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Background: How to assess the importance of predictors in systematic reviews (SR) of prediction models remains largely unknown. The commonly used indicators of importance for predictors in individual models include parameter estimates, information entropy, etc., but they cannot be quantitatively synthesized through meta-analysis. Methods: We explored the synthesis method of the importance indicators in a simulation study, which mainly solved the following four methodological issues: (1) whether to synthesize the original values of the importance indicators or the importance ranks; (2) whether to normalize the importance ranks to a same dimension; (3) whether and how to impute the missing values in importance ranks; and (4) whether to weight the importance indicators according to the sample size of the model during synthesis. Then we used an empirical SR to illustrate the feasibility and validity of the synthesis method. Results: According to the simulation experiments, we found that ranking or normalizing the values of the importance indicators had little impact on the synthesis results, while imputation of missing values in the importance ranks had a great impact on the synthesis results due to the incorporation of variable frequency. Moreover, the results of means and weighted means of the importance indicators were similar. In consideration of accuracy and interpretability, synthesis of the normalized importance ranks by weighted mean was recommended. The synthesis method was used in the SR of prediction models for acute kidney injury. The importance assessment results were approved by experienced nephrologists, which further verified the reliability of the synthesis method. Conclusions: An importance assessment of predictors should be included in SR of prediction models, using the weighted mean of importance ranks normalized to a same dimension in different models. [ABSTRACT FROM AUTHOR]

Objective: Maternal obesity is a highly suggestive risk factor of offspring congenital heart diseases (CHD). However, the risk of offspring CHD associated with maternal underweight has rarely been mentioned. Therefore, this study aimed to explore the effect of preconception underweight on offspring CHD. Methods: From November 2017 to August 2021, 132 386 pregnant women were enrolled in a birth cohort study in China in early pregnancy, and completed follow‐up until delivery (or miscarriage/termination). Offspring CHD was diagnosed by prenatal ultrasound examination in both live births and stillbirths. Log‐binomial regression and restricted cubic spline were used to estimate the risk of offspring CHD associated with preconception body mass index (BMI). A generalized additive model was used to explore the modification effect of maternal age on the association between preconception BMI and offspring CHD. Results: A total of 129 096 pregnant women were included in the analysis. The incidence of CHD in the underweight, normal weight, overweight, and obesity groups were 117/17 313 (0.68%), 556/85 695 (0.65%), 128/19 936 (0.64%), 47/6152 (0.76%), respectively. Both underweight and obesity before pregnancy marginally increased the risk of offspring CHD. The association between preconception BMI and offspring CHD varied by maternal age, with low preconception BMI associated with a significantly higher risk of offspring CHD in women <24 years (RR 2.32, 95% CI: 1.07–5.01 for 17 vs 21 kg/m2). Conclusion: Preconception underweight was associated with an increased risk of offspring CHD in young pregnant women. Therefore, weight gain is important to prevent offspring CHD, especially for young women with low preconception BMI. Synopsis: For young women, weight gain is recommended to achieve a preconception BMI of at least 18.5 kg/m2 to prevent offspring from CHD. [ABSTRACT FROM AUTHOR]

Only a few randomized trials have analyzed the clinical outcomes of elderly ST-segment elevation myocardial infarction (STEMI) patients (≥ 75 years old). Therefore, the best reperfusion strategy has not been well established. An observational study focused on clinical outcomes was performed in this population.Based on the national registry on STEMI patients, the in-hospital outcomes of elderly patients with different reperfusion strategies were compared. The primary endpoint was defined as death. Secondary endpoints included recurrent myocardial infarction, ischemia driven revascularization, myocardial infarction related complications, and major bleeding. Multivariable regression analysis was performed to adjust for the baseline disparities between the groups.Patients who had primary percutaneous coronary intervention (PCI) or fibrinolysis were relatively younger. They came to hospital earlier, and had lower risk of death compared with patients who had no reperfusion. The guideline recommended medications were more frequently used in patients with primary PCI during the hospitalization and at discharge. The rates of death were 7.7%, 15.0%, and 19.9% respectively, with primary PCI, fibrinolysis, and no reperfusion (P < 0.001). Patients having primary PCI also had lower rates of heart failure, mechanical complications, and cardiac arrest compared with fibrinolysis and no reperfusion (P < 0.05). The rates of hemorrhage stroke (0.3%, 0.6%, and 0.1%) and other major bleeding (3.0%, 5.0%, and 3.1%) were similar in the primary PCI, fibrinolysis, and no reperfusion group (P > 0.05). In the multivariable regression analysis, primary PCI outweighs no reperfusion in predicting the in-hospital death in patients ≥ 75 years old. However, fibrinolysis does not.Early reperfusion, especially primary PCI was safe and effective with absolute reduction of mortality compared with no reperfusion. However, certain randomized trials were encouraged to support the conclusion.

Background and objective: The major contributing risk factors to airflow obstruction (AO) in China remain largely unknown. We examined the environmental and lifestyle risk factors of unrecognized AO in the baseline of a population‐based cohort drawn from 115 urban and rural communities across 12 provinces in China. Methods: Amongst 46,285 adults recruited from 2005 to 2009, 3686 were identified with AO on spirometry (defined by the ratio of forced expiratory volume in the first second to forced vital capacity <0.7) and without known chronic lung disease. These cases were age‐ and sex‐matched to 11,129 controls with normal spirometry and no chronic lung disease from the same community. Conditional multivariable adjusted OR and population attributable fraction (PAF) were calculated for each identified risk factor and their combined effect. Results: Compared to controls, smoking initiation age <20 years (OR 1.22 [95% CI 1.01–1.48]), smoking duration ≥40 years (OR 1.82 [1.50–2.22]), low vegetables (OR 1.86 [1.67–2.07]) and fruits (OR 1.14 [1.02–1.29]) intake, cooking with biomass fuels (OR 2.54 [2.32–2.78]) and poor kitchen ventilation (OR 1.37 [1.19–1.58]) were significantly associated with elevated risks of unrecognized AO. The combined effect of these lifestyle factors significantly elevated the odds by 25 fold (18.6–34.3). The addition of prior tuberculosis and low socioeconomic status further increased the odds to 40.1 (28.2–57.0) and the PAF to 66.7% (51.1–78.1). Conclusion: Smoking, unhealthy diet, biomass cooking fuels and low socioeconomic status are strongly associated with AO. Addressing these risk factors could substantially reduce the burden of AO in China. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background and objective: No previous studies have examined differences in spirometry measurements among ethnic populations in China, and factors which may influence ethnic differences are unclear. Our study aimed to investigate whether forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) differ among Han Chinese and other ethnic minorities in China. Methods: We recruited 7137 individuals aged 35–70 years from four areas of China inhabited by ethnic minority groups between 2007 and 2009. We conducted spirometry tests for all available participants, and compared FEV1 and FVC among Uygur, Hui, Mongolian, Dai and Han Chinese ethnicities, using nonlinear multiplicative regression models. Results: A total of 2005 healthy never‐smokers were enrolled in the analysis. For all ethnicities, spirometry values increased with height and decreased with age; FEV1 and FVC were consistently higher in males than in females. Compared with Han Chinese, FEV1 was 4.42% (95% CI: 2.11–6.78%) higher in Mongolians, 4.08% (95% CI: 1.33–6.76%) lower in Uygurs, 4.39% (95% CI: 1.33–7.35%) lower in Hui people and 4.72% (95% CI: 1.80–7.55%) lower in Dai people, after adjusted for potential confounders including height, age, sex and place of residence. We observed similar differences for FVC. Conclusions: We detected significant differences in spirometry measurements among ethnic populations in China. Such differences cannot be fully explained by demographic, anthropometric or socioeconomic factors, but may also be attributed to genetic background as well as indoor and outdoor environmental exposures that need further investigation. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) is common in hospitalized children. A post-AKI outcomes prediction model is important for the early detection of important clinical outcomes associated with AKI so that early management of pediatric AKI patients can be initiated., Methods: Three retrospective cohorts were set up based on two pediatric hospitals in China, in which 8205 children suffered AKI during hospitalization. Two clinical outcomes were evaluated, i.e. hospital mortality and dialysis within 28 days after AKI occurrence. A Genetic Algorithm was used for feature selection, and a Random Forest model was built to predict clinical outcomes. Subsequently, a temporal validation set and an external validation set were used to evaluate the performance of the prediction model. Finally, the stratification ability of the prediction model for the risk of mortality was compared with a commonly used mortality risk score, the pediatric critical illness score (PCIS)., Results: The prediction model performed well for the prediction of hospital mortality with an area under the receiver operating curve (AUROC) of 0.854 [95% confidence interval (CI) 0.816-0.888], and the AUROC was >0.850 for both temporal and external validation. For the prediction of dialysis, the AUROC was 0.889 (95% CI 0.871-0.906). In addition, the AUROC of the prediction model for hospital mortality was superior to that of PCIS ( P  < .0001 in both temporal and external validation)., Conclusions: The new proposed post-AKI outcomes prediction model shows potential applicability in clinical settings., Competing Interests: On behalf of all authors, the corresponding author states that there is no conflict of interest., (© The Author(s) 2025. Published by Oxford University Press on behalf of the ERA.)

Background: Few large-scale studies have evaluated the effectiveness of percutaneous coronary intervention (PCI) technological advances in the treatment of patients with unprotected left main coronary artery disease (LM-CAD). We aim to identify independent factors that affect the prognosis of PCI in patients with unprotected LM-CAD and to assess the impact of PCI technological advances on long-term clinical outcomes., Methods and Results: A total of 4512 consecutive patients who underwent unprotected LM-CAD PCI at Fuwai Hospital from 2004 to 2016 were enrolled. Multivariable Cox proportional hazards model was used to identify which techniques can independently affect the incidence of major adverse cardiac events (MACEs; a composite of cardiac death, myocardial infarction, or target vessel revascularization). The incidence of 3-year MACEs was 9.0% (406/4512). Four new PCI techniques were identified as the independent protective factors of MACEs, including second-generation drug-eluting stents (hazard ratio [HR], 0.61 [95% CI, 0.37-0.99]), postdilatation (HR, 0.75 [95% CI, 0.59-0.94]), final kissing balloon inflation (HR, 0.78 [95% CI, 0.62-0.99]), and using intravascular ultrasound (HR, 0.78 [95% CI, 0.63-0.97]). The relative hazard of 3-year MACEs was reduced by ≈50% with use of all 4 techniques compared with no technique use (HR, 0.53 [95% CI, 0.32-0.87])., Conclusions: PCI technological advances including postdilatation, second-generation drug-eluting stent, final kissing balloon inflation, and intravascular ultrasound guidance were associated with improved clinical outcomes in patients who underwent unprotected LM-CAD PCI.