Background: The vasoactive-ventilation-renal (VVR) score includes pulmonary and renal dysfunctions not previously addressed by the vasoactive inotrope score (VIS) and may be a better predictor of cardiac care unit (CC...Background: The vasoactive-ventilation-renal (VVR) score includes pulmonary and renal dysfunctions not previously addressed by the vasoactive inotrope score (VIS) and may be a better predictor of cardiac care unit (CCU) length of stay (LOS) in patients undergoing re-entry sternotomy (defined as no earlier than 30 days after previous sternotomy) for congenital heart disease (CHD). Methods: Patients undergoing re-entry sternotomy for CHD from August 1, 2009 to June 30, 2016 were studied retrospectively. A total of 96 patients undergoing 133 re-entry procedures were identified. VVR scores were calculated on CCU admission post-procedure (at 0 hour), 24-hour, and 48-hour after admission to the CCU. The response variable was CCU LOS.? Recursive partition analysis identified variables predicting LOS. Results: 133 re-entry sternotomies in 96 patients made up the samples of the database;11 samples were removed due to incomplete data or placement on ECMO. Of the initial 25 features, 5 were removed for near zero variance and 3 categorical features were removed for non-information. Covariance analysis did not demonstrate any significant correlation amongst the remaining features. Initial recursive tree regression using ANOVA, cross validation and conditional predictive p-value (cp) = 0.01 produced 3 trees. The tree with lowest cross validation error was selected. The resulting 2 split trees with ventilator days less than 20 days and VVR score at 48 hours greater than 23 identified three CCU LOS groups with mean CCU LOS of 77.6, 55.1, and 9.5 days. Conclusions: Recursive partition analysis identified ventilator days greater than 20 days and the sub-population VVR at 48 hours as predictive of CCU LOS in patients undergoing re-entry sternotomy for CHD.展开更多
Objective: We aim to detect over-time variations in mortality of liver transplant recipients stratified by the period of transplant. Since this is a retrospective investigation, bias reduction caused by possible confo...Objective: We aim to detect over-time variations in mortality of liver transplant recipients stratified by the period of transplant. Since this is a retrospective investigation, bias reduction caused by possible confounding effects can be achieved by using propensity score weighting in a multivariate logistic regression model. Methods: Medical charts of all adult liver transplant recipients (n = 250) who were transplanted in three periods 2005-2009, 2010-2014 and 2015-2019 were retrospectively reviewed. The following recipient factors were analyzed: recipients and donors’ ages, sex, renal impairment, body mass index (BMI), presence of bacterial or viral infections, MELD (Model for end-stage diseases). Multivariate logistic model adjusted by Propensity Scores (PS) was used to identify the effect of the risk factors on mortality, and death within five years, in the targeted time frame. Patient outcomes are recorded as;(patient status = 1 if dead, or patient status = 0 if alive). Results: Meld score, recipient age, and renal impairments were shown to be predictors of mortality in transplanted patients. Multivariate regression model was used to identify the significance of the specified risk factors, followed by pairwise comparisons between periods. Pairwise comparisons between periods using logistic regression weighted by the inverse propensity score, correcting for the possible confounding effect of measured covariates showed that the death rate is significantly reduced in subsequent periods as compared to the initial period. Conclusions: The clinical implications of these findings are the ability to stratify patients at high risk of posttransplant death by planning more intensive and accurate management for them.展开更多
目的 观察祛浊清源汤治疗糖尿病肾病患者的临床疗效及对其肾功能指标的影响。方法 选取2019年9月—2021年3月期间衡水市中医医院收治的120例糖尿病肾病患者作为研究对象,按照随机数字表法分为对照组和观察组,每组各60例。两组患者均给...目的 观察祛浊清源汤治疗糖尿病肾病患者的临床疗效及对其肾功能指标的影响。方法 选取2019年9月—2021年3月期间衡水市中医医院收治的120例糖尿病肾病患者作为研究对象,按照随机数字表法分为对照组和观察组,每组各60例。两组患者均给予优质蛋白、降糖、利尿消肿等基础治疗。对照组给予依那普利治疗,观察组在对照组基础上给予祛浊清源汤口服。连续治疗16周后,观察比较两组患者临床疗效,治疗前及治疗16周后中医证候积分,肾功能指标[血清肌酐(Serum creatinine, Scr)、尿素氮(Blood urea nitrogen, BUN)、24 h尿蛋白定量(24 h urine protein quantification, 24 h UPQ)、24 h尿微量白蛋白排泄率(24 h urine microalbumin excretion rate, 24 h UAER)]水平及不良反应发生情况。结果 治疗后观察组临床总有效率93.33%(56/60)明显高于对照组78.33%(47/60),差异有统计学意义(P<0.05)。治疗后两组患者神疲乏力、少气懒言、腰膝酸软、口干咽燥、潮热盗汗、夜尿频多积分均较治疗前降低,差异有统计学意义(P<0.05);且观察组神疲乏力、少气懒言、腰膝酸软、口干咽燥、潮热盗汗、夜尿频多积分均较对照组明显降低,差异有统计学意义(P<0.05)。治疗后两组患者肾功能24 h UAER、24 h UPQ、BUN、Scr水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组肾功能24 h UAER、24 h UPQ、BUN、Scr水平均较对照组明显降低,差异有统计学意义(P<0.05)。治疗期间,两组患者不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 祛浊清源汤治疗糖尿病肾病疗效较好,能够明显改善中医症状,同时可以改善肾功能,具有较高安全性,具有临床推广意义。展开更多
文摘Background: The vasoactive-ventilation-renal (VVR) score includes pulmonary and renal dysfunctions not previously addressed by the vasoactive inotrope score (VIS) and may be a better predictor of cardiac care unit (CCU) length of stay (LOS) in patients undergoing re-entry sternotomy (defined as no earlier than 30 days after previous sternotomy) for congenital heart disease (CHD). Methods: Patients undergoing re-entry sternotomy for CHD from August 1, 2009 to June 30, 2016 were studied retrospectively. A total of 96 patients undergoing 133 re-entry procedures were identified. VVR scores were calculated on CCU admission post-procedure (at 0 hour), 24-hour, and 48-hour after admission to the CCU. The response variable was CCU LOS.? Recursive partition analysis identified variables predicting LOS. Results: 133 re-entry sternotomies in 96 patients made up the samples of the database;11 samples were removed due to incomplete data or placement on ECMO. Of the initial 25 features, 5 were removed for near zero variance and 3 categorical features were removed for non-information. Covariance analysis did not demonstrate any significant correlation amongst the remaining features. Initial recursive tree regression using ANOVA, cross validation and conditional predictive p-value (cp) = 0.01 produced 3 trees. The tree with lowest cross validation error was selected. The resulting 2 split trees with ventilator days less than 20 days and VVR score at 48 hours greater than 23 identified three CCU LOS groups with mean CCU LOS of 77.6, 55.1, and 9.5 days. Conclusions: Recursive partition analysis identified ventilator days greater than 20 days and the sub-population VVR at 48 hours as predictive of CCU LOS in patients undergoing re-entry sternotomy for CHD.
文摘Objective: We aim to detect over-time variations in mortality of liver transplant recipients stratified by the period of transplant. Since this is a retrospective investigation, bias reduction caused by possible confounding effects can be achieved by using propensity score weighting in a multivariate logistic regression model. Methods: Medical charts of all adult liver transplant recipients (n = 250) who were transplanted in three periods 2005-2009, 2010-2014 and 2015-2019 were retrospectively reviewed. The following recipient factors were analyzed: recipients and donors’ ages, sex, renal impairment, body mass index (BMI), presence of bacterial or viral infections, MELD (Model for end-stage diseases). Multivariate logistic model adjusted by Propensity Scores (PS) was used to identify the effect of the risk factors on mortality, and death within five years, in the targeted time frame. Patient outcomes are recorded as;(patient status = 1 if dead, or patient status = 0 if alive). Results: Meld score, recipient age, and renal impairments were shown to be predictors of mortality in transplanted patients. Multivariate regression model was used to identify the significance of the specified risk factors, followed by pairwise comparisons between periods. Pairwise comparisons between periods using logistic regression weighted by the inverse propensity score, correcting for the possible confounding effect of measured covariates showed that the death rate is significantly reduced in subsequent periods as compared to the initial period. Conclusions: The clinical implications of these findings are the ability to stratify patients at high risk of posttransplant death by planning more intensive and accurate management for them.
文摘目的 观察祛浊清源汤治疗糖尿病肾病患者的临床疗效及对其肾功能指标的影响。方法 选取2019年9月—2021年3月期间衡水市中医医院收治的120例糖尿病肾病患者作为研究对象,按照随机数字表法分为对照组和观察组,每组各60例。两组患者均给予优质蛋白、降糖、利尿消肿等基础治疗。对照组给予依那普利治疗,观察组在对照组基础上给予祛浊清源汤口服。连续治疗16周后,观察比较两组患者临床疗效,治疗前及治疗16周后中医证候积分,肾功能指标[血清肌酐(Serum creatinine, Scr)、尿素氮(Blood urea nitrogen, BUN)、24 h尿蛋白定量(24 h urine protein quantification, 24 h UPQ)、24 h尿微量白蛋白排泄率(24 h urine microalbumin excretion rate, 24 h UAER)]水平及不良反应发生情况。结果 治疗后观察组临床总有效率93.33%(56/60)明显高于对照组78.33%(47/60),差异有统计学意义(P<0.05)。治疗后两组患者神疲乏力、少气懒言、腰膝酸软、口干咽燥、潮热盗汗、夜尿频多积分均较治疗前降低,差异有统计学意义(P<0.05);且观察组神疲乏力、少气懒言、腰膝酸软、口干咽燥、潮热盗汗、夜尿频多积分均较对照组明显降低,差异有统计学意义(P<0.05)。治疗后两组患者肾功能24 h UAER、24 h UPQ、BUN、Scr水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组肾功能24 h UAER、24 h UPQ、BUN、Scr水平均较对照组明显降低,差异有统计学意义(P<0.05)。治疗期间,两组患者不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 祛浊清源汤治疗糖尿病肾病疗效较好,能够明显改善中医症状,同时可以改善肾功能,具有较高安全性,具有临床推广意义。
