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Risk of Retinal Vein Occlusion between Glucagon-Like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase-4 Inhibitors in Type 2 Diabetes: A Retrospective Cohort Study

Objective

To evaluate whether glucagon-like peptide-1 receptor agonists (GLP-1RAs) are associated with reduced retinal vein occlusion (RVO) risk compared with dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with type 2 diabetes mellitus (T2DM).

Design

A multinational, retrospective cohort study.

Participants

Adults with T2DM newly prescribed GLP-1RAs or DPP-4 inhibitors between 2006 and 2023 were included in our analysis.

Methods

This study leveraged data from populations across 21 countries. Propensity score matching at a 1:1 ratio balanced age, sex, race, glycated hemoglobin (HbA1c), body mass index (BMI), estimated glomerular filtration rate, medications, and comorbidities between GLP-1RA and DPP4 inhibitor users.

Main Outcomes Measures

We observed the occurrence of incident RVO and branch RVO (BRVO) in the overall population and in subpopulations stratified by age, sex, race, GLP-1RA type, baseline HbA1c, BMI, and diabetes duration.

Results

Among 79 486 matched participants, GLP-1RA use is associated with a lower risk of RVO (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.54-0.98) and BRVO (HR, 0.62; 95% CI, 0.41-0.95) over 5 years compared with DPP-4 inhibitor use. This association is consistent among patients aged ≥50 years, Blacks, those prescribed human-analog GLP-1RAs, and those with baseline HbA1c ≥8%, BMI ≥30 kg/m2, and diabetes duration ≥3 years.

Conclusions

Glucagon-like peptide-1 receptor agonist use was linked to reduced RVO and BRVO risks in patients with T2DM when compared with DPP-4 inhibitor use, particularly in high-risk populations, suggesting potential benefits of GLP-1RAs over DPP-4 inhibitors in managing ocular complications in T2DM.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Metformin intake and risk of metabolic acidosis after radical cystectomy with urinary diversion: A comparative study using data from the TriNetX research network

PURPOSE

To investigate the association of diabetes mellitus and metformin use with metabolic acidosis risk after radical cystectomy (RC) and urinary diversion for bladder cancer.

MATERIALS AND METHODS

This retrospective cohort study used TriNetX Research Network data. Patients undergoing RC with continent diversion or ileal conduit for bladder cancer were identified using International Classification of Diseases, 10th Revision (ICD-10) and ICD-10 Procedure Coding System (ICD-10-PCS) codes. The primary outcome was acidosis between 1 month and 3 years postsurgery. Risk ratios (RR) and odds ratios (OR) were calculated based on diabetes and metformin use, stratified by diversion type and chronic kidney disease stage. Propensity score matching balanced potential confounders.

RESULTS

We identified 1,986 patients who underwent continent diversion and 11,184 who underwent ileal conduit reconstruction. In matched analyses, diabetes patients had higher acidosis risk (continent diversion: RR 1.87, 95% confidence interval [CI] 1.39-2.51; ileal conduit: RR 1.94, 95% CI 1.66-2.27). The risk was highest for diabetes patients with metformin prescription (continent diversion: RR 2.06, 95% CI 1.63-2.61; ileal conduit: RR 2.13, 95% CI 1.84-2.47). However, among patients with diabetes, metformin use did not significantly affect acidosis rates in most analyses. Continent diversion patients had higher acidosis risk than ileal conduit patients (RR 1.89, 95% CI 1.58-2.26).

CONCLUSION

Diabetes significantly increases metabolic acidosis risk after RC with urinary diversion, especially in continent diversion patients. While metformin may contribute to metabolic acidosis risk, its impact appears less significant than that of diabetes. Careful monitoring and appropriate metformin adjustments are crucial in this population.

Nontyphoidal salmonellosis is associated with an increased risk of stroke: Insights from multinational real-world data

BACKGROUND

Stroke is a significant cause of morbidity and mortality worldwide, contributing substantially to the global burden of disease. In low- and middle-income countries, stroke tends to occur at younger ages, with infection being one of the notable contributing factors. Previous studies have explored the impact of nontyphoidal Salmonella (NTS) on vascular and blood-related diseases, with animal experiments confirming related mechanisms. This study aims to investigate the association between NTS and cerebrovascular diseases (CVDs), with a focus on identifying specific patient populations more susceptible to stroke due to infection.

METHODS

This retrospective cohort study utilized the TriNetX database, including 4708 patients infected with NTS compared with a healthy population, with disease risk tracked over 6 months, 1 year, and lifelong periods. The primary outcome was CVDs (ICD-10-CM: I60-I69), while secondary outcomes examined hemorrhagic stroke (ICD-10-CM: I60-I62) and ischemic stroke (ICD-10-CM: I63). Subgroup analyses were conducted based on gender and age at index, with sensitivity analysis performed by comparing hospitalized patients, utilizing different databases, and evaluating the specificity of the NTS-CVD association by examining patients with a higher risk of acute myocardial infarction (AMI).

RESULTS

The lifelong hazard ratios (HRs) for cerebrovascular diseases (CVD), hemorrhagic stroke, and ischemic stroke following NTS infection were 1.606 (95% confidence interval (CI), 1.410-1.830), 1.866 (95% CI, 1.304-2.669), and 1.717 (95% CI, 1.385-2.130), respectively. A significant increase in the risk of hemorrhagic stroke was observed in the short term and mid-term, with HRs of 3.345 (95% CI, 1.091-10.259) and 2.816 (95% CI, 1.184-6.699), respectively. Subgroup analyses indicated statistically significant associations with the primary outcomes across all age groups. Males demonstrated a higher risk of hemorrhagic stroke, with an HR of 1.891 (95% CI, 1.142-3.310), whereas females exhibited a stronger association with ischemic stroke, with an HR of 1.592 (95% CI, 1.189-2.132). These associations remained significant among hospitalized patients, while no significant relationship was observed between NTS infection and AMI. The findings of this study were reproducible in a US-based database.

CONCLUSION

There is a significant association between NTS and CVD, with a particularly important impact on the occurrence of stroke in younger populations, especially regarding the elevated risk of hemorrhagic stroke.

Use of Sodium-Glucose Transport Protein 2 Inhibitors and the Incidence of Urolithiasis: A Multi-Database and Cross-Country Study in Patients With Type 2 Diabetes Mellitus

The benefits of sodium-glucose transport protein 2 inhibitor (SGLT2i) use on severe urolithiasis requiring surgery remains unclear. All patients with incident T2D in Taiwan National Health Institution databases (2016-2021) and TriNetX datasets (2014-2023) were retrospectively analyzed. The study analyzed a propensity score-matched pairs with T2D treated with SGLT2i or dipeptidyl peptidase 4 inhibitors (DPP4i). The primary outcome was the incidence of urolithiasis and urolithiasis requiring surgery during the study period. Urolithiasis diagnoses were identified using International Classification of Diseases diagnostic codes and categorized into upper and lower urinary tract stones. Cases of urolithiasis requiring surgery were determined by the presence of both diagnostic codes and surgical procedure codes within the same outpatient visit or hospitalization. Conditional and time-dependent Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During the study period, 5700 participants were diagnosed with urolithiasis, 1297 participants were urolithiasis requiring surgery in Taiwan NHIRD cohort 8438 participants with urolithiasis as well as 289 participants with urolithiasis requiring surgery were in the TriNetX cohort. Adjusted HRs of urolithiasis and urolithiasis requiring surgery were 0.82-fold (95% CI, 0.77-0.87), 0.72-fold (95% CI, 0.63-0.82) in Taiwan NHIRD, 0.84 (95% CI, 0.78-0.90), and 0.62 (95% CI, 0.44-0.88) in TriNetX cohort respectively. Similar protective associations with SGLT2i use against urolithiasis were observed across subgroups in both datasets from Taiwan NHIRD and TriNetX. In conclusion, SGLT2i might protect against kidney stones and severe cases requiring surgery in T2D patients.

Clinical effectiveness of oral antiviral treatment for non-hospitalized high-risk patients with COVID-19 during Omicron JN.1 subvariant wave: a US-based propensity-matched cohort study

BACKGROUND

This real-world study aimed to assess the effectiveness of novel oral antiviral agents in managing COVID-19 among high-risk patients during the Omicron JN.1 subvariant wave.

METHODS

Data from the TriNetX US network were analyzed using a multi-institutional propensity score matching (PSM) analysis. High-risk non-hospitalized adults with COVID-19 were included, and patients receiving oral antiviral agents (study group) were compared to those not receiving antiviral agents (control group). Primary outcomes included all-cause emergency department (ED) visits, hospitalizations, or death within 30 days.

RESULTS

Among 67,495 high-risk patients identified, 17,852 received oral antiviral agents (study group) and 49,643 did not (control group). After PSM, two matched cohorts of 17,847 patients each were established. The study group receiving antiviral agents exhibited a significantly lower risk of primary composite outcome during the 30-day follow-up period compared to the control group (HR, 0.77; 95% CI, 0.72-0.84). Regarding the secondary outcomes, the study group consistently exhibited a significantly lower risk of all-cause ED visits (4.2% vs. 5.4%; HR, 0.78; 95% CI, 0.71-0.86), hospitalization (2.8% vs. 3.3%; HR, 0.86; 95% CI, 0.77-0.97), and mortality (0.1% vs. 0.3%; HR, 0.17; 95% CI, 0.08-0.35) than the control group. Subgroup analyses showed consistent benefits across various demographic and clinical characteristics, except in individuals with booster vaccination.

CONCLUSIONS

Oral antiviral agents significantly reduced the risk of adverse outcomes among high-risk COVID-19 patients during the Omicron JN.1 subvariant wave. These findings support the potential benefits of oral antiviral therapy in treating COVID-19, particularly in high-risk populations.

Differential Risk Profiles for Slipped Capital Femoral Epiphysis in Pediatric Patients: A Comparative Analysis of Normal and Elevated BMI Groups

INTRODUCTION

Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescents that primarily affects those with higher body mass index (BMI). This study aimed to compare risk factors between pediatric patients with normal BMI (<85th percentile, normal-weight group) and obese BMI (≥85th percentile, classic group) in the context of SCFE.

METHODS

In this multi-institution case-control study, data from 1,200 pediatric patients diagnosed with SCFE from 2003 to 2023 were analyzed. Patients were dichotomized based on their BMI percentiles into normal-weight and classic groups. Multivariate logistic regression models that adjusted for various demographic and other patient characteristics were employed to calculate adjusted odds ratios (ORs) for the target risk factors.

RESULTS

The study included 172 patients in the normal-weight group and 1,028 in the classic group. Notable differences were noted in age (P < 0.001), thyrotropin levels (P < 0.001), and calcidiol levels (P < 0.001) between the two groups. Regression analysis revealed that patients in the normal-weight group had higher odds of being White (OR = 2.10; 95% CI: 1.49 to 2.95; P < 0.001) compared with the classic group. Additional findings indicated increased odds of hypothyroidism (OR = 1.86; P = 0.01) and lower odds of vitamin D deficiency (OR = 0.51; P = 0.02) in the normal-weight group compared with the classic group.

CONCLUSION

This study highlights notable differences in risk factors between normal-weight and overweight pediatric patients with SCFE. Race and ethnicity, thyroid function, and vitamin D levels emerged as differential risk factors with normal-weight patients having two times higher the risk of hypothyroidism (incidence 19.85% in normal-weight vs. 10.89% classic). These findings suggest that risk profiles for SCFE are more complex than previously understood and vary markedly with BMI. We recommend evaluation of hypothyroidism in normal weight patients with SCFE because one in every five patients in this group was diagnosed with hypothyroidism.

LEVEL OF EVIDENCE

Level III.

The impact of insulin pump therapy compared to multiple daily injections on complications and mortality in type 1 diabetes: A real-world retrospective cohort study

AIMS

Clinical trials have demonstrated the benefits of insulin pump therapy compared with multiple daily injections (MDI) in type 1 diabetes. However, contemporaneous real-world data are limited. This study investigated the real-world impact of insulin pump therapy compared with MDI.

MATERIALS AND METHODS

A retrospective cohort study of adults with type 1 diabetes was performed on the TriNetX platform, a global network providing access to anonymised medical records. Outcomes analysed include HbA1c, diabetic ketoacidosis, macro- and microvascular complications and all-cause mortality. The five-year follow-up period, between January 2018 and March 2025, was divided into time windows for analysis.

RESULTS

95 122 individuals with type 1 diabetes were identified. After propensity score matching for confounders including age, ethnicity, gender, chronic kidney disease, retinopathy, HbA1c and microalbuminuria, 17 124 patients remained in both the pump and MDI cohorts. The absolute reduction in HbA1c was comparable at five years (-5.3 mmol/mol [-0.5%] in the pump group and -4.5 mmol/mol [-0.4%] in MDI). Overall mortality was lower (RR = 0.716 [95% CI 0.639-0.803], p < 0.001) in those on a pump compared to MDI. The occurrence of diabetic ketoacidosis was lower in the pump group compared to MDI (RR = 0.848 [95% CI 0.786-0.915], p < 0.001). The risk of diabetic retinopathy was increased in the pump group (RR = 1.331 [95% CI 1.247-1.420], p < 0.001).

CONCLUSIONS

Insulin pump therapy was associated with lower all-cause mortality and risk of diabetic ketoacidosis, but an increased risk of diabetic retinopathy compared with MDI. This result should be interpreted with caution due to potential differences in retinal screening frequency and subsequent bias.

Risk of Osteoarthritis and Arthroplasty Between Baclofen and Tizanidine: A Target Trial Emulation Study

BACKGROUND

Preclinical studies have shown that baclofen may reduce the risk of osteoarthritis through its anti-inflammatory effect.

OBJECTIVE

We aimed to clarify this association by comparing the risks of osteoarthritis and joint replacement surgery in patients receiving baclofen and tizanidine.

METHODS

This retrospective cohort study was conducted on the global TriNetX platform (October 31, 2024). New users of baclofen and tizanidine aged ≥40 years were included in the baclofen and tizanidine group, respectively. The propensity score matching method was used. The primary outcomes were osteoarthritis and joint replacement surgery. The secondary outcomes included all-cause mortality, a composite outcome of osteoarthritis and all-cause mortality, and a composite outcome of joint replacement surgery and all-cause mortality. Cause specific hazard ratios (HRs) with 95% confidence intervals (CIs) of the outcomes were calculated with Cox regression using the TriNetX platform.

RESULTS

Two well-balanced groups containing 68,210 patients each were generated by propensity score matching (age: 57.8 years; female: 55.6% in both groups). Baclofen users had a significantly lower risk of developing osteoarthritis than tizanidine users (HR: 0.965, 95% CI: 0.941 to 0.989). A similar relationship was observed for joint replacement surgery (HR: 0.847, 95% CI: 0.750 to 0.956). However, the composite outcome of osteoarthritis or death had a HR of 1.129 (95% CI: 1.109 to 1.150), and the HR of joint replacement surgery or death was 1.509 (95% CI: 1.463 to 1.556). The HR of death was 1.577 (95% CI: 1.527 to 1.629), suggesting a higher risk of mortality in the baclofen group.

CONCLUSION

The surviving baclofen users had a lower risk of osteoarthritis and joint replacement surgery compared to surviving tizanidine users. However, baclofen users exhibited a higher risk of mortality than tizanidine users. Future studies are necessary to clarify the impact of baclofen on osteoarthritis and joint replacement surgery while accounting for mortality.

Hidradenitis Suppurativa and Ocular Diseases: Real-world Evidence of 57,972 Patients

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurring dermal abscesses and cutaneous fistulas of intertriginous skin regions, significantly impacting patients' quality of life. While HS has been associated with various comorbidities such as metabolic and chronic inflammatory diseases, many systemic effects of this systemic disease remain to be investigated. In this study, 2 cohorts of patients with and without HS were created - matched for sex, age, and nicotine dependence - each comprising 28,986 patients, using the real-world database TriNetX, to investigate the association of ocular diseases and HS. Not only an increased risk of disorders of refraction and accommodation in HS patients (OR 3.466; 95% CI 3.100, 3.876), but also a higher risk of ocular diseases, including disorders of the lacrimal system, was demonstrated when compared with the control cohort (OR 3.523; 95%CI 2.912, 4.263). Although previous studies have suggested an increased risk of ocular comorbidities in HS patients, ocular history is not routinely queried during visits. Here, the need for further exploration of the association of ocular diseases and HS and for incorporating this into clinical practice is emphasized.

Impact of mental health comorbidities on the effect of cataract surgery on dementia risk: a real-world retrospective cohort study

BACKGROUND

Cataract surgery has been shown to reduce the risk of developing dementia in the future; however, its impact on different dementia subtypes, including vascular dementia, remains unknown. Moreover, its dementia-protecting effect among cataract patients with common mental disorder (CMD) remains unclear.

METHODS

Patients aged 65 or older diagnosed with cataract between 2012 and 2021 were included and grouped based on whether they underwent cataract surgery within 1 year of diagnosis. Propensity-score matching was used to balance baseline characteristics, and Cox proportional hazards models were applied to assess dementia incidence within 5 years post-cataract between groups. Subgroup analyses were performed based on CMD status.

RESULTS

After propensity-score matching, 75 757 patients were included in both surgery and control groups. Cataract surgery significantly reduced dementia risk (HR=0.677, 95% CI =0.638 to 0.719, p<0.001), particularly for Alzheimer's disease (HR=0.643, 95% CI=0.576 to 0.716, p<0.001), with no significant effect on vascular dementia (HR=0.968, 95% CI=0.851 to 1.101, p=0.621). Subgroup analyses showed a significant reduction in dementia risk for patients without CMD (HR=0.666, 95% CI=0.624 to 0.710, p<0.001), but no protective effect in those with CMD, regardless of CMD status.

CONCLUSION

Cataract surgery is linked to a lower risk of dementia, especially Alzheimer's disease, in patients with cataract. However, this protective effect is diminished in those with CMD.

A quantitative analysis of the use of anonymization in biomedical research

Anonymized biomedical data sharing faces several challenges. This systematic review analyzes 1084 PubMed-indexed studies (2018-2022) using anonymized biomedical data to quantify usage trends across geographic, regulatory, and cultural regions to identify effective approaches and inform implementation agendas. We identified a significant yearly increase in such studies with a slope of 2.16 articles per 100,000 when normalized against the total number of PubMed-indexed articles (p = 0.021). Most studies used data from the US, UK, and Australia (78.2%). This trend remained when normalized by country-specific research output. Cross-border sharing was rare (10.5% of studies). We identified twelve common data sources, primarily in the US (seven) and UK (three), including commercial (seven) and public entities (five). The prevalence of anonymization in the US, UK, and Australia suggests their practices could guide broader adoption. Rare cross-border anonymized data sharing and differences between countries with comparable regulations underscore the need for global standards.

Partial Meniscectomy Increases Risk of ACL Revision Surgery Compared to Meniscus Repair in Patients with Concurrent Meniscus and ACL Tears after ACL Reconstruction

PURPOSE

To compare the rates of revision ACL reconstruction, meniscal reoperation, and total knee arthroplasty (TKA) associated with partial meniscectomy and meniscal repair performed at the time of index ACL reconstruction in patients with concurrent meniscus and ACL tears.

METHODS

The TriNetX database was queried for patients undergoing ACL reconstruction following January 1, 2000, with minimum one year clinical follow up. Inclusion criteria for this study were patients who had partial meniscectomy, meniscal repair, or isolated ACL reconstruction without meniscus injury. Statistical analyses were performed using Python with significance thresholds of p < 0.05.

RESULTS

A total of 39,126 patients were followed for an average of 5.02 years. Patients undergoing meniscal repair were less likely to experience revision ACL reconstruction compared to those undergoing partial meniscectomy (RR: 0.78, CI: 0.71-0.85, p < 0.001). Meniscus reoperation occurred significantly more in patients undergoing meniscal repair (RR: 1.26, CI: 1.17-1.35, p = <0.001) than those undergoing partial meniscectomy. Regarding TKA, partial meniscectomy carried a more than sixfold increased risk compared to isolated ACL reconstruction (RR: 6.4, CI: 2.49-16.42, p < 0.001).

CONCLUSIONS

In patients with ACL injury, ACL reconstruction, and concurrent meniscus tear, those patients treated with meniscus repair were less likely to undergo revision surgery. In these patients, medial meniscal injuries were associated with ACL revision than lateral meniscal injury regardless of the method of treatment. When meniscus repair is performed, this is associated with lower rate of future total knee arthroplasty.

LEVEL OF EVIDENCE

Level III Retrospective Cohort Study.

Association Between Preoperative COVID-19 Infection and Postoperative Outcomes in Patients with Obstructive Sleep Apnea Undergoing Metabolic Surgery: A Retrospective Analysis

BACKGROUND

Obstructive sleep apnea (OSA) is highly prevalent in patients undergoing metabolic surgery and can complicate recovery. While OSA and COVID-19 share common pathophysiological mechanisms involving systemic inflammation and respiratory dysfunction, their combined impact on surgical outcomes remains poorly understood.

METHODS

Using TriNetX data from June 2022 to December 2024, we retrospectively analyzed adult patients with OSA undergoing metabolic surgery. Patients were divided into two groups: those with COVID-19 infection within 4 weeks before surgery and controls without infection in the preceding 8 weeks. After propensity score matching, 8,733 pairs were analyzed. The primary outcomes included postoperative pneumonia and respiratory failure within 30 days. The secondary outcomes included acute kidney injury (AKI), intensive care unit (ICU) admission, mortality, surgical site infection (SSI), emergency department (ED) visit, and deep vein thrombosis (DVT).

RESULTS

No significant differences were found between the COVID-19 and control groups in postoperative pneumonia (0.28% vs. 0.32%, p = 0.5785) or respiratory failure (0.30% vs. 0.38%, p = 0.3613). Secondary outcomes, including the incidence of AKI, ICU admission, mortality, SSI, ED visit, and DVT, showed no significant differences. Chronic obstructive pulmonary disease (COPD) emerged as the strongest risk factor for both pneumonia (odds ratio 6.06, p = 0.002) and respiratory failure (odds ratio 4.22, p = 0.013).

CONCLUSION

Recent preoperative COVID-19 infection did not significantly impact postoperative outcomes in patients with OSA undergoing metabolic surgery. However, the presence of COPD substantially increases the risk of respiratory complications, suggesting the need for additional preoperative optimization in these patients.

COVID- 19 vaccination reduces new-onset fibromyalgia risk in survivors

BACKGROUND

Numerous studies have demonstrated that COVID-19 is associated with an increased risk of new-onset fibromyalgia (FM), which not only significantly impacts patients' quality of life but also places a substantial burden on healthcare systems. However, no studies have yet investigated whether COVID-19 vaccination may mitigate the risk of developing new-onset FM in individuals who have survived COVID-19. This study aimed to assess the potential effect of COVID-19 vaccination in reducing the risk of new-onset FM among COVID-19 survivors.

METHODS

We utilized the data resources from the TriNetX platform to compare 90,508 COVID-19 survivors who received the COVID-19 vaccine with 90,508 unvaccinated survivors. The Cox proportional hazards regression model was used to estimate the hazard ratio (HR) and its corresponding 95% confidence interval (CI). The incidence was calculated using the Kaplan-Meier survival analysis method. Furthermore, we conducted detailed subgroup analyses and sensitivity analyses.

RESULTS

The cohort analysis of the present study revealed a significant reduction in the risk of new-onset FM among COVID-19 survivors who received the COVID-19 vaccine, compared to the unvaccinated group (HR 0.84; 95% CI 0.71-0.99). Notably, the results of the subgroup analysis indicated that the COVID-19 vaccine exerted a protective effect against the development of new-onset FM in males, individuals with a body mass index (BMI) < 30, and those with comorbid depression and anxiety.

CONCLUSIONS

Our findings suggest that COVID-19 vaccination may play a protective role in reducing the risk of new-onset FM among COVID-19 survivors. The findings may indicate the importance of targeting vaccination to specific subgroups, such as males, individuals with lower BMIs, and those with mental health conditions, including depression and anxiety. This approach may enhance the protective effects of the vaccine and further reduce the incidence of long-term health complications associated with COVID-19. Further research is needed to validate these observations.

Risk Factors for Developing Perthes Disease: A Comprehensive National Analysis Spanning 2 Decades

BACKGROUND

Perthes disease is an uncommon pediatric condition affecting the hip joint, causing varying degrees of femoral head necrosis. The underlying cause of Perthes remains unknown, thus it is crucial to identify risk factors associated with its development to aid in early diagnosis and intervention. This study aimed to analyze risk factors associated with Perthes in a large cohort.

METHODS

A case-control study was conducted using data from a U.S. national database from 2003 to 2023. Patients diagnosed with Perthes were compared with those without the disease. Variables potentially associated with Perthes were analyzed using multivariable logit models, and adjusted odds ratios (AOR) with 95% CI were calculated. Statistical significance was determined, and a P -value <0.05 was considered significant.

RESULTS

The study included 4034 patients with Perthes and 3,483,745 age-matched controls. The mean age of patients with Perthes was 8.38 years, compared with 8.35 years in the control group ( P =0.27). Significant risk factors identified included male sex (AOR: 3.14, P <0.001), white race (AOR: 2.16, P <0.001), and obesity (AOR: 2.21, P <0.001). Conversely, Black (AOR: 0.26, P <0.001), Hispanic (AOR: 0.53, P <0.001), and Asian (AOR: 0.55, P <0.001) races were associated with lower odds of developing Perthes. Additional significant risk factors included tobacco exposure (AOR: 1.25, P =0.02), hypertension (AOR: 1.64, P <0.001), and thrombophilia (AOR: 9.17, P <0.001).

CONCLUSIONS

This study is the largest study on Perthes disease in literature, identifying several independent risk factors, including male sex, white race, obesity, tobacco exposure, hypertension, obesity, and thrombophilia. Among children with Perthes, thrombophilia exhibited the highest adjusted odds ratio, despite its rarity. These findings offer valuable insights for further research aimed at elucidating the underlying etiology of Perthes disease, particularly with regards to the roles of vascular and metabolic pathways.

LEVEL OF EVIDENCE

Level III-prognostic case-control study.

Meeting Report on "10th Anniversary Symposium on Inflammatory Skin Disease"

The Lübeck Institute of Experimental Dermatology celebrated its 10th Anniversary Symposium on Inflammatory Skin Diseases at the University of Lübeck, Germany, on October 17-18, 2024. This event brought together international key opinion leaders, faculty members, researchers, and clinicians to foster insightful discussions on the diagnosis, pathomechanisms, and treatment of autoimmune skin diseases, with a particular focus on pemphigus, pemphigoid diseases, and systemic sclerosis.

Glucagon-like peptide-1 receptor agonist use is associated with increased risk of perioperative complication and readmission following shoulder arthroplasty

BACKGROUND

Glucagon-like peptide-1 (GLP-1) receptor agonists, increasingly used for diabetes management and weight loss, have been linked to lower readmission rates after knee and hip arthroplasty. However, their impact on total shoulder arthroplasty (TSA) outcomes remains unclear. This study investigates the effects of GLP-1 receptor agonists on major complications and revisions following TSA.

METHODS

A retrospective query of the TriNetX database from 2010 to 2023 was performed to identify patients who underwent anatomic or reverse TSA and were prescribed GLP-1 receptor agonists. GLP-1 receptor agonist users were 1:1 propensity score-matched to controls for demographic factors and comorbidities, yielding 1259 patients in each group. Outcomes included 90-day postoperative medical complications and readmission and revision surgery at 2 years. Odds ratios (ORs), 95% confidence intervals, and P values were calculated. After Bonferroni correction, P < .005 was considered significant.

RESULTS

GLP-1 receptor agonist users (n = 1259) experienced significantly higher rates of deep vein thrombosis (1.6% vs. 0.9%; OR 3.0; P = .001), myocardial infarction (1.60% vs. 0.9%; OR 2.84; P = .003), pneumonia (3.34% vs. 1.50%; OR 2.25; P = .003), transfusion (7.1% vs. 4.3%; OR 1.7; P = .003), and readmission (8.1% vs. 5.2%; OR 1.6; P = .004) in the 90-day postoperative period compared to patients not taking GLP-1 receptor agonists. There were no differences in the rates of stroke, pulmonary embolism, postoperative anemia, or renal failure. In patients with a minimum 2-year follow-up (n = 776), there was no difference in revision rate (3.2% vs. 1.8%; OR 1.8; P = .07).

CONCLUSION

GLP-1 receptor agonist use during TSA was associated with an increased risk of deep vein thrombosis, myocardial infarction, pneumonia, need for transfusion, and readmission. Further investigation into the perioperative risk assessment and medical optimization of patients utilizing GLP-1 receptor agonists may be warranted.

Association between orchiectomy and asthma: Insights from 2 population-based cohorts

Background

Orchiectomy, which results in hypogonadism, may increase the risk of asthma due to androgen deficiency.

Objectives

We aimed to investigate the association between orchiectomy and asthma risk.

Methods

Men aged 18 years or older between 1999 and 2016 were identified from the national real-world database IBM-Explorys. We used multivariable logistic regression adjusted for age and body mass index to determine the risk of asthma among individuals who had and had not undergone orchiectomy. To reproduce our findings, we selected men aged 18 years or older with or without a history of orchiectomy who were enrolled in the globally federated TriNetX database as of May 2024.

Results

In the IBM-Explorys database, the orchiectomy group had a 2-fold increase in the odds of having asthma (adjusted odds ratio = 2.03 [95% CI = 1.91-2.16]; P < .001). Similarly, in the TriNetX database, the risk of asthma was higher in the orchiectomy group than in the nonorchiectomy group (adjusted odds ratio =1.61 [95% CI = 1.42-1.82]; P < .001).

Conclusion

Patients who have undergone an orchiectomy are at increased risk of developing asthma. More research is needed to determine the mechanisms underlying the relationship between asthma diagnosis and orchiectomy.

Legislative Changes on Opioid Prescriptions for Ocular Procedures in a United States Cohort

This ecological study examines the prevalence of postoperative opioid prescriptions among ophthalmic surgical patients during the implementation of four opioid policy interventions in Ohio. Changes in ophthalmic prescribing among 53 health care systems throughout the United States are compared to a population from the MetroHealth System in Cuyahoga County, Ohio. Opioid prescription prevalence spiked among all populations amid Ohio's "pill mill" and mandatory registration policies and then consistently decreased during the state's mandatory reporting and number-of-day restrictions. Black, Hispanic, and male subgroups across the country were more likely to receive opioids relative to other subgroups during most policy periods, but their rates were likely driven by trauma-related procedures. Prescribing fluctuations among ophthalmologists in the MetroHealth System generally matched national trends and did not correlate with prescribing trends among other specialties in Ohio. Consistent with previous research, opioid prescribing in ophthalmology remains low compared to other specialties throughout the country. [Ophthalmic Surg Lasers Imaging Retina 2025;56:312-315.].

Comparative risk of dementia in diabetic stroke patients prescribed SGLT2 vs. DPP-4 inhibitors: A propensity-matched retrospective cohort study

OBJECTIVE

Diabetes is a significant risk factor for both stroke and dementia. This study aimed to compare the risk of incident dementia between sodium-glucose cotransporter 2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors in diabetic patients with a history of ischemic stroke.

MATERIALS

We conducted a propensity-matched retrospective cohort study using observational data from the TriNetX global federated health research network. Patients aged 18 years or older with type 2 diabetes (T2D) and a history of ischemic stroke, newly prescribed either an SGLT2 or DPP-4 inhibitor from July 1, 2013, to June 30, 2024, were included. Propensity score matching was employed to balance baseline characteristics between treatment groups. The primary outcome was incident dementia, with secondary outcomes including degenerative and vascular dementia.

RESULTS

After propensity score matching, each group consisted of 15901 patients. Over a mean follow-up of 2.52 years, SGLT2 inhibitor use was associated with lower risks of overall dementia (hazard ratio [HR] 0.66; 95% confidence interval [CI] 0.59-0.74), degenerative dementia (HR 0.68; 95% CI 0.60-0.76), and vascular dementia (HR 0.59, 95% CI 0.49-0.70) compared to DPP-4 inhibitor use. These findings remained consistent across various sensitivity and subgroup analyses.

CONCLUSIONS

In diabetic patients with a history of ischemic stroke, initiating SGLT2 inhibitors, compared to DPP-4 inhibitors, is associated with a lower risk of incident dementia. This association was observed for both degenerative and vascular dementias. These findings support the preferential use of SGLT2 inhibitors in this high-risk population, warranting further investigation through randomized clinical trials.

Apixaban in patients with nonvalvular atrial fibrillation, heart failure and low body weight: A report from a global federated research dataset

BACKGROUND

Atrial fibrillation (AF) and low body weight (BW, <60 kg) are common in patients with heart failure (HF). However, the safety and effectiveness of direct oral anticoagulants (DOACs) in this group remain unclear. This study compares the efficacy and safety of apixaban versus vitamin K antagonists (VKAs) in patients with nonvalvular AF, low BW and HF.

METHODS

We analysed 155,152 patients with HF and AF, weighing ≤100 kg and treated with oral anticoagulants (apixaban 86,493; VKA 68,659), from the TriNetX Global Research Network. Outcomes included ischaemic stroke/systemic embolism (SEE), clinically relevant bleedings, intracranial haemorrhage (ICH), all-cause death and net clinical benefit (composite of stroke/SEE, bleedings and all-cause death) across three BW categories: 60-100 kg (reference), 50-60 kg (low BW) and ≤50 kg (very low BW). Propensity score matching was used to balance the treatment groups.

RESULTS

Patients with low BW had a higher risk of adverse events compared to those with reference BW, regardless of treatment. Apixaban consistently reduced the risk of ischaemic stroke/SEE and bleeding (including ICH) across all BW ranges (all p-interaction >.10), and improved net clinical benefit compared to VKA (reference BW: HR .82 [95% CI: .80-.84]; low BW: HR .79 [95% CI: .74-.85]; very low BW: HR .86 [95% CI: .78-.95], p-interaction = .366). However, a significant BW-treatment interaction was observed for all-cause mortality, indicating reduced relative effectiveness of apixaban vs. VKA as BW decreases.

CONCLUSION

In this large real-world analysis, treatment with apixaban was associated with a superior effectiveness and safety profile compared to VKA in patients with AF, HF and low BW. These results remained consistent, albeit slightly attenuated, in patients with very low BW. These findings provide preliminary evidence supporting the use of apixaban in this high-risk population.

The Impact of Anxiety and Depression on Postoperative Pain Management and Emergency Room Visits in Pediatric Patients With Surgically Treated Lower Extremity Fractures: A Propensity-matched Cohort Analysis

BACKGROUND

Anxiety and depression (AD) are prevalent comorbidities in pediatric patients and may influence postoperative outcomes. The impact of AD on postoperative pain medication use and emergency room (ER) visits in children with surgically treated lower extremity fractures has not been well-documented. This study aimed to evaluate the association between AD and outpatient postoperative pain medication requirements as well as ER visits in this population.

METHODS

A retrospective cohort study was conducted using electronic medical records from 2000 to 2023 in a large national database of health care organizations across the United States. Pediatric patients (age below 18) with surgically treated lower extremity fractures were included. Patients were categorized into 2 groups: those with AD and those without (No-AD). Patients were further dichotomized into 2 groups based on fracture location: femur (femur) versus tibia or ankle (tibia/ankle). Outcomes of interest included the use of intravenous (IV) opiates within 3 days postoperatively, the number of outpatient oral (PO) opiate prescriptions, and the proportion of patients with at least one ER visit within 1 year postsurgery. Hazard ratios (HRs) were calculated using Cox proportional hazard models, adjusting for demographic and clinical characteristics.

RESULTS

A total of 25,658 patients with either femur or tibia/ankle fractures were included. After matching, 735 patients were included in the AD femur cohort, and 945 in the AD tibia/ankle cohort. Each cohort was matched 1:1 with their control counterparts. In the femur fracture cohort, 49.80% of AD patients and 46.53% of No-AD patients required IV opiates within the first 3 days after surgery (HR, 1.09; P =0.21). Outpatient PO opiate use was significantly higher in AD patients (55.78% vs. 38.50%, HR, 1.64; P <0.001). In addition, AD patients had a higher proportion of ER visits (20.3% vs. 11.7%, HR, 1.68; P <0.001). In the tibia/ankle fracture cohort, 55.2% of AD patients and 48.3% of No-AD patients required IV opiates within the first 3 days (HR, 1.18; P <0.001). Outpatient PO opiate use was also higher in AD patients (46.35% vs. 32.06%, HR, 1.55; P <0.001). ER visits were more frequent in AD patients (21.26% vs. 9.63%, HR, 2.08; P <0.001).

CONCLUSIONS

Pediatric patients with AD undergoing surgery for lower extremity fractures have increased postoperative pain medication requirements and higher rates of ER visits compared with those without AD. These findings highlight the need for targeted interventions, such as the use of preoperative counseling or multimodal pain regimens, to manage postoperative pain and reduce ER visits in this vulnerable population.

LEVEL OF EVIDENCE

Prognostic level III.

Cardiovascular and thromboembolic outcomes with immune checkpoint inhibitors in gastroesophageal cancer: a propensity score-matched cohort study

BACKGROUND

Immune checkpoint inhibitors (ICIs) have been associated with an increased risk of cardiovascular and thromboembolic events. However, the incidence of cardiovascular and thromboembolic events associated with ICIs in gastroesophageal cancers is unknown.

METHODS

We performed a propensity score-matched cohort study using the TriNetX Analytics Network database, which comprises de-identified data from over 130 participating healthcare institutions. Patients who received ICI and chemotherapy were compared with those who received only chemotherapy. The primary outcomes were cardiovascular events including pericarditis, myocarditis, heart failure, myocardial infarction, ischemic stroke, atrial fibrillation, conduction disorders as well as venous thromboembolism (VTE) within 1-year of ICI or chemotherapy. We matched the cohorts based on predetermined variables including demographics, metastatic disease, chemotherapy, underlying comorbidities, and the use of cardiovascular and lipid-lowering medications.

RESULTS

We identified 1,448 patients who received ICI and chemotherapy and 11,966 patients who received chemotherapy only. After matching, 1,425 patients remained in each cohort. The mean age was 63.1 ± 12.7 years in the ICI and chemotherapy cohort and 62.9 ± 12.1 years in the chemotherapy-only cohort. ICI was associated with a higher incidence of pericarditis (45.6 vs. 30.9 cases per 1000 patient-years; HR 1.51 [95% CI 1.03-2.22]) and VTE (102.5 vs. 75.1 cases per 1000 patient-years; HR 1.40 [95% CI 1.09-1.80]). The incidence of other cardiovascular outcomes were similar between the two cohorts.

CONCLUSION

In this cohort study, the use of ICI and chemotherapy was associated with an approximately 40-50% increased risk of pericarditis and VTE than patients on chemotherapy only.

Comparison of Outcomes of Percutaneous Mechanical Aspiration vs Tricuspid Valve Surgery in Drug Use-Associated Endocarditis of the Tricuspid Valve

Background

People who inject drugs (PWID) and present with infective endocarditis (IE) of the tricuspid valve may need valve surgery due to persistent infection, heart failure, or embolic risk. Vacuum-assisted percutaneous mechanical aspiration (PMA) has been proposed as a potential option for those who cannot undergo surgery.

Methods

We queried TriNetX, a database that provides access to electronic medical record data across health care organizations, to identify PWID who had tricuspid valve IE and underwent PMA between 2016 and 2024, using diagnostic and procedure codes. Short-term procedural and clinical outcomes were compared with PWID who underwent tricuspid valve surgery.

Results

In total, 129 patients underwent the PMA procedure and 952 had valve surgery. A higher proportion of the PMA cohort was female (66% vs 57%) and of non-White race (32% vs 22.5%). At 1 month postprocedure, the surgical group had a lower rate of death (2.5% vs 7.9%, P = .001), while the PMA group had a lower risk of heart block or need for pacemaker implantation (0% vs 4%). After propensity matching between groups, these differences were not significant. At 1 year postprocedure, groups had similar rates of heart failure, tricuspid insufficiency, or offer of treatment intervention for opioid use disorder.

Conclusions

Short-term outcomes seem comparable between PMA and tricuspid valve surgery in tricuspid valve IE in PWID. Additional studies with larger cohort numbers are needed to further evaluate the difference in long-term postoperative outcomes between the groups.

Vitamin D Deficiency and the Clinical Outcomes of Calcimimetic Therapy in Dialysis Patients: A Population-Based Study

BACKGROUND

Vitamin D deficiency (VDD) is prevalent in patients with secondary hyperparathyroidism (SHPT) undergoing dialysis and may attenuate the efficacy of calcimimetic therapy, which is designed to reduce parathyroid hormone (PTH) levels and improve clinical outcomes. This study aimed to investigate the impact of vitamin D status on all-cause mortality, major adverse cardiovascular events (MACEs), fractures, and hypocalcemia in dialysis patients receiving calcimimetics.

METHODS

This retrospective cohort study utilized the TriNetX database to identify dialysis patients treated with calcimimetics between 2010 and 2024. Patients were classified into VDD (<20 ng/mL) and vitamin D-adequate (VDA, ≥30 ng/mL) groups. Propensity score matching (1:1) was performed on 95 covariates to minimize confounding. Outcomes, including all-cause mortality, MACEs, fractures, hypocalcemia, and PTH suppression (≤300 pg/mL), were compared between groups over a 3-year follow-up. Multiple comparisons were adjusted using the Bonferroni-Holm correction.

RESULTS

All-cause mortality was significantly higher in the VDD group (25.4%) compared to the VDA group (20.9%), with an adjusted odds ratio (OR) of 1.29 (95% CI: 1.10-1.51, p = 0.002, corrected α = 0.007). While initial analyses suggested associations between VDD and the increased risks of MACEs, fractures, and hypocalcemia, these results did not remain significant after correction. Subgroup analysis indicated that comorbidities, such as obesity, dyslipidemia, and depression, amplified these risks in the VDD group. No significant differences were observed for PTH suppression (≤300 pg/mL) between groups.

CONCLUSIONS

VDD is independently associated with increased all-cause mortality in dialysis patients with SHPT, even after multiple comparison adjustments. While risks for MACEs, fractures, and hypocalcemia showed non-significant trends, their observed patterns suggest potential clinical relevance. Optimizing vitamin D status may enhance clinical outcomes in this high-risk population, warranting further investigation through randomized controlled trials.

Comparison of bariatric surgery and community weight management for idiopathic intracranial hypertension in a multicenter retrospective cohort study

Idiopathic Intracranial Hypertension (IIH) is a neurological disorder characterized by elevated intracranial pressure without definitive etiology, primarily affecting young, obese women. This study aimed to compare the efficacy of bariatric surgery versus conventional community weight management in treating IIH. We conducted a retrospective cohort study in IIH patients undergoing bariatric procedures versus conventional weight loss interventions. Propensity score matching was employed to balance study groups. Outcomes were assessed at 3, 6, 12, and 24 months, including papilledema, headache, visual symptoms, and therapeutic interventions. Bariatric surgery demonstrated superior outcomes compared to community weight management. Papilledema incidence was consistently lower in the bariatric group (RR = 0.591 at 24 months, p = 0.0001). Headache prevalence and visual symptoms were also reduced in the surgical group. Acetazolamide dose was lower in bariatric patients, starting at 12 and 24 months. Subgroup analysis of different bariatric procedures showed comparable efficacy. Body mass index reduction was significantly greater in the bariatric group throughout the follow-up period. This study provides evidence supporting the efficacy of bariatric surgery in managing IIH, with superior outcomes across multiple parameters compared to conventional weight management. The sustained improvements in papilledema, headache, and visual symptoms, coupled with for the reduction in pharmacological intervention dose, suggest that bariatric surgery may offer a more definitive solution for IIH patients with concurrent obesity. Further research is needed to develop evidence-based guidelines for patient selection and optimize post-operative care protocols.

Perspective review: Will generative AI make common data models obsolete in future analyses of distributed data networks?

Integrating real-world healthcare data is challenging due to diverse formats and terminologies, making standardization resource-intensive. While Common Data Models (CDMs) facilitate interoperability, they often cause information loss, exhibit semantic inconsistencies, and are labor-intensive to implement and update. We explore how generative artificial intelligence (GenAI), especially large language models (LLMs), could make CDMs obsolete in quantitative healthcare data analysis by interpreting natural language queries and generating code, enabling direct interaction with raw data. Knowledge graphs (KGs) standardize relationships and semantics across heterogeneous data, preserving integrity. This perspective review proposes a fourth generation of distributed data network analysis, building on previous generations categorized by their approach to data standardization and utilization. It emphasizes the potential of GenAI to overcome the limitations CDMs with GenAI-enabled access, KGs, and automatic code generation. A data commons may further enhance this capability, and KGs may well be needed to enable effective GenAI. Addressing privacy, security, and governance is critical; any new method must ensure protections comparable to CDM-based models. Our approach would aim to enable efficient, real-time analyses across diverse datasets and enhance patient safety. We recommend prioritizing research to assess how GenAI can transform quantitative healthcare data analysis by overcoming current limitations.

Enhanced Recovery With Combined Epidural and General Anesthesia in Children With Cerebral Palsy Undergoing Hip Reconstructive Surgery: A National Cohort Study

BACKGROUND

Pediatric patients with cerebral palsy (CP) undergoing hip reconstruction face significant postoperative pain challenges. This study aimed to assess the efficacy and safety of epidural anesthesia combined with general anesthesia compared with general anesthesia alone in reducing postoperative opiate usage, postoperative complications, and length of hospital stay in this vulnerable population.

METHODS

A retrospective cohort study was conducted, analyzing medical records of pediatric CP patients who underwent bilateral proximal femoral osteotomy between 2003 and 2023, using a large national US health care database. Patients were dichotomized into 2 groups based on anesthesia technique: general anesthesia only (General) and general anesthesia with adjunct epidural anesthesia (Epidural). The primary outcome measured was the use of IV opiates within the first 3 days postoperation. Secondary outcomes included the use of per os (PO) opiates, length of stay (LOS), and postoperative complications such as ICU admission, mortality, pneumonia, respiratory failure, urinary retention, and urinary tract infections within 90 days postoperatively. Patient characteristics, including age, BMI percentile, gastrostomy and tracheostomy status, as well as concomitant hamstring lengthening and pelvic osteotomy, were propensity matched between groups.

RESULTS

In total, 1303 CP patients were identified, including 502 patients with general plus epidural anesthesia and 801 patients with general anesthesia only. After matching, there remained 361 patients in each group (a total of 722 patients who were included for analysis). The Epidural group demonstrated a significantly lower proportion of IV opiate usage within the first 3 days postoperation. There were no significant differences in the rates of ICU admissions, mortality, pneumonia, respiratory failure, urinary retention, or urinary tract infections between groups. However, the general plus epidural anesthesia group demonstrated lower usage of PO opiates 90 days postoperatively compared with the general anesthesia only group. The epidural group further demonstrated a 1.3-days shorter LOS.

CONCLUSIONS

The addition of epidural anesthesia to general anesthesia in pediatric CP patients undergoing proximal femoral osteotomy reduces hospital stay and IV opioid use postoperatively, without increasing complications. These findings support considering epidural anesthesia to enhance recovery and reduce opioid-related side effects in these patients.

LEVEL OF EVIDENCE

Level III-therapeutic study.

Comparative Effectiveness of Dupilumab Versus Mepolizumab and Benralizumab in Asthma: A Multinational Retrospective Cohort Study

BACKGROUND

Several biologic agents have been approved for asthma treatment. However, previous comparative effectiveness studies have been indirect treatment comparisons or restricted in geographical scope.

OBJECTIVE

To compare the effectiveness of dupilumab versus mepolizumab and benralizumab in reducing asthma exacerbations among patients with asthma.

METHODS

Data from the Global Collaborative Network of TriNetX were used. Patients aged ≥18 years who received dupilumab, mepolizumab, or benralizumab for asthma between November 1, 2018, and January 1, 2024, were included. The primary outcome was time to the first asthma exacerbation within the 1-year follow-up period. Two comparisons were performed: (1) dupilumab versus mepolizumab and (2) dupilumab versus benralizumab. Propensity score matching was used to balance covariates between the groups. The risk of asthma exacerbations was estimated using Kaplan-Meier curves and Cox proportional hazards models. Subgroup analyses were conducted based on eosinophil counts (≥300, ≥150 to <300, and <150 cells/μL), the presence of chronic obstructive pulmonary disease (COPD), and exacerbation history (0 and ≥1 events).

RESULTS

Dupilumab was associated with a lower risk of asthma exacerbations compared with mepolizumab (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.62-0.76) and benralizumab (HR, 0.74; 95% CI, 0.67-0.82). Benefits of dupilumab were pronounced in patients with eosinophil counts ≥300 cells/μL, those with COPD, and those without an exacerbation history.

CONCLUSION

Dupilumab was associated with a decreased risk of asthma exacerbations compared with both mepolizumab and benralizumab among patients with asthma. Further research incorporating comprehensive biomarker data is needed to optimize biologic selection.

Outcomes following total shoulder arthroplasty in patients with obstructive sleep apnea

BACKGROUND

Obstructive sleep apnea (OSA) is a known risk factor for various medical complications including cardiovascular disease, cognitive dysfunction, and respiratory failure. With global prevalence of OSA on the rise, understanding its impact on common orthopedic procedures has become increasingly important. Although the impact of OSA has been studied in patients undergoing total hip arthroplasty and cervicothoracic spinal surgery, its relationship with total shoulder arthroplasty (TSA) is still unclear. Therefore, the purpose of this study was to evaluate the relationship of complications following TSA in patients with OSA.

METHODS

A retrospective cohort analysis using the TriNetX research platform was conducted on all patients with OSA undergoing an anatomic or reverse TSA. Patients were excluded if they had a history of revision TSA, hemiarthroplasty, chronic respiratory diseases, upper humerus fracture, a body mass index of less than 30, or were aged <18 years. Medical complications were assessed at 7, 30, and 90 days, whereas orthopedic complications were assessed at 2 and 5 years. Mortality was evaluated over a 5-year period using Kaplan-Meier analysis. Outcomes were compared using odds ratios, and a P value < .05 was considered significant.

RESULTS

Final analysis included 5636 patients in both the OSA and non-OSA in each cohort with 1:1 propensity score-based matching. Patients undergoing TSA with OSA were at higher risk of acute kidney injury (1.69% vs. 1.10%), pulmonary embolism (0.62% vs. 0.34%), pneumonia (0.89% vs. 0.46%), ischemic stroke (0.73% vs. 0.39%), respiratory failure (0.43% vs. 0.18%), emergency department visits (2.45% vs. 1.86%), and readmission rates (6.62% vs. 4.19%) at 7, 30, and 90 days postoperatively. Patients with OSA experienced higher rates of wound dehiscence (0.64% vs. 0.32%) and urinary tract infections (1.70% vs. 1.21%) at 30 and 90 days postoperatively. Finally, rates of deep vein thrombosis in the OSA cohort were only elevated at 90 days postoperatively (1.99% vs. 1.15%). All orthopedic outcomes and mortality rates were comparable between both cohorts throughout the 5 years.

CONCLUSION

The findings of this study suggest that patients with OSA may experience higher rates of medical complications in the short term, but no difference in orthopedic or mortality outcomes in the long term. Further research is warranted to explore how the severity of OSA influences complication rates after TSA and to identify preventative strategies that surgeons can implement to mitigate the adverse effects of OSA on postoperative outcomes.

Insomnia increases the risk for specific autoimmune diseases: a large-scale retrospective cohort study

Objective

The global rise of autoimmune diseases presents a significant medical challenge, with inadequate treatment options, high morbidity risks, and escalating healthcare costs. While the underlying mechanisms of autoimmune disease development are not fully understood, both genetic predispositions and lifestyle factors, particularly sleep, play critical roles. Insomnia and circadian rhythm sleep disorders not only impair sleep but also disrupt multi-organ interactions by dysregulating sympathetic nervous system activity, altering immune responses, and influencing neuroendocrine function. These disruptions can contribute to immune system dysregulation, increasing the risk of autoimmune disease development.

Methods

To assess the impact of impaired sleep on the risk of developing autoimmune diseases, a global population-based retrospective cohort study was conducted using electronic health records from the TriNetX US Global Collaborative Network, including 351,366 subjects in each propensity score matched group. Twenty autoimmune diseases were examined, and propensity score matching was employed to reduce bias. Three sensitivity analyses were conducted to test the robustness of the results.

Results

The study identified significantly increased risks for several autoimmune diseases associated with impaired sleep, likely mediated by dysregulated neuroimmune and autonomic interactions. Specifically, cutaneous lupus erythematosus [hazard ratio (HR) = 2.119; confidence interval (CI) 1.674-2.682; p < 0.0001], rheumatoid arthritis (HR = 1.404; CI 1.313-1.501; p < 0.0001), Sjögren syndrome (HR = 1.84; CI 1.64-2.066; p < 0.0001), and autoimmune thyroiditis (HR = 1.348; CI 1.246-1.458; p < 0.0001) showed significantly increased risks. No diseases demonstrated reduced risks, and 4 out of 20 tested diseases did not show significant HR increases in any analysis.

Conclusion

This study highlights the integral role of sleep in maintaining immune homeostasis through multi-organ interactions involving the autonomic nervous system, immune signalling pathways, and endocrine regulation. Disruptions in these systems due to chronic sleep impairment may predispose individuals to autoimmune diseases by altering inflammatory responses and immune tolerance. These findings underscore the necessity of recognizing and treating sleep disorders not only for general wellbeing but also as a potential strategy to mitigate the long-term risk of autoimmune disease development.

Bromocriptine for Idiopathic Intracranial Hypertension: A Retrospective Multicenter Cohort Study

Introduction

Idiopathic Intracranial Hypertension (IIH) is a disorder characterized by elevated intracranial pressure without an identifiable cause, commonly affecting young obese women. Current treatment strategies, including weight loss, acetazolamide, and surgical interventions, have limitations due to side effects, adherence challenges, and potential complications. Bromocriptine, a dopamine D2 receptor agonist, has emerged as a potential novel therapy due to its metabolic effects. This study aims to evaluate the safety and efficacy of bromocriptine in IIH management through a retrospective cohort analysis.

Methods

A retrospective analysis was conducted, focusing on patients with IIH. Propensity score matching was applied to balance baseline characteristics, including age, sex, race, and BMI, between the bromocriptine and control groups. Key outcome measures, papilledema, headache severity, refractory IIH status, and acetazolamide dose dependency, were assessed at multiple follow-up intervals.

Results

The bromocriptine group demonstrated significant improvement in papilledema and headache severity over 24 months, with early effects observed at one month. There was a marked reduction in refractory IIH (30.66% lower incidence at 24 months, p<0.0001) and reduced dependency on acetazolamide from three months onward (p=0.0246). The safety profile was favorable, with comparable adverse event rates to controls, although allergic skin reactions were noted in the bromocriptine group.

Conclusion

Bromocriptine shows promise as an effective and safe therapeutic option for IIH, with sustained improvement in clinical parameters and reduced reliance on conventional treatment. Future randomized controlled trials are needed to confirm these findings and explore optimal dosing strategies.

Increased risk of skin cancers in mucous membrane pemphigoid: a large-scale matched cohort study of 117 million US individuals

Introduction

Mucous membrane pemphigoid (MMP) is an autoimmune disease affecting the oral mucosa, conjunctivae and other mucous membranes. The mainstay treatment options are local and systemic corticosteroids and immunomodulatory therapies. Current research on cancer risk in MMP is scarce and has yielded conflicting results.

Methods

The aim of this study was to investigate the risk of developing skin cancer in patients with MMP by performing a large-scale, retrospective matched cohort study utilizing data from over 117 million US individuals. The risk of skin cancer in patients with MMP was observed within a 5-year follow-up period, along with three temporal difference analyses and stratification for disease severity.

Results

MMP was associated with an increased risk of several types of skin cancers within the first 5 years of follow-up, particularly squamous cell carcinoma, basal cell carcinoma, and non-melanoma skin cancer. Stratification by disease severity showed significantly elevated risks in severe cases.

Discussion

These findings underscore the importance of regular skin cancer screening and risk-based monitoring in MMP patients, particularly those with severe disease. Integrating dermatologic surveillance into routine care could facilitate early detection and timely intervention. Additionally, these results highlight the need for further research into cancer risks in other autoimmune blistering diseases, helping to refine long-term management strategies.

Rate of Osteoporosis Evaluation and Treatment Following Kyphoplasty in Patients With Vertebral Compression Fractures: A Retrospective Study and Review of the Literature

Background

Lifetime risk of an osteoporotic fracture is 50% for women and 20% for men. Of these fractures, vertebral compression fractures (VCF) are the most common. While surgery plays a crucial role in managing these fractures, preventative measures are also critical when addressing the risk of osteoporotic VCFs. Although many recent guidelines recommend osteoporosis evaluation and treatment for patients with VCFs, the true proportion of patients who undergo an osteoporosis workup following their kyphoplasty procedure is unknown. The aim of this study is to assess the frequency of osteoporosis screening and treatment in patients who undergo a kyphoplasty procedure to correct a vertebral fragility fracture.

Methods

This study utilized the TriNetX Research Network, a database containing de-identified patient information. Using this database, we identified patients from 89 institutions with non-traumatic VCFs and VCFs that resulted from low-energy trauma who subsequently underwent a kyphoplasty procedure. We then analyzed any follow-up osteoporosis treatment or screening they received.

Results

A total of 3371 patients were identified to have undergone kyphoplasty to treat a VCF for the first time. To our knowledge, this is the largest study of its kind to date. Among these patients, 71.3% never had a DEXA scan or prior medical treatment for osteoporosis within 2 years before their kyphoplasty procedure. Additionally, 56.1% of all patients with VCFs treated with kyphoplasty for the first time were never screened or treated for osteoporosis in the two years preceding and 1 year following the procedure.

Conclusion

Our results suggest that only 15.2% of patients with a vertebral fragility fracture secondary to decreased bone density are screened and treated for osteoporosis. Despite existing guidelines recommending osteoporosis evaluation and treatment for patients with VCFs, our findings highlight missed opportunities for intervention. Improving the implementation of existing screening protocols and increasing awareness among healthcare providers could reduce VCF-associated morbidity and mortality.

Mortality and medical utilization in rheumatoid arthritis associated interstitial lung disease: A real-world, large-scale retrospective study comparing Janus kinase inhibitors and tumor necrosis factor inhibitors

OBJECTIVE

The study is aimed to investigate the effectiveness of Janus kinase inhibitors (JAKi) on rheumatoid arthritis associated interstitial lung disease (RA-ILD) compared to tumor necrosis inhibitors (TNFi).

METHODS

We applied a retrospective matched cohort analysis using the TriNetX database. The study included patients diagnosed with RA-ILD who received new prescriptions for JAKi or TNFi. The primary outcome was all-cause mortality, and secondary outcomes included medical utilizations. Hazard ratios (HRs) and Cox regression analyses were performed to assess these outcomes.

RESULTS

Among 23,707 RA-ILD patients, 812 were selected for each treatment group (JAKi and TNFi) following propensity score matching. The JAKi group exhibited a higher all-cause mortality risk compared to the TNFi group (HR 1·458, 95 % CI: 1·136-1·870). JAKi group was also associated with a higher risk for hospitalization (HR 1·167, 95 % CI: 1·011-1·348), critical care services (HR 1·854, 95 % CI: 1·414-2·431), and mechanical ventilation (HR 2·609, 95 % CI: 1·718-3·962). Subgroup analysis indicated a heightened mortality risk in JAKi-treated patients aged over 65 years old (HR 1·815, 95 % CI: 1·316-2·503), and those with cardiovascular risk factors (HR 1·636, 95 % CI: 1·197-2·237). Sensitivity analysis yielded results that were not entirely consistent with the primary analysis, except for the subgroup aged over 65, where results remained aligned.

CONCLUSION

This real-world, large-scale cohort study indicated an association of higher mortality and medical utilizations in RA-ILD patients treated with JAKi compared to TNFi, especially among those over 65 years of age. These findings highlight the need for careful assessment when prescribing JAKi or TNFi for patients with RA-ILD.

Glucagon-Like Peptide-1 Receptor Agonists and Liver Outcomes in Patients With MASLD and Type 2 Diabetes

BACKGROUND AND AIMS

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) have demonstrated long-term liver benefits in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes (T2D). However, no direct comparison between these therapies has been conducted. This study aimed to compare major adverse liver outcomes (MALOs) between GLP-1 RAs and SGLT2is in patients with MASLD and T2D.

METHODS

Using the TriNetX Research Network, a multinational and multi-institutional database, we identified adults with MASLD and T2D who received their first prescription for either a GLP-1 RA or an SGLT2i between January 2010 and June 2023. We conducted a propensity score-matched (PSM) cohort study comparing new users of GLP-1 RAs and SGLT2is. The primary outcome was the risk of MALOs, a composite endpoint consisting of decompensated cirrhosis events, hepatocellular carcinoma, and liver transplantation. Secondary outcomes included all-cause mortality and individual components of the primary outcome.

RESULTS

This study included 15,176 pairs of patients treated with either a GLP-1 RA or a SGLT2i. The adjusted hazard ratio (HR) for MALO associated with GLP-1 RAs relative to SGLT2is was 0.84 (95% confidence interval [CI]: 0.73-0.97; incidence rate: 88.9 versus 105.3 events per 10,000 person-years), primarily driven by reduction in decompensated cirrhosis events (adjusted HR: 0.83, 95% CI: 0.71-0.96). GLP-1 RAs were associated with lower all-cause mortality (adjusted HR: 0.84, 95% CI: 0.75-0.94).

CONCLUSION

GLP-1 RAs are associated with better long-term liver outcomes compared to SGLT2is in patients with MASLD and T2D.

Cannabis Use During Pregnancy Correlates With Adverse Maternal Mental Health Outcomes: A Retrospective Study

Introduction The prevalence of cannabis use during pregnancy has risen alongside its legalization and perceived safety, often being used to alleviate pregnancy-related discomforts. However, cannabis use during pregnancy may have adverse implications for maternal mental health, including increased rates of depression, panic disorder, suicidal ideation, and alcohol abuse. This study aims to evaluate the association between cannabis use during pregnancy and these mental health outcomes. Methods This retrospective cohort study utilized the TriNetX database, including over 2 million pregnant patients from 69 U.S. healthcare organizations (HCOs). A cohort of 51,087 cannabis users during pregnancy was compared to 1,936,508 non-users. Outcomes analyzed included depression, panic disorder, suicidal ideation, and alcohol abuse, identified using the International Classification of Diseases, 10th Revision (ICD-10) codes. Risk ratios, hazard ratios, and Kaplan-Meier survival probabilities were calculated, with statistical significance set at p < 0.05. Results Cannabis use during pregnancy was associated with higher incidences of all four mental health outcomes. Alcohol abuse showed the greatest relative risk (risk ratio = 13.57; hazard ratio = 12.44), followed by suicidal ideation (risk ratio = 10.67; hazard ratio = 9.81), panic disorder (risk ratio = 5.47; hazard ratio = 5.01), and depression (risk ratio = 2.66; hazard ratio = 3.50). Depression affected 29.7% of cannabis users, compared to 11.2% of non-users, with significant differences in survival probabilities (p < 0.001). Conclusion Cannabis use during pregnancy is significantly associated with increased risks of adverse mental health outcomes. These findings emphasize the importance of screening for cannabis use and mental health conditions during pregnancy and underscore the need for public health initiatives addressing the risks of prenatal cannabis use. Further research is needed to explore causal relationships and dosing effects.

Metabolic and Bariatric Operation and the Path to Kidney Transplantation

BACKGROUND

Obesity is a significant barrier to kidney transplantation for patients with end-stage renal disease (ESRD). We aimed to evaluate the long-term impact of metabolic and bariatric surgery (MBS) on kidney transplantation access and outcomes in individuals with obesity and patients with ESRD.

STUDY DESIGN

A retrospective cohort study using data from 64 US healthcare organizations included 132,989 individuals with obesity (BMI ≥ 30 kg/m²) and ESRD requiring dialysis, of whom 6,263 (4.6%) underwent MBS. Propensity score matching produced 1:1 matched groups of 6,238 patients each, analyzed for 10 years. Primary outcomes included rates of kidney transplant waitlist placement, transplantation, and overall mortality. Secondary outcomes focused on 22,979 transplant recipients, including 1,701 (7.4%) patients who underwent MBS, to evaluate posttransplant adverse events.

RESULTS

During a median follow-up of 33.3 months (MBS) and 28.5 months (controls), patients who underwent MBS demonstrated higher rates of waitlist placement (19.12% vs 10.53%, hazard ratio [HR] 1.800, 95% CI 1.636 to 1.980, p < 0.001) and transplantation (27.06% vs 16.09%, HR 1.712, 95% CI 1.584 to 1.852, p < 0.001) at 10 years, with benefits evident within 1-month postoperation. Mortality was lower in the MBS group (30.55% vs 36.44%, HR 0.768, 95% CI 0.723 to 0.817, p < 0.001). In transplant recipients, patients who underwent MBS had lower cardiovascular complications (37.3% vs 40.6%, risk ratio 0.92, p = 0.007) and all-cause mortality (16.70% vs 20.88%, HR 0.82, p < 0.001), with no significant differences in graft rejection or failure.

CONCLUSIONS

MBS significantly improves access to kidney transplantation and long-term survival for obese patients with ESRD. Patients who underwent MBS demonstrated notable improvements in cardiovascular health, potentially leading to a better quality of life and survival. These findings suggest that MBS should be considered as part of the comprehensive care for this high-risk population.

Semaglutide and the risk of adverse liver outcomes in patients with nonalcoholic fatty liver disease and type 2 diabetes: a multi-institutional cohort study

BACKGROUND

Semaglutide has shown potential liver benefits in patients with nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2D). However, no direct comparisons have been made between semaglutide and other antidiabetic medications, including sodium-glucose cotransporter-2 inhibitors (SGLT2i), thiazolidinediones (TZD), and dipeptidyl peptidase-4 inhibitors (DPP-4i), regarding liver outcomes in patients with both NAFLD and T2D.

METHODS

This retrospective cohort study utilized the TriNetX electronic health record database, a multinational and multi-institutional database. Adults with NAFLD and T2D who received their first prescription for either semaglutide or other antidiabetic medications were included. New users of semaglutide were matched 1:1 via propensity score matching with users of SGLT2i, DPP-4i, and TZD. The primary outcome was major adverse liver outcome (MALO), a composite end point consisting of decompensated cirrhosis, hepatocellular carcinoma, and liver transplantation. Secondary outcomes included the individual components of MALO and all-cause mortality.

RESULTS

A total of 648,070 adult patients with T2D and NAFLD were identified, and patients were categorized into three different comparison groups based on their drug of interest. Semaglutide was associated with a lower risk of MALO compared to SGLT2i (adjusted hazard ratio [aHR], 0.73; 95% CI 0.60-0.88), DPP-4i (aHR, 0.72; 95% CI 0.56-0.86), and TZD (aHR, 0.76; 95% CI 0.56-0.99). Additionally, semaglutide was linked to a lower risk of all-cause mortality compared to SGLT2i (aHR, 0.62; 95% CI 0.53-0.72), DPP-4i (aHR, 0.42; 95% CI 0.36-0.49), and TZD (aHR, 0.67; 95% CI 0.54-0.83).

CONCLUSION

Semaglutide is associated with better liver outcomes and a lower risk of all-cause mortality compared to SGLT2i, DPP-4i, and TZD in patients with NAFLD and T2D.

Working Toward Defining Frailty in Breast Surgery: A Multi-institution Cohort Study Identifying Risk Factors of Free Flap Failure Following Autologous Breast Reconstruction

BACKGROUND

The integration of frailty assessments into preoperative evaluation protocols is essential for enhancing surgical procedure safety. As autologous breast reconstruction (ABR) increases in popularity, it is critical to stratify risk in patients with significant comorbidities with an ABR-specific frailty model. The aim of this study was to identify comorbidities associated with patients for unilateral or bilateral ABR flap failure, to develop a frailty index with a multi-institutional database.

METHODS

The TriNetX database was queried for patients who underwent free flap breast reconstruction (CPT code 19364) between 2016 and 2024 across 89 healthcare institutions. Patients who experienced unilateral or bilateral flap failure (ICD-10 T86.821) were identified; preoperative comorbidities that occurred at a significantly different frequency were detected. Subsequently, univariate and multivariable logistic regression analyses were used to identify independent risk factors of free flap failure. Odds ratios were converted into relative risk ratios and probabilities using the baseline frequency of flap failure without any comorbidity.

RESULTS

A total of 10,291 patients who underwent either unilateral or bilateral primary free flap ABR were identified. A total of 120 (1.17%) patients experienced partial or total flap failure. Comorbidities of interest were seen among infectious, oncologic, hematologic, cardiovascular, gastrointestinal, and dermatologic systems. Significant risk factors on multivariable logistic regression included history of anemia (OR, 2.87), breast abscess (OR, 2.98), chronic obstructive pulmonary disease (OR, 3.08), hypertension (OR, 1.69), and body mass index ≥30 (OR, 2.37) (P < 0.05 for all). The baseline frequency of flap failure without any comorbidity was 0.73%. The presence of one or more risk factors increased the probability of 1-week flap failure anywhere from 1.23% (hypertension alone) to 43.69% (all five comorbidities).

CONCLUSIONS

Select preoperative comorbidities were identified as patient-specific risk factors for postoperative flap failure. A future direction may also include identifying complications specific to certain flap techniques and within partial and total flap failures, as well as prospectively tracking data per flap, rather than per patient through the TriNetX database.

Mortality in adult patients with chronic spontaneous urticaria: A real-world cohort study

BACKGROUND

Chronic spontaneous urticaria (CSU), a common and debilitating disease, is widely held not to be life limiting, but the mortality of CSU has not been investigated.

OBJECTIVE

We sought to assess all-cause mortality in patients with CSU, risk for comorbidities that are leading causes of death, and impact of guideline-recommended urticaria treatments on mortality rates.

METHODS

This was a retrospective population-based cohort study of electronic health records of 272,190 adult patients with CSU and 12,728,913 controls without urticaria from the US collaborative network TriNetX.

RESULTS

The study included 264,680 propensity score-matched patients with CSU (mean [SD] age = 47.5 [19.8] years; 71.5% female) and a corresponding number of controls without urticaria. Patients with CSU had higher 3-month (hazard ratio [HR] 2.10, 95% CI 1.97-2.22), 1-year (HR 1.77, 95% CI 1.71-1.83), and 5-year (HR 1.69, 95% CI 1.65-1.73) all-cause mortality (all P < .0001). Compared with controls, patients with CSU exhibited higher risk and rates of the leading causes of death in the United States, including suicidal ideations/suicide attempts (HR 3.14, 95% CI 3.00-3.28) and malignant neoplasms (HR 2.09, 95% CI 2.02-2.16). The risk of mortality appeared to be more pronounced in White and younger patients with CSU. All-cause mortality rates at 5 years were significantly lower in patients treated with second-generation H1 antihistamines versus untreated patients (1.0% vs 2.3%; HR 1.84, P < .0001) and omalizumab-treated patients versus antihistamine-treated patients (0.7% vs 2.6%; HR 3.99, P = .0003).

CONCLUSIONS

CSU is associated with increased mortality likely due to comorbidities, especially suicide, and effective CSU treatment may reduce mortality. These findings should be investigated in additional studies and in other populations.

Artificial intelligence-based drug repurposing with electronic health record clinical corroboration: A case for ketamine as a potential treatment for amphetamine-type stimulant use disorder

BACKGROUND AND AIMS

Amphetamine-type stimulants are the second-most used illicit drugs globally, yet there are no US Food and Drug Administration (FDA)-approved treatments for amphetamine-type stimulant use disorders (ATSUD). The aim of this study was to utilize a drug discovery framework that integrates artificial intelligence (AI)-based drug prediction, clinical corroboration and mechanism of action analysis to identify FDA-approved drugs that can be repurposed for treating ATSUD.

DESIGN AND SETTING

An AI-based knowledge graph model was first utilized to prioritize FDA-approved drugs in their potential efficacy for treating ATSUD. Among the top 10 ranked candidate drugs, ketamine represented a novel candidate with few studies examining its effects on ATSUD. We therefore conducted a retrospective cohort study to assess the association between ketamine and ATSUD remission using US electronic health record (EHR) data. Finally, we analyzed the potential mechanisms of action of ketamine in the context of ATSUD.

PARTICIPANTS AND MEASUREMENTS

ATSUD patients who received anesthesia (n = 3663) or were diagnosed with depression (n = 4328) between January 2019 and June 2022. The outcome measure was the diagnosis of ATSUD remission within one year of the drug prescription.

FINDINGS

Ketamine for anesthesia in ATSUD patients was associated with greater ATSUD remission compared with other anesthetics: hazard ratio (HR) = 1.58, 95% confidence interval (CI) = 1.15-2.17. Similar results were found for ATSUD patients with depression when comparing ketamine with antidepressants and bupropion/mirtazapine with HRs of 1.51 (95% CI = 1.14-2.01) and 1.68 (95% CI = 1.18-2.38), respectively. Functional analyses demonstrated that ketamine targets several ATSUD-associated pathways including neuroactive ligand-receptor interaction and amphetamine addiction.

CONCLUSIONS

There appears to be an association between clinician-prescribed ketamine and higher remission rates in patients with amphetamine-type stimulant use disorders.

Khorana risk score in lung cancer patients treated with immune checkpoint inhibitors: a real-world study

BACKGROUND

Lung cancer patients are at increased risk of venous thromboembolism (VTE) and arterial thrombosis, particularly when treated with immune checkpoint inhibitors (ICIs). The Khorana Risk Score (KRS), an effective tool for predicting VTE risk in chemotherapy recipients, needs further validation in lung cancer patients treated with ICIs.

METHODS

We utilized a global database and conducted a retrospective cohort study. Lung cancer patients receiving ICIs were classified into intermediate (KRS 1-2) and high-risk (KRS ≥ 3) groups. The primary outcome was VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE); secondary outcomes included arterial thrombosis and all-cause mortality. Risk comparisons were performed using Cox proportional hazards analysis.

RESULTS

Among 5,378 patients, those with a high KRS had a greater risk of VTE (HR: 1.38, 95% CI: 1.15-1.65), including DVT (HR: 1.43, 95% CI: 1.12-1.82) and PE (HR: 1.32, 95% CI: 1.05-1.67). High KRS was also associated with increased arterial thrombosis (HR: 1.60, 95% CI: 1.29-1.96), ischemic stroke (HR: 1.73, 95% CI: 1.32-2.25), and elevated mortality (HR: 1.66, 95% CI: 1.48-1.87).

CONCLUSION

A high KRS (≥ 3) is associated with a higher risk of thrombotic events and mortality in lung cancer patients treated with ICIs. These findings suggest that KRS may aid risk stratification in this population, warranting further prospective research.

Pregnancy-Induced Hypertension and Association With Future Autoimmune Diseases

OBJECTIVE

To explore the associations between hypertensive disorders of pregnancy and the subsequent development of autoimmune diseases.

METHODS

This retrospective cohort study used TriNetX, a federated network of real-world data. Using the Global Collaborative Network data, we collected electronic medical records from 102 health care organizations with 131 million patient records from 2006 to 2020. The study assessed the risk of autoimmune diseases in women aged 16-45 years. Two cohorts were compared: the pregnancy-induced hypertension cohort, which included women with gestational hypertension, preeclampsia, or eclampsia, and the normotensive pregnancy cohort. Women with preexisting autoimmune diseases or hypertension and those with complications occurring before 20 weeks of gestation were excluded. Propensity score matching was used to ensure balanced cohorts. The primary outcome was the long-term risk of autoimmune diseases during a follow-up period of up to 18 years. The secondary outcome evaluated the association between the risk of autoimmune diseases and both the patient's age and the severity of pregnancy-induced hypertension.

RESULTS

The prevalence of pregnancy-induced hypertension was found to be 13.4%. After propensity score matching, among 289,564 women, those with pregnancy-induced hypertension demonstrated a significantly higher risk of developing autoimmune diseases during long-term follow-up. The risk of systemic lupus erythematosus was notably higher (hazard ratio 1.87, 95% CI, 1.60-2.18), along with elevated risks of multiple sclerosis, Addison disease, antiphospholipid syndrome, inflammatory bowel disease, mixed connective tissue disease, and rheumatoid arthritis. Subgroup analysis revealed that women of advanced maternal age with pregnancy-induced hypertension had a similar risk of developing autoimmune diseases compared with younger women. In addition, the risk of these autoimmune diseases increased with the severity of pregnancy-induced hypertension.

CONCLUSION

Women with a history of pregnancy-induced hypertension face a higher long-term risk of autoimmune diseases, emphasizing the need for ongoing monitoring and preventive care.

Validating Khorana Risk Score in gastric cancer patients on immune checkpoint inhibitors and chemotherapy

INTRODUCTION

Patients with gastric cancer are at a high risk of venous thromboembolism (VTE), and immune checkpoint inhibitors (ICIs) may further increase this risk. While the Khorana Risk Score (KRS) has been validated primarily in chemotherapy-treated populations, its utility in ICI-treated patients remains unclear.

METHODS

Using the TriNetX Global Collaborative Network, we analyzed data from 2782 patients with gastric cancer treated with ICIs. Patients were stratified into high-risk (KRS ≥3) and intermediate-risk (KRS = 2) groups based on pre-treatment laboratory values and BMI. Cox proportional-hazards analyses were performed to evaluate the association between KRS and outcomes, including VTE, all-cause mortality, and arterial thrombosis, over a one-year follow-up period.

RESULTS

High-risk patients had a 26% higher risk of VTE (HR: 1.26, [95% CI: 1.06-1.50]) and a 43% higher risk of all-cause mortality (HR: 1.43, [95% CI: 1.27-1.62]) compared to intermediate-risk patients. The incidence of deep vein thrombosis (DVT) was also significantly higher in the high-risk group (HR: 1.27, [95% CI: 1.01-1.59]), but no significant differences were observed for pulmonary embolism (PE) or arterial thrombosis.

CONCLUSION

These findings suggest the KRS may effectively stratify VTE risk and mortality in gastric cancer patients treated with ICIs.