ObjectiveTo evaluate the screening performance of commonly used renal function indicators for chronic kidney disease (CKD) in subjects of different ages, so as to explore the appropriate screening regimen for Chinese population.MethodsA total of 2 131 adult subjects in Sichuan Orthopaedic Hospital or Mianyang Central Hospital from May 2016 to October 2017 were selected. They were divided into three groups according to age: group A (18–39 years, n=278), group B (40–64 years, n=1 167), and group C (≥65 years, n=686). Serum levels of creatinine (SCr), urea, and cystatin C [CysC; to calculate estimated glomerular filtration rate (eGFR) based on this index], as well as urine levels of albumin, total protein and creatinine were measured, and urine albumin to creatinine ratio (ACR) and urine protein to creatinine ratio (PCR) were calculated respectively. CKD was diagnosed according to the Kidney Disease: Improving Global Outcomes (KDIGO) Guideline (2012 Edition). The receiver-operating characteristic (ROC) curve analysis was finally performed to investigate the diagnostic performance of each indicator for CKD.ResultsThe prevalences of CKD in group A, B, and C were 10.8% (30/278), 16.4% (191/1 167), and 45.8% (314/686), respectively, and the difference among these groups was statistically significant (χ2=233.525, P<0.001). In addition, the levels of the six renal function indicators between CKD and non-CKD subjects also had statistically significant differences in different age groups (P<0 05="" otherwise="" roc="" curve="" analysis="" revealed="" that="" the="" diagnostic="" values="" of="" these="" indicators="" were:="" acr="" or="" pcr=""> eGFR or CysC > serum urea or SCr (AllP<0 05="" except="" that="" egfr="" cysc="" serum="" urea="" and="" scr="" in="" group="" a="" assessed="" the="" similar="" diagnostic="" performance="" among="" the="" three="" indicators="" recommended="" by="" kdigo="" guideline="" the="" diagnostic="" performances="" of="" acr="" and="" pcr="" in="" different="" age="" groups="" were:="" group="" b="" 0="" 915="" 0="" 914=""> group A (0.885, 0.890) > group C (0.841, 0.846), while the diagnostic performance of eGFR was group C (0.807) > group B (0.728) > group A (0.696). The best boundary values of ACR and PCR were lower while the value of eGFR was higher than the corresponding KDIGO recommended medical decision levels.ConclusionsACR is the first choice for screening CKD when the renal function index creatinine is normal. Moreover, eGFR can further improve the diagnostic value, especially in subjects over 65 years old.
ObjectiveTo analyze the thyroid hormone levels in patients with acute type A aortic dissection (ATAAD) and assess its clinical significance.MethodsWe included 88 patients with ATAAD who underwent surgical treatment in Beijing Anzhen Hospital between January 2018 and August 2018. Meanwhile, we extracted 187 blood samples of healthy people from our laboratory (Beijing Lab for Cardiovascular Precision Medicine, Beijing, China) as control group. Examining preoperative thyroid hormone levels and perioperative serum creatine for patients and examining thyroid hormone levels for healthy people. Based on difference in thyroid hormone levels between patients and healthy people, we divide patients into abnormal thyroid hormone groups and control groups, analyzing the relationship between thyroid hormone levels and variance of postoperative serum creatinine.ResultsPatients with ATAAD have lower total triiodothyronine (TT3), thyrotropin (TSH), free triiodothyronine (FT3) and higher free thyroxine (FT4) levels than healthy people (respectively, P<0.001, P<0.001, P<0.001 and P<0.001). What’s more, patients with ATAAD who had low TT3 before operation had higher elevation of postoperative serum creatinine and rate of acute kidney injury(P=0.019).CONCLUSIONSPatients with ATAAD have different thyroid hormone levels than healthy people, preoperative TT3 is associated with elevation of postoperative serum creatinine and occurrence of acute kidney injury. Thyroid function measurement should be a routine preoperative examination in patients with ATAAD.
Objective To investigate the risk factors for early in-hospital death in patients with acute Stanford type A aortic dissection and emergency surgical treatment. MethodsWe retrospectively analyzed the clinical data of 189 patients with acute Stanford type A aortic dissection who underwent surgery in the First Affiliated Hospital of Xinjiang Medical University between January 2017 and January 2020. There were 160 males and 29 females with an average age of 46.35±9.17 years. All patients underwent surgical treatment within 24 hours. The patients were divided into a survival group (n=160) and a death group (n=29) according to their outcome (survival or death) during hospitalization in our hospital. Perioperative clinical data were analyzed and compared between the two groups. Results The overall in-hospital mortality was 15.34% (29/189). There was a statistical difference between the two groups in white blood cell count, blood glucose, aspartate aminotransferase (AST), bilirubin, creatinine, operative method, operation time, aortic occlusion time, or cardiopulmonary bypass time (P<0.05). Multivariate regression identified white blood cell count [OR=1.142, 95%CI (1.008, 1.293)], bilirubin [OR=0.906, 95%CI (0.833, 0.985)], creatinine [OR=1.009, 95%CI (1.000, 1.017)], cardiopulmonary bypass time [OR=1.013, 95%CI (1.003, 1.024)] as postoperative risk factors for early in-hospital death in the patients undergoing acute Stanford type A aortic dissection surgery (P<0.05). Conclusion Our study demonstrated that white blood cell, bilirubin, creatinine and cardiopulmonary bypass time are independent risk factors for in-hospital death after acute Stanford type A aortic dissection surgery.
ObjectiveTo observe and evaluate the predictive value of serum cystatin C (Cys-C) on the risk of sight-threatening diabetic retinopathy (STDR). MethodsA non-randomized controlled cross-sectional clinical study. Ninety-two patients with type 2 diabetes mellitus (T2DM) who were admitted to Department of Ophthalmology of Beijing Tsinghua Changgung Hospital from January 2022 to October 2022 were included in the study. Among them, 50 were male, 42 cases were female, with the mean age of (58.24±12.49) years. The mean duration of T2DM was (13.18±8.35) years, of which 38 cases had a duration of ≥10 years. Twenty-nine cases complicated with hypertension, of which 16 cases had a duration of ≥10 years. Seventeen cases complicated with chronic kidney disease stage 2 and 23 cases were treated with lipid-lowering drugs. Hemoglobin Alc, serum Cys-C, serum lipids and renal function were tested, and urinary microalbumin/creatinine ratio (ACR) was calculated. According to the 2003 American Academy of Ophthalmology "Clinical Guidelines for Diabetic Retinopathy (DR)" and international clinical DR severity grading standards, the patients were divided into STDR and non-STDR groups, with 44 and 48 cases in each group, respectively. STDR was defined as severe non-proliferative DR, proliferative DR, and macular edema. Logistic regression was used to analyze the independent risk factors of STDR in T2DM patients. Receiver operating characteristic curve (ROC curve) was used to calculate and analyze the area under ROC curve (AUC) and the predictive value of serum Cys-C and ACR in predicting STDR in T2DM patients. ResultsSerum Cys-C levels in STDR and non-STDR groups were 1.10 (0.94, 1.28) and 0.91 (0.83, 1.02) mg/L, respectively, with ACR of 4.29 (1.05, 21.89) and 1.39 (0.77, 3.80) mg/mmol, respectively. Compared with non-STDR group, serum Cys-C and ACR in STDR group were higher, and the difference was statistically significant (Z=－3.984, －3.280; P＜0.05). Multivariate logistic regression analysis showed that serum Cys-C was an independent risk factor for STDR (odds ratio=1.337, 95% confidence interval 1.145-2.090, P=0.033), and the risk of STDR increased by 33.7% for every 0.1 mg/L increase in serum Cys-C. ROC analysis results showed that serum Cys-C＞1.065 mg/L combined with ACR＞5.84 mg/mmol predicted the AUC of STDR in T2DM patients was 0.661, with the specificity of 95.8%. ConclusionsThe high serum Cys-C level is an independent risk factor for STDR in T2DM patients. Serum Cys-C has high predictive value for the occurrence of STDR.