ObjectiveTo observe and evaluate the predictive value of serum cystatin C (Cys-C) on the risk of sight-threatening diabetic retinopathy (STDR). MethodsA non-randomized controlled cross-sectional clinical study. Ninety-two patients with type 2 diabetes mellitus (T2DM) who were admitted to Department of Ophthalmology of Beijing Tsinghua Changgung Hospital from January 2022 to October 2022 were included in the study. Among them, 50 were male, 42 cases were female, with the mean age of (58.24±12.49) years. The mean duration of T2DM was (13.18±8.35) years, of which 38 cases had a duration of ≥10 years. Twenty-nine cases complicated with hypertension, of which 16 cases had a duration of ≥10 years. Seventeen cases complicated with chronic kidney disease stage 2 and 23 cases were treated with lipid-lowering drugs. Hemoglobin Alc, serum Cys-C, serum lipids and renal function were tested, and urinary microalbumin/creatinine ratio (ACR) was calculated. According to the 2003 American Academy of Ophthalmology "Clinical Guidelines for Diabetic Retinopathy (DR)" and international clinical DR severity grading standards, the patients were divided into STDR and non-STDR groups, with 44 and 48 cases in each group, respectively. STDR was defined as severe non-proliferative DR, proliferative DR, and macular edema. Logistic regression was used to analyze the independent risk factors of STDR in T2DM patients. Receiver operating characteristic curve (ROC curve) was used to calculate and analyze the area under ROC curve (AUC) and the predictive value of serum Cys-C and ACR in predicting STDR in T2DM patients. ResultsSerum Cys-C levels in STDR and non-STDR groups were 1.10 (0.94, 1.28) and 0.91 (0.83, 1.02) mg/L, respectively, with ACR of 4.29 (1.05, 21.89) and 1.39 (0.77, 3.80) mg/mmol, respectively. Compared with non-STDR group, serum Cys-C and ACR in STDR group were higher, and the difference was statistically significant (Z=－3.984, －3.280; P＜0.05). Multivariate logistic regression analysis showed that serum Cys-C was an independent risk factor for STDR (odds ratio=1.337, 95% confidence interval 1.145-2.090, P=0.033), and the risk of STDR increased by 33.7% for every 0.1 mg/L increase in serum Cys-C. ROC analysis results showed that serum Cys-C＞1.065 mg/L combined with ACR＞5.84 mg/mmol predicted the AUC of STDR in T2DM patients was 0.661, with the specificity of 95.8%. ConclusionsThe high serum Cys-C level is an independent risk factor for STDR in T2DM patients. Serum Cys-C has high predictive value for the occurrence of STDR.
Objective To explore the independent risk factors for hospital infections in tertiary hospitals in Gansu Province, and establish and validate a prediction model. Methods A total of 690 patients hospitalized with hospital infections in Gansu Provincial Hospital between January and December 2021 were selected as the infection group; matched with admission department and age at a 1∶1 ratio, 690 patients who were hospitalized during the same period without hospital infections were selected as the control group. The information including underlying diseases, endoscopic operations, blood transfusion and immunosuppressant use of the two groups were compared, the factors influencing hospital infections in hospitalized patients were analyzed through multiple logistic regression, and the logistic prediction model was established. Eighty percent of the data from Gansu Provincial Hospital were used as the training set of the model, and the remaining 20% were used as the test set for internal validation. Case data from other three hospitals in Gansu Province were used for external validation. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) were used to evaluate the model effectiveness. Results Multiple logistic regression analysis showed that endoscopic therapeutic manipulation [odds ratio (OR)=3.360, 95% confidence interval (CI) (2.496, 4.523)], indwelling catheter [OR=3.100, 95%CI (2.352, 4.085)], organ transplantation/artifact implantation [OR=3.133, 95%CI (1.780, 5.516)], blood or blood product transfusions [OR=3.412, 95%CI (2.626, 4.434)], glucocorticoids [OR=2.253, 95%CI (1.608, 3.157)], the number of underlying diseases [OR=1.197, 95%CI (1.068, 1.342)], and the number of surgical procedures performed during hospitalization [OR=1.221, 95%CI (1.096, 1.361)] were risk factors for hospital infections. The regression equation of the prediction model was: logit(P)=–2.208+1.212×endoscopic therapeutic operations+1.131×indwelling urinary catheters+1.142×organ transplantation/artifact implantation+1.227×transfusion of blood or blood products+0.812×glucocorticosteroids+0.180×number of underlying diseases+0.200×number of surgical procedures performed during the hospitalization. The internal validation set model had a sensitivity of 72.857%, a specificity of 77.206%, an accuracy of 76.692%, and an AUC value of 0.817. The external validation model had a sensitivity of 63.705%, a specificity of 70.934%, an accuracy of 68.669%, and an AUC value of 0.726. Conclusions Endoscopic treatment operation, indwelling catheter, organ transplantation/artifact implantation, blood or blood product transfusion, glucocorticoid, number of underlying diseases, and number of surgical cases during hospitalization are influencing factors of hospital infections. The model can effectively predict the occurrence of hospital infections and guide the clinic to take preventive measures to reduce the occurrence of hospital infections.
Objective To identify and analyze risk factors for acute renal failure (ARF) following lung transplantation and to develop a predictive model. Methods Data for this study were obtained from the United Network for Organ Sharing (UNOS) database, encompassing patients who underwent unilateral or bilateral lung transplantation between 2015 and 2022. We analyzed both preoperative and postoperative clinical characteristics of the patients. A combined approach utilizing random forest and least absolute shrinkage and selection operator (LASSO) regression was employed to identify key factors associated with the incidence of ARF post-transplantation, based on which a nomogram model was developed. The predictive performance of the constructed model was evaluated in both training and validation sets, using receiver operating characteristic (ROC) curves and area under the curve (AUC) metrics to verify and compare model effectiveness. ResultsA total of 15 110 lung transplantation patients were included in the study, consisting of6 041 males and 9 069 females, with a median age of 62.00 years (interquartile range: 54.00 to 67.00). The analysis revealed statistically significant differences between postoperative renal dialysis and non-dialysis patients regarding preoperative lung diagnosis, estimated glomerular filtration rate (eGFR), mechanical ventilation, preoperative ICU treatment, extracorporeal membrane oxygenation (ECMO) support, infections occurring within two weeks prior to transplantation, Karnofsky Performance Status (KPS) score, waitlist duration, double-lung transplantation, and ischemia time (P<0.05). Five key variables associated with ARF after lung transplantation were identified through random forest and LASSO regression: recipients’ eGFR, preoperative ICU treatment, ECMO support, bilateral lung transplantation, and ischemia time. A nomogram model was subsequently established. Model evaluation demonstrated that the constructed predictive model achieved high accuracy in both training and validation sets, with favorable AUC values, confirming its validity and reliability. ConclusionThis study identifies common risk factors for ARF following lung transplantation and introduces an effective predictive model with potential clinical applications.
ObjectiveTo investigate the risk factors for central lymph node metastasis (CLNM) in patients with clinically negative lymph node (cN0 stage) papillary thyroid carcinoma (PTC).MethodsThe clinicopathological data of 250 patients with cN0 PTC who underwent thyroidectomy and central lymph node dissection (CLND) in Department of General Surgery of Xuzhou Central Hospital from June 2016 to June 2019 were retrospectively analyzed. The influencing factors of CLNM in patients with cN0 PTC were analyzed by univariate analysis and binary logistic regression, and then R software was used to establish a nomogram prediction model, receiver operating characteristic curve was used to evaluate the differentiation degree of the model, and Bootstrap method was used for internal verification to evaluate the calibration degree of the model.ResultsCLNM occurred in 147 of 250 patients with cN0 PTC, with an incidence of 58.8%. Univariate analysis showed that multifocal, bilateral, tumor diameter, and age were correlated with CLNM (P<0.01). The results of binary logistic regression analysis showed that multifocal, bilateral tumors, age≥45 years old, and tumor diameter>1 cm were independent risk factors for CLNM in patients with cN0 PTC (P<0.05). The area under the curve (AUC) of the nomogram prediction model established on this basis was 0.738, and the calibration prediction curve in the calibration diagram fitted well with the ideal curve.ConclusionsCLNM is more likely to occur in PTC. The nomogram model constructed in this study can be used as an auxiliary means to predict CLNM in clinical practice.
Objective To explore the relationship between preoperative fasting plasma glucose (FPG) and postoperative pulmonary complications (PPCs) in type 2 diabetic patients undergoing elective thoracoscopic lung resection, and provide a reference for prediction and prevention of PPCs in the clinic. Methods A retrospective analysis was performed on the type 2 diabetic patients who underwent elective thoracoscopic lung resection for the first time in our hospital from January 2017 to March 2021. According to the level of FPG one day before the operation, the patients were divided into three groups: a hypoglycemia group (<6.1 mmol/L), a medium level blood glucose group (≥6.1 mmol/L and <8.0 mmol/L) and a high blood glucose group (≥8.0 mmol/L). Besides, the patients were divided into a PPCs group and a non-PPCs group according to whether PPCs occurred. The risk factors for PPCs were analyzed by logistic regression analysis, and the predictive value of preoperative FPG level on PPCs was estimated by the area under the receiver operating characteristic curve (AUC). Results A total of 130 patients were included, including 75 (57.7%) males and 55 (42.3%) females with an average age of 63.5±9.0 years. Logistic regression analysis showed that compared to non-PPCs patients, the level of preoperative FPG (P=0.023) and smoking history ratio (P=0.036) were higher and the operation time was longer (P=0.004) in the PPCs patients. High FPG level on preoperative day 1 and longer operation time were associated with PPCs risk. Besides, the preoperative FPG of 6.79 mmol/L was the threshold value to predict the occurrence of PPCs [AUC=0.653, 95%CI (0.559, 0.747), P=0.003]. Conclusion There is a certain correlation between preoperative FPG level and postoperative PPCs, which may be used as an index to predict the occurrence of PPCs.
ObjectiveTo investigate the risk factors of lymph node metastasis for early distal gastric signet ring cell cancer and indications of radical surgery.MethodsFrom Mar. 2013 to Nov. 2018, a total of 91 early gastric cancer patients who accepted radical gestrectomy and regional lymph node dissection, and proved postoperatively for early distal gastric signet ring cell cancer in the First Affiliated Hospital of Soochow University were enrolled in this study. We collected clinicpathologic characteristics, such as gender, age, maximum diameter of tumor, number of lesions, depth of invasion, macroscopic type, and lymphovascular invasion, to explore the risk factors of lymph node metastasis and further analyze the indication of radical surgery.ResultsAll 91 patients accepted radical gestrectomy and regional lymph node dissection, 10 patients suffered from lymph node metastasis. Univariate analysis showed a positive relationship between maximum diameter of tumor (χ2=5.631, P=0.025), depth of invasion (χ2=4.389, P=0.016), number of lesions (χ2=5.615, P=0.023), and lymphovascular invasion (χ2=22.500, P=0.001) and lymph node metastasis of early distal gastric signet ring cell cancer. The multivariate analysis revealed that maximum diameter of tumor (OR=3.675, P=0.012), depth of invasion (OR=3.886, P=0.015), and lymphovascular invasion (OR=8.711, P<0.001) were independent risk factors of lymph node metastasis.ConclusionsThe risk of lymph node metastasis of early distal gastric signet ring cell cancer was high in those with tumor diameter≥2 cm, submucosal cancer, and lymphovascular invasion. Radical surgery might be necessary in cases of early distal gastric signet ring cell cancer that satisfying one of the following criteria: tumor diameter≥2 cm and lymphovascular invasion.
ObjectiveTo identify the predictors of postoperative acute kidney injury in patients undergoing surgery for Stanford type A acute aortic dissection. MethodsA total of 220 patients who underwent surgery for type A acute aortic dissection in Qingdao Municipal Hospital from September 2010 to September 2017 were divided into two groups including a group A and a group B based on whether acute kidney injury occurred or not after surgery. There were 40 patients with 29 males and 11 females with the mean age of 54.6±9.2 years in the group A, 180 patients with 133 males and 47 females with the mean age of 48.5±7.9 years in the group B. Univariate and multivariate analyses (logistic regression) were used to identify the predictive risk factors.ResultsOverall in-hospital mortality was 5.5%. In univariate analysis, there were statistically significant differences with respect to the age, preoperative creatinine, preoperative white blood cell, the European system for cardiac operative risk evaluation (EuroSCORE), total cardiopulmonary bypass (CPB) time, deep hypothermic circulatory arrest (DHCA) time, arch replacement, red blood cell transfusion intraoperative and in 24 hours postoperatively, postoperative mechanical ventilation time, ICU stay duration, hospital stay duration and in hospital mortality. Multivariate logistic analysis showed that preoperative creatinine, preoperative white blood cell, CPB time, and red blood cell transfusion intraoperative and in 24 hours postoperatively were the independent predictors for postoperative acute kidney injury.ConclusionThe incidence of acute kidney injury is high after surgery for acute Stanford type A aortic dissection. It can be predicted based on above factors, for patients with these risk factors, more perioperative care strategies are needed in order to induce the incidence of acute kidney injury.
Objective To explore the related factors of upper urinary tract deterioration (UUTD) in spinal cord injury patients using intermittent catheterization (IC-SCI) in the community. Methods Patients with spinal cord injury in the Chinese community were selected for investigation between August 3 and August 31, 2020. The included patients were divided into UUTD group and non-UUTD group. The basic information, intermittent catheterization practices, and urinary complications were compared between the two groups. Logistic regression was used to analyze the risk factors contributing to UUTD. Results A total of 431 patients were surveyed. Among them, there were 310 males and 121 females, 246 cases in the non-UUTD group and 185 cases in the UUTD group. There were statistically significant differences in the disease duration, gender, etiology, urinary incontinence, urinary tract infection, bladder calculi and nephrolithiasis between the two groups (P<0.05); there was no statistically significant difference in the other indicators between the two groups (P>0.05). The results of logistic regression analysis showed that urinary tract infection [odds ratio (OR)=3.229, 95% confidence interval (CI) (1.706, 6.110), P<0.001], nephrolithiasis [OR=4.846, 95%CI (2.617, 8.973), P<0.001], and urinary incontinence [OR=2.345, 95%CI (1.116, 4.925), P=0.024] were risk factors for UUTD. Conclusion Urinary tract infection, nephrolithiasis and urinary incontinence are independent risk factors for UUTD in community-based IC-SCI patients and deserve attention for preventive strategies.
Objective To evaluate the risk factors for cognitive impairment and their interactions in acute ischemic stroke (IS) patients. Methods IS patients admitted to the Department of Neurology, the People’s Hospital of Mianyang between January 2019 and January 2022 were selected. Patients were divided into a cognitive impairment group and a cognitive normal group. The demographic characteristics and clinical data of the subjects were collected, and the traditional risk factors for cognitive impairment were determined by univariate and multivariate logistic regression analysis. The multifactor dimensionality reduction test was used to detect the possible interactions between risk factors. Results A total of 255 patients were included. Among them, 88 cases (34.5%) in the cognitive impairment group and 167 cases (65.5%) in the cognitive normal group. The results of factor logistic regression analysis showed that after adjusting for covariates, big and medium infarction volume, severe IS, moderate to severe carotid artery stenosis as well as high hypersensitive C-reactive protein (hs-CRP) were associated with post-IS cognitive impairment (P<0.05). The cognitive impairment increased by 22.632 times [odds ratio=22.632, 95% confidence interval (5.980, 85.652), P<0.001] in patients with big and medium infarction volume, severe IS and high hs-CRP. Conclusions The cognitive impairment is common in acute IS. Patients with big and medium infarction volume, non-mild stroke, carotid artery stenosis, high hs-CRP, and non-right sided infarction are prone to cognitive impairment, and there are complex interactions among these risk factors.
ObjectiveTo investigate the risk factors of cervical lymph node metastasis of papillary thyroid microcarcinoma (PTMC) with clinical lymph node metastasis negative (cN0).MethodThe clinicopathologic data of patients with cN0 PTMC who underwent at least one lobectomy plus central lymph node dissection in this hospital from January 2013 to December 2018 were retrospectively collected and the risk factors of lymph node metastasis were analyzed.ResultsA total of 1 821 patients with cN0 PTMC were enrolled in this study. The results of postoperative pathology showed there were 837 (46.0%) cases with lymph node metastasis, in which of 805 (44.2%) cases with central lymph node metastasis; 252 (33.1%) had lateral lymph node metastasis among 761 patients underwent lateral lymph node dissection. The results of univariate analysis showed that male, age <55 years old, tumor diameter ≥5 mm, bilateral cancer, capsule invasion, and multiple foci were associated with lymph node metastasis of cN0 PTMC (P<0.05). Further binary logistic regression multivariate analysis results showed that these factors (except multiple foci) were the independent risk factors of lymph node metastasis of cN0 PTMC (P<0.05). While the results found that the risk of lateral lymph node metastasis was increased with the increasing of the number of central lymph node metastasis in patients with cN0 PTMC (P<0.05).ConclusionsCervical lymph node metastasis of cN0 PTMC is related to many factors, and central lymph node metastasis indicates a higher risk of lateral lymph node metastasis. For patients with risk factors, preventive central lymph node dissection should be given at the first surgery and decided whether to perform lateral lymph node dissection according to the intraoperative situation.