Logistic Regression Curve Research Articles

Causality between sarcopenia and diabetic neuropathy.

Past studies have demonstrated that diabetic neuropathy is related to sarcopenia, but the further causal relation is still unclear. We sought to investigate the causal relationship by combining data from cross-sectional and Mendelian randomization (MR) studies. The genome-wide association studies data were collected from the UK Biobank and the European Working Group on Sarcopenia to conduct a bi-directional two-sample MR study to explore the causality between diabetic neuropathy and relevant clinical traits of sarcopenia, including appendicular lean mass (ALM), walking speed and low hand grip strength. The inverse-variance weighted and various sensitivity analyses were used to obtain MR estimates. We also enrolled a total of 196 Type 2 diabetes patients from April 2021 to April 2024 and divided them into the Distal peripheral neuropathy (DPN) group (n=51) and non-DPN group (n=145) via vibration perception threshold (VPT) and neuropathy deficit score. Logistic regression and ROC curve analysis were used to investigate the relationship between DPN and relevant sarcopenia clinical features. According to a forward MR analysis, decreased walking speed (OR: 0.04, 95% confidence interval (CI): 0.01-0.16; P<0.001) and increased ALM (1.25 [1.05-1.50], P=0.012) had a causal effect on developing diabetic neuropathy. According to reverse MR results, developing diabetic neuropathy had a causal effect on decreased walking speed (0.99 [0.99-1.00], P=0.007) and low grip strength (1.05 [1.02-1.08], P<0.001). The cross-sectional study showed that 5-time stand time (P=0.002) and 6-meter walking speed (P=0.009) had an inverse association with DPN. Additionally, we discovered that ASMI (P=0.030) and 5-time stand time (P=0.013) were separate risk factors for DPN.ConclusionThe MR study suggested that diabetic neuropathy may have a causality with relevant clinical traits of sarcopenia, and our cross-sectional study further proved that sarcopenia indexes are predictors of diabetic neuropathy.

Diagnostic Utility of Triglyceride-Glucose Index in Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Study on Lean Population.

Approximately 10-20% of individuals with non-alcoholic fatty liver disease (NAFLD) are lean, and the underlying pathophysiology is not yet understood. This study aims to explore the characteristics and the diagnostic value of triglyceride-glucose index (TyG) in early diagnosis of lean NAFLD. 99 patients with lean NAFLD and 1891healthy controls were included in thehealthexamination. The characteristics were compared between groups. Restricted cubic spline was utilized to analyze the relationship between TyG index and the risk of lean NAFLD. Logistic regression and receiver operating curve (ROC) were applied to explore the diagnostic value of TyG index for lean NAFLD. Overall, 99 (4.97%) patients had lean NAFLD. Patients with lean NAFLD have significant abnormal glycolipid metabolism and higher TyG index. Restriction cube spline analysis showed a significant dose-response relationship between the TyG index and risk of lean NAFLD. After adjusting for confounders, the relationship remained and the risk of developing lean NAFLD increased 2.99 times for per unit increase of TyG index (95% CI: 1.94, 4.67, P<0.001). The areas under the ROC of the TyG index for lean NAFLD detection were 0.851 (0.815 to 0.886). The TyG index is positively associated with the risk of developing lean NAFLD and could be a useful marker for early diagnosis of lean NAFLD.

The association between weight-adjusted-waist index and muscle strength in adults: a population-based study.

The relationship between the weight-adjusted-waist index (WWI) and grip strength, a crucial marker in assessing sarcopenia, lacks clarity. We aimed to explore the relationship between WWI and muscle strength across genders. The cross-sectional study involved adults with complete data on WWI and grip strength from the 2011-2014 National Health and Nutrition Examination Survey. WWI was derived by dividing waist circumference by the square root of weight. Weighted multivariable logistic regression and smooth curve fitting techniques were used to examine the independent association and potential non-linear relationship between WWI and grip strength. A two-piecewise linear regression model was utilized to determine the threshold effect. Additionally, subgroup analyses and interaction tests were conducted. The study encompassed 9,365 participants, including 4,661 males and 4,704 females. Multivariate logistic regression analysis revealed a negative correlation between WWI and grip strength among males (β = -11.49, 95% CI: -12.38, -10.60, p < 0.001) as well as females (β = -2.53, 95% CI: -2.98, -2.08, p < 0.001). Subgroup analysis showed that the negative correlation of WWI with grip strength remained consistent across various age groups and levels of obesity for both males and females. An increase in WWI correlates with reduced muscle strength in both males and females. WWI was negatively associated not only with muscle mass but also with muscle strength. WWI may serve as an assessment tool for sarcopenia, but further large-scale studies are needed to clarify causality.

Time-varying living arrangements and suicide death in the general population sample: 14-year causal survival analysis via pooled logistic regression.

While past research suggested that living arrangements are associated with suicide death, no study has examined the impact of sustained living arrangements and the change in living arrangements. Also, previous survival analysis studies only reported a single hazard ratio (HR), whereas the actual HR may change over time. We aimed to address these limitations using causal inference approaches. Multi-point data from a general Japanese population sample were used. Participants reported their living arrangements twice within a 5-year time interval. After that, suicide death, non-suicide death and all-cause mortality were evaluated over 14 years. We used inverse probability weighted pooled logistic regression and cumulative incidence curve, evaluating the association of time-varying living arrangements with suicide death. We also studied non-suicide death and all-cause mortality to contextualize the association. Missing data for covariates were handled using random forest imputation. A total of 86,749 participants were analysed, with a mean age (standard deviation) of 51.7 (7.90) at baseline. Of these, 306 died by suicide during the 14-year follow-up. Persistently living alone was associated with an increased risk of suicide death (risk difference [RD]: 1.1%, 95% confidence interval [CI]: 0.3-2.5%; risk ratio [RR]: 4.00, 95% CI: 1.83-7.41), non-suicide death (RD: 7.8%, 95% CI: 5.2-10.5%; RR: 1.56, 95% CI: 1.38-1.74) and all-cause mortality (RD: 8.7%, 95% CI: 6.2-11.3%; RR: 1.60, 95% CI: 1.42-1.79) at the end of the follow-up. The cumulative incidence curve showed that these associations were consistent throughout the follow-up. Across all types of mortality, the increased risk was smaller for those who started to live with someone and those who transitioned to living alone. The results remained robust in sensitivity analyses. Individuals who persistently live alone have an increased risk of suicide death as well as non-suicide death and all-cause mortality, whereas this impact is weaker for those who change their living arrangements.

Association between the composite dietary antioxidant index and constipation: Evidence from NHANES 2005-2010.

Dietary antioxidants have been found to improve various diseases, including digestive, cardiovascular, and urinary disorders. However, the relationship between CDAI and constipation remains unclear. This study aims to investigate the potential link between CDAI and constipation among adults in the United States. This study utilized data from the National Health and Nutrition Examination Survey (NHANES) collected between 2005 and 2010. Dietary data from the respondents were obtained through two 24-hour dietary recall interviews. Multiple statistical methods, including multivariable logistic regression, subgroup analysis, and smooth curve fitting analysis, were used to explore the association between CDAI and chronic constipation. A total of 10,904 participants were included in the study, of whom 1,184 were identified as having chronic constipation. After adjusting for potential confounders, multivariable logistic regression analysis showed that higher CDAI was significantly associated with a lower risk of constipation (OR = 0.958 [0.929, 0.987]). Compared to the lowest quartile, the highest quartile of CDAI was associated with a significantly reduced prevalence of constipation (OR = 0.704 [0.535, 0.927]). Subgroup analysis indicated that differences in gender, alcohol intake, and smoking status might influence the association between CDAI and constipation. Smooth curve analysis revealed an "n" shaped relationship between CDAI and constipation among non-alcohol consumers, with a turning point at a CDAI value of 1.08. An elevated CDAI is negatively correlated with the incidence of chronic constipation, suggesting that increasing dietary antioxidant intake may reduce constipation prevalence. These findings underscore the importance of dietary antioxidants in maintaining gut health and provide comprehensive guidance for clinical and public health practices.

Influence of Neonatal Ankyloglossia on exclusive breastfeeding in the six first months of life: a cohort study.

To analyze the influence of ankyloglossia on the prevalence and duration of exclusive breastfeeding of full-term infants up to the sixth month of life. Prospective cohort study, carried out with 225 mother-infant dyads who were followed up in the first six months of life in a center specialized in breastfeeding in a tertiary hospital. Full-term infants with asymptomatic ankyloglossia (no need for surgery) were compared with infants without change at monthly follow-up. Ankyloglossia was diagnosed using the Bristol Tongue Assessment Tool, with a positive diagnosis being considered for those with a score less than or equal to 5 considering functional and anatomical aspects. Statistical analyzes were performed using descriptive statistics, logistic regression (weaning determinants), relative risk, and survival curves (to analyze breastfeeding duration between groups with and without ankyloglossia). Ankyloglossia was associated with weaning (considered even partial) before the sixth month of life. After adjusted analysis, a higher risk of weaning was detected in infants with this alteration, with a risk present from the second month of life. In the survival analysis, the duration of breastfeeding in infants with ankyloglossia was shorter when compared to children without alterations. Compared to infants with normal lingual frenulum, babies with ankyloglossia had shorter exclusive breastfeeding time, but well above the average observed in the general population. The risk of weaning for this group was also higher.

Influência da Anquiloglossia neonatal na amamentação exclusiva nos seis primeiros meses de vida: estudo de coorte

ABSTRACT Purpose To analyze the influence of ankyloglossia on the prevalence and duration of exclusive breastfeeding of full-term infants up to the sixth month of life. Methods Prospective cohort study, carried out with 225 mother-infant dyads who were followed up in the first six months of life in a center specialized in breastfeeding in a tertiary hospital. Full-term infants with asymptomatic ankyloglossia (no need for surgery) were compared with infants without change at monthly follow-up. Ankyloglossia was diagnosed using the Bristol Tongue Assessment Tool, with a positive diagnosis being considered for those with a score less than or equal to 5 considering functional and anatomical aspects. Statistical analyzes were performed using descriptive statistics, logistic regression (weaning determinants), relative risk, and survival curves (to analyze breastfeeding duration between groups with and without ankyloglossia). Results Ankyloglossia was associated with weaning (considered even partial) before the sixth month of life. After adjusted analysis, a higher risk of weaning was detected in infants with this alteration, with a risk present from the second month of life. In the survival analysis, the duration of breastfeeding in infants with ankyloglossia was shorter when compared to children without alterations. Conclusion Compared to infants with normal lingual frenulum, babies with ankyloglossia had shorter exclusive breastfeeding time, but well above the average observed in the general population. The risk of weaning for this group was also higher.

Association between nocturia and serum albumin in the U.S. adults from NHANES 2005-2012.

Nocturia, a prevalent chronic condition, impacts individuals' quality of life but remains underexplored. This study aimed to assess the association between serum albumin levels and nocturia. Based on the analysis of the National Health and Nutrition Examination Survey (NHANES) database (2005-2012), our study included a total of 6345 adults (≥20 years old). Nocturia was defined as ≥2 nocturnal voiding episodes. Logistic regression and smooth curve fitting analyzed the linear and nonlinear correlations between serum albumin and nocturia, with subgroup analysis. Among 6345 participants, 1821 (28.7%) experienced nocturia. Logistic regression analysis revealed a linear negative correlation between serum albumin and nocturia risk (OR = 0.9549, 95% CI = 0.9280 ~ 0.9827, P = 0.002). Even after quartile division of serum albumin concentration, this correlation persisted within each group, and a smooth curve fitting validated the nonlinear negative correlation between the two. Subgroup analysis further demonstrated significant impacts of body mass index (BMI), alcohol consumption, and age on this association. This cross-sectional study indicated that higher serum albumin levels were associated with a reduced risk of nocturia in U.S. adults aged 20 and older, highlighting the importance of serum albumin in the prevention and treatment of nocturia and providing clinical guidance.

The relationship between multimorbidity and cognitive function in older Chinese adults: based on propensity score matching.

The goal of this study was to further validate the effect of multimorbidity on cognitive performance in older adults after controlling for confounders using propensity score matching (PSM). A cross-sectional survey of older adult people aged 60 years or older selected by convenience sampling was conducted in seven medical institutions, three communities, and five nursing homes in Zunyi City, Guizhou Province. The data collected included general information, health-related information, and Mini-Mental State Examination (MMSE) scores. Variables were controlled for confounders by PSM to analyze differences in cognitive ability between multimorbidity and nonmultimorbidity older adults. Logistic regression and multivariate-adjusted restricted cubic spline (RCS) curves for matched samples were used to assess the relationship between multimorbidity and cognitive decline. A total of 14,175 respondents were enrolled, and the mean age of the participants included in this study was 71.26 ± 7.1 years, including 7,170 (50. 58%) of the participants were males, 7,005 (49.42%) were females, and 5,482 participants (38.67%) were screened for cognitive decline. After PSM, logistic regression analysis revealed that multimorbidity was a risk factor for cognitive decline (OR = 1.392, 95% CI = 1.271-1.525, p < 0.001). The RCS show that the risk of cognitive decline is always greater in older adults with multimorbidity than in older adults without multimorbidity at the same age. Age, sex, marital status, educational level, monthly income, drinking status, participation in social activities, and exercise were influential factors for cognitive decline in older adults (p < 0.05). The incidence of cognitive decline in older adults with multimorbidity was also greater than that in older adults with one chronic disease (p < 0.001). The risk of cognitive decline in older adults with multimorbidity is greater than that in older adults without multimorbidity; therefore, the government should strengthen the prevention and treatment of multimorbidity in older adults to further protect their cognitive abilities.

Influence of H19 polymorphisms on breast cancer: risk assessment and prognostic implications via LincRNA H19/miR-675 and downstream pathways.

Breast cancer, as the most prevalent malignancy among women globally, continues to exhibit rising incidence rates, particularly in China. The disease predominantly affects women aged 40 to 60 and is influenced by both genetic and environmental factors. This study focuses on the role of H19 gene polymorphisms, investigating their impact on breast cancer susceptibility, clinical outcomes, and response to treatment. We engaged 581 breast cancer patients and 558 healthy controls, using TaqMan assays and DNA sequencing to determine genotypes at specific loci (rs11042167, rs2071095, rs2251375). We employed in situ hybridization and immunohistochemistry to measure the expression levels of LincRNA H19, miR-675, MRP3, HOXA1, and MMP16 in formalin-fixed, paraffin-embedded samples. Statistical analyses included chi-squared tests, logistic regression, and Kaplan-Meier survival curves to evaluate associations between genetic variations, gene expression, and clinical outcomes. Genotypes AG at rs11042167, GT at rs2071095, and AC at rs2251375 were significantly associated with increased risk of breast cancer. Notably, the AA genotype at rs11042167 and TT genotype at rs2071095 were linked to favorable prognosis. High expression levels of LincRNA H19, miR-675, MRP3, HOXA1, and MMP16 in cancer tissues correlated with advanced disease stages and poorer survival rates. Spearman correlation analysis revealed significant positive correlations between the expression of LincRNA H19 and miR-675 and specific genotypes, highlighting their potential regulatory roles in tumor progression. The study underscores the critical roles of LincRNA H19 and miR-675 as prognostic biomarkers in breast cancer, with their overexpression associated with disease progression and adverse outcomes. The H19/LincRNA H19/miR-675/MRP3-HOXA1-MMP16 axis offers promising targets for new therapeutic strategies, reflecting the complex interplay between genetic markers and breast cancer pathology. The findings confirm that certain H19 SNPs are associated with heightened breast cancer risk and that the expression profiles of related genetic markers can significantly influence prognosis and treatment response. These biomarkers hold potential as targets for personalized therapy and early detection strategies in breast cancer, underscoring the importance of genetic research in understanding and managing this disease.

Evaluation of the combined predictive value of multiple indicators based on diaphragmatic ultrasound using logistic regression and ROC curve in weaning from mechanical ventilation in pediatric patients.

Conventional single indicators have low sensitivity and specificity for predicting weaning from mechanical ventilation in pediatric patients, necessitating the establishment of a combined prediction model for predicting weaning outcomes. To explore the combined predictive value of PaO2/FiO2 Ratio (P/F ratio), diaphragm excursion-rapid shallow breathing index (DE-RSBI), diaphragm thickening fraction-rapid shallow breathing index (DTF-RSBI), and Pediatric Critical Illness Score (PCIS) in weaning from mechanical ventilation in pediatric patients. Sixty critically ill pneumonia pediatric patients requiring mechanical ventilation treatment from July 2022 to June 2023 at the Second Affiliated Hospital of Jiaxing University were selected. They all underwent a spontaneous breathing trial (SBT) and were divided into the weaning success group (42 cases) and weaning failure group (18 cases) based on the weaning outcome. Parameters including total duration of illness, mechanical ventilation duration, heart rate (HR), P/F ratio, diaphragm excursion (DE), DE-RSBI, diaphragm thickening fraction (DTF), DTF-RSBI, and PCIS were included in univariate and multivariate logistic regression analyses to determine independent factors affecting pediatric weaning success. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of P/F ratio, DE-RSBI, DTF-RSBI, PCIS alone or in combination for weaning success. Comparing P/F ratio, DE, DE-RSBI, DTF, DTF-RSBI and PCIS, there were statistically significant differences (P < 0.05). Through collinearity analysis and binary logistic regression analysis,P/F ratio [OR = 0.777, 95% CI (0.641,0.941)], DE-RSBI [OR = 1.694, 95% CI (1.172, 2.447)], DTF-RSBI [OR = 1.057, 95% CI (1.002, 1.114)], and PCIS [OR = 0.661, 95% CI (0.445, 0.982)] were identified as independent factors affecting successful weaning(P < 0.05).The regression equation was: LogitP = 73.299-0.253 P/F ratio + 0.525DE-RSBI + 0.055DTF-RSBI-0.43PCIS.The sensitivity of the combined indicator Logit(P) in predicting successful weaning from mechanical ventilation in pediatric patients was 88.9%, with a specificity of 95.2% (optimal cutoff value of 0.511), and the area under the ROC curve (AUC) was 0.960 [95% CI (0.915, 1.000)]. The AUC of the combined prediction model for predicting pediatric weaning was greater than that of P/F ratio, DE-RSBI, DTF-RSBI and PCIS alone (Z values = 9.129, 2.061, 2.075, 8.326, P < 0.05). In mechanically ventilated pediatric patients, the combined prediction model has better predictive value for weaning success compared to using P/F ratio, DE-RSBI, DTF-RSBI, or PCIS alone.

INEQUALITY IN AWARENESS, TREATMENT, AND CONTROL OF VISUAL IMPAIRMENTS AMONG OLDER ADULTS AND ELDERLY IN INDIA

Abstract Globally, 1.1 billion people have some form of visual impairment, and 90 percent of them live in low and middle-income countries. The prevalence of visual impairment is increasing, and the likelihood of increasing this trend is also higher. Yet, there is little evidence on the extent of awareness, treatment, and control (ATC) of visual impairment in India. We estimate the prevalence and ATC of visual impairment among older adults and the elderly across socioeconomic groups. We used the unit data from the first round of the Longitudinal ageing study of India (LASI), 2017-18, bivariate analysis, estimated age sex-adjusted prevalence, logistic regression, concentration index, and concentration curve used in the analyses. Among the 45+ population, 30.18% have any form of visual impairment, around 47.96% have awareness about the visual impairment, 17.21% have taken treatment for vision-related issues, and 12.70% have control vision after treatment. The prevalence was higher among the illiterate poor and females; however, the awareness, treatment, and control were higher among those with higher education who belongs to the richer richest wealth quintile. The concentration index and concentration curve suggest that higher prevalence was concentrated among the poor, and contrary to that, awareness treatment and control were concentrated among richer. To deal with it, public health services from the primary, secondary, and tertiary levels may be integrated for effective care of growing, underdiagnosed, and untreated visual impairments among older adults and the elderly in India.

Association of carotid atherosclerotic plaque and intima-media thickness with the monocyte to high-density lipoprotein cholesterol ratio among low-income residents of rural China: a population-based cross-sectional study

BackgroundThe monocytes to high-density lipoprotein cholesterol ratio (MHR) has been identified as a potential biomarker for cardiovascular and cerebrovascular diseases. In this population-based cross-sectional study, we explored the relationships among carotid artery disease (CAD), including the presence of carotid atherosclerotic plaque (CAP) and carotid artery intima-media thickness (CIMT), the MHR, and related parameter changes.MethodsThis cross-sectional study, Conducted from April to June 2019 in a rural area of Tianjin, involved middle-aged and elderly participants. Based on carotid ultrasound examinations, participants were divided into CAP and non-CAP groups. Logistic regression and Receiver Operating Characteristic (ROC) curve analyses were utilized to assess MHR’s predictive value for CAP. Gender-specific analyses were also performed to examine predictive variations. The relationship between CIMT and MHR was evaluated using linear regression.ResultsOf the 2109 participants meeting the inclusion criteria, 51.6% were identified with CAP. Multivariate analysis revealed a significant association between MHR and CAP prevalence, (OR, 9.670; 95% CI, 2.359–39.631; P = 0.002), particularly in females (OR, 5.921; 95% CI, 1.823–19.231; P = 0.003), after adjusting for covariates. However, no significant correlation was found between CIMT and MHR when adjusted for other factors. The ROC analysis showed the area under the curve for MHR and CAP to be 0.569 (95% CI: 0.544–0.593; P < 0.001).ConclusionsThese findings suggested that it is crucial to enhance early screening and intervention for CAD, specifically focusing on the prevention and progression of CAP, to address the unique health challenges faced by low-income groups in rural settings. Emphasizing these preventive measures could significantly contribute to improving cardiovascular health outcomes in this vulnerable population.

Is prehospital physical performance a predictor of functional capacity decline at discharge in hospitalized Brazilian older adults?

BackgroundHospitalization contributes to functional decline in older adults. ObjectiveTo assess the relationship between physical performance on admission and functional capacity and functional capacity decline at discharge, and to investigate tools capable of predicting this decline. MethodsProspective longitudinal study with 75 older adults admitted to a public hospital between July 2021 and February 2022. The independent variable was physical performance evaluated on admission by handgrip strength (HGS) and the Short Physical Performance Battery (SPPB). The dependent variables were functional capacity for basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs) and their decline between admission and discharge. Statistical analyses were performed using linear and logistic regression and ROC curves. ResultsThe median time between admission and participant assessment was 1 day (IQR=1–2 days). Median hospitalization time was 18 days (IQR= 7.5–30 days). Functional capacity for BADLs and IADLs declined in 39% and 79% of the participants, respectively. Performance in HGS and the SPPB at baseline, in adjusted models, explained 29.3 to 35.3% of functional capacity at discharge. One additional point in the SPPB decreased the risk of functional capacity decline for BADLs by 20.9% (OR=0.79, 95% CI: 0.68, 0.91). The AUC values for the SPPB (AUC=0.67) and HGS (AUC=0.65) were significant in identifying functional decline for BADLs, but not IADLs. ConclusionIn Brazilian older adults, physical performance on admission was related to functional capacity and its decline at discharge. Physical performance on admission is predictive of functional decline at discharge.

Validating the association of Oxford classification and renal function deterioration among Taiwanese individuals with Immunoglobulin A nephropathy

Validation of the Oxford classification (MEST and MEST-C) for Immunoglobulin A nephropathy (IgAN) in the Taiwanese population is lacking. Our study aimed to validate this classification and assess individual lesion impact. We conducted a retrospective cohort study at Taichung Veterans General Hospital, Taiwan (Jan 2011–Jul 2023). Composite renal outcomes were evaluated using clinical conditions and estimated glomerular filtration rate (eGFR). We used Kaplan–Meier, univariable/multivariable logistic regression and ROC curves. Subgroup analysis considered eGFR < or ≥ 30.0 ml/min/1.73 m2. In 366 renal biopsies, serum creatinine was 1.34 mg/dl, eGFR 53.8 ml/min/1.73 m2, urine protein–creatinine ratio 1159 mg/g. T1/T2 lesions had lowest baseline eGFR (39.6/11.5 ml/min/1.73 m2), correlating with poorest renal survival (median survival 54.7/34.4 months). Univariable analysis linked all individual variables to worse renal outcomes. Multivariable analysis (MEST/MEST-C) showed only T1/T2 linked to worse outcomes. T score had highest predictive power (AUC 0.728, sensitivity 60.2%, specificity 83.6%), with MEST having high AUC (0.758). No extra predictive power was seen transitioning MEST to MEST-C. Subgroup analysis (eGFR < 30.0 ml/min/1.73 m2) associated C1 with improved renal outcomes (odds ratio 0.14, 95% CI 0.03–0.65). T lesion correlated with worse outcomes across subgroups. The T lesion consistently correlated with worse renal outcomes across all groups and baseline statuses. Integrating the C lesion into the transition from MEST to MEST-C did not enhance predictive power. Importantly, the C1 lesion was linked to improved renal outcomes in the eGFR < 30.0 ml/min/1.73 m2 subgroup, likely due to treatment effects.

Tau‐PET to predict conversion from mild cognitive impairment to dementia; a head‐to‐head comparison against amyloid‐PET and MRI

AbstractBackgroundIn contrast to amyloid‐PET and MRI, tau‐PET imaging has not been integrated into clinical practice even though it shows a close relationship with clinical symptoms. With the present study, we aim to assess the performance of tau‐PET to predict conversion to dementia (all‐cause and AD) in individuals with mild cognitive impairment (MCI), and compare it with amyloid‐PET and MRI.MethodWe selected participants from an ongoing multicenter study (n = 408, Table 1). The following ROIs were used to define quantified thresholds for positivity using an independent cognitively unimpaired reference group: a temporal meta‐region for tau‐PET and an AD‐susceptible temporoparietal region for MRI‐based cortical thickness. For amyloid‐PET, we used the standard Centiloid mask and a published threshold of 27 Centiloids to determine positivity. We additionally performed visual reads for all imaging modalities. We used Cox proportional hazard, logistic regression, and receiver operating curve (ROC) analyses to assess the performance of amyloid‐PET (A), tau‐PET (T), and MRI (N) to predict progression from MCI to dementia over a mean follow‐up period of 2 years.ResultHazard ratios indicated that tau‐PET and amyloid‐PET positivity (both when assessed quantitatively and using visual reads) conveyed a greater risk of progression to dementia than MRI, and that a combination of A+ and T+ (or N+) conveyed a greater risk than A‐T‐N‐ or isolated A+ or T+ (Figure 1). ROC analyses revealed that only tau‐PET performed better than demographics alone when predicting all‐cause dementia while both amyloid‐ and tau‐PET performed better than demographics and MRI when predicting AD dementia. LASSO logistic regression revealed that the optimal model to predict conversion from MCI to all‐cause dementia included a quantitative MRI marker and tau‐PET visual read. For optimal prediction of AD dementia specifically, the quantitative measure of amyloid‐PET was added in addition to the quantitative MRI marker and the tau‐PET visual read (Table 2).ConclusionAmong individuals with MCI, tau‐PET performs best when predicting dementia, and can be optimized when combined with MRI. For AD dementia, tau‐PET and amyloid‐PET are the best‐performing modalities, but an optimal prediction is again achieved when combined with MRI.

A logarithm derived from Mokken scaling analysis of the Addenbrooke’s Cognitive Examination–Revised discriminates with high accuracy Alzheimer’s disease from behavioral variant frontotemporal dementia

AbstractBackgroundThe ACE‐R is an accurate and brief cognitive battery for the detection of mild dementia, especially for the discrimination between Alzheimer’s disease (AD) and behavioral variant frontotemporal dementia (bvFTD). The aim of this study was to develop a logarithm based on discriminative items of the ACE‐R for AD combined with relevant demographic characteristics that may help to differentiate AD from bvFTD.MethodThe ACE‐R was administered to 102 patients with mild dementia due to probable AD and 37 patients with mild bvFTD from two Brazilian research centers. All individuals were submitted to the Mattis Dementia Rating Scale (DRS) and the ACE‐R. The performance of the patients was compared and analyzed. Mokken scaling analysis was applied to identify the latent trait on the AD Group, and later, multivariate logistic regression and ROC curve analysis were carried out to assess the ACE‐R’s ability to discriminate AD and bvFTD.ResultMean ± SD total scores in the ACE‐R were 70.2 ± 10.8 in AD and 72.2 in bvFTD. AD Mokken ACE‐R (MokACE‐R‐AD) comprises 12 items measuring the same latent concept. In our sample, logistic regression with cross‐validation pointed that MokACE‐R‐AD, Age, Male sex, and items Orientation to time and location and the item of Memory (name and address recall) share importance as independent variables (p&lt;0.05) to differentiate AD from bvFTD. The proposed logarithm reached an area under the ROC curve of 0.922, with 88% sensitivity, 88% specificity, 71% PPV and 96% NPV.ConclusionThe new logarithm using the ACE‐R items achieved high diagnostic accuracy in identifying mild AD versus bvFTD. Furthermore, the final ROC curves showed the superiority of the model proposed in relation to the analysis of the subscales individually or the VLOM ratio, as the literature previously reported. Further analysis in larger samples, with biomarkers or pathological confirmation, are necessary to confirm these findings.

Tau‐PET to predict conversion from mild cognitive impairment to dementia; a head‐to‐head comparison against amyloid‐PET and MRI

AbstractBackgroundIn contrast to amyloid‐PET and MRI, tau‐PET imaging has not been integrated into clinical practice even though it shows a close relationship with clinical symptoms. With the present study, we aim to assess the performance of tau‐PET to predict conversion to dementia (all‐cause and AD) in individuals with mild cognitive impairment (MCI), and compare it with amyloid‐PET and MRI.MethodWe selected participants from an ongoing multicenter study (n = 408, Table 1). The following ROIs were used to define quantified thresholds for positivity using an independent cognitively unimpaired reference group: a temporal meta‐region for tau‐PET and an AD‐susceptible temporoparietal region for MRI‐based cortical thickness. For amyloid‐PET, we used the standard Centiloid mask and a published threshold of 27 Centiloids to determine positivity. We additionally performed visual reads for all imaging modalities. We used Cox proportional hazard, logistic regression, and receiver operating curve (ROC) analyses to assess the performance of amyloid‐PET (A), tau‐PET (T), and MRI (N) to predict progression from MCI to dementia over a mean follow‐up period of 2 years.ResultHazard ratios indicated that tau‐PET and amyloid‐PET positivity (both when assessed quantitatively and using visual reads) conveyed a greater risk of progression to dementia than MRI, and that a combination of A+ and T+ (or N+) conveyed a greater risk than A‐T‐N‐ or isolated A+ or T+ (Figure 1). ROC analyses revealed that only tau‐PET performed better than demographics alone when predicting all‐cause dementia while both amyloid‐ and tau‐PET performed better than demographics and MRI when predicting AD dementia. LASSO logistic regression revealed that the optimal model to predict conversion from MCI to all‐cause dementia included a quantitative MRI marker and tau‐PET visual read. For optimal prediction of AD dementia specifically, the quantitative measure of amyloid‐PET was added in addition to the quantitative MRI marker and the tau‐PET visual read (Table 2).ConclusionAmong individuals with MCI, tau‐PET performs best when predicting dementia, and can be optimized when combined with MRI. For AD dementia, tau‐PET and amyloid‐PET are the best‐performing modalities, but an optimal prediction is again achieved when combined with MRI.

102. Assessing ChatGPT Performance in the Brazilian Infectious Disease Specialist Certification Examination

Abstract Background Advances in artificial intelligence have the potential to impact medical fields, including the use of natural language processing-based models, such as ChatGPT. The ability of the ChatGPT to provide insightful responses across diverse fields of expertise could assist in medical decision-making and knowledge management processes. ChatGPT has already demonstrated high accuracy in medical examinations such as the USMLE. To explore the potential of this tool in various contexts, our study aimed to evaluate the accuracy of the ChatGPT in the 2022 Brazilian Infectious Disease Specialist Certification Examination. Methods We conducted a test to evaluate the performance of GPT-3.5 and GPT-4 on the 2022 Brazilian Infectious Disease Specialist Certification Exam. A theoretical exam, consisting of 80 multiple-choice questions with five alternatives, was used to test performance. The GPT was given a command containing the question statement and alternatives, and a brief comment on the logic behind the answer was requested. Descriptive statistics were used to analyze the absolute performance of the correct answers in the ChatGPT-3.5 and ChatGPT-4 models. In addition, the degree of correlation between answers and performance throughout the test was estimated using Spearman's coefficient and a logistic regression curve, respectively. Results Of the 80 questions in the exam, four were excluded because they were invalidated in the final answer key. ChatGPT-3.5 had an accuracy of 53.95% (41/76), whereas ChatGPT-4 had an accuracy of 73.68% (56/76). Spearman's correlation coefficient between the two models was 0.585. There was a slight trend towards improvement in ChatGPT-4 performance throughout the test, as observed in the logistic regression curve. Comparison of Accuracy between ChatGPT 3.5 and ChatGPT4 The graph shows the percentage of accuracy for the two GPT models. The performance of ChatGPT-4 was superior to ChatGPT-3.5. Distribution of Correct and Incorrect Responses by ChatGPT-4 in Medical Test Questions The graph displays the distribution of responses generated by ChatGPT-4. The logistic regression curve shows a slight upward trend, indicating a slight improvement in performance as the questions were answered. Conclusion ChatGPT-4 achieved performance above the 60% minimum threshold required for the certification exam. This indicates that it is a promising technology in various fields, including infectious diseases. However, its potential applications and associated ethical dilemmas must be thoroughly assessed. This advancement also highlights the need for medical education to concentrate on developing competence, skills, and critical thinking rather than relying solely on memorization Disclosures All Authors: No reported disclosures

The identification of novel stroke-related sphingolipid biomarkers using UPLC-MS/MS

BackgroundStroke is a prominent contributor to global mortality and morbidity, thus necessitating the establishment of dependable diagnostic indicators. The objective of this study was to ascertain metabolites linked to sphingolipid metabolism and assess their viability as diagnostic markers for stroke. MethodsTwo cohorts, consisting of 56 S patients and 56 healthy volunteers, were incorporated into this investigation. Metabolite data was obtained through the utilization of Ultra Performance Liquid Chromatography and Tandem Mass Spectrometry (UPLC-MS/MS). The mass spectrometry data underwent targeted analysis and quantitative evaluation utilizing the multiple reaction monitoring mode of triple quadrupole mass spectrometry. Various data analysis techniques, including Orthogonal Partial Least Squares-Discriminant Analysis (OPLS-DA), least absolute shrinkage and selection operator (LASSO) regression, Support Vector Machine (SVM), logistic regression, and Receiver Operating Characteristic (ROC) curves were employed. ResultsA comprehensive analysis detected a total of 129 metabolites related to sphingolipid metabolism, encompassing ceramides, 1-phosphoceramides, phytoceramides, glycosphingolipids, sphingomyelins, and sphingomyelins. The implementation of OPLS-DA analysis revealed significant disparities between individuals with stroke and controls, as it successfully identified 31 metabolites that exhibited significant differential expression between the two groups. Furthermore, functional enrichment analysis indicated the participation of these metabolites in diverse biological processes. Six metabolic markers, namely CerP(d18:1/20:3), CerP(d18:1/18:1), CerP(d18:1/18:0), CerP(d18:1/16:0), SM(d18:1/26:1), and Cer(d18:0/20:0), were successfully validated as potential diagnostic markers for stroke. The utilization of ROC analysis further confirmed their diagnostic potential, while a logistic regression model incorporating these markers demonstrated robust efficacy in distinguishing stroke patients from healthy controls. Conclusionthese identified metabolic markers exhibit clinical significance and hold promise as valuable tools for the diagnosis of stroke.