Analysis Of Risk Factors Research Articles

Rheumatoid arthritis prediction and risk factor analysis based on logistic regression and machine learning: A NHANES survey

Abstract. Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation of the synovial joints, leading to pain, swelling, and eventually joint deformity and disability. It affects approximately 0.5% to 1% of the global population, with higher prevalence rates observed in women and in developed countries. Therefore, offer potential strategies to identify at-risk individuals before the onset of overt symptoms, facilitating proactive interventions to mitigate disease progression. In this study, the National Health and Nutrition Examination Survey (NHANES) was used to derive several ML and logistic regression methods to predict the onset of RA among adults and compare the performance by Receiver Operating Characteristic (ROC) curve using 4 predicting models such as logistic regression, random forest, support victor machine and XGBoost. The logistic regression performed better than any other methods because of its AUC and easier interpretability. Also, with logistic regression risk factors like BMI, SII, diabetes, age, gender, smoking, education and PHQ-9 are determined. These results could help diagnose and decrease the development of RA.

Machine learning based risk factor analysis in the prognosis of heart failure

Abstract. Heart failure, one of the significant causes of death, poses challenges to healthcare systems due to its high hospitalization rates and substantial economic burden. This study explores the key factors predicting survival among heart failure patients by evaluating a variety of clinical, demographic, and lifestyle elements. Employing logistic regression, this analysis utilizes data from 299 patients at the Faisalabad Institute of Cardiology, each marked with 12 risk factors, and conducts a 10-fold cross-validation to ensure robustness. Results reveal that age, serum sodium, and serum creatinine levels are crucial predictors of mortality. Contrary to expectations, ejection fraction plays a lesser role. This study broadens our understanding of the complex risk factors linked to heart failure, helping to refine predictive models that could improve patient outcomes and reduce the economic pressures on healthcare systems, especially in regions facing financial difficulties. The study also highlights the potential role of lifestyle factors, such as dietary and physical activity patterns, in managing heart failure, suggesting a broader approach for future research and interventions.

Pain in Prison: A Risk Factor Analysis of 57 Prisoners' Deaths by Suicide in Illinois, United States.

United States prisons have elevated rates of suicide deaths compared to the general population. Thus, this manuscript aims to identify suicide risk factors, using data collected in Illinois (IL) state prisons between 2013-2021. First, we present comprehensive demographic, psychological, and prison-related descriptive statistics regarding 57 suicide decedents. Next, we compared this subset to IL state population-level prison reports to identify suicide-specific risk factors. Suicide decedents were predominately male, White, serving their first sentence, had a psychiatric diagnosis, and had no work assignment. Lethal attempts frequently occurred during evening off-hours, on Wednesdays, and were preceded by "mental health decompensation" and significant life transitions. Suicide-specific risk factors included identifying as White or Asian, having an offense type of habitual criminal or sex offender, being divorced, and not having children. We close with readily implementable suggestions to reduce suicides in prisons such as increasing off-hours and shift change staffing and social support interventions.

Analysis of clinical characteristics and risk factors on serrated polyps with synchronous advanced adenoma in elderly and non-elderly people: a retrospective cohort study

ObjectivesSerrated polyps (SPs) with synchronous advanced adenoma (AA) may increase the incidence of colorectal cancer. However, current studies do not address this combination of SPs and AAs in detail with...

Analysis of influential factors of stent-related adverse events after percutaneous coronary intervention more than twice: a single-center retrospective study

We aimed to assess the factors affecting patient outcomes in multiple stent placements over a 10-year period. The single-center study included 1,200 patients who had multiple stents implanted at least twice or more. Participants were divided into the adverse outcomes as endpoints (n = 204 [17%]) and control groups. Univariate and multivariate analyses of stent-related adverse events risk during 10 years and logistic regression analysis of the adverse outcomes risk factors were performed. Univariate analysis revealed the impact of acute coronary syndrome (ACS), diabetes mellitus, hypertriglyceridemia, cumulative lesions in the left anterior descending (LAD) and left circumflex (LCX) arteries, number of stents in the LAD, LCX, and right coronary artery (RCA), presence of multiple coronary artery lesions, total number of stents used, and intervals between the first and second and between the fourth and fifth implantations. For secondary stent implantation, significant factors in univariate analysis included the number of LAD and LCX lesions, stents in LAD, LCX, and RCA, extent of coronary lesions, ACS, hypertension, diabetes, and total stent count. Many factors affect the outcomes in this patient group over time. Reducing the need for frequent percutaneous coronary intervention and considering the number of stents implanted are essential to improving outcomes.

Logistic regression analysis of risk factors for anxiety and depression in patients with coronary heart disease and subclinical hypothyroidism

We sought to explore the risk factors for anxiety and depression in patients with coronary heart disease and subclinical hypothyroidism through logistic regression analysis. A retrospective analysis was conducted on 168 patients with coronary heart disease and subclinical hypothyroidism admitted to the Department of Cardiology of our hospital from February 2020 to November 2022. Patients were categorized into the control group, anxiety group, and depression group based on the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Rating Scale (HAMD) scores. All participants were informed about the protocol and provided signed informed consent upon inclusion. The study examined influencing factors for anxiety and depression in patients with coronary heart disease and subclinical hypothyroidism. Collect patients’ gender, age, presence or absence of chronic diseases (including Diabetes, hypertension and hyperthyroidism), sleep quality, dietary habits, psychosocial stress, living environment, social support, education level, and blood TSH levels. The linear relationship between anxiety, depression, and each influencing factor was quantified using the Pearson correlation coefficient. Blood level of TSH and free T4 were detected by chemiluminescence immunoassay. Multiple logistic regression was applied to analyze the factors influencing anxiety and depression in these patients. Various factors were identified as significant influencers of anxiety and depression in patients with coronary heart disease and subclinical hypothyroidism. For anxiety, presence or absence of chronic diseases, sleep quality, dietary habits, psychosocial pressure, living environment, and blood TSH levels were found to be influential (P < 0.05). Similarly, for depression, presence or absence of chronic diseases, sleep quality, social support, quality of life, social support, education level, and blood TSH levels were identified as significant factors (P < 0.05). The study revealed positive correlations between presence or absence of chronic diseases, psychosocial stress, and TSH levels with anxiety symptoms in patients with coronary heart disease and subclinical hypothyroidism (P < 0.05). Conversely, sleep quality, dietary patterns, and living environment showed negative correlations with anxiety symptoms (P < 0.05).Gender and age had no correlation with anxiety levels (P > 0.05). Presence or absence of chronic diseases and TSH levels were positively correlated with depressive symptoms in patients with coronary heart diseaseand subclinical hypothyroidism (P < 0.05). On the other hand, sleep quality, social support, quality of life, and educational level were negatively correlated with anxiety symptoms (P < 0.05). Gender and age had no correlation with depression (P > 0.05). Notably, TSH levels in both the anxiety and depression groups were higher than those in the control group (P < 0.05), with no significant difference in free T4 levels among the groups (P > 0.05). The combination of chronic illness types, living habits (sleep quality, dietary habits), psychosocial pressure, living environment, and TSH levels emerged as risk factors for anxiety in patients with coronary heart disease and subclinical hypothyroidism (P < 0.05). Similarly, the combination of chronic illness types, sleep quality, social support, quality of life, education level, and TSH levels were identified as risk factors for depression in these patients (P < 0.05). This logistic regression analysis underscores the significant impact of factors such as types of chronic illness, sleep quality, social support, living environment, education level, and TSH levels on anxiety and depression symptoms in patients with coronary heart disease and subclinical hypothyroidism. These findings highlight the importance of considering these multiple risk factors collectively when devising treatment and management strategies to reduce the risk of mental health issues in this patient population.

Analysis of Risk Factors for the Incidence of Hyperemesis Gravidarum at RSIA Fatimah and at RSUD Haji Makassar

Background: 32.26% of pregnant women in South Sulawesi in 2018 experienced disorders or complications during their pregnancy, 24.3% of them experienced disorders in the form of continuous vomiting / diarrhea. If nausea and vomiting occurs more than 5 times a day, it is called hyperemesis gravidarum. One of the risk factors for hyperemesis gravidarum is education. a person's education greatly affects the ability to think and the level of understanding and acceptance of something that is conveyed. Objective: This study aims to analyze the risk factors for the occurrence of hyperemesis gravidarum in pregnant women at the Fatimah Mother and Child Hospital and at the Regional General Hospital Haji Makassar. Method: This type of research is an observational analytic research with a case control approach. The population and sample used are all pregnant women who are recorded in the register book for 2020-2022 at RSIA Fatimah Makassar and RSUD Haji Makassar with a sample of 75 cases and controls that met the inclusion criteria. Result: The results showed that the prevalence of hyperemesis gravidarum at RSIA Fatimah Makassar and RSU Haji Makassar 2020-2022 was 50% (n = 75). The results of statistical analysis were mother's age OR 0.389 (95% CI = 0.174-0.870), Parity OR 0.469 (95% CI = 0.244-0.901), Education OR 3.083 (95% CI = 1.536-6.190), Occupation OR 1.158 ( CI 95% = 0.547-2.451), The results of bivariate analysis, namely maternal education OR 3.083 (95% CI = 1.536-6.190) is a risk factor for the occurrence of hyperemesis gravidarum. Conclusion: Maternal education is a risk factor for hyperemesis gravidarum with an OR value of 3.083 &gt; 1 and a p-value = 0.002 &lt;0.05.

Incidence and risk factor analysis of moderate-to-severe pain after preoperative CT-guided hook-wire puncture localization of pulmonary nodules

BackgroundPain is a relatively common complication after hook-wire puncture localization. However, the problem of pain occurrence following this localization procedure has not been sufficiently examined. In this prospective study, we aimed to investigate the incidence and risk factors associated with acute pain after preoperative CT-guided hook-wire puncture localization of pulmonary nodules.MethodsClinical data were collected prospectively from patients with small pulmonary nodules who underwent preoperative CT-guided hook-wire puncture localization between May 2022 and May 2023 at the Affiliated Hospital of Xuzhou Medical University. Patients were divided into two groups on the basis of the presence or absence of moderate-to-severe pain following the localization process. Univariate logistic analysis was conducted to analyse the clinical data of the two groups. Subsequently, the significant variables (P < 0.1) from the univariate analysis were subjected to multivariate logistic analysis, followed by the establishment of regression equations to determine the significant risk factors related to moderate-to-severe pain after hook-wire puncture localization.ResultsA total of 281 patients with small pulmonary nodules undergoing preoperative CT-guided hook-wire puncture localization were finally included, with a mean age of 54.86 years (SD = 12.1 years) and female predominance (67.6%). In the resting state, 53% of the patients reported moderate-to-severe pain. Univariate analysis revealed that age (P = 0.085), the depth of localization needle insertion into the lung (P = 0.024) and the location of the chest wall puncture (P = 0.07) were associated with moderate-to-severe pain occurrence after hook-wire puncture localization (P < 0.1). Furthermore, multivariate logistic regression analysis demonstrated that the depth of localization needle insertion into the lung (OR = 0.953, 95% CI: 0.914–0.992, P = 0.02) and the location of the chest wall puncture (lateral chest wall vs. anterior chest wall: OR = 2.101, 95% CI: 1.166–3.784, P = 0.013; posterior chest wall vs. anterior chest wall: OR = 1.163, 95% CI: 0.895–2.971, P = 0.11) were independent predictors of moderate-to-severe pain incidence following CT-guided hook-wire puncture localization (P < 0.05).ConclusionModerate-to-severe pain is prevalent in patients with pulmonary nodules who undergo preoperative CT-guided hook-wire puncture localization. The depth of needle insertion into the lung and the location of the chest wall puncture are significant predictors of moderate-to-severe pain onset.

Risk factors for wound complications after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) compared to repeated liver resection - a propensity score matching analysis

AimSufficient liver function is crucial in extracellular matrix growth, hemostasis, and wound healing. Repeated abdominal surgery is a known risk factor for the development of wound complications. This study aimed to evaluate this high-risk constellation in patients undergoing associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) and repeated liver resections (RLR) in comparison to single liver resection (SLR).MethodForty patients who underwent ALPPS between 2011 and 2020 were evenly matched with patients undergoing RLR or SLR (n = 40 per group) using propensity scores. Postoperative outcomes were compared and factors associated with wound complications were analyzed.ResultsPostoperative wound complications were significantly more frequent in ALPPS group (p = 0.001). The reoperation rate was not significantly different between the three groups (p = 0.143). However, surgical reintervention due to wound complications occurred more frequently in the ALPPS group in relation to RLR and SLR (17.5% vs. 7.5% and 5% respectively). Length of stay was significantly longer in the ALPPS group (p = 0.033). ALPPS was an independent risk factor for postoperative wound complication (OR = 8.55, 95% CI:1.07–68.44, p = 0.043). Risk factor analysis identified age ≥ 60 years (OR = 27.64, 95% CI:3.09-246.75, p = 0.003), BMI ≥ 30 kg/m2 (OR = 30.21, 95% CI:3.35-271.83, p = 0.002), and low postoperative albumin levels (OR = 168.41, 95% CI:7.76-3651.18, p = 0.001) as independent predictors of postoperative wound complications after major liver resection.ConclusionPatients undergoing ALPPS and RLR are faced with a high risk of developing wound complications. Older age, obesity, a history of previous abdominal surgery, and a decreased postoperative albumin level were independent risk factors for wound complications.

Abstract 4136280: Inflammation and Cancer Mortality among CVD Individuals: NHANES-Continuous study

Background: Both cancer and cardiovascular disease (CVD) are the leading causes of death worldwide. While previous research showed a relationship between CVD and cancer incidence, limited evidence is available regarding the relationship between inflammation and cancer mortality in CVD patients. Methods: A prospective cohort study using data from the continuous National Health and Nutrition Examination Survey (NHANES) (1999-2016) merged with Medicare and National Death Index (NDI) mortality data until December 31, 2018. We included CVD individuals with no history of cancer at baseline to investigate the relationship between inflammatory markers, including Neutrophil-to-Lymphocyte ratio (NLR), as the main exposure and cancer mortality as the main outcome. Results: We included 4,089 adult individuals representing 127,809,316 individuals (47% females, 72% non-Hispanic Whites, and 5% Hispanics). The risk factor analysis (Table) using the competing risk modeling showed that while inflammatory markers did not show significant associations with cancer mortality in the overall analysis, upon stratification by race/ethnicity, NH-Blacks showed higher cancer mortality with higher WBC count (aHR 5.61, 95% CI 1.66-18.91, p=0.007) and NLR (aHR 2.97, 95% CI 1.19-7.42, p=0.02), but lower cancer mortality with higher neutrophil (aHR 0.08, 95% CI 0.01-0.60, p=0.02) and lymphocyte (aHR 0.34, 95% CI 0.15-0.80, p=0.02) counts. Notably, our NH-Blacks showed lower neutrophils at baseline than others which could be explained by a phenomenon called “Benign Ethnic Neutropenia -BEN-” that still brings more complexity when interpreting NLR. Conclusions: Our study highlights the close relationship between cardiovascular health, inflammation, and cancer mortality. The findings also suggest that race/ethnicity may play a significant role in the relationship between inflammation and cancer mortality among individuals with CVD. Yet, further research is still needed to underpin the biological pathways influencing this relationship.

Abstract 4124307: Outcome of Obesity in Atrial Fibrillation - Insights from The National Inpatient Sample Database

Background: Obesity is considered a significant risk factor for numerous cardiovascular conditions due to its effects on cardiac structure and function. The prevalence of atrial fibrillation (AF) is elevated among patients with obesity due to the dysregulation of several mechanisms. Weight loss has been shown to reverse cardiac remodeling, leading to a lower recurrence of AF despite the better prognosis in obese patients described as the obesity paradox. Methods: We utilized the National Inpatient Sample 2016-2019 to extract patients ≥18 years of age admitted with AF as the primary diagnosis based on ICD 10 codes. We performed univariate and multivariate regression analysis for known coronary risk factors. We divided patients based on their body mass index (BMI), and our primary outcomes were determining the odds of electrical cardioversion (ECV) and cardiac ablation (CA) due to AF. Results: The analysis included 1,625,809 weighted patients. Patients include underweight (6.66%), normal BMI (4.03), overweight (6.51%), obesity class I (20.65%), obesity class II (21.45%), and obesity class III (40.7). After multivariate regression analysis, patients with obesity class I, II, or III had higher odds of ECV, irrespectively of coronary risk factors (OR 1.3, 95% CI 1.25-1.37, OR 1.3, 95% CI 1.32-1.43, OR 1.3, 95% CI1.29-1.38, respectively, with statistically significant P values). However, underweight or normal BMI patients had fewer odds of ECV (OR 0.5 95%CI 0.49-0.61 and OR 0.6 95%CI 0.58-0.74, respectively, with P values &lt;0.001). Meanwhile, there was no statistical significance between a BMI and the odds of CA. Conclusion: Our study highlights the significant impact of BMI on managing atrial fibrillation, particularly regarding electrical cardioversion (ECV). Patients in higher BMI categories (obesity class I, II, and III) demonstrated increased odds of undergoing ECV, suggesting that obesity may influence treatment approaches and outcomes in AF management. Interestingly, BMI did not affect the likelihood of cardiac ablation (CA), indicating a more complex relationship between body weight and AF treatment modalities that warrants further investigation. These findings underscore the importance of personalized treatment strategies to optimize outcomes, with a focus on weight management.

Abstract 4120657: A Personal Risk Assessment Device in Patients with Chest Pain

Introduction: Early prehospital chest pain assessment improves acute coronary syndrome (ACS) outcomes and can reduce unnecessary Emergency Room (ER) visits but requires medical personnel and electrocardiographic (ECG) equipment. Objective: To evaluate the feasibility of a personal credit-card sized chest pain self-assessment device (HeartBeam, Santa Clara, CA, USA) in diagnosing ACS. Methods: ACS risk was estimated by serial likelihood ratio analysis of 3 components: pre-existing coronary heart disease (CHD) risk (pre-calculated based on pooled ASCVD equation), chest pain characteristics (interactive proprietary questionnaire), and integrated near-orthogonal 3-lead self-recorded vectorcardiogram (VCG) with optional comparison to baseline using portable handheld HeartBeam recorder. Final ACS risk was graded High/Intermediate/Low by the cloud-based proprietary algorithm. High risk was considered positive for ACS. Results: 184 ER patients with chest pain (Age 57 +/- 7years, 90 Male, 43 (23%) ACS) comprised learning (n=96) and test (n=88) sets. ACS sensitivity was 28/28 (100%) in learning and 15/16 (94%) in test set with specificity of 43% and 42% respectively. In the subset of patients with pain-free portable VCG recorded 9 months later used as a “reverse baseline” (n=110) sensitivity was 17/17 (100%) and 11/12 (92%), specificity 54% and 58% in learning and test set, respectively (p&gt;0.1 with no baseline). Single patient missed by the analysis had known coronary disease with usual anginal episode resulting in minor troponin leak. In “reverse baseline” analysis 41/110 (37%) patients were classified as Low risk compared to 18/184 (10%) without baseline (p&lt;0.001), all negative for ACS. Based on the analysis of CHD risk factors, chest pain characteristics, and 12-lead ECG, a consensus of 3-member ER chest pain unit physicians panel had sensitivity/specificity of 94/54% for the whole and 93/48% for the “reverse baseline” groups (p&gt;0.1 with HeartBeam device). Conclusion: HeartBeam chest pain self-assessment device provides accurate ACS detection comparable to expert ER physicians using 12 lead ECG. The presence of baseline recording reduces the number of false positive results. If confirmed in larger studies, it can be used to facilitate outpatient chest pain assessment and triage by remote physicians and patients themselves.

Abstract 4127345: National Cohort Study on Hypertensive Disorders of Pregnancy Among Women with Congenital Heart Disease: Insights from Multiple Centers

Background: Hypertensive disorders of pregnancy (HDP) are among the primary reasons for maternal and perinatal deaths globally. Encompassing chronic hypertension, pregnancy induced hypertension (PIH), and preeclampsia, HDP are among the most frequent complications encountered during pregnancy. Considering the emerging congenital heart disease (CHD) population globally, research on HDP in pregnancies with CHD is urgently needed. Methods: Outcomes for 2220 pregnant women with CHD were evaluated retrospectively from 1993 to 2016 and prospectively from 2017 to 2019 from 7 tertiary hospitals. Maternal death, cardiac complications, obstetric and offspring complications of completed pregnancies and their demographics, cardiac characteristics, and comorbidities were collected. To identify the risk factors for HDP, univariate and multivariate analysis were performed through logistic regression. Results: Of 2220 completed pregnancies with CHD from 7 tertiary institutions, 77 women had PIH, and 76 women had preeclampsia. The main CHD diagnosis of patients with PIH was shunt lesion (including ASD, VSD, and PDA), left heart abnormality (including AS/AI, BAV, and COA), and single ventricle (SV). The main CHD diagnosis of patients with preeclampsia was shunt lesion (including ASD, VSD, and PDA), left heart abnormality (including AS/AI and MS/MI), and right heart abnormality (including TOF, PS/PAS/PI, DORV and DCRV). In parturients with PIH, the mortality and incidence of heart failure were 2.60% and 15.58%, respectively. In parturients with preeclampsia, the mortality and incidence of heart failure were 6.58% and 23.68%, respectively. Pregnancies with HDP had a significantly higher incidence of adverse maternal and offspring events than pregnancies without HDP. Independent risk factors for HDP included multiple gestation, use of medically assisted reproduction, having elevated brain natriuretic peptide (BNP) level, delayed first ANC visit, and absence of strict antenatal supervision. Conclusion: In summary, the presence of HDP in women with CHD significantly increased the risk of mortality and morbidity for both the mother and the child, particularly in cases involving preeclampsia.

Abstract 4123540: Cardiovascular Health and Cancer Incidence and Mortality: NHANES-III and -Continuous study

Background: Cancer and cardiovascular disease (CVD) are the leading causes of death worldwide. Limited evidence is available regarding the relationship between CVD, cardiovascular risk factors (CVRF), and cancer mortality; and how CVRF further modify that relationship. Methods: The first part included 438 and 2100 CVD patients aged 65+ from NHANES-III and Continuous (1999-2016) datasets, respectively. Competing risk models with subdistribution hazards ratio (aHR) were used to identify risk factors for cancer incidence. The second part included 44,591 adult individuals from NHANES-Continuous merged with Medicare and National Death Index mortality data until the end of 2018. We included individuals with no history of cancer at baseline. We used competing risk modeling to test the relationship between CVD at baseline and cancer mortality. We also conducted a comprehensive risk factor analysis. Results: In the first part (Figure), females in NHANES-III had lower cancer risk (aHR 0.39, P=0.001) compared to males. Poor physical activity was associated with increased cancer risk in both datasets (aHR 2.59 in NHANES-III, aHR 1.59 in Continuous). In NHANES-Continuous, age (aHR 1.07, P&lt;0.001) and current smoking (aHR 2.55, P=0.001) showed a significant association with developing cancer. No other factors investigated showed significant associations. In the second analysis (Table), the included sample size represented 1,738,423,317 individuals (52% females, 67% non-Hispanic Whites, and 9% Hispanics). Competing risk modeling showed a significantly higher risk of cancer mortality in individuals with CVD (aHR 1.37, 95% CI 1.07-1.76, P=0.01) after adjusting for age, sex, and race/ethnicity. Notably, cancer mortality increased with aging (aHR 1.08, 95%CI 1.05-1.11, P&lt;0.0001), current smoking status (aHR 6.78, 95%CI 3.43-13.42, P&lt;0.0001), and obesity (aHR 2.32, 95%CI 1.13-4.79, P=0.02). Finally, a significant interaction (P=0.034) was found where those with CVD and obesity showed higher cancer mortality than those with normal BMI (aHR, 95%CI 1.03-2.91, P=0.04). Conclusions: Our study highlights the close relationship between cardiovascular health and cancer, including among CVD patients. Our findings suggest that physical activity and obesity may play a significant role in cancer incidence and mortality among the general population and CVD patients. These findings emphasize the need for more proactive approach in the management of shared risk factors for CVD and cancer.

Distinct phenotype and risk factor analysis of persistent airflow limitation among asthmatic children: a case-control study

BackgroundPersistent airflow limitation (PAL) in childhood asthma is associated with a poor prognosis. The aim of this study was to categorize asthmatic children with PAL into distinct phenotypes and investigate the risk factors associated with each phenotype.MethodsWe conducted a case-control study with a total of 119 PAL patients and 120 non-PAL (NPAL) individuals. To classify the patients into appropriate clusters, unsupervised cluster analysis using K-means clustering was employed. The clusters were then compared to explore different PAL phenotypes. Univariate and multivariate logistic regression analyses were performed to identify risk factors for PAL and calculate odds ratios (ORs) with 95% confidence intervals (95%CIs).ResultsK-means clustering divided patients into three clusters: Cluster 0 included 120 NPAL patients, Cluster 1 characterized by elevated blood neutrophils included 66 PAL patients, and Cluster 2 exhibited elevated blood eosinophils and FeNO levels, containing 53 PAL patients. Independent risk factors for PAL included older age in both Cluster 1 (9∼\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\sim$$\\end{document}11y: OR 12.67, 95%CI 3.30-55.74; ≥\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\ge$$\\end{document}11y: OR 5.42, 95%CI 1.26-25.69) and Cluster 2 (9∼\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\sim$$\\end{document}11y: OR 7.25, 95%CI 1.70-33.35; ≥\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\ge$$\\end{document}11y: OR 11.28, 95%CI 2.79-51.89), as well as pneumonia history, with an OR of 6.41(95%CI 1.34-33.41) in Cluster 1 and an OR of 7.92(95%CI 1.83-37.44) in Cluster 2. Furthermore, specific factors associated with Cluster 1 included BMI above 22 kg/m2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$m^2$$\\end{document}(OR 12.28, 95%CI 2.68-70.45), asthma duration exceeding three years (OR 4.77, 95%CI 1.60-15.94), and a blood neutrophil percentage between 0.4 and 0.5 (OR 4.13, 95%CI 1.17-16.6). In Cluster 2, independent risk factors included a blood eosinophil percentage greater than 0.07 (OR 4.36, 95%CI 1.16-19.73) and a high FeNO level (OR 3.94, 95%CI 1.35-11.97).ConclusionOur study identified two phenotypes of PAL in asthmatic children: non-eosinophilic and eosinophilic inflammation. Older age and a history of pneumonia were independent risk factors for both phenotypes. For non-eosinophilic inflammation PAL, specific contributing factors included higher BMI, long duration of asthma, and a blood neutrophil percentage between 0.4 and 0.5. Elevated FeNO levels and blood eosinophilic percentage were independently associated with eosinophilic inflammation PAL.

Increased risk of persistent pulmonary hypertension of the newborn in twin anaemia polycythaemia sequence donors.

Introduction This study aimed to describe the prevalence and risk factors for respiratory complications in monochorionic twins with twin anaemia polycythaemia sequence (TAPS). Methods All neonates diagnosed with postnatal TAPS at our centre between 2002 and 2023 were included in this retrospective study. The primary outcome was the prevalence of respiratory complications, including respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD) and persistent pulmonary hypertension of the newborn (PPHN). Secondary outcomes included need of respiratory support during admission and a risk-factor analysis for adverse respiratory outcome. Results In our study of 100 postnatally diagnosed TAPS pregnancies, 32% (62/199) experienced RDS and 13% (25/199) had BPD, with no difference between donors and recipients. PPHN occurred in 7% of cases, more frequently in donors (11%, 11/100) than in recipients (3%, 3/100) (OR = 1.3, 95%CI 0.2-2.6). Lower gestational age at birth and severe fetal anaemia were found to be significant independent risk factors associated with PPHN in TAPS twins (OR = 0.3, 95%CI 0.1-0.5), respectively (OR = 1.9, 95%CI 0.8-3.1). Conclusion TAPS donor twins have a four-fold increased risk of PPHN due to anaemia compared to recipient twins. Given the life-threatening nature of PPHN, TAPS twins should be born in hospitals equipped to treat it.

Clinical characteristics, risk factor analysis and outcomes in 61 eyes with graft rejection after descemet stripping endothelial keratoplasty, with a review of literature.

To report the demographic profile, clinical characteristics, risk factors and outcomes of graft rejection after DSEK. A total of 3073 eyes had DSEK between 2012 and 2019, of which 1710 eyes that had follow up of more than one year. Sixty-one eyes who had graft rejection during this period were studied. Overall, incidence of graft rejection during the study period was 3.6% (61/1710 eyes) in those with follow up more than one year. The median age of patients was 58 (IQR 37.5-68) years. The indications were prior failed graft (34 eyes: 28 penetrating keratoplasty; 6 DSEK), post cataract surgery edema (12 eyes), Fuchs corneal endothelial dystrophy (6 eyes), corneal edema post inflammation (5 eyes) and iridocorneal endothelial syndrome (4 eyes). Of the 34 eyes with failed grafts, nine were post-rejection graft failures (two after endothelial keratoplasty and seven after penetrating keratoplasty), remaining 25 eyes were non-rejection graft failures. Ocular co-morbidities were noted in 41 eyes, of which secondary glaucoma was the most common (14 eyes). Clinical signs of graft rejection were diffuse edema, keratic precipitates and endothelial rejection line. Rejection episode occurred between 6-12months after surgery in 20 (33%) eyes, 12-24months in 15 (25%) eyes, 2-3years in 12 (20%) eyes, and beyond 3years in 14(23%) eyes. Graft clarity was restored in 55 (90%) eyes, which was complete in 41 (67%) eyes, partial in 14 (23%) eyes, and clarity was not restored in 6 (10%) eyes. The statistically significant risk factors for rejection were non-use of steroids (p value < 0.001), DSEK for failed graft (p value < 0.02) and DSEK for corneal edema post-inflammation (p value < 0.0014). DSEK for failed graft was a significant risk factor for graft failure after the rejection episode (p value < 0.05). Graft rejection may occur as late as 5years post-DSEK, emphasizing the need for long-term steroids instillation. Non-use of topical steroids, DSEK for failed graft and corneal edema post inflammation are risk factors for graft rejection. DSEK for failed graft was also seen as a risk factor for failure after the rejection episode The graft survival rate after the rejection episode was 90% at 6months, 50% at 2years and 10% at 5years.

Global, regional, and national burden of tuberculosis and attributable risk factors for 204 countries and territories, 1990–2021: a systematic analysis for the Global Burden of Diseases 2021 study

BackgroundTuberculosis (TB) remains a major global health threat. Despite ongoing efforts to control and eradicate TB, various factors including socioeconomic issues, policy modifications, and unexpected public health crises like COVID-19 pandemic have posed new obstacles to achieving TB elimination. This study aims to analyze the changes in global tuberculosis burden over the past 32 years, and provide scientific support for global initiatives targeting the eradication of TB in the post-pandemic period.MethodsThe data for this study were obtained from the Global Burden of Disease (GBD) 2021 database, with age-standardized incidence rate (ASIR), prevalence rate (ASPR), mortality rate (ASDR), and disability-adjusted life years (DALYs) as the primary assessment indicators. Dynamic changes in the TB burden were analyzed by estimating the annual percentage changes (EAPCs). The attributable ratios of six main risk factors to TB burden were calculated, and the correlation between the Socio-Demographic Index (SDI) and the TB burden was analyzed using Pearson correlation tests.ResultsThe global TB incidence decreased from 8.6 million cases in 1990 to 8.4 million cases in 2021, with a corresponding decline in deaths. However, the TB burden remains higher among men than women. The highest incidence and mortality rates were observed in the age group of 15–69 years, with a notable gender disparity, especially in Eastern Europe. These rates were generally elevated in low-income and lower-middle-income regions, with significantly higher Age-Standardized Incidence Rates and Age-Standardized Death Rates in males compared to females. A significant negative correlation was found between SDI values and TB burden. Analyzing risk factors from the Global Burden of Disease study, it was determined that globally, dietary risks, high body-mass index, high fasting plasma glucose, low physical activity, tobacco, and alcohol use were the main contributors to TB age-standardized Disability-Adjusted Life Years, with tobacco and alcohol use having the most significant impact. Analysis of risk factors suggests that tailored public health interventions for specific genders and regions can effectively lessen the TB burden.

Myosteatosis Evaluated Based on Intramuscular Adipose Tissue Content Is a Risk Factor for Postoperative Complications in Crohn's Disease.

Crohn's disease causes acute and chronic inflammation that often make the preoperative evaluation of surgical risks difficult. Myosteatosis is used for the evaluation of muscle quality to assess sarcopenia. However, data on the relationship between myosteatosis and surgical outcomes in patients with Crohn's disease are lacking. Among patients with Crohn's disease who underwent surgery between 2007 and 2022, we investigated the impact of myosteatosis on postoperative complications using intramuscular adipose tissue content (IMAC). Our study included data from 97 patients who underwent analysis for cutoff values and factors associated with IMAC and 72 who underwent analysis for risk factors of postoperative complications. Body mass index (BMI; P < .001) and visceral adipose tissue/height index (P < .001) were significantly correlated with IMAC. High BMI (P < .001) and a history of abdominal surgery for Crohn's disease (P = .012) were identified as factors affected with high IMAC. Multivariate analysis revealed high IMAC and external fistulas as independent risk factors for postoperative complications (odds ratio [OR], 5.010; 95% CI, 1.300-19.30; P = .019 and OR, 7.850; 95% CI, 1.640-37.50; P = .010, respectively), especially infectious complications. This study established IMAC as a valuable marker for sarcopenic obesity and predicting postoperative complications in patients with Crohn's disease. Furthermore, evaluating myosteatosis using IMAC will facilitate the decision of the optimal timing of surgery, prediction of complications, and treatment of sarcopenia in patients with Crohn's disease.

Machine-learning-based prediction of cardiovascular events for hyperlipidemia population with lipid variability and remnant cholesterol as biomarkers.

Dyslipidemia poses a significant risk for the progression to cardiovascular diseases. Despite the identification of numerous risk factors and the proposal of various risk scales, there is still an urgent need for effective predictive models for the onset of cardiovascular diseases in the hyperlipidemic population, which are essential for the prevention of CVD. We carried out a retrospective cohort study with 23,548 hyperlipidemia patients in Shenzhen Health Information Big Data Platform, including 11,723 CVD onset cases in a 3-year follow-up. The population was randomly divided into 70% as an independent training dataset and remaining 30% as test set. Four distinct machine-learning algorithms were implemented on the training dataset with the aim of developing highly accurate predictive models, and their performance was subsequently benchmarked against conventional risk assessment scales. An ablation study was also carried out to analyze the impact of individual risk factors to model performance. The non-linear algorithm, LightGBM, excelled in forecasting the incidence of cardiovascular disease within 3years, achieving an area under the 'receiver operating characteristic curve' (AUROC) of 0.883. This performance surpassed that of the conventional logistic regression model, which had an AUROC of 0.725, on identical datasets. Concurrently, in direct comparative analyses, machine-learning approaches have notably outperformed the three traditional risk assessment methods within their respective applicable populations. These include the Framingham cardiovascular disease risk score, 2019 ESC/EAS guidelines for the management of dyslipidemia and the 2016 Chinese recommendations for the management of dyslipidemia in adults. Further analysis of risk factors showed that the variability of blood lipid levels and remnant cholesterol played an important role in indicating an increased risk of CVD. We have shown that the application of machine-learning techniques significantly enhances the precision of cardiovascular risk forecasting among hyperlipidemic patients, addressing the critical issue of disease prediction's heterogeneity and non-linearity. Furthermore, some recently-suggested biomarkers, including blood lipid variability and remnant cholesterol are also important predictors of cardiovascular events, suggesting the importance of continuous lipid monitoring and healthcare profiling through big data platforms.