some hospitals resulted in airway obstruction. The technique of percutaneous tracheotomy and intubation provides convenience for emergency treatment of critical burns and mass burn. The Chinese Geriatrics Society organized some experts in China to discuss the indications, timing, methods, extubation, and precautions of tracheotomy and intubation for burn patients. The national experts consensus on tracheotomy and intubation for burn patients (2018 version) was written to provide a reference standard for clinical treatment.

[National experts consensus on tracheotomy and intubation for burn patients (2018 version)]

Airway edema, stenosis, obstruction and even asphyxia are easy to occur in patients with extensive burn, deep burn of head, face, and neck area, inhalation injuries, etc., which threaten life. Timely tracheotomy and intubation is an important treatment measure, but lack of knowledge and improper handling in some hospitals resulted in airway obstruction. The technique of percutaneous tracheotomy and intubation provides convenience for emergency treatment of critical burns and mass burn. The Burn and Trauma Branch of Chinese Geriatrics Society organized some experts in China to discuss the indications, timing, methods, extubation, and precautions of tracheotomy and intubation for burn patients. The national experts consensus on tracheotomy and intubation for burn patients (2018 version) was written to provide a reference standard for clinical treatment.

Body roundness index and body adiposity index: two new anthropometric indices to identify metabolic syndrome among Chinese postmenopausal women

OBJECTIVES

Body roundness index (BRI) and body adiposity index (BAI) have been recently proposed to assess obesity. The objectives of this cross-sectional study were to compare their potential for identifying metabolic syndrome (MetS) with traditional obesity indices in Chinese postmenopausal women.

METHODS

A total of 817 participants were involved in this study. Odds ratio and corresponding 95% confidence intervals (CI) between MetS and all indices were evaluated by binary logistic regression analysis. Receiver operating characteristic curve and area under curve (AUC) were employed to evaluate the abilities to identify MetS among all the indices. The differences in the AUC values between traditional indices and BAI as well as BRI were also evaluated.

RESULTS

The upper values of all indices were significantly associated with the presence of MetS after adjusting for potential confounders, except for BAI. There were no significant differences in the AUC values between BRI and the traditional indices; however, the AUC values of all the traditional indices were significantly larger than that of BAI.

CONCLUSIONS

Neither BAI nor BRI was superior to traditional obesity indices for predicting MetS. BAI showed the weakest predictive ability, while BRI showed potential for use as an alternative obesity measure in assessment of MetS.

Relationship between serum uric acid levels and hepatic steatosis in non-obese postmenopausal women

OBJECTIVE

Serum uric acid levels have been reported to be associated with non-alcoholic fatty liver disease (NAFLD). However, very few studies specifically examining the relationship between serum uric acid (SUA) levels and NAFLD in postmenopausal women have been reported in China, especially in postmenopausal women with normal body mass index (BMI) in whom NAFLD is not uncommon.

METHODS

A cross-sectional study was employed of 528 Chinese normal-BMI postmenopausal women (aged 41-79 years) who participated in annual health check-ups. NAFLD is defined as a hepatic steatosis observed on liver ultrasonography in the absence of a second cause. Of all the participants, 121 women were diagnosed with hepatic steatosis (NAFLD group) and the others were without (non-NAFLD group). SUA quartiles were defined as follows: Q1, < 3.8 mg/dl; Q2, 3.8-4.4 mg/dl; Q3, 4.5-5.0 mg/dl; Q4, 5.1-6.0 mg/dl. Stepwise multivariable regression analysis was used to assess the relationships between SUA level and other variables. The association between SUA quartiles and hepatic steatosis was assessed using binary logistic regression.

RESULTS

Compared to the non-NAFLD group, the mean level of SUA was significantly higher in the NAFLD group (p < 0.01). The adjusted odds ratio (95% confidence interval) for the presence of hepatic steatosis in the highest SUA quartile vs. the lowest quartile was 2.774 (1.396-5.513) for all women (p < 0.01) after adjusting for the factors which were independently associated with uric acid level including waist circumference, high blood pressure, blood urea nitrogen, creatinine, γ-glutamyltransferase, and triglycerides. Most estimates changed little after further adjustment for age, metabolic syndrome, drinking status, and smoking status. The presence of hepatic steatosis significantly increased in the third and fourth quartiles of SUA. The prevalence of hepatic steatosis increased gradually with an increasing SUA quartile (p for trend < 0.01).

CONCLUSION

Higher SUA levels even within the normal range are positively and independently associated with the presence of hepatic steatosis in Chinese postmenopausal women with normal BMI.

Relationship between serum uric acid levels and metabolic syndrome in Chinese postmenopausal women

OBJECTIVE

Serum uric acid levels have been reported to be associated with metabolic syndrome (MetS). However, few studies specifically examining the relationship between serum uric acid (SUA) levels and MetS in postmenopausal women have been reported in China. Thus, we conducted this study in order to assess the relationship between SUA levels and MetS in Chinese postmenopausal women.

METHODS

A cross-sectional study of 1022 Chinese postmenopausal women (aged 42-80 years) who participated in annual health check-ups was employed. MetS was defined by National Cholesterol Education Program/Adult Treatment Panel III criteria (NCEP-ATP III). Of all the participants, 385 women were diagnosed with MetS (MetS group) and the others were without MetS (non-MetS group). SUA quartiles were defined as follows: Q1, < 3.9 mg/dl; Q2, 3.9-4.5 mg/dl; Q3, 4.6-5.1 mg/dl; Q4, 5.2-6.0 mg/dl. The association between SUA quartiles and MetS was assessed using binary logistic regression.

RESULTS

The adjusted odds ratio (95% confidence interval) for the presence of metabolic syndrome in the highest SUA quartile vs. the lowest quartile was 3.768 (2.386-5.950) for all women (p < 0.01) after adjusting for age, body mass index, blood urea nitrogen, serum creatinine, total cholesterol, low density lipoprotein cholesterol and C-reactive protein. The presence of MetS significantly increased in the second, third and fourth quartiles of SUA. The prevalence of MetS increased gradually with an increasing serum uric acid quartile (p for trend < 0.001).

CONCLUSION

Higher SUA levels are positively and independently associated with the presence of MetS in Chinese postmenopausal women.