Factors associated with absent microhematuria in symptomatic urinary stone patients.

INTRODUCTION: The aim of this study was to identify factors associated with absent hematuria in patients with symptomatic urinary stones. METHODS: This retrospective study analyzed the clinical and imaging findings of emergency department patients who underwent computed tomography (CT) for suspected ureteral colic over the past 2years. All patients also underwent a microscopic urinalysis, and the presence of 4 or more red blood cells/high-power field was defined as microhematuria. RESULTS: A total of 798 patients were included in this study. Of these patients, 750 (94.0%) presented with hematuria, while 48 (6.0%) urine samples did not have evidence of hematuria. The group with an absence of hematuria was more likely to have a lower stone location (located in an area from the distal ureter to the bladder) and perinephric stranding on CT than the hematuria group (75.0% vs. 54.3%, p=0.005; 47.9% vs. 30.5%, p=0.012, respectively). The degree of hematuria at each stone location was significantly different (p=0.001). In multivariate analysis, perinephric stranding (odds ratios (OR) 1.87 [95% confidence interval (CI) 1.01-3.46], p=0.047), a lower stone location (OR 2.72 [95% CI 1.37-5.36], p=0.004), and elevated serum blood urea nitrogen (BUN) levels (OR 1.06 [95% CI 1.01-1.12], p=0.026) were associated with absent hematuria. CONCLUSIONS: In this large cohort of patients with renal colic, 6% had no microhematuria. Although some CT findings and elevated BUN were independently associated with hematuria absence, there was no difference in the demographics, time of presentation and degree and location of pain between the groups.

Quantitative analysis of relative volume of low apparent diffusion coefficient value can predict neurologic outcome after cardiac arrest.

INTRODUCTION: Predicting neurologic outcomes after cardiac arrest (CA) is challenging. This study tested the hypothesis that a quantitative analysis of diffusion weighted imaging (DWI) using the FMRIB Software Library (FSL) can predict neurologic outcomes after CA and can clarify the optimal apparent diffusion coefficient (ADC) thresholds for predicting poor neurologic outcomes. METHODS: Out-of-hospital CA patients treated with targeted temperature management (TTM) who underwent DWI were included in this study. Voxel-based analysis was performed to calculate the mean ADC value. ADC thresholds (750, 700, 650, 600, 550, 500, 450 and 400) and brain volumes below each threshold were also analyzed for their correlation with outcomes. The patients were divided into early (within 48 h after return of spontaneous circulation (ROSC)) and late group (between 48 h and 7 days after ROSC) according to the DWI scan time. The primary outcome was a poor neurologic outcome at 6 months after CA, defined as a cerebral performance category (CPC) of 3-5. RESULTS: One hundred ten DWIs were analyzed. The mean ADC values were 789.0 (761.5-826.5) × 10-6 mm2/s for the good neurologic outcome group and 715.2 (663.1-778.4) × 10-6 mm2/s for the poor neurologic outcome group (p < 0.001). All the ADC thresholds could differentiate patients with good versus poor outcomes. The ADC threshold of 400 × 10-6 mm2/s had the highest odds ratio (4.648 in the early group and 11.283 in the late group) after adjusting for initial rhythm and anoxic time. To achieve 100% specificity using an ADC threshold of 400 × 10-6 mm2/s, the sensitivity was 64% (cutoff value; >2.5% ADC threshold of 400 × 10-6 mm2/s) in the early group and 79.2% (cutoff value; >1.66% ADC threshold of 400 × 10-6 mm2/s) in the late group. CONCLUSIONS: Voxel-based analysis using FSL software can predict neurologic outcomes after CA. The ADC threshold of 400 × 10-6 mm2/s had the highest OR for predicting a poor neurologic outcome.

Association between the neutrophil-to-lymphocyte ratio and neurological outcomes in patients undergoing targeted temperature management after cardiac arrest.

PURPOSE: This study aimed to elucidate the association between the neutrophil-to-lymphocyte ratio (NLR) and neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients treated with targeted temperature management (TTM). MATERIALS AND METHODS: A retrospective study was performed on patients treated with TTM after OHCA. Patients were divided into two groups according to their calculated NLRs (NLR < 6 and NLR ≥ 6). The primary outcome was poor neurological outcome at 6 months as defined by a Cerebral Performance Category between 3 and 5. RESULTS: A total of 216 were included and 131 subjects had poor neurological outcomes at 6 months. In the univariate model, NLRs ≥ 6 at 48 and 72 h after ROSC were associated with poor neurological outcomes (OR: 3.716, 95% CI: 1.243-11.114; OR: 7.429, 95% CI: 3.693-14.945, respectively). In the multivariate logistic regression analysis, an NLR ≥ 6 at 72 h was associated with poor neurological outcomes after adjusting for history of HTN, shockable rhythm, cardiac cause of arrest and time from collapse to ROSC and highest WBC, hs-CRP, lactate and pneumonia (OR = 3.299, 95% CI = 1.080-10.081). CONCLUSIONS: An NLR ≥ 6 at 72 h after the ROSC is associated with poor neurological outcomes at 6 months after CA.