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Preview: QJM - Advance Access

QJM: An International Journal of Medicine Advance Access

Published: Wed, 14 Mar 2018 00:00:00 GMT

Last Build Date: Thu, 15 Mar 2018 01:52:09 GMT


Microscopic hematuria is a risk factor of incident chronic kidney disease in the Korean general population: a community-based prospective cohort study

Wed, 14 Mar 2018 00:00:00 GMT

Although asymptomatic microscopic hematuria (MH) is a common finding in clinical practice, its long-term outcome remains unknown.
This study evaluated the clinical implication of MH in the general population using a large-scale long-term longitudinal cohort database.
This study included 8719 participants from the Korean Genome and Epidemiology Study between 2001 and 2014. MH was defined as ≥ 5 red blood cells per high-power field in random urinalysis without evidence of pyuria. The primary study outcome measure was incident chronic kidney disease (CKD), defined as estimated glomerular filtration rate (eGFR) <60 mL min−1⋅1.73⋅m−2.
During a median follow-up of 11.7 years, CKD occurred in 677 (7.8%) subjects. In Cox regression after adjustment for multiple confounders, subjects with MH had a significantly higher risk of incident CKD than those without [hazard ratio (HR), 1.45; 95% CI, 1.12–1.87; P = 0.005]. Isolated MH without proteinuria was also a risk factor of incident CKD (HR, 1.37; 95% CI, 1.04–1.79; P = 0.023) and the risk was further increased in MH with concomitant proteinuria (HR, 5.41; 95% CI, 2.54–11.49; P < 0.001). In propensity score matching analysis after excluding subjects with proteinuria, multivariable stratified Cox regression analysis revealed that subjects with isolated MH had a significantly higher risk of incident CKD than those without (HR, 1.83; 95% CI, 1.14–2.94; P = 0.012).
The presence of MH is associated with an increased risk of incident CKD in the general population. Therefore, attentive follow-up is warranted in persons with MH for early detection of CKD.

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Wed, 14 Mar 2018 00:00:00 GMT

Validation of the MARS (Medical Admission Risk System): A combined physiological and laboratory risk prediction tool for 5- to 7-day in-hospital mortality

Sat, 10 Mar 2018 00:00:00 GMT

The MARS (Medical Admission Risk System) uses 11 physiological and laboratory data and had promising results in its derivation study for predicting 5 and 7 day mortality.
To perform an external independent validation of the MARS score.
An unplanned secondary cohort study.
Patients admitted to the medical admission unit (MAU) at The Hospital of South West Jutland were included from 2 October 2008 until 19 February 2009 and 23 February 2010 until 26 May 2010 were analysed. Validation of the MARS score using 5 and 7 day mortality was the primary endpoint.
5858 patients were included in the study. 2923 (49.9%) patients were women with a median age of 65 years (15-107). The MARS score had an AUROC of 0.858 (95% CI: 0.831-0.884) for 5-day mortality and 0.844 (0.818-0.870) for 7 day mortality with poor calibration for both outcomes.
The MARS score had excellent discriminatory power but poor calibration in predicting both 5 and 7-day mortality. The development of accurate combination physiological/laboratory data risk scores has the potential to improve the recognition of at risk patients.