Corrigendum: Assessment of risk scores to predict mortality of COVID-19 patients admitted to the intensive care unit.

[This corrects the article DOI: 10.3389/fmed.2023.1130218.].

Metabolic Syndrome: An Overview on Its Genetic Associations and Gene-Diet Interactions.

Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors that includes central obesity, hyperglycemia, hypertension, and dyslipidemias and whose inter-related occurrence may increase the odds of developing type 2 diabetes and cardiovascular diseases. MetS has become one of the most studied conditions, nevertheless, due to its complex etiology, this has not been fully elucidated. Recent evidence describes that both genetic and environmental factors play an important role on its development. With the advent of genomic-wide association studies, single nucleotide polymorphisms (SNPs) have gained special importance. In this review, we present an update of the genetics surrounding MetS as a single entity as well as its corresponding risk factors, considering SNPs and gene-diet interactions related to cardiometabolic markers. In this study, we focus on the conceptual aspects, diagnostic criteria, as well as the role of genetics, particularly on SNPs and polygenic risk scores (PRS) for interindividual analysis. In addition, this review highlights future perspectives of personalized nutrition with regard to the approach of MetS and how individualized multiomics approaches could improve the current outlook.

Assessment of risk scores to predict mortality of COVID-19 patients admitted to the intensive care unit.

Objectives: To assess the ABC2-SPH score in predicting COVID-19 in-hospital mortality, during intensive care unit (ICU) admission, and to compare its performance with other scores (SOFA, SAPS-3, NEWS2, 4C Mortality Score, SOARS, CURB-65, modified CHA2DS2-VASc, and a novel severity score). Materials and methods: Consecutive patients (≥ 18 years) with laboratory-confirmed COVID-19 admitted to ICUs of 25 hospitals, located in 17 Brazilian cities, from October 2020 to March 2022, were included. Overall performance of the scores was evaluated using the Brier score. ABC2-SPH was used as the reference score, and comparisons between ABC2-SPH and the other scores were performed by using the Bonferroni method of correction. The primary outcome was in-hospital mortality. Results: ABC2-SPH had an area under the curve of 0.716 (95% CI 0.693-0.738), significantly higher than CURB-65, SOFA, NEWS2, SOARS, and modified CHA2DS2-VASc scores. There was no statistically significant difference between ABC2-SPH and SAPS-3, 4C Mortality Score, and the novel severity score. Conclusion: ABC2-SPH was superior to other risk scores, but it still did not demonstrate an excellent predictive ability for mortality in critically ill COVID-19 patients. Our results indicate the need to develop a new score, for this subset of patients.

Oral epithelial dysplasia grading: Comparing the binary system to the traditional 3-tier system, an actuarial study with malignant transformation as outcome.

BACKGROUND: Establishing the risk of malignant transformation (MT) in oral leukoplakia is usually based on grading oral epithelial dysplasia (OED) on biopsy tissue, for which two systems are proposed: a 3-tier and a binary system. Only very few actuarial studies have tested the accuracy of such methods in predicting MT, especially for the binary system. This study aimed to assess the accuracy of the two grading systems in predicting MT in a cohort of oral leukoplakia (OL) from Brazil, with follow-up data. METHODS: The sample comprised 878 individuals diagnosed with OL from 2005 to 2018. Follow-up data were obtained both locally and from the regional cancer registry. All lesions were graded using both the 3-tier and the binary systems. Kaplan-Meier curves (Log-rank Mantel-Cox) were used to assess risk and kappa to assess interobserver agreement. RESULTS: Thirty-five individuals underwent MT (4%). Both systems demonstrated prognostic value, though the 3-tier system proved superior, with OR 9.23 (3.42-23.69), PPV 0.152, NPV 0.98, compared to binary OR 3.49 (1.79-6.79), PPV 0.079, NPV 0.976. Interobserver agreement was also superior in the 3-tier system (0.47, p < 0.05) compared to the binary system (0.139, p = 0.39). Combining the two systems enhanced prognostic values (OR 14.28, PPV 0.217, NPV 0.981). CONCLUSION: The 3-tier system presented superior prognostic value to the binary system. Combining both systems to double-grade intermediate lesions might enhance risk assessment.

Diagnostic accuracy of blood biomarkers and non-invasive scores for the diagnosis of NAFLD and NASH: Systematic review and meta-analysis.

INTRODUCTION AND OBJECTIVES: Fatty liver disease is an important public health problem. Early diagnosis is critical to lower its rate of progression to irreversible/terminal stages. This study aimed to evaluate the accuracy of non-invasive prediction scores for fatty liver disease (NAFLD and NASH) diagnosis in adults. MATERIALS AND METHODS: A search was conducted in 10 databases, a qualitative synthesis of 45 studies, and quantitative analysis of the six most common scores. There were 23 risk scores found for NAFLD diagnosis and 32 for NASH diagnosis. The most used were Fatty Liver Index (FLI), aspartate aminotransferase (AST) to Platelet Ratio Index, Fibrosis-4 Index (FIB-4), AST/alanine aminotransferase (ALT) ratio, BARD score, and NAFLD fibrosis score (NFS). RESULTS: The results from the meta-analysis for FLI: Area under the curve (AUC) of 0.76 (95% Confidence Interval [CI] 0.73, 0.80), sensitivity 0.67 (CI 95% 0.62, 0.72) and specificity 0.78 (CI 95% 0.74, 0.83). The AST to Platelet Ratio Index: AUC 0.83 (CI 95% 0.80, 0.86), sensitivity 0.45 (95% CI 0.29, 0.62), and specificity of 0.89 (95% CI 0.83, 0.92). The NFS: AUC of 0.82 (CI 95% 0.78, 0.85), sensitivity 0.30 (CI 95% 0.27, 0.33) and specificity 0.96 (CI 95% 0.95,0.96). CONCLUSIONS: The FLI for NAFLD and AST to Platelet Ratio Index for NASH were the risk scores with the highest prognostic value in the included studies. Further research is needed for the application of new diagnostic risk scores for NAFLD and NASH.

The MAGGIC risk score in the prediction of death or hospitalization in patients with heart failure: Comparison with natriuretic peptides.

BACKGROUND: The MAGGIC risk score has been validated to predict mortality in patients with heart failure (HF). OBJECTIVES: To assess the score ability to predict hospitalization and death and to compare with natriuretic peptides. METHODS: Ninety-three consecutive patients (mean age 62±10 years) with chronic HF and left ventricular ejection fraction (EF) <50% were studied. The MAGGIC score was applied at baseline and the patients were followed for 219±86 days. MAGGIC score was compared with NT-proBNP in the prediction of events. The primary end point was the time to the first event, which was defined as cardiovascular death or hospitalization for HF. RESULTS: There were 23 (24.7%) events (3 deaths and 20 hospitalizations). The median score in patients with and without events was, respectively, 20 [interquartile range 14.2-22] vs. 15.5 [11/21], p=0.16. A ROC curve was performed and a cutoff point of 12 points showed a sensitivity of 87% and specificity of 37% with an area under the curve of 0.59 (95% CI 0.48-0.69) which was lower than that of NT-proBNP (AUC 0.67; 95% CI 0.56-0.76). The mean event-free survival time for patients above and below this cutpoint was 248.8±13 vs. 290±13.7 days (log rank test with p=0.044). Using the COX proportional hazard model, age (p=0.004), NT-proBNP >1000 pg/mL (p=0.014) and the MAGGIC score (p=0.025) were independently associated with the primary outcome. CONCLUSION: The MAGGIC risk score was an independent predictor of events, including heart failure hospitalization. The addition of biomarkers improved the accuracy of the score.

Systems-Level Analysis of Genetic Variants Reveals Functional and Spatiotemporal Context in Treatment-resistant Schizophrenia.

Treatment-resistant schizophrenia (TRS) occurs in one-third of the patients, but the molecular determinants of poor antipsychotic response remain unclear. We compared genetic data of patients with TRS (n = 63) with non-TRS (n = 111) by polygenic risk scores (PRS) calculated by PRSice software using PGC2_SCZ (Psychiatric Genomics Consortium - Schizophrenia) data. TRS criteria followed the International Psychopharmacology Algorithm Project SCZ algorithm. Statistical clustering and functional enrichment analyses of genes harboring TRS-linked variants were performed. Individuals on the top three deciles of schizophrenia PRS distribution exhibited higher odds of being refractory to antipsychotics than those on the bottom three deciles. Clusters of interacting variant-harboring genes were identified among the association signals. They are upregulated in the dorsolateral prefrontal, orbitofrontal, temporal, and inferior parietal areas during adolescence and early adulthood. Similar gene modules were found using transcriptional data from the same brain regions in individuals with schizophrenia. Genes were enriched among markers of cortical interneurons and somatosensory pyramidal cells. Finally, the enrichment of the clustered genes in drug-response expression signatures revealed compounds that could be employed to identify novel antipsychotic targets. In conclusion, we identified variant-harboring genes that may predispose SCZ patients to poor antipsychotic response and found statistically enriched clusters which provided functional and spatiotemporal context for TRS, suggesting that genotypic variation may converge to biological alterations at the interplay between actin dynamics and synaptic organization.

Predictive Score for Carbapenem-Resistant Gram-Negative Bacilli Sepsis: Single-Center Prospective Cohort Study.

A clinical-epidemiological score to predict CR-GNB sepsis to guide empirical antimicrobial therapy (EAT), using local data, persists as an unmet need. On the basis of a case-case-control design in a prospective cohort study, the predictive factors for CR-GNB sepsis were previously determined as prior infection, use of mechanical ventilation and carbapenem, and length of hospital stay. In this study, each factor was scored according to the logistic regression coefficients, and the ROC curve analysis determined its accuracy in predicting CR-GNB sepsis in the entire cohort. Among the total of 629 admissions followed by 7797 patient-days, 329 single or recurrent episodes of SIRS/sepsis were enrolled, from August 2015 to March 2017. At least one species of CR-GNB was identified as the etiology in 108 (33%) episodes, and 221 were classified as the control group. The cutoff point of ≥3 (maximum of 4) had the best sensitivity/specificity, while ≤1 showed excellent sensitivity to exclude CR-GNB sepsis. The area under the curve was 0.80 (95% CI: 0.76-0.85) and the number needed to treat was 2.0. The score may improve CR-GNB coverage and spare polymyxins with 22% (95% CI: 17-28%) adequacy rate change. The score has a good ability to predict CR-GNB sepsis and to guide EAT in the future.

A SAGE score cutoff that predicts high-pulse wave velocity as measured by oscillometric devices in Brazilian hypertensive patients.

We aimed to identify the optimal cutoff SAGE score for Brazilian hypertensive patients who had their pulse wave velocity (PWV) measured with oscillometric devices. A retrospective analysis of patients who underwent central blood pressure measurement using a validated oscillometric device, the Mobil-O-Graph® (IEM, Stolberg, Germany), between 2012 and 2019 was performed. Patients with arterial hypertension and available data on all SAGE parameters were selected. An ROC curve was constructed using the Youden index to define the best score to identify patients at high risk for high PWV. A total of 837 patients met the criteria for SAGE and diagnosis of hypertension. The median age was 59.0 years (interquartile range [IQR]: 47.0-68.0), and 50.7% of the patients were women. The following comorbidities and conditions were present: dyslipidemia (37.4%), diabetes (20.7%), a body mass index score ≥30 kg/m2 (36.6%), use of antihypertensive drugs (69.5%), and smoking (18.3%). The median peripheral blood pressure was 128 mmHg (IQR: 117-138 mmHg) for systolic and 81 mmHg (IQR: 73-90 mmHg) for diastolic blood pressure. The median PWV was 8.3 m/s (7.1-9.8 m/s), and the prevalence of high PWV (≥10 m/s) was 22.9% (192 patients). A cutoff SAGE score ≥8 was effective at identifying a high risk of PWV ≥ 10 m/s, achieving 67.19% sensitivity (95% CI: 60.1-73.8) and 93.95% specificity (95% CI: 91.8-95.7). With this cutoff point, 1 out of every 5 treated hypertensive patients would be referred for a PWV measurement. A SAGE score of ≥8 identified Brazilian hypertensive patients with a high risk of future cardiovascular events (PWV ≥ 10 m/s).

Machine learning with D-dimer in the risk stratification for pulmonary embolism: a derivation and internal validation study.

AIM: To develop a machine learning model to predict the diagnosis of pulmonary embolism (PE). METHODS AND RESULTS: We undertook a derivation and internal validation study to develop a risk prediction model for use in patients being investigated for possible PE. The machine learning technique, generalized logistic regression using elastic net, was chosen following an assessment of seven machine learning techniques and on the basis that it optimized the area under the receiver operator characteristic curve (AUC) and Brier score. Models were developed both with and without the addition of D-dimer. A total of 3347 patients were included in the study of whom, 219 (6.5%) had PE. Four clinical variables (O2 saturation, previous deep venous thrombosis or PE, immobilization or surgery, and alternative diagnosis equal or more likely than PE) plus D-dimer contributed to the machine learning models. The addition of D-dimer improved the AUC by 0.16 (95% confidence interval 0.13-0.19), from 0.73 to 0.89 (0.87-0.91) and decreased the Brier score by 14% (10-18%). More could be ruled out with a higher positive likelihood ratio than by the Wells score combined with D-dimer, revised Geneva score combined with D-dimer, or the Pulmonary Embolism Rule-out Criteria score. Machine learning with D-dimer maintained a low-false-negative rate at a true-negative rate of nearly 53%, which was better performance than any of the other alternatives. CONCLUSION: A machine learning model outperformed traditional risk scores for the risk stratification of PE in the emergency department. However, external validation is needed.

Association between Polygenic Risk Scores for ADHD and Asthma: A Birth Cohort Investigation.

OBJECTIVE: Shared genetic mechanisms have been hypothesized to explain the comorbidity between ADHD and asthma. To evaluate their genetic overlap, we relied on data from the 1982 Pelotas birth cohort to test the association between polygenic risk scores (PRSs) for ADHD (ADHD-PRSs) and asthma, and PRSs for asthma (asthma-PRSs) and ADHD. METHOD: We analyzed data collected at birth, 2, 22, and 30 years from 3,574 individuals. RESULTS: Subjects with ADHD had increased risk of having asthma (OR 1.92, 95% CI 1.01-3.66). The association was stronger for females. Our results showed no evidence of association between ADHD-PRSs and asthma or asthma-PRSs and ADHD. However, an exploratory analysis suggested that adult ADHD might be genetically associated with asthma. CONCLUSION: Our results do not support a shared genetic background between both conditions. Findings should be viewed in light of important limitations, particularly the sample size and the self-reported asthma diagnosis. Studies in larger datasets are required to better explore the genetic overlap between adult ADHD and asthma.

Estimación de riesgo en pacientes con infarto agudo de miocardio con elevación del segmento ST: Su realidad en Cuba

RESUMEN El infarto agudo de miocardio con elevación del segmento ST es una de las enfermedades cardiovasculares con mayor mortalidad. Su pronóstico se relaciona con la probabilidad de desarrollar complicaciones a corto o largo plazo y depende más de las condiciones al ingreso que de los factores de riesgo coronario previos. Los estudios encaminados a desarrollar una fórmula que permita cuantificar riesgo de muerte o complicaciones de un paciente con infarto agudo de miocardio, mediante una puntuación o score, se remontan a la década de 1950. Las diferencias en la aplicabilidad de estas escalas de estratificación de riesgo existentes, a la población cubana, derivan del hecho de haber sido desarrolladas en países de ingresos altos, por lo cual su extrapolación es cuestionable. Existen diferencias sociodemográficas, étnicas, genéticas e idiosincráticas, que pueden ser la causa de que los resultados predichos en los estudios originales no sean reproducibles con exactitud en poblaciones diferentes.

ABSTRACT ST-segment elevation myocardial infarction is one of the cardiovascular diseases with the highest mortality. Its prognosis is related to the probability of developing short- or long-term complications and depends more on conditions at admission than on previous coronary risk factors. Studies aimed at developing a formula to quantify the risk of death or complications in patients with acute myocardial infarction using either a rating or a score date back to the 1950s. Differences in the applicability of these risk stratification scores within the Cuban population are due to the fact that they were developed in high-income countries and, therefore, their extrapolation is questionable. Sociodemographic, ethnic, genetic and idiosyncratic differences may prevent the results predicted in the original studies from being accurately reproduced in different populations.

Suicidal ideation and planning among Mexican adolescents are associated with depression polygenic risk scores.

Suicide is a major public health problem in Mexico and around the world. Genetic predisposition for major depressive disorder (MDD) has been associated with increased risk for suicidal behaviors (SB) in populations of European ancestry (EA). Here, we examine whether MDD polygenic risk scores (MDD PRS), derived from a genome-wide association study involving EA individuals, predict SB, including ideation, planning, and attempt, among Mexican youth using a longitudinal design. At baseline, participants (N = 1,128, 12-17 years, 55% women) were interviewed and genotyped as part of a general population survey on adolescent mental health. Eight years later, they were recontacted for a follow up visit (N = 437, 20-25 years, 63% women). At both assessments, individuals reported on their engagement in SB within the past year. MDD PRS were significantly positively associated with SB, particularly suicide ideation and planning during adolescence, accounting for ~4-5% of the variance in these outcomes. In contrast, associations between MDD PRS and SB during young adulthood did not reach statistical significance. Our results suggest that increased genetic liability for depression increased risk for SB, particularly during adolescence, expanding our knowledge of the genetic underpinnings of SB.

Integrative Genomic-Epigenomic Analysis of Clozapine-Treated Patients with Refractory Psychosis.

Clozapine (CLZ) is the only antipsychotic drug that has been proven to be effective in patients with refractory psychosis, but it has also been proposed as an effective mood stabilizer; however, the complex mechanisms of action of CLZ are not yet fully known. To find predictors of CLZ-associated phenotypes (i.e., the metabolic ratio, dosage, and response), we explore the genomic and epigenomic characteristics of 44 patients with refractory psychosis who receive CLZ treatment based on the integration of polygenic risk score (PRS) analyses in simultaneous methylome profiles. Surprisingly, the PRS for bipolar disorder (BD-PRS) was associated with the CLZ metabolic ratio (pseudo-R2 = 0.2080, adjusted p-value = 0.0189). To better explain our findings in a biological context, we assess the protein-protein interactions between gene products with high impact variants in the top enriched pathways and those exhibiting differentially methylated sites. The GABAergic synapse pathway was found to be enriched in BD-PRS and was associated with the CLZ metabolic ratio. Such interplay supports the use of CLZ as a mood stabilizer and not just as an antipsychotic. Future studies with larger sample sizes should be pursued to confirm the findings of this study.

Prognostic value of APACHE II score in postoperative of cardiac surgery. / Valor pronóstico del sistema de calificación APACHE II en el postoperatorio de cirugía cardíaca

Antecedentes y objetivos: El sistema de calificación APACHE II permite predecir la mortalidad intrahospitalaria en terapia intensiva. Sin embargo, no está validado para cirugía cardíaca, ya que no posee buena capacidad diferenciadora. El objetivo es determinar el valor pronóstico de APACHE II en el postoperatorio de procedimientos cardíacos. Materiales y métodos: Se analizó en forma retrospectiva la base de cirugía cardíaca. Se incluyó a pacientes intervenidos entre 2017 y 2018, de los cuales se calculó la puntuación APACHE II. Se utilizó curva ROC para determinar el mejor valor de corte. El punto final primario fue mortalidad intrahospitalaria. Como puntos finales secundarios se evaluó la incidencia de bajo gasto cardíaco (BGC), accidente cerebrovascular (ACV), sangrado quirúrgico y necesidad de diálisis. Se realizó un modelo de regresión logístico multivariado para ajustar a las variables de interés. Resultados: Se analizó a 559 pacientes. La media del sistema de calificación APACHE II fue de 9.9 (DE 4). La prevalencia de mortalidad intrahospitalaria global fue de 6.1%. El mejor valor de corte de la calificación para predecir mortalidad fue de 12, con un área bajo la curva ROC de 0.92. Los pacientes con APACHE II ≥ 12 tuvieron significativamente mayor mortalidad, incidencia de BGC, ACV, sangrado quirúrgico y necesidad de diálisis. En un modelo multivariado, el sistema APACHE II se relacionó de modo independiente con mayor tasa de mortalidad intrahospitalaria (OR, 1.14; IC95%, 1.08-1.21; p < 0.0001). Conclusiones: El sistema de clasificación APACHE II demostró ser un predictor independiente de mortalidad intrahospitalaria en pacientes que cursan el postoperatorio de cirugía cardíaca. Background and objectives: The APACHE II score allows predicting in-hospital mortality in patients admitted to intensive care units. However, it is not validated for patients undergoing cardiac surgery, since it does not have a good discriminatory capacity in this clinical scenario. The aim of this study is to determine prognostic value of APACHE II score in postoperative of cardiac surgery. Materials and methods: The study was performed using the cardiac surgery database. Patients undergoing surgery between 2017 and 2018, with APACHE II score calculated at the admission, were included. The ROC curve was used to determine a cut-off value The primary endpoint was in-hospital death. Secondary endpoints included low cardiac output (LCO), stroke, surgical bleeding, and dialysis requirement. A multivariable logistic regression model was developed to adjust to various variables of interest. Results: The study evaluated 559 patients undergoing cardiac surgery. The mean of APACHE II Score was 9.9 (SD 4). The prevalence of in-hospital death was 6.1%. The best prognostic cut-off value for the primary endpoint was 12, with a ROC curve of 0.92. Patients with an APACHE II score greater than or equal to 12 had significantly higher mortality, higher incidence of LCO, stroke, surgical bleeding and dialysis requirement. In a multivariate logistic regression model, the APACHE II score was independently associated with higher in-hospital death (OR, 1.14; 95CI%, 1.08-1.21; p < 0.0001). Conclusions: The APACHE II Score proved to be an independent predictor of in-hospital death in patients undergoing postoperative cardiac surgery, with a high capacity for discrimination.

Valor pronóstico del sistema de calificación APACHE II en el postoperatorio de cirugía cardíaca / Prognostic value of APACHE II score in postoperative of cardiac surgery

Resumen Antecedentes y objetivos: El sistema de calificación APACHE II permite predecir la mortalidad intrahospitalaria en terapia intensiva. Sin embargo, no está validado para cirugía cardíaca, ya que no posee buena capacidad diferenciadora. El objetivo es determinar el valor pronóstico de APACHE II en el postoperatorio de procedimientos cardíacos. Materiales y métodos: Se analizó en forma retrospectiva la base de cirugía cardíaca. Se incluyó a pacientes intervenidos entre 2017 y 2018, de los cuales se calculó la puntuación APACHE II. Se utilizó curva ROC para determinar el mejor valor de corte. El punto final primario fue mortalidad intrahospitalaria. Como puntos finales secundarios se evaluó la incidencia de bajo gasto cardíaco (BGC), accidente cerebrovascular (ACV), sangrado quirúrgico y necesidad de diálisis. Se realizó un modelo de regresión logístico multivariado para ajustar a las variables de interés. Resultados: Se analizó a 559 pacientes. La media del sistema de calificación APACHE II fue de 9.9 (DE 4). La prevalencia de mortalidad intrahospitalaria global fue de 6.1%. El mejor valor de corte de la calificación para predecir mortalidad fue de 12, con un área bajo la curva ROC de 0.92. Los pacientes con APACHE II ≥ 12 tuvieron significativamente mayor mortalidad, incidencia de BGC, ACV, sangrado quirúrgico y necesidad de diálisis. En un modelo multivariado, el sistema APACHE II se relacionó de modo independiente con mayor tasa de mortalidad intrahospitalaria (OR, 1.14; IC95%, 1.08-1.21; p < 0.0001). Conclusiones: El sistema de clasificación APACHE II demostró ser un predictor independiente de mortalidad intrahospitalaria en pacientes que cursan el postoperatorio de cirugía cardíaca.

Abstract Background and objectives: The APACHE II score allows predicting in-hospital mortality in patients admitted to intensive care units. However, it is not validated for patients undergoing cardiac surgery, since it does not have a good discriminatory capacity in this clinical scenario. The aim of this study is to determine prognostic value of APACHE II score in postoperative of cardiac surgery. Materials and methods: The study was performed using the cardiac surgery database. Patients undergoing surgery between 2017 and 2018, with APACHE II score calculated at the admission, were included. The ROC curve was used to determine a cut-off value The primary endpoint was in-hospital death. Secondary endpoints included low cardiac output (LCO), stroke, surgical bleeding, and dialysis requirement. A multivariable logistic regression model was developed to adjust to various variables of interest. Results: The study evaluated 559 patients undergoing cardiac surgery. The mean of APACHE II Score was 9.9 (SD 4). The prevalence of in-hospital death was 6.1%. The best prognostic cut-off value for the primary endpoint was 12, with a ROC curve of 0.92. Patients with an APACHE II score greater than or equal to 12 had significantly higher mortality, higher incidence of LCO, stroke, surgical bleeding and dialysis requirement. In a multivariate logistic regression model, the APACHE II score was independently associated with higher in-hospital death (OR, 1.14; 95CI%, 1.08-1.21; p < 0.0001). Conclusions: The APACHE II Score proved to be an independent predictor of in-hospital death in patients undergoing postoperative cardiac surgery, with a high capacity for discrimination.

Bioelectrical impedance analysis-derived phase angle is related to risk scores of a first cardiovascular event in adults.

OBJECTIVE: The aim of this study was to investigate the association between phase angle (PhA) and first cardiovascular (CV) event risk. METHODS: This was a cross-sectional study. PhA was determined using a single-frequency bioelectrical impedance analyzer. Scores from the American College of Cardiology/American Heart Association (ACC/AHA; N = 455; 49% men) and the Framingham General Cardiovascular (FRS-CVD; N = 489; 49% men) were used to estimate the risk for a first CV event in adults. Logistic and multinomial regressions were used to evaluate the relationship between ACC/AHA and FRS-CVD risk scores (outcomes) and PhA. Additionally, the consumption of in natura or minimally processed foods was included in the models as an adjustment variable. RESULTS: Men and women, classified according to ACC/AHA (P < 0.001; P = 0.035) and FRS-CVD scores (P = 0.002; P = 0.012) as low risk for first event CV, presented higher PhA values than participants with elevated risk. However, only in men categorized as CV high risk, the third PhA tertile (>7.3°) was associated with a CV lower risk (ACC/AHA, odds ratio, 0.28; 95% confidence interval [CI], 0.14-0.56; FRS-CVD, relative risk ratio, 0.11; 95% CI, 0.03-0.37). The adjustment of all models for consumption of in natura or minimally processed foods did not change the results. CONCLUSION: Higher PhA values were associated with lower risk for a first CV event in men classified in higher-risk categories. In natura or minimally processed food consumption did not influence the relationship between PhA and CV risk. These results may encourage future research about possible applications of PhA as an additional index in primary prevention of CV events.

Comparison of scores for the classification of cardiometabolic risk in adult patients enrolled in a Venezuelan program for chronic non-communicable diseases: a cross-sectional study

ABSTRACT BACKGROUND: Several continuous measurements of cardiometabolic risk (CMR) have emerged as indexes or scores. To our knowledge, there are no published data on its application and validation in Latin America. OBJECTIVE: To evaluate four continuous measurements of metabolic status and CMR. We established its predictive capacity for four conditions associated with CMR. DESIGN AND SETTING: Cross-sectional study conducted at a healthcare center in the state of Carabobo, Venezuela. METHODS: The sample comprised 176 Venezuelan adults enrolled in a chronic disease care program. Four CMR scores were calculated: metabolic syndrome (MetS) Z-score; cardiometabolic index (ICMet); simple method for quantifying MetS (siMS) score; and siMS risk score. CMR biomarkers, proinflammatory status and glomerular function were assessed. MetS was established in accordance with a harmonized definition. RESULTS: Patients with MetS showed higher levels of all scores. All scores increased as the number of MetS components rose. The scores showed significant correlations with most CMR biomarkers, inflammation and glomerular function after adjusting for age and sex. In the entire sample, MetS Z-score, siMS score and siMS risk score showed the ability to detect MetS, reduced glycemic control, proinflammatory status and decreased estimated glomerular filtration rate. ICMet only discriminated MetS and proinflammatory state. There were some differences in the predictive capacity of the scores according to sex. CONCLUSIONS: The findings support the use of the scores assessed here. Follow-up studies should evaluate the predictive capacity of scores for cardiovascular events and diabetes in the Venezuelan population.

Cardiovascular risk stratification and appropriate use of statins in patients with systemic lupus erythematosus according to different strategies.

INTRODUCTION/OBJECTIVES: Cardiovascular risk management of patients with systemic lupus erythematosus (SLE) is medically relevant. The objectives were to estimate the cardiovascular risk by different strategies in patients with SLE, analyzing which proportion of patients would be candidates to receive statin therapy, and identify how many patients with statin indication received such drugs. METHOD: A cross-sectional study was performed from a secondary database. Following the recommendations of National Institute for Health and Care Excellence (NICE) guidelines and the Argentine Consensus, the QRISK-3 and the adjusted Framingham (multiplying factor × 2) scores were calculated in primary prevention subjects. The indications for statin therapy according to these recommendations were analyzed. RESULTS: In total, 110 patients were included. Regarding patients without previous cardiovascular history, the median adjusted Framingham score was 12.8% (4.1-21.9), and 45.2%, 22.6%, and 32.2% of them were classified at low, moderate, or high risk. The median QRISK-3 score was 6.0% (2.1-14.1) and 42.1% of subjects were classified "at risk". Only 60% of subjects in secondary prevention received statins, although no patient received the recommended doses. Analyzing patients in primary prevention who did not receive statins (87%), 43.4% and 45.2% of the patients were eligible for statin therapy according to NICE guidelines and Argentine Consensus, respectively. CONCLUSIONS: Our findings showed that a large proportion of patients with SLE have a considerable cardiovascular risk and many of them would be eligible for statin therapy. However, the statin use observed was low.Key Points• A large proportion of patients with lupus have a considerable cardiovascular risk, explained in part by dyslipidemia.• Many patients with SLE would be eligible for statin therapy according to risk stratification based on conventional risk factors.• The use of statins in this population is inadequate.