RESUMO
Objective: 26% of all pregnancies end in miscarriage, and up to 10% of clinically diagnosed pregnancies, and recurrent pregnancy loss is 5% among couples of childbearing ages. Although there are several known causes of pregnancy loss in the first half, including recurrent pregnancy loss, including parental chromosomal abnormalities, uterine malformations, endocrinological disorders, and immunological abnormalities, about half of the cases of pregnancy loss in its first half remain unexplained. Methods: The review includes observational controlled studies (case-control or cohort, longitudinal studies, reviews, meta-analyses), which include the study of biochemical factors for predicting pregnancy losses in the first half, in singlet pregnancy. The Newcastle-Ottawa Scale (NOS) was used to assess the research quality. Results: Finally, 27 studies were included in the review, which has 134904 examined patients. The results of the review include estimates of ß-human chorionic gonadotropin, progesterone, pregnancy-associated protein - A, angiogenic vascular factors, estradiol, α-fetoprotein, homocysteine and CA-125 as a predictors or markers of the first half pregnancy losses. Conclusion: It may be concluded that to date, research data indicate the unavailability of any reliable biochemical marker for predicting pregnancy losses in its first half and require either a combination of them or comparison with clinical evidence. A fairly new model shall be considered for the assessment of α-fetoprotein in vaginal blood, which may have great prospects in predicting spontaneous miscarriages.
Assuntos
Aborto Habitual , Biomarcadores , Feminino , Humanos , Gravidez , Biomarcadores/sangue , Aborto Habitual/sangue , Valor Preditivo dos TestesRESUMO
OBJECTIVE: To establish the accuracy of frozen section examination in identifying tumor spread through air spaces (STAS), as well as to propose a reproducible technical methodology for frozen section analysis. We also aim to propose a method to be incorporated into the decision making about the need for conversion to lobectomy during sublobar resection. METHODS: This was a nonrandomized prospective study of 38 patients with lung cancer who underwent surgical resection. The findings regarding STAS in the frozen section were compared with the definitive histopathological study of paraffin-embedded sections. We calculated a confusion matrix to obtain the positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity and accuracy. RESULTS: The intraoperative frozen section analysis identified 7 STAS-positive cases that were also positive in the histopathological examination, as well as 3 STAS-negative cases that were positive in the in the histopathological examination. Therefore, frozen section analysis was determined to have a sensitivity of 70%, specificity of 100%, PPV of 100%, NPV of 90.3%, and accuracy of 92% for identifying STAS. CONCLUSIONS: Frozen section analysis is capable of identifying STAS during resection in patients with lung cancer. The PPV, NPV, sensitivity, and specificity showed that the technique proposed could be incorporated at other centers and would allow advances directly linked to prognosis. In addition, given the high accuracy of the technique, it could inform intraoperative decisions regarding sublobar versus lobar resection.
Assuntos
Secções Congeladas , Neoplasias Pulmonares , Sensibilidade e Especificidade , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Estudos Prospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Reprodutibilidade dos Testes , Período Intraoperatório , Valor Preditivo dos Testes , Idoso de 80 Anos ou mais , Invasividade Neoplásica , Adulto , Cuidados Intraoperatórios/métodos , Pneumonectomia/métodosRESUMO
OBJECTIVE: The aim of this study was to investigate the role of systemic immune-inflammation index, neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, and platelet-lymphocyte ratios calculated in the first trimester as inflammatory markers in predicting gestational diabetes mellitus diagnosis. METHODS: This study was conducted retrospectively at a tertiary center between January 2020 and June 2023. A total of 111 pregnant women with gestational diabetes and 378 pregnant women in the control group were included in the study. Systemic immune-inflammation index, neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, and platelet-lymphocyte ratios values were compared between the gestational diabetes mellitus group patients and the healthy group. Receiver operating characteristic analysis curve was used for predicting gestational diabetes mellitus using systemic immune-inflammation index and lymphocyte-monocyte ratio. RESULTS: In pregnant women in the first trimester, systemic immune-inflammation index and lymphocyte-monocyte ratio values based on routine complete blood count parameters were found to be statistically significantly higher in gestational diabetes mellitus patients compared to healthy patients, while neutrophil-lymphocyte ratio and platelet-lymphocyte ratios values were found to be similar (p=0.033, p=0.005, p=0.211, and p=0.989). For predicting gestational diabetes mellitus, a cut-off value of 655.75 for systemic immune-inflammation index resulted in 80.2% sensitivity and 34.4% specificity, and a cut-off value of 3.62 for lymphocyte-monocyte ratio resulted in 56.8% sensitivity and 63.2% specificity, indicating good discriminatory ability. CONCLUSION: We believe that systemic immune-inflammation index and lymphocyte-monocyte ratio values measured in the first-trimester complete blood count parameters are effective in predicting gestational diabetes mellitus but are not effective in determining insulin requirement.
Assuntos
Biomarcadores , Diabetes Gestacional , Neutrófilos , Primeiro Trimestre da Gravidez , Curva ROC , Humanos , Diabetes Gestacional/sangue , Diabetes Gestacional/imunologia , Diabetes Gestacional/diagnóstico , Feminino , Gravidez , Primeiro Trimestre da Gravidez/sangue , Primeiro Trimestre da Gravidez/imunologia , Estudos Retrospectivos , Adulto , Biomarcadores/sangue , Inflamação/sangue , Inflamação/imunologia , Linfócitos/imunologia , Valor Preditivo dos Testes , Monócitos/imunologia , Estudos de Casos e Controles , Contagem de Plaquetas , Contagem de Linfócitos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: The Duke Activity Status Index (DASI) questionnaire has been the focus of numerous investigations - its discriminative and prognostic capacity has been continuously explored, supporting its use in the clinical setting, specifically during rehabilitation in patients with chronic heart failure (CHF).However, studies exploring optimal DASI questionnaire threshold scores are limited. OBJECTIVE: To investigate optimal DASI questionnaire thresholds values in predicting mortality in a CHF cohort and assess mortality rates based on the DASI questionnaire using a thresholds values obtained. METHODOLOGY: This is a prospective cohort study with a 36-month follow-up in patients with CHF. All patients completed a clinical assessment, followed by DASI questionnaire, pulmonary function, and echocardiography. The Receiver Operating Characteristic (ROC) curve analysis was used to discriminate the DASI questionnaire score in determining the risk of mortality. For survival analysis, the Kaplan-Meier model was used to explore the impact of ≤/>23 points on mortality occurring during the 36-month follow-up. RESULTS: One hundred and twenty-four patients were included, the majority being elderly men. Kaplan Meier analysis revealed that ≤/> 23 was a strong predictor of CHF mortality over a 36-month follow-up. CONCLUSION: A score of ≤/>23 presents good discriminatory capacity to predict mortality risk in 36 months in patients with CHF, especially in those with reduced or mildly reduced ejection fraction. Age, ejection fraction, DASI questionnaire score and use of digoxin are risk factors that influence mortality in this population.
Assuntos
Insuficiência Cardíaca , Valor Preditivo dos Testes , Humanos , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/diagnóstico , Masculino , Feminino , Estudos Prospectivos , Idoso , Pessoa de Meia-Idade , Prognóstico , Fatores de Tempo , Fatores de Risco , Doença Crônica , Medição de Risco , Inquéritos e Questionários , Seguimentos , Idoso de 80 Anos ou mais , Estado Funcional , Nível de SaúdeRESUMO
OBJECTIVE: The aim of our study was to determine the role of serum glucose-potassium ratio in predicting inhospital mortality in coronary care unit patients. METHODS: This study used data from the MORtality in CORonary Care Units in Turkey study, a national, observational, multicenter study that included all patients admitted to coronary care units between September 1, 2022, and September 30, 2022. Statistical analyses assessed the independent predictors of mortality. Two models were created. Model 1 included age, history of heart failure, chronic kidney disease, hypertension, diabetes mellitus, and coronary artery disease. Model 2 included glucose-potassium ratio in addition to these variables. Multivariate regression and receiver operating characteristic analysis were performed to compare Model 1 and Model 2 to identify if the glucose-potassium ratio is an independent predictor of inhospital mortality. RESULTS: In a study of 3,157 patients, the mortality rate was 4.3% (n=137). Age (p=0.002), female gender (p=0.004), mean blood pressure (p<0.001), serum creatinine (p<0.001), C-reactive protein (p=0.002), white blood cell (p=0.002), and glucose-potassium ratio (p<0.001) were identified as independent predictors of mortality through multivariate regression analysis. The receiver operating characteristic analysis indicated that Model 2 had a statistically higher area under the curve than Model 1 (area under the curve 0.842 vs area under the curve 0.835; p<0.001). A statistically significant correlation was found between the inhospital mortality and glucose-potassium ratio (OR 1.015, 95%CI 1.006-1.024, p<0.001). CONCLUSION: Our study showed that the glucose-potassium ratio may be a significant predictor of inhospital mortality in coronary care unit patients.
Assuntos
Glicemia , Unidades de Cuidados Coronarianos , Mortalidade Hospitalar , Potássio , Humanos , Feminino , Masculino , Potássio/sangue , Pessoa de Meia-Idade , Unidades de Cuidados Coronarianos/estatística & dados numéricos , Idoso , Glicemia/análise , Fatores de Risco , Curva ROC , Turquia/epidemiologia , Valor Preditivo dos Testes , Valores de ReferênciaRESUMO
OBJECTIVE: This study investigated the significance of serum hypoxia-inducible factor (HIF)-1α/HIF-2 α and Chitinase 3-Like protein 1 (YKL-40) levels in the assessment of vascular invasion and prognostic outcomes in patients with Follicular Thyroid Cancer (FTC). METHODS: This prospective study comprised 83 patients diagnosed with FTC, who were subsequently categorized into a recurrence group (17 cases) and a non-recurrence group (66 cases). The pathological features of tumor vascular invasion were classified. Serum HIF-1α/HIF-2α and YKL-40 were quantified using a dual antibody sandwich enzyme-linked immunosorbent assay, while serum Thyroglobulin (Tg) levels were measured using an electrochemiluminescence immunoassay method. The Spearman test was employed to assess the correlation between serum factors, and the predictive value of diagnostic factors was determined using receiver operating characteristic curve analysis. A Cox proportional hazards regression model was utilized to analyze independent factors influencing prognosis. RESULTS: Serum HIF-1α, HIF-2α, YKL-40, and Tg were elevated in patients exhibiting higher vascular invasion. A significant positive correlation was observed between Tg and HIF-1α, as well as between HIF-1α and YKL-40. The cut-off values for HIF-1α and YKL-40 in predicting recurrence were 48.25 pg/mL and 60.15 ng/mL, respectively. Patients exceeding these cut-off values experienced a lower recurrence-free survival rate. Furthermore, serum levels surpassing the cut-off value, in conjunction with vascular invasion (v2+), were identified as independent risk factors for recurrence in patients with FTC. CONCLUSION: Serum HIF-1α/HIF-2α and YKL-40 levels correlate with vascular invasion in FTC, and the combination of HIF-1α and YKL-40 predicts recurrence in patients with FTC.
Assuntos
Adenocarcinoma Folicular , Fatores de Transcrição Hélice-Alça-Hélice Básicos , Biomarcadores Tumorais , Proteína 1 Semelhante à Quitinase-3 , Subunidade alfa do Fator 1 Induzível por Hipóxia , Invasividade Neoplásica , Valor Preditivo dos Testes , Humanos , Proteína 1 Semelhante à Quitinase-3/sangue , Feminino , Masculino , Subunidade alfa do Fator 1 Induzível por Hipóxia/sangue , Pessoa de Meia-Idade , Prognóstico , Adulto , Adenocarcinoma Folicular/sangue , Adenocarcinoma Folicular/patologia , Adenocarcinoma Folicular/mortalidade , Estudos Prospectivos , Fatores de Transcrição Hélice-Alça-Hélice Básicos/sangue , Biomarcadores Tumorais/sangue , Neoplasias da Glândula Tireoide/sangue , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/mortalidade , Idoso , Recidiva Local de Neoplasia/sangue , Recidiva Local de Neoplasia/patologia , Ensaio de Imunoadsorção Enzimática , Valores de Referência , Adulto Jovem , Estatísticas não Paramétricas , Curva ROCRESUMO
OBJECTIVE: In the hepatitis C virus (HCV) diagnostic algorithm, an anti-HCV screening test is recommended first. In countries with low HCV prevalence, anti-HCV testing can often give false-positive results. This may lead to unnecessary retesting, increased costs, and psychological stress for patients. METHODS: In this study, the most appropriate S/Co (signal-cutoff) value to predict HCV viremia in anti-HCV test(+) individuals was determined, and the effect of genotype differences was evaluated. Of the 96,515 anti-HCV tests performed between 2020 and 2023, 934 were reactive. A total of 332 retests and 65 patients without HCV-ribonucleic acid (RNA) analysis were excluded. Demographic data were calculated for 537 patients, and 130 patients were included in the study. RESULTS: The average age of 537 patients was 55±18 years, and 57.1% were women. The anti-HCV positivity rate was 0.62% (602/96,515), and the actual anti-HCV positivity rate was 0.13% (130/96,515). Anti-HCV levels were higher in HCV-RNA(+) patients than in HCV-RNA-negative individuals (p<0.0001) (Table 1). Receiver operating characteristic curve analysis identified the optimal S/Co value to be 10.86 to identify true positive cases. Sensitivity was 96.1%, specificity was 61.2%, positive predictive value (PPV) was 44.2%, and negative predictive value (NPV) was 98% (Figure 2). A total of 107 (82.3%) of the patients were identified as GT1, and the most common subtype was GT1b (n=100). CONCLUSION: If anti-HCV S/Co is ≥10.86, direct HCV RNA testing may be recommended; However, the possibility of false positivity should be considered in patients with a S/Co value below 10.86.
Assuntos
Genótipo , Hepacivirus , Anticorpos Anti-Hepatite C , Hepatite C , Valor Preditivo dos Testes , RNA Viral , Viremia , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Hepacivirus/genética , RNA Viral/sangue , RNA Viral/análise , Anticorpos Anti-Hepatite C/sangue , Hepatite C/genética , Hepatite C/sangue , Adulto , Idoso , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: The aim of this study was to investigate whether there is a difference in serum nitric oxide levels between patients who return spontaneously after cardiopulmonary resuscitation and those who do not. We also examined the potential of using serum nitric oxide levels as a marker to make an accurate decision about patient survival. METHODS: We included 100 consecutive patients who were brought to the emergency clinic due to cardiac arrest. Blood samples were taken from these patients at admission, 30 min after admission, and when resuscitation was terminated. RESULTS: We found that there was a significant difference in NO1 and NO3 values between the group of patients who did not return after cardiopulmonary resuscitation and the group in which spontaneous circulation returned. The NO1 value was significant in the receiver operating characteristic (ROC) analysis, while the NO3 value was not. A higher NO1 value provided a higher rate of survival. CONCLUSION: Our findings suggest that nitric oxide may be a useful parameter to support the decision about patient survival. A higher NO1 value is associated with a better prognosis and survival rate. Therefore, serum nitric oxide levels may be a suitable indicator to support the decision-making process regarding patient survival.
Assuntos
Biomarcadores , Reanimação Cardiopulmonar , Óxido Nítrico , Retorno da Circulação Espontânea , Humanos , Óxido Nítrico/sangue , Masculino , Feminino , Estudos de Casos e Controles , Estudos Prospectivos , Pessoa de Meia-Idade , Biomarcadores/sangue , Idoso , Retorno da Circulação Espontânea/fisiologia , Prognóstico , Parada Cardíaca/sangue , Parada Cardíaca/terapia , Parada Cardíaca/mortalidade , Curva ROC , Valor Preditivo dos Testes , Adulto , Valores de ReferênciaRESUMO
OBJECTIVE: Coronary artery disease (CAD) is frequent, but coronary slow flow (CSF) is a less common cardiovascular disease with a significant risk of mortality and morbidity. Endocan is a proinflammatory glycopeptide that has been investigated in cardiovascular diseases as well as some inflammatory diseases in recent years. We planned to compare the levels of endocan in both CAD and CSF in a similar population and examine the relationship of endocan with additional clinical variables. MATERIALS AND METHODS: In the trial, we included 169 consecutive subjects having a coronary angiography indication. According to the results of coronary angiography, 58 people were included in the CAD group, 52 were in the CSF group, and 59 people were in the control group. The control group includes those who did not have any lesions in their epicardial coronary arteries. Thrombolysis in myocardial infarction (TIMI)-frame counts (TFC) were calculated for all patients. RESULTS: Notably, 2.6% of the population in our study had CSF. Both the CAD (555±223 pg/mL) and CSF (559±234 pg/mL) groups had higher endocan levels than the control group (331±252 pg/mL) (p<0.001). There were similar endocan levels between the CAD and CSF groups. Endocan levels were shown to be favorably associated with mean TFC (r=0.267; p0.001). Serum endocan levels (particularly those above 450 pg/mL) and the presence of hyperlipidemia were the most important predictors of both CAD and CSF. CONCLUSION: Endocan levels are higher in CAD and CSF patients than in those with normal coronary arteries.
Assuntos
Biomarcadores , Angiografia Coronária , Doença da Artéria Coronariana , Proteínas de Neoplasias , Proteoglicanas , Humanos , Proteoglicanas/sangue , Proteoglicanas/líquido cefalorraquidiano , Masculino , Feminino , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/líquido cefalorraquidiano , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Pessoa de Meia-Idade , Proteínas de Neoplasias/sangue , Proteínas de Neoplasias/líquido cefalorraquidiano , Proteínas de Neoplasias/análise , Estudos de Casos e Controles , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Idoso , Circulação Coronária/fisiologia , Valor Preditivo dos Testes , Fatores de RiscoRESUMO
OBJECTIVE: Sudden cardiac death or arrest describes an unexpected cardiac cause-related death or arrest that occurs rapidly out of the hospital or in the emergency room. This study aimed to reveal the relationship between coronary angiographic findings and cardiac death secondary to acute ST-elevation myocardial infarction. MATERIALS AND METHODS: Patients presenting with acute ST-elevation myocardial infarction complicated with cardiac arrest were included in the study. The severity of coronary artery disease, coronary chronic total occlusion, coronary collateral circulation, and blood flow in the infarct-related artery were recorded. Patients were divided into two groups, namely, deaths secondary to cardiac arrest and survivors of cardiac arrest. RESULTS: A total of 161 cardiac deaths and 42 survivors of cardiac arrest were included. The most frequent (46.3%) location of the culprit lesion was on the proximal left anterior descending artery. The left-dominant coronary circulation was 59.1%. There was a difference in the SYNTAX score (16.3±3.8 vs. 13.6±1.9; p=0.03) and the presence of chronic total occlusion (19.2 vs. 0%; p=0.02) between survivors and cardiac deaths. A high SYNTAX score (OR: 0.38, 95%CI: 0.27-0.53, p<0.01) was determined as an independent predictor of death secondary to cardiac arrest. CONCLUSION: The chronic total occlusion presence and SYNTAX score may predict death after cardiac arrest secondary to ST-elevation myocardial infarction.
Assuntos
Angiografia Coronária , Parada Cardíaca , Infarto do Miocárdio com Supradesnível do Segmento ST , Índice de Gravidade de Doença , Humanos , Feminino , Masculino , Parada Cardíaca/mortalidade , Pessoa de Meia-Idade , Idoso , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Fatores de Risco , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Oclusão Coronária/mortalidade , Oclusão Coronária/complicações , Oclusão Coronária/diagnóstico por imagem , Valor Preditivo dos Testes , Medição de Risco , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/epidemiologiaRESUMO
Transarterial chemoembolization (TACE) is an established therapeutic strategy for intermediate stage Barcelona Clinic Liver Cancer (BCLC) hepatocellular carcinoma (HCC). However, patients who are early refractory to TACE may not benefit from repeated TACE treatment. Our primary objective was to assess the diagnostic value of inflammatory markers in identifying early TACE refractory for patients with early (BCLC 0 and A) or intermediate (BCLC B) stage HCC. We retrospectively reviewed the HCC patients who underwent TACE as the initial treatment in two hospitals. Patients with early TACE refractoriness had significantly poorer median overall survival (OS) (16 vs 40 months, P<0.001) and progression-free survival (PFS) (7 vs 23 months, P<0.001) compared to TACE non-refractory patients. In the multivariate regression analysis, tumor size (P<0.001), bilobular invasion (P=0.007), high aspartate aminotransferase-to-platelet ratio index (APRI) (P=0.007), and high alpha fetoprotein (AFP) level (P=0.035) were independent risk factors for early TACE refractoriness. The predictive model showcasing these factors exhibited high ability proficiency, with an area under curve (AUC) of 0.833 (95%CI=0.774-0.892) in the training cohort, 0.750 (95%CI: 0.640-0.861) in the internal-validation cohort, and 0.733 (95%CI: 0.594-0.872) in the external-validation cohort. Calibration curve analysis revealed good agreement between the actual and predicted probabilities of early TACE refractoriness. Our preliminary study estimated the potential value of inflammatory markers in predicting early TACE refractoriness and provides a predictive model to assist in identifying patients who may not benefit from repeat TACE treatment.
Assuntos
Biomarcadores Tumorais , Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/diagnóstico , Quimioembolização Terapêutica/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso , Biomarcadores Tumorais/sangue , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Adulto , alfa-Fetoproteínas/análise , alfa-Fetoproteínas/metabolismoRESUMO
BACKGROUND: Renal dysfunction is a common complication following liver transplantation (LT). This study aimed to determine whether a comprehensive assessment of kidney function using nineteen serum and urinary biomarkers (BMs) within the first 48 h post-LT could enhance the prediction of severe acute kidney injury (AKI) and the need of kidney replacement therapy (KRT) during the first postoperative week. METHODS: Blood and urine (U) samples were collected during the pre- and postoperative periods. Nineteen BMs were evaluated to assess kidney health in the first 48 h after LT. Classification and regression tree (CART) cross-validation identified key predictors to determine the best BM combination for predicting outcomes. RESULTS: Among 100 LT patients, 36 developed severe AKI, and 34 required KRT within the first postoperative week. Preoperative assessment of U neutrophil gelatinase-associated lipocalin (NGAL) and liver-type fatty acid-binding protein (L-FABP) predicted the need for KRT with 75% accuracy. The combined assessment of U osmolality (OSM), U kidney injury molecule 1 (KIM-1), and tissue inhibitor of metalloproteinase (TIMP-1) within 48 h post-LT predicted severe AKI with 80% accuracy. U-OSM alone, measured within 48 h post-LT, had an accuracy of 83% for predicting KRT need, outperforming any BM combination. CONCLUSIONS: Combined BM analysis can accurately predict severe AKI and KRT needs in the perioperative period of LT. U-OSM alone proved to be an effective tool for monitoring the risk of severe AKI, available in most centers. Further studies are needed to assess its impact on AKI progression postoperatively.Registered at Clinical Trials (clinicaltrials.gov) in March 24th, 2014 by title 'Acute Kidney Injury Biomarkers: Diagnosis and Application in Pre-operative Period of Liver Transplantation (AKIB)' and identifier NCT02095431.
Assuntos
Injúria Renal Aguda , Biomarcadores , Lipocalina-2 , Transplante de Fígado , Terapia de Substituição Renal , Humanos , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/urina , Injúria Renal Aguda/sangue , Injúria Renal Aguda/terapia , Transplante de Fígado/efeitos adversos , Biomarcadores/sangue , Biomarcadores/urina , Masculino , Feminino , Pessoa de Meia-Idade , Lipocalina-2/urina , Lipocalina-2/sangue , Adulto , Receptor Celular 1 do Vírus da Hepatite A/análise , Receptor Celular 1 do Vírus da Hepatite A/sangue , Receptor Celular 1 do Vírus da Hepatite A/metabolismo , Idoso , Proteínas de Ligação a Ácido Graxo/sangue , Proteínas de Ligação a Ácido Graxo/urina , Inibidor Tecidual de Metaloproteinase-1/sangue , Estudos Prospectivos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/sangue , Valor Preditivo dos TestesRESUMO
OBJECTIVE: The study used machine learning models to predict the clinical outcome with various attributes or when the models chose features based on their algorithms. METHODS: Patients who presented to an orthopedic outpatient department with joint swelling or myalgia were included in the study. A proforma collected clinical information on age, gender, uric acid, C-reactive protein, and complete blood count/liver function test/renal function test parameters. Machine learning decision models (Random Forest and Gradient Boosted) were evaluated with the selected features/attributes. To categorize input data into outputs of indications of joint discomfort, multilayer perceptron and radial basis function-neural networks were used. RESULTS: The random forest decision model outperformed with 97% accuracy and minimum errors to anticipate joint pain from input attributes. For predicted classifications, the multilayer perceptron fared better with an accuracy of 98% as compared to the radial basis function. Multilayer perceptron achieved the following normalized relevance: 100% (uric acid), 10.3% (creatinine), 9.8% (AST), 5.4% (lymphocytes), and 5% (C-reactive protein) for having joint pain. Uric acid has the highest normalized relevance for predicting joint pain. CONCLUSION: The earliest artificial intelligence-based detection of joint pain will aid in the prevention of more serious orthopedic complications.
Assuntos
Artralgia , Inteligência Artificial , Proteína C-Reativa , Aprendizado de Máquina , Ácido Úrico , Humanos , Feminino , Masculino , Ácido Úrico/sangue , Adulto , Pessoa de Meia-Idade , Artralgia/sangue , Artralgia/diagnóstico , Artralgia/etiologia , Proteína C-Reativa/análise , Algoritmos , Valor Preditivo dos Testes , Adulto Jovem , Idoso , Redes Neurais de Computação , Reprodutibilidade dos Testes , Creatinina/sangue , Biomarcadores/sangue , AdolescenteRESUMO
OBJECTIVE: The aim of this study was to evaluate the role of the prognostic nutritional index in predicting in-hospital mortality among patients with acute ischemic stroke. METHODS: This retrospective, observational study included patients diagnosed with acute ischemic stroke at the emergency department of the hospital between January 1, 2022, and January 1, 2023. Demographic data, vital parameters, comorbidities, stroke interventions, and laboratory data were collected from electronic medical records. Prognostic nutritional index was calculated using serum albumin levels and a total lymphocyte count. The primary outcome was in-hospital mortality. RESULTS: The study included 176 patients, divided into survivor (93.2%, n=164) and deceased (6.8%, n=12) groups. No significant differences were observed in age, gender, blood pressure, heart rate, or body temperature between the groups. Atrial fibrillation was significantly more common in the deceased group (50%) compared to the survivor group (18.9%) (p=0.011). The median lymphocyte count was significantly higher in the survivor group (1,353 [interquartile range, IQR 984-1,968]/mm³) compared to the deceased group (660 [IQR 462-1,188]/mm³) (p=0.009). The median albumin level was significantly lower in the deceased group (3.31 [IQR 2.67-3.4] g/dL) compared to the survivor group (3.74 [IQR 3.39-4.21] g/dL) (p<0.001). The median prognostic nutritional index was significantly higher in the survivor group (46.05 [IQR 39.1-51.3]) compared to the deceased group (36.7 [IQR 28.7-40.5]) (p<0.001). The area under the receiver operating characteristic for prognostic nutritional index predicting mortality was 0.791 (95%CI 0.723-0.848) (p=0.0002), with a cut-off value of ≤41.92 providing the highest diagnostic accuracy. CONCLUSIONS: Prognostic nutritional index is a valuable prognostic indicator for in-hospital mortality in acute ischemic stroke patients. Low prognostic nutritional index values are associated with increased mortality risk. Incorporating prognostic nutritional index into clinical practice may aid in the early identification of high-risk patients and the optimization of treatment strategies. Further research is needed to validate these findings and explore the broader clinical applications of prognostic nutritional index.
Assuntos
Mortalidade Hospitalar , Avaliação Nutricional , Humanos , Feminino , Masculino , Estudos Retrospectivos , Prognóstico , Idoso , Pessoa de Meia-Idade , Contagem de Linfócitos , Albumina Sérica/análise , Fatores de Risco , Idoso de 80 Anos ou mais , AVC Isquêmico/mortalidade , AVC Isquêmico/sangue , Acidente Vascular Cerebral/mortalidade , Valor Preditivo dos Testes , Estado Nutricional/fisiologia , Curva ROCRESUMO
PURPOSE: To evaluate the predictive value of initial intraocular pressure difference of the detached and fellow eyes of patients with complex rhegmatogenous retinal detachment on postoperative persistent ocular hypotony. METHODS: This retrospective observational study included 538 eyes of 538 unilateral complex rhegmatogenous retinal detachment patients with a proliferative vitreoretinopathy grade of C-1 or higher, treated with silicone oil endotamponade following pars plana vitrectomy. The patients were divided into Group A (patients having silicone oil removal without ocular hypotony; n=504) and Group B (patients with persistent ocular hypotony following silicone oil removal [n=8, 23.5%] and with retained silicone oil [n=26, 76.5%] due to the risk of persistent ocular hypotony; total n=34). Ocular hypotony was defined as an intraocular pressure of <6 mmHg on two or more occasions. Patients' demographics, including age, sex, and follow-up time, and ocular characteristics, including ocular surgical and trauma history, initial and final best-corrected visual acuity, intraocular pressure and initial intraocular pressure difference of the detached and fellow eyes, and anatomical success rates and postoperative complications, were retrospectively collected from the electronic patient files. RESULTS: The initial intraocular pressure was significantly lower in the detached eyes of Group B than in Group A (8.3 ± 3.5 vs. 12.9 ± 3.3, p<0.001). Also, the initial intraocular pressure difference was significantly higher in Group B than in Group A (8.9 ± 3.2 vs. 2.2 ± 2.7mmHg, p<0.001). The receiver operating characteristic curve analysis showed that the cutoff value of the initial intraocular pressure difference was 7.5mmHg for the risk of persistent ocular hypotony. The most influential factors on postoperative persistent ocular hypotony in the binary logistic regression analysis were the initial intraocular pressure difference and the need for a retinectomy. CONCLUSION: In eyes with complex rhegmatogenous retinal detachment treated with pars plana vitrectomy and silicone oil tamponade, the initial intraocular pressure difference could be of value in predicting postoperative persistent ocular hypotony and could guide surgeons on the decision of silicone oil removal.
Assuntos
Pressão Intraocular , Hipotensão Ocular , Descolamento Retiniano , Óleos de Silicone , Acuidade Visual , Vitrectomia , Humanos , Descolamento Retiniano/cirurgia , Vitrectomia/efeitos adversos , Vitrectomia/métodos , Hipotensão Ocular/etiologia , Hipotensão Ocular/fisiopatologia , Feminino , Masculino , Estudos Retrospectivos , Pressão Intraocular/fisiologia , Pessoa de Meia-Idade , Adulto , Idoso , Acuidade Visual/fisiologia , Fatores de Risco , Resultado do Tratamento , Complicações Pós-Operatórias/etiologia , Adulto Jovem , Vitreorretinopatia Proliferativa/cirurgia , Vitreorretinopatia Proliferativa/fisiopatologia , Vitreorretinopatia Proliferativa/etiologia , Valor Preditivo dos Testes , Tamponamento Interno , Fatores de Tempo , Valores de ReferênciaRESUMO
OBJECTIVE: This study was to investigate the role of serum Klotho, fetuin-A, and Matrix Gla Protein (MGP) in Coronary Artery Calcification (CAC) in patients with Maintenance Hemodialysis (MHD) and their predictive value for CAC. METHODS: 100 patients receiving MHD were selected. Serum Klotho, fetuin-A, and MGP levels were detected by ELISA. CAC scores were assessed by coronary CT scan. Multifactor analysis was used to evaluate the risk factors affecting CAC. The ability of serum Klotho, fetuin-A, and MGP levels to diagnose CAC was evaluated by receiver operating characteristic curves. RESULTS: Serum Klotho, fetuin-A, and MGP were independent risk factors for CAC. Serum Klotho, fetuin-A, and MGP were valuable in the diagnosis of CAC in MHD patients. CONCLUSION: There is a close relationship between Klotho, fetuin-A, and MGP levels in MHD patients and CAC.
Assuntos
Biomarcadores , Proteínas de Ligação ao Cálcio , Doença da Artéria Coronariana , Proteínas da Matriz Extracelular , Glucuronidase , Proteínas Klotho , Proteína de Matriz Gla , Diálise Renal , Calcificação Vascular , alfa-2-Glicoproteína-HS , Humanos , Diálise Renal/efeitos adversos , Masculino , Feminino , Proteínas de Ligação ao Cálcio/sangue , Pessoa de Meia-Idade , alfa-2-Glicoproteína-HS/análise , alfa-2-Glicoproteína-HS/metabolismo , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Glucuronidase/sangue , Proteínas da Matriz Extracelular/sangue , Biomarcadores/sangue , Calcificação Vascular/sangue , Calcificação Vascular/diagnóstico por imagem , Idoso , Fatores de Risco , Ensaio de Imunoadsorção Enzimática , Adulto , Curva ROC , Calcinose/sangue , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Valor Preditivo dos TestesRESUMO
Leptospirosis is a zoonotic disease with significant global impact and a challenging diagnosis. The utilization of adequately validated rapid tests is relevant for the opportune identification of the disease and for reduction in fatality rates. The present study analyzes the accuracy and reliability of the Dual Path Platform (DPP) assay -produced in Brazil by the Oswaldo Cruz Foundation (Fiocruz)- for diagnosing leptospirosis. Firstly, a serological panel was constructed in the Brazilian Reference Laboratory for Leptospirosis using samples routinely handled by reference laboratories of six Brazilian states. It consisted of 150 positive (according to MAT and IgM-ELISA) and 250 negative samples for leptospirosis. Subsequently, the panel samples were distributed to the reference laboratories for the performance of DPP assays in triplicate. Different measures were used in the assessment of diagnostic quality. Predictive values were estimated for different pre-test probability settings. Sensitivities varied between 67.33 % and 74.00 % and specificities between 93.20 % and 98.40 % in the states, and there were adequate agreements between them. Accuracies were lower for the samples of patients with less than 7 days of symptoms. In contexts of prevalence values up to around 25 %, positive and negative predictive values were around 90 %. However, in situations of high pre-test probabilities, NPVs were low. This study improves understanding of the use of DPP in diagnosing leptospirosis, particularly its application in healthcare settings. As long as the time of symptoms onset and clinical and epidemiological contexts are adequately considered for the interpretation of results, DPP is a valid option to be used in the leptospirosis diagnostic routine.