ABSTRACT
Objective:To construct a simple model of arteriovenous fistula classification,and to achieve the classification of arteriovenous fistula in hemodialysis patients.Methods:The study was a retrospective analysis, a total of 304 hemodialysis patients with internal fistula in People′s Hospital of Deyang City from January 2016 to January 2021 were selected by convenience sampling method,depending on whether the internal fistula was dysfunctional, patients were divided into 64 in the internal fistula failure group and 240 in the internal fistula patency group. Independent influence factors and their regression coefficient were obtained by single-factor analysis and logistic regression analysis, The risk score formula was established based on the regression coefficient to form a simple model of internal fistula classification.The model was evaluated by receiver operating characteristic curve and the scoring criteria for internal fistula classification was determined.Results:Logistic regression analysis showed that diabetes mellitus, hypotension, age≥60 years old, compression time≥30 min, blood phosphorus>1.78 mmol/L, triglyceride>1.71 mmol/L and fibrinogen>4 g/L were independent influencing factors of internal fistula failure (all P<0.05).The area under the receiver operating characteristic curve was 0.858(95% CI 0.789-0.928, P<0.01), and the best critical value of the internal fistula classification was 7.5, the sensitivity was 80.4% and the specificity was 84.8%. Conclusions:By obtaining the predictors of internal fistula failure, conducted the risk score, and constructed a simple model of internal fistula classification, which can effectively predicted the risk of internal fistula failure. It is conducive to the implementation of internal fistula classification management and the puncture of corresponding grade, to ensure the pathway safety of patients.
ABSTRACT
Objective To investigate the value of cardiac troponin Ⅰ (cTn Ⅰ) in diagnosis of multi-trauma patients combined with myocardiac contusion.Methods A retrospective review was made on 98 cases of multi-trauma patients combined with blunt chest trauma.The groups were identified according to whether the patients were associated with myocardiac contusion or not,including myocardiac contusion group (n =48) and non-myocardiac contusion group (n =50).The detection and diagnosis of myocardiac contusion in the use of different cut-off points of cTn Ⅰ and creatine kinase MB isoenzyme/creatine kinase (CKMB/CK) or their combination were compared between groups.Results cTn Ⅰ ≥0.60 ng/ml had a specificity of 90.0％,a sensitivity of 64.6％ and a Youden index of 0.54 in diagnosis of myocardiac contusion,indicating a best diagnostic accuracy as a single parameter.As compared with the single use of cTn Ⅰ ≥ 0.60 ng/ml or CKMB/CK ≥ 6％ in diagnosis of myocardiac contusion,the combined use of two parameters presented a significantly higher diagnostic sensitivity (85.4％ vs 64.6％ ; 85.4％ vs 27.1％ respectively,both P ＜ 0.05),but no markedly lower specificity (84.0％ vs 90.0％ ; 84.0％ vs 88.0％ respectively,both P ＞0.05).cTn Ⅰ level was positively correlated with ISS score of the multi-trauma patients combined with myocardiac contusion (r =0.534,P ＜ 0.01).Mortality rate in patients with severely increased cTn Ⅰ was much higher than that in patients with mild-moderately increased cTn Ⅰ (P ＜ 0.01).Conclusions cTn Ⅰ ≥0.60 ng/ml presents a high sensitivity and preferable specificity for diagnosis of multiple trauma patients combined with myocardiac contusion.It can be served as a biomarker for diagnosis of MC and its combination with CKMB/CK≥6％ improves the diagnostic sensitivity.cTn Ⅰ can be used as an assessment indicator for the early risk stratification and outcome in multi-trauma patients combined with myocardiac contusion.