Restricted Cubic Spline Models Research Articles

Correlation between blood pressure control status and cognitive impairment in older adults: A national cross-sectional study.

Hypertension is closely related to cognitive impairment; however, the correlation between blood pressure control and cognitive impairment in the hypertensive population is unclear. We aimed to explore the relationship between blood pressure control and cognitive impairment in older adults with hypertension. Using the cross-sectional data from the 2018 Chinese Longitudinal Healthy Longevity Survey, 5,860 people with self-reported history of hypertension were divided into the hypotension, intermediate blood pressure, and hypertension groups. Cognitive impairment was defined as a score of < 18 on the Chinese version of the Mini-Mental State Examination. Demographics of the population were also collected. Bivariate Logistic regression analysis and restricted cubic spline (RCS) model were used to analyze the relationship between blood pressure control and cognitive impairment. After adjusting for confounding factors, binary logistic regression analysis showed that the intermediate group was significantly associated with an increased risk of cognitive impairment than the hypotension group, whereas the hypertension group was significantly correlated with a reduced risk of cognitive impairment. No significant correlation was found between blood pressure control and cognitive impairment in patients aged <80 years, with hearing impairment, or with cerebrovascular diseases, whether in the hypotension or hypertension groups. There was a significant correlation between hypotension and cognitive impairment, and no correlation between hypertension and cognitive impairment in people aged ≥ 80 years, Han ethnicity and those who used antihypertensive drugs. Furthermore, RCS model analysis showed that there was a non-linear relationship between systolic blood pressure and cognitive impairment in individuals aged ≥ 80 years and those using antihypertensive drugs. There was a linear relationship between diastolic blood pressure and cognitive impairment. Blood pressure control in the hypertensive group was significantly associated with a lower risk of cognitive impairment.

Systemic inflammation response index (SIRI)-based risk of pneumonia following successful PCI in STEMI patients

Background In patients with ST-elevation myocardial infarction (STEMI), pulmonary infection after successful primary percutaneous coronary intervention (PCI) is a severe complication that often results in death. It is not known whether there are any predictive markers for the onset of pneumonia in STEMI patients after successful PCI. Methods According to whether pneumonia occurred within two weeks of PCI, 619 STEMI patients were divided into pneumonia and nonpneumonia groups. The area under the receiver operating characteristic curve (AUC) was used to assess the predictive accuracy of the SIRI for pneumonia risk following successful PCI. Using a restricted cubic spline (RCS) and multivariate regression analysis, we investigated the relationship between the SIRI and PCI-induced pneumonia. Results Patients in the pneumonia group had a significantly greater SIRI than did those in the nonpneumonia group at admission (7.81 ± 7.53 vs. 3.35 ± 3.08, p < 0.001). Patients in the SIRI ≥ 4.04 group exhibited greater vulnerability to pneumonia after successful PCI than did those in the SIRI < 4.04 group (OR: 5.20, 95% CI: 3.53–7.72, p < 0.001). According to the ROC curve, the SIRI is highly predictive of pneumonia after PCI for STEMI patients, with an AUC of 0.766 (95% CI: 0.724–0.808). As the SIRI increased, the pneumonia risk increased in the RCS model. Conclusion As a result of PCI for STEMI patients, the SIRI is a good indicator of pneumonia risk. The likelihood of pneumonia occurring in STEMI patients after PCI generally increases with increasing SIRI.

Comprehensive Cross-Sectional Study of the Triglyceride Glucose Index, Organophosphate Pesticide Exposure, and Cardiovascular Diseases: A Machine Learning Integrated Approach

Using NHANES data from 2003 to 2008, 2011 to 2012, and 2015 to 2020, we examined the relationship between urinary organophosphate pesticide (OPP) metabolites and the triglyceride glucose (TyG) index. The TyG index evaluates insulin resistance, a crucial factor in metabolic diseases. Linear regression analyzed urinary metabolites in relation to the TyG index and OPPs. An RCS (restricted cubic spline) model explored the nonlinear relationship of a single OPP metabolite to TyG. A weighted quantile regression and quantile-based g-computation assessed the impact of combined OPP exposure on the TyG index. XGBoost, Random Forest, Support Vector Machines, logistic regression, and SHapley Additive exPlanations models investigated the impact of OPPs on the TyG index and cardiovascular disease. Network toxicology identified CVD targets associated with OPPs. This study included 4429 participants based on specific criteria. Linear regression analysis indicated that diethyl thiophosphate was positively correlated with the TyG index. The positive correlation between OPP metabolites and the TyG index at low to moderate concentrations was confirmed by WQS and QGC analyses. The machine learning results aligned with traditional statistical findings. Network toxicology identified PTGS3, PPARG, HSP40AA1, and CXCL8 as targets influenced by OPPs. OPP exposure influences IR and cardiometabolic health, highlighting the importance of public health prevention.

Relationship between prenatal metals exposure and neurodevelopment in one-year-old infants in the CLIMB study.

Prenatal metals exposure and its effects on infant neurodevelopment have garnered significant attention. However, most studies focus on individual metals, neglecting combined effects. We aimed to assess the effects of both single and combined prenatal metals exposure on one-year-old infants' neurodevelopment. This study included 189 mother-infant pairs from the Complex Lipids in Mothers and Babies (CLIMB) cohort. The concentrations of 21 metallic elements and 2 metalloids in umbilical cord blood (UCB) serum were measured using inductively coupled plasma mass spectrometry (ICP-MS). Neurodevelopment was measured using Chinese version of Bayley Scales of Infant Development (BSID) for the Psychomotor Development Index (PDI) and the Mental Development Index (MDI). Multiple statistical methods, including linear models, restricted cubic splines (RCS), weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR). After adjusting for potential confounders, prenatal arsenic (As) and strontium (Sr) levels were associated with lower PDI scores (As: β = -2.324; 95 % CI: -4.61, -0.04; Sr: β = -2.426; 95 % CI: -4.67, -0.18) by linear regression, while Sr was associated with lower MDI scores (β = -2.841; 95 % CI: -5.44, -0.25). RCS models revealed nonlinear dose-response relationships between manganese (Mn) and calcium (Ca) with PDI, and for Mn, As, and zirconium (Zr) with MDI. Interactions between certain metals were also identified. Metals mixture had an overall negative effect on both PDI and MDI scores, with Mn being the primary contributor. Prenatal exposure to selected metals or metal mixtures is associated with poorer neurodevelopment in one-year-old infants.

Association between the dietary inflammatory index and depressive symptoms in adults with metabolic syndrome: a cross-sectional study from the NHANES database

ObjectiveThe comorbidity of metabolic syndrome (MS) and depressive symptoms has emerged as a growing public health concern, contributing to a substantial global economic burden. The pathogenesis of this comorbidity is thought to be closely linked to inflammation. However, research examining the impact of the Dietary Inflammatory Index (DII) on depressive symptoms in adults with MS remains limited. This study aims to investigate the association between the DII and depressive symptoms in adults with MS, utilizing data from the National Health and Nutrition Examination Survey (NHANES).MethodsThis cross-sectional study included 7,553 participants aged 20 and older MS from six cycles of the NHANES (2007–2018). Depressive symptoms were assessed using the Patient Health Questionnaire scores, and dietary information was gathered to calculate the Dietary Inflammatory Index (DII). The association between DII scores and depressive symptoms in individuals with MS was evaluated through multivariable logistic regression analysis, adjusting for relevant covariates. Subgroup analyses and restricted cubic splines (RCS) were performed to explore this relationship further.ResultsAmong the participants, 907 individuals (12.0%) were identified as having depressive symptoms. After adjusting for all covariates, a positive correlation was observed (OR = 1.09, 95% CI: 1.04–1.14). After adjusting for all covariates, a positive association was observed between DII scores and depressive symptoms (OR = 1.09, 95% CI: 1.04–1.14). Individuals in the highest tertile of DII scores had significantly higher odds of depressive symptoms compared to those in the lowest tertile (OR = 1.36, 95% CI: 1.13–1.65). Subgroup analyses revealed that men were more likely to experience depressive symptoms among adults with MS. The RCS model revealed a nonlinear positive association between DII scores and depressive symptoms in these participants.ConclusionOur study indicates that the DII is positively correlated with an increased likelihood of depressive symptoms among adults with MS in the United States. These findings align with existing research and necessitate further validation through prospective cohort studies.

Association of serum neurofilament light chain with cognitive impairment: findings from the National Health and Nutrition Examination Survey.

Serum Neurofilament Light chain (NfL) is a promising biomarker of neuronal damage, used to assess the extent of neuronal injury and neurodegeneration, and it is widely applied in the diagnosis of neurodegenerative disease and monitoring disease progression. This article aims to determine whether serum NfL associated with cognitive level. Using NHANES data, we conducted an analysis of cognitive test results for 450 adults aged 60 years and older and examined their correlation with serum NfL levels. When exploring the association between cognitive test scores and serum NfL levels, regression models and restricted cubic spline (RCS) regression models were employed to adjust for potential confounding factors. The least absolute shrinkage and selection operator (LASSO) regression was applied for identifying key cognitive impairment factors, which was then included in the establishment of a risk prediction nomogram model, with the receiver operating characteristic (ROC) curve being built to evaluate its discriminatory power for cognitive impairment. It was found that there is a strong positive correlation between serum NfL levels and both low total cognitive function (total-CF) OR: 1.028 (95%CI = 1.015-1.041 p < 0.001) and low Digit Symbol Substitution Test (DSST) OR: 1.026 (95%CI = 1.003-1.050, p = 0.027). Furthermore, using the RCS model, we observed a linear trend in the relationship between NfL and low total-CF. The nomogram model based on NfL identified by LASSO regression displayed a considerable predicative value for low total-CF, with an area under the curve [AUC = 85.6% (81.6-89.3%)]. There is a strong correlation between serum NfL levels and cognitive function, especially DSST, which reflects attention and information processing abilities, as well as overall cognitive function, but not memory and language fluency. Thus, NfL may serve as a serum biomarker for dementia monitoring.

Association between atherogenic index of plasma and future risk of cardiovascular disease in individuals with cardiovascular-kidney-metabolic syndrome stages 0–3: a nationwide prospective cohort study

BackgroundAs an emerging concept, Cardiovascular-kidney-metabolic syndrome (CKM) elucidates the intricate interconnection between metabolic disorders(Mets), cardiovascular disease(CVD), and chronic kidney disease(CKD). Within this context, while numerous studies have demonstrated a correlation between the Atherogenic Index of Plasma (AIP) and CVD, the precise relationship between long-term fluctuations in the AIP and the incidence of CVD in patients with CKM syndrome remains unclear.MethodThe CKM stages 0–3 population was obtained from the China Health and Retirement Longitudinal Study (CHARLS). The outcome CVD was defined as self-reported heart disease and/or stroke. AIP control level was classified using k-mean cluster analysis. Logistic regression was used to analyse the effect of cumulative AIP (cumAIP) on the incidence of CVD. Restricted cubic spline models (RCS) were used to explore the potential non-linear relationship between cumulative AIP and CVD risk at different CKM syndrome stages.ResultsOf the 3429 CKM stages 0–3 participants, 620 patients developed CVD during the 3-year follow-up period. After adjusting for various confounders, the odds ratio (OR) for the well-controlled class 2 compared with the best AIP control class 1 were 1.37 (1.04, 1.81), the OR for the moderately-controlled class 3 were 1.54 (95% CI, 1.04–2.26), the poorly-controlled class 4 were 1.65 (95% CI, 1.13–2.41), and the worst-controlled class 5 were 2.14 (95% CI, 1.15–3.97). In restricted cubic spline regression analyses, changes in AIP were linearly associated with the occurrence of CVD events. Further weighted quartiles and regression analyses indicated that triglyceride(TG) was a key variable for AIP in predicting CVD events in the CKM stages 0–3 population.ConclusionsPoor control level of AIP are associated with an increased risk of CVD events in the population of CKM stages 0–3. Long-term dynamic monitoring of changes in AIP may help in the early identification of patients at high risk of developing CVD in the individuals with CKM stages 0–3.

Association between cardiovascular health and metabolic dysfunction-associated steatotic liver disease: a nationwide cross-sectional study

PurposeEvidence concerning the effect of cardiovascular health (CVH) on the risk of metabolic dysfunctional-associated steatotic liver disease (MASLD) is scarce. This study aimed to investigate the association between CVH and MASLD.Methods5680 adults aged ≥ 20 years from the National Health and Nutrition Examination Survey 2017-March 2020 were included. Life’s essential 8 (LE8) was applied to assess CVH. Weighted binary logistic regression was employed to calculate the odds ratio (OR) and 95% confidence interval (CI) to investigate the association of CVH with MASLD. Restricted cubic spline (RCS) was conducted to explore the dose-response association between LE8 and its subscales scores with MASLD.ResultsAmong 5680 participants, 724, 3901, and 1055 had low, moderate, and high CVH levels, respectively, with a MASLD diagnosis prevalence of 36.83%. In the fully adjusted logistic regression model, ORs for MASLD were 0.50 (95% CI, 0.37–0.69) for participants with moderate CVH and 0.21 (95% CI, 0.13–0.34) for those with high CVH, when compared to those with low CVH (P < 0.001 for trend). OR for MASLD was 0.68 (95% CI, 0.61–0.77) for each 10-point increase in LE8 score. RCS model demonstrated a non-linear dose-response relationship between LE8 score and health factors score with MASLD, while a linear relationship was found between health behaviors score and MASLD. Subgroup analysis showed a consistent negative correlation between LE8 score and MASLD, and sensitivity analysis validated the reliability of these findings.ConclusionsHigher LE8 score was associated with a lower risk of MASLD. Encouraging adherence to optimal CVH levels may help mitigate the burden of MASLD.

Association between urinary phthalate metabolites and sarcopenia in US adults from NHANES 2011-2018.

Phthalates, widely used as chemical additives, are often found as mixtures in the environment. However, the combined impact of phthalate exposure on sarcopenia remains unclear. This study aimed to investigate the relationships between phthalates and sarcopenia in adults. We analyzed data from 3,536 participants from the National Health and Nutrition Examination Survey (NHANES) conducted between 2011 and 2018.Multivariable logistic regression, restricted cubic splines (RCSs), weighted quantile sum regression (WQS), quantile-based g computation (qgcomp), and Bayesian kernel machine regression (BKMR) models were employed to assess the individual, nonlinear, and combined associations between phthalate metabolites and sarcopenia. In addition, subgroup analyses were performed to elucidate sex- and age-specific differences. Multivariable logistic regression revealed that MBP, MEP, and MiBP were positively associated with sarcopenia (P < 0.05) after adjusting for several covariates, including age, sex, race/ethnicity, education level, marital status, body mass index (BMI), smoking status, alcohol drinking, hypertension, diabetes, stroke, congestive heart failure, chronic kidney disease, physical activity, protein intake and energy intake. MBP exhibited a nonlinear relationship with sarcopenia in the RCS model. Furthermore, mixed phthalate metabolites were associated with a higher risk of sarcopenia in the WQS and qgcomp models. The BKMR model indicated an increasing trend in sarcopenia risk. Subgroup analyses showed stronger associations among individuals aged 20-40 years. BKMR analyses also revealed potential interaction effects between MCPP, MECPP, MBP, and MEP on sarcopenia risk. This study provides new evidence that co-exposure to phthalates might increase the risk of sarcopenia. Further research is needed to explore the causal relationship between phthalate metabolites and sarcopenia, as well as to elucidate the underlying mechanisms involved.

Association between NAFLD and liver fibrosis with nutritional risk index based on the NHANES 2017–2018

BackgroundNutrition and its associated inflammation have been acknowledged as vital factors in the etiopathogenesis of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis. The nutritional risk index (NRI) has been widely recognized as a valid indicator of nutritional status in several diseases, including osteoporosis and cardiovascular disease. However, the role of NRI in NAFLD and liver fibrosis remains unclear.MethodsParticipants were selected from the National Health and Nutrition Examination Survey data for the 2017–2018 cycle. Association between NRI and both NAFLD and liver fibrosis was evaluated using multiple logistic regression and restricted cubic spline (RCS) analysis. Mediation analysis was employed to assess the influence of inflammation on the association between NRI and both NAFLD and liver fibrosis.ResultsCompared to their respective control groups, individuals with NAFLD and liver fibrosis exhibited higher NRI levels. Multiple logistic regression analyses indicated that NRI was positively associated with the odds of NAFLD and liver fibrosis across both continuous scales and quantile groups, with adjustments for relevant covariables. The RCS model demonstrated a dose-response effect between NRI and the odds of NAFLD, but not with liver fibrosis. Receiver operating characteristic (ROC) analysis revealed the area under the ROC curves of 0.798 and 0.775 for NAFLD and liver fibrosis, respectively. Mediation analysis showed that inflammation accounted for 3.139% of the effect of NRI on the odds of NAFLD, suggesting inflammation might partially mediate the impact of NRI on NAFLD.ConclusionsOur findings indicate that NRI may serve as a potential associated marker for these liver diseases, underscoring the importance of nutritional status in their etiopathogenesis.

Copper Intake and Mortality Among Asthmatic Adults: A Cohort Study.

Previous studies have proved trace mineral disorders to be related to changes in oxidative stress, inflammatory state, and immune response in asthmatics. However, there is a scarcity of studies that examine the correlation between copper intake with mortality in asthmatic people. The aim of this research was to investigate the effect of copper intake on the asthmatic population's mortality. This investigation included 3175 individuals from the NHANES. Multiple statistical models were used in this investigation to discuss the correlation between copper intake and the asthmatic population's mortality. These models included Cox proportional hazards models, trend tests, restricted cubic splines (RCS), threshold effect model, and CoxBoost model. Three Cox hazard models showed an inverse relationship between copper intake and the risk of death in asthmatics. Statistical tests, such as trend tests, RCS models, and threshold effect models, proved an inverse and linear link between dietary copper and the risk of death. Through Kaplan-Meier analysis, asthmatic adults who had higher copper intake had a higher survival rate compared to asthmatics with lower copper intake. The CoxBoost model indicated that the intake of copper, selenium, and zinc had a protective effect on mortality, whereas iron was associated with an increased risk of death. The research proved an inverse and linear correlation between dietary copper intake and the risk of death among asthmatic people. Improving copper intake may have a positive impact on the long-term survival of individuals with asthma.

Differential effects of systemic immune inflammation indices on hepatic steatosis and hepatic fibrosis: evidence from NHANES 1999–2018

BackgroundSeveral studies have demonstrated that systemic immune inflammation index (SII) has a positive relationship with hepatic steatosis. However, it is lack of system evidence for the correlation between SII and hepatic fibrosis. The objective of this study was to evaluate the relationships between SII and hepatic steatosis or hepatic fibrosis.MethodsA cross-sectional analysis was performed from the National Health and Nutrition Examination Survey (NHANES). Fibrosis-4 index (FIB-4), NAFLD fibrosis score (NFS) and hepamet fibrosis score (HFS) were the indicators for hepatic fibrosis; fatty liver index (FLI), NAFLD liver fat score (LFS) and Framingham steatosis index (FSI) were the indicators for hepatic steatosis. Pearson’s test, generalized linear model (GLM) and restricted cubic splines (RCS) were used to analyze associations of SII with hepatic fibrosis and hepatic steatosis.ResultsA total of 21,833 participants were enrolled in the study. Pearson’s test and GLM revealed that there were negative relationships between SII and hepatic fibrosis (FIB-4, NFS and HFS), while positive relationships between SII and hepatic steatosis (FLI, LFS and FSI). The corresponding β (95%CI) of SII and hepatic fibrosis were − 0.35(-0.46, -0.24), -0.67(-0.71, -0.63) and − 0.10(-0.12, -0.09), respectively. The corresponding β (95%CI) of SII and hepatic steatosis were 6.12(4.75, 7.50), 0.22(0.12, 0.31) and 0.27(0.20, 0.34), respectively. Statistically significant non-linear association were found in SII with hepatic fibrosis and hepatic steatosis in RCS model (all P < 0.001).ConclusionThere was a negative significant association between SII and hepatic fibrosis, while a positive significant association between SII and hepatic steatosis.

L-shaped association between triglyceride-glucose body mass index and short-term mortality in ICU patients with sepsis-associated acute kidney injury.

Sepsis is a systemic inflammatory response syndrome, with sepsis-associated acute kidney injury (SA-AKI) being a common complication. Insulin resistance (IR) is closely related to the stress response, inflammatory response, and severity of critical illness. The triglyceride-glucose body mass index (TyG-BMI) is a valuable tool for assessing IR. However, the relationships between TyG-BMI and clinical outcomes in patients with SA-AKI remain unclear. We conducted a retrospective analysis of ICU patients with SA-AKI using data from the MIMIC-IV database. The Boruta algorithm was employed to select significant features for predicting short-term mortality in SA-AKI patients. Multivariate Cox proportional hazards regression, sensitivity analysis, restricted cubic spline (RCS) models, and Kaplan-Meier (K-M) survival analysis were used to assess the relationship between TyG-BMI and short-term mortality in SA-AKI patients. Subgroup analyses considered the effects of age, sex, ethnicity, comorbidities and septic shock. This study included 3,349 patients, with males accounting for 60.5% of the patients. The Boruta analysis identified the TyG-BMI as an important clinical feature. Higher TyG-BMI values were significantly associated with reduced short-term mortality rates (28, 90, and 180 days) in patients with SA-AKI; for each standard deviation increase in TyG-BMI, the risk of all-cause death decreased by 0.2% (p < 0.0001). Kaplan-Meier analysis demonstrated that patients with high TyG-BMIs had significantly lower mortality rates than did those with low TyG-BMIs. The RCS model revealed an L-shaped nonlinear relationship between the TyG-BMI and mortality. Sensitivity analyses indicated that the association remained significant even after excluding patients with myocardial infarction, congestive heart failure, or those who were hospitalized in the ICU for less than 2 days. Subgroup analyses revealed a significant interaction effect on short-term mortality in CRRT patients (p < 0.05). The relationship between the TyG-BMI and short-term mortality in ICU patients with SA-AKI is significant, indicating its potential value for early risk assessment and clinical intervention.

Serum concentrations of different or multiple vitamins and Sarcopenia risk among US adults: insights from NHANES

BackgroundThe relationship between serum concentrations of different or multiple vitamins and sarcopenia remains underexplored. This investigation evaluates potential links between serum concentrations of different or multiple vitamins and sarcopenia prevalence among adults in the United States.MethodsUtilizing a cross-sectional design, this research draws from the National Health and Nutrition Examination Survey (NHANES) dataset of 2003–2006, encompassing 5,060 participants with comprehensive serum vitamin A, E, B9, B12, C, and D concentrations, alongside sarcopenia and covariate measurements. Participant stratification into distinct vitamin co-exposure clusters was achieved through K-means clustering. Analytical models, including weighted logistic regression, restricted cubic splines (RCS), weighted quantile sum regression (WQS), quantile g-computation (Q-gcomp), and Bayesian kernel machine regression (BKMR), were employed to evaluate the association between serum concentrations of different or multiple vitamins and sarcopenia risk, with an emphasis on nonlinearity.ResultsIn this study, sarcopenia was detected in 681 individuals (13.46%). Logistic regression results did not demonstrate any linear association between individual vitamin levels and sarcopenia risk (PFDR > 0.05). Contrastingly, the RCS model unveiled significant non-linear relationships for vitamins A and D (P_non-linear < 0.05). The K-means clustering results showed that participants in high-level vitamin exposure group had lower sarcopenia risk compared with those in low-level vitamin exposure group (OR (95% CI): 0.582 (0.397, 0.852)). Additionally, higher serum concentrations of different or multiple vitamins correlated inversely with sarcopenia risk (P_trend = 0.002). This inverse association was corroborated by WQS, Q-gcomp, and theBKMR models and remained consistent upon sensitivity analysis.ConclusionsThis study elucidates an inverse correlation between serum concentrations of different or multiple vitamins and sarcopenia risk, emphasizing a non-linear association, particularly with suboptimal vitamin D concentrations. Given the limitations of the NHANES study, further researches are required to clarify the existence of these relationships.

Rheumatoid Factor Titer as an Indicator of the Risk of Rheumatoid Arthritis Activity: Dose-Effect Analysis with the Restricted Cubic Spline Model.

Rheumatoid factor (RF) titer is known to be correlated to rheumatoid arthritis (RA) activity, but the ideal cut-off titer of RF remains unclear. Here, the relationship between RF titer and RA activity was investigated in order to determine the ideal RF value indicative of the risk of RA activity. Clinical data from 2044 eligible patients were collected from the First Affiliated Hospital of Anhui Medical University from February 2022 to October 2023. A restricted cubic spline (RCS) model was used to evaluate the relationship between RF titer and RA activity. Data from a total of 2044 patients with RA were collected and analyzed. Multivariate logistic regression analysis revealed that higher RF levels were significant predictors of the risk of RA activity calculated according to the disease activity score 28 (DAS28)-erythrocyte sedimentation rate (ESR) (OR = 2.020, 95% CI = 1.457-2.801, P < 0.001) and DAS28-C reactive protein (CRP) (OR = 1.526, 95% CI = 1.092-2.131, P = 0.013), after the results were adjusted for potential covariates. The relationship between log2RF and the risk of RA activity was non‑linear in the RCS model (P < 0.05). The cutoff value of RF titers for determining the risk of RA activity was 65.80 IU/mL. When RF exceeded the cutoff value, the risk of RA activity based on DAS28-ESR increased by 99.2% and the risk of RA activity based on DAS28-CRP increased by 62.8% (P < 0.001). The risk of RA activity increased non-linearly with the continuous change in RF titer.

Influence of TyG Index on Large Vascular Occlusive Stroke Following Endovascular Treatment.

This study aimed to investigate the impact of the triglyceride-glucose index (TyG index) on clinical consequences in individuals with large vascular occlusion (LVO)-induced acute ischemic stroke (AIS) following endovascular treatment (EVT). We conducted a single-center retrospective cohort study, including AIS with LVO who underwent EVT. Patients were categorized into TyG index groups, calculated as "(fasting triglyceride [mg/dL] × fasting blood glucose [mg/dL]/2)." Clinical outcomes were assessed, including poor outcome (modified Rankin Scale [mRS] > 2 [3-6]) at 90 days, early neurological deterioration (END), symptomatic intracranial hemorrhage (sICH), and 90-day mortality after EVT. Logistic regression and restricted cubic splines (RCS) were used to examine the relationship between the TyG index and clinical outcomes. Receiver operating characteristic (ROC) curve was constructed to evaluate the prognostic capacity of the TyG index. A total of 424 patients were included. Higher TyG levels were associated with worse functional outcome at 90 days (per unit: p = 0.006), sICH (per unit: p = 0.002, T3 versus T1: p = 0.004), and 90-day mortality (T2 versus T1: p = 0.011, T3 versus T1: p = 0.029) in logistic regression. A RCS model revealed a linear association between the TyG index and poor outcome at 90 days, sICH, and 90-day mortality (p for nonlinearity > 0.05). In ROC curve analysis, the traditional risk factors model (area under the curve [AUC]: 0.824, 95% CI: 0.784-0.859) was outperformed by the conventional risk factors + TyG index model (AUC: 0.845, 95% CI: 0.807-0.878) in predicting poor outcome (p = 0.021). A higher TyG index is associated with worse clinical outcomes in LVO-induced AIS patients after EVT. Additionally, the TyG index enhances risk prediction of traditional risk factors for poor outcome.

Association between exposure to arsenic, cadmium, and lead and chronic kidney disease: evidence from four practical statistical models.

Environmental exposure to arsenic (As), lead (Pb) and cadmium (Cd) may cause chronic kidney disease (CKD), with varying independent effects and unclear combined impact. This study aimed to evaluate these effects on CKD. 1,398 individuals were included. Urine arsenic (UAs) was determined by atomic fluorescence method. Urinary cadmium (UCd) and blood lead (BPb) levels were determined by graphite-furnace atomic absorption spectrometry. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60mL/min/1.73m2or proteinuria. Generalized linear models (GLM), restricted cubic spline (RCS) models, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) models were employed to study the independent and combined effects of exposure to As, Pb and Cd on CKD risk. Compared with non-CKD subjects, UAs, UCd, BPb, and creatinine adjusted urinary cadmium (UCdCr) were all significantly higher in CKD subjects. Compared with the lowest quartiles, the ORs (95%CIs) of CKD risk in the highest quartiles were 2.09 (1.16-3.74) for UAs, 2.84(1.56-5.18) for UCd, and 1.79 (1.05-3.06) for UCdCr, respectively. UAs, UCd, and UCdCr were all significantly positively associated with CKD risk in p-trend tests. RCS models revealed non-linear links between UAs, UCd, UCdCr and CKD risk, while a linear dose-response existed for BPb and CKD risk. The OR (95%CI) in WQS models were 1.72 (1.25-2.36) with UAs being the highest weighing metal(loid). BKMR models showed co-exposure mixture linked to higher CKD risk when the ln-transformed metal(loid)s above their 55th percentile. The ln-transformed UAs and UCdCr was significantly positively associated with CKD risk when the other two ln-transformed metals levels were all fixed at their different percentile levels. Synergism between Cd and Pb was also apparent. Single As, and Cd exposure were positively associated with an increased CKD risk. Co-exposure to As, Pb and Cd was positively associated with CKD risk, with As playing a dominant role.

The Association Between Brominated Flame Retardants Exposure and Liver-Related Biomarkers in US Adults.

Background: Emerging studies demonstrate that exposure to brominated flame retardants (BFRs) can have harmful effects on human health. Our study focused on the relationship between exposure to various BFRs and markers of liver function. Methods: To further explore the association between BFR exposure and liver function impairment, we used data from the National Health and Nutrition Examination Surveys (NHANES) for three cycles from 2009 to 2014, leaving 4206 participants (≥20 years of age) after screening. Nine BFRs and eight liver function tests (LFTs) were measured in the participants' serum to represent BFRs and liver function impairment in vivo. To investigate whether there is a relationship between BFRs and health outcome, statistical research methods such as the weighted linear regression model, restricted cubic spline (RCS), weighted quantile sum (WQS), quantile-based g computing (QGC), and the Bayesian Kernel Machine Regression (BKMR) were used to evaluate the correlation between serum BFRs and LFTs. Results: The studies reveals that exposure to BFRs is associated with liver function biomarkers. In a weighted linear regression model, we found that PBB153, PBDE99, PBDE154, PBDE209, PBDE85 exposure was positively correlated with AST, ALT, GGT, ALP, TP, and SL risk. In RCS model, the nonlinear relationships between PBB153 and AST, ALT, and GGT and PBDE209 and ALT and TP are the most significant. The exposure to combined BFRs was positively correlated with AST, ALT, and GGT in WQS and QGC models. BKMR analysis showed that BFR exposure was positively correlated with AST, ALT, ALP, and GGT. Conclusions: Exposure to BFRs is associated with liver function impairment, suggesting that BFR exposure is potentially toxic to the human liver, but more in-depth studies are needed to explore this correlation.

Association between iron metabolism and acute kidney injury in cardiac surgery with cardiopulmonary bypass: a retrospective analysis from two datasets

ObjectiveWe sought to explore the linear or nonlinear relationship between preoperative iron metabolism and acute kidney injury following cardiac surgery (CSA-AKI) with cardiopulmonary bypass (CPB).MethodsPatients who underwent cardiac surgery with CPB between December 2018 and April 2021 were retrospectively collected from Fuwai Hospital and Medical Information Mart for Intensive Cared dataset (MIMIC-IV). The measurements of iron metabolism included serum iron (SI), serum ferritin (SF), transferrin (TRF), transferrin saturation (TS), and total iron binding capacity (TIBC). Logistic regression and restricted cubic spline (RCS) were used for linear and nonlinear analysis. The primary outcome was postoperative AKI with 48 h after cardiac surgery.ResultsOf 10,639 patients screened (2420 in Fuwai Hospital and 8219 in MIMIC-IV dataset),1488 eligible patients were enrolled for the final analysis (Fuwai Hospital: n = 744, MIMIC-IV: n = 744).The incidence of AKI was 25.7% and 56.5%, respectively. Logistic regression showed that the levels of TRF (odds ratio (OR) = 1.53,95%CI:1.01–2.14, p = 0.012) and TIBC (OR = 1.05,95%CI:1.02–1.07, p < 0.001) were independent risk factor for AKI. Moreover, in the spline models adjusted with age (median:56), female, and history of diabetes, a significant statistical difference was observed between SI, SF, TRF, TS, TIBC (p for nonlinear < 0.05) and AKI in the Fuwai Hospital dataset. Additionally, the levels of SI (p for nonlinear 0.0364),SF (p for nonlinear 0.0461) were also in non-linear relationship with AKI in the MIMIC-IV dataset.ConclusionIron metabolism markers (SI, SF, TS, TRF, and TIBC) displayed a nonlinear relationship with AKI by the RCS model (adjusted by age, gender, and history of diabetes). Notably, the MIMIC-IV dataset, which includes elderly patients, also demonstrated a nonlinear relationship between SI, SF and AKI. These findings highlight the potential therapeutic value of targeting proteins related to iron metabolism in patients with AKI.Clinical trial numberNot applicable.

Association between triglyceride glucose index and endometriosis in adults in the United States: A comprehensive study from the National Health and Nutrition Examination Survey (NHANES).

The triglyceride glucose (TyG) index has been well recognized as a reliable marker of insulin resistance and substantially correlated with the pathogenesis and progression of hypertension and cardiovascular diseases. However, no study has investigated the association between the TyG index and endometriosis. Therefore, this study aimed to uncover an association between the TyG index and endometriosis. This cross-sectional investigation employed the extensive dataset derived from the National Health and Nutrition Examination Survey (NHANES) (1999-2006). To explore the potential connection between the TyG and endometriosis, a multivariate weighted logistic regression model was established. The nonlinear relationship between the TyG index and the risk of endometriosis was explored using restricted cubic spline models (RCS). Furthermore, subgroup analyses were conducted. Ultimately, 2,508 individuals were included in this investigation. The findings unveiled a robust positive correlation between the TyG index and the susceptibility to endometriosis (OR [95% CI]: 1.52 [1.024,2.258]; P < 0.05). This positive association remained consistent across diverse subgroups. Age, birthplace, and whether one ovary was removed were identified as significant risk factors. In RCS analysis, the TyG index showed a nearly linear relationship with the risk of endometriosis (P-nonlinear > 0.05). The findings indicate a positive association between the TyG index and the risk of endometriosis, exhibiting an approximate non-linear relationship.