BACKGROUND Acute pancreatitis(AP),a severe pancreatic inflammatory condition,with a mor-tality rate reaching up to 40%.Recently,AP shows a steadily elevating prevalence,which causes the greater number of hospital admi...BACKGROUND Acute pancreatitis(AP),a severe pancreatic inflammatory condition,with a mor-tality rate reaching up to 40%.Recently,AP shows a steadily elevating prevalence,which causes the greater number of hospital admissions,imposing the substantial economic burden.Acute kidney injury(AKI)complicates take up approximately 15%of AP cases,with an associated mortality rate of 74.7%-81%.AIM To evaluate the efficacy of estimated plasma volume status(ePVS)in forecasting AKI in patients with AP.METHODS In this retrospective cohort study,AP cases were recruited from the First College of Clinical Medical Science of China Three Gorges University between January 2019 and October 2023.Electronic medical records were adopted for data extrac-tion,including demographic data and clinical characteristics.The association between ePVS and AKI was analyzed using multivariate logistic regression models,with potential confounders being adjusted.Nonlinear relationship was examined with smooth curve fitting,and infection points were calculated.Further analyses were performed on stratified subgroups and interaction tests were conducted.RESULTS Among the 1508 AP patients,251(16.6%)developed AKI.ePVS was calculated using Duarte(D-ePVS)and Kaplan-Hakim(KH-ePVS)formulas.After adjusting for covariates,the AKI risk exhibited 46%[odds ratio(OR)=1.46,95%confidence interval(CI):0.96-2.24]and 11%(OR=1.11,95%CI:0.72-1.72)increases in the low tertile(T1)of D-ePVS and KH-ePVS,respectively,and 101%(OR=2.01,95%CI:1.31-3.05)and 51%(OR=1.51,95%CI:1.00-2.29)increases in the high tertile(T3)relative to the reference tertile(T2).Nonlinear curve fitting revealed a U-shaped association of D-ePVS with AKI and a J-shaped association for KH-ePVS,with inflection points at 4.3 dL/g and-2.8%,res-pectively.Significant interactions were not observed in age,gender,hypertension,diabetes mellitus,sequential organ failure assessment score,or AP severity(all P for interaction>0.05).CONCLUSION Our results indicated that ePVS demonstrated the nonlinear association with AKI incidence in AP patients.A U-shaped curve was observed with an inflection point at 4.3 dL/g for the Duarte formula,and a J-shaped curve at-2.8%for the Kaplan-Hakim formula.展开更多
Background Acute kidney injury(AKI)is a common and serious complication following coronary artery bypass grafting(CABG),with an incidence rate ranging from 4%to 28%.The estimated plasma volume status(ePVS)-a novel mar...Background Acute kidney injury(AKI)is a common and serious complication following coronary artery bypass grafting(CABG),with an incidence rate ranging from 4%to 28%.The estimated plasma volume status(ePVS)-a novel marker calculated from routine hematocrit and hemoglobin levels-reflects both volume overload and hemodilution,which are potential contributors to renal impairment.Nevertheless,the relationship between ePVS and AKI in patients undergoing CABG remains poorly understood.Therefore,this study aimed to investigate the association of ePVS with the risk of AKI in adult patients who underwent CABG.Methods This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care(MIMIC)-IV database,covering the period from 2008 to 2019.The primary outcome was the occurrence of AKI following admission to the intensive care unit(ICU).Hematocrit and hemoglobin levels were measured within 24 hours after ICU admission.The ePVS was calculated using the Strauss-derived Duarte formula:ePVS=[100-hematocrit(%)]/hemoglobin(g/dL).AKI was defined in accordance with the Kidney Disease Improving Global Outcomes(KDIGO)criteria.Multivariable logistic regression models were used to adjust for demographics,comorbidities,and critical laboratory markers.Patients were stratified into three groups based on the ePVS tertiles(low:≤6.30;middle:6.30-8.08;high:>8.08).Multivariate logistic regression and subgroup analyses were applied to explore the association of the ePVS with the risk of AKI.Furthermore,we also examined the association of ePVS with AKI by employing generalized additive models.Results A total of 3,388 patients were included in the final analysis,of whom 2,573(75.94%)developed AKI.Following multivariable adjustment,each unit increase in ePVS was associated with a 9%increase in the odds of AKI(OR:1.09,95%CI:1.05-1.14;P<0.001).When analyzed by ePVS tertiles,the highest tertile demonstrated a significantly elevated AKI risk compared with the lowest tertile(OR:1.48,95%CI:1.18-1.86,P=0.0007),with a significant dose-response relationship observed across tertiles(P for trend<0.001).Subgroup analyses further indicated that the association between ePVS and AKI was more pronounced among patients with pre-existing renal or peripheral vascular disease and was statistically significant only in White patients.Conclusions ePVS was independently associated with an increased risk of AKI in adults undergoing CABG.These findings supported the potential utility of ePVS as a simple,economical clinical tool for early identification of patients at high risk for AKI following cardiac surgery.展开更多
Iodine is an element that is essential for the synthesis of thyroid hormones.Adequate intake of dietary iodine has been recognized as a critical factor for maintaining health.It is a well-known fact that iodine defici...Iodine is an element that is essential for the synthesis of thyroid hormones.Adequate intake of dietary iodine has been recognized as a critical factor for maintaining health.It is a well-known fact that iodine deficiency can impede the production of thyroid hormones in both the mother and fetus,which increases the risk of brain damage in the fetal stage.展开更多
文摘BACKGROUND Acute pancreatitis(AP),a severe pancreatic inflammatory condition,with a mor-tality rate reaching up to 40%.Recently,AP shows a steadily elevating prevalence,which causes the greater number of hospital admissions,imposing the substantial economic burden.Acute kidney injury(AKI)complicates take up approximately 15%of AP cases,with an associated mortality rate of 74.7%-81%.AIM To evaluate the efficacy of estimated plasma volume status(ePVS)in forecasting AKI in patients with AP.METHODS In this retrospective cohort study,AP cases were recruited from the First College of Clinical Medical Science of China Three Gorges University between January 2019 and October 2023.Electronic medical records were adopted for data extrac-tion,including demographic data and clinical characteristics.The association between ePVS and AKI was analyzed using multivariate logistic regression models,with potential confounders being adjusted.Nonlinear relationship was examined with smooth curve fitting,and infection points were calculated.Further analyses were performed on stratified subgroups and interaction tests were conducted.RESULTS Among the 1508 AP patients,251(16.6%)developed AKI.ePVS was calculated using Duarte(D-ePVS)and Kaplan-Hakim(KH-ePVS)formulas.After adjusting for covariates,the AKI risk exhibited 46%[odds ratio(OR)=1.46,95%confidence interval(CI):0.96-2.24]and 11%(OR=1.11,95%CI:0.72-1.72)increases in the low tertile(T1)of D-ePVS and KH-ePVS,respectively,and 101%(OR=2.01,95%CI:1.31-3.05)and 51%(OR=1.51,95%CI:1.00-2.29)increases in the high tertile(T3)relative to the reference tertile(T2).Nonlinear curve fitting revealed a U-shaped association of D-ePVS with AKI and a J-shaped association for KH-ePVS,with inflection points at 4.3 dL/g and-2.8%,res-pectively.Significant interactions were not observed in age,gender,hypertension,diabetes mellitus,sequential organ failure assessment score,or AP severity(all P for interaction>0.05).CONCLUSION Our results indicated that ePVS demonstrated the nonlinear association with AKI incidence in AP patients.A U-shaped curve was observed with an inflection point at 4.3 dL/g for the Duarte formula,and a J-shaped curve at-2.8%for the Kaplan-Hakim formula.
基金supported by the Guangdong Provincial Medical Science and Technology Research Fund Program(No.2024112010149612)。
文摘Background Acute kidney injury(AKI)is a common and serious complication following coronary artery bypass grafting(CABG),with an incidence rate ranging from 4%to 28%.The estimated plasma volume status(ePVS)-a novel marker calculated from routine hematocrit and hemoglobin levels-reflects both volume overload and hemodilution,which are potential contributors to renal impairment.Nevertheless,the relationship between ePVS and AKI in patients undergoing CABG remains poorly understood.Therefore,this study aimed to investigate the association of ePVS with the risk of AKI in adult patients who underwent CABG.Methods This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care(MIMIC)-IV database,covering the period from 2008 to 2019.The primary outcome was the occurrence of AKI following admission to the intensive care unit(ICU).Hematocrit and hemoglobin levels were measured within 24 hours after ICU admission.The ePVS was calculated using the Strauss-derived Duarte formula:ePVS=[100-hematocrit(%)]/hemoglobin(g/dL).AKI was defined in accordance with the Kidney Disease Improving Global Outcomes(KDIGO)criteria.Multivariable logistic regression models were used to adjust for demographics,comorbidities,and critical laboratory markers.Patients were stratified into three groups based on the ePVS tertiles(low:≤6.30;middle:6.30-8.08;high:>8.08).Multivariate logistic regression and subgroup analyses were applied to explore the association of the ePVS with the risk of AKI.Furthermore,we also examined the association of ePVS with AKI by employing generalized additive models.Results A total of 3,388 patients were included in the final analysis,of whom 2,573(75.94%)developed AKI.Following multivariable adjustment,each unit increase in ePVS was associated with a 9%increase in the odds of AKI(OR:1.09,95%CI:1.05-1.14;P<0.001).When analyzed by ePVS tertiles,the highest tertile demonstrated a significantly elevated AKI risk compared with the lowest tertile(OR:1.48,95%CI:1.18-1.86,P=0.0007),with a significant dose-response relationship observed across tertiles(P for trend<0.001).Subgroup analyses further indicated that the association between ePVS and AKI was more pronounced among patients with pre-existing renal or peripheral vascular disease and was statistically significant only in White patients.Conclusions ePVS was independently associated with an increased risk of AKI in adults undergoing CABG.These findings supported the potential utility of ePVS as a simple,economical clinical tool for early identification of patients at high risk for AKI following cardiac surgery.
基金sponsored by the Young Scholar Scientific Research Foundation of the National Institute of Nutrition and Health of China CDC[Grant No:NINH2016001]
文摘Iodine is an element that is essential for the synthesis of thyroid hormones.Adequate intake of dietary iodine has been recognized as a critical factor for maintaining health.It is a well-known fact that iodine deficiency can impede the production of thyroid hormones in both the mother and fetus,which increases the risk of brain damage in the fetal stage.
