Relative Importance Of Risk Factors Research Articles

Bayesian analysis of risk factors for infection with a genotype of porcine reproductive and respiratory syndrome virus in Ontario swine herds using monitoring data

Porcine reproductive and respiratory syndrome (PRRS) has a worldwide distribution. This economically important endemic disease causes reproductive failure in breeding stock and respiratory tract illness in young pigs. In Ontario restricted fragment length polymorphism (RFLP) 1-18-4 has been determined as one of the most common virus genotypes.Individual-level models (ILMs) for infectious diseases, fitted in a Bayesian MCMC framework, have been used to describe both the spatial and temporal spread of diseases. They are an intuitive and flexible class of models that can take into account population heterogeneity via various individual-level covariates. The objective of this study is to identify relative importance of risk factors for the spread of the genotype 1-18-4 from monitoring data in southern Ontario using ILMs. Specifically, we explore networks through which resources are obtained or delivered, as well as the ownership structure of herds, and identify factors that may be contributing to high risk of infection.A population of 316 herds which experienced their PRRS outbreaks between September 2004 and August 2007 are included in the analyses, in which 194 (61%) are sow herds. During the study period, 45 herds (27 sow herds) experienced their first outbreak due to RFLP 1-18-4. Our results show that the three relatively most important factors for the spread of 1-18-4 genotype in Ontario swine herds were sharing the same herd ownership, gilt source and market trucks. All other networks had relatively smaller impact on spread of this PRRSV genotype. Spatial proximity could not be identified as important contributor to spread. Our findings also suggest that gilt acclimation should be practiced whenever possible and appropriate to reduce the risk for the herd and for others as it is already widely implemented and recommended in the North American swine industry.

Research on Risk Management of Sports Events Based on Analytic Hierarchy Process

How to position various types of risk in the process of sports events reasonably has become the hot spot in the study of risk management. We simplify the AHP algorithm by the method of approximation algorithms through the study of the theory and algorithms of analytical hierarchy process. Meanwhile, AHP is introduced to the study of sports events risk. A multi-level risk index system is established, and relative importance of risk factors is determined. More objective judgment of the risk situation of risk factors in the events is made and events risks are systematically analyzed from the perspective of evaluation combined with the risk characteristics of sports events. Then the quantitative relationship among the comparison of the projects is given from the perspective of mathematical analysis, with the analysis of the results given by the expert survey method, through specific examples. Specific management and control strategy is designed for various kinds of risks in sports events according to the condition of risk rating of sports events and the results of positioning analysis. Appropriate risk response strategies are made in the paper. This method has important practical significances for the purpose of realizing sports events management successfully.

Predictors of Basal Cell Carcinoma in High-Risk Patients in the VATTC (VA Topical Tretinoin Chemoprevention) Trial

Basal cell carcinoma (BCC) is the most common cancer in the United States today, and patients who have had one are likely to have multiple carcinomas over time. Predictors of new BCCs on the face and ears among those at very high risk have not been studied in detail. We sought to do so prospectively in the context of a 6-year trial. We found that the number of BCCs in the prior 5 years was the most important predictor. Age, sun sensitivity, occupational sun exposure before the age of 30 years (but not afterward), lower educational level, history of eczema, the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and more sunscreen use in the week, but not the 6 months, before enrollment were also independent predictors, but sunburns, baseline sun exposure, and other sun-protective measures, other skin cancers, and actinic keratoses were not. None of the eczema patients had a history of topical calcineurin use. The cumulative risk of BCC was 55% at 5 years. These findings document the key risk factors in this very high-risk population, suggesting that the history of eczema may increase the risk in those at high risk and that early sun exposure is important even in this group, and underscoring the need for chemopreventive strategies.

Deciphering the Importance of Host and Environmental Factors that Influence the Genesis of Asthma During Childhood

Deciphering the Importance of Host and Environmental Factors that Influence the Genesis of Asthma During Childhood

Relative importance of risk factors for coronary heart disease – The Hordaland Homocysteine Study

Objectives. The aim was to rank coronary heart disease (CHD) risk factors according to their importance in predicting CHD morbidity and mortality using a scale-independent statistical approach. Design. We studied 15 515 community-dwelling adults in a population-based cohort established during 1992–93 in Western Norway. Participants were 40–42 and 65–67 years old at baseline and were followed through 2006. Endpoints were non-fatal/fatal acute myocardial infarction (AMI) and CHD death. Each factor was rank transformed and scaled to the range 0–5 before estimation of Cox models. Hazard ratios (HR) may thus be interpreted as HR per quintile increment for each factor, and the magnitude of the HR was used to rank the risk factors according to strength. Results. Total cholesterol and triglycerides were important risk factors for both CHD death and non-fatal/fatal AMI only in the middle-aged group. Risk factors were generally stronger in the middle-aged, except total homocysteine which was significantly associated with CHD death in the oldest group only. The only significant difference between men and women was found for single living which was an important risk factor for non-fatal/fatal AMI in middle-aged women but not in middle-aged men. Conclusions. We have demonstrated a simple method for direct and scale-independent comparison of the strength of both categorical and continuous risk factors. The importance of individual risk factors differed substantially between the two age groups.

A Scoring System (DISTAL) for Predicting Failure of Snuffbox Arteriovenous Fistulas

ObjectivesA first fistula failing will lead to serious morbidity in a proportion of patients. Snuffbox fistulas have the advantage of proximal vessel preservation, and although several factors have been associated with failure, the relative importance of these factors combined and their clinical applicability is unknown. The aim of this study was to determine the relative importance of risk factors for snuffbox fistula failure and create a simple scoring system to aid fistula placement decision making. Methods218 consecutive patients were examined using Cox regression analysis to determine risk factors for failure. Primary patency was used as the endpoint. ResultsDiabetes, IHD, Stroke, Two snuffbox procedures, Age > 70 and Less than 2.0 mm vein (DISTAL, maximum score 6) were significant predictors of primary patency failure. There was a clear decrease in primary patency with increasing DISTAL score (log rank χ2 = 30.3, DF = 5, P < 0.001). Performing snuffbox procedures on patients with a score ≤3 would give a 23% reduction in the number of failures within two months for a 12% reduction in the number of patients offered snuffbox procedures. ConclusionThe DISTAL scoring system could give large improvements in primary patency for the snuffbox fistula if the results can be validated in other datasets.

Identifying questions in the American Association of Swine Veterinarian's PRRS risk assessment survey that are important for retrospectively classifying swine herds according to whether they reported clinical PRRS outbreaks in the previous 3 years

The American Association of Swine Veterinarian's (AASV) Production Animal Disease Risk Assessment Program (PADRAP) is a web-based program that offers a set of risk assessment surveys being used by veterinarians who are members of the AASV. Members use PADRAP to help producers systematically assess risk factors that may be associated with clinical outcomes. As assessments are performed the completed surveys are added to the dataset maintained at the Iowa State University College of Veterinary Medicine. One of the surveys included in PADRAP is the porcine reproductive and respiratory syndrome (PRRS) Risk Assessment for the Breeding Herd. The aim of the study was to categorize questions in version 2 of the PRRS Risk Assessment for the Breeding Herd survey as important or unimportant for classifying herds according to whether they reported clinical PRRS outbreaks in the previous 3 years. The results elucidate the relative importance of risk factors and areas of risk factors for clinical outcomes and removing unimportant questions may reduce the time required to complete the survey without affecting the quality of information obtained. Surveys from 896 sow herd sites in the United States and Canada completed between March 2005 and March 2009 were included in the analysis. The survey contained a large number of questions with a complex correlation structure among the questions. Responses for several questions were dependent upon responses to others. To address these issues, an approach was developed using a series of statistical methods including random forest, principle component analysis, logistic regression and receiver operating characteristic (ROC) analysis to classify the herds using the questions in the survey as explanatory variables. Questions were ranked by importance and systematically excluded from least important to most important. The questions excluded, without significantly affecting the performance of the model for classifying herds were identified as unimportant. Thirty-eight of the 127 questions analyzed were identified as unimportant for classifying herds according to whether they reported clinical PRRS outbreaks in the previous 3 years. Sections of the survey where a large number of questions were identified as unimportant included (1) entry of semen into the breeding herd and (2) transportation of live animals. Sections with a high percentage of questions identified as unimportant included (1) characteristics of the site, (2) disposal of dead animals and waste management and (3) employee and visitors.

Risk assessment of river-type hydropower plants using fuzzy logic approach

In this paper, a fuzzy rating tool was developed for river-type hydropower plant projects, and risk assessment and expert judgments were utilized instead of probabilistic reasoning. The methodology is a multi-criteria decision analysis, which provides a flexible and easily understood way to analyze project risks. The external risks, which are partly under the control of companies, were considered in the model. A total of eleven classes of risk factors were determined based on the expert interviews, field studies and literature review as follows: site geology, land use, environmental issues, grid connection, social acceptance, macroeconomic, natural hazards, change of laws and regulations, terrorism, access to infrastructure and revenue. The relative importance of risk factors was determined from the survey results. The survey was conducted with the experts that have experience in the construction of river-type hydropower schemes. The survey results revealed that the site geology and environmental issues were considered as the most important risks. The new risk assessment method enabled a Risk Index (R) value to be calculated, establishing a 4-grade evaluation system. The proposed risk analysis will give investors a more rational basis to make decisions and it can prevent cost and schedule overruns.

Obesity, smoking, alcohol consumption and years lived with disability: a Sullivan life table approach

BackgroundTo avoid strong declines in the quality of life due to population ageing, and to ensure sustainability of the health care system, reductions in the burden of disability among elderly populations are urgently needed. Life style interventions may help to reduce the years lived with one or more disabilities, but it is not fully understood which life style factor has the largest potential for such reductions. Therefore, the primary aim of this paper is to compare the effect of BMI, smoking and alcohol consumption on life expectancy with disability, using the Sullivan life table method. A secondary aim is to assess potential improvement of the Sullivan method by using information on the association of disability with time to death.MethodsData from the Dutch Permanent Survey of the Living Situation (POLS) 1997-1999 with mortality follow-up until 2006 (n = 6,446) were used. Using estimated relative mortality risks by risk factor exposure, separate life tables were constructed for groups defined in terms of BMI, smoking status and alcohol consumption. Logistic regression models were fitted to predict the prevalence of ADL and mobility disabilities in relationship to age and risk factor exposure. Using the Sullivan method, predicted age-specific prevalence rates were included in the life table to calculate years lived with disability at age 55. In further analysis we assessed whether adding information on time to death in both the regression models and the life table estimates would lead to substantive changes in the results.ResultsLife expectancy at age 55 differed by 1.4 years among groups defined in terms of BMI, 4.0 years by smoking status, and 3.0 years by alcohol consumption. Years lived with disability differed by 2.8 years according to BMI, 0.2 years by smoking and 1.6 by alcohol consumption. Obese persons could expect to live more years with disability (5.9 years) than smokers (3.8 years) and drinkers (3.1 years). Employing information on time to death led to lower estimates of years lived with disability, and to smaller differences in these years according to BMI (2.1 years), alcohol (1.2 years), and smoking (0.1 years).ConclusionsCompared with smoking and drinking alcohol, obesity is most strongly associated with an increased risk of spending many years of life with disability. Although employing information on the relation of disability with time to death improves the precision of Sullivan life table estimates, the relative importance of risk factors remained unchanged.

Changes in the Relative Importance of Dynamic Risk Factors for Recidivism During Adolescence

This study examined which dynamic risk factors for recidivism play an important role during adolescence. The sample consisted of 13,613 American juveniles who had committed a criminal offense. The results showed that the importance of almost all dynamic risk factors, both in the social environment domain (school, family, relationships) and in the individual domain (attitude, skills, aggressiveness), decreased as juveniles grew older. Therefore, the potential effect of an intervention aimed at these factors will also decrease as juveniles grow older. The relative importance of the risk factors also changed: In early adolescence, risk factors in the family domain showed the strongest association with recidivism, whereas in late adolescence risk factors in the attitude, relationships, and school domain were more strongly related to recidivism. These results suggest that the focus of an intervention needs to be attuned to the age of the juvenile to achieve the maximum potential effect on recidivism.

Low bone mass in urban Indian women above 40 years of age: prevalence and risk factors

Objective. To assess the prevalence and the relative importance of risk factors for low bone mass in Indian pre- and post-menopausal women.Methods. Data were collected on anthropometry and lifestyle factors in apparently healthy 80 pre- and 92 post-menopausal (40–75 years) women. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry. Fasting blood samples were analysed for Parathyroid hormone, vitamin D, calcium and zinc.Results. BMD at all three sites was significantly lower in post-menopausal than the pre-menopausal women (p < 0.001). Prevalence of osteoporosis was highest at the lumbar spine (25.8%) in post-menopausal women, while prevalence of osteopenia was high in pre-menopausal women (44.3%). Vitamin D deficiency was seen in 54.5% pre and 41.8% post-menopausal women and significant correlation of serum 25(OH)D levels (r = 0.16) was obtained only for total hip Z-score (p < 0.05). Correlation between sun index and lumbar spine BMD was marginally significant (r = 0.14, p = 0.07). Generalised linear models revealed that after adjusting for age, weight and height, percent decrease of 2.1–4.5% in BMD may be attributed to menopause.Conclusion. Age, weight, height, menopause, low intakes of calcium and low 25(OH)D along with poor sunlight exposure are the major factors contributing to bone loss in Indian women above 40 years of age.

Prosthetic Joint Infection Risk after TKA in the Medicare Population

The current risk of infection in contemporary total knee arthroplasty (TKA) as well as the relative importance of risk factors remains under debate as a result of the rarity of the complication and temporal changes in the treatment and prevention of infection. We therefore determined infection incidence and risk factors after TKA in the Medicare population. The Medicare 5% national sample administrative data set was used to identify and longitudinally follow patients undergoing TKA for deep infections and revision surgery between 1997 and 2006. Cox regression was used to evaluate patient and hospital characteristics. In 69,663 patients undergoing elective TKA, 1400 TKA infections were identified. Infection incidence within 2 years was 1.55%. The incidence between 2 and up to 10 years was 0.46%. Women had a lower risk of infection than men. Comorbidities also increased TKA infection risk. Patients receiving public assistance for Medicare premiums were at increased risk for periprosthetic joint infection (PJI). Hospital factors did not predict an increased risk of infection. PJI occurs at a relatively high rate in Medicare patients with the greatest risk of PJI within the first 2 years after surgery; however, approximately one-fourth of all PJIs occur after 2 years. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Significant human risk factors in aircraft maintenance technicians

We examined significant human risk factors in aircraft maintenance technicians (AMTs) in the airline industry. We conducted an empirical study of Taiwan’s airlines to determine these risk factors and to illustrate how a quantifiable evaluation approach integrates experts’ opinions about the relative importance of risk factors. We developed an expert questionnaire and modified the human factors SHELL model to categorize the risk factors that we derived from the literature and the opinions of 107 senior experts. The empirical results showed that there are nine significant risk factors out of 77 preliminary and 46 primary risk factors. The results also provided support for the approach and model presented in this work, demonstrating that they are both strategically effective and practically acceptable. Analyzing and ranking the significant risk factors for AMTs in this fashion may help airlines to better focus on their major operational and managerial weaknesses in order to improve maintenance operations under the condition of limited resources.

Risk contributions, information and reverse stress testing

In this paper we describe methods of decomposing risk into subcomponents such as contributing instruments, subportfolios or underlying risk factors e.g., equity, foreign exchange, economy-wide systematic and interest rate risk factors. The Euler allocation principle for allocation of instrument and subportfolio risk contributions to the total portfolio risk is widely applied in practice for portfolio managers risk budgeting and economic capital allocations. However, the decomposition of risk factors into summable contributions is in general not possible and we describe a non-parametric method of extracting relative information of risk factors that is valid for general non-linear portfolios. The measure is based on the Kullback information theory and while it does not constitute a decomposition it can be used to judge the relative importance of risk factors in determining profit and loss. The measure is also useful for understanding the relevance of so-called reverse stress tests where a certain loss level is identified with certain risk factor values. The use of the information measure is illustrated with an application to a portfolio of derivatives.

Predicting Outcomes Following Gastrostomy Insertion Using the Sheffield Gastrostomy Score. A Prospectively Devised Scoring System with a Validation Cohort

Introduction: Several scoring systems are used in the field of Gastroenterology. Although, previous studies have demonstrated the substantial risk of death following gastrostomy insertion and some risk factors have been identified - no previous investigators have described a scoring system for gastrostomy insertion. We undertook a prospective, unselected, dual centre study in order to establish the relative importance of risk factors for mortality after gastrostomy insertion. We then formulated a simple numerical scoring system to categorize patients' risk of death. We then sought to validate our scoring system on an independent second cohort of patients. Methods All patients referred for gastrostomy are prospectively included in a database along with demographic, biochemical and outcome data. We analysed gastrostomy insertions from 2 teaching hospitals from February 2004 to February 2007. There were 887 referrals resulting in 837 gastrostomy insertions. The largest cohort was at site A and was used to construct a risk stratification scoring system. Site B was used to validate the scoring system. Results Site A received 552 referrals and 403 new gastrostomies were inserted (median age 64, 268 males). Overall 30 day mortality rate was 51/403 (12.7%) with the highest risk in those with dementia (40%) followed by stroke (22.2%). Univariate analysis identified that 30 day mortality was associated with age (OR 3.4), albumin (OR 5.6), cardiac comorbidity (OR 2.0) and neurological comorbidity (OR 1.7). On multivariate analysis only age and albumin remained significant (both p < 0.001) and were then modelled and attributed scores with age scoring 0 or 1 and albumin scoring 0, 1 or 2 giving composite scores from 0 to 3. Scores of 0, 1, 2 and 3 gave 30 day mortalities (95% confidence interval) of 0% (0 - 2.1), 7% (2.9 - 13.9), 21.3% (13.5 - 30.9) and 37.3% (24.1 - 51.9) respectively. Kaplan-Meier curves stratified by total score showed a significantly increased mortality at 7 (p = 0.0003), 30 (p < 0.0001) and 90 (p < 0.0001) days. Site B (validation cohort) received 335 referrals and inserted 153 new gastrostomies (median age 77, 64 males) with a 30 day mortality of 24/153 (15.7%). Application of the scoring system in this validation cohort gave comparable 30 day mortality figures of 0%, 7.7%, 15.6% and 29.3% for scores 0, 1, 2 and 3 respectively. Conclusions: The Sheffield gastrostomy score can be used to categorise patients being considered for gastrostomy insertion and to calculate risk of death at 30 days. Further external validation is required.

Hepatitis A: who in NSW is most at risk of infection?

The incidence of hepatitis A in NSW has declined in recent years, but the relative importance of risk factors remains unclear. We analysed case data from the NSW Notifiable Diseases Database from 1991 to 2006. Hepatitis A notification rates fell from 18.9 to 1.4 cases per 100 000 between 1991 and 2006. International travel to endemic areas was the likely exposure for 50 per cent of cases between 2002 and 2006. Rates were five times higher in travellers born in countries where hepatitis A is endemic compared with those born in Australia. Travellers born in endemic countries should be carefully assessed for vaccination before departure.

Hypertensive Cardiac Remodeling in Males and Females

Cardiovascular diseases affect women and men differently: there are sex-dependent differences in the age at which they become manifest, in the pathophysiologic consequences of various insults, in the relative importance of risk factors, and in the responses to several treatments (as reviewed recently).1,2 Although many of these differences may relate to modifications of the lipid profile, as well as differences in the functions of endothelial and/or vascular smooth muscle cells, it is becoming clear that direct actions within the heart itself must also be considered. The current review will, therefore, focus on sex-specific differences in the remodeling responses of cardiac ventricles to various challenges. At baseline, male and female hearts display several differences: (1) coronary artery size is smaller in women3; (2) there are differences in the electrophysiological properties of the hearts, as females have faster resting heart rates and longer rate-corrected QT intervals4,5; (3) male and female hearts differ in terms of the pattern of expression of certain genes6; and (4) there are differences in the contractile properties of male and female hearts.7,8 More importantly, there are significant differences in the way male and female hearts respond to various challenges. In rodents, aortic banding-induced pressure overload increases left ventricular mass to the same extent in males and females, but function is better preserved in females, and males show an early transition to heart failure.9,10 In rats, volume overload induces eccentric dilated hypertrophy in male Sprague–Dawley rats but not in females.11 Differences in the remodeling responses can also be seen after myocardial infarction (MI), because female rats develop less thickening of noninfarcted regions and less pronounced diastolic dysfunction than their male counterparts,12 and post-MI rupture of the left ventricle is less frequent in female than in male mice.13,14 …

Acute upper gastrointestinal nonvariceal bleeding: How to determine low risk patients for rebleeding and mortality after endoscopic sclerotherapy?

Successful endoscopic sclerotherapy is effective in securing hemostasis for bleeding lesions and remains the first line and only needed therapy for most of the patients (pts), but bleeding reoccurs in 10% to 30% pts, and 4% to 14% of the pts die after acute nonvariceal upper gastrointestinal bleeding (UGIB). The need for hospitalization and its duration for all the bleeding pts is still a controversial question. To create the simple scoring system able to determine low risk pts for rebleeding and mortality by establishing the relative importance of risk factors for rebleeding and mortality after successful endoscopic sclerotherapy of acute nonvariceal UGIB. Prospective study included 3 15 pts who where admitted to hospital because of acute nonvariceal UGIB. All of them underwent gastroscopy with successful sclerotherapy within 12 hours after the admission. We investigated the episode of rebleeding and death during the initial hospitalization, and analyzed the following parameters: age, gender, drug intake, shock, bleeding stigmata, location of bleeding lesion and comorbidity. Rebleeding occurred in 53 pts (16.8%) and was determined by shock, bleeding stigmata and comorbidity. Eleven pts (3.5%) died and shock, rebleeding and comorbidity were all independent, statistically significant predictors of pts' mortality. The numerical scores for determination of pts with different risk levels for rebleeding and mortality have been developed using the significant predictors of rebleeding and death. The score values for rebleeding ranged from 3 to 9 and pts with values < or = 4 had low risk of rebleeding. We identified 59 pts (18.7% of all) with score for rebleeding < or = 4. Score values for mortality risk ranged from 3 to 8 and the values < 5 revealed negligible risk of death. In our group we found 290 pts (92.1% of all) with low mortality score values. Following the successful initial endoscopic sclerotherapy, these scores can help to identify pts with low risk of rebleeding and negligible risk of death, so they can be treated as outpatients.

Evaluating software project portfolio risks

As in any other business, software development organizations try to maximize their profits and minimize their risks. The risks represent uncertain events and conditions that may prevent enterprises from attaining their goals, turning risk management into a major concern, not only for project managers but also for executive officers involved with strategic objectives. In this sense, economical concepts can greatly support Software Engineers in the effort to better quantify the uncertainties of either a single project or even a project portfolio. In this paper, we present a technique for evaluating risk levels in software projects through analogies with economic concepts. This technique allows a manager to estimate the probability distribution of earnings and losses incurred by an organization in relation to its software project portfolio. This approach has been calibrated by data collected in an empirical study, which has been planned and accomplished to provide information about the relative importance of risk factors in software projects. A usage example of such an approach is presented. Finally, we introduce a case tool specially built to support the application of the proposed techniques.

Cardiac Calcifications: Fetuin???A and Other Risk Factors in Hemodialysis Patients

Cardiac calcifications are a frequent finding in hemodialysis for chronic renal failure. Several factors may play a role in the intimal and medial calcification of coronary arteries such as age and some known atherogenetic factors. In addition, Fetuin-A has been proposed as a protective agent through solubilization of calcium phosphate salt. Fetuin-A is also a marker of inflammatory-nutritional state, and its changes could be an expression of this condition. The aim of this cross-sectional study is to evaluate the relative importance of risk factors of calcifications with special regard to Fetuin-A. The study was conducted with 132 hemodialysis patients. They were subjected to multislice computed tomography for evaluation of calcium deposits in the heart. In addition, the patients were sampled for evaluation of calcium-phosphate parameters, lipid profile, nutritional and inflammatory markers, and also Fetuin-A. There was a wide variability of the extent of calcium deposits expressed as Agatston score, with only 9.3% of patients without calcifications. Age, hemodialysis age, sex, calcium-phosphate parameters, and lipid profile were important risk factors, together with nutritional and inflammatory status of the patients. An inverse correlation between coronary calcium score and Fetuin-A emerged from a multiple regression analysis. However, there was no significant difference in serum Fetuin-A among different grades of calcium score. By dividing the patients in tertiles of serum Fetuin-A, an association between low levels of Fetuin-A and high calcification score was found. Fetuin-A as dependent variable was strictly linked to prealbumin serum levels. In addition, there was a clear link between cardiac calcification scores and inflammatory-nutritional markers. Serum calcium and treatment with calcitriol emerged as predictive variables of coronary score.Fetuin-A could be involved in the process of calcification both in the case of markedly low serum levels, due to decreased prevention of calcium phosphate precipitation, and also as a marker of inflammation, a well-known risk factor of atherogenesis. Treatment with intravenous calcitriol could marginally enhance cardiac calcifications, probably through its hypercalcemic effect.