Letter to the Editor
Reply
Réplica
a Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, Spain
b Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, Madrid, Spain
c Servicio de Cardiología, Hospital Clínico Universitario, Universitat de València, INCLIVA, Valencia, Spain
d CIBER Cardiovascular, Madrid, Spain
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Editor:" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "e2" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pau Llàcer, Luis Manzano, Julio Núñez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Pau" "apellidos" => "Llàcer" "email" => array:1 [ 0 => "paullacer@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Luis" "apellidos" => "Manzano" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Julio" "apellidos" => "Núñez" 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"identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Réplica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We would like to thank the authors of the letter entitled “Comparison Between CA125 and NT-proBNP for Evaluating Congestion in Acute Heart Failure” in reference to the paper with the same title.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We wish to clarify that, in said study, we aimed to examine the relationship between plasma NT-proBNP and carbohydrate antigen 125 (CA125) levels with subrogated clinical and ultrasound parameters of congestion, such as the presence of pleural effusion (yes/no), tibiomalleolar edemas (yes/no), and the diameter of the inferior vena cava (IVC) assessed by ultrasonography in 191 patients hospitalized for acute heart failure.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> As reflected in the original articles, factors independently associated with the presence of pleural effusion and peripheral edemas were evaluated through a logistic regression analysis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> To evaluate factors related to the IVC diameter, we carried out a multiple linear regression analysis assuming that there is a linear relationship between a larger IVC diameter and a greater severity of intravascular congestion. The authors of the cited letter suggest that the use of a multiple linear regression model was not appropriate in this scenario considering that the relationship between the IVC diameter and CA125 levels did not follow a linear pattern. Although the linear model requires the relationship between the dependent and independent variable to be linear, we can occasionally observe phenomena in which this does not apply, and the use of fractional polynomials is a mathematical strategy whereby linearity is restored by transforming the independent variable, which in this case is CA125. However, it would be very confusing for the reader to appreciate the correlation using the variable transformed into its polynomial (it would look like a straight line between the IVC variable with CA125 values raised to a power of 0.5). In this case, the statistical package back-transforms the CA125 values into the original values, but the relationship curve defined by the polynomial used previously remains.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">As a result, whenever these associations had a non-linear nature, they were modeled using non-linear terms (e.g., quadratic, cubic, etc.) applying the fractional polynomial method.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Once such polynomial was identified (CA125 was included as fp-.5 specifically in this study), it was included in the regression model instead of the original variable. Thus, the non-linear relationship between both variables (Y|X) was modeled by means of the fractional polynomial, which in the regression model is included as a new variable (X’<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>X<span class="elsevierStyleSup">2</span>) that meets the linearity principle. Figure 3a depicts such non-linear relationship between variables IVC diameter and CA125 to facilitate its interpretation.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Llàcer P, Manzano L, Núñez J. Réplica a la carta al Editor al artículo «Comparación entre CA125 y NT-proBNP para valorar la congestión en insuficiencia cardiaca aguda». Med Clin (Barc). 2022;159:e2.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison between CA125 and NT-proBNP for evaluating congestion in acute heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Llàcer" 1 => "MÁ Gallardo" 2 => "P. Palau" 3 => "M.C. Moreno" 4 => "C. Castillo" 5 => "C. Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2020.05.063" "Revista" => array:6 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2021" "volumen" => "156" "paginaInicial" => "589" "paginaFinal" => "594" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32951882" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Regression using fractional polynomials of continuous covariates: parsimonious parametric modelling" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Royston" 1 => "D.G. 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Sauerbrei" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ije/28.5.964" "Revista" => array:6 [ "tituloSerie" => "Int J Epidemiol" "fecha" => "1999" "volumen" => "28" "paginaInicial" => "964" "paginaFinal" => "974" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10597998" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015900000001/v2_202301300833/S2387020622002947/v2_202301300833/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015900000001/v2_202301300833/S2387020622002947/v2_202301300833/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020622002947?idApp=UINPBA00004N" ]
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