Journal of clinical medicine research最新文献

{"title":"Evaluating Grasp Function in Patients With Chronic Inflammatory Demyelinating Polyneuropathy Using Dynamometers: A Comprehensive Review.","authors":"Periklis Tsoumanis, Theocharis Chatzoglou, Thomas Iraklis Smyris, Christos Stefanou, Dimitris Tsoumanis, Stefanos Stefanou, Kostas Tepelenis, Alexandra Barbouti, Aikaterini Marini, Paraskevas Zafeiropoulos, Dimitrios Varvarousis","doi":"10.14740/jocmr6179","DOIUrl":"10.14740/jocmr6179","url":null,"abstract":"<p><p>Chronic inflammatory demyelinating polyneuropathy (CIDP) is a progressive neurological disorder characterized by weakness and impaired sensory function due to damage to peripheral nerves. Evaluating grasp function is critical for understanding the impact of CIDP on patients' daily activities and guiding rehabilitation strategies. This comprehensive review examines the role of dynamometers in quantifying grip strength deficits, tracking disease progression, and assessing treatment outcomes in CIDP patients. Key findings highlight the utility of dynamometers in quantifying grip strength deficits, tracking disease progression, and evaluating treatment outcomes. The review also explores methodological considerations, such as standardizing testing protocols and integrating dynamometric measurements with clinical scales. By providing insights into the functional impairments associated with CIDP and the effectiveness of therapeutic interventions, this review underscores the role of dynamometry in advancing patient care and enhancing the quality of life for individuals living with this condition. Future research directions include the development of more sensitive dynamometric tools and longitudinal studies to better understand the relationship between grip strength and overall disease trajectory in CIDP.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"17 3","pages":"136-144"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Ascorbic Acid on the Incidence of Postoperative Delirium Among Elderly Patients Undergoing Cardiovascular Surgery: A Pilot Study.","authors":"Yusuke Iizuka, Kentaro Fukano, Sayaka Oki, Ikumi Sawada, Keika Miyazawa, Shohei Ono, Koichi Yoshinaga, Masamitsu Sanui, Atsushi Yamaguchi","doi":"10.14740/jocmr6169","DOIUrl":"10.14740/jocmr6169","url":null,"abstract":"<p><strong>Background: </strong>Ascorbic acid is a strong antioxidant that prevents postoperative delirium by inhibiting reactive oxygen species production. This pilot study was designed to investigate the prevalence of postoperative delirium among older patients undergoing cardiovascular surgery, who received perioperative ascorbic acid administration, to estimate an appropriate sample size for further randomized controlled trials.</p><p><strong>Methods: </strong>This single-arm prospective interventional study enrolled patients aged > 70 years scheduled to undergo elective cardiovascular surgery using cardiopulmonary bypass. Ascorbic acid (500 mg) was administered intravenously every 6 h for a total of eight times following the induction of general anesthesia. The incidence of postoperative delirium was evaluated until discharge using the Confusion Assessment Method for the Intensive Care Unit.</p><p><strong>Results: </strong>Data from 48 patients were analyzed. Of the 48 patients, 16 developed postoperative delirium (33.3%). Patients in the delirium group had more severe heart failure (New York Heart Association Classification), higher European System for Cardiac Operative Risk Evaluation scores, lower intraoperative Bispectral Index, longer duration of cardiopulmonary bypass and surgery, incidence of postoperative cerebral infarction, longer intubation time, and length of intensive care unit stay.</p><p><strong>Conclusions: </strong>The incidence of postoperative delirium among older patients undergoing cardiovascular surgery who received ascorbic acid perioperatively (2 g/day for 2 days) was 33%. This incidence was comparable to that observed in a previous observational study, suggesting that ascorbic acid administration may not be effective in preventing the incidence of postoperative delirium.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"17 3","pages":"145-152"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Pulmonary Arterial Hypertension-Targeted Therapy in Patients With Pulmonary Hypertension due to Interstitial Lung Disease.","authors":"Kavitha C Selvan, Krittika Teerapuncharoen, Remzi Bag","doi":"10.14740/jocmr6164","DOIUrl":"10.14740/jocmr6164","url":null,"abstract":"<p><strong>Background: </strong>The aim of the study was to determine whether treatment with oral pulmonary arterial hypertension (PAH)-targeted therapy is associated with functional or hemodynamic improvement in patients with pulmonary hypertension due to interstitial lung disease (PH-ILD).</p><p><strong>Methods: </strong>We conducted a retrospective review of 1,507 consented patients with pulmonary hypertension (PH) from the University of Chicago PH Registry. Exclusion criteria included: enrollment in PH-related clinical trials, use of inhaled treprostinil or iloprost and prior PAH-targeted therapy initiated before consenting to registry enrollment, thus precluding baseline data. Data analyzed included demographics, interstitial lung disease (ILD) classification, PAH-targeted therapy, functional data, hemodynamics, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) before and after initiation of treatment. Data were analyzed using paired <i>t</i>-test, or related-samples Wilcoxon signed rank test.</p><p><strong>Results: </strong>Of 37 patients included, 27 (73%) received treatment with one PAH-targeted therapy and nine (24%) received dual therapy. At baseline, median NT-proBNP was 1,498 ng/dL (675 - 3,208), mean pulmonary artery pressure (mPAP) was 45 ± 11 mm Hg, and pulmonary vascular resistance (PVR) of 9 ± 4 Wood units (WU). In patients with measurements both before and after treatment with PAH-targeted therapy, there was a decrease in PVR (n = 13, 8 vs. 5 WU, P < 0.001), an increase in cardiac output (n = 13, 4 vs. 5 L/min, P = 0.014), and a decrease in NT-proBNP levels (n = 26, 1,421 vs. 842 ng/dL, P = 0.045).</p><p><strong>Conclusions: </strong>In this study, use of PAH-targeted therapy in patients with PH-ILD was associated with statistically significant and clinically meaningful improvements in NT-proBNP and pulmonary hemodynamics.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"17 3","pages":"153-163"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ischemic Preconditioning Negatively Affects Thrombogenic Clotting Profile in Cerebral Small Vessel Occlusion Stroke Patients.","authors":"Line Boel Norregaard, Nicolai Rytter, Laura Cathrine Christoffersen, Lasse Gliemann, Christian Stevns Hansen, Matthew Lawrence, Philip Adrian Evans, Christina Kruuse, Ylva Hellsten","doi":"10.14740/jocmr6086","DOIUrl":"10.14740/jocmr6086","url":null,"abstract":"<p><strong>Background: </strong>The study evaluated the effect of an acute and a 2-week daily repetitive ischemic preconditioning (IPC) on conduit artery vascular function and thrombogenic clotting profile, in patients with a recent ischemic stroke.</p><p><strong>Methods: </strong>Fourteen patients, aged 71 ± 8 years, with a cerebral small vessel occlusion stroke were included in a randomized, controlled, open-label cross-over study. Treatment consisted of 2 weeks of daily IPC, four 5-min rounds of upper-arm occlusion, interspersed by 5 min rest periods. Control was without treatment. Brachial artery flow-mediated dilation (FMD) was determined at baseline and after the control and treatment periods. Before and after each period, the patients underwent an acute bout of IPC. Blood samples were obtained for thrombogenic clotting profile at baseline and after the acute IPC bout, both before and after the control and treatment periods.</p><p><strong>Results: </strong>The period of daily IPC increased brachial artery diameter but did not influence FMD. Acutely, IPC was found to induce an increase in fractal dimension, indicating a denser clot microstructure, and a reduction in plasma levels of plasminogen activator inhibitor 1 (PAI-1). There was no effect of daily IPC on the basal thrombogenic clotting profile, or on the change in clotting profile induced by acute IPC.</p><p><strong>Conclusions: </strong>Collectively, the data show that acute IPC leads to a prothrombotic clotting profile, despite antiplatelet therapy. Moreover, 2 weeks of daily treatment with IPC does not influence conduit artery vascular function or thrombogenicity in stroke patients.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"17 2","pages":"97-105"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11835555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Bone Mineral Density Score in Post-Stroke Neuromuscular Deficit.","authors":"Ifran Saleh, Auliya Akbar, Harris S Hasan, Nyimas D Yulisa, Dina Aprilya","doi":"10.14740/jocmr6070","DOIUrl":"10.14740/jocmr6070","url":null,"abstract":"<p><strong>Background: </strong>Disuse osteoporosis in hemiparetic patients often results in significant morbidity, decreased quality of life, and different clinical characteristics. The study aimed to investigate the effect of these clinical factors on bone mineral density (BMD).</p><p><strong>Methods: </strong>This was an analytical observational study with a cross-sectional method evaluating hemiparetic patients at Cipto Mangunkusumo Hospital from 2018 to 2019. BMD (g/cm²) was assessed using dual energy X-ray absorptiometry (DXA) on the spine and both sides of the body. The relationship and correlation between BMD and delta BMD scores with clinical characteristics were analyzed. A linear regression test was used to assess the correlation between variables.</p><p><strong>Results: </strong>A total of 34 participants were recruited for this study. There was a difference between the healthy and paretic side of BMD of both hip and wrist (P < 0.001), strong positive correlation between the onset of hemiparesis and wrist and hip delta BMD (r = 0.779, P = 0.001 and r = 0.791, P = 0.001), and significant association between delta BMD and age and motor strength. Multivariate analysis shows that the onset of hemiparesis was a strong predictor of delta BMD (aR² wrist = 0.486, aR² hip = 0.614). There was a 7.36% decrease in the mean BMD score of the paretic side compared to the non-paretic side.</p><p><strong>Conclusion: </strong>A low BMD score is prevalent in seven out of 10 patients with post-stroke neuromuscular deficit. Age, limb strength, the onset of hemiparesis, and rehabilitation compliance are associated with decreased BMD among patients with post-stroke neuromuscular deficit.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"17 2","pages":"119-124"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11835557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Prior Metformin Use on Stroke Outcomes: A Systematic Review and Updated Meta-Analysis.","authors":"Anas Elgenidy, Ahmed Yasser Shaban, Khaled Saad, Yasser Hamed, Ahmed Elhadi Rhab, Mohamed Khalafalla Darwish, Alaa Essam Kamal, Mohamed Salem Abdelkader, Hamza Anas Marzouk, Mohamed Mahmoud Gomaa, Hassan Ahmed Hashem, Amira Elhoufey, Hamad Ghaleb Dailah, Rami A Metwally, Noran ElBazzar, Nevin Shalaby","doi":"10.14740/jocmr6159","DOIUrl":"10.14740/jocmr6159","url":null,"abstract":"<p><strong>Background: </strong>Metformin is a commonly prescribed oral hypoglycemic agent for diabetic patients. Its effect in reducing the incidence of stroke has already been proven. We aimed to explore the impact of prior metformin use on stroke outcomes.</p><p><strong>Methods: </strong>The Web of Science, PubMed, Embase, and Cochrane Library were searched to identify relevant studies involving stroke patients with a history of metformin use and comparing them to non-metformin users. We analyzed the following outcomes: modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), mortality, or length of hospitalization.</p><p><strong>Results: </strong>Eleven studies, with 13,825 participants, were included. The metformin group showed higher favorable mRS 0 - 2 than the non-metformin group (risk ratio (RR) = 1.14, 95% confidence interval (CI): 1.09 - 1.19, P value < 0.01). Also, significantly lower mortality rates were seen in the metformin group (RR = 0.54, 95% CI: 0.46 - 0.63, P value ≤ 0.01). NIHSS at discharge was lower in the metformin group than the non-metformin group (mean difference (MD) = -0.46, 95% CI: -0.82 - -0.11, P value < 0.01). The mRS 3 - 6 indicates less favorable outcomes were higher in the non-metformin group (RR = 0.85, 95% CI: 0.77 - 0.93). At the same time, NIHSS at admission showed no statistically significant difference between the two groups. These results indicate that metformin has a beneficial impact on the severity of stroke.</p><p><strong>Conclusions: </strong>Pre-stroke metformin therapy is associated with better post-stroke clinical outcomes and lower mortality rates. These results highlight the potential neuroprotective role of metformin and emphasize its role as an adjunctive treatment in stroke management. Further research is required to understand its mechanism better.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"17 2","pages":"76-88"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11835556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Alloimmunization Events in Thalassemia Patients With Repeated Transfusions in the Rhesus Blood Group System: A Systematic Review and Meta Analysis.","authors":"Vitasari Indriani, Budi Mulyono, Teguh Triyono, Anastasia Evi Handayaningsih, Lukman Ade Chandra","doi":"10.14740/jocmr6142","DOIUrl":"10.14740/jocmr6142","url":null,"abstract":"<p><strong>Background: </strong>Alloimmunization presents a significant challenge for patients with β-thalassemia major who depend on regular transfusion therapy. This systematic review and meta-analysis aimed to evaluate the frequency of alloimmunization within the Rhesus blood group system and identify the most prevalent alloantibodies.</p><p><strong>Methods: </strong>A comprehensive search across multiple databases was conducted to locate epidemiological studies reporting alloimmunization in thalassemia patients undergoing repeated transfusions, specifically focusing on Rhesus antibodies. Statistical analyses were performed using R software, and heterogeneity was assessed using I² statistics.</p><p><strong>Results: </strong>This review included 20 studies with a total of 4,650 patients. The overall prevalence of alloimmunization was 5.4% (95% confidence interval (CI): 3.1-9.3%) across all ages, with a prevalence of 9.1% (95% CI: 5.3-15.2%) in children and 25% (95% CI: 12.7-41.2%) in adults. The pooled overall prevalence was 6.6% (95% CI: 4.2-10.2%). Among the 488 alloimmunized patients, 310 developed Rhesus-specific antibodies, with anti-E (34.58%) and anti-D (13.69%) being the most frequent.</p><p><strong>Conclusions: </strong>This study underscores the substantial prevalence of Rhesus antibodies among alloimmunized thalassemia patients. Implementing extended phenotype matching for transfusions could significantly reduce the risk of alloantibody formation in this population. Future analyses should explore factors influencing alloimmunization rates, such as ethnic diversity, matching protocols, and age-related variations, to inform clinical practice better.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"17 2","pages":"106-118"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11835558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Kidney Injury in Autoimmune-Mediated Rheumatic Diseases.","authors":"Daniel Patschan, Gerhard Schmalz, Wajima Safi, Friedrich Stasche, Igor Matyukhin, Oliver Ritter, Susann Patschan","doi":"10.14740/jocmr6149","DOIUrl":"10.14740/jocmr6149","url":null,"abstract":"<p><p>Acute kidney injury (AKI) is increasingly affecting hospitalized patients worldwide. Patients with inflammatory rheumatic diseases, although primarily impacted by functional impairment and sometimes structural damage to joints, bones, and muscle tissue, may also develop AKI during the course of their disease. This narrative review aimed to summarize potential causes of AKI and the associated disease patterns. The following databases were searched for references: PubMed, Web of Science, Cochrane Library, and Scopus. The search period covered from 1958 to 2024. Certain inflammatory rheumatic diseases increase the risk of AKI due to specific types of kidney disease. However, the most common conditions, such as rheumatoid arthritis and spondylarthritis, rarely cause AKI directly. Among the medications used for pain and sometimes disease activity control, nonsteroidal anti-inflammatory drugs (NSAIDs) can potentially induce AKI, even progressing to acute tubular necrosis. There is evidence that certain rheumatic diseases are associated with increased risk of AKI, independently of directly affecting kidney function or structure. However, the data on this topic are quite limited. AKI is a potentially significant issue for patients with inflammatory rheumatic diseases. Additional data on the increased risk of AKI, independent of direct kidney involvement, are needed.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"17 2","pages":"67-75"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11835554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolomics for Distinguishing Cardiovascular Risk in Rheumatoid Arthritis Across Different Disease-Modifying Antirheumatic Drug Therapies.","authors":"Inga Claus, Meike Hoffmeister, Selina Strathmeyer, Steffen Heelemann, Constantin Remus, Werner Dammermann, Oliver Ritter, Daniel Patschan, Susann Patschan","doi":"10.14740/jocmr6145","DOIUrl":"10.14740/jocmr6145","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid arthritis (RA) significantly increases the overall risk of cardiovascular disease (CVD). In addition to conventional risk factors, the inflammatory activity of the disease itself and medications that promote atherosclerosis contribute to an even greater risk. In this study, we performed metabolomic analysis in RA patients, both on and off disease-modifying anti-rheumatic drug (DMARD) therapy, with the aim of identifying new candidates for more sophisticated cardiovascular risk (CVR) assessment.</p><p><strong>Methods: </strong>This is an observational, cross-sectional investigation that included patients with established RA. DMARD therapy, if prescribed, consisted of methotrexate (MTX) alone or in combination with other conventional disease-modifying anti-rheumatic drugs (cDMARDs) or biologic disease-modifying anti-rheumatic drugs (bDMARDs), or other cDMARDs or bDMARDs without MTX, respectively. Metabolomic profiling was conducted using a Bruker AVANCE NEO 600 MHz nuclear magnetic resonance (NMR) spectrometer. The spectra obtained were Fourier transformed using TopSpin software (version 4.0, Bruker Biospin, Germany). All spectra were automatically phased and subjected to baseline correction. Subsequently, the spectra were analyzed using the proprietary Profiler software (version 1.4_Blood, lifespin GmbH, Germany), and a quantitative metabolite list was generated.</p><p><strong>Results: </strong>In total, 200 patients were included in the study, 54 subjects were not receiving any DMARDs (n = 47 untreated at the time of inclusion, n = 7 with established disease but not receiving DMARD therapy), and 146 were receiving DMARD treatment. No metabolic differences were found in relation to drug therapy or RA activity. The following CVR factors were associated with significant metabolic abnormalities: distress, arterial hypertension, diabetes mellitus and an average higher Framingham score. Distressed individuals showed abnormalities in histidine metabolism.</p><p><strong>Conclusions: </strong>Our findings have aided in the identification of potential surrogate markers for assessing the burden of CVD in individuals with RA. Histidine may be of particular diagnostic importance in CVR assessment in RA.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"17 2","pages":"89-96"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11835553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Extended Intensive Care Unit Stay Following Coronary Artery Bypass Grafting and Its Impact on Hospitalization and Mortality.","authors":"Nizar R Alwaqfi, Majd M AlBarakat, Walid K Hawashin, Hala R Qariouti, Ayah J Alkrarha, Rana B Altawalbeh","doi":"10.14740/jocmr6024","DOIUrl":"10.14740/jocmr6024","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery bypass grafting (CABG) is a prevalent surgical procedure aimed at alleviating symptoms and improving survival in patients with coronary artery disease (CAD). Postoperative care typically necessitates an intensive care unit (ICU) stay, which is ideally less than 24 h. However, various preoperative, intraoperative, and postoperative factors can prolong ICU stays, adversely affecting hospital resources, patient outcomes, and overall healthcare costs. This study investigates the factors contributing to prolonged ICU stay (> 48 h) following CABG and CABG combined with valve surgery, and examines the associated impacts on complications and mortality.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed 1,395 patients who underwent isolated CABG or CABG combined with heart valve surgery at King Abdullah University Hospital (KAUH) between January 2004 and December 2022. Patients were categorized into two groups: those with ICU stays ≤ 48 h (group 1, n = 1,082) and those with ICU stays > 48 h (group 2, n = 313). Clinical, laboratory, and demographic data were collected and evaluated to identify risk factors for prolonged ICU stays.</p><p><strong>Results: </strong>Patients in group 2 were older, with a mean age of 61.5 years compared to 58.7 years in group 1 (P < 0.001). Significant predictors of prolonged ICU stay included preoperative conditions such as recent myocardial infarction (odds ratio (OR) = 1.69, P = 0.015), chronic obstructive pulmonary disease or asthma (OR = 1.49, P = 0.003), and preoperative renal impairment (OR = 1.89, P = 0.002). Intraoperative factors such as emergency or urgent procedures (OR = 2.19, P < 0.001) and prolonged ventilator support (OR = 5.92, P < 0.001) were also significant. Postoperative complications, including renal impairment (OR = 6.78, P < 0.001) and pneumonia or sepsis (OR = 8.92, P < 0.001), were strongly associated with extended ICU stays.</p><p><strong>Conclusions: </strong>Prolonged ICU stays are indicative of patients with more severe baseline conditions, greater surgical complexity, and higher rates of postoperative complications, which collectively contribute to increased risks of severe adverse outcomes and mortality. Prolonged ICU stays after CABG are strongly associated with preoperative comorbidities, intraoperative challenges, and postoperative complications, leading to increased mortality and significant healthcare resource utilization. Identifying these risk factors and implementing targeted strategies to address them can help minimize ICU stay durations, improve patient outcomes, and enhance the efficiency of cardiac surgery care. Future research should focus on refining predictive models and optimizing perioperative management to further reduce the burden of prolonged ICU stays on healthcare systems.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"17 1","pages":"14-21"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}