scholarly journals Outcomes of Diabetic and Nondiabetic Patients Undergoing General and Vascular Surgery

ISRN Surgery ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Stephen Serio ◽  
John M. Clements ◽  
Dawn Grauf ◽  
Aziz M. Merchant
Keyword(s):  
Vascular Surgery ◽  
Surgical Outcomes ◽  
Postoperative Mortality ◽  
Binary Logistic Regression ◽  
Cost Effective ◽  
Binary Logistic Regression Analysis ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Insulin Dependent ◽  
The Cost

Aims. Preoperative diabetic and glycemic screening may or may not be cost effective. Although hyperglycemia is known to compromise surgical outcomes, the effect of a diabetic diagnosis on outcomes is poorly known. We examine the effect of diabetes on outcomes for general and vascular surgery patients. Methods. Data were collected from the Michigan Surgical Quality Collaborative for general or vascular surgery patients who had diabetes. Primary and secondary outcomes were 30-day mortality and 30-day overall morbidity, respectively. Binary logistic regression analysis was used to identify risk factors. Results. We identified 177,430 (89.9%) general surgery and 34,006 (16.1%) vascular surgery patients. Insulin and noninsulin diabetics accounted for 7.1% and 9.8%, respectively. Insulin and noninsulin dependent diabetics were not at increased risk for mortality. Diabetics are at a slight increased odds than non-diabetics for overall morbidity, and insulin dependent diabetics more so than non-insulin dependent. Ventilator dependence, 10% weight loss, emergent case, and ASA class were most predictive. Conclusions. Diabetics were not at increased risk for postoperative mortality. Insulin-dependent diabetics undergoing general or vascular surgery were at increased risk of overall 30-day morbidity. These data provide insight towards mitigating poor surgical outcomes in diabetic patients and the cost effectiveness of preoperative diabetic screening.

scholarly journals Association of Circulating ANGPTL8 Levels With Renal Dysfunction: A Case-Control Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Xiaoyu Meng ◽  
Huajie Zou ◽  
Danpei Li ◽  
Peng Yu ◽  
Li Huang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Logistic Regression ◽  
Regression Analysis ◽  
General Population ◽  
Renal Dysfunction ◽  
Binary Logistic Regression ◽  
Case Control ◽  
Binary Logistic Regression Analysis ◽  
Diabetic Patients ◽  
Increased Risk

Background: Chronic kidney disease (CKD) is recognized as a major public health problem with high morbidity and mortality worldwide. Recently, angiopoietin-like protein 8 (ANGPTL8) was found to regulate lipid metabolism. Previous studies suggested that serum ANGPTL8 levels increased in patients with diabetes, especially in diabetic patients with albuminuria. This study aimed to investigate the association between circulating levels of ANGPTL8 and kidney function in the general population.Methods: The subjects were patients with renal dysfunction [estimated glomerular filtration rate (eGFR) <60/min/1.73 m2] from Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal study (the REACTION study). Each case was matched by age, sex, and body mass index (BMI) with one control whose eGFR was ≥ 90 ml/min/1.73 m2. The case and control groups were compared using a paired t-test. Binary logistic regression analysis was used to calculate the odds ratio (OR) of renal dysfunction (RD).Results: Among 135 case-control pairs, circulating ANGPTL8 levels were elevated in patients with RD compared to control subjects [799.96 (410.12-1086.44) vs. 609.58 (365.13-740.06) pg/ml, p < 0.05]. Partial correlations showed that ANGPTL8 levels were negatively correlated with eGFR (r = −0.26, p < 0.05). Multivariable-adjusted binary logistic regression analysis showed that elevated ANGPTL8 levels were associated with an increased risk of RD (OR in quartile 4 vs. 1, 3.80; 95% CI, 1.71-8.41). Interestingly, the association between ANGPTL8 levels and RD was consistent with the overall findings in both nondiabetic individuals (OR, 1.44; 95% CI, 1.09 to 1.91) and diabetic patients (OR, 2.71; 95% CI, 1.13-6.49) in the subgroup analyses. Furthermore, the estimates for this association were also significant in females (OR, 2.12; 95% CI, 1.33-3.37), individuals aged > 60 years (OR, 1.55; 95% CI, 1.16-2.07), individuals with a BMI <24 (OR, 1.66; 95% CI, 1.16-2.39), and individuals without hyperlipidaemia (OR, 1.61; 95% CI, 1.16-2.23) (all p-values <0.05).Conclusion: Elevated circulating ANGPTL8 levels were associated with increased risk of RD in the general population, especially among females, individuals aged > 60 years, individuals with a BMI < 24, individuals without diabetes mellitus, individuals with diabetes mellitus (DM), and individuals without hyperlipidaemia. This finding implies that ANGPTL8 may play a role in the pathological process of RD.

The cost-effectiveness of insulin analogs and regular insulin for diabetes control: a case study in Iran

2020 ◽  
Vol 33 (4/5) ◽  
pp. 323-331
Author(s):  
Mohsen pakdaman ◽  
Raheleh akbari ◽  
Hamid reza Dehghan ◽  
Asra Asgharzadeh ◽  
Mahdieh Namayandeh
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Regular Insulin ◽  
Diabetes Control ◽  
Diabetic Patients ◽  
Insulin Analogs ◽  
Content Type ◽  
Patients With Diabetes ◽  
The Government ◽  
The Cost

PurposeFor years, traditional techniques have been used for diabetes treatment. There are two major types of insulin: insulin analogs and regular insulin. Insulin analogs are similar to regular insulin and lead to changes in pharmacokinetic and pharmacodynamic properties. The purpose of the present research was to determine the cost-effectiveness of insulin analogs versus regular insulin for diabetes control in Yazd Diabetes Center in 2017.Design/methodology/approachIn this descriptive–analytical research, the cost-effectiveness index was used to compare insulin analogs and regular insulin (pen/vial) for treatment of diabetes. Data were analyzed in the TreeAge Software and a decision tree was constructed. A 10% discount rate was used for ICER sensitivity analysis. Cost-effectiveness was examined from a provider's perspective.FindingsQALY was calculated to be 0.2 for diabetic patients using insulin analogs and 0.05 for those using regular insulin. The average cost was $3.228 for analog users and $1.826 for regular insulin users. An ICER of $0.093506/QALY was obtained. The present findings suggest that insulin analogs are more cost-effective than regular insulin.Originality/valueThis study was conducted using a cost-effectiveness analysis to evaluate insulin analogs versus regular insulin in controlling diabetes. The results of study are helpful to the government to allocate more resources to apply the cost-effective method of the treatment and to protect patients with diabetes from the high cost of treatment.

Insulin-Dependent Diabetic Patients are at Increased Risk of Postoperative Hyperglycemia When Undergoing Total Joint Arthroplasty

2020 ◽  
Vol 35 (9) ◽  
pp. 2375-2379
Author(s):  
Brian M. Godshaw ◽  
Michael S. Warren ◽  
Michael A. Nammour ◽  
George F. Chimento ◽  
Alaa E. Mohammed ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Insulin Dependent ◽  
Insulin Dependent Diabetic

scholarly journals Complications and risk factors regarding the outcomes of canine babesiosis in Central Europe – A retrospective analysis of 240 cases

2020 ◽  
Vol 68 (2) ◽  
pp. 160-168
Author(s):  
Anja Strobl ◽  
Frank Künzel ◽  
Alexander Tichy ◽  
Michael Leschnik
Keyword(s):  
Medical Records ◽  
Biochemical Analysis ◽  
Complete Blood Count ◽  
Renal Involvement ◽  
Binary Logistic Regression ◽  
Binary Logistic Regression Analysis ◽  
Risk Of Death ◽  
Increased Risk ◽  
Serum Biochemical ◽  
Severity Of The Disease

AbstractThe purpose of this study was to investigate retrospectively the prevalence of the complicated and uncomplicated forms of babesiosis and to evaluate various laboratory and clinical parameters of dogs infected with Babesia canis in order to assess their prognostic value regarding the outcomes of the disease. Medical records, complete blood count and serum biochemical analysis from the animal hospital information system of 240 dogs were reviewed and evaluated retrospectively. Binary logistic regression analysis was used to ascertain correlations between alterations in the obtained parameters and survival probability. The results showed that creatinine levels of more than 5 mg/dL and phosphate levels of more than 3 mmol/L have a highly significant link to death (P ≤ 0.001). Albumin levels of <2.2 g/dL (P = 0.003) and a rectal body temperature below 38 °C (P ≤ 0.001) may also serve as prognostic markers for the severity of the disease. If renal involvement was present, 33.9% of the dogs died, while 40.0% of the dogs died in the presence of pancreatitis. The parameters creatinine, phosphate, albumin and rectal temperature serve as reliable predictive markers of an increased risk of death in the case of an infection with B. canis.

scholarly journals The Correlation between Carotid Intima-Media Thickness and Neutrophil to Lymphocyte Ratio in Prediabetes Patients

2021 ◽  
Vol 42 (6) ◽  
pp. 464-470
Author(s):  
Dayoung Lee ◽  
Mi-Jeong Park ◽  
Mee Young Kim ◽  
Jung Jin Cho ◽  
Jong Lull Yoon
Keyword(s):  
Regression Analysis ◽  
Binary Logistic Regression ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Neutrophil To Lymphocyte Ratio ◽  
Binary Logistic Regression Analysis ◽  
Diabetic Patients ◽  
Cvd Risk ◽  
Lymphocyte Ratio ◽  
Media Thickness

Background: Prediabetes is a metabolic state between normoglycemia and diabetes and is known to carry a higher risk of developing overt diabetes and cardiovascular disease (CVD). The relative and absolute risks of all-cause mortality, CVD, coronary heart disease, and stroke in prediabetes patients, as well as in diabetic patients, is higher than that in patients with normoglycemia. Carotid intima-media thickness (cIMT) is a method used to stratify CVD risk. In this study, we aimed to determine whether the neutrophil-to-lymphocyte ratio (NLR) correlates with cIMT in prediabetes patients.Methods: From January 1, 2016, to February 20, 2021, 581 adults their 30s–70s who underwent carotid ultrasonography as part of a comprehensive medical examination at the Dongtan Sacred Heart Hospital were enrolled. Statistical analysis using SPSS presented t-test and chi-square test significance levels into a group with normal cIMT (nIMT; cIMT <1 mm) and a group with thick cIMT (tIMT; cIMT ≥1 mm). Binary logistic regression analysis was performed to confirm the correlation between NLR and cIMT.Results: In prediabetic adults, age, hemoglobin A1c (HbA1c), systolic blood pressure, and NLR were significantly higher in the tIMT group than in the nIMT group. In the regression analysis, NLR, age, and HbA1c were significantly correlated with cIMT.Conclusion: NLR was significantly higher in the tIMT group than in the nIMT group; therefore, NLR may be used to assess CVD risk in prediabetes patients.

scholarly journals The triglyceride-glucose index played an important role in prognosis in critically ill patients with heart disease

2021 ◽  
Author(s):  
Guangyao Zhai ◽  
Biyang Zhang ◽  
Jianlong Wang ◽  
Yuyang Liu ◽  
Yujie Zhou
Keyword(s):  
Heart Disease ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Binary Logistic Regression ◽  
Independent Effect ◽  
Binary Logistic Regression Analysis ◽  
Triglyceride Glucose Index ◽  
Increased Risk ◽  
Patients With Diabetes

Abstract Background As an alternative method to evaluate insulin resistance (IR), triglyceride-glucose index (TyG) was shown to be related to the severity and prognosis of cardiovascular diseases. The main objective of this study was to explore the association between TyG and in-hospital mortality in critically ill patients with heart disease Method: TyG was calculated as previously reported: ln [fasting TGs (mg/dL) * FBG (mg/dL)/2]. All patients were divided into four different categories based on TyG quartiles. Primary outcome was in-hospital mortality. Binary logistic regression analysis was performed to determine the independent effect of TyG. Result 4839 critically ill patients with heart disease were included. In-hospital mortality increased as TyG quartiles increased (Quartile 4 vs Quartile 1: 12.1 vs 5.3, P < 0.001). Even after adjusting for confounding variables, TyG was still independently associated with the increased risk of in-hospital mortality in critically ill patients with heart disease (Quartile 4 vs Quartile 1: OR, 95% CI: 2,43, 1.79–3.31, P < 0.001, P for trend < 0.001). However, we did not observe the association between increased TyG and the risk of mortality in patients with diabetes. Furthermore, as TyG quartiles increased, the length of intensive care unit (ICU) stay was prolonged (Quartile 4 vs Quartile 1: 2.3, 1.3–4.9 vs 2.1, 1.3–3.8, P = 0.007). And the significant interactions were not found in most subgroups. Conclusion TyG was independently correlated with in-hospital mortality in critically ill patients with heart disease.

Continuation of Anti-TNF in Patients With Ulcerative Colitis in Remission Is Not Cost-effective Compared With Treatment Withdrawal: A Markov Model

2020 ◽  
Author(s):  
Remi Mahmoud ◽  
Chris van Lieshout ◽  
Geert W J Frederix ◽  
Bindia Jharap ◽  
Bas Oldenburg
Keyword(s):  
Ulcerative Colitis ◽  
Health Care ◽  
Cost Effectiveness ◽  
Markov Model ◽  
Cost Effective ◽  
Health Care Expenditures ◽  
Increased Risk ◽  
The Cost ◽  
Cost Effectiveness Threshold ◽  
Effectiveness Threshold

Abstract Background and Aims Anti-tumour necrosis factor alpha [anti-TNF] treatment accounts for 31% of health care expenditures associated with ulcerative colitis [UC]. Withdrawal of anti-TNF in patients with UC in remission may decrease side effects and infections, while promoting cost containment. Approximately 36% of patients relapse within 12–24 months of anti-TNF withdrawal, but reintroduction of treatment is successful in 80% of patients. We aimed to evaluate the cost-effectiveness of continuation versus withdrawal of anti-TNF in patients with UC in remission. Methods We developed a Markov model comparing cost-effectiveness of anti-TNF continuation versus withdrawal, from a health care provider perspective. Transition probabilities were calculated from literature, or estimated by an expert panel of 11 gastroenterologists. Deterministic and probabilistic sensitivity analyses were performed to account for assumptions and uncertainty. The cost-effectiveness threshold was set at an incremental cost-effectiveness ratio of €80,000 per quality-adjusted life-year [QALY]. Results At 5 years, anti-TNF withdrawal was less costly [-€10,781 per patient], but also slightly less effective [-0.04 QALY per patient] than continued treatment. Continuation of anti-TNF compared with withdrawal costs €300,390/QALY, exceeding the cost-effectiveness threshold. Continued therapy would become cost-effective if the relapse rate following anti-TNF withdrawal was ≥43% higher, or if adalimumab or infliximab [biosimilar] prices fell below €87/40 mg and €66/100 mg, respectively. Conclusions Continuation of anti-TNF in UC patients in remission is not cost-effective compared with withdrawal. A stop-and-reintroduction strategy is cost-saving but is slightly less effective than continued therapy. This strategy could be improved by identifying patients at increased risk of relapse.

scholarly journals Determinants of Diabetic Nephropathy among Diabetic Patients in General Public Hospitals of Tigray, Ethiopia, 2018/19

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Teklewoini Mariye Zemicheal ◽  
Degena Bahrey Tadesse ◽  
Hagos Tasew Atalay ◽  
Girmay Teklay Weldesamuel ◽  
Gebrewahd Bezabh Gebremichael ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Nephropathy ◽  
Glycemic Control ◽  
Binary Logistic Regression ◽  
Sampling Technique ◽  
Public Hospitals ◽  
Systematic Sampling ◽  
Binary Logistic Regression Analysis ◽  
Diabetic Patients ◽  
Adherence To Medication

Background. Diabetic nephropathy is real damage resulting from having uncontrolled diabetes mellitus. Unmanaged diabetic nephropathy is one of the most leading causes of kidney failure. There is a scarcity of information on the determinants of diabetic nephropathy among diabetes mellitus patients in Ethiopia. Identification of the determinants can help devise a strategy to properly address the disease and its consequences. Therefore, this study was designed to assess the determinants of diabetic nephropathy among diabetes mellitus patients. Methods. Unmatched case-control study design with 168 cases and 672 controls with a mean age of 45.18 and 62.12, respectively, participated in the study. An interviewer-administered questionnaire was employed for data collection, and a systematic sampling technique was used to select the study participants. Data were entered into Epi data and exported to SPSS for data clarification and analysis. Binary logistic regression analysis was carried out to check the level of association between diabetic nephropathy and the independent variables. Results. Comorbidity (AOR: 4.96 at 95 CI: 1.77–13.87), hypertension (AOR: 6.33, 95% CI: 2.51–16.02), poor glycemic control (AOR: 3.27, 95% CI: 1.31, 8.21), age (AOR: 1.14, 95%: 1.09–1.19), duration with diabetes mellitus since diagnosis (AOR: 1.83, 95 CI: 1.62–2.06), and nonadherence to diabetic medication (AOR: 3.3, 95% CI: 1.34, 8.15), diet (AOR: 5.96, 95%: 1.92–18.54), and exercise (AOR: 5.60, 95% CI: 1.94–16.21) were the determinants of diabetic nephropathy. Conclusion. Adherence to medication, diet, and exercise should be empowered to achieve glycemic control and to prevent diabetic nephropathy. More attention has to be also given for old aged diabetic patients, long duration since diagnosis of diabetes mellitus, hypertension, and other comorbidities.

Cost-Effectiveness of Behavior Activation Versus Supportive Therapy on Adherence to Eye Exams in Older African Americans With Diabetes

2016 ◽  
Vol 32 (6) ◽  
pp. 661-667 ◽  
Author(s):  
David Winters ◽  
Robin Casten ◽  
Barry Rovner ◽  
Ann Murchison ◽  
Benjamin E. Leiby ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Supportive Therapy ◽  
Cost Effective ◽  
Care Utilization ◽  
Diabetic Patients ◽  
Cost Effectiveness Ratio ◽  
Eye Exams ◽  
The Cost ◽  
To Receive

Although the importance of ophthalmologic screening in diabetic patients is widely recognized by clinicians, the cost-effectiveness of strategies aimed at improving eye care utilization in this population is not well established. A cost-effectiveness analysis was performed comparing behavior activation (BA) to supportive therapy (ST) in activating patients to receive a dilated fundus exam (DFE) and promoting healthy management of diabetes. Two hundred six subjects were randomized to receive either BA or ST between 2009 and 2013. Cost-effectiveness was calculated as incremental cost-effectiveness ratio (ICER) of BA versus ST. Total costs for BA and ST per participant were $259.02 and $216.12, respectively. At the 6-month follow-up, 87.91% of BA subjects received a DFE compared to 34.48% of ST subjects. The ICER for BA versus ST was $80.29/percent increase in DFE rate. In terms of improving DFE rates, BA was found to be more cost-effective than ST.

scholarly journals AB0281 MORTALITY PREDICTORS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A SINGLE TERTIARY CENTER REFERRAL EXPERIENCE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1166.2-1167
Author(s):  
C. M. Gamboa-Alonso ◽  
G. Figueroa-Parra ◽  
A. L. De-Leon-Ibarra ◽  
M. Á. Villarreal-Alarcón ◽  
J. Díaz-Angulo ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Renal Involvement ◽  
Binary Logistic Regression ◽  
University Hospital ◽  
Binary Logistic Regression Analysis ◽  
Systemic Lupus ◽  
Factors Associated ◽  
Increased Risk ◽  
Tertiary Center

Background:Systemic Lupus Erythematosus (SLE) is a heterogeneous chronic multisystemic disease that has an increased risk of requiring inpatient management with higher morbidity and mortality rates.The most frequent causes of mortality are a high disease activity, infections, and cardiovascular diseases.Objectives:To determine the predictors of mortality in patients diagnosed with SLE.Methods:A longitudinal, descriptive, observational study was performed from March 2017-March 2020 at the University Hospital of the Autonomous University of Nuevo León, México, including patients with a diagnosis of SLE according to the ACR-EULAR 2012/2019 criteria.Descriptive statistics were used for demographic variables. Associations between mortality and clinical variables were determined using binary logistic regression analysis; a p <0.05 was considered statistically significant. The SPSS program version 20 was used.Results:One-hundred and eighty-six patients with SLE diagnosis who fulfilled ACR-EULAR 2012/2019 criteria were included, 161 (86.6%) were women; the mean age was 35.8 (SD 15.41) years. The main chief complaints were dyspnea 31 (16.7%), fever in 28 (15.1%), renal involvement in 21 (11.29%), and arthritis in 19 (10.22%) patients.Of the 186 patients, 34 (18.3%) had a readmission, 13 (7%) required intensive care unit management, 68 (36.6%) had some type of infection and 22 (11.8%) died. Factors associated with mortality are shown in table 1.Patients receiving steroids and immunosuppression previous to hospitalization were 73 (39.2%) and 92 (49.5%) respectively.Conclusion:Infections remain the leading cause of death in SLE patients. Factors that predispose to infections are a chronic use of steroids and immunosuppression as well as high activity of disease.References:[1]Wu X-Y, Yang M, Xie Y-S, Xiao W-G, Lin J, Zhou B, et al. Causes of death in hospitalized patients with systemic lupus erythematosus: a 10-year multicenter nationwide Chinese cohort. Clin Rheumatol. enero de 2019;38(1):107-15.Table 1.Association between clinical and therapeutic factors with mortality in SLE patients.Factors associated with mortalityUnivariadoMultivariadoβ (95 % IC)β (95 % IC)□Age0.93 (0.96-1.02)0.98 (0.96-1.02)Use of mechanical ventilation3.83 (1.07-13.4)*3.07 (0.59-16.04)Previous use of steroids3.92 (1.51-10.15)*2.04 (0.58-7.35)Previous use of immunosupression4.04 (1.42-11.45)*2.85 (0.71-11.48)Infection3.57 (1.41-9.01)*3.25 (1.19-8.86)*p <0.05 *Disclosure of Interests:None declared

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