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Research Article | DOI: https://doi.org/10.31579/2640-1045/208
1Department of History, The University of Burdwan, Burdwan, West Bengal, India.
2Department of Statistics, The University of Burdwan, Burdwan, West Bengal, India.
*Corresponding Author: Rabindra Nath Das, Department of Statistics, The University of Burdwan, Burdwan, W.B.,713104, India.
Citation: Mahashweta Das, Gaurab Bhattacharyya, Rabindra N. Das, (2025), Effects of Serum Creatinine on Heart, Diabetes, And Anaemia Patients, J. Endocrinology and Disorders, 9(1); DOI:10.31579/2640-1045/208
Copyright: © 2025, Rabindra Nath Das. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 07 January 2025 | Accepted: 20 January 2025 | Published: 30 January 2025
Keywords: creatinine phosphokinase (CPK); ejection fraction (EFT); hypertension; joint generalized linear models (JGLMs); serum creatinine (SCT); serum sodium (SNa)
Objectives: The report aims to examine the effects of serum creatinine (SCT) on heart, diabetes, anaemia and normal study units, and along with the other biological factors. The study is based on the relationship of serum creatinine with heart, diabetes, anaemia patients and many other factors.
Materials & Methods: A real data set of 299 heart patients with 13 study characters is taken in the current study, the data set is available herein: https://archive.ics.uci.edu/ml/datasets/Heart+failure+clinical+records, and the serum creatinine probabilistic model has been developed applying statistical joint generalized linear models.
Results: From the fitted Log-normal model, the mean serum creatinine (SCT) is positively associated with age (P<0.0001). It is partially negatively associated with ejection fraction (EFT) (P=0.0974) and partially positively associated with the joint interaction effects (JIEs) of EFT and the death-event (DEE), i.e., EFT*DEE (P=0.1168). It is negatively associated with creatinine phosphokinase (CPK) (P<0.0001) and serum sodium (SNa) (P<0.0001), while it is positively associated with their JIEs, i.e., CPK*SNa (P<0.0001). It is negatively associated with high blood pressure (BP) (P=0.0030). It is partially negatively associated with the JIEs of anaemia status (ANS) and time up to the end of the follow-up period (TFP) i.e., ANS*TFP (P=0.1299), while it is independent of both the ANS and TFP. It is negatively associated with the smoking status (SMS) (P=0.0007), and positively associated with the JIEs of SMS and TFP, i.e. SMS*TFP (P=0.0016). Variance of SCT is negative associated with age (P=0.0543) and ANS (P=0.0044), while it is positively associated with their JIEs, i.e. AGE*ANS (P=0.0070). SCT variance is negatively associated with CPK (P=0.0001), while it is partially positively associated with the JIEs of CPK and ANS i.e., CPK*ANS (P=0.1482). Variance of SCT is negatively associated with diabetes mellitus status (DMS) (P=0.0199), while it is positively associated with the JIEs of CPK and DMS i.e., CPK*DMS (P=0.0086). There are many more significant effects in the SCT variance model.
Conclusions: From this data set, it is clear that mean and variance of serum creatinine is associated with the heart, diabetes and anaemia patients. It affects age, EFT, CPK, SNa, PLC, BP, ANS, DMS, SMS, SEX, TFP, DEE and their many joint interaction effects.
Several studies pointed out that elevated serum creatinine (SCT) may be an independent explanatory factor of all-cause of cardiovascular disease parameters and mortality predictor variables [1-4]. These articles have studied some specific cardiac disease groups such as patients with recent stroke [1], hypertensive individuals [2], survivors of myocardial infarction [3], and the elderly individuals [4]. Effects of SCT level on hypertension have been studied in different articles [5-8], but there is no firm conclusion of the effect of SCT on high blood pressure (BP). Some articles have tried to identify the effects of SCT on some other cardiac parameters such as ejection fraction (EFT), heart rate, BP and stroke, but there are no definite conclusions [5-8].
Role of SCT on diabetes patients has been studied in different articles [9-13]. A very few articles have focused on association of low SCT level with type 2 diabetes mellitus [14-16]. For example, a case-control study of 1122 study units in Trinidad and Tobago showed an association of low SCT level with type 2 diabetes mellitus [14]. Similarly, a cross-sectional study of 1017 subjects with morbid obesity age group 18–75 years have shown a positive association between SCT level and diabetes prevalence [15]. Article [16] has studied whether low SCT level, a surrogate marker of skeletal muscle mass, was correlated with an increased risk of incident dysglycemia including type 2 diabetes mellitus.
Effects of SCT levels on anaemia patients have been studied in different articles [17-20]. Previous articles have tried to establish a relationship between hemoglobin (Hgb) levels and SCT levels of anaemia patients. Numasawa, Inohara, Ishii et al. [17] have tried to derive a simple composite indicator of baseline Hgb and SCT levels to examine their joint (or compound) effects on clinical outcomes. These researchers have derived a single explanatory factor (or index) namely Hgb/SCT ratio to examine the effects of clinical outcomes. Earlier articles [18-20] have pointed out that preprocedural anemia and impaired renal function are correlated with each other. It is observed that there is no definite conclusion based on some suitable statistical modeling. These findings may invite some doubts and debates.
Some earlier articles have examined the effects of serum creatinine (SCT) on heart, diabetes and anaemia patients using simple correlation, regression analysis, and machine learning etc. Most of the earlier articles invite some doubts and debates, as the analysis approaches that are used in the earlier articles are not appropriate. In addition, appropriate model diagnostics of the used methods are not discussed in the earlier articles. The effects of SCT are little studied based on probabilistic modelling. The current article examines the following research queries.
The article searches the above research problems considering the following sections such as materials & methods, statistical analysis & results, discussions, and conclusions. The serum creatinine probabilistic model is displayed in Table 1 based on the data set pointed in the materials section. The probabilistic serum creatinine means and dispersion models are developed by joint generalized linear models (JGLMs), which is described in the methods section. The obtained findings of SCT analysis are presented in the results section, and the results are illustrated in the discussion section. Based on the derived SCT probabilistic model, the present article has obtained some information that is presented in the conclusions section.
Materials
The serum creatinine probabilistic model is derived herein using a data set of 299 heart failure subjects collected from the Faisalabad Institute of Cardiology under the Allied Hospital at Faisalabad in Punjab, Pakistan, during the period April to December 2015 [21, 22]. The data set is available in the site
https://archive.ics.uci.edu/ml/datasets/Heart+failure+clinical+records,
The data set is clearly presented by the authors in the article [22]. The original study [21] contained 194 male and 105 female subjects, and they all had left ventricular systolic dysfunction. All the subjects had previous heart failures, and accordingly, they were classed in III or IV heart failure stages of New York Heart Association (NYHA) classification [23]. The ethics approval and the participant consents of the study is clearly stated in the original article [21]. Recently an article by Chicco and Jurman [24] illustrates clearly this heart failure data set using two tables, which describe separately continuous and attribute characters.
The study contains 13 characters out of which 7 are continuous and 6 are attribute. The continuous study characters are age (x1), creatinine phosphokinase (CPK) (x3), ejection fraction (EFT) (x5), platelets count (PLC) (x7), serum creatinine (SCT) (x8), serum sodium (SNa) (x9), time up to the end of the follow-up period (TFP) (x12), while the attribute characters are anaemia status (ANS) of the patients (0= no anaemia, 1= anaemia) (Fx2), diabetes mellitus status (DMS) of the patients (0= no diabetes, 1= diabetes) (Fx4), high blood pressure (BP) of patients (0= normal BP, 1=high BP) (Fx6), sex (0=female, 1=male) (Fx10), smoking status (SMS) (0=no smoking, 1= smoking) (Fx11), death event (DEE) (0=alive, 1=death) (Fx13). A subject was classed as anaemia patient if his/her haematocrit levels were lower than 36% [21]. There is no information regarding the classification of high BP patients in the original article [21]. The death event indicates that the patient died (=1) or survived (=0) up to the end of the follow-up period, that was 130 days on average [21].
The creatinine phosphokinase (CPK) indicates the CPK enzyme levels in blood. If a muscle tissue gets damaged, CPK flows into the blood. So high CPK enzyme levels in the blood of a subject might indicate a heart failure or injury [25]. The serum creatinine (SCT) is a waste product produced by creatine, if a muscle breaks down. High serum creatinine levels in blood may indicate renal dysfunction [26]. Medical practitioners focus on serum creatinine in blood to examine the kidney function [27]. The original data source article [21] unfortunately does not present any information whether any patient had primary kidney disease or not, and it does not provide any additional information about what type of follow-up was carried out for examining kidney disease patients. The ejection fraction (EFT) indicates the percentage of how much blood the left ventricle pumps out with each contraction. Serum sodium (SNa) a mineral substance is responsible for the correct functioning of nerves and muscles. The serum sodium blood routine test of a subject indicates the normal or abnormal levels of sodium in the blood. An abnormally low level of sodium in the blood might be caused by heart failure [28]. Further information about the data set can be obtained easily from the original articles [21, 22]. Interested readers may go through the original articles [21, 22].
Statistical Methods
In the present study, serum creatinine (SCT) is the aimed response random variable that is to be modeled with the left biochemical, cardiac, disease status and physiological factors. It is identified that the response SCT is heteroscedastic and non-normally distributed random variable. The variance of SCT is not stabilized with any suitable transformation, so it is modeled herein using joint generalized linear models (JGLMs) under both the gamma and log-normal distribution, which has been clearly given in [29-32]. For detailed discussion about JGLMs, interested readers may consult with the book by Lee, Nelder and Pawitan [29]. Very shortly JGLMS under both the gamma and log-normal distribution are shortly presented herein.
JGLMs for log-normal distribution: For the positive response Yi (=SCT) with E(Yi=SCT) = µi (mean) and Var(Yi=SCT) = µi2 = say, where ’s are dispersion parameters, and V (
) reveals the variance function. Generally, the log transformation Zi = log (Yi=SCT) is applied to stabilize the variance Var (Zi) ≈ , but the variance may not always be stabilized [32]. For developing an improved model, JGLMs for the mean and dispersion are considered. For the response SCT, assuming log-normal distribution, JGL mean and dispersion models (with Zi = log (Yi=SCT)) are as follows:
E(Zi)= µ zi and Var (Zi) = σzi2,
µ zi=xit β and log (σzi2) = git γ,
where xit and git are the dependent or explanatory factors/variables vectors linked to the regression coefficients β and γ, respectively.
JGLMs for gamma distribution: For the above stated Yi’s (=SCT), the variance has two components such as (based on the mean parameters) and (free of µi’s). The variance function V (
) reveals the GLM family distributions. For example, if V() =, it is Poisson, gamma if V() = , and normal if V()= 1 etc. Gamma JGLMs means and dispersion models of SCT are as follows:
and ,
where and are the GLM link functions associated for the mean and dispersion linear predictors respectively, and , are the explanatory factors/variables vectors attached with the mean and dispersion parameters respectively. Maximum likelihood (ML) method is used for estimating mean parameters, while the restricted ML (REML) method is applied for estimating dispersion parameters, which are explicitly stated in the book by Lee, Nelder and Pawitan [29].
Statistical Analysis
The response SCT is modeled by JGLMs with both the Gamma and Log-normal distributions. In the analysis, SCT is considered as the response (dependent) variable, and the remaining 12 variables are considered as the SCT’s explanatory variables. Final model has been chosen based on the lowest Akaike information criterion (AIC) value (within each class), which minimizes both the squared error loss and predicted additive errors [33, p. 203--204]. According to the AIC criterion, JGLMs Log-normal fit (AIC=301.0) is better than the Gamma fit (AIC= 345.513).
In the SCT mean model, only one main effects sex (=Fx10) (P=0.2478) (insignificant in the Log-normal model, while it is partially significant in the Gamma model (P=0.1234)), and two partially significant joint effects such as EFT*DEE (x5*Fx13) (P=0.1168) and TFP*ANS (x12*Fx2) (P=0.1299) are included for better model fitting [33]. Note that in Epidemiology, partial significant effects are known as confounders. The other partially or insignificant effects such as EFT (x5) (P=0.0974), DEE (Fx13) (P=0.7184), TFP (x12) (P=0.3731) and ANS (Fx2) (P=0.4901) are included in the mean model due to Nelder’s marginality rule [34], namely that if an interaction effect (for example, here EFT*DEE) is significant or partially significant, so all its related lower-order effects (for example, here EFT and DEE) should be included in the mean model. Similarly, in the variance model, some partially significant or insignificant effects such as CPK*ANS (x3*Fx2) (P=0.1482), TFP*ANS (x12*Fx2) (P=0.2757) (for Gamma model (P=0.1482)) and SMS (Fx11) (P=0.3812) are included. In both the fitted models there are many discrepancies such as AIC values, values of the estimates, standard errors, P-values etc. [34]. Log-normal fitted models give better fit, and the analysis results are presented for both the models in Table 1.
The derived SCT’s probabilistic model (Table 1) is a data derived model that should be examined using model checking tools. All the valid interpretations are drawn from the data generated probabilistic model. For the joint Log-normal fitted SCT models (Table 1), model verification graphical analysis is displayed in Figure 1. Figure 1(a) presents the SCT fitted absolute residuals against the fitted values, which is almost a flat line, implying that variance is constant with the running means. Figure 1(b) displays the normal probability plot for the SCT fitted mean model (Table 1) that does not show any lack of fit. These two Figures 1(a) and 1(b) do not show any SCT fitted model’s (Table 1) discrepancy. These two figures show that the Log-normal fitted SCT model (Table 1) is an approximate of the unknown SCT model.
Figure. 1 (a)
Figure 1 (b)
Figure 1: For the joint Log-normal SCT fitted models (Table 1), the (a) absolute residuals plot with the SCT fitted values, and (b) the normal probability plot for the SCT mean model
Final SCT analysis outcomes for both the fitted Log-normal and Gamma models are displayed in Table 1. AIC rule selects the Log-normal fitted SCT model. The following results are described herein using the SCT fitted Log-normal model.
From the SCT fitted mean Log-normal model (Table 1), it is derived that mean SCT is positively associated with AGE (P<0 P=0.0974) P=0.1168). P=0.0030). P=0.1299), P=0.4901) P=0.3731). P=0.0007), P=0.0016).>
From the SCT fitted dispersion Log-normal model (Table 1), it is derived that the variance of SCT is negatively associated with age (P=0.0543) and ANS (P=0.0044), while it is positively associated with their JIEs, i.e. AGE*ANS (P=0.0070). SCT variance is negatively associated with CPK (P=0.0001), while it is partially positively associated with the JIEs of CPK and ANS i.e., CPK*ANS (P=0.1482). Variance of SCT is negatively associated with diabetes mellitus status (DMS) (P=0.0199) and CPK (P=0.0001), while it is positively associated with their JIEs of CPK*DMS (P=0.0086). SCT variance is negatively associated with EFT (P=0.0019) and ANS (P=0.0044), while it is positively associated with their JIEs of EFT*ANS (P=0.0234). It is negatively associated with PLC (P=0.0547) and BP (P=0.0137), while it is positively associated with their JIEs of PLC*BP (P=0.0347). It is negatively associated with DEE (P=0.0002) and EFT (P=0.0019), while it is positively associated with their JIEs of EFT*DEE (P<0 P=0.1416) P=0.0044), P=0.2757). P=0.0914), P=0.3812). >
Log-normal fitted SCT mean (z) model (Table 1) is
z= 2.83 + 0.007 AGE – 00029 EFT + 0.0519 DEE + 0.0069 EFT*DEE – 0.0019 CPK – 0.0215 SNa + 0.0001 CPK*SNa – 0.1113 BP – 0.0003 TFP + 0.0602 ANS – 0.0008 TFP*ANS + 0.049 SEX – 0.2591 SMS + 0.0015 TFP*SMS,
and the fitted SCT variance (z) model is
z= exp. (1.6286 – 0.0224 AGE – 4.0776 ANS + 0.0518 AGE*ANS - 0.0006 CPK + 0.0005 CPK*ANS – 0.5959 DMS + 0.0006 CPK*DMS – 0.0355 EFT + 0.0332 EFT*ANS – 0.0001 PLC – 1.4723 BP + 0.0001 PLC*BP–2.4493 DEE + 0.0767 EFT*DEE– 0.0028TFP – 0.0032 TFP*ANS + 0.4080 SEX – 0.2012 SMS).
Note that mean SCT is explained by AGE, EFT, DEE, EFT*DEE, CPK, SNa, CPK*SNa, BP, TFP, ANS, TFP*ANS, SEX, SMS, TFP*SMS, while its variance is explained by AGE, ANS, AGE*ANS, CPK, CPK*ANS, DMS, CPK*DMS, EFT, EFT*ANS, PLC, BP, PLC*BP, DEE, EFT*DEE, TFP, TFP*ANS, SEX, SMS.
| Model | Covariates | Gamma Model Fit | Log-Normal Model Fit | ||||||
| Estimate | s.e. | t-value | p-value | Estimate | s.e. | t-value | p-value | ||
Mean | constant | 3.1105 | 0.6709 | 4.636 | <0> | 2.8300 | 0.6385 | 4.432 | <0> |
| AGE (x1) | 0.0072 | 0.0016 | 4.472 | <0> | 0.0070 | 0.0015 | 4.497 | <0> | |
| EFT (x5) | -0.0037 | 0.0018 | -2.008 | 0.0456 | -0.0029 | 0.0017 | -1.663 | 0.0974 | |
| DEE(Fx13) | -0.1619 | 0.1516 | -1.068 | 0.2864 | 0.0519 | 0.1437 | 0.361 | 0.7184 | |
| x5*Fx13 | 0.0139 | 0.0046 | 2.956 | 0.0034 | 0.0069 | 0.0044 | 1.573 | 0.1168 | |
| CPK(x3) | -0.0021 | 0.0004 | -4.940 | <0> | -0.0019 | 0.0004 | -4.403 | <0> | |
| SNa (x9) | -0.0230 | 0.0049 | -4.662 | <0> | -0.0215 | 0.0046 | -4.585 | <0> | |
| x3*x9 | 0.0001 | 0.0001 | 4.773 | <0> | 0.0001 | 0.0001 | 4.273 | <0> | |
| BP (Fx6) | -0.1222 | 0.0401 | -3.051 | 0.0025 | -0.1113 | 0.0373 | -2.988 | 0.0030 | |
| TFP (x12) | -0.0004 | 0.0004 | -1.075 | 0.2833 | -0.0003 | 0.0003 | -0.892 | 0.3731 | |
| ANS(Fx2) | 0.1491 | 0.0922 | 1.618 | 0.1068 | 0.0602 | 0.0870 | 0.691 | 0.4901 | |
| x12*Fx2 | -0.0013 | 0.0005 | -2.466 | 0.0142 | -0.0008 | 0.0005 | -1.519 | 0.1299 | |
| SEX(Fx10) | 0.0696 | 0.0451 | 1.545 | 0.1234 | 0.0490 | 0.0423 | 1.158 | 0.2478 | |
| SMS(Fx11) | -0.2570 | 0.0765 | -3.358 | 0.0009 | -0.2591 | 0.0758 | -3.417 | 0.0007 | |
| x12*Fx11 | 0.0014 | 0.0005 | 2.965 | 0.0033 | 0.0015 | 0.0005 | 3.191 | 0.0016 | |
Dispersion | Constant | 1.6712 | 1.1746 | 1.423 | 0.1558 | 1.6286 | 1.1068 | 1.472 | 0.1421 |
| AGE(x1) | -0.0184 | 0.0122 | -1.510 | 0.1321 | -0.0224 | 0.0116 | -1.932 | 0.0543 | |
| ANS(Fx2) | -3.6705 | 1.4494 | -2.532 | 0.0119 | -4.0776 | 1.4191 | -2.873 | 0.0044 | |
| x1*Fx2 | 0.0431 | 0.0194 | 2.216 | 0.0275 | 0.0518 | 0.0191 | 2.716 | 0.0070 | |
| CPK(x3) | -0.0006 | 0.0002 | -4.182 | <0> | -0.0006 | 0.0002 | -3.889 | 0.0001 | |
| x3*Fx2 | 0.0007 | 0.0004 | 1.696 | 0.0910 | 0.0005 | 0.0004 | 1.450 | 0.1482 | |
| DMS(Fx4) | -0.6130 | 0.2659 | -2.305 | 0.0219 | -0.5959 | 0.2545 | -2.341 | 0.0199 | |
| x3*Fx4 | 0.0007 | 0.0003 | 2.594 | 0.0100 | 0.0006 | 0.0002 | 2.644 | 0.0086 | |
| EFT (x5) | -0.0393 | 0.0116 | -3.404 | 0.0007 | -0.0355 | 0.0113 | -3.126 | 0.0019 | |
| x5*Fx2 | 0.0387 | 0.0149 | 2.593 | 0.0100 | 0.0332 | 0.0146 | 2.279 | 0.0234 | |
| PLC(x7) | -0.0001 | 0.0001 | -1.988 | 0.0478 | -0.0001 | 0.0001 | -1.929 | 0.0547 | |
| BP(Fx6) | -1.2327 | 0.6029 | -2.045 | 0.0418 | -1.4723 | 0.5938 | -2.480 | 0.0137 | |
| x7*Fx6 | 0.0001 | 0.0001 | 1.870 | 0.0625 | 0.0001 | 0.0001 | 2.122 | 0.0347 | |
| DEE(Fx13) | -2.6839 | 0.6671 | -4.023 | <0> | -2.4493 | 0.6584 | -3.720 | 0.0002 | |
| x5*Fx13 | 0.0813 | 0.0165 | 4.938 | <0> | 0.0767 | 0.0160 | 4.791 | <0> | |
| TFP(x12) | -0.0026 | 0.0019 | -1.323 | 0.1869 | -0.0028 | 0.0019 | -1.474 | 0.1416 | |
| x12*Fx2 | -0.0042 | 0.0029 | -1.450 | 0.1482 | -0.0032 | 0.0029 | -1.092 | 0.2757 | |
| SEX(Fx10) | 0.3776 | 0.2507 | 1.507 | 0.1329 | 0.4084 | 0.2412 | 1.694 | 0.0914 | |
| SMS(Fx11) | -0.2245 | 0.2368 | -0.948 | 0.3439 | -0.2012 | 0.2293 | -0.877 | 0.3812 | |
| AIC | 345.513 | 301.0 | |||||||
Table 1: Results for mean and dispersion models for serum creatinine from Gamma & Log-normal fit
The mean and variance SCT analysis outputs for Log-normal and Gamma fitted models are shown in Table 1. The SCT fitted Log-normal mean and variance models are shown above. In Table 1, there are some discrepancies in SCT fitting between the Log-normal and Gamma models (Table 1), which are well illustrated in [35].
In the given data set, there are only two heart disease related risk factors such as ejection fraction (EFT) (x5) and high blood pressure status (BP) (0= normal BP, 1=high BP) (Fx6). The data set contains only one anaemia status (ANS) disease factors, (0= no anaemia, 1= anaemia) (Fx2), and only one subject’s diabetes mellitus status (0= no diabetes, 1= diabetes) (DMS) (Fx4). Table 1 shows different mean-variance associations of SCT with (i) cardiac parameters (EFT & BP) (ii) anaemia status (ANS) disease factor and (iii) subject’s diabetes mellitus status (DMS), and the effects of SCT on the cardiac parameters, anaemia status and diabetes mellitus status are discussed in the following paragraphs.
From the SCT fitted mean Log-normal model (Table 1), it is derived that mean SCT is positively associated with AGE (P<0 P=0.0974) P=0.1168). P=0.0030), P=0.0019) P=0.0044), P=0.0234).It P=0.0547) P=0.0137), P=0.0347). P=0.0002) P=0.0019),>
From the SCT fitted mean Log-normal model (Table 1), it is derived that mean SCT level is partially negatively associated with the JIEs of anaemia status (ANS) (0= no anaemia, 1= anaemia) and time up to the end of the follow-up period (TFP) i.e., ANS*TFP (P=0.1299), while it is independent of both the ANS (P=0.4901) and TFP (P=0.3731). This indicates that the mean SCT level is higher for non-anaemia patients with smaller follow up time. The variance of SCT is negatively associated with age (P=0.0543) and ANS (P=0.0044), while it is positively associated with their JIEs, i.e. AGE*ANS (P=0.0070). It indicates that SCT level’s scatteredness increases for the anaemia patients with older ages. SCT variance is negatively associated with CPK (P=0.0001), while it is partially positively associated with the JIEs of CPK and ANS i.e., CPK*ANS (P=0.1482). This implies that SCT level’s scatteredness increases for the anaemia patients with higher CPK levels. SCT variance is negatively associated with TFP (P=0.1416) (partially) and ANS (P=0.0044), while it is partially negatively associated with their JIEs of TFP*ANS (P=0.2757). This indicates that SCT level’s scatteredness increases for the non-anaemia patients with lower follow up time. Same as cardiac patients, it can be restated that SCT variance is negatively associated with EFT (P=0.0019) and ANS (P=0.0044), while it is positively associated with their JIEs of EFT*ANS (P=0.0234) It indicates that SCT level’s scatteredness increases for the anaemia patients with higher EFT levels.
From the SCT fitted mean Log-normal model (Table 1), it is observed that mean SCT is not associated with the subject’s diabetes mellitus status (DMS) (0= no diabetes, 1= diabetes), while its variance is associated with DMS. Note that variance of SCT is negatively associated with DMS (P=0.0199) and CPK (P=0.0001), while it is positively associated with their JIEs of CPK*DMS (P=0.0086). It indicates that SCT level’s scatteredness increases for the diabetes patients with higher CPK levels.
From the SCT fitted Log-normal model (Table 1), it is observed that mean and variance of SCT are associated with some other factors, which are not jointly associated with the above three disease factors. Note that mean SCT is negatively associated with creatinine phosphokinase (CPK) (P<0 P=0.0007), P=0.0016), P=0.3731) P=0.0914),>
The report has derived the associations of SCT with cardiac factors EFT & BP, anaemia status, diabetes status and some other physiological and biochemical parameters of some cardiac patients. The fitted SCT models is finalized based on the smallest AIC value on comparison of both Log-normal (AIC=301.0) and Gamma (AIC=345.513) fitted JGLMs, model diagnostic plots (Figure 1) and small standard error of the estimates (Table 1). It has been derived herein that SCT level increases at older ages, and for smokers with the joint effect of long time follow up. In addition, SCT level is higher for the cardiac patients who are near to death than the surviving cardiac patients, and also higher SCT levels can decrease BP, that may invite stroke for the cardiac patients. Also, the mean SCT level is higher for non-anaemia patients with smaller follow up time. Mean SCT level increases as the joint effect of CPK*SNa increases. Moreover, SCT’s variance level has different associations of many factors that have been discussed above. The given data set does not give any information regarding kidney patients, so it is not possible to conclude about the kidney patients. The current data set does not contain diabetes markers such as glucose level, HbA1c, anaemia indicator hemoglobin, and many other cardiac parameters. So, the current report is unable to focus on the effects of SCT on these above parameters. It is expected that future researchers may consider these parameters for more fruitful studies. Therefore, the report will help the cardiac, anaemia, diabetes patients, researchers and practitioners to know the effect of SCT levels. Care should be taken for the SCT levels at older ages along with smoking, SNa and CPK levels.
Funding Resource: The work is not supported by any agency.
Conflict of interest: The authors confirm that this article content has no conflict of interest.
Acknowledgement: The authors are very grateful to the principal data investigators, who provided the data freely for scientific study.
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Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
