Is low postoperative cholesterol level really an independent risk factor of adverse outcomes after living donor liver transplantation?

To the Editor:We read with great interest the article by Yang et al.[1]evaluating the effects of postoperative serum total cholesterol(s TC)changes on early allograft dysfunction and survival after living donor liver transplantation(LDLT).By the multivariate regression analysis,they showed that patients with s TC<1.42 mmol/L on postoperative day 3 had 4.08-fold and 2.72-fold greater risks of

Prognostic factors for community-acquired pneumonia in middle-aged and elderly patients treated with integrated medicine

OBJECTIVE:To identify prognostic factors in middle-aged and elderly patients with community-acquired pneumonia(CAP) who underwent integrated interventions involving traditional Chinese medicine(TCM) and modern medicine.METHODS:Patients aged ≥45 years and diagnosed with CAP were divided into a middle-aged cohort(45-59 years) and an elderly cohort(≥60 years),and clinical data comprising 75 predictor variables in seven classes were collected.After replacing missing data,calibrating multicenter differences and classifYing quantitative data,univariate and multivariate analysis were performed.RESULTS:On multivariate analysis,eight independent risk factors-respiration rate,C reactive protein(CRP),cost of hospitalization,anemia,gasping,confusion,moist rales and pneumonia severity index(PSI)-were correlated with the outcome "not cured" in the elderly cohort.Nine factors-neutrophil percentage(Neu%),blood urea nitrogen(BUN),time to clinical stability,appetite,anemia,confusion,being retired or unemployed,Gram-negative bacterial infection and educational level-were correlated with not cured in the middle-aged cohort.CONCLUSION:Independent predictive risk factors correlated with adverse outcomes in elderly patients were higher respiration rate,CRP≥four times the mean or median for the patient's center,cost of hospitalization>11,323 RMB and PSI>II,plus anemia,gasping,confusion and moist rales;those in middle-aged patients were higher Neu%,BUN≥mean or median,loss of appetite,anemia,confusion,being retired or unemployed and lower educational level.Gram-negative bacterial infection and time to clinical stability>9 days were protective factors.

Risk factors associated with mortality of COVID-19 in 3125 counties of the United States

Background:The number of cumulative confirmed cases of COVID-19 in the United States has risen sharply since March 2020.A county health ranking and roadmaps program has been established to identify factors associated with disparity in mobility and mortality of COVID-19 in all counties in the United States.The risk factors associated with county-level mortality of COVID-19 with various levels of prevaIence are not well understood.Methods:Using the data obtained from the County Health Rankings and Roadmaps program,this study applied a negative binomial design to the courtty-level mortality counts of COVID-19 as of August 27,2020 in the United States.In this design,the infected counties were categorized into three levels of infections using clustering analysis based on time-var ying cumulative con firmed cases from March 1 to August 27,2020.COVID-19 patients were not analyzed in dividually but were aggregated at the county-level,where the coun ty-level deaths of COVID-19 con firmed by the local health agencies.Clustering analysis and Kruskal-Wallis tests were used in our statistical analysis.