BackgroundThis study aimed at developing and validating a scoring model to stratify critically ill patients after cardiac surgery based on risk for dysphagia, a common but often neglected complication.MethodsData were prospectively collected and analyzed from January 2016 to June 2017 from 395 consecutive post cardiac surgery patients at the cardiac care unit (CCU) at a single center; 103 (26.1%) developed dysphagia. Univariate and multivariate logistic analyses were used to identify independent predictors for dysphagia. The survival nomogram was developed on the basis of a multivariable Cox model, which allowed us to obtain survival probability estimations. The predictive performance of the nomogram was verified for discrimination and calibration. Areas under receiver operating characteristic curve analysis were used to illustrate and evaluate the diagnostic performance of the novel model.ResultsThe final novel scoring model, named SSG-OD, consists of three independent factors: gastric intubation (OR = 1.024, 95% CI 1.015–1.033), sedative drug use duration (OR = 1.031, 95% CI 1.001–1.063) and stroke or not (OR = 6.182, 95% CI 3.028–12.617). SSG-OD identified patients at risk for dysphagia with sensitivity of 68.5% and specificity of 89.0% (OR = 0.833, 95% CI: 0.782–0.884). The positive and negative likelihood ratios were 6.22 and 0.35.ConclusionsThe novel SSG-OD scoring system to risk stratify CCU patients for dysphagia is an easy-to-use bedside prognostication aid with good predictive performance and the potential to reduce aspiration incidence and accelerate recovery.
T3 was downregulated in acute aortic dissection. Low T3 level was a risk factor for in-hospital death and acute renal failure in patients with acute aortic dissection.
Background: Mineralocorticoid receptor antagonists (MRA) improve outcomes in chronic kidney disease (CKD) and acute myocardial infarction (AMI) patients. However, the lack of evidence regarding long-term clinical outcomes in the use of MRA, including spironolactone, in patients with AMI combined with CKD.Objectives: This study aimed to investigate whether spironolactone could significantly reduce the risk of all-cause mortality and re-admission in patients with AMI and CKD.Methods: In this single center, observational, retrospective, registry based clinical study, a total of 2,465 AMI patients were initially screened; after excluding patients with estimated glomerular filtration rate more than 60 ml/min/1.73 m2, 360 patients in the standard treatment group and 200 patients in the spironolactone group met the criteria. All enrolled patients follow-up for 30 months. The primary outcomes were all-cause mortality and re-admission. The key safety outcome was hyperkalemia rates during the 30 months follow-up period.Results: 160 (44.4%) and 41 (20.5%) patients in the standard treatment and spironolactone groups died, respectively [hazard ratio (HR): 0.389; 95% confidence interval (CI): 0.276–0.548; p < 0.001]. Re-admission occurred in 217 (60.3%) and 95 (47.5%) patients in the standard treatment and spironolactone groups, respectively (HR: 0.664; 95% CI: 0.522–0.846; p = 0.004). The spironolactone group was divided into two based on the daily dose, low dose group (no more than 40 mg) and high dose group (more than 40 mg); the differences in the mortality rate between low dose group (16.7%) and the standard treatment group (44.4%) (HR: 0.309; 95% CI: 0.228–0.418; p < 0.001) and high dose group (34.1%) (HR: 0.429; 95% CI: 0.199–0.925; p = 0.007) were significant. The differences in re-hospitalization rate between low dose group (43.6%) and the standard treatment group (60.3%) (HR: 0.583; 95% CI: 0.457–0.744; p < 0.001) and high dose group (61.4%) (HR: 0.551; 95% CI: 0.326–0.930; p = 0.007) was significant. Hyperkalemia occurred in 18 (9.0%) and 18 (5.0%) patients in the spironolactone group and standard treatment group, respectively (HR: 1.879; 95% CI: 0.954–3.700; p = 0.068). Whereas, Hyperkalemia occurred in high dose group (20.5%) significantly more often than in the standard treatment group (p < 0.001) and low dose group (5.8%) (p = 0.003).Conclusion: Using MRA, such as spironolactone, may substantially reduce the risk of both all-cause mortality and re-admission in patients with AMI and CKD; the use of low-dose spironolactone has the best efficacy and safety. However, this was a relatively small sample size, single center, observational, retrospective, registry based clinical study and further prospective evaluation in adequately powered randomized trials were needed before further use of spironolactone in AMI with CKD population.
Background: The purpose of this study was to identify possible diagnostic indicators for heart failure (HF) and to investigate the function of immune cell infiltration in this pathophysiology.Methods: HF datasets from the Gene Expression Metascape database were utilized. R software was used to the identify differentially-expressed genes (DEGs) and perform functional correlation analysis. Least absolute shrinkage and selection operator (LASSO) and Boruta algorithms elimination algorithms were then employed to screen and validate the HF diagnostic variables. Finally, Single-sample Gene Set Enrichment Analysis (ssGSEA) was utilized to assess immune cell infiltration in HF tissues, and the Spearman association between gene expression and immune cell concentration was investigated.Results: A total of 239 DEGs were screened in this study. SERPINA3 (area under the curve, AUC =0.958), FCN3 (AUC =0.972), FREM1 (AUC =0.954), and MNS1 (AUC =0.948) were identified as diagnostic factors of HF. The gene set differentiation analysis (GSVA) (R package "GSVA") results showed that the high expression of FREM1 and MNS1 genes was involved in bile acid, fatty acid, and heme metabolism, suggesting that the core gene affects the progression of HF by regulating metabolism. Meanwhile, the high expression of FCN3 and SERPINA3 was related to xenobiotic metabolism, inflammatory response, and adipogenesis.Conclusions: Given the importance of immune cell infiltration in the genesis and progression of HF, SERPINA3, FCN3, FREM1, and MNS1 may be used as diagnostic variables for HF.
Background With the establishment of the cardiac-gut axis concept, increasing evidence has suggested the involvement and important regulatory role of the gut microbiota (GM) in cardiovascular diseases. Whereas, the relationship between GM and atrial fibrillation (AF) still poorly understood.Objectives The aim of this study was to investigate whether there were differences in GM between AF patients and healthy controls, and to discover the factors that affecting the changes of GM.Methods In this study, we enrolled 30 hospitalized patients with AF and 30 matched patients with sinus rhythm (SR). GM species in fecal samples were evaluated through amplicon sequencing targeting the 16Sribosomal RNA gene. GM species richness, diversity, differential abundance of individual taxa between AF and SR were analyzed.Results AF patients showed decreased species richness and α-diversity compared to SR patients, but there was no statistical difference. The phylogenetic diversity was significant decreased in AF group (P<0.001). The β-diversity indexes revealed significant differences in GM community structure between AF group and SR group. After investigated the individual taxa, AF group showed altered relative abundance in several taxa compared to the SR group. linear discriminant analysis (LDA) effect size (LEfSe) analysis revealed, a significant decrease in Bifidobacterium and a greater abundance of Lactobacillus, Fusobacterium, Haemophilus in AF group compared with the SR group.Conclusions In AF patients, the GM phylogenetic diversity and β-diversity decreased, the relative abundance altered in several taxa and the bacterial community structure changed. GM dysbiosis might play a crucial part in the occurrence and development of AF.Clinical Trial Registration: chictr.org.cn identifier: ChiCTR2100050063
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