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BACKGROUND: Complete blood count (CBC), red cell distribution width (RDW), mean platelet volume (MPV), mean corpuscular volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC), or platelet (PLT) count are referred as predictors of adverse clinical outcomes in patients. The aim of the research was to identify potential factors of acute mortality in Polish emergency department (ED) patients by using selected hematological biomarkers and routine statistical tools. METHODS: The study presents statistical results on patients who were recently discharged from inpatient facilities within one month prior to the index ED visit. In total, the analysis comprised 14,881 patients with the first RDW, MPV, MCV, MCH, MCHC, or PLT biomarkers' measurements recorded in the emergency department within the years 2016-2019 with a subsequent one month of all-cause mortality observation. The patients were classified with the codes of the International Statistical Classification of Diseases and Related Health Problems after 10th Revision (ICD10). RESULTS: Based on the analysis of RDW, MPV, MCV, MCH, MCHC, and PLT on acute deaths in patients, we establish strong linear and quadratic relationships between the risk factors under study and the clinical response (P < 0.05), however, with different mortality courses and threats. In our statistical analysis, (1) gradient linear relationships were found for RDW and MPV along an entire range of the analyzed biomarkers' measurements, (2) following the quadratic modeling, an increasing risk of death above 95 fL was determined for MCV, and (3) no relation to excess death in ED patients was calculated for MCH, MCHC, and PLT. CONCLUSION: The study shows that there are likely relationships between blood counts and expected patient mortality at some time interval from measurements. Up to 1 month of observation since the first measurement of an hematological biomarker, RDW and MPV stand for a strong relationship with acute mortality of patients, whereas MCV, MCH, MCHC, and PLT give the U-shaped association, RDW and MPV can be established as the stronger predictors of early deaths of patients, MCV only in the highest levels (>95 fL), whereas MCH, MCHC, and PLT have no impact on the excess acute mortality in ED patients.
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Biomarcadores/sangre , Mortalidad Hospitalaria , Recuento de Células Sanguíneas , Servicio de Urgencia en Hospital , Índices de Eritrocitos , Humanos , Clasificación Internacional de Enfermedades , Volúmen Plaquetario Medio , Recuento de Plaquetas , Polonia , Estudios RetrospectivosRESUMEN
This study presents the statistical results of patients who had been recently discharged from hospital within one month after their treatment in the emergency department (ED). Using routine (14,881) MCV and RDW measurements and statistical tools, we could predict acute mortality in these patients (N = 1158), adjusted for age. It is likely that an increase in the MCV and RDW parameters may correlate in some of our older patients with a poor prognosis with an increased level of circulating IGF-I, which affects red blood cell parameters. The research presents the prognostic statistics of the analyzed clinical factors as well as speculates on the potential correlation of these parameters with the regenerative potential of stem-cell compartment. Analysis shows that both MCV and RDW are statistically significant (Area Under Curve [AUC], lower CI 95% >50%) predictors of acute mortality in ED patients. The classification of patients based on their MCV threshold (= 92.2 units) indicates a proper clinical prognosis in nearly 6 of 10 subjects (AUC >58%), whereas taking into account RDW (=13.8%) indicates a proper clinical prognosis in no more than 7 of 10 individuals. The report concludes that by employing strongly fitting (95%) quadratic modeling of the ORs against the biomarkers studied, one can notice a similar relationship between MCV and RDW as diagnostic tools to predict regenerative potential and clinical outcomes in older patients. Although RDW alone had a 10% higher diagnostic value in terms of predicting early death in the emergency department in patients that were admitted to the ED and subsequently hospitalized, also taking the MCV measurement improved accuracy in predicting clinical outcomes by 2.5% compared to RDW alone.
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Índices de Eritrocitos , Mortalidad , Regeneración/fisiología , Adulto , Anciano , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Biológicos , Oportunidad Relativa , Pronóstico , Curva ROCRESUMEN
Many studies have found correlations between abnormal MPV and clinical reactivity in a variety of diseases. In the present paper, we sought MPV-related neurological diseases that are less frequently reported in the literature. The electronic medical records of 852 neurological patients with mean platelet volume (MPV) measurements (F = 45%, age = 55.7 ± 18.7, 8-104) were searched after the patients had received a diagnosis of a neurological disease (new and old episodes) according to the nine classes of the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). A set of consecutive statistical methods (i.e., cluster analysis, segmented regression, linear correlation, propensity score matching, and mixed effects Poisson regression) were used to establish a link between MPV and neurological disease. A statistically significant (p < 0.05) relationship with MPV was found only in pain syndrome patients, with seven out of eight clinically diagnosed migraine episodes. With all other ICD-10 classes of neurological diseases, the effect of MPV was found to be nonsignificant (p > 0.05). MPV may implicate a clinical relationship with pain syndrome and migraine episodes. More complex statistics could help analyse data and find new correlations.
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Trastornos Migrañosos/sangre , Trastornos Migrañosos/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Modelos Lineales , Masculino , Volúmen Plaquetario Medio , Persona de Mediana Edad , Polonia , Puntaje de Propensión , Adulto JovenRESUMEN
INTRODUCTION: Many pathobiological processes that manifest in a patient's organs could be associated with biomarker levels that are detectable in different human systems. However, biomarkers that promote early disease diagnosis should not be tested only in personalized medicine but also in large-scale diagnostic evaluations of patients, such as for medical management. OBJECTIVE: We aimed to create an easy algorithmic risk assessment tool that is based on obtainable "everyday" biomarkers, identifying infection and cancer patients. PATIENTS: We obtained the study data from the electronic medical records of 517 patients (186 infection and 331 cancer episodes) hospitalized at Gorzów Hospital, Poland, over a one and a half-year period from the 1st of January 2017 to the 30th of June 2018. METHODS AND RESULTS: A set of consecutive statistical methods (cluster analysis, ANOVA, and ROC analysis) was used to predict infection and cancer. For in-hospital diagnosis, our approach showed independent clusters of patients by age, sex, MPV, and disease fractions. From the set of available "everyday" biomarkers, we established the most likely bioindicators for infection and cancer together with their classification cutoffs. CONCLUSIONS: Despite infection and cancer being very different diseases in their clinical characteristics, it seems possible to discriminate them using "everyday" biomarkers and popular statistical methods. The estimated cutoffs for the specified biomarkers can be used to allocate patients to appropriate risk groups for stratification purposes (medical management or epidemiological administration).
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Biomarcadores de Tumor/sangre , Enfermedades Transmisibles/complicaciones , Neoplasias/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/normas , Niño , Preescolar , Enfermedades Transmisibles/sangre , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Neoplasias/sangre , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: It is generally accepted that the Pro12Ala polymorphism in peroxisome proliferator-activated receptor-gamma2 (PPAR-gamma2) is associated with an increased risk of type 2 diabetes. However, studies on an association between the polymorphism and obesity have yielded inconsistent findings. Also, a role of PPAR-gamma receptors in development of chronic diabetic complications cannot be excluded. The aim of this study was to investigate an association between Pro12Ala polymorphism and body weight changes, insulin resistance, insulin secretion and incidence of diabetic complications in obese patients with long-lasting type 2 diabetes. METHODS: In 216 obese patients with at least a 10-year history of type 2 diabetes, a detailed medical history was taken and a physical examination with assessment of diabetic complications was performed as well as evaluation of insulin resistance (homeostatic model assessment-HOMA), insulin secretion and other biochemical parameters. PCR-RFLP was used to assess Pro12Ala polymorphism. Two subgroups of patients were compared: homozygotic Pro/Pro and Ala allele carriers (Ala/Ala + Ala/Pro). RESULTS: No differences between the analyzed groups in body weight changes, insulin resistance and insulin secretion were found, but Ala allele was significantly more frequent in males than in females. There was no difference in incidence and progression of diabetic complications with only a trend towards higher incidence of diabetic retinopathy in patients with Ala allele. CONCLUSIONS: There is no association between Pro12Ala PPAR-gamma2 polymorphism and body mass changes observed during a course of type 2 diabetes, differences in peripheral insulin resistance and incidence and progression of diabetic complications in obese patients with long-lasting type 2 diabetes.
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Peso Corporal , Complicaciones de la Diabetes , Diabetes Mellitus Tipo 2 , Resistencia a la Insulina/fisiología , Obesidad , PPAR gamma/genética , Polimorfismo de Nucleótido Simple , Anciano , Diabetes Mellitus Tipo 2/genética , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Humanos , Insulina/metabolismo , Masculino , Persona de Mediana Edad , PPAR gamma/metabolismo , Factores de RiesgoRESUMEN
INTRODUCTION: Long asymptomatic course of diabetes and insufficient treatment lead to many chronic complications. AIM OF STUDY: Assessment of the quality of ambulatory diabetes care in Szczecin and nearest region. MATERIAL AND METHODS: In year 2001 patients with previously diagnosed diabetes hospitalized in 35 wards of several hospitals in Szczecin were inquired for data concerning ambulatory care before hospitalization. STUDY GROUP: 120 subjects (60 women and 60 men), aged 65 +/- 13 years, diabetes duration 9.1 +/- 7.1 years. Type 2 diabetes--104 cases, type 1-10 cases, other types of diabetes--6 cases. RESULTS: Health care was provided by general practitioners (GPs) for 63% of patients, by diabetologist for 31% of them; 6% stayed out of control. In the proceeding month 49% of subjects attended visit related to diabetes; in 10% such a visit was reported in the period longer than 6 months. Glucose measurement performed every day was reported by 28% of subjects, once a month--by 36%, rarely--by 15%. Blood pressure measurements were performed by doctors in 43% of subjects, self control was performed by 42% of them and in 10% blood pressure was not measured at all. In the proceeding year eyes examination related to diabetes was performed in 63% of patients; in 26% such examination was never done. Foot examination was never done in 66% of diabetics. ECG examination was done in 57% of subjects last year, in 39% it was never done. Cholesterol serum level was measured last year in 52% of subjects. CONCLUSIONS: 1. Quality of ambulatory diabetes care is highly unsatisfactory and insufficient. 2. To improve health care for diabetics obligatory training in practical diabetology was conducted for all GPs from north-west region of Poland in 2002 y.