Multivariate Binary Logistic Regression Analysis Research Articles

Predictive value of serum β2-microglobulin in cardiac valve calcification in maintenance hemodialysis patients.

Cardiac valve calcification (CVC) is associated with adverse cardiovascular events. We studied the risk factors of CVC in maintenance hemodialysis (MHD) patients and the value of serum β2-microglobulin (β2-MG) levels in predicting the incidence of CVC. β2-MG is a middle molecular weight toxin. In recent years, researchers found that elevated blood β2-MG was associated with coronary, thoracic, and abdominal aortic calcifications with significant correlations. β2-MG has been emerging as a strong biomarker for cardiovascular mortality in uremic patients but its role in CVC is not well studied. This study looked specifically at CVC occurrence in relation to β2-MG for MHD patients. Patients who underwent MHD for more than 3 months in the First People's Hospital of Nantong City from November 2012 to November 2019 with complete available data were included in the study. The patients were divided into the CVC group and the non-CVC group. The general information and clinical laboratory indicators of the patients were collected in a retrospective manner. We analyzed the risk factors for developing CVC in MHD patients using binary logistic regression method. Receiver operating characteristic (ROC) curves were used to calculate the cut-off value of β2-MG for predicting CVC. The decision tree (DT) method was used to classify and explore the probability of CVC in patients with MHD. The β2-MG in the CVC group was significantly higher than that in the non-CVC group (t=6.750, P<0.001). Multivariate binary logistic regression analysis showed that gender, age, serum β2-MG, and hemodialysis (HD) adequacy (Kt/V urea) were independent risk factors for CVC in MHD patients. ROC analysis showed that a β2-MG value of 25 µg/L was the best cut-off point for predicting CVC in MHD patients. According to binary logistic regression analysis, the β2-MG ≥25 µg/L group was 3.39 times more likely to develop CVC than the β2-MG <25 µg/L group [odds ratio (OR), 3.39; 95% confidence interval (CI), 1.63-7.06; P=0.001]. The DT model determined that serum β2-MG ≥25 µg/L and age >69 years were important determinants for predicting CVC in MHD patients. Serum β2-MG in MHD patients has a positive correlation with the severity and occurrence of CVC.

Depression, anxiety, psychological distress and associated factors among students attending Nemelifen Secondary and Preparatory School, Afar regional state, Ethiopia: a cross-sectional study

ObjectivesThis study aimed to assess the magnitude of depression, anxiety, psychological distress and associated factors in Nemelifen Secondary and Preparatory School at Awash 7 Kilo, zone 3, Afar, Ethiopia.DesignAn institutional-based...

Factors Influencing Blood Donation Practice Among Health Care Providers of Public Hospitals in Bahir Dar City, North West Ethiopia: A Case Control Study.

Blood donation is a technique in which blood is collected from a healthy individual for transfusion to someone else. WHO estimates that it is necessary to donate blood to 2% to 3% of the country's population to meet blood needs. However, blood donation remains challenging in developing countries. This study aimed to identify factors influencing blood donation practices among healthcare providers in public hospitals in Bahir Dar City. This institution-based unmatched case-control study was conducted in Bahir Dar City Public Hospitals from May 01 to May 25, 2022. Total sample size was 491 (123 cases and 368 controls) and then the study subject was selected by using simple random sampling technic and collect data through self-administered questionnaire. Bi-variable and multi-variable binary logistic regression analyses were used to determine the association between dependent and independent variables. Finally, the results are presented in charts and tables, and the AOR and CI are reported. Statistical significance was set at P < 0.05. Fear of anemia (adjusted odds ratio (AOR): 0.02; 95% CI 0.007-0.078), lack of opportunity (AOR: 0.42; 95% CI 0.22-0.83), lack of time (AOR: 0.03; 95% CI, 0.005-0.199), profession (AOR: 0.15; 95% CI, 0.05-0.42), aware of free medical checkup (AOR: 31.79; 95% CI 13.13-76.94), willingness to donate blood (AOR: 5.09; 95% CI 2.25-11.50), blood group type (AOR: 5.67; 95% CI 1.42-22.68), and higher work experience (AOR: 7.99; 95% CI 2.59-24.67) were found to be significantly associated with blood donation practice. This study revealed that multiple factors influenced the practice of blood donation among healthcare providers. Therefore, access to blood donation areas and emphasizing the importance of donor blood donation are important for facilitating blood donation.

Sex-specific associations of cardiovascular risk factors and coronary plaque composition for hemodynamically significant coronary artery stenosis: a coronary computed tomography angiography study

BackgroundIt has been reported that there are sex differences in plaque composition and hemodynamically significant stenosis. This study aimed to explore the impact of sex on cardiovascular risk factors for specific plaque compositions and hemodynamically significant stenosis.MethodsData regarding demographics and cardiovascular risk factors were collected. Hemodynamically significant stenosis was identified by a computed tomography-derived fractional flow reserve of ≤ 0.8. Associations among cardiovascular risk factors, plaque composition, and hemodynamically significant stenosis were assessed using a multivariate binary logistic regression analysis across sexes. The discriminating capacity of diverse plaque components for hemodynamically significant stenosis was assessed by area under the receiver-operating characteristics curve with 95% confidence intervals.ResultsA total of 1164 patients (489 men and 675 women) were included. For men, hyperlipidemia and cigarette smoking were risk factors for each plaque component (all P < 0.05), and diabetes mellitus also predicted fibrotic components (P < 0.05). For women, risk factors for each plaque component were hypertension and diabetes mellitus (all P < 0.01). Nonetheless, hyperlipidemia (P < 0.05) was a specific risk factor for non-calcified components. Calcified components combined with fibrotic components showed superior discrimination of hemodynamically significant stenosis in men and calcified components alone in women (all P < 0.01). Hypertension (P < 0.01) was a risk factor for hemodynamically significant stenosis in women. In contrast, diabetes, hyperlipidemia, and cigarette smoking were risk factors for hemodynamically significant stenosis in men (all P < 0.05).ConclusionsIn men, hemodynamically significant stenosis was predicted by a combination of calcified and fibrotic components with multiple risk factors. In women, hemodynamically significant stenosis was predicted by calcified components caused by a single risk factor. It might be a key point to improve prognosis by more precise risk management between men and women, which needs to be proved by further prospective trials.

Disparities in knowledge of cardiovascular risk factors and prevention methods related to cardiovascular status and functional health literacy, Poland, 2020-2021.

Numerous studies have reported a significant role for health literacy (HL) in the prevention or treatment of various diseases. However, in Poland there was no scientific research involving the status of cardiovascular disease (CVD) and HL in the assessment of health knowledge simultaneously, therefore, it became the objective of the study. We aimed to evaluate the level of CVD knowledge depending on CVD status and functional HL in Polish population. The study population consisted of 2827 participants from the WOBASZ II Survey aged 20-89 years: 2266 were CVD-free (non-CVD), 361 were hospitalized with CVD (CVDH[+]) and 200 were diagnosed with CVD, but not hospitalized (CVDH[-]). The Newest Vital Sign test (NVS) was applied to determine functional HL. Self-reported knowledge of CVD risk factors (RFs) and prevention methods (PMs) between people with different CVD status depending on HL was estimated. Multivariable ordinal and binary logistic regression analyzes were performed to find predictors of RFs and PMs knowledge. The knowledge of CVD RFs and/or PMs was strictly related to HL and CVD status. Inadequate HL decreased the satisfactory (≥5 RFs/PMs) knowledge of RFs (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.40-0.62) and PMs (OR, 0.56; 95% CI, 0.45-0.71). CVDH(-) people were more likely to have a satisfactory PMs knowledge (OR, 1.49; 95% CI, 1.02-2.16), while CVDH(+) persons a satisfactory RFs knowledge (OR, 1.85; 95% CI, 1.35-2.53). HL and CVD status are the key determinants of CDV RFs/PMs knowledge. Functional HL significantly affects health knowledge; therefore, HL screening should be recommended in primary care to increase the effectiveness of primary CVD prevention.

Identifying Tumor Deposits in Patients with Locally Advanced Rectal Cancer: Using Multiplanar High-Resolution T2WI.

The prognosis of postoperative tumor deposits (TDs) is worse than positive lymph node metastases alone. To detect TDs by using multiplanar high-resolution T2-weighted imaging (HRT2WI). This retrospective study enrolled 130 patients with locally advanced rectal cancer (LARC). Using pathology-proven tumor deposits (pTDs) as the gold standard, all patients were divided into the pTDs-negative and pTDs-positive groups, the correlation of clinicopathological factors and image features [such as MRI-detected tumor deposits (mTDs), MRI-detected metastatic lymph node (mLN), MRI-detected extramural vascular invasion (mEMVI), maximal extramural depth (EMD), etc.] with pTDs were analyzed by univariate analysis and multivariate binary logistic regression analysis, and the nomogram was established based on the latter. The diagnostic efficiency was evaluated by the receiver operating characteristic curve (ROC) analysis and area under curve (AUC). mTDs, mLN, mEMVI, and EMD were significantly different between the pTDs-positive and pTDs-negative groups (P < 0.05), with the AUC of 0.767, 0.746, 0.664 and 0.644, respectively. mTDs and mLN were independent risk factors for pTDs (odds ratio: 5.74 and 3.90, P < 0.05). The AUC, sensitivity, specificity, negative predictive value, and accuracy of the nomogram were 0.814 (95% CI: 0.720 ~ 0.908), 73.9%, 79.4%, 93.4%, and 78.5%, respectively. Seventeen of 23 patients with pTDs were identified as mTDs, with a moderate agreement between pTDs and mTDs (Kappa=0.419). Multiplanar HRT2WI can be used as a preoperative diagnostic tool to identify TDs in LARC. The combined model constructed by mTDs and mLN shows a good diagnostic performance for TDs.

Risk model and validation of carbapenem-resistant Klebsiella pneumoniae infection in patients with cerebrovascular disease in the ICU.

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an emerging global epidemic. The intention of this study was to explore the risk model and validation of CRKP infection in patients with cerebrovascular disease in the intensive care unit (ICU). The data of patients with cerebrovascular disease and Klebsiella pneumoniae infection were retrospectively collected. The patients were divided into the CRKP group and the carbapenem-susceptible Klebsiella pneumoniae (CSKP) group. There were significant differences (P < 0.05) between the CRKP group and the CSKP group for many variables. Multivariate binary logistic regression analysis showed that the number of types of antibiotics used, history of glucocorticoid use, and duration of mechanical ventilation before the occurrence of infectious bacteria are the independent risk factors for CRKP infection in patients with cerebrovascular disease in the ICU, and a nomogram risk model was constructed accordingly. The area under the ROC curve of the risk model was 0.868 (95% CI: 0.803-0.934).

Determinants of contraceptive continuation among women in sub-Saharan Africa

BackgroundContraceptive continuation is an important factor that has significant implications on total fertility rates and reproductive health outcomes, like unintended pregnancies. Therefore, it is imperative to understand the factors that influence women’s decision to continue the use of contraceptives. The present study examined the determinants of contraceptive continuation among women in sub-Saharan Africa (SSA).MethodsData for the study were extracted from the most recent Demographic and Health Surveys (DHS) of twenty-four (24) countries in SSA. Descriptive and multivariable binary logistic regression analysis were conducted. Frequencies, percentanges, and an adjusted odds ratio with 95% confidence intervals were used to present the results.ResultsCompared to adolescents, adult women aged 45–49 years [aOR: 1.24; CI: 1.13–1.37] had higher odds of contraceptive continuation. The odds of contraceptive continuation were lower among those working [aOR: 0.96; CI: 0.93–0.98] compared to those not working. Also, the study shows that the likelihood of contraceptive continuation was lower among those exposed to family planning messages compared to those not exposed [aOR: 0.91; CI: 0.88–0.93]. Compared to women who used LARCs, women who used pills [aOR: 0.34; CI: 0.33–0.36], injectable [aOR: 0.42; CI: 0.40–0.43], other modern contraceptives [aOR: 0.72; CI: 0.68–0.75] or traditional methods [aOR: 0.50; CI: 0.478–0.523] were less likely to continue with their contraception. Women with one birth [aOR: 0.86; CI: 0.83–0.90] and those with 2 + births in the last five years [aOR: 0.54; CI: 0.512–0.56] reported lower odds of contraceptive continuation as compared to those with no births. Compared to women with no children living, those with 4 + children living had lower odds of contraceptive continuation [aOR: 0.62; CI: 0.57–0.67]. The study also found that the likelihood of contraceptive continuation was higher among those with secondary education [aOR: 1.08; CI: 1.04–1.12] as compared to those with no formal education. Contraceptive continuation was also higher among those who have information on choice [aOR: 3.91; CI: 3.82–4.01], and also higher among those who were undecided about having an additional child [aOR: 1.39; CI: 1.33–1.46]. Compared to West AfricaAngola, women from all other sub-regions were less likely to continue using contraceptives Comoros were more likely to continue with contraception [aOR: 1.49; CI: 1.24–1.78].ConclusionTo improve contraceptive continuation among women of reproductive age, countries in SSA must invest heavily in advocacy and dissemination of family planning messages, and information of choice. Also, much commitment should be directed towards enhancing the use of long-acting reversible contraceptive use.

NELA 1 Sarcopenia versus clinical frailty scale in predicting the risk of postoperative mortality after emergency laparotomy: A retrospective cohort study

Abstract Aims To compare predictive significance of sarcopenia and clinical frailty scale in terms of postoperative mortality in patients undergoing emergency laparotomy. Methods In compliance with STROCSS statement standards a retrospective cohort study with prospective data collection approach was conducted. The study period was between January 2017 and January 2022. All adult patients with non-traumatic acute abdominal pathology who underwent emergency laparotomy in our centre were included. The primary outcome was 30-day mortality and secondary outcomes were in-hospital mortality and 90-day mortality. The predictive value of sarcopenia and clinical frailty scale were compared using the Receiver Operating Characteristic (ROC) curve analysis and multivariable binary logistic regression analysis. Results A total of 1043 eligible patients were included. The risk of 30-day mortality, in-hospital mortality, and 90-day mortality were 8%, 10%, and 11%, respectively. ROC curve analysis suggested that sarcopenia is a significantly stronger predictor of 30-day mortality (AUC: 0.87 vs 0.70, P&amp;lt;0.0001), in-hospital mortality (AUC: 0.79 vs 0.67, P=0.0011), and 90-day mortality (AUC: 0.79 vs 0.67, P=0.0009) compared with clinical frailty scale. Moreover, multivariable binary logistic regression analysis identified sarcopenia as an independent predictor of mortality (coefficient: 4.22119, P&amp;lt;0.0001) but did not identify clinical frailty score as independent predictor (coefficient: 0.066311, P=0.5544). Conclusions Sarcopenia is a stronger predictor of postoperative mortality compared with clinical frailty score in patients undergoing emergency laparotomy. It cancels out the predictive value of clinical frailty scale in multivariable analyses; hence among the two variables, sarcopenia deserves to be included in preoperative predictive tools.

Adolescent breakfast skipping is associated with poorer academic performance: a school-based study from Hidhabu Abote District, Ethiopia

BackgroundBreakfast is regarded as “the most important meal of the day,” suggested to positively affect learning in children and adolescent in terms of cognitive and school performance. Yet, studies in LMIC settings are few and show very inconsistent results.ObjectiveTo assess the prevalence and correlates of breakfast skipping and its association with school performance among randomly selected in-school adolescents in Hidhabu Abote Wereda, North Shewa Zone, Central Ethiopia.MethodsA cross-sectional study was conducted from November to December 2020. A total of 422 participants were selected randomly from high schools of Hidhabu Abote Wereda. Data were entered in to Epiata version 3.1 and exported to SPSS version 24 for analysis. Bivariate and multivariate binary logistic regression analysis identified factors that were significantly associated with the breakfast skipping. Odds ratio along with 95% Confidence interval was estimated to measure the strength of the association and level of statistical significance declared at p-value less than 0.05.ResultsThe magnitude of breakfast skipping was 41.3%, (95% CI (36.6–46.0)]. There was statistically significant association between breakfast skipping and overall academic performance [AOR: 5.18, 95% CI (1.54–7.46)], mathematics performance (3.88, 95% CI (1.34–11.22)], and English language performance scores [2.92, 95% CI (1.38–7.58)]. Being female [AOR = 1.857, 95% CI (1.05–3.27)], household food insecurity [AOR: 2.478, 95% CI (1.36–4.51)], and less maternal education [AOR 1.89, 95% CL (3.38–7.77)] were independently associated with breakfast skipping. The primary reasons given for breakfast skipping were lack of time, lack of appetite in morning, and concerns around weight gain.ConclusionNearly half of in-school adolescents were skipped breakfast meals, and reportedly in most cases for reasons unrelated to lack of food access. Students who skipped breakfast had lower levels of school performance.

Systemic Risk Factors for Vitreous Hemorrhage Secondary to Polypoidal Choroidal Vasculopathy.

It remains unclear whether systemic factors are associated with an increased risk of vitreous hemorrhage (VH) secondary to polypoidal choroidal vasculopathy (PCV), and there is no method to predict the possibility of VH occurrence in patients with PCV. This study aimed to investigate and visualize systemic risk factors for VH in patients with PCV. Data on the sex, age, history of systematic diseases, best-corrected visual acuity, intraocular pressure, and laboratory data of patients with PCV were collected from the medical record system. Univariate and multivariate binary logistic regression analyses were applied to investigate independent risk factors for VH in patients with PCV. Receiver operating characteristic analysis and nomograms were used to visualize the independent risk factors. The patient population comprised 115 patients with VH secondary to PCV and 181 patients with PCV without VH. Binary logistic regression analyses showed that higher white blood cell count [WBC; odds ratios (OR) 1.247], higher aspartate aminotransferase/alanine aminotransferase ratio (AST/ALT; OR 2.339), and longer activated partial thromboplastin time (APTT; OR 1.196) were independent risk factors of VH in patients with PCV. Integrated application of APTT, AST/ALT, and WBC as markers showed the best performance for distinguishing patients with VH, with an area under the curve of 0.723. The nomogram was created for doctors to calculate the possibility of VH in a patient with PCV. Higher WBC, higher AST/ALT, and longer APTT are independent serum risk factors of VH secondary to PCV, which may shed light on VH prevention in patients with PCV.

Determinants of pneumonia among under-five children at Hiwot Fana specialized hospital, Eastern Ethiopia: unmatched case-control study

BackgroundGlobally, pneumonia is a serious public health issue. Clear evidence is necessary for the early detection and treatment of pneumonia's causes. Yet, there is limited data on this issue in the current study area. Thus, this study aimed to pinpoint the determinants of pneumonia among under-five children at Hiwot Fana Specialized Hospital, Eastern Ethiopia.MethodsA hospital-based unmatched case-control study was conducted among a sample of 348 (116 cases and 232 controls) children at Hiwot Fana Specialized Hospital from October 1 to November 30, 2022. A consecutive sampling technique was employed, and data were collected with a pre-tested interviewer-administered questionnaire. The data was entered into Epi-Data version 3.1 and analyzed using SPSS version 25 software. Bivariate and multivariate binary logistic regression analyses were fitted. Variables with a 95% confidence interval having a p-value < 0.05 were considered statistically significant.ResultsAn overall total of 347 (115 cases and 232 controls) among under-five children was included in this study. Factors such as hand washing before child feeding [AOR: 3.11 (1.74-5.57)], birth to 6 months breastfeeding [AOR: 2.76 (1.35-5.25)], zinc supplementation [AOR: 2.5 (1.33-4.40)], diarrhea in the last 2 weeks [AOR: 4.7 (2.64-8.33)], and Upper Respiratory Tract Infections in the last 2 weeks [AOR: 5.46 (3.21-10.92)] were found to be determinants of pneumonia.ConclusionsThis study pointed out that the under-five pneumonia was relatively large. Factors such as hand washing before child feeding, birth to 6 months of breastfeeding, zinc supplementation of the child, diarrhea in the last 2 weeks, and Upper Respiratory Tract Infections in the last 2 weeks were determinants of under-five pneumonia. In this study, the primary risk factors for pneumonia may be preventable with no or minimal cost. Therefore, we advise suitable and sufficient health education addressing the prevention and management of pneumonia.

Association between hemoglobin glycation index and non-alcoholic fatty liver disease in the patients with type 2 diabetes mellitus.

The hemoglobin glycation index (HGI) represent the disparity between actual glycated hemoglobin measurements and predicted HbA1c. It serves as a proxy for the degree of non-enzymatic glycation of hemoglobin, which has been found to be positively correlated with diabetic comorbidities. In this study, we investigated the relationship between HGI and non-alcoholic fatty liver disease (NAFLD), along with other relevant biological markers in patients with diabetes. This cross-sectional study consisted of 3,191 adults diagnosed with type 2 diabetes mellitus. We calculated the predicted glycated hemoglobin levels based on fasting blood glucose levels. Multivariate binary logistic regression analysis was conducted to examine the correlation between the HGI and NAFLD. Hepatic steatosis was diagnosed using ultrasonography. Among all participants, 1,784 (55.91%) were diagnosed with NAFLD. Participants with confirmed NAFLD showed elevated body mass index, diastolic blood pressure, liver enzyme, total cholesterol, triglyceride, low-density lipoprotein and uric acid levels compared with those without NAFLD. In the unadjusted model, participants in the last tertile of HGI were 1.40-fold more likely to develop NAFLD than those in the first tertile (95% confidence interval 1.18-1.66; P < 0.001). In the fully adjusted model, those in the last tertile of HGI had a 39% increased risk of liver steatosis compared with confidence interval in the first tertile of HGI (95% confidence interval 1.12-1.74; P < 0.001). A higher HGI suggests an elevated risk of developing NAFLD in patients with type 2 diabetes.

The Prevalence of Restless Legs Syndrome Among Pregnant Women in Saudi Arabia.

Pregnancy hasbeenassociatedwith restlesslegssyndrome (RLS). RLS is underdiagnosed in most countries. The purpose of this study was to assess the prevalence of RLS among Saudi pregnant women. This cross-sectional study included 459 pregnant women from all Saudi provinces between December 2022 and March 2023. A structured online questionnaire assessing demographic and pregnancy characteristics, medical conditions, sleep quality, and RLS symptoms was conducted. The prevalence of RLS was 26.6% among the participants. Calcium deficiency was significantly associated with RLS (adjusted odds ratio (OR)=2.16, 95% confidence interval (CI)=1.2-3.9, p=0.01), but there was no significant association between RLS and vitamin D and iron deficiencies (p>0.05), according to multivariate binary logistic regression analysis. Moreover, RLS increased the risk of insomnia and frequent waking up(adjusted OR=4.95, 95% CI=2.50-9.83, p<0.001, and adjusted OR=2.87, 95% CI=1.55-5.32, p=0.001, respectively). RLS is common among pregnant women in Saudi Arabia. The study indicates that RLS during pregnancy is linked tocalcium deficiency and negatively affects sleep quality.

The Efficacy of Daily Local Antibiotic Lavage via an Epidural Suction-Irrigation Drainage Technique in Spondylodiscitis and Isolated Spinal Epidural Empyema: A 20-Year Experience of a Single Spine Center.

Various treatment modalities are available for local antibiotic therapy in spondylodiscitis (SD) and isolated spinal epidural empyema (ISEE), but there is no evidence-based recommendation. Postoperative epidural suction-irrigation drainage (ESID) is thought to reduce bacterial load, which may prevent the development of relapse, wound healing, hematogenous spread, and systemic complications. We evaluated the efficacy of postoperative ESID over 20 years on disease progression and outcome in SD and ISEE. Detailed demographic, clinical, imaging, laboratory, and microbiological characteristics were examined in our cohorts of 208 SD and ISEE patients treated with and without ESID at a university spine center in Germany between 2002 and 2022. Between-group comparisons were performed to identify meaningful differences for the procedure. We included data from 208 patients (142 SD, 68.3% vs. 66 ISEE, 31.7%) of whom 146 were ESID patients (87 SD, 59.6% vs. 59 ISEE, 40.4%) and 62 were NON-ESID patients (55 SD, 88.7% vs. 7 ISEE, 11.3%). ESID patients with SD showed more frequent SSI (ESID: 22, 25.3% vs. NON-ESID: 3, 5.5%, p = 0.003), reoperations due to empyema persistence or instability (ESID: 37, 42.5% vs. NON-ESID: 12, 21.8%, p = 0.012), and a higher relapse rate (ESID: 21, 37.5% vs. NON-ESID: 6, 16.7%, p = 0.037) than NON-ESID patients with SD. The success rate in NON-ESID patients with SD was higher than in ESID patients with SD (ESID: 26, 29.9% vs. NON-ESID: 36, 65.6%, p < 0.001). Multivariate binary logistic regression analysis showed that ESID therapy (p < 0.001; OR: 0.201; 95% CI: 0.089-0.451) was a significant independent risk factor for treatment failure in patients with SD. Our retrospective cohort study with more than 20 years of experience in ESID technique shows a negative effect in patients with SD in terms of surgical site infections and relapse rate.

Establishment and evaluation of early in-hospital death prediction model for patients with acute pancreatitis in intensive care unit

To investigate the death risk prediction factors of acute pancreatitis (AP) patients in intensive care unit (ICU), and to establish a death prediction model and evaluate its efficacy. A retrospective cohort study was conducted using the data in the Medical Information Mart for Intensive Care-III (MIMIC-III). The clinical data of 285 AP patients admitted to the ICU in the database were collected, including age, gender, blood routine and blood biochemical indicators, comorbidities, simplified acute physiology score III (SAPS III) and hospital prognosis. By using univariate analysis, the differences in the clinical data of the patients were compared between the two groups. Binary multivariate Logistic regression analysis was used to screen out independent predictors of in-hospital death in AP patients. A death prediction model was established, and the nomogram was drawn. The receiver operator characteristic curve (ROC curve) was plotted, and the area under the ROC curve (AUC) was used to test the discrimination of the prediction model. In addition, the prediction model was compared with the SAPS III score in predicting in-hospital death. The calibration ability of the prediction model was evaluated by the Hosmer-Lemeshow goodness of fit test, and a calibration map was drawn to show the calibration degree of the prediction model. Among 285 patients with AP, 29 patients died in the hospital and 256 patients survived. Univariate analysis showed that the patients in the death group were older than those in the survival group (years old: 70±17 vs. 58±16), and had higher white blood cell count (WBC), total bilirubin (TBil), serum creatinine (SCr), blood urea nitrogen (BUN), red blood cell volume distribution width (RDW), proportion of congestive heart failure and SAPS III score [WBC (×109/L): 18.5 (13.9, 24.3) vs. 13.2 (9.3, 17.9), TBil (μmol/L): 29.1 (15.4, 66.7) vs. 16.2 (10.3, 29.1), SCr (μmol/L): 114.9 (88.4, 300.6) vs. 79.6 (53.0, 114.9), BUN (mmol/L): 13.9 (9.3, 17.8) vs. 6.1 (3.7, 9.6), RDW: 0.152 (0.141, 0.165) vs. 0.141 (0.134, 0.150), congestive heart failure: 34.5% vs. 14.8%, SAPS III score: 66 (52, 90) vs. 39 (30, 48), all P < 0.05]. Multivariate Logistic regression analysis showed that age [odds ratio (OR) = 1.038, 95% confidence interval (95%CI) was 1.005-1.073], WBC (OR = 1.103, 95%CI was 1.038-1.172), TBil (OR = 1.247, 95%CI was 1.066-1.459), BUN (OR = 1.034, 95%CI was 1.014-1.055) and RDW (OR = 1.344, 95%CI was 1.024-1.764) were independent risk predictors of in-hospital death in patients with AP. Logistic regression model was established: Logit(P) = 0.037×age+0.098×WBC+0.221×TBil+0.033×BUN+0.296×RDW-12.133. ROC curve analysis showed that the AUC of the Logistic regression model for predicting the in-hospital death of patients with AP was 0.870 (95%CI was 0.794-0.946), the sensitivity was 86.2%, and the specificity was 78.5%, indicating that the model had good predictive performance, and it was superior to the SAPS III score [AUC was 0.831 (95%CI was 0.754-0.907), the sensitivity was 82.8%, and the specificity was 75.4%]. A nomogram model was established based on the result of multivariate Logistic regression analysis. The calibration map showed that the calibration curve of the nomogram model was very close to the standard curve, with the goodness of fit test: χ2 = 6.986, P = 0.538, indicating that the consistency between the predicted death risk of the nomogram model and the actual occurrence risk was relatively high. The older the AP patient is, the higher the WBC, TBil, BUN, and RDW, and the greater the risk of hospital death. The death prediction Logistic regression model and nomogram model constructed based on the above indicators have good discrimination ability and high accuracy for high-risk patients with hospital death, which can accurately predict the probability of death in AP patients and provide a basis for prognosis judgment and clinical treatment of AP patients.

Comparisons between HER2-low and HER2-zero tumors with 21-gene multigene assay in 2,295 ER+ HER2- breast cancer.

13 Background: HER2-positivity is an essential marker for therapeutic decisions, while HER2 expression is heterogenous. In recent years, there has been increasing recognition of a subgroup of breast cancer patients who have low levels of HER2 expression, also known as HER2-low because trastuzumab deruxtecan offers clinical benefit for patients with HER2-low metastatic breast cancer. Despite the growing interest in HER2-low breast cancer, there is limited research on how multigene assays can help differentiate between HER2-low and HER2-negative breast cancer. Among ER+HER2- breast cancer, we compared genomic characteristics between HER2-low and HER2-zero using the 21-gene assay. Methods: A retrospective review of clinical records was performed in 2,295 patients who underwent Oncotype DX test in two hospitals between 2013 and 2020. Patients were classified into two groups as the HER2-zero and HER2-low based on HER2 IHC and SISH test. In cases with HER2 2+, no amplification of HER2 gene was confirmed by silver in situ hybridization. High genomic risk was defined as cases with 21-gene recurrence score (RS)&gt;25. Multivariable binary logistic-regression analysis was performed. Results: Of these, 944 (41.1%) were assigned in the HER2-zero, and 1351 (58.9%) were in the HER2-low. The averages of RS were 17.082 in the HER2-zero breast cancer and 18.503 in the HER2-low, respectively (P-value&lt;0.005). HER2 score identified by qRT-PCR was 8.912 in the HER2 zero group and was 9.337 in the HER2 low group (P&lt;0.005). When we compared a proportion of high RS between two groups, the high RS rate was 12.4% (117 of 944) in the HER2-zero, while it was 17.0% (230 of 1351) in the HER2-low (p=0.002). In multivariable analysis, HER2-low was demonstrated as an independent factor for high RS with an odds ratio 1.517 (1.172-1.964) independent of ER, PR, and Ki67. Within the subgroup with invasive ductal carcinoma, the high RS rates of HER2-low and HER2-zero were 19% and 14%, respectively. In the all patients, recurrence-free survival and overall survival did not differ between HER2-low and HER2-zero groups. Conclusions: Within ER+HER2- breast cancer, HER2-low tumors are associated with high RS, especially for histologically invasive ductal carcinoma. A prognostic influence of HER2-low expression among ER+HER2- breast cancer remains as an area that requires further study.

Ventricular pacing dependency after transcatheter aortic valve replacement: a prospective cohort.

Atrioventricular conduction disturbance occurs in a significant number of patients undergoing transcatheter aortic valve replacement (TAVR). However, not all cases are ventricular pacing-dependent. Thus, we aimed to study the incidence, predictors, and outcomes of new ventricular pacing dependency (VpDep) after TAVR. We prospectively analyzed 130 consecutive transfemoral TAVR cases performed in Ramathibodi Hospital between 2015 and 2020. Three patients with prior ventricular pacing-dependent on cardiac implantable electronic devices (CIEDs) were excluded. The endpoints were VpDep at 1 month and all-cause mortality at the follow-up period end in 2021. The effects of variables on VpDep and all-cause mortality were evaluated using multivariate binary logistic regression and Cox regression analyses, respectively. First-degree atrioventricular block (AVB) was considered severe when the PR interval was >300 ms. Of the 127 patients [mean age, 81.8 years; 62.2% females; 67.7% balloon-expandable (BE) device], 7 patients (5.5%) had CIEDs implanted before TAVR that were not ventricular pacing-dependent. TAVR was successfully performed in 126 (99.2%) patients. Periprocedural stroke, cardiac tamponade, and major bleeding occurred in 2 (1.6%), 4 (3.1%), and 4 (3.1%) patients, respectively. The VpDep incidence at 1 month was 7.9% (n=10) among all patients and 34.5% among those with CIEDs (n=29). VpDep was more likely to occur in patients with pre-existing right bundle branch block (RBBB) [odds ratio (OR), 21.38; 95% confidence interval (CI): 3.28-139.33; P=0.001] and severe 1st degree or Mobitz I AVB (OR, 14.79; 95% CI: 1.65-132.74; P=0.016). After a mean follow-up of 25.8 months [standard deviation (SD), 21.2 months], death from any cause occurred in 18 patients (14.2%). However, VpDep was not associated with an increased mortality. In this real-world cohort, pre-existing conduction abnormalities were significantly associated with a higher risk of VpDep. Mortality was similar between patients with and without VpDep.

The Association between the L3 Skeletal Muscle Index Derived from Computed Tomography and Clinical Outcomes in Patients with Urinary Tract Infection in the Emergency Department.

The occurrence of a critical event during a urinary tract infection (UTI) can have a significant impact on mortality. This study aimed to investigate the association between the skeletal muscle index (SMI) and critical events in patients with a UTI. From April 2019 to March 2022, a total of 478 patients who met the diagnostic criteria of a UTI and underwent an abdominal CT were included in this study. Multivariate binary logistic regression analysis was used to assess independent predictors of critical events. The primary outcome was any critical event, defined as the initiation of dialysis, invasive ventilation, initiation of vasoactive medications, cardiac arrest, or death. The UTI patients were divided into two groups: those with a low SMI (n = 93) and those with a high SMI (n = 385). In multivariate analysis, a low SMI, diabetes mellitus, altered mentality, lactate levels, and creatinine levels were identified as significant predictors of critical events. A low SMI is an independent factor associated with the occurrence of critical events in UTI patients during hospitalization. Patients with a low SMI, indicating muscle wasting, may have less resilience to infections and a higher risk of experiencing severe complications. Considering the SMI along with other clinical factors can help health care providers assess and manage UTI patients.

Vitamin K insufficiency predicts incidence of frailty in community-dwelling older adults: The Otassha Study.

Vitamin K is a fat-soluble vitamin discovered as an essential factor for blood coagulation. It is suggested that vitamin K can benefit several aging-related diseases, including osteoporosis, osteoarthritis, and dementia. We previously reported the cross-sectional association of vitamin K insufficiency with frailty in community-dwelling older adults. In October 2020, a health examination of community-dwelling older adults (The Otassha Study) was performed, including frailty evaluation and blood tests. We used a ucOC and OC ratio (ucOC/OC) to indicate vitamin K insufficiency. One year later, we conducted a follow-up evaluation of frailty on 518 people who were not frail at baseline. The serum ucOC/OC at the baseline examination was divided into quartiles (Q1, Q2, Q3, and Q4). Odds ratio (OR) and 95% confidence interval (CI) were calculated using multivariate binary logistic regression for each quartile of ucOC/OC to determine the risk of incident frailty in the follow-up study, with the lowest quartile (Q1) as the reference. Among the 518 older adults who were not frail at baseline, 66 people (12.7%) became frail in the follow-up study. In the multivariate binary logistic regression analysis, setting the lowest quartile of ucOC/OC (Q1) as a reference, the OR of the incident frailty in the highest quartile (Q4) was 2.53 (95% CI 1.07, 4.92) which was significantly different from Q1. The findings of this longitudinal study suggest that vitamin K insufficiency has nutritional importance in predicting the future incidence of frailty in the Japanese older adult population.