Discriminatory Capacity Research Articles

QRISK3 and SCORE2 are equally reliable predictors of carotid plaques in patients with systemic lupus erythematosus.

Cardiovascular (CV) disease is the leading cause of death among patients with systemic lupus erythematosus (SLE). This study aimed to compare the performance of QRESEARCH-risk estimator version 3 (QRISK3) and the Systematic Coronary Risk Evaluation-2 (SCORE2) scores to identify SLE patients at high risk of CV events, as indicated by the presence of carotid plaques. Subclinical atherosclerosis was evaluated using carotid ultrasound in 365 SLE patients. QRISK3 and SCORE2 were calculated. The relationship between these scores and the presence of carotid plaques was analyzed by treating the scores as continuous and categorical variables, and separately and in combination. Logistic regression and area under the receiver operating characteristic curve (AUC) analyses were used to assess their predictive accuracy. The discriminatory capacity of QRISK3, with an AUC of 0.770 (95%CI : 0.720, 0.821), and SCORE2, with an AUC of 0.800 (95%CI : 0.753, 0.843), for carotid plaque was similar, with no statistically significant difference (p= 0.070). However, when examining the association of both calculators considered continuously and together with their interaction, the discriminatory capacity of this combination was significantly greater than that of QRISK3 alone (p= 0.034) but did not differ from SCORE2 (p= 0.71). QRISK3 and SCORE2 are equally reliable predictors of carotid plaques in SLE patients. The combination of both calculators offers significantly better discrimination than QRISK3 alone but shows no significant difference when compared with SCORE2 alone. Therefore, SCORE2 alone, without the need for additional tools, can be used to identify patients with SLE who are at high risk of CV events.

Performance of a Global Functional Assay Based on Interferon-γ Release to Predict Infectious Complications and Cancer After Kidney Transplantation

The QuantiFERON-Monitor assay (QTF-Monitor) is intended to assess innate and adaptive immune responses by quantifying interferon (IFN)-γ release upon whole blood stimulation with a TLR7/8 agonist and an anti-CD3 antibody. We performed the QTF-Monitor in 126 kidney transplant recipients (KTRs) at different points during the first 6 post-transplant months. The primary outcome was overall infection, whereas secondary outcomes included bacterial infection, opportunistic infection and de novo cancer. The association between IFN-γ production and outcomes was analyzed as “low” immune responses (<15 IU/mL) and as a continuous variable to explore alternative thresholds. There were no significant differences in the occurrence of overall infection according to the QTF-Monitor at any monitoring point. Regarding secondary outcomes, KTRs with a low response at week 2 experienced a higher incidence of bacterial infection (50.8% versus 24.4%; P-value = 0.006). Low response at month 1 was also associated with opportunistic infection (31.6% versus 14.3%; P-value = 0.033). The discriminative capacity of IFN-γ levels was poor (areas under the ROC curve: 0.677 and 0.659, respectively). No differences were observed for the remaining points or post-transplant cancer. In conclusion, the QTF-Monitor may have a role to predict bacterial and opportunistic infection in KTRs when performed early after transplantation.

Construction of nomogram for wound recurrence in elderly patients with venous leg ulcers

BackgroundVenous Leg Ulcers (VLUs) are one of the most serious and intractable complications of chronic venous insufficiency. This study aims to develop a nomogram based on a theoretical model to predict the probability of wound recurrence in older patients with VLUs.MethodsThe elderly patients with VLUs attending the five hospitals between September 2021 and October 2022 were enrolled in this research, and randomized to the training and validation cohorts based on the corresponding ratio (7:3). Recurrent events were recorded during a six-month follow-up after the baseline data collection. The univariate analysis, the least absolute shrinkage and selection operator (LASSO) regression method were used to screen variables, and multiple logistic regression was used to establish a risk prediction model, which was presented by nomogram. Receiver operating curves (ROC), Hosmer–Lemeshow test, as well as calibration curves, were adopted to assess the effectiveness of the nomogram. The prognostic value of the nomogram was also examined.ResultsA total of 608 elderly patients with VLUs were included in the study. They were randomly divided into the training cohort (N = 421) and the validation cohort (N = 187). In the training cohort, Lasso regression and multivariate logistic regression analysis indicated that previous recurrence number, last ulcer duration, lower extremity DVT history, and frailty were independent risk factors for wound recurrence in elderly patients with VLUs, while daily exercise time and self-efficacy were protective factors. A nomogram was established with a good discrimination capacity and predictive efficiency with and the area under the curve (AUC) of 0.869 (95%CI: 0.831–0.908) in the training set and 0.890 (95%CI: 0.841–0.938) in the validation set. The p values of the Hosmer-Lemeshow test for both sets were 0.887 and 0.772, respectively, both greater than 0.05. The calibration degree charts showed that the data point connection was similar to the diagonal, indicating that the model’s prediction probability of wound recurrence in elderly VLUs patients is close to the actual probability.ConclusionThis study constructed a new nomogram to predict the risk of wound recurrence in elderly patients with VLUs. The nomogram has excellent accuracy and reliability, which can help healthcare workers and patients actively monitor and follow up with patients to prevent the recurrence of ulcers and make clinical decisions.

Utility of the triglycerides/HDL cholesterol ratio in older adult patients in Colombia

Abstract Introduction Alterations in lipid metabolism are responsible for atherogenesis and an increased risk of atherosclerotic cardiovascular disease. The triglycerides to high-density lipoprotein cholesterol ratio (TG/HDL-C) is used to assess the risk of cardiovascular diseases; however, it has not been evaluated in older adults. The aim of the present study is to evaluate the TG/HDL-C ratio in elderly patients and analyze its correlation and discriminatory capacity with cardiovascular risk factors according to data from the SABE Colombia survey. Purpose Describe the sociodemographic characteristics, cardiovascular history, lifestyle, and cardiovascular risk score in the older adult population included in the SABE Colombia Study.Describes the distribution of triglyceride levels, cholesterol, and the TAG-HDL ratio in the older adult population included in the SABE Colombia Study. Evaluate the relationship between the TAG/HDL Cholesterol Index and cardiovascular risk factors such as hypertension, prediabetes, type 2 diabetes mellitus, cardiovascular disease, cerebrovascular disease Determine if there is a correlation and the degree of correlation between the TAG/HDL Cholesterol ratio and variables related to higher cardiovascular risk and stablish cutoff points of the triglyceride to HDL cholesterol ratio as indicators of the onset of risk factors Materials and Methods Cross-sectional study in adults aged 60 years and older included in the national SABE Colombia survey (National Survey of Health, Well-being, and Ageing conducted in Colombia in 2015), which included 244 municipalities from all departments of the country. A correlation test was performed to assess the presence and degree of correlation between the TAG/HDL index and cardiovascular risk factors, and ROC curve analysis was conducted to evaluate the performance of the TAG/HDL index in identifying risk factors. Results A total of 23,694 patients with the necessary information for the study were included. The median age was 69 years, 57.3% were women, and 34.3% were of white race. 23.5% had hypertension, and 16.4% had diabetes mellitus. 13.4% had a history of cardiovascular disease, and 2.5% had cerebrovascular disease. While the specific correlation between the index and different cardiovascular risk factors is generally low to moderate, good discriminatory capacity was found for diabetes and metabolic syndrome with the following values: diabetes, with an area under the curve (AUC) of 0.871 and a cut-off point of 9.17; and for metabolic syndrome, the AUC was 0.840, with a cut-off point of 8.81. Conclusions Our findings show that the TG/HDL ratio has intermediate correlation for different cardiovascular risk factors; however, it has excellent predictive ability for the presence of diabetes and metabolic syndrome. These findings are very useful in the clinical evaluation, screening, and detection of cardiovascular risk factors in the population aged 60 years and older in Colombia.Scatter plots of TAG/HDL ratio comparedROC curves for diabetes and metabolic s

Validation of the MIDA mortality risk score in a surgical cohort of patients with primary mitral regurgitation

Abstract Background and aim The MIDA scale is a prognostic tool for stratification of short- and long-term mortality risk in patients with primary mitral regurgitation (PMR). The aim of this study is to validate the MIDA (1) score in our population of PMR treated with surgery. Methods Retrospective analysis of a prospective cohort of patients with PMR who underwent mitral valve surgery in a tertiary care center from 2014 to 2022. The necessary parameters for calculating the MIDA Score (age, symptoms, atrial fibrillation, left atrial diameter, right ventricular systolic pressure (RVSP), left ventricular end-systolic diameter (LVESD), and LV ejection fraction (LVEF)) were collected, and the MIDA score for each patient was calculated. Thereafter, patients were classified into seven different risk groups. One year and long-term mortality during follow-up were recorded. A logistic regression analysis was performed to evaluate the association of each parameter with outcomes. Finally, curves for the cumulative incidence of all-cause mortality according to the MIDA score were generated with the Kaplan–Meier method. Results A total of 349 patients were included. Mean age was 68.5 [12.4] years, 55.8% were male, and the median LVEF was 60% (55-65). Mean follow up was 3.28 (2) years. One year mortality occurred in 29 (8.3%) patients, and long-term mortality in 59 (16.9%). According to the MIDA score, the distribution of patients in each subgroup was as follows: score 0 (n=28), score 1-2 (n=35), score 3-4 (n=60), score 5-6 (n=99), score 7-8 (n=81), score 9-10 (n=35), score > 11 (n=11). Most of our cohort was classified as intermediate-risk patients, with a median score of 6 (3-8). In the univariable logistic regression analysis, age, symptoms before surgery and RVSP were the only MIDA parameters significantly associated with mortality (Table-Figure 1). In our population, the discriminatory capacity of the MIDA score, was moderate, with an area under the ROC curve of 0.676 CI (0.624-0.725) for one year mortality, and 0.702 (0.651-0.749) for long term mortality. The best cut-off point for predicting one-year and long-term mortality was a MIDA score of 7. Kaplan-Meier curves for mortality during follow-up are shown in Figure 2. Conclusions The MIDA score showed a fair discriminatory capacity in our surgical cohort of patients with PMR. Variables included in the score that had a significant association with mortality were age, presence of symptoms and elevated RVSP. LV parameters included in the MIDA, which are the current class I indication for surgery, did not show a significant association with outcomes. Different echocardiographic variables to evaluate cardiac damage in PMR are needed to achieve better stratification.Table-Figure 1Figure 2

Lower early mortality after acute pulmonary embolism in patients with WHO-defined obesity: results from a post-hoc cohort analysis with external validation

Abstract Background The relationship between obesity, defined as a Body Mass Index (BMI) ≥ 30 kg/m2, and mortality in venous thrombo-embolism remains controversial. Objectives To compare early outcomes after pulmonary embolism (PE) between obese patients, and non-obese, non-underweight patients. Methods We performed a post-hoc analysis based on prospectively recorded individual patient data from the multicenter BFC-FRANCE registry. We compared rates of outcomes using multivariable logistic regression or a Cox model for 30-day and 6-month outcomes respectively. We assessed the incremental value of adding BMI information on top of the 30-day European Society of Cardiology (ESC) prognostic algorithm. Results A total of 2,390 patients with a BMI ≥ 18.5 kg/m2 (mean age, 66.9±16.8 years; 1,188 men [49.7%]) were included, 686 patients [28.7%] in the obese group, and 1,704 patients [71.3%] in the non-obese group. Mortality rates were significantly lower in obese patients versus non-obese patients at 30 days (OR, 0.59; 95% CI, 0.35-0.98), and 6 months. Cox-model-derived adjusted curves for all-cause death at 6 months, with hazard ratios (HRs) between obese and non-obese patients, after acute PE, are shown in the Figure. Rates of secondary non-fatal outcomes (including recurrent VTE) did not differ between groups. The addition of the obesity information on top of the ESC prognostic model improved global model fit, and discriminatory and calibration capacities, yielding significant reclassification based on the observed mortality rates with the ESC model as reference. Findings were confirmed in an external validation using 35,796 PE patients from the RIETE registry. Conclusion We present evidence indicating lower early and mid-term mortality after PE in patients classified as obese based on BMI, compared with non-obese, non-underweight patients. BMI should likely be incorporated into algorithms or scoring systems for predicting early mortality following PE.

Troponin/creatine kinase ratio for discrimination of type 1 and type 2 myocardial infarction

Abstract Background High-sensitivity cardiac troponin (hs-cTn) is the laboratory gold-standard to diagnose myocardial infarction (MI). Yet, discrimination between different entities of myocardial injury, i.e. acute and chronic myocardial injury, and Type 1 (T1MI) versus Type 2 MI (T2MI), is still most challenging. Since, management of these entities is substantially different, there is an unmet clinical need for better discrimination. In clinical practice creatine-kinase (CK) is often used to decide whether patients with elevated hs-cTn concentrations are referred to primary invasive coronary angiography. However, it is unclear if the combined evaluation of CK and hs-cTn improves the discrimination between different types of myocardial injury, and MI. Objective Our aim was to evaluate, if the combination hs-cTnI with CK improves discrimination of acute versus chronic myocardial injury, and T1MI versus T2MI. Methods We included patients presenting with suspected MI to the emergency department of a tertiary center. CK and hs-cTnI (Architect STAT) were determined at presentation, and after 1h and 3h. Final diagnoses were adjudicated according to the 4th Universal Definition of MI. STEMI patients were excluded from analyses. We calculated ratios of hs-cTnI and CK for each patient at each timepoint. Receiver-operator-curves with corresponding area under the curve (AUC) were used to assess the discriminative performance and compared with hs-cTnI alone. Logistic regression analysis was applied to calculate odds ratios (OR; 95% confidence intervals) for all ratios as well as hs-cTnI to distinguish T1MI vs T2MI, and chronic injury vs. any acute injury (acute myocardial injury, T1MI, T2MI). ORs are displayed using restricted cubic splines and values were entered log-transformed in the model. Results Of 3346 patients (median age 63 years, 36.4% women), 427 (12.8%) had MI, 103 (3.1%) had acute and 864 (25.8%) chronic injury. Log-transformed ratio of hs-cTnI/CK at presentation resulted in an AUC of 0.75 with an OR per SD for T1MI of 2.74 [2.14, 3.58], which was similar to hs-cTnI alone (AUC 0.76, p=0.75, OR per SD 3.07 [2.35, 4.09]). No significant differences were observed for measurements at 1h and 3h (Figure 1 A-C). Additionally, there was no improvement of discriminative performance regarding the discrimination of chronic and any acute myocardial injury by using hs-cTnI/CK ratios at any timepoint (AUCratio0h 0.77, AUChsTnI0h 0.8, p=0.17; ORratio0h per SD 3.44 [2.96, 4.02], ORhs-cTnI0h per SD 4.35 [3.66, 5.20]) (Fig. 1D-F). Restricted cubic splines show the overlapping correlation of increased propability for T1MI and any acute injury with higher hs-cTnI/CK ratios as well as hs-cTnI alone. (Figure 2). Conclusion The addition of CK to hs-cTnI does not improve discriminative capacity between patients with T1MI and T2MI, as well as between chronic and any acute myocardial injury compared to hs-cTnI alone.Figure 1:ROC curvesFigure 2:Natural cubic splines

Albumin creatinine index added to the grace score increases its discriminative capacity for mortality at 12 years of follow-up in patients with acute coronary syndrome

Abstract introduction There is currently no information on the prognostic value of the GRACE score with the additional addition of the albumin-creatinine index (ABI) for the prediction of very long-term mortality in unselected populations of acute coronary syndromes (ACS). Objectives To evaluate the additive value of the albumin-creatinine index in spontaneous urine sample to the GRACE score for the prediction of 12-year mortality from all causes in an unselected cohort of patients with acute coronary syndrome. Material and methods A prospective cohort study was carried out, which included patients admitted to a Community Hospital with a diagnosis of ACS. These patients had their IAC measured in a single spontaneous urine sample based on the principle of immunoturbidimetry in the first 24 hours of admission. The end point of the analysis was all-cause mortality at follow-up. The GRACE 2.0 score was calculated for all patients in the study. The scores were compared according to the following metrics: their power to discriminate between events and non-events (ROC Areas), calibration or goodness of fit, evaluating the agreement between the proportion of events and non-events expected by both scores observed by Hosmer Lemeshow Test. The comparison between the areas under the ROC Curves was carried out using De Long's test with the MEDCALC program version 19.1.7. The net reclassification index and its 95% CI (GRACE score + IAC/GRACE score) were evaluated. Results 600 patients with ACS were analyzed, with an average age of 64 years. The GRACE score risk subgroups were divided by the established cut-off values: low risk (0 to 108), intermediate (109 to 139) and high risk (greater than 139). The area under the curve of the Grace score for mortality during follow-up was 0.79 (95% CI 0.69-0.89), while the area under the ROC curve of the GRACE + IAC score was 0.81 (95% CI 0.74-0.87). ). Comparing the two areas by the De Long test, the difference was statistically significant (P < 0.0001; 95% CI 0.07- 0.015). On the other hand, contingency tables were developed and the Hosmer Lemeshow Test (goodness of fit) was performed on the GRACE score and the GRACE + IAC score, observing agreement between expected events and non-events, throughout all subgroups of risk. In addition, reclassifications were made into deceased and survivors by applying the GRACE + IAC score on the GRACE score. The net reclassification rate was 28% (95% CI 21-35). The chi square of its Mc Nemar Test was 3.69 p < 0.0002. The absolute comprehensive discriminatory improvement was 0.01 (95% CI 0.009-0.02) and the corresponding relative value was 8.2% (95% CI 7.9-8.5). Conclusions In this unselected ACS cohort, the albumin-creatinine index added to the GRACE score significantly increases its ability to discriminate mortality from all causes in a 12-year follow-up.Comparison between ROC curvesHosmer Lemeshow test

Electrocardiographic criteria for the diagnosis of left ventricular hypertrophy in patients with severe aortic stenosis

Abstract Introduction There is a lack of data regarding the performance of current electrocardiographic (EKG) criteria for left ventricular hypertrophy (LVH) in patients with severe aortic stenosis (AS). Purpose To test the performance of the current EKG scores to diagnosis LVH in AS patients, and also to compare the performance of a new proposed score. Methods The present study evaluated 80 patients with severe AS that underwent cardiac magnetic resonance to diagnose LVH, defined as left ventricular indexed mass of 95 g/m² for female and 115 g/m² for male patients. The EKG criteria used for left ventricular hypertrophy were Sokolow-Lyon criteria, Romhilt-Estes point score system, Cornell voltage criteria and Peguero-Lo Presti criteria. Results Among the 80 patients included in analysis, 58.7% were male and the mean age was 64±8 years. There was a high prevalence of comorbidities, highlighting diabetes (32.5%), hypertension (67.5%), atrial fibrillation (5.0%) and coronary artery disease (11.3%). Regarding echocardiogram, the median left ventricle ejection fraction was 64 (56-68)% and the median indexed aortic valve area was 0.43 (0.35-0.49) cm²/m². Cardiac magnetic resonance analysis demonstrated a mean left ventricle mass of 168±55g, and the LVH incidence was 26.3%. Regarding EKG, Strain pattern was found in 49.1% of the patients, Cornell voltage criteria was positive in 51.3%, Sokolow-Lyon criteria in 51.3%, Romhilt-Estes point score system in 42.5% and Peguero-Lo Presti criteria in 61.3%. Discriminative capacity of electrocardiographic criteria for LVH is shown in Figure 1. Peguero-Lo Presti score had the best diagnostic accuracy in the overall population and in male sex (AUC 0.776), while Cornell voltage criteria had the best diagnostic accuracy in female patients (AUC 0.776). Based on linear regression model, the proposed score was created to predict LVH at cardiac magnetic resonance: 48 + (1.3 x Deepest S wave) + (0.5 x S wave in V1 or V2 plus R wave in V5). The proposed score cutoff value of 90.5 mm had a sensitivity of 0.765 and specificity of 0.707 (for male sex: 0.769 and 0.655, respectively; for female sex: 0.750 and 0.759, respectively). Compared to the scores described in the literature, the proposed score had the best area AUC for the overall population (Figure 1), for female and male patients (AUC 0.796, 0.819 and 0.780, respectively). Conclusion In patients with severe AS, the proposed score had the best diagnostic accuracy compared to the scores described in the literature for LVH identification, followed by Peguero-Lo Presti score, even when analyzed based on gender. Besides, the proposed score had also acceptable sensitivity and specificity for LVH detection.AUC of electrocardiographic scores.

Physical activity and sedentary behavior as screening tools for dynapenic abdominal obesity and dynapenic obesity in older adults: A cross-sectional investigation

ObjectiveTo investigate the discriminatory capacity of habitual physical activity (HPA) and sedentary behavior (SB) when screening for dynapenic abdominal obesity (DAO) and dynapenic obesity (DO) in older adults. MethodsA cross-sectional population epidemiological investigation was conducted with 207 older adults. Obesity was diagnosed by high waist circumference and body mass index. Dynapenia was identified through low handgrip-strength. ResultsIn men, the best HPA cutoff points to discriminate DAO and DO were, respectively, 80 minutes/week (sensitivity: 100%; specificity: 71.95%) and 145 minutes/week (sensitivity: 100%; specificity: 54.88%). The best SB value for DAO was 351.43 minutes/day (sensitivity: 100%; specificity: 65.85%) and 400 minutes/day (sensitivity: 100%; specificity: 79.27%) for DO. In women, 150 minutes/week was the best HPA value for both DAO (sensitivity: 75%; specificity: 57.84%) and DO (sensitivity: 90.91%; specificity: 56.76%). The best SB cutoff points for DAO and DO were 381.43 minutes/day (sensitivity: 60%; specificity: 82.35%) and 337.14 minutes/day (sensitivity: 72.73%; specificity: 65.80%), respectively. ConclusionBoth HPA and SB demonstrated discriminatory capacity for screening DAO and DO in the study population.

Arthroscopy has a higher discriminative capacity than MRI in detecting mild cartilage lesions.

To determine whether current magnetic resonance imaging (MRI) could detect superficial cartilage lesions that are observed during diagnostic arthroscopy in patients with knee pain who have not been diagnosed with joint disease. Adult patients with knee pain of unclear origin lasting more than three months, scheduled for a therapeutic/diagnostic arthroscopy were recruited. Demographic and clinical data, pain assessment, MRI imaging, and observations of cartilage damage in the medial femoral condyle during arthroscopic procedure were documented. Patients were categorized based on the presence of cartilage damage assessed via MRI and/or direct visualization. Concordance between these assessments and its variation with age and patient-reported pain were examined. Out of the 95 patients recruited, 48 exhibited lesions in the medial femoral condyle (MFC) during arthroscopic examination, while only 24 of them showed lesions on the MRI scans. The thickness of the cartilage in the MFC was significantly lower in patients with cartilage damage detected by MRI compared with those without. Among patients with cartilage lesions identified during arthroscopy, those also showing lesions on the MRI had lower cartilage thickness and higher Outerbridge score than those without lesions on the MRI. Patients with detectable cartilage damage on the MRI were significantly older and reported higher levels of pain than those with damage detected only by arthroscopic examination. Despite significant technological advancements in MRI, arthroscopy still proves superior in identifying mild structural cartilage lesions that are not identifiable by this technique.

Serum sodium concentration predicting mortality in patients with aneurysmal subarachnoid hemorrhage

BackgroundTo date, inconsistent evidence exists on the role of hypernatremia in patients with aneurysmal subarachnoid hemorrhage (aSAH) who underwent surgical clipping. We aimed to investigate the association between serum sodium and mortality in these patients. MethodsA cohort study was performed to include adult patients with aSAH who underwent surgical clipping in a university hospital. The primary outcome was follow-up mortality. Propensity score matching (PSM) was used for matching patients’ baseline characteristics. Net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to assess and compare the reclassification and discrimination capacity of different models. Trends in serum sodium over time were detected by the ordinary least squares model. ResultsOf 618 aSAH patients with surgical clipping during the study period, normal serum sodium was observed in 467 patients (75.6 %), and admission hypernatremia was noted in 151 patients (24.4 %). After adjustment with multivariate regression analysis, patients with hypernatremia had significantly higher odds for follow-up mortality (aOR: 2.86, 95 % CI: 1.54 to 5.30; P = 0.001). PSM analysis observed similar results (aOR: 2.38, 95 % CI: 1.29 to 4.55; P = 0.009). The incorporation of serum sodium during hospitalization markedly enhanced the IDI (P < 0.001) and NRI (P < 0.001) for the prediction of mortality. ConclusionsIn conclusion, the findings from this cohort study of aSAH patients with surgical clipping indicated that serum sodium can be an independent predictive factor of all-cause mortality, and inferior sequelae in aSAH patients. These findings endorsed the importance of managing hypernatremia and monitoring serum sodium in patients with aSAH.

Determining the Prognostic Value of Complete Blood Count Subgroup Parameters in Staphylococcus aureus Bacteremia.

Serum cytokine alterations are associated with increased Staphylococcus aureus bacteremia (SAB) mortality. Unfortunately, clinical use of these cytokines is uncommon due to limited availability and high cost. Complete blood count (CBC) with differential reflects the host immune response, and CBC subgroup parameters may have prognostic value in SAB. We sought to determine the association between CBC subgroup parameters on the day of index blood culture and 30-day all-cause mortality in SAB patients. We conducted a retrospective study of adult SAB patients with infectious diseases consultation to evaluate the discriminatory capacity of CBC subgroup parameters in predicting SAB mortality. Clinical and microbiological data were collected, including severity of illness and CBC subgroup parameters, on the day of index blood culture. The primary outcome was 30-day all-cause mortality. A multivariable logistic regression model was used to determine the association between patient-level variables and mortality. A total of 119 patients were included. The overall 30-day all-cause mortality rate was 10.1%. The median neutrophil-to-lymphocyte count ratio (NLCR) among survivors was 13.6 vs 23.2 among non-survivors (p = .007). Median lymphocyte count among survivors was 0.9 x 103 cells/μL vs 0.6 x 103 cells/μL among non-survivors (p = .031). Median platelet count was higher among survivors than non-survivors (239 x 103 cells/μL vs 171 x 103 cells/μL, respectively; p = .018). All other CBC subgroup parameters were similar between the two groups. Known SAB mortality predictors, including age, were also associated with increased mortality. Lower lymphocyte count was independently associated with increased mortality (adjusted odds ratio [aOR] 0.236, 95% confidence interval [CI] 0.064-0.872), as was higher PITT bacteremia score (aOR 2.439, 95% CI 1.565-3.803). CBC subgroup parameters may have prognostic value in SAB. Additional study is warranted to further ascertain the prognostic value of these readily available laboratory values.

The PANoptosis-related hippocampal molecular subtypes and key biomarkers in Alzheimer’s disease patients

Alzheimer’s Disease (AD) is a neurodegenerative disorder, and various molecules associated with PANoptosis are involved in neuroinflammation and neurodegenerative diseases. This work aims to identify key genes, and characterize PANoptosis-related molecular subtypes in AD. Moreover, we establish a scoring system for distinguishing PANoptosis molecular subtypes and constructing diagnostic models for AD differentiation. A total of 5 hippocampal datasets were obtained from the Gene Expression Omnibus (GEO) database. In total, 1324 protein-encoding genes associated with PANoptosis (1313 apoptosis genes, 11 necroptosis genes, and 31 pyroptosis genes) were extracted from the GeneCards database. The Limma package was used to identify differentially expressed genes. Weighted Gene Co-Expression Network Analysis (WGCNA) was conducted to identify gene modules significantly associated with AD. The ConsensusClusterPlus algorithm was used to identify AD subtypes. Gene Set Variation Analysis (GSVA) was used to assess functional and pathway differences among the subtypes. The Boruta, Least Absolute Shrinkage and Selection Operator (LASSO), Random Forest (RF), and Support Vector Machine Recursive Feature Elimination (SVM-RFE) algorithms were used to select the three PANoptosis-related Key AD genes (PKADg). A scoring model was constructed based on the Boruta algorithm. PANoptosis diagnostic models were developed using the RF, SVM-RFE, and Logistic Regression (LR) algorithms. The ROC curves were used to assess the model performance. A total of 48 important genes were identified by intersecting 725 differentially expressed genes and 2127 highly correlated module genes from WGCNA with 1324 protein-encoding genes related to PANoptosis. Machine learning algorithms identified 3 key AD genes related to PANoptosis, including ANGPT1, STEAP3, and TNFRSF11B. These genes had strong discriminatory capacities among samples, with Receiver Operating Characteristic Curve (ROC) analysis indicating Area Under the Curve (AUC) values of 0.839, 0.8, and 0.868, respectively. Using the 48 important genes, the ConsensusClusterPlus algorithm identified 2 PANoptosis subtypes among AD patients, i.e., apoptosis subtype and mild subtype. Apoptosis subtype patients displayed evident cellular apoptosis and severe functionality damage in the hippocampal tissue. Meanwhile, mild subtype patients showed milder functionality damage. These two subtypes had significant differences in apoptosis and necroptosis; however, there was no apparent variation in pyroptosis functionality. The scoring model achieved an AUC of 100% for sample differentiation. The RF PANoptosis diagnostic model demonstrated an AUC of 100% in the training set and 85.85% in the validation set for distinguishing AD. This study identified two PANoptosis-related hippocampal molecular subtypes of AD, identified key genes, and established machine learning models for subtype differentiation and discrimination of AD. We found that in the context of AD, PANoptosis may influence disease progression through the modulation of apoptosis and necrotic apoptosis.

Artificial Intelligence &amp; the Capacity for Discrimination: The Imperative Need for Frameworks, Diverse Teams &amp; Human Accountability

The increasing integration of Artificial Intelligence (AI) in various industries has led to concerns about how these systems can perpetuate discrimination, particularly in fields like employment, healthcare, and public policy. Multiple academic and business perspectives on AI discrimination, focusing on the need for global policy coordination and ethical oversight to mitigate biased outcomes, ask for our technical innovators to create contingencies that will better protect humanity’s experience with AI’s ever-expanding reach. Central to the key constructs such as biased datasets, algorithmic transparency, and the global governance of AI systems can function as a harmful drawback to these systems. Without adequate data governance and transparency, AI systems can perpetuate discrimination. AI's ability to discriminate stems primarily from biased data and the opacity of machine learning models, necessitating proactive research and policy implementation on a global scale. These frameworks must transcend the limitations of the experiences or perspectives of their programmers to ensure that AI innovations are ethically sound and that their use in global organizations adheres to principles of fairness and accountability. This synthesis will explore how these articles advocate for comprehensive, continuous monitoring of AI systems and policies that address both local and international concerns, offering a roadmap for organizations to innovate responsibly while mitigating the risks of AI-driven discrimination.

Psychometric properties of the Functional Literacy Questionnaire among Portuguese adolescents.

Robust tools to assess self-reported adolescent functional health literacy are lacking. In Portugal, the only available tool is the Newest Vital Sign for Portuguese adolescents (NVS-PTeen), though presenting modest validity and reliability properties. A new instrument-the Functional Literacy Questionnaire (FLiQ)-was developed, inspired by the NVS-PTeen, but following the European Regulation for food labeling and targeting a balanced assessment of numeracy and verbal comprehension skills. This study aimed to evaluate several psychometric properties of the FLiQ when administered to Portuguese adolescents. We conducted a longitudinal observational study with three phases: (1) Delphi panel with health literacy experts; (2) self-administration of FLiQ and NVS-PTeen to adolescents in 7th to 9th grades; and (3) re-administration of FLiQ four weeks after baseline, to the same group of participants. FLiQ's content validity was excellent, with an Average-Content Validity Index of .95. Overall, 372 adolescents (50.3% girls) aged between 12-17 years (median age: 13) participated in the study. Of these, 150 completed the test-retest assessment. Internal consistency was good (Kuder-Richardson Fornula-20 = .70), as well as test-retest reliability (Intraclass Coefficient Correlation = .82). FLiQ total score was weakly correlated with the school year (rho = .174), and moderately with Portuguese (rho = .348) and Mathematics grades (rho = .333). Factor analysis indicated a two-dimension structure, reflecting numeracy and verbal comprehension skills. Item response theory analysis revealed differences in difficulty and discrimination capacity among items, all with adequate fit values. FLiQ is a valid and reliable tool. It can be used to monitor functional health literacy levels in Portuguese adolescents.

The biomarkers associated with non-dipper pattern in patients with type 2 diabetes with hypertension.

The non-dipper pattern is present in about 50 percent of patients with type 2 diabetes (T2D) and hypertension, a status associated with more frequent cardiovascular complications and restrained prognosis. This study aimed to identify simple biomarkers that can be used for the classification of dipper and non-dipper individuals with type 2 diabetes and hypertension. 138 consecutive patients with type 2 diabetes mellitus (DM) and hypertension underwent 24-hour ambulatory blood pressure monitoring (ABPM), 54 (39.1%) dippers and 84 (60.9%) non-dippers; CBC and determinations of different biomarkers, as well as their ratio was also performed, for comparing the two dipper profiles. The different dipper profiles were established by ABPM, which highlights the mean arterial pressure (MAP), the mean heart rate (MHR), and the mean pulse pressure (MPP). The area under the receiver operating characteristic curve (AUC) was used to evaluate the ability of biomarkers to differentiate dippers from non-dippers. The study included 54 dipper and 84 non-dipper patients. The median age was 64 years (interquartile range 58-74), ranging from 24 to 85 years. The comparison between dipper and non-dipper in patients with type 2 diabetes and hypertension concerning different biomarkers found only two that were statistically significant: triglycerides to hemoglobin A1c (HbA1c) ratio and triglycerides to glucose ratio. For both biomarkers, the dippers had higher values than non-dippers. The best AUCs were found for triglycerides (Trig) to glucose ratio of 0.774 (95% confidence interval 0.601 - 0.92), statistically significant, followed at a distance by lymphocytes, platelets-lymphocytes ratio (PLR), platelet distribution width (PDW-SD), mean platelet volume (MPV) /Lymphocytes, and others, none of them being statistically significant. This study offers valuable insights into the classification of dipper and non-dipper individuals with type 2 diabetes and hypertension using several biomarkers. Notably, the triglyceride-to-glucose ratio appeared as a significant marker with considerable discriminative capacity, indicating its potential therapeutic value in risk stratification and personalized treatment strategies.

Monocyte to high-density lipoprotein cholesterol ratio reflects the peripheral inflammatory state in parkinsonian disorders

BackgroundIn Parkinson’s disease (PD) and Parkinson plus syndrome (PPS), inflammation is recognized as a relevant or contributing factor in the advancement of the diseases. For this reason, numerous biomarkers signaling immune alteration in both the central and peripheral nervous systems have been evaluated in PD and PPS. Nonetheless, the comprehensive inflammatory indices derived from readily available standard blood tests in PD, PPS, and healthy controls (HC) were rarely evaluated especially in the early stage of the diseases. ObjectiveThe aim of this study is to explore the serum level of peripheral inflammatory markers among the patients and investigate whether these markers contribute to symptoms. MethodClinical data and blood test results from drug naïve, early-stage 139 PD and 87 PPS patients, along with 139 age- and sex-matched healthy controls (HC) to PD were enrolled, with exclusion criteria applied to conditions potentially affecting inflammation. The study examined the disparities in peripheral inflammation among the groups, using total and subpopulation of white blood cells (WBCs), platelet count, red cell distribution width (RDW), high-density lipoprotein cholesterol (HDL-C), and other composite values reflecting inflammation including RDW to platelet ratio (RPR), neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), neutrophil to HDL-C ratio (NHR), monocyte to HDL-C ratio (MHR), lymphocyte to HDL-C ratio (LHR), platelet to HDL-C ratio (PHR), systemic inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI). ResultThe MHR values were significantly higher in both PD and PPS groups compared to HC (p < 0.001), and NHR was significantly higher in the PPS group only compared to the HC group (p < 0.001). However, no significant differences in all the inflammatory markers were observed between PPS and PD (p > 0.05). Subgroup analysis of progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) patients revealed significantly higher NHR and MHR levels compared to the HC group (p = 0.025, p = 0.050, respectively), with no significant difference among PSP, MSA, and PD groups. After adjustment for age, sex, and disease duration, MHR was positively associated with H&Y in the total population (β = 0.288, p < 0.001), negatively associated with MMSE in the PD group (β = −0.245, p = 0.017), and positively associated with both H&Y (β = 0.432, p < 0.001) and UPDRS part II (β = 0.295, p = 0.018) in PPS group. ConclusionNHR and MHR values are not effective as reliable diagnostic markers due to overlap among groups and their limited discriminative capacity in ROC analyses. However, MHR may potentially serve as an indicator reflecting peripheral inflammation in the early stage of PD and PPS compared to HC.

Ergonomic adequacy of university tablet armchairs for male and female: A multigroup item response theory analysis

Brazilian university tablet armchairs, often based on international standards, may not suit students well due to anthropometric differences between sexes. This study developed a scale to compare ergonomic adequacy for male and female students, with the potential to significantly impact the future of school furniture. A closed-ended questionnaire containing a four-point Likert scale was administered to 258 students, covering aspects such as seat, backrest, tablet arm, extension, material holder, and general features. The questionnaire's discriminatory capacity and item difficulty were assessed using the Multigroup Item Response Theory. The items presented satisfactory values of factor loading (F>0.3), commonality (h2>0.2), discrimination (ai>0.7), and difficulty (bi) ∈ [-4.105;4.208]. Furthermore, the items cover information in a good region above and below the mean (-4 <θ < 4) for both genders. The scale presented eight levels ranging from no adequacy (θ ≤ 29.99) to maximum adequacy (θ ≥ 90.00). Male and female exhibited different response patterns, indicating opportunities for furniture improvement for each gender. For example, female often disagree more strongly with ergonomic characteristics at lower levels than male, particularly regarding seat height and backrest width. Male and female responded differently, suggesting varied adequacy needs even at the same adequacy level. These findings could guide Brazilian manufacturers and regulators in producing school furniture considering students' diverse body dimensions and comfort, quality, and safety perceptions.

Measures of angularity in digital images.

In light of the growing interest in studying the affective and aesthetic attributes of curvature, the present paper describes four digital image processing techniques that can be used to objectively discriminate between angular and curvilinear stimuli. MATLAB scripts for each of the techniques accompany the paper. Three studies are then reported that evaluate the efficacy of five metrics, derived from the four techniques, at quantifying the degree of angularity depicted in an image. Images of simple polygons (Study 1), artistic drawings of everyday objects (Study 2), and real-world objects, typefaces, and abstract patterns (Study 3) were analyzed. Logistic regression models were used to determine the relative importance of the metrics at distinguishing between angular and curvilinear items. With one exception, all of the metrics were capable of distinguishing between angular and curvilinear items at a level above chance, but some metrics were better at doing so than others, and their discriminative capacity was influenced by the characteristics of the image. The strengths and limitations of the metrics are discussed, as well as some practical recommendations.