Hazard functioning modeling for dextrose fluids associated hemodilution; Cox-regressional analysis for patients’ Hematocrit Hemoglobin Ratio
1 Clinical Pharmacy department, Royal Medical Services, Amman, Jordan.
2 Internal Medicine department, Royal Medical Services, Amman, Jordan.
Research Article
World Journal of Biology Pharmacy and Health Sciences, 2024, 18(02), 005–015.
Article DOI: 10.30574/wjbphs.2024.18.2.0212
Publication history:
Received on 15 April 2024; revised on 15 April 2024; accepted on 16 April 2024
Abstract:
Aims: This study looks at the cox-regressional relationships between hematocrit to hemoglobin ratio (HHR) and a group of outcomes of interest (cOI). These outcomes include death from any cause, acute myocardial infarction, stroke, and severe dilutional hyponatraemia incidence. Additionally other outcome of interest in this study will be prolongation of admission days, infection rate, acute kidney injury, and mandating the transition to the critical unit and mechanical ventilation intubation. The study also will investigate the performances of the tested ratio and will explore their sensitivity, specificity, and accuracy indexes.
Methods: Between 2018 and 2022, a retrospective study was conducted at the King Hussein Medical Centre in Amman, Jordan, involving 926 patients. The study aimed to determine the potential risk of dilution of red blood cells in circulation caused by dextrose-containing fluids in patients with chronic kidney disease. The study aimed to determine the ideal threshold levels of the investigated ratio (HHR) to enhance clinical outcomes and safety margins, particularly in patients with severe renal impairment or chronic kidney disease in a hospital setting. The study included patients with fluctuating kidney function, renal replacement therapy, uncontrolled diabetes, and conditions necessitating specific fluid regimens. The study used binary logistic regression and cox-regression proportional hazard modelling to examine the correlation between the hematocrit to haemoglobin ratio and the composite outcomes of interest (cOI) in patients from Jordan. The findings suggest that higher cOI likelihood indicates a more advantageous condition, while lower values suggest a less advantageous condition.
Results: A retrospective study at the KHMC in Amman, Jordan, involved 1306 patients from 2018 to 2022. The study focused on the hematocrit to haemoglobin ratio (HHR) and achieved correct classification rates of 70.8%. The best HHR was 2.555:1, with a 42.8% chance of occurring at this level. Cox-Regression Proportional Hazard Modelling revealed a censored percentage of 83.4% in HHR>2.555 stratum and 51.5% in HHR≤2.555 stratum. The study found a high percentage of HD patients processed in the analysis.
Conclusion: Intravenous dextrose fluids associated hemodilutional state is linked to all-cause mortality in admitted medically and surgically patients and cardiovascular death. Low ratio increases the risk. Factors such as malnutrition and kidney function loss contribute to prognosis. Future studies should focus on mechanistic pathways, optimal targets, age, and sociodemographic factors.
Keywords:
Hematocrit to hemoglobin ratio; Maintenance fluid associated hemodilutional Optimal operating thresholds; Overall health status; Cox-Regression Modeling; Jordanian cohort.
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