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Dimitri Guy Rohner, Lukas Burget, Christoph Henzen, Stefan Fischli. Impact on diabetes control and patient-reported outcomes of a newer implantable continuous glucose monitoring system (Eversense® CGM System): a single-centre retro- and prospective observational study. Swiss Med Wkly 2024; 154:3366. [PMID: 38579290 DOI: 10.57187/s.3366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
AIMS OF THE STUDY The Eversense® CGM System is the first and only continuous glucose monitoring system (CGMS) that uses a fully subcutaneous implanted sensor. This study aimed to evaluate effectiveness, safety and patient-reported outcomes in patients using the Eversense® CGM System in a realistic clinical setting, assessed at a single Swiss diabetes centre (Luzerner Kantonsspital) with prolonged follow-up. METHODS This was a prospective and retrospective observational study that included patients with type 1 diabetes mellitus in whom at least one Eversense® glucose sensor was implanted between 2017 and 2022. The primary endpoint was the change in HbA1c levels from the baseline (before implantation of the sensor) to 6 ± 2 and 12 ± 2 months and the last follow-up (newest available value) after implantation. The secondary outcome measures were the number of premature sensor breakdowns, adverse events related to the implantation procedure (infection, bleeding, difficulties with implantation or explantation) and patient-related outcomes (assessed with a questionnaire). RESULTS A total of 33 patients participated in this study. The median follow-up time was 50 (IQR 22.3-58.5) months. In total, 178 sensor implantations were performed. Valid HbA1c results were available for 26 participants. Compared to the baseline values, HbA1c levels at 6 and 12 months and the last follow-up changed by -0.25%, -0.45 and -0.2 (p = 0.278, 0.308 and 0.296, respectively). We recorded 16 (9%) premature sensor breakdowns, all occurring between 2019 and 2020. Apart from one late-onset infection and four complicated sensor removals, no major complications were assessed. The results of the questionnaire showed a subjective improvement in hypoglycaemia rates, a better perception of hypoglycaemia and the impression of better diabetes management. Common issues with the device reported by the patients were technical errors (connection problems) and problems with the removal procedure. CONCLUSIONS The use of the Eversense® CGM System resulted in changes in HbA1c of between -0.2% and -0.45%. The rate of premature sensor breakdown was low. Major complications following sensor implantation or removal were absent, apart from one case of infection and four cases of complicated removal. Patient-reported outcomes with the Eversense® CGM System showed a subjective positive impact on hypoglycaemia rates, greater confidence in managing hypoglycaemia and diabetes in general, and easy handling of the transmitter and mobile app. Technical issues must be considered but are nowadays, with the use of the newest sensor generation, very rare.
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Affiliation(s)
- Dimitri Guy Rohner
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine, Luzerner Kantonsspital, Luzern, Switzerland
| | - Lukas Burget
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine, Luzerner Kantonsspital, Luzern, Switzerland
| | - Christoph Henzen
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine, Luzerner Kantonsspital, Luzern, Switzerland
| | - Stefan Fischli
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine, Luzerner Kantonsspital, Luzern, Switzerland
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Henzen C. Die vielen Ursachen der Adipositas und ihre Behandlung. Rev Med Suisse 2024; 20:174-175. [PMID: 38268374 DOI: 10.53738/revmed.2024.20.858.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
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Pasi P, Kröll D, Siegfried A, Sykora M, Wildisen A, Milone C, Milos G, Horka L, Fischli S, Henzen C. Plasma concentrations of SSRI/SNRI after bariatric surgery and the effects on depressive symptoms. Front Psychiatry 2023; 14:1132112. [PMID: 37181889 PMCID: PMC10166804 DOI: 10.3389/fpsyt.2023.1132112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/29/2023] [Indexed: 05/16/2023] Open
Abstract
Background Depression and treatment with antidepressants SSRI/SNRI are common in people with morbid obesity who are candidates for bariatric surgery. There is few and inconsistent data about the postoperative plasma concentrations of SSRI/SNRI. The aims of our study were to provide comprehensive data about the postoperative bioavailability of SSRI/SNRI, and the clinical effects on depressive symptoms. Methods Prospective multicenter study including 63 patients with morbid obesity and therapy with fixed doses of SSRI/SNRI: participants filled the Beck Depression Inventory (BDI) questionnaire, and plasma levels of SSRI/SNRI were measured by HPLC, preoperatively (T0), and 4 weeks (T1) and 6 months (T2) postoperatively. Results The plasma concentrations of SSRI/SNRI dropped significantly in the bariatric surgery group from T0 to T2 by 24.7% (95% confidence interval [CI], -36.8 to -16.6, p = 0.0027): from T0 to T1 by 10.5% (95% 17 CI, -22.7 to -2.3; p = 0.016), and from T1 to T2 by 12.8% (95% CI, -29.3 to 3.5, p = 0.123), respectively.There was no significant change in the BDI score during follow-up (-2.9, 95% CI, -7.4 to 1.0; p = 0.13).The clinical outcome with respect to SSRI/SNRI plasma concentrations, weight change, and change of BDI score were similar in the subgroups undergoing gastric bypass surgery and sleeve gastrectomy, respectively. In the conservative group the plasma concentrations of SSRI/SNRI remained unchanged throughout the 6 months follow-up (-14.7, 95% CI, -32.6 to 1.7; p = 0.076). Conclusion In patients undergoing bariatric surgery plasma concentrations of SSRI/SNRI decrease significantly by about 25% mainly during the first 4 weeks postoperatively with wide individual variation, but without correlation to the severity of depression or weight loss.
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Affiliation(s)
- Patrick Pasi
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Dino Kröll
- Division of Visceral Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Alena Siegfried
- Department of Surgery, Division of Visceral Surgery, Cantonal Hospital, Lucerne, Switzerland
| | - Martin Sykora
- Department of Surgery, Division of Visceral Surgery, Cantonal Hospital, Lucerne, Switzerland
| | - Alessandro Wildisen
- Department of Surgery, Division of Visceral Surgery, Cantonal Hospital, Lucerne, Switzerland
| | - Cristiana Milone
- Department of Surgery, Division of Visceral Surgery, Cantonal Hospital, Lucerne, Switzerland
| | - Gabriella Milos
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Laura Horka
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Stefan Fischli
- Department of Internal Medicine, Division of Endocrinology, Cantonal Hospital, Lucerne, Switzerland
| | - Christoph Henzen
- Department of Internal Medicine, Division of Endocrinology, Cantonal Hospital, Lucerne, Switzerland
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Baumgartner A, Olpe T, Griot S, Mentil N, Staub N, Burn F, Schindera S, Kaegi-Braun N, Tribolet P, Hoess C, Pavlicek V, Bilz S, Sigrist S, Brändle M, Henzen C, Thomann R, Rutishauser J, Aujesky D, Rodondi N, Donzé J, Stanga Z, Mueller B, Schuetz P. Association of CT-based diagnosis of sarcopenia with prognosis and treatment response in patients at risk of malnutrition - A secondary analysis of the Effect of early nutritional support on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT) trial. Clin Nutr 2023; 42:199-207. [PMID: 36603460 DOI: 10.1016/j.clnu.2022.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIM CT-derived measures of muscle mass may help to identify patients with sarcopenia. We investigated the prognostic significance of CT-derived sarcopenia and muscle attenuation with nutritional markers, clinical outcomes and response to nutritional support in medical in-patients at nutritional risk. METHOD Within this secondary analysis of the randomized-controlled Effect of early nutritional support on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT) comparing individualized nutritional support with usual care nutrition in medical inpatients, we investigated associations of CT-based sarcopenia and muscle attenuation at the level L3 with different nutritional and clinical outcomes, and the response to the nutritional intervention. The primary composite endpoint was adverse clinical outcome within 30 days of hospital admission. RESULTS We included 573 of 2028 EFFORT patients with available CT scans, of which 68.4% met the CT-based definition of sarcopenia and 72.9% had low muscle attenuation. In multivariate analysis, low skeletal muscle index was associated with higher nutritional risk (coefficient per NRS class -0.94 (95%CI -1.87 to -0.01) p = 0.049) and higher risk for adverse clinical outcomes (adjusted odds ratio 1.59 (95% CI 1.06 to 2.38), p = 0.024). Low muscle attenuation was also associated with adverse clinical outcome (adjusted odds ratio 1.67 (95%CI 1.08 to 2.58), p = 0.02). Nutritional support tended to be more effective in reducing mortality in non-sarcopenic patients compared to patients with CT-based sarcopenia (p for interaction 0.058). CONCLUSIONS Within a population of medical patients at nutritional risk, CT-based sarcopenia and muscle attenuation were associated with several nutritional parameters and predicted adverse clinical outcomes. Information from CT scans, thus may help to better characterize these patients, and may be helpful in guiding therapeutic interventions.
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Affiliation(s)
- Annic Baumgartner
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Tobias Olpe
- Medical Faculty of the University of Basel, Switzerland
| | | | - Nicole Mentil
- Medical Faculty of the University of Basel, Switzerland
| | | | - Felice Burn
- Department of Radiology Kantonsspital Aarau, Aarau, Switzerland
| | | | - Nina Kaegi-Braun
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Pascal Tribolet
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Claus Hoess
- Internal Medicine, Kantonsspital Muensterlingen, Switzerland
| | | | - Stefan Bilz
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | - Sarah Sigrist
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | - Michael Brändle
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | | | | | | | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Jacques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Zeno Stanga
- Division of Diabetology, Endocrinology, Nutritional Medicine & Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
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Henzen C. Künstliche Intelligenz und Diabetesmanagement. Rev Med Suisse 2023; 19:134-135. [PMID: 36715391 DOI: 10.53738/revmed.2023.19.811.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Christoph Henzen
- Departementsleiter Medizin und Chefarzt Allgemeine Innere Medizin und Endokrinologie/Diabetologie, Luzerner Kantonsspital, 6000 Luzern 16
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Komminoth M, Donath MY, Hepprich M, Schuetz P, Blum CA, Mueller B, Reny JL, Gosselin P, Breville G, Brändle M, Henzen C, Leuppi JD, Kistler AD, Thurnheer R, Beuschlein F, Rudofsky G, Aeberli D, Villiger PM, Böhm S, Chifu I, Fassnacht M, Meyer G, Bojunga J, Cattaneo M, Sluka C, Schneider H, Rutishauser J. Glucocorticoid withdrawal and glucocorticoid-induced adrenal insufficiency: Study protocol of the randomized controlled «TOASST" (Taper Or Abrupt Steroid STop) multicenter trial. PLoS One 2023; 18:e0281585. [PMID: 37018188 PMCID: PMC10075434 DOI: 10.1371/journal.pone.0281585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/15/2022] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Despite the widespread use of glucocorticoids in inflammatory and autoimmune disorders, there is uncertainty about the safe cessation of long-term systemic treatment, as data from prospective trials are largely missing. Due to potential disease relapse or glucocorticoid-induced hypocortisolism, the drug is often tapered to sub-physiological doses rather than stopped when the underlying disease is clinically stable, increasing the cumulative drug exposure. Conversely, the duration of exposure to glucocorticoids should be minimized to lower the risk of side effects. METHODS We designed a multicenter, randomized, triple-blinded, placebo-controlled trial to test the clinical noninferiority of abrupt glucocorticoid stop compared to tapering after ≥28 treatment days with ≥420 mg cumulative and ≥7.5 mg mean daily prednisone-equivalent dose. 573 adult patients treated systemically for various disorders will be included after their underlying disease has been stabilized. Prednisone in tapering doses or matching placebo is administered over 4 weeks. A 250 mg ACTH-test, the result of which will be revealed a posteriori, is performed at study inclusion; all patients are instructed on glucocorticoid stress cover dosing. Follow-up is for 6 months. The composite primary outcome measure is time to hospitalization, death, initiation of unplanned systemic glucocorticoid therapy, or adrenal crisis. Secondary outcomes include the individual components of the primary outcome, cumulative glucocorticoid doses, signs and symptoms of hypocortisolism, and the performance of the ACTH test in predicting the clinical outcome. Cox proportional hazard, linear, and logistic regression models will be used for statistical analysis. CONCLUSION This trial aims to demonstrate the clinical noninferiority and safety of abrupt treatment cessation after ≥28 days of systemic glucocorticoid therapy in patients with stabilized underlying disease. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03153527; EUDRA-CT: 2020-005601-48 https://clinicaltrials.gov/ct2/show/NCT03153527?term=NCT03153527&draw=2&rank=1.
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Affiliation(s)
- Mathis Komminoth
- Department of Medicine, Clinical Trial Unit, Cantonal Hospital Baden and University of Basel (J.R.), Basel, Switzerland
| | - Marc Y Donath
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Matthias Hepprich
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Philipp Schuetz
- Department of Medicine, Cantonal Hospital Aarau and University of Basel, Basel, Switzerland
| | - Claudine A Blum
- Department of Medicine, Cantonal Hospital Aarau and University of Basel, Basel, Switzerland
| | - Beat Mueller
- Department of Medicine, Cantonal Hospital Aarau and University of Basel, Basel, Switzerland
| | - Jean-Luc Reny
- Department of Medicine, University Hospitals Geneva, Geneva, Switzerland
| | - Pauline Gosselin
- Department of Medicine, University Hospitals Geneva, Geneva, Switzerland
| | - Gautier Breville
- Department of Medicine, University Hospitals Geneva, Geneva, Switzerland
| | - Michael Brändle
- Department of Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Christoph Henzen
- Department of Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Jörg D Leuppi
- Department of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Andreas D Kistler
- Department of Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Robert Thurnheer
- Department of Medicine, Cantonal Hospital Münsterlingen, Münsterlingen, Switzerland
| | - Felix Beuschlein
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - Gottfried Rudofsky
- Division of Endocrinology and Diabetes, Cantonal Hospital Olten, Olten, Switzerland
| | - Daniel Aeberli
- Department of Rheumatology and Immunology, University Hospital Bern, Bern, Switzerland
| | | | - Stephan Böhm
- Department of Medicine, Hospital Bülach, Bülach, Switzerland
| | - Irina Chifu
- Department of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany
| | - Martin Fassnacht
- Department of Endocrinology and Diabetes, University Hospital Würzburg, Würzburg, Germany
| | - Gesine Meyer
- Department of Endocrinology and Diabetes, University Hospital Frankfurt am Main, Frankfurt, Germany
| | - Jörg Bojunga
- Department of Endocrinology and Diabetes, University Hospital Frankfurt am Main, Frankfurt, Germany
| | - Marco Cattaneo
- Clinical Trial Unit, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Constantin Sluka
- Clinical Trial Unit, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Helga Schneider
- Department of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Jonas Rutishauser
- Department of Medicine, Clinical Trial Unit, Cantonal Hospital Baden and University of Basel (J.R.), Basel, Switzerland
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Vavanikunnel J, Sewing L, Triantafyllidou M, Steighardt A, Baumann S, Egger A, Grize L, Felix B, Kraenzlin M, Henzen C, Meier C. Determinants of Low Bone Turnover in Type 2 Diabetes-the Role of PTH. Calcif Tissue Int 2022; 111:587-596. [PMID: 36190530 PMCID: PMC9613733 DOI: 10.1007/s00223-022-01022-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 09/03/2022] [Indexed: 11/25/2022]
Abstract
Determinants of low bone turnover in type 2 diabetes (T2DM) are poorly understood. To investigate the relationship between markers of bone turnover, glycaemic control, disease duration and calciotropic hormones in T2DM we assessed baseline biochemical data from the DiabOS Study, a prospective multicenter observational cohort study. In a cross-sectional study-design data from 110 postmenopausal women and men aged 50-75 years diagnosed with T2DM for at least 3 years and 92 non-diabetic controls were evaluated. Biochemical markers of bone formation (N-terminal propeptide of type I procollagen [PINP]), bone-specific alkaline phosphatase [BAP]) and resorption (C-terminal cross-linking telopeptide of type I collagen [CTX]), measures of calcium homeostasis (intact parathormone [iPTH], 25-Hydroxyvitamin D, calcium, magnesium) and glycaemic control were assessed. After adjustment for age, gender and body mass index (BMI), patients with T2DM had lower serum levels of PINP (p < 0.001), CTX (p < 0.001), iPTH (p = 0.03) and magnesium (p < 0.001) compared to controls. Serum calcium, creatinine, 25-Hydroxyvitamin D and sclerostin did not differ between both groups. In multivariate linear regression analyses only serum iPTH remained an independent determinant of bone turnover markers in T2DM (PINP: p = 0.02; CTX: p < 0.001 and BAP: p < 0.01), whereas glycated haemoglobin (HbA1c), disease duration, age and BMI were not associated with bone turnover. In conclusion low bone turnover in T2DM is associated with low iPTH. The underlying mechanism remains to be elucidated.
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Affiliation(s)
- Janina Vavanikunnel
- Division of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Lilian Sewing
- Division of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland
| | | | - Anna Steighardt
- Department of Internal Medicine, Kantonsspital Lucerne, Switzerland
| | - Sandra Baumann
- Division of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Andrea Egger
- Division of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Leticia Grize
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Barbara Felix
- Division of Endocrinology, Kantonsspital Baselland, Switzerland
| | | | - Christoph Henzen
- Department of Internal Medicine, Kantonsspital Lucerne, Switzerland
| | - Christian Meier
- Division of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland.
- Endocrine Clinic and Laboratory, Basel, Switzerland.
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Kaegi-Braun N, Boesiger F, Tribolet P, Gomes F, Kutz A, Hoess C, Pavlicek V, Bilz S, Sigrist S, Brändle M, Henzen C, Thomann R, Rutishauser J, Aujesky D, Rodondi N, Donzé J, Stanga Z, Lobo DN, Cederholm T, Mueller B, Schuetz P. Validation of modified GLIM criteria to predict adverse clinical outcome and response to nutritional treatment: A secondary analysis of a randomized clinical trial. Clin Nutr 2022; 41:795-804. [PMID: 35263688 DOI: 10.1016/j.clnu.2022.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND & AIMS The Global Leadership Initiative on Malnutrition (GLIM) recently suggested specific criteria to standardize the diagnosis of malnutrition. There is need for validation of these criteria regarding response to nutrition treatment. Our aim was to validate modified GLIM (mGLIM) criteria among medical inpatients at risk of disease related malnutrition for prediction of outcome and response to nutritional therapy. METHODS This is a secondary analysis of the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), a multicenter randomized controlled trial conducted between April 2014 and February 2018. Adult medical inpatients at nutritional risk (Nutrition Risk Score 2002 ≥ 3 points) were randomly assigned to receive nutritional therapy according to an algorithm based on individualized nutritional requirements (intervention group) or standard hospital food (control group). We included all participants with available information regarding mGLIM criteria. The primary outcome was adverse clinical outcome, which was a composite of 30-day all-cause mortality, ICU-admission, rehospitalization rate, major complications and decline in functional status. RESULTS Of 1917 eligible participants at nutritional risk, 1181 (61.6%) met the diagnosis of malnutrition based on mGLIM criteria. The incidence of adverse clinical outcome was significantly higher in mGLIM-positive participants compared with mGLIM-negative participants [330/1181 (27.9%) versus 140/736 (19.0%); multivariable adjusted odds ratio [OR] 1.53; 95% CI 1.22-1.93; p < 0.001]. Regarding the effect of nutritional therapy, the reduction in adverse clinical outcomes was higher in mGLIM-positive participants [180/581 (31.0%) vs. 150/600 (25.0%), OR 0.69; 95% CI 0.53-0.9, p = 0.007], compared with mGLIM-negative participants [75/379 (19.8%) versus 65/357 (18.2%), OR 0.95; 95% CI 0.65-1.40, p = 0.797], a finding that was, however, not significant in interaction analysis (p for interaction = 0.217). CONCLUSION Data from this secondary analysis of a multicenter randomized trial involving medical inpatients at nutritional risk validate the strong prognostic value of mGLIM criteria regarding adverse clinical outcomes and other long-term outcomes. However, further research is needed to improve the ability of GLIM criteria to predict therapeutic response to nutritional interventions. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02517476.
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Affiliation(s)
- Nina Kaegi-Braun
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Fabienne Boesiger
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Pascal Tribolet
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland; Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Filomena Gomes
- The New York Academy of Sciences, New York, NY, USA; NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Alexander Kutz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Claus Hoess
- Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - Vojtech Pavlicek
- Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - Stefan Bilz
- Internal Medicine and Endocrinology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Sarah Sigrist
- Internal Medicine and Endocrinology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Michael Brändle
- Internal Medicine and Endocrinology, Kantonsspital St Gallen, St Gallen, Switzerland
| | | | - Robert Thomann
- Internal Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Jonas Rutishauser
- Internal Medicine, Kantonsspital Baselland, Standort Bruderholz, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Jacques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Zeno Stanga
- Division of Diabetes, Endocrinology, Nutritional Medicine, and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dileep N Lobo
- Nottingham Digestive Diseases Centre and National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.
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Bretschera C, Boesiger F, Kaegi-Braun N, Hersberger L, Lobo DN, Evans DC, Tribolet P, Gomes F, Hoess C, Pavlicek V, Bilz S, Sigrist S, Brändle M, Henzen C, Thomann R, Rutishauser J, Aujesky D, Rodondi N, Donzé J, Stanga Z, Mueller B, Schuetz P. Admission serum albumin concentrations and response to nutritional therapy in hospitalised patients at malnutrition risk: Secondary analysis of a randomised clinical trial. EClinicalMedicine 2022; 45:101301. [PMID: 35198927 PMCID: PMC8844847 DOI: 10.1016/j.eclinm.2022.101301] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Historically, admission serum albumin concentrations have been considered useful biochemical markers for nutrition assessment. However, there is a lack of randomised trial data investigating whether low albumin concentrations are helpful for identifying patients benefitting from nutritional support. METHODS This study was a secondary analysis of the EFFORT trial, a Swiss-wide multicentre, randomised controlled trial comparing individualised nutritional support with usual care nutrition in medical inpatients from April 1, 2014, to February 1, 2018. 1389 of 2028 patients at nutritional risk with available albumin concentrations on admission were included. The primary endpoint was all-cause mortality within 30 and 180 days. Patients were stratified into groups of low or normal albumin based on the albumin cut-off of 30 g/L. ClinicalTrials.gov number, NCT02517476. FINDINGS 1389 patients (mean age, 73.1 (SD 3.5) years; 747 (53.8%) men) were included and 676 (48.7%) had low serum albumin concentrations at admission (<30 g/L). Mortality at 180 days was significantly increased in the low albumin group compared with patients with normal albumin concentrations (219/676 (32.4%) vs. 162/713 (22.7%), fully adjusted HR 1.4, 95%CI 1.11 to 1.77, p = 0.005]. Effects of nutritional support on 30-day mortality were similar for patients with low compared to patients with normal albumin concentrations (HR 0.68, 95%CI 0.44 to 1.05 vs. HR 0.70, 95%CI 0.41 to 1.20), with no evidence for a subgroup effect (p for interaction=0.97). INTERPRETATION Based on this secondary analysis of a randomised trial, low admission serum albumin concentrations in hospitalised, non-critically ill, medical patients at nutritional risk had prognostic implications and indicated higher mortality risk but were not helpful in selecting patients for nutritional interventions. FUNDING The Swiss National Science Foundation (SNSF) (PP00P3_150531) and the Research Council of the Kantonsspital Aarau (1410.000.058 and 1410.000.044) provided funding for the EFFORT trial.
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Affiliation(s)
- Céline Bretschera
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse, Aarau CH-5001, Switzerland
| | - Fabienne Boesiger
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse, Aarau CH-5001, Switzerland
| | - Nina Kaegi-Braun
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse, Aarau CH-5001, Switzerland
| | - Lara Hersberger
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse, Aarau CH-5001, Switzerland
| | - Dileep N. Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, Queen's Medical Centre, Nottingham Biomedical Research Centre, National Institute for Health Research (NIHR), Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - David C. Evans
- Trauma / Critical Care Surgery, Ohio Health Grant Medical Center, Columbus, OH, USA
| | - Pascal Tribolet
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse, Aarau CH-5001, Switzerland
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Filomena Gomes
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse, Aarau CH-5001, Switzerland
- The New York Academy of Sciences, New York, NY, USA
| | - Claus Hoess
- Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - Vojtech Pavlicek
- Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - Stefan Bilz
- Internal Medicine and Endocrinology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Sarah Sigrist
- Internal Medicine and Endocrinology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Michael Brändle
- Internal Medicine and Endocrinology, Kantonsspital St Gallen, St Gallen, Switzerland
| | | | - Robert Thomann
- Internal Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Jonas Rutishauser
- Internal Medicine, Kantonsspital Baselland Standort Bruderholz, Switzerland
| | | | - Nicolas Rodondi
- Department of General Internal Medicine, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Jacques Donzé
- Medical Faculty of the University of Basel, Basel, Switzerland
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Zeno Stanga
- Division of Diabetology, Endocrinology, Nutritional Medicine, and Metabolism, Switzerland
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse, Aarau CH-5001, Switzerland
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse, Aarau CH-5001, Switzerland
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Corresponding author at: Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse, Aarau CH-5001, Switzerland.
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11
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Gass JM, Wicke C, Mona C, Strobel K, Müller W, Metzger J, Suter-Widmer I, Henzen C, Fischli S. 18F-Fluorocholine-PET combined with contrast-enhanced CT for localizing hyperfunctioning parathyroid glands and optimizing surgical treatment in patients with hyperparathyroidism. Endocrine 2022; 75:593-600. [PMID: 34561784 DOI: 10.1007/s12020-021-02877-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/12/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE Hyperparathyroidism (HPT) is a common disorder. A cure can only be achieved by removing all diseased glands. It is critical to localize the hyperfunctioning glands exactly to prevent extensive surgical exploration. The number of false negative/inconclusive results in standard imaging techniques is high. We aimed to evaluate the diagnostic accuracy of 18F-Fluorocholine-PET in combination with contrast-enhanced CT (FCH-PET/CT) and its sensitivity in patients with primary, secondary/tertiary, and familial HPT with negative and/or discordant findings in ultrasound and/or 99mTc-sestamibi scintigraphy/SPECT/CT. METHODS A total of 96 patients with HPT and negative/equivocal conventional imaging were referred for FCH-PET/CT. In this retrospective, single institution study, 69 patients, who have undergone surgery and histopathologic workup, were analyzed. Of the 69 patients included, 60 patients suffered from primary HPT, four from secondary or tertiary HPT, and five from familial HPT. Sensitivities, positive predictive values, and accuracies were calculated. RESULTS Sensitivity/positive predictive value (PPV) per lesion was 87.5/98.3% for primary HPT, 75/100% for secondary/tertiary HPT and 25/66.7% for familial HPT. Sensitivity/PPV per patient was 91.5/98.2% for primary HPT, 100/100% for secondary/tertiary HPT and 50/100% for familial HPT. All patients showed normalized serum calcium levels in the postoperative period. The follow-up rate was 97%. Of the patients included in the study, 58 of 60 patients with primary HPT, and four of four patients with secondary/tertiary HPT showed normal calcium and parathyroid hormone (PTH) levels after six months and were cured. Of the patients with familial HPT, four of five patients were cured. CONCLUSION Diagnostic accuracy of 18F-Fluorocholine-PET/CT for patients with pHPT is excellent. 18F-Fluorocholine-PET/CT is a valuable tool for endocrine surgeons to optimize the surgical treatment of patients with hyperparathyroidism.
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Affiliation(s)
- Jörn-Markus Gass
- Division of Visceral Surgery, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
- Thyroid Center, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Corinna Wicke
- Thyroid Center, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Caroline Mona
- Division of Endocrinology, Diabetes and Clinical Nutrition, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Klaus Strobel
- Thyroid Center, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
- Division of Radiology and Nuclear Medicine, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Werner Müller
- Thyroid Center, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
- Division of Otorhinolaryngology and Head and Neck Surgery, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Jürg Metzger
- Division of Visceral Surgery, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
- Thyroid Center, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Isabelle Suter-Widmer
- Division of Endocrinology, Diabetes and Clinical Nutrition, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Christoph Henzen
- Thyroid Center, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
- Division of Endocrinology, Diabetes and Clinical Nutrition, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Stefan Fischli
- Thyroid Center, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland.
- Division of Endocrinology, Diabetes and Clinical Nutrition, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland.
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12
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van der Vet PCR, Kusen JQ, Rohner-Spengler M, Link BC, Verleisdonk EJMM, Knobe M, Henzen C, Schmid L, Babst R, Beeres FJP. The Quality of Life, Patient Satisfaction and Rehabilitation in Patients With a Low Energy Fracture-Part III of an Observational Study. Geriatr Orthop Surg Rehabil 2021; 12:21514593211046407. [PMID: 34868722 PMCID: PMC8642119 DOI: 10.1177/21514593211046407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 07/29/2021] [Accepted: 08/17/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Due to the aging population the incidence of Low Energy Fractures (LEF) increases. LEF have high mortality and morbidity rates and often cause elderly to lose independence. Patient-reported outcomes, such as Quality of Life (QoL) and patient satisfaction (PS) are needed to evaluate treatment, estimate cost-benefit analyses, and to improve clinical decision-making and patient-centered care. Objective The primary goal was to evaluate QoL and PS in patients with LEF, and to compare QoL scores to the community dwelling population. Second, we observed the amount and type of physiotherapy (PT) sessions the patients conducted. Methods A single-center cohort study was conducted in Switzerland. Patients between 50 and 85 years, who were treated in the hospital for LEF, were followed 1 year after initial fracture. Data on QoL were obtained through the Euroqol-5-Dimension questionnaire-3-Level (EQ-5D-3L) and the EQ VAS (visual analog scale). PS was measured by a VAS on satisfaction with treatment outcome. Data on PT sessions, mobility and use of analgesics were collected by telephone interviews and written surveys. Results were compared between the different fracture locations and subgroup analyses were performed for age categories. Results 411 patients were included for analysis. The median scores of the EQ-5D-3L index-VAS and PS were 0.90 (0.75-1.0), 90 (71.3-95) and 100 (90-100). Significant differences in all scores were found between fracture location (P < .05), with hip fracture patients and patients with a malleolar fracture scoring lowest in all measures. QoL index in hip fracture patients was 0.76 (0.70-1.00), QoL VAS 80 (70-90), and PS 95 (80-100). Median amount of PT sessions in all patients was 18 (9-27) and a significant difference was found between fracture locations. Patients with a fracture of the humerus received the highest amount of PT sessions 27 (18-36), hip fracture patients had a median of 18 (9-27) sessions. Conclusion At follow-up, QoL throughout all patients with a LEF was comparable to a normal population. Remarkably, though hip fracture patients seem to suffer from a clinically relevant loss of QoL, they received fewer PT sessions and performed fewer long-lasting home training than patients with a humerus fracture. Intensive, progressive rehabilitation with a high frequency of supervised training is recommended after hip fracture. The low frequency of PT sessions found in this study is unsatisfying. In hip fracture patients and in patients with a malleolar fracture, especially when aged over 75 years, more efforts are required to improve rehabilitation and subsequently QoL.
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Affiliation(s)
- Puck C R van der Vet
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jip Q Kusen
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Bjoern-Christian Link
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Egbert-Jan M M Verleisdonk
- Department of Orthopaedic and Trauma Surgery, Diakonessenhuis Utrecht Zeist Doorn, Utrecht, The Netherlands
| | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Christoph Henzen
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Lukas Schmid
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Reto Babst
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Frank J P Beeres
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
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13
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Kaegi-Braun N, Tribolet P, Baumgartner A, Fehr R, Baechli V, Geiser M, Deiss M, Gomes F, Kutz A, Hoess C, Pavlicek V, Schmid S, Bilz S, Sigrist S, Brändle M, Benz C, Henzen C, Thomann R, Rutishauser J, Aujesky D, Rodondi N, Donzé J, Stanga Z, Mueller B, Schuetz P. Value of handgrip strength to predict clinical outcomes and therapeutic response in malnourished medical inpatients: Secondary analysis of a randomized controlled trial. Am J Clin Nutr 2021; 114:731-740. [PMID: 33829236 DOI: 10.1093/ajcn/nqab042] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Disease-related malnutrition is associated with loss of muscle mass and impaired functional status. Handgrip strength (HGS) has been proposed as an easy-to-use tool to assess muscle strength in clinical practice. OBJECTIVES We investigated the prognostic implications of HGS in patients at nutritional risk with regard to clinical outcomes and response to nutritional support. METHODS This was a secondary analysis of the randomized controlled, multicenter, Effect of Early Nutritional Support on Frailty, Functional Outcome, and Recovery of Malnourished Medical Inpatients Trial, which compared the effects of individualized nutritional support with usual hospital food in medical inpatients at nutritional risk. Our primary endpoint was 30-d all-cause mortality. The association between sex-specific HGS and clinical outcomes was investigated using multivariable regression analyses, adjusted for randomization, age, weight, height, nutritional risk, admission diagnosis, comorbidities, interaction terms, and study center. We used interaction terms to investigate possible effect modification regarding the nutritional support intervention. RESULTS Mean ± SD HGS in the 1809 patients with available handgrip measurement was 17.0 ± 7.1 kg for females and 28.9 ± 11.3 kg for males. Each decrease of 10 kg in HGS was associated with increased risk of 30-d mortality (female: adjusted OR: 2.11; 95% CI: 1.23, 3.62, P = 0.007; male: adjusted OR: 1.44; 95% CI: 1.07, 1.93, P = 0.015) and 180-d mortality (female: adjusted OR: 1.45; 95% CI: 1.0, 2.10, P = 0.048; male: adjusted OR: 1.55; 95% CI: 1.28, 1.89, P < 0.001). Individualized nutritional support was most effective in reducing mortality in patients with low HGS (adjusted OR: 0.29; 95% CI: 0.10, 0.82 in patients in the ≤10th percentile compared with OR: 0.98; 95% CI: 0.66, 1.48 in patients in the >10th percentile; P for interaction = 0.026). CONCLUSIONS In medical inpatients at nutritional risk, HGS provided significant prognostic information about expected mortality and complication risks and helps to identify which patients benefit most from nutritional support. HGS may thus improve individualization of nutritional therapy.This trial was registered at clinicaltrials.gov as NCT02517476.
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Affiliation(s)
- Nina Kaegi-Braun
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Pascal Tribolet
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.,Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland.,Faculty of Life Sciences, University of Vienna, Vienna, Austria
| | - Annic Baumgartner
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Rebecca Fehr
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Valerie Baechli
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Martina Geiser
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Manuela Deiss
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Filomena Gomes
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.,The New York Academy of Sciences, New York City, NY, USA
| | - Alexander Kutz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.,Medical Faculty of the University of Basel, Switzerland
| | - Claus Hoess
- Internal Medicine, Kantonsspital Muensterlingen, Switzerland
| | | | - Sarah Schmid
- Internal Medicine, Kantonsspital Muensterlingen, Switzerland
| | - Stefan Bilz
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | - Sarah Sigrist
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | - Michael Brändle
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | - Carmen Benz
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | | | | | | | | | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Jacques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.,Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Zeno Stanga
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.,Medical Faculty of the University of Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.,Medical Faculty of the University of Basel, Switzerland
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14
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Gass JM, Wicke C, Henzen C, Mona C, Strobel K, Metzger J, Suter I, Müller W, Fischli S. 18F-Fluorcholine-PET/CT for localizing hyperfunctioning parathyroid glands and optimizing surgical treatment in patients with hyperparathyroidism. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Hyperparathyroidism (HPT) is a common endocrine disorder. Definitive cure can only be reached by surgical removal of all diseased glands. The surgical strategy and management continue to evolve. Exact preoperative localization of hyperfunctioning glands is of paramount importance to prevent unnecessary surgical exploration. Unfortunately, the number of false negative or inconclusive results in standard imaging techniques is rather high. The aim of this study is to evaluate the diagnostic accuracy of 18F-Fluorcholine-PET/CT (FCH-PET/CT) and its sensitivity in a large cohort of patients with primary as well as secondary/tertiary and familial HPT with negative and/or discordant findings in ultrasound and/or 99mTc-sestamibi scintigraphy/SPECT/CT.
Methods
Between 2015 and 2020 96 patients with HPT and negative/equivocal conventional imaging were referred for FCH-PET/CT. 69 patients who have undergone surgery and histopathologic workup were analyzed in this retrospective single institution study. 60 patients suffered from primary HPT, 4 from secondary or tertiary HPT and 5 from familial HPT. Sensitivities, positive predictive values, and accuracies were calculated.
Results
All patients showed normalized serum calcium levels in the direct postoperative period.
50 of 60 patients (8 results are awaited) with primary HPT and 4 of 4 patients with secondary/tertiary HPT showed normal calcium levels after 6 months and were cured. 4 of 5 patients with familial HPT were cured as well while 1 patient deceased before 6 month follow up. Sensitivity per lesion for primary HPT was 88%, for secondary/tertiary HPT 75% and for familial HPT 75%, respectively. Sensitivity per patient was 92% for primary HPT, 100% for secondary/tertiary HPT and 50% for familial HPT, respectively. Positive predictive value was 98% in primary HPT and 100% in secondary/tertiary HPT and 100% in familial HPT as well.
Conclusion
Diagnostic accuracy of 18F-Fluorcholine-PET/CT for patients with primary as well as secondary/tertiary and familial hyperparathyreoidism ist excellent . 18F-Fluorcholine-PET/CT is a valuable tool for endocrine surgeons to optimize the surgical treatment of patients with hyperparathyroidism.
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Affiliation(s)
- J -M Gass
- Thyroid Center Lucerne, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - C Wicke
- Thyroid Center Lucerne, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - C Henzen
- Department of Endocrinology, Diabetes and Clinical Nutrition, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - C Mona
- Department of Endocrinology, Diabetes and Clinical Nutrition, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - K Strobel
- Department of Nuclear Medicine and Radiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - J Metzger
- Department of Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - I Suter
- Department of Endocrinology, Diabetes and Clinical Nutrition, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - W Müller
- Department of Otolaryngology, Head and Neck Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - S Fischli
- Department of Endocrinology, Diabetes and Clinical Nutrition, Cantonal Hospital Lucerne, Lucerne, Switzerland
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15
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Bargetzi L, Brack C, Herrmann J, Bargetzi A, Hersberger L, Bargetzi M, Kaegi-Braun N, Tribolet P, Gomes F, Hoess C, Pavlicek V, Bilz S, Sigrist S, Brändle M, Henzen C, Thomann R, Rutishauser J, Aujesky D, Rodondi N, Donzé J, Laviano A, Stanga Z, Mueller B, Schuetz P. Nutritional support during the hospital stay reduces mortality in patients with different types of cancers: secondary analysis of a prospective randomized trial. Ann Oncol 2021; 32:1025-1033. [PMID: 34022376 DOI: 10.1016/j.annonc.2021.05.793] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/29/2021] [Accepted: 05/14/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Nutritional support in patients with cancer aims at improving quality of life. Whether use of nutritional support is also effective in improving clinical outcomes requires further study. PATIENTS AND METHODS In this preplanned secondary analysis of patients with cancer included in a prospective, randomized-controlled, Swiss, multicenter trial (EFFORT), we compared protocol-guided individualized nutritional support (intervention group) to standard hospital food (control group) regarding mortality at 30-day (primary endpoint) and other clinical outcomes. RESULTS We analyzed 506 patients with a main admission diagnosis of cancer, including lung cancer (n = 113), gastrointestinal tumors (n = 84), hematological malignancies (n = 108) and other types of cancer (n = 201). Nutritional risk based on Nutritional Risk Screening (NRS 2002) was an independent predictor for mortality over 180 days with an (age-, sex-, center-, type of cancer-, tumor activity- and treatment-) adjusted hazard ratio of 1.29 (95% CI 1.09-1.54; P = 0.004) per point increase in NRS. In the 30-day follow-up period, 50 patients (19.9%) died in the control group compared to 36 (14.1%) in the intervention group resulting in an adjusted odds ratio of 0.57 (95% CI 0.35-0.94; P = 0.027). Interaction tests did not show significant differences in mortality across the cancer type subgroups. Nutritional support also significantly improved functional outcomes and quality of life measures. CONCLUSIONS Compared to usual hospital nutrition without nutrition support, individualized nutritional support reduced the risk of mortality and improved functional and quality of life outcomes in cancer patients with increased nutritional risk. These data further support the inclusion of nutritional care in cancer management guidelines.
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Affiliation(s)
- L Bargetzi
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland
| | - C Brack
- Medical Faculty of the University of Basel, Basel, Switzerland
| | - J Herrmann
- Medical Faculty of the University of Basel, Basel, Switzerland
| | - A Bargetzi
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland
| | - L Hersberger
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland
| | - M Bargetzi
- Medical Faculty of the University of Basel, Basel, Switzerland; Division of Oncology, Hematology and Transfusion Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - N Kaegi-Braun
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - P Tribolet
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - F Gomes
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; The New York Academy of Sciences, New York, USA
| | - C Hoess
- Internal Medicine, Kantonsspital Muensterlingen, Muensterlingen, Switzerland
| | - V Pavlicek
- Internal Medicine, Kantonsspital Muensterlingen, Muensterlingen, Switzerland
| | - S Bilz
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | - S Sigrist
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | - M Brändle
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | - C Henzen
- Internal Medicine, Kantonsspital Luzern, Luzern, Switzerland
| | - R Thomann
- Internal Medicine, Buergerspital Solothurn, Solothurn, Switzerland
| | - J Rutishauser
- Internal Medicine, Kantonsspital Baselland, Liestal, Switzerland
| | - D Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - N Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - J Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, USA
| | - A Laviano
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Z Stanga
- Division of Diabetes, Endocrinology, Nutritional Medicine & Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - B Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland
| | - P Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.
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16
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Fischli S, von Wyl V, Wuillemin W, von Känel R, Schütz P, Christ-Crain M, Studer F, Brander L, Schüpfer G, Metzger J, Henzen C. Impact of Adrenal Function on Hemostasis/Endothelial Function in Patients Undergoing Surgery. J Endocr Soc 2021; 5:bvab047. [PMID: 33928206 PMCID: PMC8057135 DOI: 10.1210/jendso/bvab047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Indexed: 11/19/2022] Open
Abstract
Context Glucocorticoids regulate hemostatic and endothelial function, and they are critical for adaptive functions during surgery. No data regarding the impact of adrenal function on hemostasis and endothelial function in the perioperative setting are available. Objective We assessed the association of adrenal response to adrenocorticotropic hormone (ACTH) and markers of endothelial/hemostatic function in surgical patients. Methods This prospective observational study, conducted at a tertiary care hospital, included 60 patients (35 male/25 female) undergoing abdominal surgery. Adrenal function was evaluated by low-dose ACTH stimulation test on the day before, during, and the day after surgery. According to their stimulated cortisol level (cutoff ≥ 500 nmol/L), patients were classified as having normal hypothalamic-pituitary-adrenal (HPA)-axis function (nHPA) or deficient HPA-axis function (dHPA). Parameters of endothelial function (soluble vascular cell adhesion molecule-1, thrombomodulin) and hemostasis (fibrinogen, von Willebrand factor antigen, factor VIII [FVIII]) were measured during surgery. Results Twenty-one patients had dHPA and 39 had nHPA. Compared with nHPA, patients with dHPA had significantly lower peak cortisol before (median 568 vs 425 nmol/L, P < 0.001) and during (693 vs 544 nmol/L, P < 0.001) surgery and lower postoperative hemoglobin levels (116 g/L vs 105 g/L, P = 0.049). FVIII was significantly reduced in patients with dHPA in uni- and multivariable analyses; other factors displayed no significant differences. Coagulation factors/endothelial markers changed progressively in relation to stimulated cortisol levels and showed a turning point at cortisol levels between 500 and 600 nmol/L. Conclusions Patients with dHPA undergoing abdominal surgery demonstrate impaired hemostasis which can translate into excessive blood loss.
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Affiliation(s)
- Stefan Fischli
- Division of Endocrinology, Diabetes and Clinical Nutrition, Luzerner Kantonsspital, 6000 Luzern, Switzerland
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8006 Zurich, Switzerland
| | - Walter Wuillemin
- Division of Hematology, Luzerner Kantonsspital, 6000 Luzern, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8006 Zurich, Switzerland
| | - Philipp Schütz
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland
| | - Mirjam Christ-Crain
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, 4031 Basel, Switzerland
| | - Fabian Studer
- Department of Internal Medicine, Luzerner Kantonsspital, 6000 Luzern, Switzerland
| | - Lukas Brander
- Department of Internal Medicine, Luzerner Kantonsspital, 6000 Luzern, Switzerland
| | - Guido Schüpfer
- Division of Anesthesiology, Luzerner Kantonsspital, 6000 Luzern,Switzerland
| | - Jürg Metzger
- Division of Visceral Surgery, Luzerner Kantonsspital, 6000 Luzern, Switzerland
| | - Christoph Henzen
- Division of Endocrinology, Diabetes and Clinical Nutrition, Luzerner Kantonsspital, 6000 Luzern, Switzerland.,Department of Internal Medicine, Luzerner Kantonsspital, 6000 Luzern, Switzerland
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17
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Bargetzi A, Emmenegger N, Wildisen S, Nickler M, Bargetzi L, Hersberger L, Segerer S, Kaegi-Braun N, Tribolet P, Gomes F, Hoess C, Pavlicek V, Bilz S, Sigrist S, Brändle M, Henzen C, Thomann R, Rutishauser J, Aujesky D, Rodondi N, Donzé J, Stanga Z, Mueller B, Schuetz P. Admission kidney function is a strong predictor for the response to nutritional support in patients at nutritional risk. Clin Nutr 2021; 40:2762-2771. [PMID: 33933742 DOI: 10.1016/j.clnu.2021.03.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/26/2021] [Accepted: 03/08/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) are at substantial risk of malnutrition, which negatively affects clinical outcomes. We investigated the association of kidney function assessed at hospital admission and effectiveness of nutritional support in hospitalized medical patients at risk of malnutrition. METHODS This is a secondary analysis of an investigator-initiated, randomized-controlled, Swiss multicenter trial (EFFORT) that compared individualised nutritional support with usual hospital food on clinical outcomes. We compared effects of nutritional support on mortality in subgroups of patients stratified according to kidney function at the time of hospital admission (estimated glomerular filtration rates [eGFR] <15, 15-29, 30-59, 60-89 and ≥ 90 ml/min/1.73 m2). RESULTS We included 1943 of 2028 patients (96%) from the original trial with known admission creatinine levels. Admission eGFR was a strong predictor for the beneficial effects of nutritional support in regard to lowering of 30-day mortality. Patients with an eGFR <15, 15-29 and 30-59 had the strongest mortality benefit (odds ratios [95%CI] of 0.24 [0.05 to 1.25], 0.37 [0.14 to 0.95] and 0.39 [0.21 to 0.75], respectively), while patients with less severe impairment in kidney function had a less pronounced mortality benefits (p for interaction 0.001). A similar stepwise association of kidney function and response to nutritional support was found also for other secondary outcomes. CONCLUSION In medical inpatients at nutritional risk, admission kidney function was a strong predictor for the response to nutritional therapy. Initial kidney function may help to individualize nutritional support in the future by identification of patients with most clinical benefit. CLINICAL TRIAL REGISTRATION Registered under ClinicalTrials.gov Identifier no. NCT02517476.
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Affiliation(s)
- Annika Bargetzi
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | | | | | - Manuela Nickler
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Division of Nephrology, Kantonsspital Aarau, Aarau, Switzerland
| | - Laura Bargetzi
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | - Lara Hersberger
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | - Stephan Segerer
- Division of Nephrology, Kantonsspital Aarau, Aarau, Switzerland
| | - Nina Kaegi-Braun
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Pascal Tribolet
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Filomena Gomes
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; The New York Academy of Sciences, New York City, NY, USA
| | - Claus Hoess
- Internal Medicine, Kantonsspital Muensterlingen, Switzerland
| | | | - Stefan Bilz
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | - Sarah Sigrist
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | - Michael Brändle
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | | | | | | | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Jacques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Zeno Stanga
- Division of Diabetes, Endocrinology, Nutritional Medicine & Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
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18
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Kaegi-Braun N, Tribolet P, Gomes F, Fehr R, Baechli V, Geiser M, Deiss M, Kutz A, Bregenzer T, Hoess C, Pavlicek V, Schmid S, Bilz S, Sigrist S, Brändle M, Benz C, Henzen C, Mattmann S, Thomann R, Rutishauser J, Aujesky D, Rodondi N, Donzé J, Stanga Z, Mueller B, Schuetz P. Six-month outcomes after individualized nutritional support during the hospital stay in medical patients at nutritional risk: Secondary analysis of a prospective randomized trial. Clin Nutr 2021; 40:812-819. [DOI: 10.1016/j.clnu.2020.08.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/09/2020] [Accepted: 08/15/2020] [Indexed: 01/04/2023]
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19
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Kamm CP, Nyffeler T, Henzen C, Fischli S. Hypomagnesemia-Induced Cerebellar Syndrome-A Distinct Disease Entity? Case Report and Literature Review. Front Neurol 2020; 11:968. [PMID: 33013642 PMCID: PMC7505994 DOI: 10.3389/fneur.2020.00968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022] Open
Abstract
Clinical consequences of hypomagnesemia are manifold and include various neurological syndromes up to life-threatening conditions. Despite its importance, magnesium is generally not routinely determined leading to an under-recognition of hypomagnesemia-related disorders. In the past years, there are growing numbers of reports of hypomagnesemia-induced cerebellar syndromes (HiCS) with corresponding cerebellar edema, which might be a distinct disease entity. To provide further insights into HiCS, we describe a patient with HiCS and performed a literature review on cerebellar syndromes due to severe hypomagnesemia with regard to the clinical, MRI, and laboratory findings. We identified 17 cases, so including our case, 18 cases contribute to this review. Summarized, HiCS seems to be a distinct disease entity because of the remarkable similarities of clinical, MRI, and laboratory features. It should be diagnosed and treated early to avoid recurrent disease courses, residual symptoms, and potentially life-threatening conditions such as seizures. Physicians must be alert to HiCS as magnesium is usually not part of the routine electrolyte panel.
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Affiliation(s)
- Christian P Kamm
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland.,Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thomas Nyffeler
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Christoph Henzen
- Division of Endocrinology, Diabetes and Clinical Nutrition, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Stefan Fischli
- Division of Endocrinology, Diabetes and Clinical Nutrition, Luzerner Kantonsspital, Lucerne, Switzerland
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20
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Henzen C. [Laboratory investigations in clinical diabetic practice]. Ther Umsch 2020; 77:297-301. [PMID: 32996427 DOI: 10.1024/0040-5930/a001195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Laboratory investigations in clinical diabetic practice Abstract. Laboratory analysis are useful to diagnose the proper form of diabetes mellitus, for follow-up of the metabolic control, and to identify secondary complications or associated diseases. The proof of auto-antibodies confirms Type 1 diabetes and a broad range of endocrine entities of the polyglandular autoimmune syndrome, and genetic testing classifies monogenetic diabetes like MODY or MIDDM. In secondary diabetes forms underlying disease can be detected by clinical and laboratory investigation, and thus, causal treatment of the diabetes may be possible.
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Affiliation(s)
- Christoph Henzen
- Endokrinologie / Diabetologie und klinische Ernährung, Kantonsspital Luzern
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21
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Henzen C, Fischli S. Diabetes mellitus Typ 1 und Typ 2. Therapeutische Umschau 2020; 77:287. [DOI: 10.1024/0040-5930/a001193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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22
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van Veelen NM, Fischli S, Beeres FJP, Eisenhut T, Babst R, Henzen C, Link BC. Compartment syndrome of the leg after thyroid hormone withdrawal; two cases and a systematic review of the literature. BMC Endocr Disord 2020; 20:80. [PMID: 32503586 PMCID: PMC7275613 DOI: 10.1186/s12902-020-00555-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute compartment syndrome is a rare complication of severe hypothyroidism. If the symptoms are not recognized promptly and treatment initiated immediately, there is a high risk of permanent damage. Only few other cases of compartment syndrome due to hypothyroidism have been published and the exact pathophysiological mechanism remains unknown. CASE PRESENTATIONS A 59 year old male developed acute compartment syndrome of his right lower leg after thyroid hormone withdrawal prior to radioiodine remnant ablation after total thyroidectomy for follicular thyroid cancer. He underwent emergency fasciotomy of all four compartments of the lower leg. The muscle tissue in the anterior and lateral compartment was necrotic and was therefore excised. The second patient was a 62 year old female with Hashimoto's thyroiditis, who developed acute compartment syndrome of both lower legs after thyroid hormone withdrawal due to non-compliance. Emergency fasciotomy of all four compartments of both legs was performed. The muscle tissue was viable in all compartments. CONCLUSION Although compartment syndrome due to hypothyroidism is uncommon, it is a complication physicians should be aware of. The majority of reported cases are caused by an acute withdrawal of thyroid hormones and not by undetected hypothyroidism. No previous case of compartment syndrome caused by an iatrogenic hormone withdrawal in preparation for radioactive iodine has been published. However, as shown in this report, it may be beneficial to inform patients of this rare complication prior to hormone withdrawal in preparation for remnant ablation after thyroidectomy.
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Affiliation(s)
- Nicole M van Veelen
- Department of Orthopedic and Trauma Surgery, Luzerner Kantonsspital Luzern, P.O. Box, Spitalstrasse, 6000, Lucerne, Switzerland.
| | - Stefan Fischli
- Department of Endocrinology and Diabetes, Luzerner Kantonsspital Luzern, P.O. Box, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Frank J P Beeres
- Department of Orthopedic and Trauma Surgery, Luzerner Kantonsspital Luzern, P.O. Box, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Timo Eisenhut
- Department of Orthopedic and Trauma Surgery, Luzerner Kantonsspital Luzern, P.O. Box, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Reto Babst
- Department of Orthopedic and Trauma Surgery, Luzerner Kantonsspital Luzern, P.O. Box, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Christoph Henzen
- Department of Endocrinology and Diabetes, Luzerner Kantonsspital Luzern, P.O. Box, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Björn-Christian Link
- Department of Orthopedic and Trauma Surgery, Luzerner Kantonsspital Luzern, P.O. Box, Spitalstrasse, 6000, Lucerne, Switzerland
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23
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Zumbrunn B, Stalder O, Limacher A, Ballmer PE, Bassetti S, Battegay E, Beer JH, Brändle M, Genné D, Hayoz D, Henzen C, Huber LC, Petignat PA, Reny JL, Vollenweider P, Aujesky D. The well-being of Swiss general internal medicine residents. Swiss Med Wkly 2020; 150:w20255. [PMID: 32557425 DOI: 10.4414/smw.2020.20255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Physician well-being has an impact on productivity and quality of care. Residency training is a particularly stressful period. OBJECTIVE To assess the well-being of general internal medicine (GIM) residents and its association with personal and work-related factors. METHODS We conducted an anonymous electronic survey among GIM residents from 13 Swiss teaching hospitals. We explored the association between a reduced well-being (≥5 points based on the Physician Well-Being Index [PWBI]) and personal and work-related factors using multivariable mixed-effects logistic regression. RESULTS The response rate was 54% (472/880). Overall, 19% of residents had a reduced well-being, 60% felt burned out (emotional exhaustion), 47% were worried that their work was hardening them emotionally (depersonalisation), and 21% had career choice regret. Age (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.05–1.34), working hours per week (OR 1.04 per hour, 95% CI 1.01–1.07) and <2.5 rewarding work hours per day (OR 3.73, 95% CI 2.01–6.92) were associated with reduced well-being. Administrative workload and satisfaction with the electronic medical record were not. We found significant correlations between PWBI score and job satisfaction (rs = -0.54, p<0.001), medical errors (rs = 0.18, p<0.001), suicidal ideation (rs = 0.12, p = 0.009) and the intention to leave clinical practice (rs = 0.38, p <0.001) CONCLUSIONS: Approximately 20% of Swiss GIM residents appear to have a reduced well-being and many show signs of distress or have career choice regret. Having few hours of rewarding work and a high number of working hours were the most important modifiable predictors of reduced well-being. Healthcare organisations have an ethical responsibility to implement interventions to improve physician well-being.
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Affiliation(s)
- Brigitta Zumbrunn
- Department of General Internal Medicine, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Odile Stalder
- CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - Andreas Limacher
- CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - Peter E Ballmer
- Department of Internal Medicine, Kantonsspital Winterthur, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, Switzerland
| | - Edouard Battegay
- Department of Internal Medicine, University Hospital Zurich, Switzerland
| | - Jürg Hans Beer
- Department of Internal Medicine, Cantonal Hospital of Baden, Switzerland
| | - Michael Brändle
- Department of Internal Medicine, Cantonal Hospital of St Gallen, Switzerland
| | - Daniel Genné
- Department of Internal Medicine, Cantonal Hospital of Biel, Switzerland
| | - Daniel Hayoz
- Department of Internal Medicine, Cantonal Hospital of Fribourg, Switzerland
| | - Christoph Henzen
- Department of Internal Medicine, Cantonal Hospital of Lucerne, Switzerland
| | | | | | - Jean-Luc Reny
- Division of General Internal Medicine, Geneva University Hospitals, and Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Peter Vollenweider
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Bern University Hospital, Inselspital, Bern, Switzerland
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24
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Blank S, Henzen C, Mueller X, Syburra T. Major right atrial thrombus related to central venous catheter positioning. Cardiovasc Med 2020. [DOI: 10.4414/cvm.2020.02104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sabine Blank
- Physician
- Internal Medicine
- Spitalstr.
- Luzern
- Luzern
- 6000
- SWITZERLAND
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25
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Merker M, Felder M, Gueissaz L, Bolliger R, Tribolet P, Kägi-Braun N, Gomes F, Hoess C, Pavlicek V, Bilz S, Sigrist S, Brändle M, Henzen C, Thomann R, Rutishauser J, Aujesky D, Rodondi N, Donzé J, Stanga Z, Mueller B, Schuetz P. Association of Baseline Inflammation With Effectiveness of Nutritional Support Among Patients With Disease-Related Malnutrition: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2020; 3:e200663. [PMID: 32154887 PMCID: PMC7064875 DOI: 10.1001/jamanetworkopen.2020.0663] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Inflammation is a key driver of malnutrition during illness and is often accompanied by metabolic effects, including insulin resistance and reduction of appetite. However, it still remains unclear if inflammation influences the response to nutritional support among patients with disease-related malnutrition. OBJECTIVE To examine whether patients' baseline inflammatory status is associated with the effect of nutritional support on 30-day mortality. DESIGN, SETTING, AND PARTICIPANTS This is a secondary analysis of the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), a randomized clinical trial conducted in 8 Swiss hospitals from April 2014 to February 2018. A total of 1950 participants who had C-reactive protein measurements at the time of admission were included in this secondary analysis. Data analysis was conducted between June and July 2019. INTERVENTIONS Hospitalized patients at risk for malnutrition were randomly assigned to receive protocol-guided individualized nutritional support to reach protein and energy goals (intervention group) or standard hospital food (control group). MAIN OUTCOMES AND MEASURES The primary end point was 30-day mortality. Based on C-reactive protein levels at admission, patients were stratified into groups with low, moderate, or high inflammation (<10 mg/L, 10-100 mg/L, and >100 mg/L, respectively). RESULTS A total of 1950 patients (median [interquartile range] age, 75 [65-83] years; 1025 [52.6%] men) were included; 533 (27.3%) had low levels of inflammation, 894 (45.9%) had moderate levels of inflammation, and 523 (26.8%) had high levels of inflammation. Compared with the control group, patients receiving nutritional support showed a significant reduction in 30-day mortality, regardless of C-reactive protein level (adjusted odds ratio, 0.61; 95% CI, 0.43-0.86; P = .005). In the subgroup of patients with high inflammation, there was no beneficial effect of nutritional support (adjusted odds ratio, 1.32; 95% CI, 0.70-2.50; P = .39), providing evidence that inflammation has a significant modifying association (P for interaction = .005). CONCLUSIONS AND RELEVANCE Based on this secondary analysis of a multicenter randomized trial, a patient's admission inflammatory status was associated with their response to nutritional support. If validated in future clinical trials, nutritional support may need to be individualized based on a patient's initial presentation and markers of inflammation. These results may also help to explain some of the heterogeneity in treatment effects of nutrition seen in previous critical care trials. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02517476.
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Affiliation(s)
- Meret Merker
- Medical University Department, University of Basel, Kantonsspital Aarau, Aarau, Switzerland
| | | | | | - Rebekka Bolliger
- Medical University Department, University of Basel, Kantonsspital Aarau, Aarau, Switzerland
| | - Pascal Tribolet
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Nina Kägi-Braun
- Internal Medicine, Kantonsspital Muensterlingen, Muensterlingen, Switzerland
| | | | - Claus Hoess
- Internal Medicine, Kantonsspital Muensterlingen, Muensterlingen, Switzerland
| | - Vojtech Pavlicek
- Internal Medicine, Kantonsspital Muensterlingen, Muensterlingen, Switzerland
| | - Stefan Bilz
- Internal Medicine and Endocrinology/Diabetes, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Sarah Sigrist
- Internal Medicine and Endocrinology/Diabetes, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Michael Brändle
- Internal Medicine and Endocrinology/Diabetes, Kantonsspital St Gallen, St Gallen, Switzerland
| | | | - Robert Thomann
- Internal Medicine, Kantonsspital Solothurn, Solothurn, Switzerland
| | | | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Jaques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Zeno Stanga
- Division of Diabetology, Endocrinology, Nutritional Medicine, and Metabolism, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Beat Mueller
- Medical University Department, University of Basel, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Medical University Department, University of Basel, Kantonsspital Aarau, Aarau, Switzerland
- University of Basel, Basel, Switzerland
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26
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Henzen C. [Not Available]. Rev Med Suisse 2020; 16:221. [PMID: 31995314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Christoph Henzen
- Leiter Departement Medizin, Chefarzt Innere Medizin & Endokrinologie-Diabetologie, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern 16
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Litzel M, Henzen C, Fourie L, Fischli S. [Unexpected Postoperative Diagnosis of Parathyroid Carcinoma]. Praxis (Bern 1994) 2020; 109:291-296. [PMID: 32183648 DOI: 10.1024/1661-8157/a003388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Unexpected Postoperative Diagnosis of Parathyroid Carcinoma Abstract. Parathyroid carcinoma is a rare endocrine malignancy. It typically presents itself with similar clinical features as seen in patients with primary hyperparathyroidism caused by a parathyroid adenoma. Due to overlapping clinical manifestations, imaging findings and pathological characteristics, the differentiation between benign and malignant parathyroid disease poses a diagnostic challenge, especially prior to surgery. We report the case of a 67-year-old male who presented with symptomatic hypercalcemia and primary hyperparathyroidism. During resection of the enlarged parathyroid gland, suspicious macroscopic features were noticed and the histopathology finding confirmed the malignancy. Parathyroid carcinoma is rarely diagnosed preoperatively, which is mainly due to the lack of distinctive symptoms or morphological features suggesting a malignant disease. As parathyroid carcinoma often has a genetic background, knowledge of mutation status and family history is of high relevance. Surgery with complete resection of the parathyroid carcinoma is the mainstay for a successful treatment and a good prognosis.
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Affiliation(s)
- Martin Litzel
- Abteilung Endokrinologie, Diabetologie und klinische Ernährung, Luzerner Kantonsspital Luzern
| | - Christoph Henzen
- Abteilung Endokrinologie, Diabetologie und klinische Ernährung, Luzerner Kantonsspital Luzern
| | - Lana Fourie
- Abteilung für Allgemein- und Viszeralchirurgie, Luzerner Kantonsspital Luzern
| | - Stefan Fischli
- Abteilung Endokrinologie, Diabetologie und klinische Ernährung, Luzerner Kantonsspital Luzern
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Hersberger L, Bargetzi L, Bargetzi A, Tribolet P, Fehr R, Baechli V, Geiser M, Deiss M, Gomes F, Kutz A, Kägi-Braun N, Hoess C, Pavlicek V, Schmid S, Bilz S, Sigrist S, Brändle M, Benz C, Henzen C, Nigg M, Thomann R, Brand C, Rutishauser J, Aujesky D, Rodondi N, Donzé J, Stanga Z, Mueller B, Schuetz P. Nutritional risk screening (NRS 2002) is a strong and modifiable predictor risk score for short-term and long-term clinical outcomes: secondary analysis of a prospective randomised trial. Clin Nutr 2019; 39:2720-2729. [PMID: 31882232 DOI: 10.1016/j.clnu.2019.11.041] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/27/2019] [Accepted: 11/30/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The Nutritional Risk Screening 2002 (NRS 2002) identifies patients at risk of malnutrition. We studied the prognostic implications of this score with regard to short-term and long-term clinical outcomes in a well-characterised cohort of medical inpatients from a previous trial. METHODS This is a secondary analysis of an investigator-initiated, prospective randomised controlled multicenter trial in Switzerland (EFFORT) that compared the effects of an individualised nutritional support intervention with standard of care. We investigated associations between admission NRS and several short-term and long-term outcomes using multivariable regression analyses. RESULTS Of the 2028 patients, 31% had an NRS of 3, 38% of 4 and 31% of ≥5 points, and 477 (24%) died during the 180 days of follow-up. For each point increase in NRS, we found a stepwise increase in risk of 30-day mortality (adjusted Hazard Ratio (HR) 1.22 (95% CI 1.00 to 1.48), p = 0.048) and 180-day mortality (adjusted HR 1.37 (95% CI 1.22 to 1.55), p < 0.001). NRS was associated with length of hospital stay (adjusted difference of 0.60 days per NRS point increase, 95%CI 0.23 to 0.97, p = 0.002) and functional outcomes at 180 days (adjusted decrease in Barthel index of -4.49 points per NRS point increase, 95%CI -6.54 to -2.45, p < 0.001). In a subgroup analysis, associations of NRS and short-term adverse outcomes were less pronounced in patients receiving nutritional support (intervention group) compared to control group patients (adjusted HR for 30-day mortality 1.12 [95%CI 0.83 to 1.52, p = 0.454] vs. 1.33 [95%CI 1.02 to 1.72, p = 0.032]). CONCLUSION The NRS is a strong and independent risk score for malnutrition-associated mortality and adverse outcomes over 180 days. Our data provide strong evidence that the nutritional risk, however, is modifiable and can be reduced by the provision of adequate nutritional support.
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Affiliation(s)
- Lara Hersberger
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | - Laura Bargetzi
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | - Annika Bargetzi
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | | | - Rebecca Fehr
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Valerie Baechli
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Martina Geiser
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Manuela Deiss
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Filomena Gomes
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; The New York Academy of Sciences, New York City, NY, USA
| | - Alexander Kutz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | - Nina Kägi-Braun
- Internal Medicine, Kantonsspital Muensterlingen, Switzerland
| | - Claus Hoess
- Internal Medicine, Kantonsspital Muensterlingen, Switzerland
| | | | - Sarah Schmid
- Internal Medicine, Kantonsspital Muensterlingen, Switzerland
| | - Stefan Bilz
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | - Sarah Sigrist
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | - Michael Brändle
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | - Carmen Benz
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | | | - Melina Nigg
- Internal Medicine, Kantonsspital Luzern, Switzerland
| | | | - Claudia Brand
- Internal Medicine, Buergerspital Solothurn, Switzerland
| | | | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Jacques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Zeno Stanga
- Division of Diabetology, Endocrinology, Nutritional Medicine & Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
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Merker M, Amsler A, Pereira R, Bolliger R, Tribolet P, Braun N, Hoess C, Pavlicek V, Bilz S, Sigrist S, Brändle M, Henzen C, Thomann R, Rutishauser J, Aujesky D, Rodondi N, Donzé J, Stanga Z, Mueller B, Schuetz P. Vitamin D deficiency is highly prevalent in malnourished inpatients and associated with higher mortality: A prospective cohort study. Medicine (Baltimore) 2019; 98:e18113. [PMID: 31770235 PMCID: PMC6890327 DOI: 10.1097/md.0000000000018113] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The impact of vitamin D deficiency on the recovery of patients with malnutrition remains undefined. Our aim was to study the prevalence of vitamin D deficiency in a well-characterized cohort of patients with malnutrition and its association with outcomes.Within this secondary analysis of a randomized controlled trial, we examined the association of vitamin D deficiency and adverse clinical outcomes over a follow-up of 180 days in hospitalized patients at risk for malnutrition. We measured 25-hydroxyvitamin D levels upon admission and defined Vitamin D deficiency when levels were <50nmol/l. The primary endpoint was 180-day mortality.The prevalence of vitamin D deficiency in our cohort of 828 patients was 58.2% (n = 482). Patients with vitamin D deficiency had increased 180-day mortality rates from 23.1% to 29.9% (odds ratio 1.42, 95% confidence interval [CI] 1.03-1.94, P = .03). When adjusting the analysis for demographics, comorbidities, and randomization, this association remained significant for the subgroup of patients not receiving vitamin D treatment (adjusted odds ratio 1.63, 95% CI 1.01-2.62, P = .04). There was no significantly lower risk for mortality in the subgroup of vitamin D deficient patients receiving vitamin D treatment compared to not receiving treatment (adjusted odds ratio 0.74, 95% CI 0.48-1.13, P = .15).Vitamin D deficiency is highly prevalent in the population of malnourished inpatients and is negatively associated with long-term mortality particularly when patients are not receiving vitamin D treatment. Our findings suggest that malnourished patients might benefit from vitamin D screening and treatment in case of deficiency.
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Affiliation(s)
- Meret Merker
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau
| | | | | | - Rebekka Bolliger
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau
| | - Pascal Tribolet
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau
- Department of Health Professions, Bern University of Applied Sciences, Bern
| | - Nina Braun
- Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen
| | - Claus Hoess
- Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen
| | | | - Stefan Bilz
- Internal Medicine & Endocrinology, Kantonsspital St. Gallen, St. Gallen
| | - Sarah Sigrist
- Internal Medicine & Endocrinology, Kantonsspital St. Gallen, St. Gallen
| | - Michael Brändle
- Internal Medicine & Endocrinology, Kantonsspital St. Gallen, St. Gallen
| | | | | | | | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Jaques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Zeno Stanga
- Division of Diabetology, Endocrinology, Nutritional Medicine & Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau
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Henzen C. [CME Answers: 'Hormones and Mobility', Praxis No. 9]. Praxis (Bern 1994) 2019; 108:703. [PMID: 31387499 DOI: 10.1024/1661-8157/a003268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Christoph Henzen
- 1 Innere Medizin/Endokrinologie und Diabetologie, Luzerner Kantonsspital, Luzern
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Abstract
Hormones and Mobility Abstract. Endocrine disorders affect mobility in many and sometimes characteristic ways such as Cushing's syndrome or hyperparathyroidism, which have direct, hormone-mediated effects on skeletal and muscular tissues. On the other hand, the endocrine system plays an important role in the development of (osteo)sarcopenia, the meaning of which is increasingly recognized in the prognosis of various diseases. Conversely, lack of physical activity is crucial in the development of metabolic diseases, which are associated with serious individual and socio-economic consequences.
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Affiliation(s)
- Christoph Henzen
- 1 Innere Medizin/Endokrinologie und Diabetologie, Luzerner Kantonsspital, Luzern
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Schuetz P, Fehr R, Baechli V, Geiser M, Deiss M, Gomes F, Kutz A, Tribolet P, Bregenzer T, Braun N, Hoess C, Pavlicek V, Schmid S, Bilz S, Sigrist S, Brändle M, Benz C, Henzen C, Mattmann S, Thomann R, Brand C, Rutishauser J, Aujesky D, Rodondi N, Donzé J, Stanga Z, Mueller B. Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial. Lancet 2019; 393:2312-2321. [PMID: 31030981 DOI: 10.1016/s0140-6736(18)32776-4] [Citation(s) in RCA: 415] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/20/2018] [Accepted: 10/23/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Guidelines recommend the use of nutritional support during hospital stays for medical patients (patients not critically ill and not undergoing surgical procedures) at risk of malnutrition. However, the supporting evidence for this recommendation is insufficient, and there is growing concern about the possible negative effects of nutritional therapy during acute illness on recovery and clinical outcomes. Our aim was thus to test the hypothesis that protocol-guided individualised nutritional support to reach protein and caloric goals reduces the risk of adverse clinical outcomes in medical inpatients at nutritional risk. METHODS The Effect of early nutritional support on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT) is a pragmatic, investigator-initiated, open-label, multicentre study. We recruited medical patients at nutritional risk (nutritional risk screening 2002 [NRS 2002] score ≥3 points) and with an expected length of hospital stay of more than 4 days from eight Swiss hospitals. These participants were randomly assigned (1:1) to receive either protocol-guided individualised nutritional support to reach protein and caloric goals (intervention group) or standard hospital food (control group). Randomisation was done with variable block sizes and stratification according to study site and severity of malnutrition using an interactive web-response system. In the intervention group, individualised nutritional support goals were defined by specialist dietitians and nutritional support was initiated no later than 48 h after admission. Patients in the control group received no dietary consultation. The composite primary endpoint was any adverse clinical outcome defined as all-cause mortality, admission to intensive care, non-elective hospital readmission, major complications, and decline in functional status at 30 days, and it was measured in all randomised patients who completed the trial. This trial is registered with ClinicalTrials.gov, number NCT02517476. FINDINGS 5015 patients were screened, and 2088 were recruited and monitored between April 1, 2014, and Feb 28, 2018. 1050 patients were assigned to the intervention group and 1038 to the control group. 60 patients withdrew consent during the course of the trial (35 in the intervention group and 25 in the control group). During the hospital stay, caloric goals were reached in 800 (79%) and protein goals in 770 (76%) of 1015 patients in the intervention group. By 30 days, 232 (23%) patients in the intervention group experienced an adverse clinical outcome, compared with 272 (27%) of 1013 patients in the control group (adjusted odds ratio [OR] 0·79 [95% CI 0·64-0·97], p=0·023). By day 30, 73 [7%] patients had died in the intervention group compared with 100 [10%] patients in the control group (adjusted OR 0·65 [0·47-0·91], p=0·011). There was no difference in the proportion of patients who experienced side-effects from nutritional support between the intervention and the control group (162 [16%] vs 145 [14%], adjusted OR 1·16 [0·90-1·51], p=0·26). INTERPRETATION In medical inpatients at nutritional risk, the use of individualised nutritional support during the hospital stay improved important clinical outcomes, including survival, compared with standard hospital food. These findings strongly support the concept of systematically screening medical inpatients on hospital admission regarding nutritional risk, independent of their medical condition, followed by a nutritional assessment and introduction of individualised nutritional support in patients at risk. FUNDING The Swiss National Science Foundation and the Research Council of the Kantonsspital Aarau, Switzerland.
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Affiliation(s)
- Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.
| | - Rebecca Fehr
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Valerie Baechli
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Martina Geiser
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Manuela Deiss
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Filomena Gomes
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; The New York Academy of Sciences, New York, NY, USA
| | - Alexander Kutz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Pascal Tribolet
- Internal Medicine, Spital Lachen, Lachen, Switzerland; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | | | - Nina Braun
- Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - Claus Hoess
- Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - Vojtech Pavlicek
- Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - Sarah Schmid
- Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - Stefan Bilz
- Internal Medicine and Endocrinology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Sarah Sigrist
- Internal Medicine and Endocrinology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Michael Brändle
- Internal Medicine and Endocrinology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Carmen Benz
- Internal Medicine and Endocrinology, Kantonsspital St Gallen, St Gallen, Switzerland
| | | | - Silvia Mattmann
- Internal Medicine, Kantonsspital Luzern, Luzern, Switzerland
| | - Robert Thomann
- Internal Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Claudia Brand
- Internal Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Jonas Rutishauser
- Internal Medicine, Kantonsspital Baselland, Standort Bruderholz Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Jacques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Zeno Stanga
- Division of Diabetology, Endocrinology, Nutritional Medicine, and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland
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Senn JD, Fischli S, Slahor L, Schelbert S, Henzen C. Long-Term Effects of Initiating Continuous Subcutaneous Insulin Infusion (CSII) and Continuous Glucose Monitoring (CGM) in People with Type 1 Diabetes and Unsatisfactory Diabetes Control. J Clin Med 2019; 8:jcm8030394. [PMID: 30901914 PMCID: PMC6463068 DOI: 10.3390/jcm8030394] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 12/01/2022] Open
Abstract
Background: We aimed to assess the long-term effects of the introduction of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) in people with type 1 diabetes (T1D). Methods: A prospective single-centre cohort study including participants with T1D and HbA1c > 7.5%. After completing a course in flexible intensified insulin treatment (FIT), participants were offered treatment change to CSII/CGM. FIT participants with HbA1c ≤ 7.5% who remained on multiple daily injections (MDI) and without CGM were monitored as a separate cohort to compare the cumulative incidence of diabetic complications. Results: The study cohort included 41 participants with T1D (21 male/20 female). The mean age (±SD) at inclusion was 24.2 ± 10.9 years, the mean follow-up was 8.9 ± 2.8 years, and the mean diabetes duration at the end of the study was 15.9 ± 10.1 years. The mean HbA1c level before the introduction of CSII was 8.8 ± 1.3% (73 ± 8 mmol/mol), and decreased significantly thereafter to 8.0 ± 1.1% (63 ± 7 mmol/mol) (p = 0.0001), and further to 7.6 ± 1.1% (59 ± 11 mmol/mol) after the initiation of CGM (p = 0.051). In the MDI group the HbA1c levels did not change significantly during a mean follow-up of 6.8 ± 3.2 years. The frequency of severe hypoglycaemia after the introduction of CSII/CGM declined significantly (from 9.7 to 2.2 per 100 patient-years, p = 0.03), and the cumulative incidence of newly diagnosed diabetic microvascular complications were comparable between the study group and the observational cohort. Conclusion: In people with T1D and unsatisfactory diabetes control the introduction of CSII and CGM results in a substantial and long-term improvement.
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Affiliation(s)
- Jon-Duri Senn
- Division of Endocrinology, Diabetology, and Clinical Nutrition, Department of Medicine, Lucerne Cantonal Hospital, CH-6000 Lucerne 16, Switzerland.
| | - Stefan Fischli
- Division of Endocrinology, Diabetology, and Clinical Nutrition, Department of Medicine, Lucerne Cantonal Hospital, CH-6000 Lucerne 16, Switzerland.
| | - Lea Slahor
- Division of Endocrinology, Diabetology, and Clinical Nutrition, Department of Medicine, Lucerne Cantonal Hospital, CH-6000 Lucerne 16, Switzerland.
| | - Susanne Schelbert
- Division of Endocrinology, Diabetology, and Clinical Nutrition, Department of Medicine, Lucerne Cantonal Hospital, CH-6000 Lucerne 16, Switzerland.
| | - Christoph Henzen
- Division of Endocrinology, Diabetology, and Clinical Nutrition, Department of Medicine, Lucerne Cantonal Hospital, CH-6000 Lucerne 16, Switzerland.
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34
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Henzen C. [Not Available]. Rev Med Suisse 2019; 15:289-291. [PMID: 30724515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Abstract
Male osteoporosis often remains unrecognised. Osteoporotic fractures occur approximately 10 years later in men than in women due to higher peak bone mass. However, 30% of all hip fractures occur in men. Risk factors of osteoporotic fractures can be grouped into primary and secondary causes. We present the case of a 53-year-old man, who suffered a compression fracture of a lumbar vertebra after a generalised seizure and an atraumatic rib fracture 5 months later. We could exclude secondary causes of bone mineral loss such as primary hyperparathyroidism, glucocorticoid use and hypogonadism. However, a heterozygous missense mutation of the COL1A1 gene in exon 48 in further search of a secondary cause was found. Therapy was changed from bisphosphonate treatment to teriparatide. Considering the lack of other osteogenesis imperfecta (OI) symptoms and signs, the patient's illness can be classified as mild. OI should be considered as differential diagnosis in unexplained cases with osteoporosis.
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Affiliation(s)
- Simon Lampart
- Department of Internal Medicine, Luzerner Kantonsspital, Luzern, Switzerland
| | | | - Christoph Henzen
- Department of Internal Medicine, Luzerner Kantonsspital, Luzern, Switzerland.,Division of Endocrinology and Diabetes, Luzerner Kantonsspital, Luzern, Switzerland
| | - Stefan Fischli
- Division of Endocrinology and Diabetes, Luzerner Kantonsspital, Luzern, Switzerland
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Zurfluh S, Nickler M, Ottiger M, Steuer C, Kutz A, Christ-Crain M, Zimmerli W, Thomann R, Hoess C, Henzen C, Bernasconi L, Huber A, Mueller B, Schuetz P. Dihydrotestosterone is a predictor for mortality in males with community-acquired pneumonia: results of a 6-year follow-up study. Respir Res 2018; 19:240. [PMID: 30514319 PMCID: PMC6280517 DOI: 10.1186/s12931-018-0947-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/21/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Adrenal hormone metabolite levels are altered in acute illnesses such as community-acquired pneumonia (CAP). Our aim was to investigate associations of sex and mineralocorticoid hormone metabolites with short- and long-term mortality and severity of CAP in male and female patients. METHODS We prospectively followed 285 patients (60.4% male, mean age 71 years) with CAP from a previous multicenter trial. At baseline, levels of different metabolites of sex hormones and mineralocorticoids were measured by liquid chromatography coupled to tandem mass spectrometry. We calculated Cox regression models adjusted for age and comorbidities. RESULTS All-cause mortality was 5.3% after 30 days and increased to 47.4% after 6 years. In males, high levels of dihydrotestosterone were associated with higher 6-year mortality (adjusted HR 2.84, 95%CI 1.15-6.99, p = 0.023), whereas high levels of 17-OH-progesterone were associated with lower 6-year mortality (adjusted HR 0.72, 95%CI 0.54-0.97, p = 0.029). Testosterone levels in males correlated inversely with inflammatory markers (CRP rho = - 0.39, p < 0.001; PCT rho = - 0.34, p < 0.001) and disease severity as assessed by the Pneumonia severity index (PSI) (rho = - 0.23, p = 0.003). No similar association was found for female patients. CONCLUSION Whereas in males with CAP, sex and mineralocorticoid hormone metabolite levels correlated with inflammation, disease severity and long-term survival, no similar association was found for females. Further study of sex and mineralocorticoid hormones in acute illness could generate predictive signatures with implementation in clinical practice.
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Affiliation(s)
- Seline Zurfluh
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.
| | - Manuela Nickler
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Manuel Ottiger
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Alexander Kutz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Mirjam Christ-Crain
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Basel, Switzerland
| | - Werner Zimmerli
- Basel University Medical Clinic Liestal, Liestal, Switzerland
| | - Robert Thomann
- Department of Internal Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Claus Hoess
- Department of Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - Christoph Henzen
- Department of Internal Medicine, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Luca Bernasconi
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Andreas Huber
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
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Zurfluh S, Nickler M, Ottiger M, Steuer C, Kutz A, Christ-Crain M, Zimmerli W, Thomann R, Hoess C, Henzen C, Bernasconi L, Huber A, Mueller B, Schuetz P. Association of adrenal hormone metabolites and mortality over a 6-year follow-up in COPD patients with acute exacerbation. Clin Chem Lab Med 2018; 56:669-680. [PMID: 29220883 DOI: 10.1515/cclm-2017-0873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/31/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND The release of hormones from the adrenal gland is vital in acute and chronic illnesses such as chronic obstructive pulmonary disease (COPD) involving recurrent exacerbations. Using a metabolomic approach, we aim to investigate associations of different adrenal hormone metabolites with short- and long-term mortality in COPD patients. METHODS We prospectively followed 172 COPD patients (median age 75 years, 62% male) from a previous Swiss multicenter trial. At baseline, we measured levels of a comprehensive spectrum of adrenal hormone metabolites, including glucocorticoid, mineralocorticoid and androgen hormones by liquid chromatography coupled with tandem mass spectrometry (MS). We calculated Cox regression models adjusted for gender, age, comorbidities and previous corticosteroid therapy. RESULTS Mortality was 6.4% after 30 days and increased to 61.6% after 6 years. Higher initial androgen hormones predicted lower long-term mortality with significant results for dehydroepiandrosterone (DHEA) [adjusted hazard ratio (HR), 0.82; 95% confidence interval (CI), 0.70-0.98; p=0.026] and dehydroepiandrosterone sulfate (DHEA-S) (adjusted HR, 0.68; 95% CI, 0.50-0.91; p=0.009). An activation of stress hormones (particularly cortisol and cortisone) showed a time-dependent effect with higher levels pointing towards higher mortality at short term, but lower mortality at long term. Activation of the mineralocorticoid axis tended to be associated with increased short-term mortality (adjusted HR of aldosterone, 2.76; 95% CI, 0.79-9.65; p=0.111). CONCLUSIONS Independent of age, gender, corticosteroid exposure and exacerbation type, adrenal hormones are associated with mortality at short and long term in patients with COPD exacerbation with different time-dependent effects of glucocorticoids, androgens and mineralocorticoids. A better physiopathological understanding of the causality of these effects may have therapeutic implications.
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Affiliation(s)
- Seline Zurfluh
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Manuela Nickler
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Manuel Ottiger
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Christian Steuer
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Alexander Kutz
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Mirjam Christ-Crain
- Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Werner Zimmerli
- Basel University Medical Clinic Liestal, Liestal, Switzerland
| | - Robert Thomann
- Department of Internal Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Claus Hoess
- Department of Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - Christoph Henzen
- Department of Internal Medicine, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Luca Bernasconi
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Andreas Huber
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
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Henzen C. [CME: Paraneoplastic Endocrine Syndromes]. Praxis (Bern 1994) 2018; 107:1309-1315. [PMID: 30482117 DOI: 10.1024/1661-8157/a003132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CME: Paraneoplastic Endocrine Syndromes Abstract. Paraneoplastic endocrine syndromes are caused by ectopic hormone production by malignant tumor cells. Knowledge of paraneoplastic endocrine syndromes may allow a timely diagnosis of the underlying cancer at a treatable stage and, on the other hand, appropriate treatment of the endocrine manifestations reduces morbidity and mortality of the affected patients. The most common endocrine syndromes are paraneoplastic hypercalcaemia, caused by the secretion of PTHrP, and hyponatremia, caused by the inadequate secretion of ADH. Although there may be clinical symptoms like fatigue, nausea/vomiting and renal insufficiency for hypercalcaemia and gait disturbances and mental alterations for hyponatremia, the diagnosis must be confirmed by laboratory testing and prompt the search for associated tumors.
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Affiliation(s)
- Christoph Henzen
- 1 Innere Medizin/Endokrinologie und Diabetologie, Luzerner Kantonsspital
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Baumgartner T, Zurauskaité G, Wirz Y, Meier M, Steuer C, Bernasconi L, Huber A, Christ-Crain M, Henzen C, Hoess C, Thomann R, Zimmerli W, Mueller B, Schuetz P. Association of the Tyrosine/Nitrotyrosine pathway with death or ICU admission within 30 days for patients with community acquired pneumonia. BMC Infect Dis 2018; 18:423. [PMID: 30143005 PMCID: PMC6109359 DOI: 10.1186/s12879-018-3335-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 08/15/2018] [Indexed: 01/20/2023] Open
Abstract
Background Oxidative stress is a modifiable risk-factor in infection causing damage to human cells. As an adaptive response, cells catabolize Tyrosine to 3-Nitrotyrosine (Tyr-NO2) by nitrosylation. We investigated whether a more efficient reduction in oxidative stress, mirrored by a lowering of Tyrosine, and an increase in Tyr-NO2 and the Tyrosine/Tyr-NO2 ratio was associated with better clinical outcomes in patients with community-acquired pneumonia (CAP). Methods We measured Tyrosine and Tyr-NO2 in CAP patients from a previous randomized Swiss multicenter trial. The primary endpoint was adverse outcome defined as death or ICU admission within 30-days; the secondary endpoint was 6-year mortality. Results Of 278 included CAP patients, 10.4% experienced an adverse outcome within 30 days and 45.0% died within 6 years. After adjusting for the pneumonia Severity Index [PSI], BMI and comorbidities, Tyrosine nitrosylation was associated with a lower risk for short-term adverse outcome and an adjusted OR of 0.44 (95% CI 0.20 to 0.96, p = 0.039) for Tyr-NO2 and 0.98 (95% CI 0.98 to 0.99, p = 0.043) for the Tyrosine/Tyr-NO2 ratio. There were no significant associations for long-term mortality over six-years for Tyr-NO2 levels (adjusted hazard ratio 0.81, 95% CI 0.60 to 1.11, p = 0.181) and Tyrosine/Tyr-NO2 ratio (adjusted hazard ratio 1.00, 95% CI 0.99 to 1.00, p = 0.216). Conclusions Tyrosine nitrosylation in our cohort was associated with better clinical outcomes of CAP patients at short-term, but not at long term. Whether therapeutic modulation of the Tyrosine/Tyr-NO2 pathway has beneficial effects should be evaluated in future studies. Trial registration ISRCTN95122877. Registered 31 July 2006.
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Affiliation(s)
- Thomas Baumgartner
- Division of Endocrinology, Diabetology and Metabolism, Kantonsspital Aarau, Medical University Department, Aarau, Switzerland.
| | - Giedré Zurauskaité
- Division of Endocrinology, Diabetology and Metabolism, Kantonsspital Aarau, Medical University Department, Aarau, Switzerland
| | - Yannick Wirz
- Division of Endocrinology, Diabetology and Metabolism, Kantonsspital Aarau, Medical University Department, Aarau, Switzerland
| | - Marc Meier
- Division of Endocrinology, Diabetology and Metabolism, Kantonsspital Aarau, Medical University Department, Aarau, Switzerland
| | - Christian Steuer
- Department of Laboratory Medicine Kantonsspital Aarau, Aarau, Switzerland
| | - Luca Bernasconi
- Department of Laboratory Medicine Kantonsspital Aarau, Aarau, Switzerland
| | - Andreas Huber
- Department of Laboratory Medicine Kantonsspital Aarau, Aarau, Switzerland
| | - Mirjam Christ-Crain
- Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Christoph Henzen
- Department of Internal Medicine, Kantonsspital Luzern, Lucerne, Switzerland
| | - Claus Hoess
- Department of Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - Robert Thomann
- Department of Internal Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Werner Zimmerli
- Department of Internal Medicine, Kantonsspital Liestal, Liestal, Switzerland
| | - Beat Mueller
- Division of Endocrinology, Diabetology and Metabolism, Kantonsspital Aarau, Medical University Department, Aarau, Switzerland
| | - Philipp Schuetz
- Division of Endocrinology, Diabetology and Metabolism, Kantonsspital Aarau, Medical University Department, Aarau, Switzerland
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Fenske W, Refardt J, Chifu I, Schnyder I, Winzeler B, Drummond J, Ribeiro-Oliveira A, Drescher T, Bilz S, Vogt DR, Malzahn U, Kroiss M, Christ E, Henzen C, Fischli S, Tönjes A, Mueller B, Schopohl J, Flitsch J, Brabant G, Fassnacht M, Christ-Crain M. A Copeptin-Based Approach in the Diagnosis of Diabetes Insipidus. N Engl J Med 2018; 379:428-439. [PMID: 30067922 DOI: 10.1056/nejmoa1803760] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The indirect water-deprivation test is the current reference standard for the diagnosis of diabetes insipidus. However, it is technically cumbersome to administer, and the results are often inaccurate. The current study compared the indirect water-deprivation test with direct detection of plasma copeptin, a precursor-derived surrogate of arginine vasopressin. METHODS From 2013 to 2017, we recruited 156 patients with hypotonic polyuria at 11 medical centers to undergo both water-deprivation and hypertonic saline infusion tests. In the latter test, plasma copeptin was measured when the plasma sodium level had increased to at least 150 mmol per liter after infusion of hypertonic saline. The primary outcome was the overall diagnostic accuracy of each test as compared with the final reference diagnosis, which was determined on the basis of medical history, test results, and treatment response, with copeptin levels masked. RESULTS A total of 144 patients underwent both tests. The final diagnosis was primary polydipsia in 82 patients (57%), central diabetes insipidus in 59 (41%), and nephrogenic diabetes insipidus in 3 (2%). Overall, among the 141 patients included in the analysis, the indirect water-deprivation test determined the correct diagnosis in 108 patients (diagnostic accuracy, 76.6%; 95% confidence interval [CI], 68.9 to 83.2), and the hypertonic saline infusion test (with a copeptin cutoff level of >4.9 pmol per liter) determined the correct diagnosis in 136 patients (96.5%; 95% CI, 92.1 to 98.6; P<0.001). The indirect water-deprivation test correctly distinguished primary polydipsia from partial central diabetes insipidus in 77 of 105 patients (73.3%; 95% CI, 63.9 to 81.2), and the hypertonic saline infusion test distinguished between the two conditions in 99 of 104 patients (95.2%; 95% CI, 89.4 to 98.1; adjusted P<0.001). One serious adverse event (desmopressin-induced hyponatremia that resulted in hospitalization) occurred during the water-deprivation test. CONCLUSIONS The direct measurement of hypertonic saline-stimulated plasma copeptin had greater diagnostic accuracy than the water-deprivation test in patients with hypotonic polyuria. (Funded by the Swiss National Foundation and others; ClinicalTrials.gov number, NCT01940614 .).
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Affiliation(s)
- Wiebke Fenske
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Julie Refardt
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Irina Chifu
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Ingeborg Schnyder
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Bettina Winzeler
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Juliana Drummond
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Antônio Ribeiro-Oliveira
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Tilman Drescher
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Stefan Bilz
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Deborah R Vogt
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Uwe Malzahn
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Matthias Kroiss
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Emanuel Christ
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Christoph Henzen
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Stefan Fischli
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Anke Tönjes
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Beat Mueller
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Jochen Schopohl
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Jörg Flitsch
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Georg Brabant
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Martin Fassnacht
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
| | - Mirjam Christ-Crain
- From the University of Leipzig, Department of Endocrinology and Nephrology (W.F., A.T.), and Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases (W.F.), Leipzig, the Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg (I.C., M.K., M.F.), and the Clinical Trial Center (U.M.) and Central Laboratory (M.F.), University Hospital Würzburg, Würzburg, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität, Munich (J.S.), the Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg (J.F.), and Experimental and Clinical Endocrinology, University Hospital Lübeck, Lübeck (G.B.) - all in Germany; the Clinic of Endocrinology, Diabetology and Metabolism (J.R., I.S., B.W., E.C., M.C.-C.) and the Clinical Trial Unit (D.R.V.), Department of Clinical Research, University of Basel and University Hospital Basel, Basel, the Department of Endocrinology, Kantonsspital St. Gallen, St. Gallen (T.D., S.B.), the Department of Endocrinology, Inselspital Bern, Bern (E.C.), the Department of Endocrinology, Luzerner Kantonsspital, Lucerne (C.H., S.F.), and the Division of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau, Aarau (B.M.) - all in Switzerland; and Faculdade de Medicina da UFMG, Universidade Federal de Minas Gerais (J.D., A.R.-O.), and Hermes Pardini Institute (J.D.), Belo Horizonte, Brazil
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Schuetz P, Fehr R, Baechli V, Geiser M, Gomes F, Kutz A, Tribolet P, Bregenzer T, Hoess C, Pavlicek V, Schmid S, Bilz S, Sigrist S, Brändle M, Benz C, Henzen C, Mattmann S, Thomann R, Brand C, Rutishauser J, Aujesky D, Rodondi N, Donze J, Stanga Z, Mueller B. Design and rationale of the effect of early nutritional therapy on frailty, functional outcomes and recovery of malnourished medical inpatients trial (EFFORT): a pragmatic, multicenter, randomized-controlled trial. ACTA ACUST UNITED AC 2018. [DOI: 10.18203/2349-3259.ijct20182085] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<p class="abstract"><strong>Background:</strong> Malnutrition is highly prevalent and strongly associated with clincial outcomes of medical inpatients. Still, the benefit of nutritional treatment to prevent adverse outcomes in medical inpatients at risk for malnutrition remains unproven. We describe the trial methods of the largest yet nutritional trial in medical inpatients including the rationale for key design decisions regarding the nutritional strategy, eligibility criteria, choice of control arm, and endpoints.</p><p class="abstract"><strong>Methods:</strong> The Effect of early nutritional therapy on Frailty, Functional Outcomes and Recovery of malnourished medical inpatients Trial (EFFORT) is an investigator-initiated, non-commercial, open-label RCT to compare the effects of an intensified nutritional therapy (intervention group) with a control group on medical outcomes. We include adult medical inpatients at risk of malnutrition based on a Nutritional Risk Screening 2002 (NRS) score of ≥3 points with an expected length of stay of ≥5 days. An individualized systematic nutritional assessment by study dieticians is done to define nutritional targets and to establish an implementation plan. Patients in the intervention group receive individualized early nutritional therapy based on a previously published consensus algorithm, while control group patients receive standard hospital nutrition. The study is powered to compare clinical outcomes (composite adverse outcome and mortality) in the 2 study arms as well as to address several mechanistical questions.</p><p class="abstract"><strong>Conclusion:</strong> EFFORT aims to close important gaps in the literature regarding the controversy about benefit and possible harm of nutritional therapy in medical inpatients at risk for malnutrition.</p><p class="abstract"><strong>Trial Registration: </strong>ClinicalTrials.gov NCT02517476; registered July 30, 2015.</p>
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Burmazovic S, Henzen C, Brander L, Cioccari L. One too many diabetes: the combination of hyperglycaemic hyperosmolar state and central diabetes insipidus. Endocrinol Diabetes Metab Case Rep 2018; 2018:EDM180029. [PMID: 29675260 PMCID: PMC5900797 DOI: 10.1530/edm-18-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/23/2018] [Indexed: 11/08/2022] Open
Abstract
The combination of hyperosmolar hyperglycaemic state and central diabetes insipidus is unusual and poses unique diagnostic and therapeutic challenges for clinicians. In a patient with diabetes mellitus presenting with polyuria and polydipsia, poor glycaemic control is usually the first aetiology that is considered, and achieving glycaemic control remains the first course of action. However, severe hypernatraemia, hyperglycaemia and discordance between urine-specific gravity and urine osmolality suggest concurrent symptomatic diabetes insipidus. We report a rare case of concurrent manifestation of hyperosmolar hyperglycaemic state and central diabetes insipidus in a patient with a history of craniopharyngioma. Learning points In patients with diabetes mellitus presenting with polyuria and polydipsia, poor glycaemic control is usually the first aetiology to be considered.However, a history of craniopharyngioma, severe hypernatraemia, hyperglycaemia and discordance between urine-specific gravity and osmolality provide evidence of concurrent diabetes insipidus.Therefore, if a patient with diabetes mellitus presents with severe hypernatraemia, hyperglycaemia, a low or low normal urinary-specific gravity and worsening polyuria despite correction of hyperglycaemia, concurrent diabetes insipidus should be sought.
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Affiliation(s)
- Snezana Burmazovic
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Christoph Henzen
- Department of Internal Medicine and Endocrinology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Lukas Brander
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Luca Cioccari
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Prahran, Australia
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Burget L, Parera LA, Fernandez-Cancio M, Gräni R, Henzen C, Flück CE. A rare cause of primary adrenal insufficiency due to a homozygous Arg188Cys mutation in the STAR gene. Endocrinol Diabetes Metab Case Rep 2018; 2018:EDM180003. [PMID: 29576868 PMCID: PMC5863243 DOI: 10.1530/edm-18-0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/06/2018] [Indexed: 11/10/2022] Open
Abstract
Steroidogenic acute regulatory protein (STAR) is a key protein for the intracellular transport of cholesterol to the mitochondrium in endocrine organs (e.g. adrenal gland, ovaries, testes) and essential for the synthesis of all steroid hormones. Several mutations have been described and the clinical phenotype varies strongly and may be grouped into classic lipoid congenital adrenal hyperplasia (LCAH), in which all steroidogenesis is disrupted, and non-classic LCAH, which resembles familial glucocorticoid deficiency (FGD), which affects predominantly adrenal functions. Classic LCAH is characterized by early and potentially life-threatening manifestation of primary adrenal insufficiency (PAI) with electrolyte disturbances and 46,XY disorder of sex development (DSD) in males as well as lack of pubertal development in both sexes. Non-classic LCAH manifests usually later in life with PAI. Nevertheless, life-long follow-up of gonadal function is warranted. We describe a 26-year-old female patient who was diagnosed with PAI early in life without detailed diagnostic work-up. At the age of 14 months, she presented with hyperpigmentation, elevated ACTH and low cortisol levels. As her older brother was diagnosed with PAI two years earlier, she was put on hydrocortisone and fludrocortisone replacement therapy before an Addisonian crisis occurred. Upon review of her case in adulthood, consanguinity was noted in the family. Genetic analysis for PAI revealed a homozygous mutation in the STAR gene (c.562C>T, p.Arg188Cys) in both siblings. This mutation has been previously described in non-classic LCAH. This case illustrates that early onset, familial PAI is likely due to autosomal recessive genetic mutations in known genes causing PAI.
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Affiliation(s)
- Lukas Burget
- Division of Endocrinology and Diabetes, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Laura Audí Parera
- Pediatric Endocrinology Research Unit, Vall d`Hebron, Institut de Recerca, CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
| | - Monica Fernandez-Cancio
- Pediatric Endocrinology Research Unit, Vall d`Hebron, Institut de Recerca, CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
| | - Rolf Gräni
- Division of Endocrinology and Diabetes, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Christoph Henzen
- Division of Endocrinology and Diabetes, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Christa E Flück
- Pediatric Endocrinology, Diabetology and Metabolism, Bern University Children's Hospital and Department of BioMedical Research, University of Bern, Bern, Switzerland
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Henzen C. [Not Available]. Rev Med Suisse 2018; 14:178-179. [PMID: 29380967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Henzen C. [CME-Answers: 'Paraneoplastic Endocrine Syndromes' Praxis No. 24]. Praxis (Bern 1994) 2018; 107:1423. [PMID: 31166868 DOI: 10.1024/1661-8157/a003133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Christoph Henzen
- 1 Innere Medizin und Endokrinologie-Diabetologie, Luzerner Kantonsspital
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Fischli S, Henzen C. Aktuelles zur Therapie mit GLP-1-Rezeptoragonisten bei Patienten mit Diabetes mellitus Typ 2. Therapeutische Umschau 2017; 74:433-439. [DOI: 10.1024/0040-5930/a000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. GLP-1-Rezeptoragonisten (GLP-1-RA) sind eine neuere Therapieoption zur Behandlung des Diabetes mellitus Typ 2. Diese Substanzen besitzen eine analoge Struktur zum menschlichen glukagon-like peptide 1 (GLP-1), einem für die Glukosehomöostase zentralen Inkretin, das unter anderem für die postprandiale Insulinsekretion verantwortlich ist. GLP-1-RA führen glukoseabhängig zur Stimulation der Insulin- und Hemmung der Glukagon-Sekretion. Sie besitzen kein intrinsisches Hypoglykämierisiko und bewirken eine Gewichtsabnahme. In kardiovaskulären Endpunktstudien konnte für mehrere Substanzen (Liraglutid, Semaglutid) eine Reduktion der kardiovaskulären Endpunkte gezeigt werden. Die häufigsten Nebenwirkungen der GLP-1-RA sind gastrointestinaler Natur (Nausea, Erbrechen und Diarrhö) und Ausdruck der Wirkung an zentralem Nervensystem und Gastrointestinaltrakt. GLP-1-RA sind die teuersten Diabetesmedikamente, die Applikation erfolgt subkutan und es existieren zum jetzigen Zeitpunkt noch ungenügende Daten zur längerfristigen Wirksamkeit und Dauerhaftigkeit der Behandlung. Die Auswahl der Patienten, die für eine Behandlung mit GLP-1-RA qualifizieren, muss sorgfältig geschehen. Die Substanzen können mit oralen Antidiabetika, aber auch mit Insulin, kombiniert werden. Dieser Artikel fasst Grundlagen zur Wirkung und klinischen Wirksamkeit, Nebenwirkungsprofil und Einsatzmöglichkeiten dieser Medikamente im klinischen Alltag zusammen.
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Affiliation(s)
- Stefan Fischli
- Abteilung für Endokrinologie, Diabetologie und Klinische Ernährung, Departement Medizin, Kantonsspital Luzern
| | - Christoph Henzen
- Abteilung für Endokrinologie, Diabetologie und Klinische Ernährung, Departement Medizin, Kantonsspital Luzern
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Fischli S, von Wyl V, Trummler M, Konrad D, Wueest S, Ruefer A, Heering K, Streuli R, Steuer C, Bernasconi L, Recher M, Henzen C. Iron metabolism in patients with Graves' hyperthyroidism. Clin Endocrinol (Oxf) 2017; 87:609-616. [PMID: 28833367 DOI: 10.1111/cen.13450] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/14/2017] [Accepted: 08/13/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Graves' hyperthyroidism (GH) interferes with iron metabolism and elevates ferritin. The precise mechanisms remain unclear. The influence of thyroid hormones on the synthesis/regulation of hepcidin, an important regulator of iron metabolism, remains uncharacterized. DESIGN Prospective observational study. PATIENTS We included patients (n = 31) with new-onset and untreated GH. MEASUREMENTS Laboratory parameters indicative of iron metabolism (ferritin, transferrin, hepcidin), inflammatory markers/cytokines and smoking status were assessed at the diagnosis of GH (T0) and at euthyroidism (T1) in the same patients using multivariable analyses. Hepcidin was measured by mass spectrometry (hepcidinMS ) and ELISA (hepcidinEL ). The impact of T3 on hepatic hepcidin expression was studied in a cell culture model using HepG2 cells. RESULTS Median ferritin levels were significantly lower and transferrin significantly higher at T1 than at T0. HepcidinMS levels were lower in males and females at T1 (statistically significant in males only). No statistically significant difference in hepcidinEL was detected between T0 and T1. Plasma levels of inflammatory markers (high-sensitive CRP, procalcitonin) and cytokines (interleukin 6, interleukin 1ß, tumour necrosis factor α) were not different between T0 and T1. Smokers tended to have lower fT3 and fT4 at T0 than nonsmoking GH patients. T3 significantly induced hepcidin mRNA expression in HepG2 cells. CONCLUSIONS Iron metabolism in patients with GH undergoes dynamic changes in patients with GH that resemble an acute-phase reaction. Inflammatory parameters and cytokines were unaffected by thyroid status. Gender and smoking status had an impact on ferritin, hepcidin and thyroid hormones.
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Affiliation(s)
- Stefan Fischli
- Division of Endocrinology and Diabetes, Luzerner Kantonsspital, Luzern, Switzerland
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Michael Trummler
- Department of Clinical Chemistry, Luzerner Kantonsspital, Luzern, Switzerland
| | - Daniel Konrad
- Division of Pediatric Endocrinology and Diabetology and Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Stephan Wueest
- Division of Pediatric Endocrinology and Diabetology and Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Axel Ruefer
- Division of Hematology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Kerstin Heering
- Division of Endocrinology and Diabetes, Luzerner Kantonsspital, Luzern, Switzerland
| | - Regina Streuli
- Division of Endocrinology and Diabetes, Luzerner Kantonsspital, Luzern, Switzerland
| | - Christian Steuer
- Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Luca Bernasconi
- Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Mike Recher
- Immunodeficiency Clinic, Medical Outpatient Clinic and Department of Biomedicine, University Hospital Basel and University Basel, Basel, Switzerland
| | - Christoph Henzen
- Division of Endocrinology and Diabetes, Luzerner Kantonsspital, Luzern, Switzerland
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Meier MA, Ottiger M, Vögeli A, Steuer C, Bernasconi L, Thomann R, Christ-Crain M, Henzen C, Hoess C, Zimmerli W, Huber A, Mueller B, Schuetz P. Activation of the tryptophan/serotonin pathway is associated with severity and predicts outcomes in pneumonia: results of a long-term cohort study. Clin Chem Lab Med 2017; 55:1060-1069. [PMID: 28076309 DOI: 10.1515/cclm-2016-0912] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/01/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND As part of the immune defense during infection, an increase in enzyme activity of indoleamine 2,3-dioxygenase (IDO) leads to a breakdown of tryptophan to kynurenine. In previous animal studies, therapeutic antagonism of IDO resulted in reduced sepsis mortality. We investigated the prognostic ability of tryptophan, serotonin, kynurenine and IDO (represented by the ratio of kynurenine/tryptophan) to predict adverse clinical outcomes in patients with community-acquired pneumonia (CAP). METHODS We measured tryptophan, serotonin and kynurenine on admission plasma samples from CAP patients included in a previous multicenter trial by liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). We studied their association with inflammation (C-reactive protein), infection (procalcitonin) and clinical outcome. RESULTS Mortality in the 268 included patients was 45% within 6 years of follow-up. IDO and kynurenine showed a strong positive correlation with markers of infection (procalcitonin) and inflammation (C-reactive protein) as well as sepsis and CAP severity scores. Tryptophan showed similar, but negative correlations. In a multivariate regression analysis adjusted for age and comorbidities, higher IDO activity and lower tryptophan levels were strongly associated with short-term adverse outcome defined as death and/or ICU admission within 30 days with adjusted odds ratios of 9.1 [95% confidence interval (CI) 1.4-59.5, p=0.021] and 0.11 (95% CI 0.02-0.70, p=0.021). Multivariate analysis did not reveal significant associations for kynurenine and serotonin. CONCLUSIONS In hospitalized CAP patients, higher IDO activity and lower tryptophan levels independently predicted disease severity and short-term adverse outcome. Whether therapeutic modulation of IDO has positive effects on outcome needs further investigation.
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Meier MA, Ottiger M, Vögeli A, Steuer C, Bernasconi L, Thomann R, Christ-Crain M, Henzen C, Hoess C, Zimmerli W, Huber A, Mueller B, Schuetz P. Activation of the Serotonin Pathway is Associated with Poor Outcome in COPD Exacerbation: Results of a Long-Term Cohort Study. Lung 2017; 195:303-311. [PMID: 28434116 DOI: 10.1007/s00408-017-0004-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 04/17/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND/INTRODUCTION Indoleamine 2,3-dioxygenase (IDO) metabolizes tryptophan to kynurenine. An increase of its activity is associated with severity in patients with pneumonia. In chronic obstructive pulmonary disease (COPD) patients, an elevation of serotonin has been reported. Experimental models showed that cigarette smoke inhibits monoamine oxidase (MAO) leading to higher levels of serotonin. We investigated the prognostic ability of tryptophan, serotonin, kynurenine, IDO, and tryptophan hydroxylase (TPH) to predict short- and long-term outcomes in patients with a COPD exacerbation. METHODS We measured tryptophan, serotonin, and kynurenine on admission plasma samples in patients with a COPD exacerbation from a previous trial by liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). IDO and TPH were calculated as ratios of kynurenine over tryptophan, and serotonin over tryptophan, respectively. We studied their association with parameters measured in clinical routine at emergency department admission representing inflammation (C-reactive protein [CRP]), infection (procalcitonin [PCT]), oxygenation (SpO2), as well as patients' clinical outcome, confirmed by structured phone interviews. RESULTS Mortality in the 149 included patients was 53.7% within six years of follow-up. While IDO activity showed strong positive correlations, tryptophan was negatively correlated with CRP and PCT. For 30-day adverse outcome defined as death and/or intensive care unit (ICU) admission, a multivariate regression analysis adjusted for age and comorbidities found strong associations for IDO activity (adjusted odds ratios of 31.4 (95%CI 1.1-857), p = 0.041) and TPH (adjusted odds ratios 27.0 (95%CI 2.2-327), p = 0.010). TPH also showed a significant association with mortality at 18 months, (hazard ratio 2.61 (95%CI 1.2-5.8), p = 0.020). CONCLUSION In hospitalized patients with a COPD exacerbation, higher IDO and TPH activities independently predicted adverse short-term outcomes and TPH levels were also predictive of 18-month mortality. Whether therapeutic modulation of the serotonin pathway has positive effects on outcome needs further investigation.
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Affiliation(s)
- Marc A Meier
- Medical University Department, Kantonsspital Aarau, Medical faculty, University of Basel, Tellstrasse, 5001, Aarau and Basel, Switzerland
| | - Manuel Ottiger
- Medical University Department, Kantonsspital Aarau, Medical faculty, University of Basel, Tellstrasse, 5001, Aarau and Basel, Switzerland
| | - Alaadin Vögeli
- Medical University Department, Kantonsspital Aarau, Medical faculty, University of Basel, Tellstrasse, 5001, Aarau and Basel, Switzerland
| | - Christian Steuer
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Luca Bernasconi
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Robert Thomann
- Medical Department, Buergerspital Solothurn, Solothurn, Switzerland
| | - Mirjam Christ-Crain
- Medical University Department, University Hospital Basel, Basel, Switzerland
| | | | - Claus Hoess
- Medical Department, Kantonsspital Muensterlingen, Muensterlingen, Switzerland
| | - Werner Zimmerli
- Medical University Department, Kantonsspital Baselland, Liestal, Switzerland
| | - Andreas Huber
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Medical University Department, Kantonsspital Aarau, Medical faculty, University of Basel, Tellstrasse, 5001, Aarau and Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Kantonsspital Aarau, Medical faculty, University of Basel, Tellstrasse, 5001, Aarau and Basel, Switzerland.
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Struja T, Kaeslin M, Boesiger F, Jutzi R, Imahorn N, Kutz A, Bernasconi L, Mundwiler E, Mueller B, Christ-Crain M, Meienberg F, Ebrahimi F, Henzen C, Fischli S, Kraenzlin M, Meier C, Schuetz P. External validation of the GREAT score to predict relapse risk in Graves' disease: results from a multicenter, retrospective study with 741 patients. Eur J Endocrinol 2017; 176:413-419. [PMID: 28100628 DOI: 10.1530/eje-16-0986] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/11/2017] [Accepted: 01/17/2017] [Indexed: 11/08/2022]
Abstract
CONTEXT First-line treatment in Graves' disease is often done with antithyroid agents (ATD), but relapse rates remain high making definite treatment necessary. Predictors for relapse risk help guiding initial treatment decisions. OBJECTIVE We aimed to externally validate the prognostic accuracy of the recently proposed Graves' Recurrent Events After Therapy (GREAT) score to predict relapse risk in Graves' disease. DESIGN, SETTING AND PARTICIPANTS We retrospectively analyzed data (2004-2014) of patients with a first episode of Graves' hyperthyroidism from four Swiss endocrine outpatient clinics. MAIN OUTCOME MEASURES Relapse of hyperthyroidism analyzed by multivariate Cox regression. RESULTS Of the 741 included patients, 371 experienced a relapse (50.1%) after a mean follow-up of 25.6 months after ATD start. In univariate regression analysis, higher serum free T4, higher thyrotropin-binding inhibitor immunoglobulin (TBII), younger age and larger goiter were associated with higher relapse risk. We found a strong increase in relapse risk with more points in the GREAT score from 33.8% in patients with GREAT class I (0-1 points), 59.4% in class II (2-3 points) with a hazard ratio of 1.79 (95% CI: 1.42-2.27, P < 0.001) and 73.6% in class III (4-6 points) with a hazard ratio of 2.24 (95% CI: 1.64-3.06, P < 0.001). CONCLUSIONS Based on this retrospective analysis within a large patient population from a multicenter study, the GREAT score shows good external validity and can be used for assessing the risk for relapse in Graves' disease, which influence the initial treatment decisions.
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Affiliation(s)
- Tristan Struja
- Medical University DepartmentClinic for Endocrinology, Diabetes & Metabolism
| | - Marina Kaeslin
- Medical University DepartmentClinic for Endocrinology, Diabetes & Metabolism
| | - Fabienne Boesiger
- Medical University DepartmentClinic for Endocrinology, Diabetes & Metabolism
| | - Rebecca Jutzi
- Medical University DepartmentClinic for Endocrinology, Diabetes & Metabolism
| | - Noemi Imahorn
- Medical University DepartmentClinic for Endocrinology, Diabetes & Metabolism
| | - Alexander Kutz
- Medical University DepartmentClinic for Endocrinology, Diabetes & Metabolism
| | - Luca Bernasconi
- Department of Laboratory MedicineKantonsspital Aarau, Aarau, Switzerland
| | - Esther Mundwiler
- Department of Laboratory MedicineKantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Medical University DepartmentClinic for Endocrinology, Diabetes & Metabolism
- Medical Faculty of the University of BaselBasel, Switzerland
| | - Mirjam Christ-Crain
- Medical Faculty of the University of BaselBasel, Switzerland
- Clinic for EndocrinologyDiabetes & Metabolism, University Hospital of Basel, Basel, Switzerland
| | - Fabian Meienberg
- Clinic for EndocrinologyDiabetes & Metabolism, University Hospital of Basel, Basel, Switzerland
| | - Fahim Ebrahimi
- Clinic for EndocrinologyDiabetes & Metabolism, University Hospital of Basel, Basel, Switzerland
| | - Christoph Henzen
- Medical Faculty of the University of BaselBasel, Switzerland
- Clinic for EndocrinologyDiabetes & Metabolism, Kantonsspital Luzern, Luzern, Switzerland
| | - Stefan Fischli
- Clinic for EndocrinologyDiabetes & Metabolism, Kantonsspital Luzern, Luzern, Switzerland
| | - Marius Kraenzlin
- Medical Faculty of the University of BaselBasel, Switzerland
- Clinic for EndocrinologyDiabetes & Metabolism, University Hospital of Basel, Basel, Switzerland
| | - Christian Meier
- Medical Faculty of the University of BaselBasel, Switzerland
- Clinic for EndocrinologyDiabetes & Metabolism, University Hospital of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Medical University DepartmentClinic for Endocrinology, Diabetes & Metabolism
- Medical Faculty of the University of BaselBasel, Switzerland
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