Background: The vasoactive-ventilation-renal (VVR) score includes pulmonary and renal dysfunctions not previously addressed by the vasoactive inotrope score (VIS) and may be a better predictor of cardiac care unit (CC...Background: The vasoactive-ventilation-renal (VVR) score includes pulmonary and renal dysfunctions not previously addressed by the vasoactive inotrope score (VIS) and may be a better predictor of cardiac care unit (CCU) length of stay (LOS) in patients undergoing re-entry sternotomy (defined as no earlier than 30 days after previous sternotomy) for congenital heart disease (CHD). Methods: Patients undergoing re-entry sternotomy for CHD from August 1, 2009 to June 30, 2016 were studied retrospectively. A total of 96 patients undergoing 133 re-entry procedures were identified. VVR scores were calculated on CCU admission post-procedure (at 0 hour), 24-hour, and 48-hour after admission to the CCU. The response variable was CCU LOS.? Recursive partition analysis identified variables predicting LOS. Results: 133 re-entry sternotomies in 96 patients made up the samples of the database;11 samples were removed due to incomplete data or placement on ECMO. Of the initial 25 features, 5 were removed for near zero variance and 3 categorical features were removed for non-information. Covariance analysis did not demonstrate any significant correlation amongst the remaining features. Initial recursive tree regression using ANOVA, cross validation and conditional predictive p-value (cp) = 0.01 produced 3 trees. The tree with lowest cross validation error was selected. The resulting 2 split trees with ventilator days less than 20 days and VVR score at 48 hours greater than 23 identified three CCU LOS groups with mean CCU LOS of 77.6, 55.1, and 9.5 days. Conclusions: Recursive partition analysis identified ventilator days greater than 20 days and the sub-population VVR at 48 hours as predictive of CCU LOS in patients undergoing re-entry sternotomy for CHD.展开更多
目的:探究移植肾活组织检查的病理指标与不同时期移植肾功能异常的相关性,评价移植肾病理指标在移植肾功能异常中的诊断价值,建立预测移植肾预后的模型。方法:回顾性分析2015—2018年于南京医科大学第一附属医院接受移植肾活检的同种异...目的:探究移植肾活组织检查的病理指标与不同时期移植肾功能异常的相关性,评价移植肾病理指标在移植肾功能异常中的诊断价值,建立预测移植肾预后的模型。方法:回顾性分析2015—2018年于南京医科大学第一附属医院接受移植肾活检的同种异体肾移植手术受者的临床资料及病理指标。将总体样本基于不同活检后时间(活检时、活检后第1年、活检后第3年、活检后第5年)分别进行统计学分析。采用单因素分析筛选对肾功能异常有影响的指标,通过二元Logistic回归建立模型并绘制列线图;此外,通过混合效应Logistic回归探究在各阶段均与肾功能异常相关因素的动态效应。通过受试者工作特征(receiver operating characteristic,ROC)曲线、对应的曲线下面积(area under the curve,AUC)、校准曲线判断模型的判别效度以及与实际情况的一致性。结果:共纳入121例患者,按照移植肾活检后时间将总体样本分为活检时、活检后1年、3年、5年:i评分≥1分与活检时、活检后第1、3、5年肾功能异常显著相关;动态效应分析结果为i评分≥1分与移植肾穿刺后5年内的肾功能恶化有关。依据上述统计结果绘制出列线图,AUC显示模型具有较好的判别效度。校准曲线显示模型的移植肾功能异常发生的预测概率与实际概率一致性较高。结论:构建了一个预测不同时间点移植肾功能异常的列线图模型,有效提升了移植肾穿刺后患者管理的精准度。展开更多
The purpose of the present study was to determine the association between presence and progression of Coronary Artery Calcifications (CAC) quantified with Agatston Score (AS) and inflammatory index as CRP and other pa...The purpose of the present study was to determine the association between presence and progression of Coronary Artery Calcifications (CAC) quantified with Agatston Score (AS) and inflammatory index as CRP and other parameters in unselected renal transplant recipients. Forty-five patients were underwent a baseline Multislice CT (MSCT) at the time of renal transplant and a repeat evaluation 12 - 16 months later. After second MSCT recipients were divided in three groups: Gr1 (26 patients) with absence of CAC at basal and second MSCT, Gr2 (11 patients) with reduction of CAC after one year and Gr3 (8 patients) with increased values of CAC after one year. Mean +/- Standard deviation of basal and after one year values of AS and CRP were respectively: Gr1: 2 +/-3;2 +/- 5 and 0.4 +/- 0.3;0.55 +/- 0.67;Gr2: 317 +/- 288;212 +/- 242 and 0.9 +/- 1.1;0.55 +/- 0.6;Gr3: 854 +/- 1168;1032 +/- 1153 and 0.8 +/- 0.8;1.1 +/-?0.96. We found capacity of renal transplantation to protect against development of new calcium deposits in recipients without CAC at time of transplantation. While we confirmed association in Gr2 between reduction of CAC with reduction of CRP levels and in Gr3 between increased levels of CRP with increasing of CAC. Conclusion: In this preliminary study, renal transplantation appears to slow down or increasing CAC, in strict association with modifications of CRP levels. Long term studies are needed to confirm our preliminary data and to determine the effects of CAC on cardiovascular morbidity and mortality in renal transplant recipients.展开更多
Objective: We aim to detect over-time variations in mortality of liver transplant recipients stratified by the period of transplant. Since this is a retrospective investigation, bias reduction caused by possible confo...Objective: We aim to detect over-time variations in mortality of liver transplant recipients stratified by the period of transplant. Since this is a retrospective investigation, bias reduction caused by possible confounding effects can be achieved by using propensity score weighting in a multivariate logistic regression model. Methods: Medical charts of all adult liver transplant recipients (n = 250) who were transplanted in three periods 2005-2009, 2010-2014 and 2015-2019 were retrospectively reviewed. The following recipient factors were analyzed: recipients and donors’ ages, sex, renal impairment, body mass index (BMI), presence of bacterial or viral infections, MELD (Model for end-stage diseases). Multivariate logistic model adjusted by Propensity Scores (PS) was used to identify the effect of the risk factors on mortality, and death within five years, in the targeted time frame. Patient outcomes are recorded as;(patient status = 1 if dead, or patient status = 0 if alive). Results: Meld score, recipient age, and renal impairments were shown to be predictors of mortality in transplanted patients. Multivariate regression model was used to identify the significance of the specified risk factors, followed by pairwise comparisons between periods. Pairwise comparisons between periods using logistic regression weighted by the inverse propensity score, correcting for the possible confounding effect of measured covariates showed that the death rate is significantly reduced in subsequent periods as compared to the initial period. Conclusions: The clinical implications of these findings are the ability to stratify patients at high risk of posttransplant death by planning more intensive and accurate management for them.展开更多
文摘Background: The vasoactive-ventilation-renal (VVR) score includes pulmonary and renal dysfunctions not previously addressed by the vasoactive inotrope score (VIS) and may be a better predictor of cardiac care unit (CCU) length of stay (LOS) in patients undergoing re-entry sternotomy (defined as no earlier than 30 days after previous sternotomy) for congenital heart disease (CHD). Methods: Patients undergoing re-entry sternotomy for CHD from August 1, 2009 to June 30, 2016 were studied retrospectively. A total of 96 patients undergoing 133 re-entry procedures were identified. VVR scores were calculated on CCU admission post-procedure (at 0 hour), 24-hour, and 48-hour after admission to the CCU. The response variable was CCU LOS.? Recursive partition analysis identified variables predicting LOS. Results: 133 re-entry sternotomies in 96 patients made up the samples of the database;11 samples were removed due to incomplete data or placement on ECMO. Of the initial 25 features, 5 were removed for near zero variance and 3 categorical features were removed for non-information. Covariance analysis did not demonstrate any significant correlation amongst the remaining features. Initial recursive tree regression using ANOVA, cross validation and conditional predictive p-value (cp) = 0.01 produced 3 trees. The tree with lowest cross validation error was selected. The resulting 2 split trees with ventilator days less than 20 days and VVR score at 48 hours greater than 23 identified three CCU LOS groups with mean CCU LOS of 77.6, 55.1, and 9.5 days. Conclusions: Recursive partition analysis identified ventilator days greater than 20 days and the sub-population VVR at 48 hours as predictive of CCU LOS in patients undergoing re-entry sternotomy for CHD.
文摘目的:探究移植肾活组织检查的病理指标与不同时期移植肾功能异常的相关性,评价移植肾病理指标在移植肾功能异常中的诊断价值,建立预测移植肾预后的模型。方法:回顾性分析2015—2018年于南京医科大学第一附属医院接受移植肾活检的同种异体肾移植手术受者的临床资料及病理指标。将总体样本基于不同活检后时间(活检时、活检后第1年、活检后第3年、活检后第5年)分别进行统计学分析。采用单因素分析筛选对肾功能异常有影响的指标,通过二元Logistic回归建立模型并绘制列线图;此外,通过混合效应Logistic回归探究在各阶段均与肾功能异常相关因素的动态效应。通过受试者工作特征(receiver operating characteristic,ROC)曲线、对应的曲线下面积(area under the curve,AUC)、校准曲线判断模型的判别效度以及与实际情况的一致性。结果:共纳入121例患者,按照移植肾活检后时间将总体样本分为活检时、活检后1年、3年、5年:i评分≥1分与活检时、活检后第1、3、5年肾功能异常显著相关;动态效应分析结果为i评分≥1分与移植肾穿刺后5年内的肾功能恶化有关。依据上述统计结果绘制出列线图,AUC显示模型具有较好的判别效度。校准曲线显示模型的移植肾功能异常发生的预测概率与实际概率一致性较高。结论:构建了一个预测不同时间点移植肾功能异常的列线图模型,有效提升了移植肾穿刺后患者管理的精准度。
文摘The purpose of the present study was to determine the association between presence and progression of Coronary Artery Calcifications (CAC) quantified with Agatston Score (AS) and inflammatory index as CRP and other parameters in unselected renal transplant recipients. Forty-five patients were underwent a baseline Multislice CT (MSCT) at the time of renal transplant and a repeat evaluation 12 - 16 months later. After second MSCT recipients were divided in three groups: Gr1 (26 patients) with absence of CAC at basal and second MSCT, Gr2 (11 patients) with reduction of CAC after one year and Gr3 (8 patients) with increased values of CAC after one year. Mean +/- Standard deviation of basal and after one year values of AS and CRP were respectively: Gr1: 2 +/-3;2 +/- 5 and 0.4 +/- 0.3;0.55 +/- 0.67;Gr2: 317 +/- 288;212 +/- 242 and 0.9 +/- 1.1;0.55 +/- 0.6;Gr3: 854 +/- 1168;1032 +/- 1153 and 0.8 +/- 0.8;1.1 +/-?0.96. We found capacity of renal transplantation to protect against development of new calcium deposits in recipients without CAC at time of transplantation. While we confirmed association in Gr2 between reduction of CAC with reduction of CRP levels and in Gr3 between increased levels of CRP with increasing of CAC. Conclusion: In this preliminary study, renal transplantation appears to slow down or increasing CAC, in strict association with modifications of CRP levels. Long term studies are needed to confirm our preliminary data and to determine the effects of CAC on cardiovascular morbidity and mortality in renal transplant recipients.
文摘Objective: We aim to detect over-time variations in mortality of liver transplant recipients stratified by the period of transplant. Since this is a retrospective investigation, bias reduction caused by possible confounding effects can be achieved by using propensity score weighting in a multivariate logistic regression model. Methods: Medical charts of all adult liver transplant recipients (n = 250) who were transplanted in three periods 2005-2009, 2010-2014 and 2015-2019 were retrospectively reviewed. The following recipient factors were analyzed: recipients and donors’ ages, sex, renal impairment, body mass index (BMI), presence of bacterial or viral infections, MELD (Model for end-stage diseases). Multivariate logistic model adjusted by Propensity Scores (PS) was used to identify the effect of the risk factors on mortality, and death within five years, in the targeted time frame. Patient outcomes are recorded as;(patient status = 1 if dead, or patient status = 0 if alive). Results: Meld score, recipient age, and renal impairments were shown to be predictors of mortality in transplanted patients. Multivariate regression model was used to identify the significance of the specified risk factors, followed by pairwise comparisons between periods. Pairwise comparisons between periods using logistic regression weighted by the inverse propensity score, correcting for the possible confounding effect of measured covariates showed that the death rate is significantly reduced in subsequent periods as compared to the initial period. Conclusions: The clinical implications of these findings are the ability to stratify patients at high risk of posttransplant death by planning more intensive and accurate management for them.
