ObjectivesThis study aims to develop and internally validate a prediction model, which takes account of multivariable and comprehensive factors to predict the prolonged length of stay (LOS) in patients with lower extremity atherosclerotic disease (LEAD).DesignThis is a retrospective study.SettingChina.Participants, primary and secondary outcomesData of 1694 patients with LEAD from a retrospective cohort study between January 2014 and November 2021 were analysed. We selected nine variables and created the prediction model using the least absolute shrinkage and selection operator (LASSO) regression model after dividing the dataset into training and test sets in a 7:3 ratio. Prediction model performance was evaluated by calibration, discrimination and Hosmer-Lemeshow test. The effectiveness of clinical utility was estimated using decision curve analysis.ResultsLASSO regression analysis identified age, gender, systolic blood pressure, Fontaine classification, lesion site, surgery, C reactive protein, prothrombin time international normalised ratio and fibrinogen as significant predictors for predicting prolonged LOS in patients with LEAD. In the training set, the prediction model showed good discrimination using a 500-bootstrap analysis and good calibration with an area under the receiver operating characteristic of 0.750. The Hosmer-Lemeshow goodness of fit test for the training set had a p value of 0.354. The decision curve analysis showed that using the prediction model both in training and tests contributes to clinical value.ConclusionOur prediction model is a valuable tool using easily and routinely obtained clinical variables that could be used to predict prolonged LOS in patients with LEAD and help to better manage these patients in routine clinical practice.
ObjectivesHomocysteine (Hcy) level has been widely identified as a risk factor associated with adverse outcomes in patients with lower extremity atherosclerotic disease (LEAD). However, there are still some knowledge gaps in research on the association between Hcy level and downstream adverse outcomes, such as length of stay (LOS). This study aims to explore whether and to what extent Hcy level is associated with LOS in patients with LEAD.DesignRetrospective cohort study.SettingChina.Participants, primary and secondary outcomesWe conducted a retrospective cohort study of 748 patients from inpatients with LEAD between January 2014 and November 2021 at the First Hospital of China Medical University in China. We used a slew of generalised linear models to evaluate the association between Hcy level and LOS.ResultsThe patients’ median age was 68 years and 631 (84.36%) were males. A dose–response curve with an inflection point at 22.63 µmol/L was observed between Hcy level and LOS after the adjustment of potential confounders. LOS increased before Hcy level reached the inflection point (β: 0.36; 95% CI: 0.18 to 0.55; p<0.001).ConclusionOur results show that an Hcy level <22.63 µmol/L is associated with increased LOS in patients with LEAD, which was independent of some other risk factors. This might shed light on how Hcy can be used as a key marker in the comprehensive management of patients with LEAD during hospitalisation.
The level of fibrinogen in patients with lower extremity atherosclerosis (LEAD) has been widely identified as a risk factor contributing to adverse outcomes. However, some knowledge gaps remain regarding fibrinogen levels and downstream adverse outcomes, such as length of stay (LOS). We conducted this study to examine the association between fibrinogen level and LOS in LEAD patients. The retrospective cohort study included 1428 LEAD patients between January 2014 and November 2021 in China. Several generalized linear models with a negative binomial link function were used to evaluate the association between fibrinogen level and LOS. The area under the curve (AUC) was used to evaluate the predicting effect of fibrinogen level on a LOS greater than 10 days (median LOS). The median age of the patients was 70 years old, and 1153 (80.74%) were males. Fibrinogen level was positively associated with LOS (β = 1.14; 95% CI, 0.42–1.86; p = 0.002) in LEAD patients after controlling for age, gender, number of historical hospitalizations, surgical history, vascular disease history, drinking history, smoking history, insurance type, surgical approach, lesion site, weight loss, Fontaine classification, age-adjusted Charlson comorbidity index, urea, total protein, activated partial thromboplastin time, thrombin time, prothrombin time-international normalized ratio, calcium, triglyceride, albumin/globulin ratio, phosphorus, and D-dimer. The fibrinogen-added prediction model demonstrated good discrimination and calibration, with an AUC value of 0.807. Fibrinogen level was positively associated with LOS in LEAD patients. The fibrinogen level is a widely available and easy-to-measure biochemical indicator, and it could be used as a suitable indicator for the prognosis and prophylaxis of prolonged LOS in patients with LEAD during hospitalization.
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