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1.
J Med Internet Res ; 22(6): e18585, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32501272

RESUMO

BACKGROUND: In the era of information explosion, the use of the internet to assist with clinical practice and diagnosis has become a cutting-edge area of research. The application of medical informatics allows patients to be aware of their clinical conditions, which may contribute toward the prevention of several chronic diseases and disorders. OBJECTIVE: In this study, we applied machine learning techniques to construct a medical database system from electronic medical records (EMRs) of subjects who have undergone health examination. This system aims to provide online self-health evaluation to clinicians and patients worldwide, enabling personalized health and preventive health. METHODS: We built a medical database system based on the literature, and data preprocessing and cleaning were performed for the database. We utilized both supervised and unsupervised machine learning technology to analyze the EMR data to establish prediction models. The models with EMR databases were then applied to the internet platform. RESULTS: The validation data were used to validate the online diagnosis prediction system. The accuracy of the prediction model for metabolic syndrome reached 91%, and the area under the receiver operating characteristic (ROC) curve was 0.904 in this system. For chronic kidney disease, the prediction accuracy of the model reached 94.7%, and the area under the ROC curve (AUC) was 0.982. In addition, the system also provided disease diagnosis visualization via clustering, allowing users to check their outcome compared with those in the medical database, enabling increased awareness for a healthier lifestyle. CONCLUSIONS: Our web-based health care machine learning system allowed users to access online diagnosis predictions and provided a health examination report. Users could understand and review their health status accordingly. In the future, we aim to connect hospitals worldwide with our platform, so that health care practitioners can make diagnoses or provide patient education to remote patients. This platform can increase the value of preventive medicine and telemedicine.

2.
Artigo em Inglês | MEDLINE | ID: mdl-32461221

RESUMO

OBJECTIVES: Little is known about the experience of family caregivers of patients who require prolonged mechanical ventilation (PMV). We examined the perspectives of caregivers of patients who died after PMV to explore the role of palliative care and the quality of dying and death (QODD) in patients and understand the psychological symptoms of these caregivers. METHODS: A longitudinal study was performed in five hospitals in Taipei, Taiwan. Routine palliative care family conferences and optional consultation with a palliative care specialist were provided, and family caregivers were asked to complete surveys. RESULTS: In total, 136 family caregivers of 136 patients receiving PMV were recruited and underwent face-to-face baseline interviews in 2016-2017. By 2018, 61 (45%) of 136 patients had died. We successfully interviewed 30 caregivers of patients' death to collect information on the QODD of patients and administer the Impact of Event Scale (IES), Hospital Anxiety and Depression Scale (HADS) and Center for Epidemiologic Studies Depression (CES-D) scale to caregivers. We observed that more frequent palliative care family conferences were associated with poorer QODD in patients (coefficients: -44.04% and 95% CIs -75.65 to -12.44), and more psychological symptoms among caregivers (coefficient: 9.77% and 95% CI 1.63 to 17.90 on CES-D and coefficient: 7.67% and 95% CI 0.78 to 14.55 on HADS). A higher caregiver burden at baseline correlated with lower psychological symptoms (coefficient: -0.35% and 95% CI -0.58 to -0.11 on IES and coefficient: -0.22% and 95% CI -0.40 to -0.05 on CES-D) among caregivers following the patients' death. Caregivers' who accepted the concept of palliative care had fewer psychological symptoms after patients' death (coefficient: -3.29% and 95% CI -6.32 to -0.25 on IES and coefficient: -3.22% and 95% CI -5.24 to -1.20 on CES-D). CONCLUSIONS: Palliative care conferences were more common among family members with increased distress. Higher caregiver burden and caregiver acceptance of palliative care at baseline both predicted lower levels of caregiver distress after death.

3.
Acta Diabetol ; 2020 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-32318876

RESUMO

AIMS: Dipeptidyl peptidase-4, a transmembrane glycoprotein expressed in various cell types, serves as a co-stimulator molecule to influence immune response. This study aimed to investigate associations between DPP-4 inhibitors and risk of autoimmune disorders in patients with type 2 diabetes mellitus in Taiwan. METHODS: This retrospective cohort study used the nationwide data from the diabetes subsection of Taiwan National Health Insurance Research Database between January 1, 2009, and December 31, 2013. Cox proportional hazards models were developed to compare the risk of autoimmune disorders and the subgroup analyses between the DPP-4i and DPP-4i-naïve groups. RESULTS: A total of 774,198 type 2 diabetic patients were identified. The adjusted HR of the incidence for composite autoimmune disorders in DPP-4i group was 0.56 (95% CI 0.53-0.60; P < 0.001). The subgroup analysis demonstrated that the younger patients (aged 20-40 years: HR 0.47, 95% CI 0.35-0.61; aged 41-60 years: HR 0.50, 95% CI 0.46-0.55; aged 61-80 years: HR 0.63, 95% CI 0.58-0.68, P = 0.0004) and the lesser duration of diabetes diagnosed (0-5 years: HR 0.48, 95% CI 0.44-0.52; 6-10 years: HR 0.48, 95% CI 0.43-0.53; ≧ 10 years: HR 0.86, 95% CI 0.78-0.96, P < 0.0001), the more significant the inverse association of DPP-4 inhibitors with the incidence of composite autoimmune diseases. CONCLUSIONS: DPP-4 inhibitors are associated with lower risk of autoimmune disorders in type 2 diabetes mellitus patients in Taiwan, especially for the younger patients and the lesser duration of diabetes diagnosed. The significant difference was found between the four types of DPP-4 inhibitors and the risk of autoimmune diseases. This study provides clinicians with useful information regarding the use of DPP-4 inhibitors for treating diabetic patients.

4.
JMIR Med Inform ; 8(3): e17110, 2020 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-32202504

RESUMO

BACKGROUND: Metabolic syndrome is a cluster of disorders that significantly influence the development and deterioration of numerous diseases. FibroScan is an ultrasound device that was recently shown to predict metabolic syndrome with moderate accuracy. However, previous research regarding prediction of metabolic syndrome in subjects examined with FibroScan has been mainly based on conventional statistical models. Alternatively, machine learning, whereby a computer algorithm learns from prior experience, has better predictive performance over conventional statistical modeling. OBJECTIVE: We aimed to evaluate the accuracy of different decision tree machine learning algorithms to predict the state of metabolic syndrome in self-paid health examination subjects who were examined with FibroScan. METHODS: Multivariate logistic regression was conducted for every known risk factor of metabolic syndrome. Principal components analysis was used to visualize the distribution of metabolic syndrome patients. We further applied various statistical machine learning techniques to visualize and investigate the pattern and relationship between metabolic syndrome and several risk variables. RESULTS: Obesity, serum glutamic-oxalocetic transaminase, serum glutamic pyruvic transaminase, controlled attenuation parameter score, and glycated hemoglobin emerged as significant risk factors in multivariate logistic regression. The area under the receiver operating characteristic curve values for classification and regression trees and for the random forest were 0.831 and 0.904, respectively. CONCLUSIONS: Machine learning technology facilitates the identification of metabolic syndrome in self-paid health examination subjects with high accuracy.

5.
Clin Rheumatol ; 39(5): 1633-1648, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31965378

RESUMO

OBJECTIVE: Hyperuricemia is a strong precursor of gout, which deteriorates patients' health and quality of life. Sustained adherence to urate-lowering therapies (ULTs) is crucial for efficacy and therapeutic cost-effectiveness. Recently, several new ULTs have been proposed. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to reassess the efficacy and safety of the current ULTs, focusing on adherence attrition-related adverse event reporting. METHOD: The Bayesian network meta-analysis was applied to compare ULTs. Drug efficacy and safety were measured by whether the target level of serum urate acid was achieved and whether any adverse events occurred. The results were summarized using the pooled estimates of effect sizes (odds ratios), their precisions (95% credible interval), and the ranking probabilities. RESULTS AND CONCLUSIONS: Thirty-nine RCTs were identified, accumulating 19,401 patients. Consistent with previous studies, febuxostat (≥ 40 mg/day) was superior to other monoagent ULTs. The new findings were as follows: (i) dual-agent ULTs were superior to febuxostat alone, and further surveillance on the adverse effects when lesinurad is uptitrated is needed, and (ii) terminalia bellerica 500 mg/day, a novel xanthine oxidase inhibitor (XOI) made of natural fruit extracts, and topiroxostat ≥ 80 mg/day, an XOI used mostly in Japan, could be new effective options for lowering the occurrence of adherence attrition events. Evidence from RCTs regarding second-line agents, such as probenecid and pegloticase, remains insufficient for clinical decision-making.Key Points• Dual-agent ULTs were superior to febuxostat alone, and further surveillance on the adverse-effects when lesinurad is uptitrated is needed.• Terminalia bellerica 500 mg/day, a novel xanthine oxidase inhibitor (XOI) made of natural fruit extracts, and topiroxostat 80 mg/day, an XOI used mostly in Japan, could be new effective options for lowering the occurrence of adherence attrition events.

6.
J Intensive Care Med ; 35(1): 34-41, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31079522

RESUMO

OBJECTIVES: Predictors for post-sepsis myocardial infarction (MI) and stroke are yet to be identified due to the competing risk of death. METHODS: This study included all hospitalized patients with sepsis from National Health Insurance Research Database of Taiwan between 2000 and 2011. The primary outcome was the first occurrence of MI and stroke requiring hospitalization within 180 days following hospital discharge from the index sepsis episode. The association between predictors and post-sepsis MI and stroke were analyzed using cumulative incidence competing risk model that controlled for the competing risk of death. RESULTS: Among 42 316 patients with sepsis, 1012 (2.4%) patients developed MI and stroke within 180 days of hospital discharge. The leading 5 predictors for post-sepsis MI and stroke are prior cerebrovascular diseases (hazard ratio [HR]: 2.02, 95% confidence interval [CI]: 1.74-2.32), intra-abdominal infection (HR: 1.94, 95% CI: 1.71-2.20), previous MI (HR: 1.81, 95% CI: 1.53-2.15), lower respiratory tract infection (HR: 1.62, 95% CI: 1.43-1.85), and septic encephalopathy (HR: 1.61, 95% CI: 1.26-2.06). CONCLUSIONS: Baseline comorbidities and sources of infection were associated with an increased risk of post-sepsis MI and stroke. The identified risk factors may help physicians select a group of patients with sepsis who may benefit from preventive measures, antiplatelet treatment, and other preventive measures for post-sepsis MI and stroke.


Assuntos
Infarto do Miocárdio/etiologia , Sepse/complicações , Acidente Vascular Cerebral/etiologia , Adulto , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco
7.
J Med Internet Res ; 21(12): e13563, 2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31799935

RESUMO

BACKGROUND: Medical referral is the transfer of a patient's care from one physician to another upon request. This process involves multiple steps that require provider-to-provider and provider-to-patient communication. In Taiwan, the National Health Insurance Administration (NHIA) has implemented a national medical referral (NMR) system, which encourages physicians to refer their patients to different health care facilities to reduce unnecessary hospital visits and the financial stress on the national health insurance. However, the NHIA's NMR system is a government-based electronic medical referral service, and its referral data access and exchange are limited to authorized clinical professionals using their national health smart cards over the NHIA virtual private network. Therefore, this system lacks scalability and flexibility and cannot establish trusting relationships among patients, family doctors, and specialists. OBJECTIVE: To eliminate the existing restrictions of the NHIA's NMR system, this study developed a scalable, flexible, and blockchain-enabled framework that leverages the NHIA's NMR referral data to build an alliance-based medical referral service connecting health care facilities. METHODS: We developed a blockchain-enabled framework that can integrate patient referral data from the NHIA's NMR system with electronic medical record (EMR) and electronic health record (EHR) data of hospitals and community-based clinics to establish an alliance-based medical referral service serving patients, clinics, and hospitals and improve the trust in relationships and transaction security. We also developed a blockchain-enabled personal health record decentralized app (DApp) based on our blockchain-enabled framework for patients to acquire their EMR and EHR data; DApp access logs were collected to assess patients' behavior and investigate the acceptance of our personal authorization-controlled framework. RESULTS: The constructed iWellChain Framework was installed in an affiliated teaching hospital and four collaborative clinics. The framework renders all medical referral processes automatic and paperless and facilitates efficient NHIA reimbursements. In addition, the blockchain-enabled iWellChain DApp was distributed for patients to access and control their EMR and EHR data. Analysis of 3 months (September to December 2018) of access logs revealed that patients were highly interested in acquiring health data, especially those of laboratory test reports. CONCLUSIONS: This study is a pioneer of blockchain applications for medical referral services, and the constructed framework and DApp have been applied practically in clinical settings. The iWellChain Framework has the scalability to deploy a blockchain environment effectively for health care facilities; the iWellChain DApp has potential for use with more patient-centered applications to collaborate with the industry and facilitate its adoption.

8.
J Clin Med ; 8(11)2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31653028

RESUMO

BACKGROUND: There is a medical need for an easy, fast, and non-invasive method for metabolic syndrome (MetS) screening. This study aimed to assess the ability of FibroScan to detect MetS, in participants who underwent a self-paid health examination. METHODS: A retrospective cohort study was conducted on all adults who underwent a self-paid health examination comprising of an abdominal transient elastography inspection using FibroScan 502 Touch from March 2015 to February 2019. FibroScan can assess the level of liver fibrosis by using a liver stiffness score, and the level of liver steatosis by using the controlled attenuation parameter (CAP) score. The logistic regression analysis and receiver operating characteristic curve were applied to select significant predictors and assess their predictability. A final model that included all significant predictors that are found by univariate analysis, and a convenient model that excluded all invasive parameters were created. RESULTS: Of 1983 participants, 13.6% had a physical status that fulfilled MetS criteria. The results showed that the CAP score solely could achieve an area under the curve (AUC) of 0.79 (0.76-0.82) in predicting MetS, and the AUC can be improved to 0.88 (0.85-0.90) in the final model. An AUC of 0.85 (0.83-0.88) in predicting MetS was obtained in the convenient model, which includes only 4 parameters (CAP score, gender, age, and BMI). A panel of predictability indices (the ranges of sensitivity, specificity, positive and negative likelihood ratio: 0.78-0.89, 0.66-0.82, 2.64-4.47, and 0.17-0.26) concerning gender- and BMI-specific CAP cut-off values (range: 191.65-564.95) were presented for practical reference. CONCLUSIONS: Two prediction systems were proposed for identifying individuals with a physical status that fulfilled the MetS criteria, and a panel of predictability indices was presented for practical reference. Both systems had moderate predictive performance. The findings suggested that FibroScan evaluation is appropriate as a first-line MetS screening; however, the variation in prediction performance of such systems among groups with varying metabolic derangements warrants further studies in the future.

9.
Crit Care ; 23(1): 293, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477181

RESUMO

BACKGROUND: It remains unclear whether sepsis-related cardiovascular complications have an adverse impact on survival independent of pre-existing comorbidities. To investigate the survival impact of post-sepsis cardiovascular complications among sepsis survivors, we conducted a population-based study using the National Health Insurance Database of Taiwan. METHODS: We identified sepsis patients from the National Health Insurance Research Database of Taiwan using ICD-9-CM codes involving infection and organ dysfunction between 2000 and 2011. Post-sepsis incident myocardial infarction (MI) and stroke were ascertained by ICD-9-CM codes and antiplatelet treatment. We constructed a non-sepsis comparison cohort using propensity score matching to ascertain the association between sepsis and cardiovascular complications. Furthermore, we compared the 180-day mortality and 365-day mortality between patients surviving sepsis with or without post-sepsis MI or stroke within 70 days of hospital discharge. We constructed Cox regression models adjusting for pre-existing comorbidities to evaluate the independent survival impact of post-sepsis MI or stroke among sepsis survivors. RESULTS: We identified 42,316 patients hospitalized for sepsis, from which we matched 42,151 patients 1:1 with 42,151 patients hospitalized without sepsis. Compared to patients hospitalized without sepsis, patients hospitalized with sepsis had an increased risk of MI or stroke (adjusted odds ratio 1.72, 95% CI 1.60-1.85). Among 42,316 patients hospitalized for sepsis, 486 (1.15%) patients developed incident stroke and 108 (0.26%) developed incident MI within 70 days of hospital discharge. Compared to sepsis survivors without cardiovascular complications, sepsis survivors with incident MI or stroke had a higher mortality rate at 180 days (11.68% vs. 4.44%, P = 0.003) and at 365 days (16.75% vs. 7.11%, P = 0.005). Adjusting for age, sex, and comorbidities, post-sepsis MI or stroke was independently associated with increased 180-day (adjusted hazard ratio [HR] 2.16, 95% CI 1.69-2.76) and 365-day (adjusted HR 1.90, 95% CI 1.54-2.32) mortality. CONCLUSIONS: Compared to sepsis patients without incident MI or stroke, sepsis patients with incident MI or stroke following hospital discharge had an increased risk of mortality for up to 365 days of follow-up. This increased risk cannot be explained by pre-sepsis comorbidities.


Assuntos
Doenças Cardiovasculares/mortalidade , Sepse/complicações , Sepse/mortalidade , Sobreviventes/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Sepse/epidemiologia , Estatísticas não Paramétricas , Taiwan/epidemiologia
10.
Shock ; 51(5): 619-624, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30052578

RESUMO

The aim of this study is to examine the incidence trend of sepsis over 11 years and compared mortality outcomes among Taiwanese patients with sepsis admitted from emergency department (ED) and non-ED routes. We used a nationwide health insurance database from Taiwan, which comprise of 23 million beneficiaries. Patients with sepsis were identified by ICD-9 CM codes for infection and organ dysfunction from 2001 to 2012. We performed propensity score matching and compared mortality rates between ED-admitted and non ED-admitted patients.During the 11-year study period, we identified 1,256,684 patients with sepsis. 493,397 (29.3%) were admitted through the ED, and 763,287 (70.7%) were admitted directly to the floor. For patients with sepsis, mortality in ED-admitted patients decreased from 27.2% in 2002 to 21.1% in 2012 while that in non-ED admitted patients decreased from 35.3% in 2002 to 30.7% in 2012. Although patients with sepsis admitted through the ED had a higher incidence of organ dysfunction than patients who were directly admitted, they had more favorable outcomes in mortality, length of intensive care unit stay, and hospital stay. After propensity score matching, ED-admitted patients had a 7% lower risk of 90-day mortality (HR, 0.93, 95% CI, 0.89-0.97) compared with directly admitted patients. During the study period, mortality declined faster among ED admitted sepsis patients than directly admitted sepsis patients. Results of this study should be interpreted in light of limitations. Like other administrative database studies, treatment details are not available. Further clinical studies evaluating the treatment and outcome difference between ED and non-ED admitted sepsis patients are warranted.

11.
J Am Coll Cardiol ; 72(12): 1369-1378, 2018 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-30213330

RESUMO

BACKGROUND: Previous studies raised safety concerns on the association between fluoroquinolone treatment and serious collagen disorders, aortic aneurysm and dissection (AA/AD). OBJECTIVES: This study sought to evaluate this association via a case-crossover analysis in a large national administrative database. METHODS: A case-crossover design was used to compare the distributions of fluoroquinolone exposure for the same patient across a 60-day period before the AA/AD event (hazard period) and 1 randomly selected 60-day period (referent period) between 60 to 180 days before the AA/AD events. In the sensitivity analysis, the authors repeated the main analysis using a 1:5 ratio of hazard period to referent period, to adjust for the effect of time-variant confounders. A disease-risk score-matched time control analysis was performed to investigate the potential time-trend bias. The risks were calculated by a conditional logistic regression model. RESULTS: A total of 1,213 hospitalized AA/AD patients were identified between 2001 and 2011. In the main case-crossover analysis, exposure to fluoroquinolone was more frequent during the hazard periods than during the referent periods (1.6% vs. 0.6%; odds ratio [OR]: 2.71; 95% confidence interval [CI]: 1.14 to 6.46). In the sensitivity analysis, after adjustment for infections and co-medications, the risk remains significant (OR: 2.05; 95% CI: 1.13 to 3.71). An increased risk of AA/AD was observed for prolonged exposure to fluoroquinolones (OR: 2.41 for 3- to 14-day exposure; OR: 2.83 for >14-day exposure). Susceptible period analysis revealed that the use of fluoroquinolone within 60 days was associated with the highest risk of AA/AD. In the case-time-control analysis, there was no evidence that the observed association is due to temporal changes in fluoroquinolone exposure. CONCLUSIONS: Exposure to fluoroquinolone was substantially associated with AA/AD. This risk was modified by the duration of fluoroquinolone use and the length of the hazard period.


Assuntos
Aneurisma Dissecante/epidemiologia , Antibacterianos/efeitos adversos , Aneurisma Aórtico/epidemiologia , Fluoroquinolonas/efeitos adversos , Administração Oral , Idoso , Estudos Cross-Over , Bases de Dados Factuais , Feminino , Humanos , Modelos Logísticos , Masculino , Taiwan/epidemiologia , Fatores de Tempo
12.
PLoS One ; 13(9): e0202692, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30240398

RESUMO

BACKGROUND: Predicting the survival of non-cancer related end-stage-liver-disease patients in general practice has been difficult for physicians because of the extremely variable trajectories due to multiple complex clinical factors, hence it remains a challenging issue to date. This study aimed to develop and validate a specific prognostic scoring system to early recognize the prognosis and improve the quality of end-of life care for non-cancer end-stage-liver-disease population. MATERIALS AND METHODS: A multicentre, retrospective cohort study was conducted during January 2010 ~ December 2012 and continued follow-up until December 2014. A cox proportional hazard regression analysis was used to derive and validate an optimized model. The main outcome measures were the 28-day, 3-month, 6-month, and 12-month mortality prediction. The performance of the novel model was evaluated, including discrimination and calibration. RESULTS: A total of 4,080 consecutive subjects were enrolled. The AUROCs for the 3-month survival discrimination in the MELD, MELD-Na and novel model were 0.787, 0.705 and 0.804 (P<0.001); the 6-month survival discrimination were 0.781, 0.702 and 0.797 (P<0.001); the overall survival discrimination were 0.771, 0.694 and 0.785 (P = 0.002) respectively, whereas the novel model showed a significantly higher discrimination power than did the MELD and MELD-Na for the 3-month, 6-month and overall survival prediction. In addition, calibration of external validation cohort showed no statistical difference in all 5 groups compared with the observed groups. CONCLUSION: This is a clinically relevant, validated scoring system that can be used sequentially to stratify the prognosis in non-cancer cirrhotic populations, which may help the patients along with medical team in decision making to improve the quality of end-of-life care.


Assuntos
Doença Hepática Terminal/mortalidade , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Análise de Sobrevida
13.
Medicine (Baltimore) ; 97(36): e11896, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30200074

RESUMO

Chronic kidney disease (CKD) is a risk factor for cardiovascular diseases and is associated with an increase in all-cause mortality. Studies regarding association among various body compositions in different inflamed states and the risk of CKD were rare. We aimed to evaluate the relationship among body composition, high-sensitivity C-reactive protein (hsCRP) level, and the risk of CKD.This was a retrospective cross-sectional study using annual health examination data from 2 medical centers in northern and southern Taiwan between January and December 2015. We performed a variance analysis of the estimated glomerular filtration rate (eGFR) distribution in groups based on hsCRP and body fat percentage (BFP), and a multivariate logistic regression model was used to assess the relationship among BFP, hsCRP levels, and CKD.A total of 10,267 subjects aged ≥18 years undergoing health examination were analyzed. In our study, overweight/obese patients were associated with increased risk of CKD. Nevertheless, in subjects with elevated hsCRP level, overweight/obese group with a higher BFP had a lower risk of CKD as compared with overweight/obese with normal BFP group (for BMI ≧ 23 kg/m, high BFP/high hsCRP: odds ratio [OR] for CKD 1.86, 95% confidence interval [CI] = 1.10-3.17, P = .02; normal BFP/high hsCRP group: OR 2.32, 95% CI = 1.23-4.37, P = .01) after adjusting for various confounders.Our findings suggest that various body compositions in different inflamed states may interfere with the risk of CKD. These results provide an important method for the early detection of impaired renal function by identifying various body compositions and inflammation states to detect CKD at an earlier stage.


Assuntos
Composição Corporal , Proteína C-Reativa/análise , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/patologia , Adulto , Análise de Variância , Biomarcadores/sangue , Índice de Massa Corporal , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Sobrepeso/sangue , Sobrepeso/complicações , Sobrepeso/epidemiologia , Sobrepeso/patologia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taiwan
14.
Fam Pract ; 35(3): 259-265, 2018 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-29092063

RESUMO

Background: Obesity is associated with increased risk of cardiovascular disease and chronic kidney disease (CKD). Hyperhomocysteinaemia refers to increased oxidative stress and has been associated with the risk of CKD. Objectives: We investigated the association among body mass index (BMI), homocysteine level and impaired renal function in a Taiwanese adult population. Methods: This was a retrospective cross-sectional study involving 24826 subjects who underwent a health check-up from January 2013 to December 2015. A multivariate linear regression model was developed to analyse the relationship among BMI, serum homocysteine and estimated glomerular filtration rate (eGFR). A multivariate logistic regression model was used to assess the relationship among weight categories, hyperhomocysteinaemia and CKD. Results: The prevalence of CKD in the quartile groups of homocysteine were 2.5%, 2.7%, 3.4% and 5.2% (P < 0.01). For every one-unit increase in BMI (kg/m2), the eGFR decreased by 0.50 ml/min/1.73 m2. Overweight/obese subjects with high homocysteine levels had a higher odds ratio (OR) for CKD, as compared with normal weight subjects (1.84 versus 1.38, respectively; P < 0.01 versus P = 0.02, respectively). Overweight/obese female subjects with hyperhomocysteinaemia had an OR of 3.40 [P < 0.01; 95% confidence interval (CI): 2.06-5.61] for CKD; in males, the OR was 1.66 (P < 0.01; 95% CI: 1.38-1.99). Conclusions: Patients who are overweight/obese with higher homocysteine levels have an increased risk of CKD, especially females. Additional studies exploring whether the effect of weight loss or homocysteine-lowering therapies such as folic acid, vitamin B12 supplements that may prevent or slow the progression of declining renal function, is warranted.


Assuntos
Hiper-Homocisteinemia/epidemiologia , Obesidade/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Adulto , Índice de Massa Corporal , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , População , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Taiwan/epidemiologia
15.
J Ren Nutr ; 28(2): 91-100, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29146142

RESUMO

OBJECTIVES: Abdominal obesity is an independent risk factor for cardiovascular disease and chronic kidney disease (CKD). Visceral adiposity index (VAI), a simple formula representing visceral adipose dysfunction, has already been proven to have a strong correlation with various cardiometabolic disorders. Limited studies are available regarding the relationship between VAI and renal function decline. Therefore, the purpose of this study was to evaluate the relationship between VAI and renal function and to estimate the risk of chronic kidney disease in a relatively healthy adult population in Taiwan. DESIGN: The design of the study is retrospective cross-sectional analysis. SUBJECTS: This study involved 23,570 subjects aged ≥18 years who underwent annual heath checkups between January and December 2013. A multivariate logistic regression model was used to assess the relationship between VAI and CKD. Receiver-operating characteristic curve and Youden index were developed to determine the discrimination power of VAI for metabolic syndrome and CKD. INTERVENTION: None, observational study. MAIN OUTCOME MEASURE: The main outcome measure of this study was CKD. RESULTS: In our study, the adjusted odds ratio (OR) of abnormal VAI for CKD was 1.5 (95% confidence interval [CI], 1.08-2.08; P = .016) in all subjects. A higher VAI was superior in association with CKD in men than women (OR, 1.62; 95% CI, 1.13-2.32; P = .009 vs. OR, 1.28; 95% CI, 0.66-2.47; P = .469, respectively). The area under the curve for VAI was 0.694 (95% CI, 0.660-0.729; P < .001), and using a Youden index with a cut-off VAI value of 2.96 for CKD discrimination obtained a sensitivity of 67.7% and specificity of 65.1%. CONCLUSIONS: A higher VAI score was associated with increased risks of CKD. VAI would be an applicable tool for early detection of CKD in relatively healthy adults in Taiwan, especially men.


Assuntos
Gordura Intra-Abdominal , Obesidade Abdominal/complicações , Obesidade Abdominal/diagnóstico , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/etiologia , Adulto , Índice de Massa Corporal , Estudos Transversais , Diagnóstico Precoce , Feminino , Humanos , Masculino , Razão de Chances , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Taiwan
16.
Chest ; 153(4): 805-815, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28962887

RESUMO

BACKGROUND: Whether statin treatment, proved by recent experimental studies to have an antimicrobial activity, exerts a drug- or a class-specific effect in sepsis remains unknown. METHODS: Short-term mortality in patients with sepsis was analyzed using data from the National Health Insurance Research Database. Use of statins was defined as the cumulative use of a specific statin (atorvastatin, simvastatin, or rosuvastatin) for > 30 days prior to the index sepsis admission. We determined the association between statin and sepsis outcome by multivariate-adjusted Cox models and propensity score (PS)-matched analysis, using a 1:1:1 PS matching technique. RESULTS: A total of 52,737 patients with sepsis fulfilled the inclusion criteria, of which 1,855 were prescribed atorvastatin, 916 were prescribed simvastatin, and 732 were prescribed rosuvastatin. Compared with nonusers, simvastatin (hazard ratio [HR], 0.72; 95% CI, 0.58-0.90) and atorvastatin (HR, 0.78; 95% CI, 0.68-0.90) were associated with an improved 30-day survival, whereas rosuvastatin was not (HR, 0.87; 95% CI, 0.73-1.04). Using rosuvastatin as the reference, atorvastatin (HR, 0.79; 95% CI, 0.64-0.99) and simvastatin (HR, 0.77; 95% CI, 0.59-0.99) had superior effectiveness in preventing mortality. CONCLUSIONS: Compatible with in vitro experimental findings, our results suggest that the drug-specific effect of statins on sepsis is not correlated to their lipid-lowering potency.


Assuntos
Anti-Infecciosos/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipolipemiantes/uso terapêutico , Sepse/mortalidade , Idoso , Atorvastatina/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Masculino , Insuficiência Respiratória/mortalidade , Rosuvastatina Cálcica/uso terapêutico , Sinvastatina/uso terapêutico , Taiwan/epidemiologia , Resultado do Tratamento
17.
PLoS One ; 12(9): e0183813, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28873440

RESUMO

BACKGROUND: Fluoroquinolone is a commonly prescribed antimicrobial agent, and up to 20% of its users registers adverse gastroenterological symptoms. We aimed to evaluate the association between use of fluoroquinolone and gastrointestinal tract perforation. METHODS: We conducted a nested case-control study on a national health insurance claims database between 1998 and 2011. The use of fluoroquinolones was classified into current (< 60 days), past (61-365 days prior to the index date) and any prior year use of fluoroquinolones. We used the conditional logistic regression model to estimate rate ratios (RRs), adjusting or matching by a disease risk score (DRS). RESULTS: We identified a cohort of 17,510 individuals diagnosed with gastrointestinal perforation and matched them to 1,751,000 controls. Current use of fluoroquinolone was associated with the greatest increase in risk of gastrointestinal perforations after DRS score adjustment (RR, 1.90; 95% CI, 1.62-2.22). The risk of gastrointestinal perforation was attenuated for past (RR, 1.33; 95% CI, 1.20-1.47) and any prior year use (RR, 1.46; 95% CI, 1.34-1.59). To gain insights into whether the observed association can be explained by unmeasured confounder, we compared the risk of gastrointestinal perforation between fluoroquinolone and macrolide. Use of macrolide, an active comparator, was not associated with a significant increased risk of gastrointestinal perforation (RR, 1.11, 95%CI, 0.15-7.99). Sensitivity analysis focusing on perforation requiring in-hospital procedures also demonstrated an increased risk associated with current use. To mitigate selection bias, we have also excluded people who have never used fluoroquinolone before or people with infectious colitis, enteritis or gastroenteritis. In both of the analysis, a higher risk of gastrointestinal perforation was still associated with the use of fluoroquinolone. CONCLUSIONS: We found that use of fluoroquinolones was associated with a non-negligible increased risk of gastrointestinal perforation, and physicians should be aware of this possible association.


Assuntos
Antibacterianos/efeitos adversos , Fluoroquinolonas/efeitos adversos , Gastroenteropatias/induzido quimicamente , Perfuração Intestinal/induzido quimicamente , Intestinos/efeitos dos fármacos , Administração Oral , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Intestinos/patologia , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade , Taiwan , Resultado do Tratamento
18.
J Infect ; 75(5): 409-419, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28851532

RESUMO

OBJECTIVES: To determine the trend of incidence and outcome of sepsis based on a nationwide administrative database. METHODS: We analyzed the incidence and mortality of both emergency department treated and hospital treated sepsis from 2002 through 2012 using the entire health insurance claims data of Taiwan. The national health insurance covers 99% of residents in Taiwan. Sepsis patients were identified using a set of validated ICD-9CM codes conforming to the sepsis-3 definition. The 30-day all-cause mortality was verified by linked death certificate database. RESULTS: During the 11-year study period, a total of 1,259,578 episodes of sepsis was identified. The mean incidence rate was 639 per 100,000 person-years, increasing from 637.8/100,000 persons in 2002 to 772.1/100,000 persons in 2012 (annual increase: 1.9%). The mortality rate, however, has decreased from 27.8% in 2002 to 22.8% in 2012 (annual decrease: 0.45%). The trend of incidence and mortality did not change after standardization by age and gender using 2002 as the reference standard. CONCLUSION: We showed that the incidence of sepsis has increased while the mortality has decreased in Taiwan. Despite the decreasing trend in sepsis mortality, the total number of sepsis mortality remains increasing due to the rapid increase in sepsis incidence.


Assuntos
Sepse/epidemiologia , Resultado do Tratamento , Idoso , Estudos de Coortes , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Sepse/mortalidade , Taiwan/epidemiologia
19.
Crit Care Med ; 45(9): 1500-1508, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28658023

RESUMO

OBJECTIVES: Use of calcium channel blockers has been found to improve sepsis outcomes in animal studies and one clinical study. This study determines whether the use of calcium channel blockers is associated with a decreased risk of mortality in patients with sepsis. DESIGN: Population-based matched cohort study. SETTING: National Health Insurance Research Database of Taiwan. PATIENTS: Hospitalized severe sepsis patients identified from National Health Insurance Research Database by International Classification of Diseases, Ninth Revision, Clinical Modification codes. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The association between calcium channel blocker use and sepsis outcome was determined by multivariate-adjusted Cox proportional hazard models and propensity score analysis. To examine the influence of healthy user bias, beta-blocker was used as an active comparator. Our study identified 51,078 patients with sepsis, of which, 19,742 received calcium channel blocker treatments prior to the admission. Use of calcium channel blocker was associated with a reduced 30-day mortality after propensity score adjustment (hazard ratio, 0.94; 95% CI, 0.89-0.99), and the beneficial effect could extend to 90-day mortality (hazard ratio, 0.95; 95% CI, 0.89-1.00). In contrast, use of beta-blocker was not associated with an improved 30-day (hazard ratio, 1.06; 95% CI, 0.97-1.15) or 90-day mortality (hazard ratio, 1.00; 95% CI, 0.90-1.11). On subgroup analysis, calcium channel blockers tend to be more beneficial to patients with male gender, between 40 and 79 years old, with a low comorbidity burden, and to patients with cardiovascular diseases, diabetes, or renal diseases. CONCLUSIONS: In this national cohort study, preadmission calcium channel blocker therapy before sepsis development was associated with a 6% reduction in mortality when compared with patients who have never received calcium channel blockers.


Assuntos
Antagonistas Adrenérgicos beta/administração & dosagem , Bloqueadores dos Canais de Cálcio/administração & dosagem , Unidades de Terapia Intensiva/estatística & dados numéricos , Sepse/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Modelos de Riscos Proporcionais , Fatores Sexuais , Taiwan
20.
BMC Pulm Med ; 17(1): 82, 2017 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-28472944

RESUMO

BACKGROUND: Mycobacterium tuberculosis (TB) is one of the world's most devastating public health threats. Our goal is to evaluate whether the use of non-steroidal anti-inflammatory drugs (NSAIDs) affect the risk of new incident active TB disease. METHODS: We conducted a nested case-control analysis by using a 1 million longitudinally followed cohort, from Taiwan's national health insurance research database. Effects of NSAIDs on active TB were estimated by conditional logistic regression and adjusted using a TB-specific disease risk score (DRS). NSAIDs exposures were defined as having a prescription record of NSAIDs ≧ 7 days that ended between 31 and 90 days prior to the index date. RESULTS: A total of 123,419 users of traditional NSAIDs, 16,392 users of cyclooxygenase-2 selective inhibitor (Coxibs), and 4706 incident cases of active TB were identified. Compared with nonusers, use of traditional NSAIDs was associated with an increased risk of TB in the unadjusted analysis ([RR], 1.39; 95% [CI], 1.24 - 1.57 and DRS adjusted analysis ([ARR], 1.30; 95% [CI], 1.15- 1.47). However, use of Coxibs was not associated with a significant increase in the risk of TB after DRS adjustment ([ARR], 1.23; 95% [CI], 0.89 - 1.70). CONCLUSIONS: In this large population-based study, we found that subjects using traditional NSAIDs were associated with increased risk for active TB. We did not find evidence for a causative mechanism between traditional NSAIDs and TB, and more research is required to verify whether the association between traditional NSAIDs and TB is causal, or simply reflects an increased use of anti-inflammatory drugs in the early phases of TB onset.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Tuberculose/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Bases de Dados Factuais , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Programas Nacionais de Saúde , Fatores de Risco , Taiwan/epidemiologia , Fatores de Tempo
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