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Font C, Gomez-Mesa JE, López-Núñez JJ, Calderón C, Galindo-Coral S, Wu CC, Ma J, Kroll MH, Rojas-Hernandez CM. Measurement of adherence and health-related quality of life during anticoagulation therapy in cancer-associated venous thromboembolism (VTE): a multicenter quantitative study. Support Care Cancer 2023; 31:615. [PMID: 37801086 DOI: 10.1007/s00520-023-08073-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Therapy for cancer-associated venous thromboembolism (VTE) includes long-term anticoagulation, which may have substantial impact on the health-related quality of life (HRQL) of patients. We assessed patient-reported outcomes to characterize the HRQL associated with VTE treatment and to begin to examine those HRQL elements impacting anticoagulation adherence (AA). METHODS Participants were adult cancer patients with confirmed symptomatic acute lower extremity deep venous thrombosis. Patients were excluded if there was an indication for anticoagulation other than VTE, ECOG performance status >3, or life expectancy < 3 months. Participants were assessed with a self-reported adherence tool. HRQL was measured with a 6-domain questionnaire using a seven-point Likert scale. Evaluations were performed at 30 days and 3 months after enrollment. For the primary objective, an overall adherence rate was calculated at each time point of evaluation. For the HRQL domains, non-parametric testing was used to compare results between subgroups. RESULTS Seventy-four patients were enrolled. AA and HRQL at 30 days and 3 months were assessed in 50 and 36 participants, respectively. At 30 days the AA rate was 90%, and at 3 months it was 83%. In regard to HRQL, patients suffered frequent and moderate-severe distress in the domains of emotional and physical symptoms, sleep disturbance, and limitations to physical activity. An association between emotional or physical distress and AA was observed. CONCLUSION Patients with VTE suffer a substantial impairment of their HRQL. Increased emotional distress correlated with better long-term AA. These results can be used to inform additional research aimed at developing novel strategies to improve AA.
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Affiliation(s)
- Carme Font
- Department of Medical Oncology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Juan Esteban Gomez-Mesa
- Departamento de Cardiología, Fundación Valle del Lili, Cali, Colombia
- Departamento de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Juan J López-Núñez
- Hospital Germans i Trias Pujol, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació Germans Trias i Pujol, Badalona, Spain
| | - Caterina Calderón
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | | | - Carol C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Junsheng Ma
- Biostatistics Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael H Kroll
- Section of Benign Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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2
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Li A, La J, May SB, Guffey D, da Costa WL, Amos CI, Bandyo R, Milner EM, Kurian KM, Chen DC, Do NV, Granada C, Riaz N, Brophy MT, Chitalia V, Gaziano JM, Garcia DA, Carrier M, Flowers CR, Zakai NA, Fillmore NR. Derivation and Validation of a Clinical Risk Assessment Model for Cancer-Associated Thrombosis in Two Unique US Health Care Systems. J Clin Oncol 2023; 41:2926-2938. [PMID: 36626707 PMCID: PMC10431461 DOI: 10.1200/jco.22.01542] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/25/2022] [Accepted: 12/01/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Venous thromboembolism (VTE), especially pulmonary embolism (PE) and lower extremity deep vein thrombosis (LE-DVT), is a serious and potentially preventable complication for patients with cancer undergoing systemic therapy. METHODS Using retrospective data from patients diagnosed with incident cancer from 2011-2020, we derived a parsimonious risk assessment model (RAM) using least absolute shrinkage and selection operator regression from the Harris Health System (HHS, n = 9,769) and externally validated it using the Veterans Affairs (VA) health care system (n = 79,517). Bootstrapped c statistics and calibration curves were used to assess external model discrimination and fit. Dichotomized risk strata using integer scores were created and compared against the Khorana score (KS). RESULTS Incident VTE and PE/LE-DVT at 6 months occurred in 590 (6.2%) and 437 (4.6%) patients in HHS and 4,027 (5.1%) and 3,331 (4.2%) patients in the VA health care system. Assessed at the time of systemic therapy initiation, the new RAM included components of the KS with the modified cancer subtype, cancer staging, systemic therapy class, history of VTE, history of paralysis/immobility, recent hospitalization, and Asian/Pacific Islander race. The c statistic was 0.71 in HHS and 0.68 in the VA health care system (compared with 0.65 and 0.60, respectively, for KS). Furthermore, the new RAM appropriately reclassified 28% of patients and increased the proportion of VTEs in the high-risk group from 37% to 68% in the validation data set. CONCLUSION The novel RAM stratified patients with cancer into a high-risk group with 8%-10% cumulative incidence of VTE and 7% PE/LE-DVT at 6 months (v 3% and 2%, respectively, in the low-risk group). The model had improved performance over the original KS and doubled the number of VTE events in the high-risk stratum. We encourage additional external validation from prospective studies.[Media: see text].
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Affiliation(s)
- Ang Li
- Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX
| | - Jennifer La
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
| | - Sarah B. May
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, TX
| | - Danielle Guffey
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, TX
| | - Wilson L. da Costa
- Section of Epidemiology and Population Science, Baylor College of Medicine, Houston, TX
| | - Christopher I. Amos
- Institute for Clinical & Translational Research, Baylor College of Medicine, Houston, TX
- Section of Epidemiology and Population Science, Baylor College of Medicine, Houston, TX
| | | | | | | | - Daniel C.R. Chen
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA
| | - Nhan V. Do
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA
| | - Carolina Granada
- Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX
| | - Nimrah Riaz
- Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX
| | - Mary T. Brophy
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
- Section of Hematology & Medical Oncology, Boston University School of Medicine, Boston, MA
| | - Vipul Chitalia
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA
| | - J. Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of Aging, Brigham and Women's Hospital, Boston, MA
| | - David A. Garcia
- Division of Hematology, University of Washington School of Medicine, Seattle, WA
| | - Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher R. Flowers
- Division of Cancer Medicine, Department of Lymphoma-Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Neil A. Zakai
- Departments of Medicine and Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT
| | - Nathanael R. Fillmore
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
- Section of Hematology & Medical Oncology, Boston University School of Medicine, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
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3
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Fang LJ, Yao XD, Lu MQ, Chu B, Shi L, Gao S, Xiang QQ, Wang YT, Liu X, Ding YH, Chen Y, Wang MZ, Zhao X, Hu WK, Sun K, Bao L. [Comparison of the predictive value of Padua and the IMPEDE assessment scores for venous thromboembolism in patients with newly diagnosed multiple myeloma: A single institution experience]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:395-400. [PMID: 37550189 PMCID: PMC10440615 DOI: 10.3760/cma.j.issn.0253-2727.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Indexed: 08/09/2023]
Abstract
Objective: To compare the predictive efficacy of the two thrombosis risk assessment scores (Padua and IMPEDE scores) in venous thromboembolism (VTE) within 6 months in patients with newly diagnosed multiple myeloma (NDMM) in China. Methods: This study reviewed the clinical data of 421 patients with NDMM hospitalized in Beijing Jishuitan Hospital from April 2014 to February 2022. The sensitivity, specificity, accuracy, and Youden index of the two scores were calculated to quantify the thrombus risk assessment of VTE by the Padua and IMPEDE scores. The receiver operating characteristics curves of the two evaluation scores were drawn. Results: The incidence of VTE was 14.73%. The sensitivity, specificity, accuracy, and Youden index of the Padua score were 100%, 0%, 14.7%, and 0% and that of the IMPEDE score was 79%, 44%, 49.2%, and 23%, respectively. The areas under the curve of Padua and IMPEDE risk assessment scores were 0.591 and 0.722, respectively. Conclusion: IMPEDE score is suitable for predicting VTE within 6 months in patients with NDMM.
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Affiliation(s)
- L J Fang
- Department of Hematology, Beijing Jishuitan Hospital, Beijing 100096, China
| | - X D Yao
- Department of Hematology, Beijing Jishuitan Hospital, Beijing 100096, China
| | - M Q Lu
- Department of Hematology, Beijing Jishuitan Hospital, Beijing 100096, China
| | - B Chu
- Department of Hematology, Beijing Jishuitan Hospital, Beijing 100096, China
| | - L Shi
- Department of Hematology, Beijing Jishuitan Hospital, Beijing 100096, China
| | - S Gao
- Department of Hematology, Beijing Jishuitan Hospital, Beijing 100096, China
| | - Q Q Xiang
- Department of Hematology, Beijing Jishuitan Hospital, Beijing 100096, China
| | - Y T Wang
- Department of Hematology, Beijing Jishuitan Hospital, Beijing 100096, China
| | - X Liu
- Department of Hematology, Beijing Jishuitan Hospital, Beijing 100096, China
| | - Y H Ding
- Department of Hematology, Beijing Jishuitan Hospital, Beijing 100096, China
| | - Y Chen
- Department of Hematology, Beijing Jishuitan Hospital, Beijing 100096, China
| | - M Z Wang
- Department of Hematology, Beijing Jishuitan Hospital, Beijing 100096, China
| | - X Zhao
- Department of Hematology, Beijing Jishuitan Hospital, Beijing 100096, China
| | - W K Hu
- Department of Hematology, Beijing Jishuitan Hospital, Beijing 100096, China
| | - K Sun
- Department of Hematology, Beijing Jishuitan Hospital, Beijing 100096, China
| | - L Bao
- Department of Hematology, Beijing Jishuitan Hospital, Beijing 100096, China
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4
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Han M, Wang X, Li Y, Tan J, Li C, Sheng W. Identification of coagulation-associated subtypes of lung adenocarcinoma and establishment of prognostic models. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:10626-10658. [PMID: 37322952 DOI: 10.3934/mbe.2023470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Lung adenocarcinoma (LUAD), the most common subtype of lung cancer, is a global health challenge with high recurrence and mortality rates. The coagulation cascade plays an essential role in tumor disease progression and leads to death in LUAD. We differentiated two coagulation-related subtypes in LUAD patients in this study based on coagulation pathways collected from the KEGG database. We then demonstrated significant differences between the two coagulation-associated subtypes regarding immune characteristics and prognostic stratification. For risk stratification and prognostic prediction, we developed a coagulation-related risk score prognostic model in the Cancer Genome Atlas (TCGA) cohort. The GEO cohort also validated the predictive value of the coagulation-related risk score in terms of prognosis and immunotherapy. Based on these results, we identified coagulation-related prognostic factors in LUAD, which may serve as a robust prognostic biomarker for therapeutic and immunotherapeutic efficacy. It may contribute to clinical decision-making in patients with LUAD.
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Affiliation(s)
- Mengyang Han
- Department of Pharmacology, Beijing International Science and Technology Cooperation Base of Antivirus Drug, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Xiaoli Wang
- Department of Pharmacology, Beijing International Science and Technology Cooperation Base of Antivirus Drug, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Yaqi Li
- Department of Pharmacology, Beijing International Science and Technology Cooperation Base of Antivirus Drug, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Jianjun Tan
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Chunhua Li
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Wang Sheng
- Department of Pharmacology, Beijing International Science and Technology Cooperation Base of Antivirus Drug, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
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5
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Qin Y, Zhang L, Liang X, Sun X, Wang N, Yuan M, Wang Q, Wu D. Venous and Arterial Thromboembolism in Patients with Metastatic Lung Cancer. Clin Appl Thromb Hemost 2023; 29:10760296231159121. [PMID: 36814378 PMCID: PMC9950605 DOI: 10.1177/10760296231159121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Lung cancer is the leading cause of cancer-related mortality worldwide with an increasing incidence in many countries. There were few studies on arterial and venous thromboembolism (ATE/VTE) in patients with metastatic lung cancer. Our study focused on the clinical characteristics of stage IV lung cancer patients with ATE or VTE to further explore the risk factors and prognosis. Patients diagnosed with metastatic lung cancer were enrolled from January 2011 to June 2019 at a tertiary hospital in Jiangyin, China. Log-rank test was used to reveal the survival for patients with ATE or VTE. Univariable analysis and multivariable logistic regression were used to study the risk factors for ATE. A total of 587 patients were enrolled in our study, including 52 patients with VTE and 48 with ATE. ATE occurred earlier than VTE. Patients with ATE had a worse prognosis. Multivariable logistic regression revealed that older age and a history of hypertension were independent risk factors for ATE. Patients with metastatic lung cancer were at high risk of VTE and ATE. ATE occurred earlier and was associated with a worse prognosis. Attention should be paid to metastatic lung cancer patients who may develop thromboembolism, especially ATE.
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Affiliation(s)
- Ya Qin
- Department of Oncology, Jiangyin People's Hospital, Wuxi, 214400,
Jiangsu, China,Qiong Wang, Department of Oncology,
Jiangyin People's Hospital, 163# Shoushan Road, Jiangyin, Jiangsu, China.
| | - Lingfei Zhang
- Department of Cardiology, Jiangyin Hospital of Traditional Chinese
Medicine, Wuxi, 214400, Jiangsu, China
| | - Xiao Liang
- Department of Medical Oncology, the First Affiliated Hospital of
Nanjing Medical University, Nanjing, 210000, Jiangsu, China
| | - Xia Sun
- Department of Oncology, Jiangyin People's Hospital, Wuxi, 214400,
Jiangsu, China
| | - Nanyao Wang
- Department of Oncology, Jiangyin People's Hospital, Wuxi, 214400,
Jiangsu, China
| | - Ming Yuan
- Department of Oncology, Jiangyin People's Hospital, Wuxi, 214400,
Jiangsu, China
| | - Qiong Wang
- Department of Oncology, Jiangyin People's Hospital, Wuxi, 214400,
Jiangsu, China
| | - Dan Wu
- Department of Oncology, Jiangyin People's Hospital, Wuxi, 214400,
Jiangsu, China,Dan Wu, Department of Oncology, Jiangyin
People's Hospital, 163# Shoushan Road, Jiangyin, Jiangsu, China.
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6
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Sanfilippo KM, Wang TF, Carrier M, Falanga A, Gage BF, Khorana AA, Maraveyas A, Soff GA, Wells PS, Zwicker JI. Standardization of risk prediction model reporting in cancer-associated thrombosis: Communication from the ISTH SSC subcommittee on hemostasis and malignancy. J Thromb Haemost 2022; 20:1920-1927. [PMID: 35635332 DOI: 10.1111/jth.15759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/27/2022]
Abstract
Since the development of the Khorana score to predict risk of cancer-associated venous thromboembolism (VTE), many modified and de novo risk prediction models (RPMs) have been proposed. Comparison of the prognostic performance across models requires comprehensive reporting and standardized methods for model development, validation and evaluation. To improve the standardization of RPM reporting, the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) tool was published in 2015. To better understand the quality of reporting and development of RPMs for cancer-associated VTE, we performed a literature search of published RPMs and assessed each model using the TRIPOD checklist. Our results yielded 29 RPMs for which 30 items were evaluated. There was a non-significant (p = 0.15) improvement in reporting of the 30 items in the post-TRIPOD era (81%) versus the pre-TRIPOD era (75%). Of seven items (title, sample size, missing data handling, baseline demographics, methods and results for model performance, and supplemental resources) with the lowest reporting in the pre-TRIPOD era (<70%), there was an average improvement of 22% in the post-TRIPOD era. Only two of the 22 studies published in the post-TRIPOD era acknowledged compliance with TRIPOD. Informed by the results of this assessment, the Scientific and Standardization Committee (SSC) Subcommittee on Hemostasis & Malignancy of the International Society on Thrombosis and Hemostasis (ISTH) advocates for standardization of four key elements of RPMs for cancer-associated VTE: (1) inclusion of the TRIPOD checklist, (2) clear definition of the derivation population, with justification of sample size, (3) clear definition of predictors, and (4) external validation prior to implementation.
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Affiliation(s)
- Kristen M Sanfilippo
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
- John Cochran Saint Louis Veterans Administration Medical Center, Saint Louis, Missouri, USA
| | - Tzu-Fei Wang
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Anna Falanga
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Brian F Gage
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Alok A Khorana
- Taussig Cancer Institute, Cleveland Clinic and Case Comprehensive Cancer Center, Cleveland, Ohio, USA
| | - Anthony Maraveyas
- Faculty of Health Sciences, Joint Centre for Cancer Studies, The Hull York Medical School, Castle Hill Hospital, Hull, UK
| | - Gerald A Soff
- Department of Medicine, University of Miami Health System/Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Phillip S Wells
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey I Zwicker
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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7
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Wang SC, Liao JY. Epidemiologic Implication of the Association between Herpes Simplex Virus Infection and the Risk of Type 1 Diabetes Mellitus: A Nationwide Case-Control Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137832. [PMID: 35805493 PMCID: PMC9265894 DOI: 10.3390/ijerph19137832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 02/05/2023]
Abstract
Enterovirus infection is a known risk factor for type 1 diabetes (T1DM). Whether infection with other viruses induces T1DM remains undetermined. This study investigated the association between human herpesvirus (HHV) infection and the development of T1DM, using the data from Taiwan’s National Health Insurance Research Database. Patients with T1DM and age- and sex-matched controls were included. Subjects with HHV infection were subgrouped into those with histories of varicella-zoster virus, herpes simplex virus (HSV), Epstein-Barr virus, and human cytomegalovirus infections. The odds ratio of the risk of T1DM was calculated using a multivariable conditional logistic regression model. Atopic diseases, autoimmune thyroid diseases, and history of enterovirus infection served as adjusted comorbidities. Our findings suggested a significant association between HSV infection and the risk of T1DM (adjusted odds ratio: 1.21; 95% CI: 1.01–1.47, p = 0.048), while infection with other HHVs was not. The result of HSV infection remained significant when subjects were restricted to age ≤ 18 years (adjusted odds ratio: 1.35; 95% CI: 1.08–1.70, p = 0.010). We found a history of HSV infection might be an independent predictive risk factor for T1DM. This could be potentially helpful to the practice in public health.
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Affiliation(s)
- Shao-Chang Wang
- Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan;
| | - Jung-Yu Liao
- Department of Public Health, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence: ; Tel.: +886-7-3121101 (ext. 2106)
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8
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Nose T, Imamura Y, Ohata S, Kimbara S, Miyata Y, Hyogo Y, Fujishima Y, Funakoshi Y, Toyoda M, Kiyota N, Minami H. Incidence of venous thromboembolism in patients with solid cancers in Japan: retrospective study of 2735 patients. Int J Hematol 2021; 114:319-324. [PMID: 34091877 DOI: 10.1007/s12185-021-03167-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The incidence of cancer-associated venous thromboembolism (CA-VTE) in Japan has not been fully investigated. METHODS AND RESULTS Clinicopathological information from patients with solid malignancies who first visited our department between November 2011 and March 2018 were retrospectively reviewed from medical records. The primary outcome was incidence of CA-VTE, defined as deep-vein thrombosis (DVT) and/or pulmonary embolism (PE). On median follow-up of 187 days, 91 of 2735 patients (3.3%) developed CA-VTE during their clinical course, giving an incidence rate of 40.7 per 1000 person-years. Of the 91 patients, 75 (82%) were diagnosed with DVT alone, 6 (7%) with PE alone, and 10 (11%) with both DVT and PE. CA-VTE was most frequent in non-small cell lung cancer (10.8%), followed by cancer of unknown origin (5.8%). Forty-four patients (48%) had one or more symptoms at the initial diagnosis of VTE. Five patients (6%) had a normal D-dimer level (≤ 1.0 µg/mL); of these, 2 were asymptomatic. CONCLUSIONS In this retrospective study, the incidence of CA-VTE in Japanese patients with cancer was equivalent to that in Western populations. Approximately half of CA-VTE patients were asymptomatic and 6% had normal D-dimer levels, indicating the need for closer attention to occult CA-VTE.
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Affiliation(s)
- Taku Nose
- Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yoshinori Imamura
- Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Shinya Ohata
- Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shiro Kimbara
- Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yoshiharu Miyata
- Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yasuko Hyogo
- Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yoshimi Fujishima
- Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yohei Funakoshi
- Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Masanori Toyoda
- Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Naomi Kiyota
- Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
- Cancer Center, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hironobu Minami
- Medical Oncology/Hematology, Department of Medicine, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
- Cancer Center, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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9
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Lee LH, Nagarajan C, Tan CW, Ng HJ. Epidemiology of Cancer-Associated Thrombosis in Asia: A Systematic Review. Front Cardiovasc Med 2021; 8:669288. [PMID: 34095258 PMCID: PMC8175646 DOI: 10.3389/fcvm.2021.669288] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/19/2021] [Indexed: 01/03/2023] Open
Abstract
The epidemiology of cancer associated thrombosis (CAT) in Asia is less well-studied and differs from that in the western countries. Here, we systematically examine population based and hospital-based studies reported between 1995 and 2020 to understand the epidemiology of CAT in Asia. From population-based studies, the estimated incidence of VTE in cancer patients was 1.85–9.88 per 1,000 person-years. The incidence of CAT in Asia is significantly higher than non-cancer associated VTE in the general population and cancer is perhaps the most important risk factor for VTE. Hospital-based studies were heterogeneous in study designs and reveal a wide range of prevalence of VTE among cancer patients at 0.5–44.6% while the cancer prevalence rates among VTE patients ranged from 6.1 to 65.5%. The cancer sites most associated with VTE and risk factors were similar between Asian and Western studies. CAT has a major impact on the survival of patients with cancer in Asia, but thromboprophylaxis is not commonly practiced and validated risk assessment tools are lacking. This study highlights the urgent need for large multinational epidemiological studies in Asia to establish the true burden of CAT and to guide appropriate prevention strategies.
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Affiliation(s)
- Lai Heng Lee
- Singapore General Hospital, Singapore, Singapore
| | | | | | - Heng Joo Ng
- Singapore General Hospital, Singapore, Singapore
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10
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Chou SC, Pai CH, Lin SW, Tien HF. Incidence and risk factors for venous thromboembolism in a cohort of Taiwanese patients with lung, gastric, pancreatic cancers or lymphoma. J Formos Med Assoc 2021; 121:360-366. [PMID: 33994235 DOI: 10.1016/j.jfma.2021.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/30/2020] [Accepted: 04/26/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cancer-associated venous thromboembolism (VTE) is a distinct pathological entity with much higher incidence and unique risk factors compared to general VTE. A previous study reported that cancer associated-VTE incidence in Taiwan is much lower than that reported for western countries and also lower than our anecdotal observations. To address this issue further, we initiated an investigation locally using a more detailed approach than used previously with comprehensive review of medical records to gain new insight into the incidence and risk factors for cancer-associated VTE. METHODS Medical records of all adult patients with lung, pancreatic and gastric cancers, and lymphoma diagnosed from January 2011 to December 2013 in National Taiwan University Hospital indexed through the local cancer registry database were reviewed. VTE patients were identified through diagnosis coding and comprehensive medical chart review. RESULTS Among 5620 consecutive lung, gastric and pancreatic cancer, and lymphoma patients, VTE was diagnosed in 246 (4.4%). Overall VTE incidence was 36.3 per 1000 patient-year. Multivariate analysis showed that not only high but also low body mass index (BMI) was associated with VTE risk with different cutoff levels by gender. Mildly to moderately anemic patients were at higher risk of VTE. Activated partial thromboplastin time (aPTT) had proportionally and reversely correlation to VTE risk. CONCLUSION We reported higher incidence of cancer associated VTE in Taiwan. Low BMI and short aPTT were found to be related to higher VTE risk that was not reported before.
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Affiliation(s)
- Sheng-Chieh Chou
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Chen-Hsueh Pai
- Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University, Taipei, Taiwan.
| | - Shu-Wha Lin
- Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University, Taipei, Taiwan.
| | - Hwei-Fang Tien
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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11
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Paredes-Ruiz D, Gómez-Cuervo C, Gómez-Martín C, Sánchez-Guerrero Á, González-Olmedo J, López-López F, Bover-Larroya M, Yarza-Barrio R, Jara-Casas DD, Castelo-Laureiro A, Revilla-Ostolaza Y, Paz-Ares L, Lumbreras-Bermejo C, Díaz-Pedroche C. Incidence of venous thromboembolism in patients with non-hematological cancer admitted for COVID-19 at a third-level hospital in Madrid. J Thromb Thrombolysis 2021; 53:471-478. [PMID: 33890200 PMCID: PMC8061713 DOI: 10.1007/s11239-021-02448-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 12/21/2022]
Abstract
An increased risk of venous thromboembolism (VTE) in hospitalized patients with COVID-19 has been reported. We aimed to describe the incidence rate of VTE on patients with non-hematological cancer who required hospitalization due to COVID-19 at our center. In this prospective study, non-hematological cancer patients hospitalized for confirmed COVID-19 at our institution from 1st March to 30th April 2020, were evaluated daily for VTE complications during their hospital stay, and after discharge until 30th June 2020. Furthermore, Doppler ultrasound of lower limbs was routinely performed in asymptomatic patients based on D-dimer levels and current active cancer therapy. The primary outcome of this study was the cumulative incidence of VTE. Secondary outcomes were the cumulative incidence of bleeding and mortality. A total of 58 hospitalized non-hematological cancer patients and confirmed COVID-19 were identified. Median follow-up since initial symptoms of COVID-19 was 91 days (IQR 19–104). Pulmonary embolism was diagnosed in three (5%) patients. Symptomatic catheter-related deep vein thrombosis (DVT) was observed in one patient. Doppler ultrasound of lower limbs was done in 11 asymptomatic patients, showing distal DVT in two of them (18%). The cumulative incidence of VTE on day 14 after admission was 10%, without new VTE events after hospital discharge and up to 90 days follow-up. No bleeding complication was observed. Seventeen patients (29%) died in the first 14 days after COVID-19 diagnosis. Four patients died after discharge due to malignancy progression. The cumulative incidence of VTE in non-hematological cancer patients under active treatment was 10% at day 14 after admission, with no further new events in the following 12 weeks.
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Affiliation(s)
- Diana Paredes-Ruiz
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Avenida Cordoba S/N 28041, Madrid, Spain.
| | - Covadonga Gómez-Cuervo
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Avenida Cordoba S/N 28041, Madrid, Spain
| | - Carlos Gómez-Martín
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Jesús González-Olmedo
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Avenida Cordoba S/N 28041, Madrid, Spain
| | - Flora López-López
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Mateo Bover-Larroya
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ramón Yarza-Barrio
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Luis Paz-Ares
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carlos Lumbreras-Bermejo
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Avenida Cordoba S/N 28041, Madrid, Spain
| | - Carmen Díaz-Pedroche
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Avenida Cordoba S/N 28041, Madrid, Spain
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12
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Uraguchi K, Kozakura K, Fukuda M, Marunaka H, Doi A, Ohta T, Iwata J, Kariya S. An autopsy case of Trousseau's syndrome with tumor thrombosis in unknown primary squamous cell carcinoma of the head and neck. Int Cancer Conf J 2020; 10:15-19. [PMID: 33489695 DOI: 10.1007/s13691-020-00440-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/09/2020] [Indexed: 12/11/2022] Open
Abstract
Trousseau's syndrome (TS) and tumor thrombosis (TT) are known as cancer-associated thrombosis with poor prognosis. TS is extremely rare in patients with squamous cell carcinoma. In this study, we report an unknown primary squamous cell carcinoma of the head and neck (SCCHN) patient with TS and TT in pulmonary artery definitely diagnosed by autopsy. A 73-year-old man had a past surgical history for unknown primary SCCHN and lung metastases. Three years after the initial surgery, the patient had multiple cerebral infarction, deep venous thrombosis in the legs and mediastinum metastases. Our diagnosis was TS and treatment with chemotherapy and unfractionated molecular heparin started. It could help control the hypercoagulative state and cancer progression, but finally, he died from progressive disease (mediastinum metastases and pulmonary embolism) five years after the initial surgery. An autopsy revealed multiple metastases and thrombosis in the pulmonary artery with squamous cell carcinoma microscopically. Although there is no established treatment for managing TS, intensive therapy such as a combination of chemotherapy and anticoagulant therapy can be effective in improving hypercoagulation therapy. In addition, an autopsy should be considered for patients with thrombosis to distinguish between TS and TT.
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Affiliation(s)
- Kensuke Uraguchi
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan.,Department of Otorhinolaryngology, Kochi Health Sciences Center, Kochi, Japan
| | - Kenichi Kozakura
- Department of Otorhinolaryngology, Kochi Health Sciences Center, Kochi, Japan
| | - Maki Fukuda
- Department of Neurosurgery, Kochi Health Sciences Center, Kochi, Japan
| | - Hidenori Marunaka
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Akira Doi
- Department of Otorhinolaryngology, Kochi Health Sciences Center, Kochi, Japan
| | - Tsuyoshi Ohta
- Department of Neurosurgery, Kochi Health Sciences Center, Kochi, Japan
| | - Jun Iwata
- Department of Pathology, Kochi Health Sciences Center, Kochi, Japan
| | - Shin Kariya
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
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13
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Ni-Jia-Ti MYDL, Ai-Hai-Ti DLARM, Huo-Jia ASKEJ, Wu-Mai-Er PLDM, A-Bu-Li-Zi ABDKYMJ, Shi Y, Rou-Zi NEAMN, Su WJ, Dai GZ, Da-Mo-la MHMTJ. Development of a risk-stratification scoring system for predicting lymphovascular invasion in breast cancer. BMC Cancer 2020; 20:94. [PMID: 32013960 PMCID: PMC6998851 DOI: 10.1186/s12885-020-6578-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 01/24/2020] [Indexed: 12/19/2022] Open
Abstract
Background Lymphovascular invasion (LVI) is a vital risk factor for prognosis across cancers. We aimed to develop a scoring system for stratifying LVI risk in patients with breast cancer. Methods A total of 301 consecutive patients (mean age, 49.8 ± 11.0 years; range, 29–86 years) with breast cancer confirmed by pathological reports were retrospectively evaluated at the authors’ institution between June 2015 and October 2018. All patients underwent contrast-enhanced Magnetic Resonance Imaging (MRI) examinations before surgery. MRI findings and histopathologic characteristics of tumors were collected for analysis. Breast LVI was confirmed by postoperative pathology. We used a stepwise logistic regression to select variables and two cut-points were determined to create a three-tier risk-stratification scoring system. The patients were classified as having low, moderate and high probability of LVI. The area under the receiver operating characteristic curve (AUC) was used to evaluate the discrimination ability of the scoring system. Results Tumor margins, lobulation sign, diffusion-weighted imaging appearance, MRI-reported axillary lymph node metastasis, time to signal intensity curve pattern, and HER-2 were selected as predictors for LVI in the point-based scoring system. Patients were considered at low risk if the score was < 3.5, moderate risk if the score was 3.5 to 6.0, and high risk if the score was ≥6.0. LVI risk was segmented from 0 to 100.0% and was positively associated with an increase in risk scores. The AUC of the scoring system was 0.824 (95% confidence interval [CI]: 0.776--0.872). Conclusion This study shows that a simple and reliable score-based risk-stratification system can be practically used in stratifying the risk of LVI in breast cancer.
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Affiliation(s)
- Ma-Yi-di-Li Ni-Jia-Ti
- Department of Radiology, The first people's Hospital of Kashi area, No.120, Yingbin avenue, Kashi, Xinjiang Uygur Autonomous Region, People's Republic of China
| | - Di-Li-A-Re-Mu Ai-Hai-Ti
- Department of Radiology, The first people's Hospital of Kashi area, No.120, Yingbin avenue, Kashi, Xinjiang Uygur Autonomous Region, People's Republic of China
| | - Ai-Si-Ka-Er-Jiang Huo-Jia
- Department of Radiology, The first people's Hospital of Kashi area, No.120, Yingbin avenue, Kashi, Xinjiang Uygur Autonomous Region, People's Republic of China
| | - Pa-Li-Dan-Mu Wu-Mai-Er
- Department of Radiology, The first people's Hospital of Kashi area, No.120, Yingbin avenue, Kashi, Xinjiang Uygur Autonomous Region, People's Republic of China
| | - A-Bu-du-Ke-You-Mu-Jiang A-Bu-Li-Zi
- Department of Radiology, The first people's Hospital of Kashi area, No.120, Yingbin avenue, Kashi, Xinjiang Uygur Autonomous Region, People's Republic of China
| | - Yu Shi
- Department of Radiology, The first people's Hospital of Kashi area, No.120, Yingbin avenue, Kashi, Xinjiang Uygur Autonomous Region, People's Republic of China
| | - Nu-Er-A-Mi-Na Rou-Zi
- Department of Radiology, The first people's Hospital of Kashi area, No.120, Yingbin avenue, Kashi, Xinjiang Uygur Autonomous Region, People's Republic of China
| | - Wen-Jing Su
- Department of Radiology, The first people's Hospital of Kashi area, No.120, Yingbin avenue, Kashi, Xinjiang Uygur Autonomous Region, People's Republic of China
| | - Guo-Zhao Dai
- Department of Radiology, The first people's Hospital of Kashi area, No.120, Yingbin avenue, Kashi, Xinjiang Uygur Autonomous Region, People's Republic of China
| | - Mai-He-Mi-Ti-Jiang Da-Mo-la
- Department of Radiology, The first people's Hospital of Kashi area, No.120, Yingbin avenue, Kashi, Xinjiang Uygur Autonomous Region, People's Republic of China.
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14
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Dapkevičiūtė A, Daškevičiūtė A, Zablockis R, Kuzaitė A, Jonušienė G, Diktanas S, Danila E. Association between the Khorana score and pulmonary embolism risk in patients with advanced stage lung cancer. THE CLINICAL RESPIRATORY JOURNAL 2020; 14:3-8. [PMID: 31585027 DOI: 10.1111/crj.13092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/26/2019] [Accepted: 09/19/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The Khorana score may help physicians to identify patients at high risk of Pulmonary embolism (PE) and decide who is eligible for thromboprophylaxis, however, its role in lung cancer patients remains unclear. OBJECTIVES The aim of this study was to evaluate association between the Khorana score and risk of PE development among advanced stage lung cancer inpatients treated with chemotherapy. MATERIALS AND METHODS A retrospective cohort study included 2008-2017 year data of 217 lung cancer inpatients with IIIB and IV clinical stages receiving chemotherapy. The Khorana score was evaluated and patients were divided in two groups: a group of patients with 1 point and a group of patients with 2 or more points of the Khorana score. RESULTS The study population included 46 (21.2%) female and 171 (78.8%) male patients whose median age was 62. During median observation period of 308.5 days 26 (11.9%) patients developed PE. Study included 137 patients with 1 point and 80 patients with 2 or more points of the Khorana score. The frequency of PE was 17 (12.4%) among patients with 1 point and 9 (11.3%) among patients with 2 points of the Khorana score. The relative risk of PE for patients with 2 or more points was 0.895 (95% CI = 0.379-2.114), P = 0.800. CONCLUSION The Khorana score was not associated with PE development risk among advanced stage lung cancer inpatients treated with chemotherapy.
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Affiliation(s)
- Austėja Dapkevičiūtė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Hematology, Oncology and Transfusion Medicine Center, Vilnius University Hospital Santaros Klinikos, Vilnius University, Vilnius, Lithuania
| | - Aurelija Daškevičiūtė
- Department of Neurology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rolandas Zablockis
- Clinic of Chest diseases, Immunology and Allergology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Aušrinė Kuzaitė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Gintarė Jonušienė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Saulius Diktanas
- Clinic of Chest diseases, Immunology and Allergology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Edvardas Danila
- Clinic of Chest diseases, Immunology and Allergology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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15
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Yu CH, Kor CT, Weng SC, Chang CC, Chen CP, Wu CL. Symptomatic menopausal transition and risk of subsequent stroke. PeerJ 2019; 7:e7964. [PMID: 31687279 PMCID: PMC6825412 DOI: 10.7717/peerj.7964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 09/30/2019] [Indexed: 12/02/2022] Open
Abstract
Objective To examine the long-term risk of stroke in women who have experienced symptomatic menopausal transition. Methods In this nationwide, population-based cohort study conducted from January 1, 2000 to December 31, 2013, we identified 22,058 women with no prior history of stroke, who experienced symptomatic menopausal transition at ≥45 years of age. Moreover, 22,058 women without symptomatic menopause were matched by propensity scores and enrolled as a comparison group. The propensity score was calculated by using all characteristic variables of each subject, including demographics (age and monthly income), comorbidities (hypertension, hyperlipidemia, diabetes mellitus, obesity, chronic kidney disease, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, dysrhythmia, peripheral artery occlusive disease), Charlson’s comorbidity index score, clinic visit frequency, and long-term medications (antihypertensives, antidiabetic agents, statins, antiplatelets, aspirin, warfarin, and hormone replacement therapy). The primary endpoint was the development of stroke after the onset of symptomatic menopausal transition. The Fine and Gray’s proportional subhazards model was performed to assess the association between symptomatic menopausal transition and subsequent stroke. All subjects were followed up until December 31, 2013. Results During a mean follow-up of 8.5 years (standard deviation 4.7 years, maximum 14 years), 2,274 (10.31%) women with symptomatic menopausal transition, and 1,184 (5.37%) matched comparison participants developed stroke. The incidence rates were 11.17 per 1,000 person-years in the symptomatic menopausal transition group compared with 8.57 per 1,000 person-years in the comparison group. The risk of developing stroke was significantly higher in women with symptomatic menopausal transition (crude subhazard ratio, 1.31; 95% confidence interval (CI) [1.22–1.41]; P < 0.001). After adjusting for demographics, comorbidities, clinic visit frequency, and long-term medications, the risk of stroke remained statistically significant (adjusted subhazard ratio, 1.30; 95% CI [1.21–1.40]; P < 0.001). Moreover, subgroup analyses revealed no evidence for inconsistent effects for symptomatic menopausal transition on subsequent risk of stroke across all subgroups except age, comorbidities, hypertension, and use of antihypertensives. Women with early menopausal transition (before age 50), without comorbid condition, without hypertension, or without use of antihypertensives are at a higher risk of stroke. The longer duration of symptomatic menopausal transition was associated with higher risk of stroke (P for trend < 0.001). Conclusion In this large-scale retrospective cohort study, symptomatic menopausal transition was statistically significantly associated with a 30% increased risk of stroke. Further prospective studies are required to confirm our findings.
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Affiliation(s)
- Chao-Hung Yu
- Division of Cardiology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Chew-Teng Kor
- Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Shuo-Chun Weng
- Center for Geriatrics and Gerontology, Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Chu Chang
- Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ching-Pei Chen
- Division of Cardiology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Chia-Lin Wu
- Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
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16
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Chen CM, Huang WC, Yang YH, Huang SS, Lu KY. Factors affecting long-term mortality rate after diagnosis of syringomyelia in disabled spinal cord injury patients: a population-based study. Spinal Cord 2019; 58:402-410. [PMID: 31602006 DOI: 10.1038/s41393-019-0363-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/04/2019] [Accepted: 09/25/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A retrospective, population-based study. OBJECTIVES To identify factors affecting long-term mortality and medical resources use in disabled spinal cord injury (SCI) patients after syringomyelia diagnosis. SETTING A National Health Insurance Research Database containing 10,374 patients with SCI. METHODS Data recorded between 1997 and 2012 for 376 disabled SCI patients with syringomyelia and 376 characteristics-matched disabled SCI patients without syringomyelia were collected. The index date was the date of syringomyelia diagnosis. Cox proportional hazards regression model was used to investigate the factors affecting 10-year mortality in these patients. Medical resources use was compared for 1 year before and after index date. RESULTS The survival rate at 10-year follow-up after syringomyelia diagnosis was estimated at 68.6%. The 10-year survival rate was comparable between the two groups. Age ≥ 60 (adjusted hazard ratios (aHR) 4.21, 95% confidence interval (CI) 2.97 to 5.96) and < 30 years (aHR 0.25, 95% CI 0.10 to 0.62), spinal cord or spinal canal operations within 1 year after the index date (aHR 1.84, 95% CI 1.19 to 2.84), history of pneumonia (aHR 1.55, 95% CI 1.07 to 2.26), and history of coronary heart disease (CHD) (aHR 1.85, 95% CI 1.18 to 2.89) were significantly associated with long-term mortality. Outpatient prescription costs were higher during 1 year after the diagnosis than those of 1 year before the diagnosis. CONCLUSION Age, spinal operations, history of pneumonia, and history of CHD are associated with 10-year mortality in disabled SCI patients with syringomyelia.
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Affiliation(s)
- Chien-Min Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan. .,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Wei-Chao Huang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Shih-Shin Huang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuan-Yu Lu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan
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17
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Kim MH, Jun KW, Hwang JK, Kim SD, Kim JY, Park SC, Won YS, Yun SS, Moon IS, Kim JI. Venous Thromboembolism Following Abdominal Cancer Surgery in the Korean Population: Incidence and Validation of a Risk Assessment Model. Ann Surg Oncol 2019; 26:4037-4044. [DOI: 10.1245/s10434-019-07633-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Indexed: 11/18/2022]
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18
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Aonuma AO, Nakamura M, Sakamaki K, Murai T, Matsuda C, Itaya K, Sone T, Yagisawa M, Koike Y, Endo A, Tsukuda Y, Ono Y, Nagasaka A, Nishikawa S, Yamanaka T, Sakamoto N. Incidence of cancer-associated thromboembolism in Japanese gastric and colorectal cancer patients receiving chemotherapy: a single-institutional retrospective cohort analysis (Sapporo CAT study). BMJ Open 2019; 9:e028563. [PMID: 31439602 PMCID: PMC6707673 DOI: 10.1136/bmjopen-2018-028563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Few data regarding the incidence of cancer-associated thromboembolism (TE) are available for Asian populations. We investigated the incidence of TE (TEi) and its risk factors among gastric and colorectal cancer (GCC) patients received chemotherapy in a daily practice setting. DESIGN A retrospective cohort study. SETTING A single-institutional study that used data from Sapporo City General Hospital, Japan, on patients treated between January 2008 and May 2015. PARTICIPANTS Five hundred Japanese GCC patients who started chemotherapy from January 2008 to May 2015. PRIMARY AND SECONDARY OUTCOME MEASURES TE was diagnosed by reviewing all the reports of contrast-enhanced CT performed during the follow-up period. All types of thrombosis detected by CT or additional imaging tests, such as venous TE, arterial TE and cerebral infarction, were defined as TE. Medical records of all identified patients were reviewed and potential risk factors for TE, including clinicopathological backgrounds, were collected. We defined the following patients as 'active cancer'; patients with unresectable advanced GCC, cancer recurrence during or after completing adjuvant chemotherapy and/or presence of other malignant tumours. RESULTS Of the 500 patients, 70 patients (14.0%) developed TE during the follow-up period. TEi was 9.2% and 17.3% in GCC patients, 18.1% and 3.5% in active and non-active cancer patients, and 24.0% and 12.9% in multiple and single primary, respectively. Multivariate logistic regression analysis showed that colorectal cancer (CRC) (OR 2.371; 95% CI 1.328 to 4.233), active cancer (OR 7.593; 95% CI 2.950 to 19.543) and multiple primary (OR 2.527; 95% CI 1.189 to 5.370) were independently associated with TEi. CONCLUSION TEi was 14.0% among Japanese GCC patients received chemotherapy, and was significantly higher among patients with CRC, active cancer and multiple primary than among those with gastric cancer, non-active cancer and single primary, respectively. TRIAL REGISTRATION NUMBER UMIN000018912.
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Affiliation(s)
- Ayane Oba Aonuma
- Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan
| | - Michio Nakamura
- Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan
| | - Kentaro Sakamaki
- Department of Biostatistics and Bioinformatics, University of Tokyo, Tokyo, Japan
| | - Taichi Murai
- Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan
| | - Chika Matsuda
- Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan
| | - Kazufumi Itaya
- Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan
| | - Takayuki Sone
- Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan
| | - Masataka Yagisawa
- Department of Gastroenterology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yuta Koike
- Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan
| | - Ayana Endo
- Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan
| | - Yoko Tsukuda
- Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan
| | - Yuji Ono
- Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan
| | - Atsushi Nagasaka
- Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan
| | - Shuji Nishikawa
- Department of Gastroenterology, Sapporo City General Hospital, Sapporo, Japan
| | | | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University, Sapporo, Japan
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19
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Aoyama KI, Tamura M, Uchibori M, Nakanishi Y, Arai T, Aoki T, Osawa Y, Kaneko A, Ota Y. Trousseau syndrome in a patient with advanced oral squamous cell carcinoma: a case report. J Med Case Rep 2019; 13:26. [PMID: 30691539 PMCID: PMC6350311 DOI: 10.1186/s13256-018-1833-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/03/2018] [Indexed: 12/21/2022] Open
Abstract
Background Trousseau syndrome is known as a variant of cancer-associated thrombosis. Trousseau syndrome commonly occurs in patients with lung or prostate cancer. Hypercoagulability is thought to be initiated by mucins produced by the adenocarcinoma, which react with leukocyte and platelet selectins to form platelet-rich microthrombi. This is the first report of Trousseau syndrome in a patient with oral cancer. Case presentation Here, we describe the case of a 61-year-old Japanese man diagnosed as having advanced buccal carcinoma (T4bN2bM1; the right scapula, erector spinae muscles, and the right femur), who experienced aphasia and loss of consciousness. Although magnetic resonance imaging showed cerebral infarction, carotid invasion by the tumor and carotid sheath rupturing, cardiovascular problems, and bacterial infection were not present, which indicated Trousseau syndrome. Conclusions Trousseau syndrome in oral cancer is rare, but we must always consider cancer-associated thrombosis in patients with advanced stages of cancer regardless of the primary site of the cancer and take steps to prevent it.
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Affiliation(s)
- Ken-Ichi Aoyama
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masashi Tamura
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masahiro Uchibori
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yasuhiro Nakanishi
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Toshihiro Arai
- Department of Oral and Maxillofacial Surgery, National Hospital Organization Shizuoka Medical Center, 762-1 Nagasawa, Shimizu, Sunto, Shizuoka, 411-0905, Japan
| | - Takayuki Aoki
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yuko Osawa
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Akihiro Kaneko
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yoshihide Ota
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
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Venous Thromboembolism in Asian Patients with Pancreatic Cancer Following Palliative Chemotherapy: Low Incidence but a Negative Prognosticator for Those with Early Onset. Cancers (Basel) 2018; 10:cancers10120501. [PMID: 30544670 PMCID: PMC6315992 DOI: 10.3390/cancers10120501] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/30/2018] [Accepted: 12/09/2018] [Indexed: 02/08/2023] Open
Abstract
Background: Few studies have reported the epidemiology and clinical outcome of venous thromboembolism (VTE) in Asian patients with pancreatic cancer. This study investigated the incidence, risk factors, and clinical outcome of VTE in patients with pancreatic cancer following palliative chemotherapy. Methods: The medical records of 838 patients with newly diagnosed locally advanced or metastatic pancreatic cancer who underwent palliative chemotherapy between 2010 and 2016 at four institutes in Taiwan were retrospectively reviewed. The clinical characteristics of all patients were analyzed to identify independent predictors of VTE and their effects on survival outcome. Results: During the median follow-up period of 7.7 months (range, 0.6–55.6), VTE occurred in 67 (8.0%) of the 838 patients. Leukocyte count > 11,000/μL and presence of liver metastases were the independent predictors of VTE. Patients with VTE did not show significantly poorer survival outcomes than those without VTE. However, early-onset VTE that occurred within 1.5 months after chemotherapy initiation was an independent negative prognosticator for overall survival. Conclusion: VTE incidence was found to be lower in Asian patients with pancreatic cancer than in their Western counterparts. Early-onset VTE, but not late-onset VTE, is a negative prognosticator for survival outcomes.
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Yen FS, Chen W, Wei JCC, Hsu CC, Hwu CM. Effects of metformin use on total mortality in patients with type 2 diabetes and chronic obstructive pulmonary disease: A matched-subject design. PLoS One 2018; 13:e0204859. [PMID: 30286138 PMCID: PMC6171883 DOI: 10.1371/journal.pone.0204859] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/14/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUNDS Few studies have investigated the therapeutic effects of metformin in patients with type 2 diabetes mellitus (T2DM) and chronic obstructive pulmonary disease (COPD). We compared the risk of all-cause mortality between metformin users and nonusers. METHODS We conducted a retrospective cohort study for patients with T2DM and COPD who were enrolled between January 1, 2000 and June 30, 2012. Individuals with exacerbated symptoms who were hospitalized or sent to the emergency department (ED) were identified as having exacerbated COPD; outpatient claims were identified as having stable COPD. A total of 40,597 metformin users and 39,529 nonusers comprised the cohort of stable COPD; 14,001 metformin users and 21,613 nonusers comprised the cohort of exacerbated COPD. Users and nonusers were matched using propensity score (1:1). Our primary outcome was all-cause mortality. RESULTS A total of 19,505 metformin users were matched to 19,505 nonusers in the cohort of diabetes with stable COPD. The mean follow-up time was 3.91 years. All-cause mortality was reported in 1326 and 1609 metformin users and nonusers, respectively. After multivariate adjustment, metformin users had lower risk of mortality (adjusted hazard ratio [aHR] = 0.84, p < 0.0001). Metformin users had significantly lower risk of noncardiovascular death (aHR = 0.86, p = 0.0008). A total of 7721 metformin users were matched to 7721 nonusers in the cohort of diabetes with exacerbated COPD. The mean follow-up time was 3.18 years. All-cause mortality was reported in 1567 and 1865 metformin users and nonusers, respectively. After multivariate adjustment, metformin users had significantly lower risk of mortality (aHR = 0.89, p = 0.002) and cardiovascular death (aHR = 0.70, p = 0.01). CONCLUSION This large-series, nationwide cohort study demonstrated that metformin use could significantly lower the risk of all-cause mortality in patients with T2DM and either stable or exacerbated COPD.
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Affiliation(s)
| | - Weishan Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Chii-Min Hwu
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Parker A, Peterson E, Lee AYY, de Wit C, Carrier M, Polley G, Tien J, Wu C. Risk stratification for the development of venous thromboembolism in hospitalized patients with cancer. J Thromb Haemost 2018; 16:1321-1326. [PMID: 29733498 DOI: 10.1111/jth.14139] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Indexed: 11/30/2022]
Abstract
Essentials The Khorana score is validated for risk of venous thromboembolism (VTE) in cancer outpatients. We conducted a multicenter analysis of medically hospitalized cancer patients. Patients with a higher Khorana score on admission were more likely to develop VTE. The Khorana score is predictive of in-hospital, symptomatic VTE development. SUMMARY Introduction The Khorana score is a validated risk assessment score for estimating the risk of symptomatic venous thromboembolism (VTE) in outpatients with cancer. The objective of this study was to assess the Khorana score for predicting the development of VTE in cancer patients during hospital admission. Methods We conducted an analysis of consecutive, adult cancer patients hospitalized for medical reasons between January and June 2010 in three academic medical centers. Information on objectively diagnosed, symptomatic VTE during hospitalization, use of anticoagulant thromboprophylaxis (TP) and Khorana score variables at the time of admission was collected. Results A total of 1398 patients were included. Mean age was 62 years, 51.2% were male, and mean BMI was 25.9 kg m-2 . The most frequent reasons for hospitalization were chemotherapy administration (22.3%), followed by pain control and palliation (21.4%). The overall incidence of VTE was 2.9% (95% CI, 2.0-3.8%), occurring in 5.4% (95% CI, 1.9-8.9%) of the high-, 3.2% (95% CI, 2.0-4.4%) of the intermediate- and 1.4% (95% CI, 0.3-2.6%), of the low-risk groups. High-risk patients were more likely than low-risk patients to have VTE (OR, 3.9; 95% CI, 1.4-11.2). Conclusion The Khorana score is predictive of in-hospital, symptomatic VTE development in cancer patients who are hospitalized for medical reasons and may be a useful tool for tailoring inpatient anticoagulant thromboprophylaxis.
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Affiliation(s)
- A Parker
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - E Peterson
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A Y Y Lee
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - C de Wit
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M Carrier
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - G Polley
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - J Tien
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - C Wu
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Huang CM, Chen HJ, Huang PH, Tsay GJ, Lan JL, Sung FC. Retrospective cohort study on risk of hearing loss in patients with rheumatoid arthritis using claims data. BMJ Open 2018; 8:e018134. [PMID: 29306884 PMCID: PMC5780710 DOI: 10.1136/bmjopen-2017-018134] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Population studies on hearing loss (HL) associated with rheumatoid arthritis (RA) are lacking. This study investigated the risk of developing HL in patients with RA using a nationwide population cohort. SETTING The population-based insurance claims data in the Taiwan National Health Insurance Research Database. DESIGN Retrospective cohort study followed up RA cohort and control cohort without RA frequency matched by sex, age and diagnosis year. STUDY POPULATION 18 267 patients with RA newly diagnosed in 2000-2006 and 73 068 controls without RA. MAIN OUTCOMES Incidences of HL by the end of 2011 and the RA cohort to non-RA cohort HRs after adjusting for sex, age and comorbidities. RESULTS The HL incidence was higher in the RA cohort than in the non-RA cohort (3.08 vs 1.62 per 1000 person-years), with an adjusted HR (aHR) of 1.91 (95% CI 1.70 to 2.14) for the RA cohort relative to the non-RA cohort after controlling for age, sex and comorbidities. Men and the elderly are at a higher risk. Cardiovascular comorbidities were associated with a further increased HL risk for patients with RA. Medications were associated with reduced HL incidence; patients with RA who used non-steroidal anti-inflammatory drugs (NSAIDs) had an aHR of 0.12 (95% CI 0.07 to 0.20), compared with non-users. CONCLUSIONS This study demonstrates that patients with RA are at an increased risk of developing HL. Findings highlight the need of disease-modifying treatment and scheduled auditory examinations for HL prevention and early detection for patients with RA.
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Affiliation(s)
- Chung-Ming Huang
- Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- No department. Belong to College of Medicine., College of Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Po-Hao Huang
- Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Gregory J Tsay
- Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Joung-Liang Lan
- Division of Immunology and Rheumatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University Hospital, Taichung, Taiwan
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Weng SC, Wu CL, Kor CT, Chiu PF, Wu MJ, Chang CC, Tarng DC. Migraine and subsequent chronic kidney disease risk: a nationwide population-based cohort study. BMJ Open 2017; 7:e018483. [PMID: 29284721 PMCID: PMC5770945 DOI: 10.1136/bmjopen-2017-018483] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE We compared the incidence and risk of chronic kidney disease (CKD) between subjects with new-onset migraine and matched controls without migraine in this large-scale retrospective cohort study. DESIGN Population-based cohort study. SETTING 8880 subjects with migraine and 503 070 subjects without migraine were enrolled between January 1, 2000 and December 31, 2013, all diagnosed to be without kidney disease. All the participants were registered in the National Health Insurance Research Database. PARTICIPANTS Finally, data from 7156 subjects with migraine and 7156 propensity-score-matched control subjects were analysed. PRIMARY OUTCOME MEASURE We used Cox proportional hazards regression to estimate adjusted HRs for incident CKD; subgroup analyses were performed to assess the interactive effects of migraine with demographics, comorbidities and long-term medications. RESULTS The incidence of CKD was higher in the migraine group than in the control group. The risk of developing CKD was significantly higher in subjects with migraine than without migraine (P=0.031). Subjects with migraine aged <65 years (age 40-64 (adjusted HR (aHR) 1.35; 95% CI 1.05 to 1.73); age <40 (aHR 1.55; 95% CI 1.02 to 2.36)), with ≥1 comorbid diseases (1-2 diseases (aHR 1.30; 95% CI 1.01 to 1.68); ≥3 diseases (aHR 1.45; 95% CI 1.01 to 2.07)), and not receiving anti-migraine agents (aHR 1.26; 95% CI 1.04 to 1.54) were at a higher risk of developing CKD compared with the control subjects. The interaction between migraine and comorbidities was not significant; age, male gender and long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) were independent risk factors for CKD in subjects with migraine. CONCLUSION Migraine may be an independent risk factor for CKD. Young subjects with migraine, and those with comorbid conditions or without medical control, are likely to be at higher risk for CKD. Ageing, male sex and NSAIDs tend to have an association with CKD in subjects with migraine.
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Affiliation(s)
- Shuo-Chun Weng
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Internal Medicine, Center for Geriatrics and Gerontology, Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Lin Wu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Internal Medicine, Division of Nephrology, Changhua Christian Hospital, Changhua, Taiwan
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
- Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Chew-Teng Kor
- Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Ping-Fang Chiu
- Department of Internal Medicine, Division of Nephrology, Changhua Christian Hospital, Changhua, Taiwan
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
- Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Ming-Ju Wu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Internal Medicine, Center for Geriatrics and Gerontology, Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
| | - Chia-Chu Chang
- Department of Internal Medicine, Division of Nephrology, Changhua Christian Hospital, Changhua, Taiwan
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
- Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Der-Cherng Tarng
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan
- Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital, Taipei, Taiwan
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Rupa-Matysek J, Gil L, Kaźmierczak M, Barańska M, Komarnicki M. Prediction of venous thromboembolism in newly diagnosed patients treated for lymphoid malignancies: validation of the Khorana Risk Score. Med Oncol 2017; 35:5. [PMID: 29209847 PMCID: PMC5717131 DOI: 10.1007/s12032-017-1065-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 11/29/2017] [Indexed: 01/01/2023]
Abstract
The utility of the venous thromboembolism (VTE) risk assessment model known as the Khorana Risk Score (KRS) in patients with lymphoid malignancies receiving outpatient chemotherapy is not defined. We evaluated the association of the KRS with VTE in patients treated for diffuse large B cell lymphoma (DLBCL) or Hodgkin lymphoma (HL). Retrospective analyses were performed in 428 patients, 241 of whom were newly diagnosed with DLBCL and 187 of whom had HL. During the initial therapy, 64 (15%) patients developed VTE and 56 died during follow-up. More VTE events occurred in patients with DLBCL than in patients with HL. According to the KRS, 364 (85%) and 64 (15%) patients were considered to be at intermediate risk and high risk of VTE development, respectively. The high-risk KRS patients were more often diagnosed with HL than DLBCL (19 vs. 10%, P = 0.0143). The KRS did not discriminate between high- and intermediate-risk patients with respect to VTE occurrence (17 vs. 15%, P = 0.5868). In our patients, the KRS did not adequately predict VTE (positive predictive value 15%, negative predictive value 82% and C statistic 0.51). In the multivariate analysis, bulky disease (OR 2.34; 95% CI 1.62-3.36, P < 0.0001), poor prognostic disease (OR 1.32; 95% CI 1.01-1.74, P = 0.049) and DLBCL histological subtype (OR 1.61; 95% CI 1.17-2.19, P = 0.003) were all significantly associated with the VTE development. In this cohort of patients with lymphoid malignancies, the KRS did not adequately stratify or predict VTE events in patients at a higher risk of VTE. This finding suggests the need for the development of a disease-specific VTE assessment model.
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Affiliation(s)
- Joanna Rupa-Matysek
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznan, Poland.
| | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznan, Poland
| | - Maciej Kaźmierczak
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznan, Poland
| | - Marta Barańska
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznan, Poland
| | - Mieczysław Komarnicki
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, Szamarzewskiego 84, 60-569, Poznan, Poland
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Rojas-Hernandez CM. The role of direct oral anticoagulants in cancer-related venous thromboembolism: a perspective beyond the guidelines. Support Care Cancer 2017; 26:711-720. [PMID: 29188376 DOI: 10.1007/s00520-017-3990-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/20/2017] [Indexed: 11/27/2022]
Abstract
Cancer-related venous thromboembolism (Wickham et al., Intern Med J 42(6):698-708, 2012) is an important source of morbidity and mortality in that population. The standard of care for the treatment of cancer-related venous thromboembolism (VTE) is a low molecular weight heparin (LMWH) for long periods of time. The favorable clinical trial results for efficacy and safety and availability of direct oral anticoagulants (DOAC) have remodeled the care and options for treatment of venous thromboembolism in the adult population. The data of cancer population-subgroup analysis of those studies have shown that DOAC are as effective and safe as conventional long-term oral anticoagulation with vitamin K antagonists (VKA). Additionally, non-controlled retrospective and prospective cohort data have been published describing efficacy and safety outcomes for the use of DOAC in cancer-related VTE. Altogether, the results from clinical studies have shown that direct oral anticoagulants may represent a treatment option for cancer-related VTE and an alternative to anticoagulation with VKA. Little is known about the patient-centered and system-based variables that determine the use of DOAC outside consensus guidelines, neither is known the impact of different anticoagulant modalities in adherence and quality of life in cancer patients. The objectives of this manuscript are to summarize the clinical trial-based and cohort data of cancer patients treated with DOAC for VTE and to highlight the aspects that may influence adherent to therapy, effectiveness, and safety outcomes in the treatment of cancer-related VTE.
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Affiliation(s)
- Cristhiam M Rojas-Hernandez
- Section of Benign Hematology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Suite 1464, Houston, TX, 77030, USA.
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Increased risk of peripheral arterial disease in patients with alcohol intoxication: A population-based retrospective cohort study. Alcohol 2017; 65:25-30. [PMID: 29084626 DOI: 10.1016/j.alcohol.2017.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 11/21/2022]
Abstract
Previous studies have reported that light-to-moderate drinkers have a lower risk of peripheral arterial disease (PAD) than abstainers, and that heavy drinking increases the risk of PAD. However, reports of the effects of severe alcohol drinking on PAD are lacking within a population-based cohort. Alcohol intoxication is typically considered a medical emergency at clinics in Taiwan and is commonly attributed to excessive alcohol use. The present study aimed to investigate the association between alcohol intoxication and PAD risk. We conducted a retrospective, population-based, health insurance cohort study consisting of 56,544 adult patients with alcohol intoxication between January 1, 2000 and December 31, 2009, using claims data from the National Health Insurance Research Database (NHIRD) of Taiwan. This database included a control cohort of 226,176 residents without alcohol intoxication. The patients were age- and gender-matched. The incidence rate of PAD, after data regarding alcohol intoxication were obtained, was 12.8 per 10,000 person-years, and the adjusted hazard ratio (aHR) of PAD was 3.80 (95% confidence interval [CI] = 3.35-4.32, p < 0.05). The log-rank test showed that patients with alcohol intoxication had a considerably higher PAD cumulative incidence rate than those without alcohol intoxication. Alcohol intoxication was significantly associated with an increased risk of PAD in men (hazard ratio [HR] = 3.77, 95% CI = 3.30-4.31) and women (HR = 4.26, 95% CI = 2.60-6.97). The aHRs of PAD risk were 7.64 (95% CI = 4.39-13.3), 4.51 (95% CI = 3.83-5.29), and 2.16 (95% CI = 1.69-2.77) for patients with alcohol intoxication compared to participants of the control group aged <35 years, 35-64 years, and ≥65 years, respectively. The individuals with alcohol intoxication and without any comorbidities had a 3.77-fold increased risk of PAD in comparison to that of the control cohorts (HR = 3.77, 95% CI = 3.30-4.30). The aHR of PAD in patients with alcohol intoxication was 4.53 (95% CI = 2.51-8.16) in comparison to the control cohort, which consisted of patients with at least one existing comorbidity. Alcohol intoxication, along with the severe complications of excessive alcohol use, should be considered as major risk factors of PAD in the setting of a medical emergency. Further research needs to be performed to evaluate the quantitative effect of alcohol use on PAD.
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Lin JN, Chen HJ, Lin MC, Lai CH, Lin HH, Yang CH, Kao CH. Risk of venous thromboembolism in patients with splenic injury and splenectomy. Thromb Haemost 2017; 115:176-83. [DOI: 10.1160/th15-05-0381] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/21/2015] [Indexed: 11/05/2022]
Abstract
SummaryThe spleen is a crucial organ in humans. However, little is known about the association of venous thromboembolism (VTE) with splenic injury and splenectomy in trauma patients. The aim of this study was to determine the subsequent risk of VTE following splenic injury and splenectomy. A nationwide retrospective cohort study was conducted by analysing data from the National Health Insurance Research Database in Taiwan. We included 6,162 splenic injury patients (3,033 splenectomised and 3,129 nonsplenectomised patients) and 24,648 comparison patients who were selected by frequency match based on sex, age, and the index year during 2000–2006. All patients were followed until the occurrence of VTE, 31 December, 2011, death, or withdrawal from the insurance program. The age of patients with splenic injury was 41.93 ± 16.44 years. The incidence rates of VTE were 11.81, 8.46, and 5.21 per 10,000 person-years in the splenic injury patients with splen -ectomy, splenic injury patients without splenectomy, and comparison patients, respectively. Compared with the comparison cohort, splenic injury patients with splenectomy exhibited a 2.21-fold risk of VTE (95 % confidence interval [CI], 1.43–3.43), whereas those without splenectomy exhibited a 1.71-fold risk of VTE (95 % CI, 1.05–2.80). The overall incidence rate of VTE was 1.97-fold higher in the splenic injury cohort than the comparison cohort (95 % CI, 1.38–2.81). Although splenectomy increased the risk of VTE 1.35-fold compared with no splenectomy, the difference was not statistically significant (95 % CI, 0.74–2.45). These results may alert physicians and patients to the complications of splenic injury and splenectomy.
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Lee FY, Chen WK, Chiu CH, Lin CL, Kao CH, Chen CH, Yang TY, Lai CY. Increased risk of deep vein thrombosis and pulmonary thromboembolism in patients with aortic aneurysms: A nationwide cohort study. PLoS One 2017; 12:e0178587. [PMID: 28591152 PMCID: PMC5462404 DOI: 10.1371/journal.pone.0178587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 05/06/2017] [Indexed: 02/07/2023] Open
Abstract
Studies on the association between aortic aneurysm (AA) and the subsequent risk of venous thromboembolism (VTE) are limited to a few case reports and investigations which only focused on surgical effects. Therefore, we used the National Health Insurance Research Database to clarify whether patients with AAs have a heightened risk of subsequent VTEs, including deep vein thrombosis (DVT) and pulmonary embolism (PE). Our retrospective cohort study comprised patients aged ≥ 18 years who received a diagnosis of an AA and were hospitalized at any point during 2000–2010 (n = 16,630). Each AA patient was frequency-matched to 4 non-AA hospitalized patients based on age, sex, and index year (n = 66,453). The Cox proportional hazard regressions model was used to estimate the adjusted effect of AAs on VTE risk. The overall incidence of DVT and PE was higher in the patients with AA than in the non-AA group patients (23.5 versus 13.2 and 13.5 versus 7.98/1,000 person-years). After adjustment for age, sex, duration of hospitalization in the study period, and comorbidities, patients with AAs were associated with a 1.88-fold higher risk of DVT and 1.90-fold higher risk of PE compared to the non-AA cohort. Patients with abdominal AAs were more likely to develop DVT, whereas thoracic AA patients were more likely to develop PE. A diagnosis of a ruptured AA was associated with a substantially increased risk of DVT. Surgical treatment of AAs was associated with a heightened risk of VTE within 6-months post-operation. Our study demonstrates that AAs are associated with an increased risk of subsequent VTE. Future investigations are encouraged to delineate the mechanisms underlying this association and to evaluate the cost-effectiveness of screening for VTEs in patients with AAs.
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Affiliation(s)
- Feng-You Lee
- Department of Emergency Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Wei-Kung Chen
- Department of Emergency Medicine, Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Hsiang Chiu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Chao-Hsien Chen
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, Taiwan
| | - Tse-Yen Yang
- Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- * E-mail:
| | - Ching-Yuan Lai
- Department of Emergency Medicine, Trauma and Emergency Center, China Medical University Hospital, Taichung, Taiwan
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Kitayama H, Kondo T, Sugiyama J, Kurimoto K, Nishino Y, Hirayama M, Tsuji Y. Venous thromboembolism in hospitalized patients receiving chemotherapy for malignancies at Japanese community hospital: prospective observational study. BMC Cancer 2017; 17:351. [PMID: 28525975 PMCID: PMC5438527 DOI: 10.1186/s12885-017-3326-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 05/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although Asian population was recognized to have a lower risk of venous thromboembolism (VTE), its increasing prevalence and incidence remain unclear in patients with malignancies. We attempted to predict VTE development using activation markers of coagulation and fibrinolysis. METHODS We enrolled patients with malignancy admitted to Tonan Hospital between April and December 2014 to receive a new-for-them chemotherapy regimen. All patients were examined for VTE by computed tomography and whole-leg compression ultrasonography before chemotherapy and three months later. We also examined plasma levels of thrombin-antithrombin complex (TAT) and plasmin α2-plasmin inhibitor complex (PIC) before chemotherapy. The cut off values of TAT and PIC were set at 2.1 ng/mL and 1.8 μg/mL, respectively. RESULTS Of 97 patients, the majority (67%) had distant metastases. The most common malignancies were colorectal (26%), breast (23%), and stomach (19%) cancer. VTE was detected in 29 patients (31%); all were asymptomatic. VTE was newly developed in 12 patients in the three-month observation period, which means the incidence was 49 per 1000 person-years. Non-increased PIC with increased TAT was the only significant risk factor for both VTE prevalence and incidence in multivariate analysis, and the odds ratios were 3.0 (95% confidence interval, 1.1-8.2; P = 0.034) and 9.4 (95% confidence interval, 1.7-51.9; P = 0.011), respectively. CONCLUSIONS The prevalence and incidence of VTE were high in hospitalized Japanese patients receiving chemotherapy for malignancies. Non-increased PIC with increased levels of TAT may be an independent risk factor for VTE development.
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Affiliation(s)
- Hiromitsu Kitayama
- Department of Medical Oncology, Tonan Hospital, Kita 4 Nishi 7 3-8, Chuo-ku, Sapporo, Hokkaido 060-0004 Japan
| | - Tomohiro Kondo
- Department of Medical Oncology, Tonan Hospital, Kita 4 Nishi 7 3-8, Chuo-ku, Sapporo, Hokkaido 060-0004 Japan
| | - Junko Sugiyama
- Department of Medical Oncology, Tonan Hospital, Kita 4 Nishi 7 3-8, Chuo-ku, Sapporo, Hokkaido 060-0004 Japan
| | - Kazutomo Kurimoto
- Department of Clinical Laboratory, Tonan Hospital, Kita 4 Nishi 7 3-8, Chuo-ku, Sapporo, Hokkaido 060-0004 Japan
| | - Yasuhiro Nishino
- Department of Cardiovascular Medicine, Tonan Hospital, Kita 4 Nishi 7 3-8, Chuo-ku, Sapporo, Hokkaido 060-0004 Japan
| | - Michiaki Hirayama
- Department of Gastroenterology, Tonan Hospital, Kita 4 Nishi 7 3-8, Chuo-ku, Sapporo, Hokkaido 060-0004 Japan
| | - Yasushi Tsuji
- Department of Medical Oncology, Tonan Hospital, Kita 4 Nishi 7 3-8, Chuo-ku, Sapporo, Hokkaido 060-0004 Japan
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Yang TY, Chen CS, Lin CL, Lin WM, Kuo CN, Kao CH. Risk for Irritable Bowel Syndrome in Fibromyalgia Patients: A National Database Study. Medicine (Baltimore) 2017; 96:e6657. [PMID: 28383443 PMCID: PMC5411228 DOI: 10.1097/md.0000000000006657] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Various studies have shown that irritable bowel syndrome (IBS) is highly associated with other pathologies, including fibromyalgia (FM). The objective of this study was to analyze the differences among risk factors associated with IBS following FM in a nationwide prospective cohort study.We propose that a relationship exists between FM and IBS. This article presents evidence obtained from a cohort study in which we used data from the Taiwan National Health Insurance Research Database to clarify the relationship between FM and IBS. The follow-up period ran from the start of FM diagnosis to the date of the IBS event, censoring, or December 31, 2011. We analyzed the risk of IBS using Cox proportional hazard regression models, including sex, age, and comorbidities.During the follow-up period, from 2000 to 2011, the overall incidence of IBS was higher in FM patients than in non-FM patients (7.47 vs 4.42 per 1000 person-years), with a crude hazard ratio = 1.69 (95% confidence interval [CI] 1.59-1.79). After adjustment for age, sex, and comorbidities, FM was associated with a 1.54-fold increased risk for IBS.Mutually risk factors may influence the relationship between FM and IBS. We recommend that physiologists conduct annual examinations of FM patients to reduce the incidence of IBS progression.
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Affiliation(s)
- Tse-Yen Yang
- Molecular and Genomic Epidemiology Center, China Medical University Hospital, China Medical University, Taichung
- Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua
| | - Chih-Sheng Chen
- Division of Chinese Trauma, China Medical University Hospital
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital
- College of Medicine, China Medical University, Taichung
| | - Wei-Ming Lin
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi
- Chang Gung University, Taoyuan
| | | | - Chia-Hung Kao
- Department of Nuclear Medicine and PET Center, China Medical University Hospital
- Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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Acute kidney injury and risk of deep vein thrombosis and pulmonary embolism in Taiwan: A nationwide retrospective cohort study. Thromb Res 2017; 151:29-35. [DOI: 10.1016/j.thromres.2017.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 12/04/2016] [Accepted: 01/05/2017] [Indexed: 01/12/2023]
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Kok VC. Bidirectional risk between venous thromboembolism and cancer in East Asian patients: synthesis of evidence from recent population-based epidemiological studies. Cancer Manag Res 2017; 9:751-759. [PMID: 29263699 PMCID: PMC5724426 DOI: 10.2147/cmar.s151331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Unprovoked (idiopathic) venous thromboembolism (VTE) with no obvious antecedent risk factors, is associated with a significant risk of subsequent occult cancer. Conversely, there is a heightened risk of VTE in cancer patients. This bidirectional risk can be estimated from population-based cohort studies conducted in East Asians. METHODS A literature search using medical subject heading terms and Boolean logic in PubMed and MedLine was performed in April 2017. Twenty-two papers reported from East Asia were retrieved for study and data synthesis. Proportional meta-analysis with a random-effects model was used to synthesize data with 95% confidence intervals (CIs) when appropriate. RESULTS Synthesis of data on VTE incidence in the East Asian population (I2 = 76.2%) showed that pooled incidence was 20.3 (95% CI, 11.2-32) per 100,000 person-years. VTE incidence steadily increased with age. Unprovoked VTE accounted for 35% (95% CI, 24%-48%) of all cases of incident VTE (I2 = 99.7%). The overall cancer risk was significantly higher (2.3-fold) in the VTE cohort than in comparators. Among the patients with unprovoked VTE, approximately 7% had a subsequent cancer diagnosis within 2 years of the first episode of idiopathic VTE. The risk of VTE recurrence was increased in cancer patients (adjusted odds ratio, 1.64; 95% CI, 1.26-1.99). VTE incidence was 9.9 per 1,000 person-years in cancer patients, particularly in liver, pancreas, and lung cancer patients. CONCLUSION Newly diagnosed VTE incidence is estimated at approximately 4,400 new cases annually in Taiwan and 7,100 in South Korea. Similar to the trend in VTE incidence among the general population, VTE risk in East Asian cancer patients is markedly lessened.
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Affiliation(s)
- Victor C Kok
- Division of Medical Oncology, Cancer Center, Kuang Tien General Hospital
- Asia University, Taichung, Taiwan
- Correspondence: Victor C Kok, Division of Medical Oncology, Kuang Tien General Hospital, 117 Sha-Tien Road, Shalu, Taichung 43303, Taiwan, Tel +886 4 2662 5111 extension 2263, Fax +886 4 2665 5050, Email
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Ross JA, Miller MM, Rojas Hernandez CM. Comparative effectiveness and safety of direct oral anticoagulants (DOACs) versus conventional anticoagulation for the treatment of cancer-related venous thromboembolism: A retrospective analysis. Thromb Res 2016; 150:86-89. [PMID: 28064037 DOI: 10.1016/j.thromres.2016.12.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/14/2016] [Accepted: 12/20/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE The standard of care for the treatment of cancer-related venous thromboembolism (VTE) is a low molecular weight heparin (LMWH) formulation. The recent development of direct oral anticoagulants (DOACs) and their approval for the treatment of VTE has resulted in several new options for treatment. If equivalent to LMWH in terms of safety and effectiveness, the use of DOACs in the treatment of cancer-related VTE would reduce the risk of VTE recurrence while potentially improving the quality of life of many cancer patients. METHODS We performed a retrospective analysis of adult patients with cancer-related VTE treated in our benign hematology clinic. Among the 153 patients included in our final analysis, 123 (80%) were treated with LMWH and 30 (20%) were treated with DOACs. Patients had 36 different histological types of cancer. The primary outcome was the rate of recurrence of VTE evaluated at 6 and 12months after the initiation of anticoagulation. Secondary outcomes were the rate of anticoagulant-associated clinically relevant bleeding and event-free survival for VTE recurrence. RESULTS In comparing the 2 treatment groups, there was no statistically significant difference in the cumulative rates of VTE recurrence at 6 and 12months or in the rates of major or non-major bleeding at both 6 and 12months. The median VTE recurrence-free survival rates were not reached and they were not statistically different. CONCLUSION DOACs appear to be as safe and effective as conventional therapy for the treatment of cancer-related VTE. Results of ongoing randomized clinical studies may provide definitive evidence and clarify the role of the DOACs in the setting of malignancy.
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Affiliation(s)
- Jeremy A Ross
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Marilyn M Miller
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Abstract
PURPOSE OF REVIEW Cancer is a strong risk factor for venous thromboembolism (VTE). In patients with lung cancer VTE is a significant cause for morbidity and mortality. The purpose of the review is to summarize the epidemiology of thrombotic events, risk factors for VTE and the clinical impact of VTE in patients with lung cancer. RECENT FINDINGS The rates of VTE in lung cancer patients vary according to different types of investigations, and reach 7 to 13%, including a significant number of unsuspected pulmonary emboli. Risk factors for VTE in patients with lung cancer can be basically divided into three categories: patient, tumor, and treatment related. In addition, a number of biomarkers have been described to be associated with VTE risk (e.g., D-dimer). SUMMARY Knowledge about the epidemiology, risk factors, and prognostic value of VTE in lung cancer could help to prevent thrombotic complications and improve management of patients with lung cancer.
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Abstract
Thrombosis is a common complication in cancer patients. Although the major inherited risk factors for thrombophilia are different between Asians and Caucasians, the main acquired risk factors that are associated with the development of venous thromboembolism (VTE) in Asians appear to be similar to those for Caucasians. Malignancy is the most important acquired risk factor for VTE in Asians. Recent studies have shown that the incidence of VTE is significant in Asian patients with cancer, particularly those in an advanced stage. Cancer associated VTE is more severe and associated with higher morbidity and mortality. Unprovoked VTE is associated with an increased risk of subsequent cancer diagnosis. A number of international and national guidelines are available to provide guidance to healthcare providers to treat and prevent this serious complication based on best-available evidence. Identifying cancer patients at risk for VTE and use of appropriate thromboprophylaxis in these patients can potentially improve morbidity and mortality. Although direct oral anticoagulants (DOACs) may become an attractive treatment for cancer-associated VTE, further clinical trials are needed to evaluate the safety and efficacy of DOACs directly against LMWH in cancer patients.
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Affiliation(s)
- Pantep Angchaisuksiri
- Division of Hematology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 RAMA VI Road. Rachathevi, Bangkok, 10400 Thailand
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Lee GY, Lee YT, Yeh CM, Hsu P, Lin TW, Gau JP, Yu YB, Hsiao LT, Tzeng CH, Chiou TJ, Liu JH, Liu YC, Liu CJ. Risk of stroke in patients with newly diagnosed multiple myeloma: a retrospective cohort study. Hematol Oncol 2016; 35:726-733. [PMID: 27545592 DOI: 10.1002/hon.2340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/11/2016] [Accepted: 07/13/2016] [Indexed: 11/10/2022]
Abstract
Cerebrovascular events are a common complication among patients with cancer, increasing morbidity and mortality. However, the association between multiple myeloma and cerebrovascular events remains unclear. We therefore investigated multiple myeloma patients' risk factors for stroke to devise a better stroke-prevention strategy. This study includes consecutive patients 20 years and older who were newly diagnosed with symptomatic multiple myeloma at Taipei Veterans General Hospital, a tertiary medical center, between January 1, 2002 and December 31, 2014. The primary outcome was stroke development. Patients with head injuries, brain tumors, brain parenchymal invasions, or antecedent malignancies were excluded. Hazard ratios (HRs) of stroke risk factors for multiple myeloma patients were estimated by Cox proportional regression analysis. Overall, 395 patients with a median age of 70 years were investigated. In the median follow-up period of 18 months, cerebrovascular events occurred in 16 patients, including 10 ischemic strokes and 6 hemorrhagic strokes. The 5-year estimated cumulative incidence rate was 7.45%. In the multivariate analysis, the κ light chain isotype (adjusted HR, 8.37; 95% confidence interval [CI], 1.91-39.8), previous cerebrovascular accidents (adjusted HR, 5.16; 95% CI, 1.48-17.9), and serum creatinine > 2 mg/dL (adjusted HR, 4.21; 95% CI, 1.10-16.0) were identified as independent risk factors for stroke. Subgroup analysis showed that atrial fibrillation (adjusted HR, 8.07) and previous cerebrovascular accident (adjusted HR, 4.89) are significant risk factors for ischemic stroke. Serum creatinine > 2 mg/dL (adjusted HR, 30.6) and previous cerebrovascular accident (adjusted HR, 13.9) are significant for hemorrhagic stroke. Moreover, therapeutic strategies for multiple myeloma were not associated with stroke in our study. This study demonstrates that risk of stroke increases in myeloma patients with a κ light chain isotype, previous cerebrovascular events, and renal impairment. Further prospective clinical studies to clarify the relationship between multiple myeloma and stroke are warranted.
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Affiliation(s)
- Gin-Yi Lee
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Ting Lee
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chiu-Mei Yeh
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei Hsu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ting-Wei Lin
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yuan-Bin Yu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Hwai Tzeng
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeon-Jye Chiou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Transfusion Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jin-Hwang Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Biopharmaceutical Science, National Yang-Ming University, Taipei, Taiwan.,Chong Hin Loon Memorial Cancer and Biotherapy Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Chung Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
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Lin JN, Lin CL, Yang CH, Lin MC, Lai CH, Lin HH, Kao CH. Risk of Nephrotic Syndrome following Enteroviral Infection in Children: A Nationwide Retrospective Cohort Study. PLoS One 2016; 11:e0161004. [PMID: 27508414 PMCID: PMC4979895 DOI: 10.1371/journal.pone.0161004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/15/2016] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Nephrotic syndrome is a common chronic illness encountered during childhood. Infections have been identified as a cause of nephrotic syndrome. The aim of this study was to evaluate the association between enteroviral infection and nephrotic syndrome. METHODS A nationwide retrospective cohort study was conducted by analyzing data from the National Health Insurance Research Database in Taiwan. Children aged <18 years with enteroviral infection were enrolled. Non-enterovirus-infected children were randomly selected as the comparison cohort. The primary endpoint was the occurrence of nephrotic syndrome. METHODS This study included 280,087 enterovirus-infected children and 280,085 non-enterovirus-infected children. The mean age of the enterovirus-infected children was 2.38 years, and 53.7% of these children were boys. The overall incidence densities of nephrotic syndrome for enterovirus- and non-enterovirus-infected children were 2.65 and 2.21 per 10,000 person-years, respectively. The enterovirus-infected cohort had a higher cumulative incidence of nephrotic syndrome than did the non-enterovirus-infected cohort (log-rank test, p = 0.01). Multivariable analyses revealed that children with enteroviral infection were significantly associated with an increased risk of nephrotic syndrome compared with those without enteroviral infection (adjusted hazard ratio, 1.20; 95% confidence interval, 1.04-1.39; p = 0.01), particularly in children infected with coxsackievirus. Subgroup analyses revealed that enterovirus-infected girls, children of blue-collar workers, and children without allergies had a higher risk of nephrotic syndrome than did children in the non-enterovirus-infected cohort. CONCLUSION This study revealed a significant association between enteroviral infection and nephrotic syndrome. Additional studies elucidating the role and pathogenesis of enterovirus in nephrotic syndrome are warranted.
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Affiliation(s)
- Jiun-Nong Lin
- Department of Critical Care Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chi-Hui Yang
- General Education Center, Meiho University, Pingtung, Taiwan
| | - Ming-Chia Lin
- Department of Nuclear Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chung-Hsu Lai
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Hsi-Hsun Lin
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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Peng KP, Chen YT, Fuh JL, Tang CH, Wang SJ. Association between migraine and risk of venous thromboembolism: A nationwide cohort study. Headache 2016; 56:1290-9. [DOI: 10.1111/head.12885] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/27/2016] [Accepted: 05/10/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Kuan-Po Peng
- Department of Internal Medicine; Taipei Veterans General Hospital, Taoyuan Branch; Taoyuan Taiwan (K.-P. Peng)
- Institute of Brain Science, National Yang-Ming University; Taipei Taiwan (K.-P. Peng and S.-J. Wang)
- Faculty of Medicine; National Yang-Ming University School of Medicine; Taipei Taiwan (K.-P. Peng, Y.-T. Chen, J.-L. Fuh, and S.-J. Wang)
| | - Yung-Tai Chen
- Faculty of Medicine; National Yang-Ming University School of Medicine; Taipei Taiwan (K.-P. Peng, Y.-T. Chen, J.-L. Fuh, and S.-J. Wang)
- Department of Nephrology; Institute of Internal Medicine, Taipei City Hospital Heping Fuyou Branch; Taipei Taiwan (Y.-T. Chen)
| | - Jong-Ling Fuh
- Faculty of Medicine; National Yang-Ming University School of Medicine; Taipei Taiwan (K.-P. Peng, Y.-T. Chen, J.-L. Fuh, and S.-J. Wang)
- Department of Neurology; Neurological Institute, Taipei Veterans General Hospital; Taipei Taiwan (J.-L. Fuh and S.-J. Wang)
| | - Chao-Hsiun Tang
- School of Health Care Administration; Taipei Medical University; Taipei Taiwan (C.-H. Tang)
| | - Shuu-Jiun Wang
- Institute of Brain Science, National Yang-Ming University; Taipei Taiwan (K.-P. Peng and S.-J. Wang)
- Faculty of Medicine; National Yang-Ming University School of Medicine; Taipei Taiwan (K.-P. Peng, Y.-T. Chen, J.-L. Fuh, and S.-J. Wang)
- Department of Neurology; Neurological Institute, Taipei Veterans General Hospital; Taipei Taiwan (J.-L. Fuh and S.-J. Wang)
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Stroke and Risks of Development and Progression of Kidney Diseases and End-Stage Renal Disease: A Nationwide Population-Based Cohort Study. PLoS One 2016; 11:e0158533. [PMID: 27355475 PMCID: PMC4927175 DOI: 10.1371/journal.pone.0158533] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 06/17/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND There is little information about the association between stroke and kidney diseases. We aimed to investigate the impact of stroke on long-term renal outcomes. METHODS In this large population-based retrospective cohort study, we identified 100,353 subjects registered in the National Health Insurance Research Database of Taiwan from January 1, 2000, through December 31, 2012, including 33,451 stroke patients and 66,902 age-, sex- and Charlson's comorbidity index score-matched controls. RESULTS The incidence rate of chronic kidney disease (CKD) was higher in the stroke than in the control cohort (17.5 vs. 9.06 per 1000 person-years). After multivariate adjustment, the risk of developing CKD was significantly higher in patients with stroke (adjusted hazard ratio [aHR] 1.43, 95% confidence interval [CI] 1.36-1.50, P<0.001). Subgroup analysis showed that stroke patients <50 years (aHR 1.61, P<0.001) and those with concomitant diabetes mellitus (aHR 2.12, P<0.001), hyperlipidemia (aHR 1.53, P<0.001) or gout (aHR 1.84, P<0.001) were at higher risk of incident CKD. Additionally, the risks of progression to advanced CKD and end-stage renal disease (ESRD) were significantly higher for stroke patients (aHRs, 1.22 and 1.30; P = 0.04 and P = 0.008, respectively), independent of age, sex, comorbidities and long-term medications. CONCLUSIONS Stroke is associated with higher risks for incident CKD, decline in renal function and ESRD. Younger stroke patients, as well as those with concomitant diabetes mellitus, hyperlipidemia or gout are at greater risk for kidney diseases.
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Association Between Inflammatory Bowel Disease and Erectile Dysfunction: A Nationwide Population-Based Study. Inflamm Bowel Dis 2016; 22:1065-70. [PMID: 26863266 DOI: 10.1097/mib.0000000000000695] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND To determine whether inflammatory bowel disease (IBD) is associated with an increased risk of subsequent erectile dysfunction (ED). METHODS We identified 1845 patients who received a diagnosis with IBD between 2000 and 2011 from Taiwan's National Health Insurance Research Database. For the comparison cohort, we randomly extracted the data of 7380 patients matched by sex, age, and baseline year. Follow-up continued until the development of ED, withdrawal from the National Health Insurance program, or the end of 2011. The cumulative incidences and hazard ratios (HRs) for ED development were determined. RESULTS After 12 years of follow-up, subsequent ED incidence rates in the IBD and comparison cohorts were 2.23 and 1.29 per 10,000 person-years, respectively (adjusted hazard ratio = 1.64; 95% confidence interval [CI], 1.07-2.52; P < 0.05). Compared with the non-IBD cohort without comorbidity, the risk of ED was higher in the IBD cohort with comorbidity (adjusted hazard ratio = 2.46, 95% CI, 1.32-4.58). Patients with ulcerative colitis were 2.27-fold more likely to develop ED than were patients without IBD (95% CI, 1.22-4.20). Compared with patients without IBD who were aged ≤49 years, patients with IBD aged ≥65 years were 3.36-fold more likely to develop ED (95% CI, 1.42-7.96). CONCLUSIONS We found that the patients with IBD had a 1.64-fold higher risk of developing ED than did the comparison group. Physicians should be aware of the link to ED when assessing patients with IBD.
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Wang KL, Chu PH, Lee CH, Pai PY, Lin PY, Shyu KG, Chang WT, Chiu KM, Huang CL, Lee CY, Lin YH, Wang CC, Yen HW, Yin WH, Yeh HI, Chiang CE, Lin SJ, Yeh SJ. Management of Venous Thromboembolisms: Part I. The Consensus for Deep Vein Thrombosis. ACTA CARDIOLOGICA SINICA 2016; 32:1-22. [PMID: 27122927 DOI: 10.6515/acs20151228a] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
UNLABELLED Deep vein thrombosis (DVT) is a potentially catastrophic condition because thrombosis, left untreated, can result in detrimental pulmonary embolism. Yet in the absence of thrombosis, anticoagulation increases the risk of bleeding. In the existing literature, knowledge about the epidemiology of DVT is primarily based on investigations among Caucasian populations. There has been little information available about the epidemiology of DVT in Taiwan, and it is generally believed that DVT is less common in Asian patients than in Caucasian patients. However, DVT is a multifactorial disease that represents the interaction between genetic and environmental factors, and the majority of patients with incident DVT have either inherited thrombophilia or acquired risk factors. Furthermore, DVT is often overlooked. Although symptomatic DVT commonly presents with lower extremity pain, swelling and tenderness, diagnosing DVT is a clinical challenge for physicians. Such a diagnosis of DVT requires a timely systematic assessment, including the use of the Wells score and a D-dimer test to exclude low-risk patients, and imaging modalities to confirm DVT. Compression ultrasound with high sensitivity and specificity is the front-line imaging modality in the diagnostic process for patients with suspected DVT in addition to conventional invasive contrast venography. Most patients require anticoagulation therapy, which typically consists of parenteral heparin bridged to a vitamin K antagonist, with variable duration. The development of non-vitamin K oral anticoagulants has revolutionized the landscape of venous thromboembolism treatment, with 4 agents available,including rivaroxaban, dabigatran, apixaban, and edoxaban. Presently, all 4 drugs have finished their large phase III clinical trial programs and come to the clinical uses in North America and Europe. It is encouraging to note that the published data to date regarding Asian patients indicates that such new therapies are safe and efficacious. Ultimately, our efforts to improve outcomes in patients with DVT rely on the awareness in the scientific and medical community regarding the importance of DVT. KEY WORDS Combination therapy; Hypertension; α1-blocker.
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Affiliation(s)
- Kang-Ling Wang
- General Clinical Research Center, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming University
| | - Pao-Hsien Chu
- Division of Cardiology, Department of Internal Medicine, Heart Failure Center, Healthcare Center, Chang Gung Memorial Hospital; College of Medicine, Chang Gung University
| | - Cheng-Han Lee
- Department of Internal Medicine, National Cheng Kung University Hospital; College of Medicine, National Cheng Kung University
| | - Pei-Ying Pai
- Division of Cardiology, Department of Internal Medicine, China Medical University Hospital; School of Medicine, China Medical University
| | - Pao-Yen Lin
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital
| | - Kou-Gi Shyu
- Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital
| | - Kuan-Ming Chiu
- Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital
| | - Chien-Lung Huang
- Division of Cardiology, Department of Internal Medicine, Cheng Hsin General Hospital
| | - Chung-Yi Lee
- Department of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital
| | - Yen-Hung Lin
- Department of Internal Medicine, National Taiwan University Hospital
| | - Chun-Chieh Wang
- Department of Cardiology, Chang Gung Memorial Hospital; College of Medicine, Chang Gung University
| | - Hsueh-Wei Yen
- Division of Cardiology, Department of Internal Medicine; Kaohsiung Medical University Hospital
| | - Wei-Hsian Yin
- Division of Cardiology, Department of Internal Medicine, Cheng Hsin General Hospital
| | - Hung-I Yeh
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital; Mackay Medical College
| | - Chern-En Chiang
- General Clinical Research Center, Taipei Veterans General Hospital; School of Medicine, National Yang-Ming University
| | - Shing-Jong Lin
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital
| | - San-Jou Yeh
- Division of Cardiology, Department of Internal Medicine, Heart Failure Center, Healthcare Center, Chang Gung Memorial Hospital; College of Medicine, Chang Gung University
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Lin JN, Lin CL, Lin MC, Lai CH, Lin HH, Kao CH. Pyogenic liver abscess in patients with inflammatory bowel disease: a nationwide cohort study. Liver Int 2016; 36:136-44. [PMID: 26012730 DOI: 10.1111/liv.12875] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 05/19/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Pyogenic liver abscess (PLA) is a rare and severe extraintestinal complication in patients with inflammatory bowel disease (IBD). However, the incidence of PLA in patients with IBD remains unknown. METHODS A nationwide cohort study was conducted by analysing data from the National Health Insurance Research Database in Taiwan. Patients with IBD (N = 11 504) from 2000 to 2010 and control participants without IBD (N = 46 016) were included in this study. We analysed the risks of PLA by using competing-risks (death) regression models. RESULTS The incidence of PLA was higher in the IBD cohort than in the control cohort (6.72 vs 4.06 per 10 000 person-years), with an adjusted subhazard ratio (SHR) of 1.46 (95% confidence interval [CI], 1.01-2.12). Patients with IBD who required two or more hospitalizations per year and underwent laparotomy had an increased risk of PLA. Patients with ulcerative colitis were more likely to develop PLA than were those with Crohn's disease (incidence, 8.56 vs 5.45 per 10 000 person-years; adjusted SHR, 1.65 vs 1.32). Among the IBD cohort, age and gender did not affect PLA risk. Patients with diabetes mellitus or percutaneous aspiration of the gallbladder and biliary tract and who underwent endoscopic insertion of a biliary drainage tube exhibited a significantly increased risk of PLA. CONCLUSIONS Patients with IBD exhibited an increased risk of developing PLA, particularly those with ulcerative colitis. Knowledge of the expected frequency and potential risk for this severe extraintestinal infection may minimize the serious consequences.
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Affiliation(s)
- Jiun-Nong Lin
- Department of Critical Care Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Ming-Chia Lin
- Department of Nuclear Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chung-Hsu Lai
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Hsi-Hsun Lin
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
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Venous thromboembolism in hematopoietic stem cell transplant recipients. Bone Marrow Transplant 2015; 51:473-8. [DOI: 10.1038/bmt.2015.308] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/22/2015] [Accepted: 10/23/2015] [Indexed: 01/22/2023]
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Ikushima S, Ono R, Fukuda K, Sakayori M, Awano N, Kondo K. Trousseau's syndrome: cancer-associated thrombosis. Jpn J Clin Oncol 2015; 46:204-8. [PMID: 26546690 DOI: 10.1093/jjco/hyv165] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/02/2015] [Indexed: 02/07/2023] Open
Abstract
Trousseau's syndrome (cancer-associated thrombosis) is the second leading cause of death in cancer patients, after death from cancer itself. The risk of a venous thromboembolism is 4- to 7-fold higher in patients with cancer than in those without cancer. The causes of this impaired coagulation are associated with general patient-related risk factors, and other factors that are specific to the particular cancer or treatment. It is important to assess the risk of thrombotic events in cancer patients and administer effective prophylaxis and treatment. Effective prophylaxis and treatment of venous thromboembolism reduces morbidity and mortality, and improves patients' quality of life. Low molecular weight heparin is the first-line treatment for venous thromboembolism, as an effective and safe means for prophylaxis and treatment, according to guidelines released by international scientific societies. Oral anticoagulation therapy with warfarin is preferable to no therapy. However, warfarin has low efficacy and is associated with high rates of recurrence. If low molecular weight heparin is unavailable, some guidelines recommend the use of vitamin K antagonists that have a target international normalized ratio in the range of 2-3, as acceptable alternatives. Novel oral anticoagulants that directly inhibit factor Xa or thrombin are promising for the prophylaxis of high-risk cancer patients and in the long-term treatment of venous thromboembolism. However, to date, there is insufficient evidence to support the use of these new anticoagulants.
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Affiliation(s)
- Soichiro Ikushima
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Ryu Ono
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kensuke Fukuda
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Masashi Sakayori
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Nobuyasu Awano
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Keisuke Kondo
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
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Lin JN, Lin CL, Yang CH, Lin MC, Lai CH, Lin HH, Kao CH. Increased Risk of Acute Coronary Syndrome in Patients With Diverticular Disease: A Nationwide Population-Based Study. Medicine (Baltimore) 2015; 94:e2020. [PMID: 26559302 PMCID: PMC4912296 DOI: 10.1097/md.0000000000002020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Diverticular disease and acute coronary syndrome (ACS) are common disorders that share several risk factors. Few researchers have evaluated the association between diverticular disease and ACS. We aimed to assess the risk of ACS in patients with diverticular disease. A nationwide retrospective cohort study was conducted by analyzing data from the National Health Insurance Research Database in Taiwan. All patients aged ≥20 years with a diagnosis of diverticular disease from January 1, 2000, to December 31, 2011, were included in this study. For comparison, patients without diverticular disease were randomly selected and matched with the study cohort at a 4:1 ratio according to age, sex, and the year of the diagnosis of diverticular disease. Patients with incomplete age or sex information and a history of cardiovascular diseases were excluded from the study. All patients were followed until an ACS event, withdrawal from the insurance program, or December 31, 2011. In this study, 52,681 patients with diverticular disease and 210,724 patients without diverticular disease were included. Men accounted for 56.1% of patients and 57.8% of patients were ≥50 years old. The overall incidence density of ACS in patients with diverticular disease (45.5 per 10,000 person-years) was significantly higher than in those without diverticular disease (30.3 per 10,000 person-years), with an adjusted hazard ratio (HR) of 1.23 (95% confidence interval [CI], 1.14-1.32) after adjustment for age, sex, and comorbidities. The cumulative incidence of ACS in patients with diverticular disease was significantly higher than that in the control cohort (log-rank test, P < 0.001). The adjusted HRs for the development of ACS were 1.25 (95% CI, 1.15-1.37) and 1.19 (95% CI, 1.07-1.32) in patients with diverticulitis and diverticulosis, respectively. The adjusted HRs of ACS in patients with diverticular disease additionally increased from 1.97 (95% CI, 1.73-2.23) in patients with 1 comorbidity to 5.51 (95% CI, 3.88-7.84) in those with ≥5 comorbidities. This large population-based retrospective study revealed an association between diverticular disease and ACS. Further research is warranted to determine the exact mechanism of the link between these diseases.
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Affiliation(s)
- Jiun-Nong Lin
- From the Department of Critical Care Medicine (JNL), Division of Infectious Diseases, Department of Internal Medicine (JNL, CHL, HHL), Department of Nuclear Medicine (MCL), E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan (JNL), Management Office for Health Data (CLL), Department of Nuclear Medicine and PET Center (CHK), China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science and School of Medicine (CHK), College of Medicine, China Medical University, Taichung, Taiwan (CLL); and General Education Center, Meiho University, Pingtung, Taiwan (CHY)
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Lin JN, Lin CL, Lin MC, Lai CH, Lin HH, Yang CH, Sung FC, Kao CH. Risk of leukaemia in children infected with enterovirus: a nationwide, retrospective, population-based, Taiwanese-registry, cohort study. Lancet Oncol 2015; 16:1335-43. [DOI: 10.1016/s1470-2045(15)00060-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/09/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
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Harnod T, Wang YC, Kao CH. Association of Migraine and Sleep-Related Breathing Disorder: A Population-Based Cohort Study. Medicine (Baltimore) 2015; 94:e1506. [PMID: 26356720 PMCID: PMC4616656 DOI: 10.1097/md.0000000000001506] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In this nationwide population-based cohort study, we aimed to evaluate the effects of sleep-related breathing disorders (SBD) on migraine development.Patients ages 20 years or more and diagnosed with SBD between 2000 and 2009 were evaluated as the SBD cohort (n = 3411), and compared with comparison cohort (n = 13,644). The adjusted hazard ratio (aHR) for developing migraine was calculated in both cohorts by multivariate Cox proportional hazards model.The cumulative incidence of migraine was significantly higher in the SBD cohort than in the comparison cohort. In the SBD cohort, the overall aHR for developing migraine was 2.43 (95% confidence interval [CI] = 1.72-3.44). The risk of developing migraine was higher in men (aHR 2.71) than in women (aHR 2.29) with SBD. When stratifying by age, we observed increased incidence of migraine in patients ages 20 to 44 years and 45 to 64 years, with a higher aHR of 2.51 (95% CI = 1.47-4.30) and 2.68 (95% CI = 1.63-4.43), respectively. The risk of developing migraine in the patients with SBD with or without comorbidity exhibited nonsignificant differences. After stratifying by the use of hypnotics, the aHR for developing migraine was 2.39 in the patients with hypnotics use and 3.58 in the patients without hypnotics use.Our findings indicate increased risk of developing migraine in adults, but not elderly ones, with SBD.
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Affiliation(s)
- Tomor Harnod
- From the Department of Neurosurgery, Hualien Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan (TH); College of Medicine, Tzu Chi University, Hualien, Taiwan (TH); Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan (YCW); College of Medicine, China Medical University, Taichung, Taiwan (YCW); Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan (CHK); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (CHK)
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Harnod T, Wang YC, Kao CH. Association Between Benzodiazepine Use and Epilepsy Occurrence: A Nationwide Population-Based Case-Control Study. Medicine (Baltimore) 2015; 94:e1571. [PMID: 26376408 PMCID: PMC4635822 DOI: 10.1097/md.0000000000001571] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We conducted a retrospective case-control study to evaluate the association between the risk of benzodiazepine (BZD) use and epilepsy occurrence by using data from the Taiwan National Health Insurance Research Database. We recruited 1065 participants who ages 20 years or older and newly diagnosed with epilepsy (International Classification of Diseases, Ninth Revision, Clinical Modification 345) between 2004 and 2011 and assigned them to the epilepsy group. We subsequently frequency-matched them with participants in a control group (n = 4260) according to sex, age, and index year at a 1:4 ratio. A logistic regression model was employed to calculate the odds ratio (OR) for association of epilepsy with BZD exposure. Multivariate logistic regression was conducted to estimate the dose-response relationship between BZD levels and epilepsy risk. The adjusted OR (aOR) for the association of epilepsy with BZD exposure was 2.02 (95% confidence interval [CI] = 1.68-2.42). The aOR for an average BZD dose increased to 1.26 for the participants on <0.01 defined daily dose (DDD), and increased to 4.32 for those on ≥1.50 DDD. On average, when the DDD of BZD exposure increased by 100 units, the epilepsy risk increase by 1.03-fold (95% CI = 1.01-1.04, P = 0.003). The annual BZD exposure day ranges were significantly associated with epilepsy (2-7 days: aOR = 1.67; 8-35 days: aOR = 3.16; and ≥35 days: aOR = 5.60). Whenever the annual BZD exposure increased by 30 days, the risk of epilepsy notably increased by 1.03-fold (95% CI = 1.01-1.04, P < 0.001). In addition, users who quit BZD for more than 6 months still exhibited a higher risk of epilepsy than did the non-BZD users. A considerable increase in epilepsy occurrence was observed in ones with BZD use, particularly in those with prolonged use, multiple exposure, and high-dose consumption.
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Affiliation(s)
- Tomor Harnod
- From the Department of Neurosurgery, Hualien Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan (TH); College of Medicine, Tzu Chi University, Hualien, Taiwan (TH); Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan (Y-CW); College of Medicine, China Medical University, Taichung, Taiwan (Y-CW); Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan (C-HK); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK)
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Lin JN, Lin CL, Lin MC, Lai CH, Lin HH, Yang CH, Kao CH. Increased Risk of Hemorrhagic and Ischemic Strokes in Patients With Splenic Injury and Splenectomy: A Nationwide Cohort Study. Medicine (Baltimore) 2015; 94:e1458. [PMID: 26334909 PMCID: PMC4616496 DOI: 10.1097/md.0000000000001458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The spleen is a crucial organ in humans. Little is known about the association between stroke and splenic injury or splenectomy. The aim of this study was to determine the risk of stroke in patients with splenic injury and splenectomy.A nationwide cohort study was conducted by analyzing the National Health Insurance Research Database in Taiwan. For comparison, control patients were selected and matched with splenic injury patients in a ratio of 4:1 according to age, sex, and the year of hospitalization. We analyzed the risks of stroke using a Cox proportional-hazards regression analysis.A total of 11,273 splenic injury patients, including 5294 splenectomized and 5979 nonsplenectomized patients, and 45,092 control patients were included in this study. The incidence rates of stroke were 8.05, 6.53, and 4.25 per 1000 person-years in splenic injury patients with splenectomy, those without splenectomy, and the control cohort, respectively. Compared with the control cohort, splenic injury patients with splenectomy exhibited a 2.05-fold increased risk of stroke (95% confidence interval [CI] 1.8-2.34), whereas those without splenectomy exhibited a 1.74-fold increased risk (95% CI 1.51-2). Splenectomy entailed an additional 1.21-fold increased risk of stroke compared with nonsplenectomy in patients with splenic injury.This study revealed that splenic injury and splenectomy were significantly associated with an increased risk of hemorrhagic and ischemic strokes. The results of this study may alert physicians and patients to the complications of splenic injury and splenectomy.
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Affiliation(s)
- Jiun-Nong Lin
- From the Department of Critical Care Medicine (J-NL); Department of Internal Medicine, Division of Infectious Diseases (J-NL, C-HL, H-HL), Department of Nuclear Medicine (M-CL); E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine (J-NL); College of Medicine, I-Shou University, Kaohsiung, Taiwan; Management Office for Health Data (C-LL); Department of Nuclear Medicine and PET Center (C-HK); China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science and School of Medicine (C-HK); College of Medicine (C-LL); China Medical University, Taichung, Taiwan; and General Education Center (C-HY), and Meiho University, Pingtung, Taiwan
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