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  • Association of monocyte and lymphocyte ratio with risk of abdominal aortic calcification

    by Wenting Yan, Tingting Hu

    Objectives

    The aim of the study was to evaluate the relationship between monocyte and lymphocyte ratio (MLR) with severe AAC.

    Methods

    This cross-sectional study enrolled 3041 patients with AAC from the National Health and Nutrition Examination Survey 2013–2014. Abdominal aortic calcification detected with dual-energy X-ray absorptiometry was quantified using the Kauppila score system. We measured white blood cell, neutrophil, lymphocyte counts, monocyte counts, red blood cell, calcium, 25-VitD3, and phosphorus levels in blood samples. Multivariate logistic regression was performed to examine the association between MLR (as a qualitative or quantitative variable) and severe AAC morbidity.

    Results

    Severe AAC was detected in 273 (9.0%) participants. Multivariate logistic regression analysis indicated that high MLR was an independent predictor of severe AAC (odds ratio [OR] 2.80, 95% confidence interval [CI] 1.04–7.50; P = 0.041).

    Conclusions

    Elevated MLR levels are independently associated with higher odds for severe AAC, which can serve as a new risk factor in clinical practice.



  • Editorial Note: Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: Cox-gamma shared frailty model

    by The PLOS One Editors



  • Cardiometabolic dysfunction burden and mortality outcomes in metabolic dysfunction-associated steatotic liver disease

    by Ying Wen, Yu Min, Yi Lei, Zhigong Wei

    Background/Objectives

    The term metabolic dysfunction-associated steatotic liver disease (MASLD) reflects the key role of cardiometabolic dysfunction in steatotic liver disease. We aim to assess the association between cardiometabolic dysfunction burden and mortality outcomes in MASLD.

    Methods

    Participants with MASLD were selected from the National Health and Nutrition Examination Survey (NHANES) database between 1999 and 2018. The mortality outcomes of participants with different numbers of cardiometabolic risk factors were compared by using Kaplan-Meier curves and Cox regression analysis.

    Results

    This study included 9,017 participants with MASLD (4,613 men and 4,404 women, median age 49.0). With a median 115-month follow-up, 1,447 all-cause deaths and 407 cardiovascular-specific deaths were observed. Multivariate regression analysis showed that participants with five cardiometabolic risk factors had significantly increased all-cause mortality risk compared to those with one risk factor (adjusted hazard ratio [aHR] = 3.57, 95% confidence interval [CI]: 2.04–6.24, P < 0.001). Similarly, the cardiovascular mortality risk was markedly higher for participants with five risk factors (aHR = 7.72, 95% CI: 1.89–31.53, P = 0.004). Among participants with the same number of cardiometabolic risk factors, those with blood glucose or blood pressure abnormalities showed the lowest survival rates than other subgroups. Besides, participants with younger ages were more vulnerable to the harmful prognostic effects of cardiometabolic dysfunction burden on the mortality risks.

    Conclusions

    The MASLD population with high cardiometabolic dysfunction burdens exhibits increased mortality risk. Assessing cardiometabolic dysfunction, particularly abnormalities in blood glucose and blood pressure, is crucial for effective management in this population.



  • SpO&lt;sub&gt;2&lt;/sub&gt;/FiO&lt;sub&gt;2&lt;/sub&gt; ratio as a better metric for assessment of RBC transfusion effectiveness in non-traumatic critically ill patients with physiologic derangements

    by Tilendra Choudhary, Geoffrey Smith, John D. Roback, Ravi M. Patel, Cassandra D. Josephson, Rishikesan Kamaleswaran

    Identifying critically ill patients who are likely to improve their respiratory physiology following RBC transfusion is dynamic and difficult. Current decision tools are over-reliant on hemoglobin transfusion thresholds, without considering respiratory measures that may reflect physiologic effects of anemia and functional responses to RBC transfusion. Further, routine clinical measures to determine transfusion efficacy beyond hemoglobin increment are lacking to identify patients as responders or non-responders. We present a two-center retrospective cohort study aiming to determine a potential biomarker to assess the physiologic response of RBC transfusion for non-traumatic ICU patients. The study was performed with 13,274 eligible patients at the first center. Another 3,757 from the second center were used as a validation population. We introduced a comparative analysis of two respiratory measures, SpO2 and SpO2/FiO2 (SF) ratio, in addition to hemoglobin, to assess individual patient responses to RBC transfusion. A statistical study was performed to compare these markers before and after the transfusion interval. Based on quantitative statistical analyses, we found SF ratio to be a more effective biomarker than hemoglobin alone for revealing RBC transfusion efficacy. There existed an inverse correlation between pre-transfusion SF and transfusion efficacy. The results were consistent across both centers, revealing generalizability. With the SF data from both the centers, we also developed a random forest-based regression model that significantly evaluated the level of transfusion effectiveness (p < 0.001).

  • Postoperative joint pain is associated with long-term all-cause mortality after total joint arthroplasty

    by Ming Liu, Andrew Furey, Proton Rahman, Guangju Zhai

    The aims of this study were to assess (1) if postoperative joint pain can predict long-term all-cause mortality after total joint arthroplasty (TJA), and (2) if postoperative joint pain was associated with causes of death (COD) in TJA patients. Patients who underwent total knee or hip arthroplasty were assessed once for their postoperative joint pain at least one-year after TJA using the Western Ontario and McMaster Universities Osteoarthritis Index Likert 3.0 pain subscale. Three pain definitions were utilized: “sustained pain” – pain on all five questions, “pain while active” – pain while walking and taking stairs, and “pain at rest” – pain while sitting/lying and at night while in bed. Patients reporting no pain were classified as controls. Associations between postoperative joint pain and mortality were assessed using Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression to adjust for age at TJA, sex, body mass index (BMI), cardiovascular diseases (CVD), and cancer. The distribution of COD between pain groups and controls were compared using Fisher’s exact test. A total of 727 patients were included in the study, of which 129 (18%) were deceased. The prevalence of postoperative sustained pain, pain while active, and pain at rest at 4-year after TJA was 10, 17, and 12%, respectively. The all-cause mortality rate at 11-year after TJA was 20, 26, 19, and 15% in these pain groups and controls, respectively, significantly higher in pain while active group (p = 0.006). Pain while active was positively associated with mortality when knee and hip patients were analyzed together and separately (p ≤ 0.03, hazard ratio (HR)≥1.80), and the significances became stronger after adjusting for age at surgery, sex, BMI, CVD, and cancer (p < 0.001, HR ≥ 2.57). No association was observed between postoperative joint pain and COD. Our results demonstrated that postoperative joint pain could be an important predictor for long-term all-cause mortality in TJA patients.