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Ungan G, Pons-Escoda A, Ulinic D, Arús C, Ortega-Martorell S, Olier I, Vellido A, Majós C, Julià-Sapé M. Early pseudoprogression and progression lesions in glioblastoma patients are both metabolically heterogeneous. NMR Biomed 2024; 37:e5095. [PMID: 38213096 DOI: 10.1002/nbm.5095] [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] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/06/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024]
Abstract
The standard treatment in glioblastoma includes maximal safe resection followed by concomitant radiotherapy plus chemotherapy and adjuvant temozolomide. The first follow-up study to evaluate treatment response is performed 1 month after concomitant treatment, when contrast-enhancing regions may appear that can correspond to true progression or pseudoprogression. We retrospectively evaluated 31 consecutive patients at the first follow-up after concomitant treatment to check whether the metabolic pattern assessed with multivoxel MRS was predictive of treatment response 2 months later. We extracted the underlying metabolic patterns of the contrast-enhancing regions with a blind-source separation method and mapped them over the reference images. Pattern heterogeneity was calculated using entropy, and association between patterns and outcomes was measured with Cramér's V. We identified three distinct metabolic patterns-proliferative, necrotic, and responsive, which were associated with status 2 months later. Individually, 70% of the patients showed metabolically heterogeneous patterns in the contrast-enhancing regions. Metabolic heterogeneity was not related to the regions' size and only stable patients were less heterogeneous than the rest. Contrast-enhancing regions are also metabolically heterogeneous 1 month after concomitant treatment. This could explain the reported difficulty in finding robust pseudoprogression biomarkers.
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Affiliation(s)
- Gülnur Ungan
- Centro de Investigación Biomédica en Red (CIBER), Madrid, Spain
- Departament de Bioquímica i Biologia Molecular and Institut de Biotecnologia i Biomedicina (IBB), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Albert Pons-Escoda
- Grup de Neuro-oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Daniel Ulinic
- Departament de Bioquímica i Biologia Molecular and Institut de Biotecnologia i Biomedicina (IBB), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Carles Arús
- Centro de Investigación Biomédica en Red (CIBER), Madrid, Spain
- Departament de Bioquímica i Biologia Molecular and Institut de Biotecnologia i Biomedicina (IBB), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - Ivan Olier
- Data Science Research Centre, Liverpool John Moores University (LJMU), Liverpool, UK
| | - Alfredo Vellido
- Centro de Investigación Biomédica en Red (CIBER), Madrid, Spain
- IDEAI-UPC Research Center, UPC BarcelonaTech, Barcelona, Spain
| | - Carles Majós
- Centro de Investigación Biomédica en Red (CIBER), Madrid, Spain
- Grup de Neuro-oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Margarida Julià-Sapé
- Centro de Investigación Biomédica en Red (CIBER), Madrid, Spain
- Departament de Bioquímica i Biologia Molecular and Institut de Biotecnologia i Biomedicina (IBB), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Bellfield RAA, Ortega-Martorell S, Lip GYH, Oxborough D, Olier I. Impact of ECG data format on the performance of machine learning models for the prediction of myocardial infarction. J Electrocardiol 2024; 84:17-26. [PMID: 38471239 DOI: 10.1016/j.jelectrocard.2024.03.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/08/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024]
Abstract
Background We aim to determine which electrocardiogram (ECG) data format is optimal for ML modelling, in the context of myocardial infarction prediction. We will also address the auxiliary objective of evaluating the viability of using digitised ECG signals for ML modelling. Methods Two ECG arrangements displaying 10s and 2.5 s of data for each lead were used. For each arrangement, conservative and speculative data cohorts were generated from the PTB-XL dataset. All ECGs were represented in three different data formats: Signal ECGs, Image ECGs, and Extracted Signal ECGs, with 8358 and 11,621 ECGs in the conservative and speculative cohorts, respectively. ML models were trained using the three data formats in both data cohorts. Results For ECGs that contained 10s of data, Signal and Extracted Signal ECGs were optimal and statistically similar, with AUCs [95% CI] of 0.971 [0.961, 0.981] and 0.974 [0.965, 0.984], respectively, for the conservative cohort; and 0.931 [0.918, 0.945] and 0.919 [0.903, 0.934], respectively, for the speculative cohort. For ECGs that contained 2.5 s of data, the Image ECG format was optimal, with AUCs of 0.960 [0.948, 0.973] and 0.903 [0.886, 0.920], for the conservative and speculative cohorts, respectively. Conclusion When available, the Signal ECG data should be preferred for ML modelling. If not, the optimal format depends on the data arrangement within the ECG: If the Image ECG contains 10s of data for each lead, the Extracted Signal ECG is optimal, however, if it only uses 2.5 s, then using the Image ECG data is optimal for ML performance.
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Affiliation(s)
- Ryan A A Bellfield
- Data Science Research Centre, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, UK; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Sandra Ortega-Martorell
- Data Science Research Centre, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, UK; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK; Department of Clinical Medicine, Aalborg University, Denmark
| | - David Oxborough
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK; School of Sport and Exercise Sciences, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, UK
| | - Ivan Olier
- Data Science Research Centre, Liverpool John Moores University, Byrom Street, Liverpool L3 3AF, UK; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
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Palermi S, Vecchiato M, Saglietto A, Niederseer D, Oxborough D, Ortega-Martorell S, Olier I, Castelletti S, Baggish A, Maffessanti F, Biffi A, D'Andrea A, Zorzi A, Cavarretta E, D'Ascenzi F. Unlocking the potential of artificial intelligence in sports cardiology: does it have a role in evaluating athlete's heart? Eur J Prev Cardiol 2024; 31:470-482. [PMID: 38198776 DOI: 10.1093/eurjpc/zwae008] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
The integration of artificial intelligence (AI) technologies is evolving in different fields of cardiology and in particular in sports cardiology. Artificial intelligence offers significant opportunities to enhance risk assessment, diagnosis, treatment planning, and monitoring of athletes. This article explores the application of AI in various aspects of sports cardiology, including imaging techniques, genetic testing, and wearable devices. The use of machine learning and deep neural networks enables improved analysis and interpretation of complex datasets. However, ethical and legal dilemmas must be addressed, including informed consent, algorithmic fairness, data privacy, and intellectual property issues. The integration of AI technologies should complement the expertise of physicians, allowing for a balanced approach that optimizes patient care and outcomes. Ongoing research and collaborations are vital to harness the full potential of AI in sports cardiology and advance our management of cardiovascular health in athletes.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, via Pansini 5, 80131 Naples, Italy
| | - Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Citta della Salute e della Scienza' Hospital, 10129 Turin, Italy
- Department of Medical Sciences, University of Turin, 10129 Turin, Italy
| | - David Niederseer
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Sandra Ortega-Martorell
- Data Science Research Centre, Liverpool John Moores University, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Ivan Olier
- Data Science Research Centre, Liverpool John Moores University, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Silvia Castelletti
- Cardiology Department, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Alessandro Biffi
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00187 Rome, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
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Wang R, Liu Y, Thabane L, Olier I, Li L, Ortega-Martorell S, Lip GYH, Li G. Relationship between trajectories of dietary iron intake and risk of type 2 diabetes mellitus: evidence from a prospective cohort study. Nutr J 2024; 23:15. [PMID: 38302934 PMCID: PMC10835921 DOI: 10.1186/s12937-024-00925-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/30/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND The association between dietary iron intake and the risk of type 2 diabetes mellitus (T2DM) remains inconsistent. In this study, we aimed to investigate the relationship between trajectories of dietary iron intake and risk of T2DM. METHODS This study comprised a total of 61,115 participants without a prior T2DM from the UK Biobank database. We used the group-based trajectory model (GBTM) to identify different dietary iron intake trajectories. Cox proportional hazards models were used to evaluate the relationship between trajectories of dietary iron intake and risk of T2DM. RESULTS During a mean follow-up of 4.8 years, a total of 677 T2DM events were observed. Four trajectory groups of dietary iron intake were characterized by the GBTM: trajectory group 1 (with a mean dietary iron intake of 10.9 mg/day), 2 (12.3 mg/day), 3 (14.1 mg/day) and 4 (17.6 mg/day). Trajectory group 3 was significantly associated with a 38% decreased risk of T2DM when compared with trajectory group 1 (hazard ratio [HR] = 0.62, 95% confidence interval [CI]: 0.49-0.79), while group 4 was significantly related with a 30% risk reduction (HR = 0.70, 95% CI: 0.54-0.91). Significant effect modifications by obesity (p = 0.04) and history of cardiovascular disease (p < 0.01) were found to the relationship between trajectories of dietary iron intake and the risk of T2DM. CONCLUSIONS We found that trajectories of dietary iron intake were significantly associated with the risk of T2DM, where the lowest T2DM risk was observed in trajectory group 3 with a mean iron intake of 14.1 mg/day. These findings may highlight the importance of adequate dietary iron intake to the T2DM prevention from a public health perspective. Further studies to assess the relationship between dietary iron intake and risk of T2DM are needed, as well as intervention studies to mitigate the risks of T2DM associated with dietary iron changes.
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Affiliation(s)
- Ruoting Wang
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Yingxin Liu
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada
| | - Ivan Olier
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, UK
| | - Likang Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Sandra Ortega-Martorell
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
| | - Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, 510317, China.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St West, Hamilton, ON, L8S 4L8, Canada.
- Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada.
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Abstract
Observational studies using causal inference frameworks can provide a feasible alternative to randomized controlled trials. Advances in statistics, machine learning, and access to big data facilitate unraveling complex causal relationships from observational data across healthcare, social sciences, and other fields. However, challenges like evaluating models and bias amplification remain.
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Affiliation(s)
- Ivan Olier
- Data Science Research Centre, Liverpool John Moores University, Liverpool, UK.
| | - Yiqiang Zhan
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Xiaoyu Liang
- Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, East Lansing, MI, 48824, USA
| | - Victor Volovici
- Department of Neurosurgery, Center for Medical Decision Making, Erasmus MC, Rotterdam, The Netherlands
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Ortega-Martorell S, Olier I, Johnston BW, Welters ID. Sepsis-induced coagulopathy is associated with new episodes of atrial fibrillation in patients admitted to critical care in sinus rhythm. Front Med (Lausanne) 2023; 10:1230854. [PMID: 37780563 PMCID: PMC10540306 DOI: 10.3389/fmed.2023.1230854] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Background Sepsis is a life-threatening disease commonly complicated by activation of coagulation and immune pathways. Sepsis-induced coagulopathy (SIC) is associated with micro- and macrothrombosis, but its relation to other cardiovascular complications remains less clear. In this study we explored associations between SIC and the occurrence of atrial fibrillation (AF) in patients admitted to the Intensive Care Unit (ICU) in sinus rhythm. We also aimed to identify predictive factors for the development of AF in patients with and without SIC. Methods Data were extracted from the publicly available AmsterdamUMCdb database. Patients with sepsis and documented sinus rhythm on admission to ICU were included. Patients were stratified into those who fulfilled the criteria for SIC and those who did not. Following univariate analysis, logistic regression models were developed to describe the association between routinely documented demographics and blood results and the development of at least one episode of AF. Machine learning methods (gradient boosting machines and random forest) were applied to define the predictive importance of factors contributing to the development of AF. Results Age was the strongest predictor for the development of AF in patients with and without SIC. Routine coagulation tests activated Partial Thromboplastin Time (aPTT) and International Normalized Ratio (INR) and C-reactive protein (CRP) as a marker of inflammation were also associated with AF occurrence in SIC-positive and SIC-negative patients. Cardiorespiratory parameters (oxygen requirements and heart rate) showed predictive potential. Conclusion Higher INR, elevated CRP, increased heart rate and more severe respiratory failure are risk factors for occurrence of AF in critical illness, suggesting an association between cardiac, respiratory and immune and coagulation pathways. However, age was the most dominant factor to predict the first episodes of AF in patients admitted in sinus rhythm with and without SIC.
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Affiliation(s)
- Sandra Ortega-Martorell
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - Ivan Olier
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - Brian W. Johnston
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Ingeborg D. Welters
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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Ortega-Martorell S, Olier I, Hernandez O, Restrepo-Galvis PD, Bellfield RAA, Candiota AP. Tracking Therapy Response in Glioblastoma Using 1D Convolutional Neural Networks. Cancers (Basel) 2023; 15:4002. [PMID: 37568818 PMCID: PMC10417313 DOI: 10.3390/cancers15154002] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/26/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Glioblastoma (GB) is a malignant brain tumour that is challenging to treat, often relapsing even after aggressive therapy. Evaluating therapy response relies on magnetic resonance imaging (MRI) following the Response Assessment in Neuro-Oncology (RANO) criteria. However, early assessment is hindered by phenomena such as pseudoprogression and pseudoresponse. Magnetic resonance spectroscopy (MRS/MRSI) provides metabolomics information but is underutilised due to a lack of familiarity and standardisation. METHODS This study explores the potential of spectroscopic imaging (MRSI) in combination with several machine learning approaches, including one-dimensional convolutional neural networks (1D-CNNs), to improve therapy response assessment. Preclinical GB (GL261-bearing mice) were studied for method optimisation and validation. RESULTS The proposed 1D-CNN models successfully identify different regions of tumours sampled by MRSI, i.e., normal brain (N), control/unresponsive tumour (T), and tumour responding to treatment (R). Class activation maps using Grad-CAM enabled the study of the key areas relevant to the models, providing model explainability. The generated colour-coded maps showing the N, T and R regions were highly accurate (according to Dice scores) when compared against ground truth and outperformed our previous method. CONCLUSIONS The proposed methodology may provide new and better opportunities for therapy response assessment, potentially providing earlier hints of tumour relapsing stages.
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Affiliation(s)
- Sandra Ortega-Martorell
- Data Science Research Centre, Liverpool John Moores University, Liverpool L3 3AF, UK; (I.O.); (R.A.A.B.)
| | - Ivan Olier
- Data Science Research Centre, Liverpool John Moores University, Liverpool L3 3AF, UK; (I.O.); (R.A.A.B.)
| | - Orlando Hernandez
- Escuela Colombiana de Ingeniería Julio Garavito, Bogota 111166, Colombia; (O.H.); (P.D.R.-G.)
| | | | - Ryan A. A. Bellfield
- Data Science Research Centre, Liverpool John Moores University, Liverpool L3 3AF, UK; (I.O.); (R.A.A.B.)
| | - Ana Paula Candiota
- Centro de Investigación Biomédica en Red: Bioingeniería, Biomateriales y Nanomedicina, 08193 Cerdanyola del Vallès, Spain
- Departament de Bioquímica i Biologia Molecular, Facultat de Biociències, Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain
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Wang R, Gerstein HC, Van Spall HG, Lip GY, Olier I, Ortega-Martorell S, Thabane L, Ye Z, Li G. Relationship between remnant cholesterol and risk of heart failure in participants with diabetes mellitus: reply. Eur Heart J Qual Care Clin Outcomes 2023:qcad038. [PMID: 37391362 DOI: 10.1093/ehjqcco/qcad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
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Wang R, Gerstein HC, Van Spall HGC, Lip GYH, Olier I, Ortega-Martorell S, Thabane L, Ye Z, Li G. Relationship between remnant cholesterol and risk of heart failure in participants with diabetes mellitus. Eur Heart J Qual Care Clin Outcomes 2023:7179408. [PMID: 37226578 DOI: 10.1093/ehjqcco/qcad030] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Evidence about the association between calculated remnant cholesterol (RC) and risk of heart failure (HF) in participants with diabetes mellitus (DM) remains sparse and limited. METHODS We included a total of 22 230 participants with DM from the UK Biobank for analyses. Participants were categorized into three groups based on their baseline RC measures: low (with a mean RC of 0.41 mmol/L), moderate (0.66 mmol/L), and high (1.04 mmol/L). Cox proportional hazards models were used to evaluate the relationship between RC groups and HF risk. We performed discordance analysis to evaluate whether RC was associated with HF risk independently of low-density lipoprotein cholesterol (LDL-C). RESULTS During a mean follow-up period of 11.5 years, there were a total of 2 232 HF events observed. The moderate RC group was significantly related with a 15% increased risk of HF when compared with low RC group (hazard ratio [HR] = 1.15, 95% confidence interval [CI]: 1.01-1.32), while the high RC group with a 23% higher HF risk (HR = 1.23, 95% CI: 1.05-1.43). There was significant relationship between RC as a continuous measure and the increased HF risk (P < 0.01). The association between RC and risk of HF was stronger in participants with HbA1c level ≥ 53 mmol/mol when compared with HbA1c < 53 mmol/mol (p for interaction = 0.02). Results from discordance analyses showed that RC was significantly related to HF risk independent of LDL-C measures. CONCLUSIONS Elevated RC was significantly associated with risk of HF in patients with DM. Moreover, RC was significantly related to HF risk independent of LDL-C measures. These findings may highlight the importance of RC management to HF risk in patients with DM.
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Affiliation(s)
- Ruoting Wang
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Hertzel C Gerstein
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, McMaster University, Hamilton, ON Canada
| | - Harriette G C Van Spall
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, McMaster University, Hamilton, ON Canada
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ivan Olier
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, UK
| | - Sandra Ortega-Martorell
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, UK
| | - Lehana Thabane
- Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Zebing Ye
- Department of Cardiology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
- Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
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Heseltine T, Hughes E, Mattew J, Murray S, Ortega-Martorell S, Olier I, Dey D, Lip GYH, Khoo S. The association of epicardial adipose tissue volume and density with coronary calcium in HIV-positive and HIV-negative patients. J Infect 2023; 86:376-384. [PMID: 36801347 DOI: 10.1016/j.jinf.2023.02.020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 01/27/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
AIMS We sought to assess and compare the association of epicardial adipose tissue (EAT) with cardiovascular disease (CVD) in HIV-positive and HIV-negative groups. METHODS AND RESULTS Using existing clinical databases, we analyzed 700 patients (195 HIV-positive, 505 HIV-negative). CVD was quantified by the presence of coronary calcification from both dedicated cardiac computed tomography (CT) and non-dedicated CT of the thorax. Epicardial adipose tissue (EAT) was quantified using dedicated software. The HIV-positive group had lower mean age (49.2 versus 57.8, p < 0.005), higher proportion of male sex (75.9 % versus 48.1 %, p < 0.005), and lower rates of coronary calcification (29.2 % versus 58.2 %, p < 0.005). Mean EAT volume was also lower in the HIV-positive group (68mm3 versus 118.3mm3, p < 0.005). Multiple linear regression demonstrated EAT volume was associated with hepatosteatosis (HS) in the HIV-positive group but not the HIV-negative group after adjustment for BMI (p < 0.005 versus p = 0.066). In the multivariate analysis, after adjustment for CVD risk factors, age, sex, statin use, and body mass index (BMI), EAT volume and hepatosteatosis were significantly associated with coronary calcification (odds ratio [OR] 1.14, p < 0.005 and OR 3.17, p < 0.005 respectively). In the HIV-negative group, the only significant association with EAT volume after adjustment was total cholesterol (OR 0.75, p = 0.012). CONCLUSIONS We demonstrated a strong and significant independent association of EAT volume and coronary calcium, after adjustment, in HIV-positive group but not in the HIV-negative group. This result hints at differences in the mechanistic drivers of atherosclerosis between HIV-positive and HIV-negative groups.
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Affiliation(s)
- Thomas Heseltine
- Department of Cardiology, Royal Liverpool University Hospital, Liverpool UK; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool UK.
| | - Elen Hughes
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool UK
| | - Jean Mattew
- Department of Cardiology, Royal Liverpool University Hospital, Liverpool UK
| | - Scott Murray
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool UK
| | - Sandra Ortega-Martorell
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool UK; School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool UK
| | - Ivan Olier
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool UK; School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool UK
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool UK
| | - Saye Khoo
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Vinciguerra M, Olier I, Ortega-Martorell S, Lip GYH. New use for an old drug: Metformin and atrial fibrillation. Cell Rep Med 2022; 3:100875. [PMID: 36543101 PMCID: PMC9798075 DOI: 10.1016/j.xcrm.2022.100875] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Lal and colleagues1 reported an integrative approach-combining transcriptomics, iPSCs, and epidemiological evidence-to identify and repurpose metformin, a main first-line medication for the treatment of type 2 diabetes, as an effective risk reducer for atrial fibrillation.
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Affiliation(s)
- Manlio Vinciguerra
- Liverpool Centre for Cardiovascular Science (LCCS) at University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool John Moores University, Liverpool, UK; Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Ivan Olier
- Liverpool Centre for Cardiovascular Science (LCCS) at University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool John Moores University, Liverpool, UK; School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, UK
| | - Sandra Ortega-Martorell
- Liverpool Centre for Cardiovascular Science (LCCS) at University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool John Moores University, Liverpool, UK; School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science (LCCS) at University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool John Moores University, Liverpool, UK; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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12
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Wang R, Olier I, Ortega-Martorell S, Liu Y, Ye Z, Lip GY, Li G. Association between metabolically healthy obesity and risk of atrial fibrillation: taking physical activity into consideration. Cardiovasc Diabetol 2022; 21:208. [PMID: 36229801 PMCID: PMC9563485 DOI: 10.1186/s12933-022-01644-z] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
The modification of physical activity (PA) on the metabolic status in relation to atrial fibrillation (AF) in obesity remains unknown. We aimed to investigate the independent and joint associations of metabolic status and PA with the risk of AF in obese population. Based on the data from UK Biobank study, we used Cox proportional hazards models for analyses. Metabolic status was categorized into metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). PA was categorized into four groups according to the level of moderate-to-vigorous PA (MVPA): none, low, medium, and high. A total of 119,424 obese participants were included for analyses. MHO was significantly associated with a 35% reduced AF risk compared with MUO (HR = 0.65, 95% CI: 0.57-0.73). No significant modification of PA on AF risk among individuals with MHO was found. Among the MUO participants, individuals with medium and high PA had significantly lower AF risk compared with no MVPA (HR = 0.84, 95% CI: 0.74-0.95, and HR = 0.87, 95% CI: 0.78-0.96 for medium and high PA, respectively). As the severity of MUO increased, the modification of PA on AF risk was elevated accordingly. To conclude, MHO was significantly associated with a reduced risk of AF when compared with MUO in obese participants. PA could significantly modify the relationship between metabolic status and risk of AF among MUO participants, with particular benefits of PA associated with the reduced AF risk as the MUO severity elevated.
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Affiliation(s)
- Ruoting Wang
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Ivan Olier
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, UK
| | - Sandra Ortega-Martorell
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, UK
| | - Yingxin Liu
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Zebing Ye
- Department of Cardiology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada. .,CCEM, Guangdong Second Provincial General Hospital, 510317, Guangzhou, China. .,Department of HEI, McMaster University, 1280 Main St West, L8S 4L8, Hamilton, ON, Canada.
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13
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Pieroni M, Olier I, Ortega-Martorell S, Johnston BW, Welters ID. In-Hospital Mortality of Sepsis Differs Depending on the Origin of Infection: An Investigation of Predisposing Factors. Front Med (Lausanne) 2022; 9:915224. [PMID: 35911394 PMCID: PMC9326002 DOI: 10.3389/fmed.2022.915224] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 04/07/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022] Open
Abstract
Sepsis is a heterogeneous syndrome characterized by a variety of clinical features. Analysis of large clinical datasets may serve to define groups of sepsis with different risks of adverse outcomes. Clinical experience supports the concept that prognosis, treatment, severity, and time course of sepsis vary depending on the source of infection. We analyzed a large publicly available database to test this hypothesis. In addition, we developed prognostic models for the three main types of sepsis: pulmonary, urinary, and abdominal sepsis. We used logistic regression using routinely available clinical data for mortality prediction in each of these groups. The data was extracted from the eICU collaborative research database, a multi-center intensive care unit with over 200,000 admissions. Sepsis cohorts were defined using admission diagnosis codes. We used univariate and multivariate analyses to establish factors relevant for outcome prediction in all three cohorts of sepsis (pulmonary, urinary and abdominal). For logistic regression, input variables were automatically selected using a sequential forward search algorithm over 10 dataset instances. Receiver operator characteristics were generated for each model and compared with established prognostication tools (APACHE IV and SOFA). A total of 3,958 sepsis admissions were included in the analysis. Sepsis in-hospital mortality differed depending on the cause of infection: abdominal 18.93%, pulmonary 19.27%, and renal 12.81%. Higher average heart rate was associated with increased mortality risk. Increased average Mean Arterial Pressure (MAP) showed a reduced mortality risk across all sepsis groups. Results from the LR models found significant factors that were relevant for specific sepsis groups. Our models outperformed APACHE IV and SOFA scores with AUC between 0.63 and 0.74. Predictive power decreased over time, with the best results achieved for data extracted for the first 24 h of admission. Mortality varied significantly between the three sepsis groups. We also demonstrate that factors of importance show considerable heterogeneity depending on the source of infection. The factors influencing in-hospital mortality vary depending on the source of sepsis which may explain why most sepsis trials have failed to identify an effective treatment. The source of infection should be considered when considering mortality risk. Planning of sepsis treatment trials may benefit from risk stratification based on the source of infection.
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Affiliation(s)
- Mark Pieroni
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - Ivan Olier
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - Sandra Ortega-Martorell
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - Brian W Johnston
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom
| | - Ingeborg D Welters
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom
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14
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McCabe PG, Lisboa P, Baltzopoulos B, Olier I. Externally validated models for first diagnosis and risk of progression of knee osteoarthritis. PLoS One 2022; 17:e0270652. [PMID: 35776714 PMCID: PMC9249202 DOI: 10.1371/journal.pone.0270652] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/14/2022] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE We develop and externally validate two models for use with radiological knee osteoarthritis. They consist of a diagnostic model for KOA and a prognostic model of time to onset of KOA. Model development and optimisation used data from the Osteoarthritis initiative (OAI) and external validation for both models was by application to data from the Multicenter Osteoarthritis Study (MOST). MATERIALS AND METHODS The diagnostic model at first presentation comprises subjects in the OAI with and without KOA (n = 2006), modelling with multivariate logistic regression. The prognostic sample involves 5-year follow-up of subjects presenting without clinical KOA (n = 1155), with modelling with Cox regression. In both instances the models used training data sets of n = 1353 and 1002 subjects and optimisation used test data sets of n = 1354 and 1003. The external validation data sets for the diagnostic and prognostic models comprised n = 2006 and n = 1155 subjects respectively. RESULTS The classification performance of the diagnostic model on the test data has an AUC of 0.748 (0.721-0.774) and 0.670 (0.631-0.708) in external validation. The survival model has concordance scores for the OAI test set of 0.74 (0.7325-0.7439) and in external validation 0.72 (0.7190-0.7373). The survival approach stratified the population into two risk cohorts. The separation between the cohorts remains when the model is applied to the validation data. DISCUSSION The models produced are interpretable with app interfaces that implement nomograms. The apps may be used for stratification and for patient education over the impact of modifiable risk factors. The externally validated results, by application to data from a substantial prospective observational study, show the robustness of models for likelihood of presenting with KOA at an initial assessment based on risk factors identified by the OAI protocol and stratification of risk for developing KOA in the next five years. CONCLUSION Modelling clinical KOA from OAI data validates well for the MOST data set. Both risk models identified key factors for differentiation of the target population from commonly available variables. With this analysis there is potential to improve clinical management of patients.
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Affiliation(s)
- Philippa Grace McCabe
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, England, United Kingdom
| | - Paulo Lisboa
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, England, United Kingdom
| | - Bill Baltzopoulos
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, England, United Kingdom
| | - Ivan Olier
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, England, United Kingdom
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15
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Ortega-Martorell S, Pieroni M, Johnston BW, Olier I, Welters ID. Development of a Risk Prediction Model for New Episodes of Atrial Fibrillation in Medical-Surgical Critically Ill Patients Using the AmsterdamUMCdb. Front Cardiovasc Med 2022; 9:897709. [PMID: 35647039 PMCID: PMC9135978 DOI: 10.3389/fcvm.2022.897709] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
The occurrence of atrial fibrillation (AF) represents clinical deterioration in acutely unwell patients and leads to increased morbidity and mortality. Prediction of the development of AF allows early intervention. Using the AmsterdamUMCdb, clinically relevant variables from patients admitted in sinus rhythm were extracted over the full duration of the ICU stay or until the first recorded AF episode occurred. Multiple logistic regression was performed to identify risk factors for AF. Input variables were automatically selected by a sequential forward search algorithm using cross-validation. We developed three different models: For the overall cohort, for ventilated patients and non-ventilated patients. 16,144 out of 23,106 admissions met the inclusion criteria. 2,374 (12.8%) patients had at least one AF episode during their ICU stay. Univariate analysis revealed that a higher percentage of AF patients were older than 70 years (60% versus 32%) and died in ICU (23.1% versus 7.1%) compared to non-AF patients. Multivariate analysis revealed age to be the dominant risk factor for developing AF with doubling of age leading to a 10-fold increased risk. Our logistic regression models showed excellent performance with AUC.ROC > 0.82 and > 0.91 in ventilated and non-ventilated cohorts, respectively. Increasing age was the dominant risk factor for the development of AF in both ventilated and non-ventilated critically ill patients. In non-ventilated patients, risk for development of AF was significantly higher than in ventilated patients. Further research is warranted to identify the role of ventilatory settings on risk for AF in critical illness and to optimise predictive models.
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Affiliation(s)
- Sandra Ortega-Martorell
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
- *Correspondence: Sandra Ortega-Martorell,
| | - Mark Pieroni
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - Brian W. Johnston
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Ivan Olier
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - Ingeborg D. Welters
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Ingeborg D. Welters,
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16
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Heseltine T, Murray S, Ortega-Martorell S, Olier I, Lip GYH, Khoo S. Associations of Hepatosteatosis With Cardiovascular Disease in HIV-Positive and HIV-Negative Patients: The Liverpool HIV-Heart Project. J Acquir Immune Defic Syndr 2021; 87:1221-1227. [PMID: 33990492 DOI: 10.1097/qai.0000000000002721] [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] [Received: 01/22/2021] [Accepted: 04/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hepatosteatosis (HS) has been associated with cardiovascular disorders in the general population. We sought to investigate whether HS is a marker of cardiovascular disease (CVD) risk in HIV-positive individuals, given that metabolic syndrome is implicated in the increasing CVD burden in this population. AIMS To investigate the association of HS with CVD in HIV-positive and HIV-negative individuals. METHODS AND RESULTS We analyzed computed tomography (CT) images of 1306 subjects of whom 209 (16%) were HIV-positive and 1097 (84%) HIV-negative. CVD was quantified by the presence of coronary calcification from both dedicated cardiac CT and nondedicated thorax CT. HS was diagnosed from CT data sets in those with noncontrast dedicated cardiac CT and those with venous phase liver CT using previously validated techniques. Previous liver ultrasound was also assessed for the presence of HS. The HIV-positive group had lower mean age (P < 0.005), higher proportions of male sex (P < 0.005), and more current smokers (P < 0.005). The HIV-negative group had higher proportions of hypertension (P < 0.005), type II diabetes (P = 0.032), dyslipidemia (P < 0.005), statin use (P = 0.008), and HS (P = 0.018). The prevalence of coronary calcification was not significantly different between the groups. Logistic regression (LR) demonstrated that in the HIV-positive group, increasing age [odds ratio (OR): 1.15, P < 0.005], male sex (OR 3.37, P = 0.022), and HS (OR 3.13, P = 0.005) were independently associated with CVD. In the HIV-negative group, increasing age (OR: 1.11, P < 0.005), male sex (OR 2.97, P < 0.005), current smoking (OR 1.96, P < 0.005), and dyslipidemia (OR 1.66, P = 0.03) were independently associated with CVD. Using a machine learning random forest algorithm to assess the variables of importance, the top 3 variables of importance in the HIV-positive group were age, HS, and male sex. In the HIV-negative group, the top 3 variables were age, hypertension and male sex. The LR models predicted CVD well, with the mean area under the receiver operator curve (AUC) for the HIV-positive and HIV-negative cohorts being 0.831 [95% confidence interval (CI): 0.713 to 0.928] and 0.786 (95% CI: 0.735 to 0.836), respectively. The random forest models outperformed LR models, with a mean AUC in HIV-positive and HIV-negative populations of 0.877 (95% CI: 0.775 to 0.959) and 0.828 (95% CI: 0.780 to 0.873) respectively, with differences between both methods being statistically significant. CONCLUSION In contrast to the general population, HS is a strong and independent predictor of CVD in HIV-positive individuals. This suggests that metabolic dysfunction may be attributable to the excess CVD risk seen with these patient groups. Assessment of HS may help accurate quantification of CVD risk in HIV-positive patients.
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Affiliation(s)
- Thomas Heseltine
- Department of Cardiology, Royal Liverpool University Hospital, Liverpool, United Kingdom
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom ; and
| | - Scott Murray
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom ; and
| | - Sandra Ortega-Martorell
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom ; and
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom
| | - Ivan Olier
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom ; and
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom ; and
| | - Saye Khoo
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
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17
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Olier I, Ortega-Martorell S, Pieroni M, Lip GYH. How machine learning is impacting research in atrial fibrillation: implications for risk prediction and future management. Cardiovasc Res 2021; 117:1700-1717. [PMID: 33982064 PMCID: PMC8477792 DOI: 10.1093/cvr/cvab169] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 01/18/2021] [Accepted: 05/11/2021] [Indexed: 02/01/2023] Open
Abstract
There has been an exponential growth of artificial intelligence (AI) and machine learning (ML) publications aimed at advancing our understanding of atrial fibrillation (AF), which has been mainly driven by the confluence of two factors: the advances in deep neural networks (DeepNNs) and the availability of large, open access databases. It is observed that most of the attention has centred on applying ML for dvsetecting AF, particularly using electrocardiograms (ECGs) as the main data modality. Nearly a third of them used DeepNNs to minimize or eliminate the need for transforming the ECGs to extract features prior to ML modelling; however, we did not observe a significant advantage in following this approach. We also found a fraction of studies using other data modalities, and others centred in aims, such as risk prediction, AF management, and others. From the clinical perspective, AI/ML can help expand the utility of AF detection and risk prediction, especially for patients with additional comorbidities. The use of AI/ML for detection and risk prediction into applications and smart mobile health (mHealth) technology would enable ‘real time’ dynamic assessments. AI/ML could also adapt to treatment changes over time, as well as incident risk factors. Incorporation of a dynamic AI/ML model into mHealth technology would facilitate ‘real time’ assessment of stroke risk, facilitating mitigation of modifiable risk factors (e.g. blood pressure control). Overall, this would lead to an improvement in clinical care for patients with AF.
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Affiliation(s)
- Ivan Olier
- School of Computer Science and Mathematics, Liverpool John Moores University, 3 Byrom Street, Liverpool L3 3AF, UK.,Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Sandra Ortega-Martorell
- School of Computer Science and Mathematics, Liverpool John Moores University, 3 Byrom Street, Liverpool L3 3AF, UK.,Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Mark Pieroni
- School of Computer Science and Mathematics, Liverpool John Moores University, 3 Byrom Street, Liverpool L3 3AF, UK.,Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK.,Liverpool Heart and Chest Hospital, Liverpool, UK
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18
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Ta Q, Ting J, Harwood S, Browning N, Simm A, Ross K, Olier I, Al-Kassas R. Chitosan nanoparticles for enhancing drugs and cosmetic components penetration through the skin. Eur J Pharm Sci 2021; 160:105765. [PMID: 33607243 DOI: 10.1016/j.ejps.2021.105765] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [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: 11/20/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 12/24/2022]
Abstract
Chitosan nanoparticles (CT NPs) have attractive biomedical applications due to their unique properties. This present research aimed at development of chitosan nanoparticles to be used as skin delivery systems for cosmetic components and drugs and to track their penetration behaviour through pig skin. CT NPs were prepared by ionic gelation technique using sodium tripolyphosphate (TPP) and Acacia as crosslinkers. The particle sizes of NPs appeared to be dependent on the molecular weight of chitosan and concentration of both chitosan and crosslinkers. CT NPs were positively charged as demonstrated by their Zeta potential values. The formation of the nanoparticles was confirmed by FTIR and DSC. Both SEM and TEM micrographs showed that both CT-Acacia and CT:TPP NPs were smooth, spherical in shape and are distributed uniformly with a size range of 200nm to 300 nm. The CT:TPP NPs retained an average of 98% of the added water over a 48-hour period. CT-Acacia NPs showed high moisture absorption but lower moisture retention capacity, which indicates their competency to entrap polar actives in cosmetics and release the encapsulated actives in low polarity skin conditions. The cytotoxicity studies using MTT assay showed that CT NPs made using TPP or Acacia crosslinkers were similarly non-toxic to the human dermal fibroblast cells. Cellular uptake study of NPs observed using live-cell imaging microscopy, proving the great cellular internalisation of CT:TPP NPs and CT-Acacia NPs. Confocal laser scanning microscopy revealed that CT NPs of particle size 530nm containing fluorescein sodium salt as a marker were able to penetrate through the pig skin and gather in the dermis layer. These results show that CT NPs have the ability to deliver the actives and cosmetic components through the skin and to be used as cosmetics and dermal drug delivery system.
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Affiliation(s)
- Quynh Ta
- School of Pharmacy and Biomolecular Science, Faculty of Science, Liverpool John Moores University, James Parsons Building, Byrom St, Liverpool, L3 3AF, UK
| | - Jessica Ting
- School of Pharmacy and Biomolecular Science, Faculty of Science, Liverpool John Moores University, James Parsons Building, Byrom St, Liverpool, L3 3AF, UK
| | - Sophie Harwood
- School of Pharmacy and Biomolecular Science, Faculty of Science, Liverpool John Moores University, James Parsons Building, Byrom St, Liverpool, L3 3AF, UK
| | - Nicola Browning
- Faculty of Science, Liverpool John Moores University, James Parsons Building, Byrom St, Liverpool, L3 3AF, UK
| | - Alan Simm
- Faculty of Science, Liverpool John Moores University, James Parsons Building, Byrom St, Liverpool, L3 3AF, UK
| | - Kehinde Ross
- School of Pharmacy and Biomolecular Science, Faculty of Science, Liverpool John Moores University, James Parsons Building, Byrom St, Liverpool, L3 3AF, UK
| | - Ivan Olier
- School of Computer Science and Mathematics, Liverpool John Moores University, James Parsons Building, Byrom St, Liverpool, L3 3AF, UK
| | - Raida Al-Kassas
- School of Pharmacy and Biomolecular Science, Faculty of Science, Liverpool John Moores University, James Parsons Building, Byrom St, Liverpool, L3 3AF, UK.
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19
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Sadawi N, Olier I, Vanschoren J, van Rijn JN, Besnard J, Bickerton R, Grosan C, Soldatova L, King RD. Multi-task learning with a natural metric for quantitative structure activity relationship learning. J Cheminform 2019; 11:68. [PMID: 33430958 PMCID: PMC6852942 DOI: 10.1186/s13321-019-0392-1] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/04/2019] [Indexed: 11/24/2022] Open
Abstract
The goal of quantitative structure activity relationship (QSAR) learning is to learn a function that, given the structure of a small molecule (a potential drug), outputs the predicted activity of the compound. We employed multi-task learning (MTL) to exploit commonalities in drug targets and assays. We used datasets containing curated records about the activity of specific compounds on drug targets provided by ChEMBL. Totally, 1091 assays have been analysed. As a baseline, a single task learning approach that trains random forest to predict drug activity for each drug target individually was considered. We then carried out feature-based and instance-based MTL to predict drug activities. We introduced a natural metric of evolutionary distance between drug targets as a measure of tasks relatedness. Instance-based MTL significantly outperformed both, feature-based MTL and the base learner, on 741 drug targets out of 1091. Feature-based MTL won on 179 occasions and the base learner performed best on 171 drug targets. We conclude that MTL QSAR is improved by incorporating the evolutionary distance between targets. These results indicate that QSAR learning can be performed effectively, even if little data is available for specific drug targets, by leveraging what is known about similar drug targets.
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Affiliation(s)
- Noureddin Sadawi
- Department of Medicine, Imperial College London, London, UK
- Brunel University London, London, UK
| | - Ivan Olier
- Department of Applied Mathematics, Liverpool John Moores University, Liverpool, UK
| | | | | | - Jeremy Besnard
- University of Dundee, Dundee, Dundee, UK
- Ex Scientia Ltd, Dundee, UK
| | | | | | - Larisa Soldatova
- Brunel University London, London, UK
- Goldsmiths, University of London, London, UK
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20
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Ortega-Martorell S, Candiota AP, Thomson R, Riley P, Julia-Sape M, Olier I. Embedding MRI information into MRSI data source extraction improves brain tumour delineation in animal models. PLoS One 2019; 14:e0220809. [PMID: 31415601 PMCID: PMC6695141 DOI: 10.1371/journal.pone.0220809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/23/2019] [Indexed: 01/22/2023] Open
Abstract
Glioblastoma is the most frequent malignant intra-cranial tumour. Magnetic resonance imaging is the modality of choice in diagnosis, aggressiveness assessment, and follow-up. However, there are examples where it lacks diagnostic accuracy. Magnetic resonance spectroscopy enables the identification of molecules present in the tissue, providing a precise metabolomic signature. Previous research shows that combining imaging and spectroscopy information results in more accurate outcomes and superior diagnostic value. This study proposes a method to combine them, which builds upon a previous methodology whose main objective is to guide the extraction of sources. To this aim, prior knowledge about class-specific information is integrated into the methodology by setting the metric of a latent variable space where Non-negative Matrix Factorisation is performed. The former methodology, which only used spectroscopy and involved combining spectra from different subjects, was adapted to use selected areas of interest that arise from segmenting the T2-weighted image. Results showed that embedding imaging information into the source extraction (the proposed semi-supervised analysis) improved the quality of the tumour delineation, as compared to those obtained without this information (unsupervised analysis). Both approaches were applied to pre-clinical data, involving thirteen brain tumour-bearing mice, and tested against histopathological data. On results of twenty-eight images, the proposed Semi-Supervised Source Extraction (SSSE) method greatly outperformed the unsupervised one, as well as an alternative semi-supervised approach from the literature, with differences being statistically significant. SSSE has proven successful in the delineation of the tumour, while bringing benefits such as 1) not constricting the metabolomic-based prediction to the image-segmented area, 2) ability to deal with signal-to-noise issues, 3) opportunity to answer specific questions by allowing researchers/radiologists define areas of interest that guide the source extraction, 4) creation of an intra-subject model and avoiding contamination from inter-subject overlaps, and 5) extraction of meaningful, good-quality sources that adds interpretability, conferring validation and better understanding of each case.
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Affiliation(s)
- Sandra Ortega-Martorell
- Department of Applied Mathematics, Liverpool John Moores University, Liverpool, England, United Kingdom
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Cerdanyola del Vallès, Spain
- * E-mail:
| | - Ana Paula Candiota
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Cerdanyola del Vallès, Spain
- Departament de Bioquímica i Biologia Molecular, Unitat de Biociències, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Institut de Biotecnologia i de Biomedicina, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Ryan Thomson
- Department of Applied Mathematics, Liverpool John Moores University, Liverpool, England, United Kingdom
| | - Patrick Riley
- Department of Applied Mathematics, Liverpool John Moores University, Liverpool, England, United Kingdom
| | - Margarida Julia-Sape
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Cerdanyola del Vallès, Spain
- Departament de Bioquímica i Biologia Molecular, Unitat de Biociències, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Institut de Biotecnologia i de Biomedicina, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Ivan Olier
- Department of Applied Mathematics, Liverpool John Moores University, Liverpool, England, United Kingdom
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Rashid M, Kwok CS, Gale CP, Doherty P, Olier I, Sperrin M, Kontopantelis E, Peat G, Mamas MA. Impact of co-morbid burden on mortality in patients with coronary heart disease, heart failure, and cerebrovascular accident: a systematic review and meta-analysis. Eur Heart J Qual Care Clin Outcomes 2018; 3:20-36. [PMID: 28927187 DOI: 10.1093/ehjqcco/qcw025] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 05/05/2016] [Indexed: 01/02/2023]
Abstract
Aims We sought to investigate the prognostic impact of co-morbid burden as defined by the Charlson Co-morbidity Index (CCI) in patients with a range of prevalent cardiovascular diseases. Methods and results We searched MEDLINE and EMBASE to identify studies that evaluated the impact of CCI on mortality in patients with cardiovascular disease. A random-effects meta-analysis was undertaken to evaluate the impact of CCI on mortality in patients with coronary heart disease (CHD), heart failure (HF), and cerebrovascular accident (CVA). A total of 11 studies of acute coronary syndrome (ACS), 2 stable coronary disease, 5 percutaneous coronary intervention (PCI), 13 HF, and 4 CVA met the inclusion criteria. An increase in CCI score per point was significantly associated with a greater risk of mortality in patients with ACS [pooled relative risk ratio (RR) 1.33; 95% CI 1.15-1.54], PCI (RR 1.21; 95% CI 1.12-1.31), stable coronary artery disease (RR 1.38; 95% CI 1.29-1.48), and HF (RR 1.21; 95% CI 1.13-1.29), but not CVA. A CCI score of >2 significantly increased the risk of mortality in ACS (RR 2.52; 95% CI 1.58-4.04), PCI (RR 3.36; 95% CI 2.14-5.29), HF (RR 1.76; 95% CI 1.65-1.87), and CVA (RR 3.80; 95% CI 1.20-12.01). Conclusion Increasing co-morbid burden as defined by CCI is associated with a significant increase in risk of mortality in patients with underlying CHD, HF, and CVA. CCI provides a simple way of predicting adverse outcomes in patients with cardiovascular disease and should be incorporated into decision-making processes when counselling patients.
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Affiliation(s)
- Muhammad Rashid
- Keele Cardiovascular Research Group, Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent ST4 7QB, UK
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent ST4 7QB, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Ivan Olier
- Keele Cardiovascular Research Group, Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent ST4 7QB, UK
| | - Matthew Sperrin
- Far Institute, Institute of Population Health, University of Manchester, Manchester, UK
| | | | - George Peat
- Institute for Primary Care and Health Sciences, University of Keele, Keele, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent ST4 7QB, UK.,Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, UK
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Olier I, Sirker A, Hildick-Smith DJR, Kinnaird T, Ludman P, de Belder MA, Baumbach A, Byrne J, Rashid M, Curzen N, Mamas MA. Association of different antiplatelet therapies with mortality after primary percutaneous coronary intervention. Heart 2018; 104:1683-1690. [PMID: 29437885 DOI: 10.1136/heartjnl-2017-312366] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/22/2017] [Accepted: 01/07/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Prasugrel and ticagrelor both reduce ischaemic endpoints in high-risk acute coronary syndromes, compared with clopidogrel. However, comparative outcomes of these two newer drugs in the context of primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) remains unclear. We sought to examine this question using the British Cardiovascular Interventional Society national database in patients undergoing primary PCI for STEMI. METHODS Data from January 2007 to December 2014 were used to compare use of P2Y12 antiplatelet drugs in primary PCI in >89 000 patients. Statistical modelling, involving propensity matching, multivariate logistic regression (MLR) and proportional hazards modelling, was used to study the association of different antiplatelet drug use with all-cause mortality. RESULTS In our main MLR analysis, prasugrel was associated with significantly lower mortality than clopidogrel at both 30 days (OR 0.87, 95% CI 0.78 to 0.97, P=0.014) and 1 year (OR 0.89, 95% CI 0.82 to 0.97, P=0.011) post PCI. Ticagrelor was not associated with any significant differences in mortality compared with clopidogrel at either 30 days (OR 1.07, 95% CI 0.95 to 1.21, P=0.237) or 1 year (OR 1.058, 95% CI 0.96 to 1.16, P=0.247). Finally, ticagrelor was associated with significantly higher mortality than prasugrel at both time points (30 days OR 1.22, 95% CI 1.03 to 1.44, P=0.020; 1 year OR 1.19 95% CI 1.04 to 1.35, P=0.01). CONCLUSIONS In a cohort of over 89 000 patients undergoing primary PCI for STEMI in the UK, prasugrel is associated with a lower 30-day and 1-year mortality than clopidogrel and ticagrelor. Given that an adequately powered comparative randomised trial is unlikely to be performed, these data may have implications for routine care.
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Affiliation(s)
- Ivan Olier
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK.,Department of Applied Mathematics, Liverpool John Moores University, Liverpool, UK
| | - Alex Sirker
- Department of Cardiology, The Heart Hospital, University College London Hospitals, London, UK
| | | | - Tim Kinnaird
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK.,Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Peter Ludman
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Mark A de Belder
- Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK
| | | | | | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK.,Academic Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, UK
| | - Nick Curzen
- Department of cardiology, University Hospital Southampton, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK.,Academic Department of Cardiology, Royal Stoke Hospital, University Hospital North Midlands, Stoke-on-Trent, UK
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Olier I, Sadawi N, Bickerton GR, Vanschoren J, Grosan C, Soldatova L, King RD. Meta-QSAR: a large-scale application of meta-learning to drug design and discovery. Mach Learn 2017; 107:285-311. [PMID: 31997851 PMCID: PMC6956898 DOI: 10.1007/s10994-017-5685-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 05/09/2016] [Accepted: 10/04/2017] [Indexed: 11/03/2022]
Abstract
We investigate the learning of quantitative structure activity relationships (QSARs) as a case-study of meta-learning. This application area is of the highest societal importance, as it is a key step in the development of new medicines. The standard QSAR learning problem is: given a target (usually a protein) and a set of chemical compounds (small molecules) with associated bioactivities (e.g. inhibition of the target), learn a predictive mapping from molecular representation to activity. Although almost every type of machine learning method has been applied to QSAR learning there is no agreed single best way of learning QSARs, and therefore the problem area is well-suited to meta-learning. We first carried out the most comprehensive ever comparison of machine learning methods for QSAR learning: 18 regression methods, 3 molecular representations, applied to more than 2700 QSAR problems. (These results have been made publicly available on OpenML and represent a valuable resource for testing novel meta-learning methods.) We then investigated the utility of algorithm selection for QSAR problems. We found that this meta-learning approach outperformed the best individual QSAR learning method (random forests using a molecular fingerprint representation) by up to 13%, on average. We conclude that meta-learning outperforms base-learning methods for QSAR learning, and as this investigation is one of the most extensive ever comparisons of base and meta-learning methods ever made, it provides evidence for the general effectiveness of meta-learning over base-learning.
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Affiliation(s)
- Ivan Olier
- 1Manchester Metropolitan University, Manchester, UK.,2University of Manchester, Manchester, UK
| | - Noureddin Sadawi
- 3Imperial College London, London, UK.,4Brunel University London, London, UK
| | | | | | - Crina Grosan
- 4Brunel University London, London, UK.,8Babes-Bolyai University, Cluj-Napoca, Romania
| | - Larisa Soldatova
- 4Brunel University London, London, UK.,9Goldsmiths, University of London, London, UK
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Rashid M, Rushton CA, Kwok CS, Kinnaird T, Kontopantelis E, Olier I, Ludman P, De Belder MA, Nolan J, Mamas MA. Impact of Access Site Practice on Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention Following Thrombolysis for ST-Segment Elevation Myocardial Infarction in the United Kingdom. JACC Cardiovasc Interv 2017; 10:2258-2265. [DOI: 10.1016/j.jcin.2017.07.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/05/2017] [Accepted: 07/24/2017] [Indexed: 10/18/2022]
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Springate DA, Parisi R, Olier I, Reeves D, Kontopantelis E. rEHR: An R package for manipulating and analysing Electronic Health Record data. PLoS One 2017; 12:e0171784. [PMID: 28231289 PMCID: PMC5323003 DOI: 10.1371/journal.pone.0171784] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/25/2017] [Indexed: 12/24/2022] Open
Abstract
Research with structured Electronic Health Records (EHRs) is expanding as data becomes more accessible; analytic methods advance; and the scientific validity of such studies is increasingly accepted. However, data science methodology to enable the rapid searching/extraction, cleaning and analysis of these large, often complex, datasets is less well developed. In addition, commonly used software is inadequate, resulting in bottlenecks in research workflows and in obstacles to increased transparency and reproducibility of the research. Preparing a research-ready dataset from EHRs is a complex and time consuming task requiring substantial data science skills, even for simple designs. In addition, certain aspects of the workflow are computationally intensive, for example extraction of longitudinal data and matching controls to a large cohort, which may take days or even weeks to run using standard software. The rEHR package simplifies and accelerates the process of extracting ready-for-analysis datasets from EHR databases. It has a simple import function to a database backend that greatly accelerates data access times. A set of generic query functions allow users to extract data efficiently without needing detailed knowledge of SQL queries. Longitudinal data extractions can also be made in a single command, making use of parallel processing. The package also contains functions for cutting data by time-varying covariates, matching controls to cases, unit conversion and construction of clinical code lists. There are also functions to synthesise dummy EHR. The package has been tested with one for the largest primary care EHRs, the Clinical Practice Research Datalink (CPRD), but allows for a common interface to other EHRs. This simplified and accelerated work flow for EHR data extraction results in simpler, cleaner scripts that are more easily debugged, shared and reproduced.
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Affiliation(s)
- David A. Springate
- NIHR School for Primary Care Research, University of Manchester, Manchester, United Kingdom
- Centre for Biostatistics, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
| | - Rosa Parisi
- Centre for Pharmacoepidemiology & Drug Safety, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
| | - Ivan Olier
- Informatics Research Centre, School of Computing Mathematics and Digital Technology, Manchester Metropolitan University, Manchester, United Kingdom
| | - David Reeves
- NIHR School for Primary Care Research, University of Manchester, Manchester, United Kingdom
- Centre for Biostatistics, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, University of Manchester, Manchester, United Kingdom
- The Farr Institute for Health Informatics Research, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
- * E-mail:
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Kwok CS, Hulme W, Olier I, Holroyd E, Mamas MA. Review of early hospitalisation after percutaneous coronary intervention. Int J Cardiol 2016; 227:370-377. [PMID: 27839805 DOI: 10.1016/j.ijcard.2016.11.050] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/19/2016] [Accepted: 11/05/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is the most common modality of revascularization in patients with coronary artery disease. Understanding the readmission rates and reasons for readmission after PCI is important because readmissions are a quality of care indicator, in addition to being a burden to patients and healthcare services. METHODS A literature review was performed. Relevant studies are described by narrative synthesis with the use of tables to summarize study results. RESULTS Data suggests that 30-day readmissions are not uncommon. The rate of readmission after PCI is highly influenced by the cohort and the healthcare system studied, with 30-day readmission rates reported to be between 4.7-% and 15.6%. Studies consistently report that a majority of readmissions within 30days are due to a cardiac-related disorders or complication-related disorders. Female sex, peripheral vascular disease, diabetes mellitus, renal failure and non-elective PCI are predictive of readmission. Studies also suggest that there is greater risk of mortality among patients who are readmitted compared to those who are not readmitted. CONCLUSION Readmission after PCI is common and its rate is highly influenced by the type of cohort studied. There is clear evidence that majority of readmissions within 30days are cardiac related. While there are many predictors of readmission following PCI, it is not known whether targeting patients with modifiable predictors could prevent or reduce the rates of readmission.
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Affiliation(s)
- Chun Shing Kwok
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK; University Hospital North Staffordshire, Stoke-on-Trent, UK; University of Manchester, Manchester, UK.
| | - William Hulme
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
| | - Ivan Olier
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK; University Hospital North Staffordshire, Stoke-on-Trent, UK
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK; University Hospital North Staffordshire, Stoke-on-Trent, UK; University of Manchester, Manchester, UK
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Delgado-Goñi T, Ortega-Martorell S, Ciezka M, Olier I, Candiota AP, Julià-Sapé M, Fernández F, Pumarola M, Lisboa PJ, Arús C. MRSI-based molecular imaging of therapy response to temozolomide in preclinical glioblastoma using source analysis. NMR Biomed 2016; 29:732-743. [PMID: 27061401 DOI: 10.1002/nbm.3521] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 02/14/2016] [Accepted: 02/23/2016] [Indexed: 06/05/2023]
Abstract
Characterization of glioblastoma (GB) response to treatment is a key factor for improving patients' survival and prognosis. MRI and magnetic resonance spectroscopic imaging (MRSI) provide morphologic and metabolic profiles of GB but usually fail to produce unequivocal biomarkers of response. The purpose of this work is to provide proof of concept of the ability of a semi-supervised signal source extraction methodology to produce images with robust recognition of response to temozolomide (TMZ) in a preclinical GB model. A total of 38 female C57BL/6 mice were used in this study. The semi-supervised methodology extracted the required sources from a training set consisting of MRSI grids from eight GL261 GBs treated with TMZ, and six control untreated GBs. Three different sources (normal brain parenchyma, actively proliferating GB and GB responding to treatment) were extracted and used for calculating nosologic maps representing the spatial response to treatment. These results were validated with an independent test set (7 control and 17 treated cases) and correlated with histopathology. Major differences between the responder and non-responder sources were mainly related to the resonances of mobile lipids (MLs) and polyunsaturated fatty acids in MLs (0.9, 1.3 and 2.8 ppm). Responding tumors showed significantly lower mitotic (3.3 ± 2.9 versus 14.1 ± 4.2 mitoses/field) and proliferation rates (29.8 ± 10.3 versus 57.8 ± 5.4%) than control untreated cases. The methodology described in this work is able to produce nosological images of response to TMZ in GL261 preclinical GBs and suitably correlates with the histopathological analysis of tumors. A similar strategy could be devised for monitoring response to treatment in patients. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- T Delgado-Goñi
- Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - S Ortega-Martorell
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Department of Mathematics and Statistics, Liverpool John Moores University, Liverpool, UK
| | - M Ciezka
- Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Institut de Biotecnologia i de Biomedicina, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - I Olier
- Institute for Science and Technology in Medicine, Keele University, Stoke-On-Trent, UK
- Centre for Health Informatics, Institute of Population Health University of Manchester, Manchester, UK
| | - A P Candiota
- Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Institut de Biotecnologia i de Biomedicina, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - M Julià-Sapé
- Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Institut de Biotecnologia i de Biomedicina, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - F Fernández
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Departament de Medicina i Cirurgia Animals, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - M Pumarola
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Departament de Medicina i Cirurgia Animals, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - P J Lisboa
- Department of Mathematics and Statistics, Liverpool John Moores University, Liverpool, UK
| | - C Arús
- Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Institut de Biotecnologia i de Biomedicina, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
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Olier I, Springate DA, Ashcroft DM, Doran T, Reeves D, Planner C, Reilly S, Kontopantelis E. Modelling Conditions and Health Care Processes in Electronic Health Records: An Application to Severe Mental Illness with the Clinical Practice Research Datalink. PLoS One 2016; 11:e0146715. [PMID: 26918439 PMCID: PMC4769302 DOI: 10.1371/journal.pone.0146715] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/20/2015] [Indexed: 01/08/2023] Open
Abstract
Background The use of Electronic Health Records databases for medical research has become mainstream. In the UK, increasing use of Primary Care Databases is largely driven by almost complete computerisation and uniform standards within the National Health Service. Electronic Health Records research often begins with the development of a list of clinical codes with which to identify cases with a specific condition. We present a methodology and accompanying Stata and R commands (pcdsearch/Rpcdsearch) to help researchers in this task. We present severe mental illness as an example. Methods We used the Clinical Practice Research Datalink, a UK Primary Care Database in which clinical information is largely organised using Read codes, a hierarchical clinical coding system. Pcdsearch is used to identify potentially relevant clinical codes and/or product codes from word-stubs and code-stubs suggested by clinicians. The returned code-lists are reviewed and codes relevant to the condition of interest are selected. The final code-list is then used to identify patients. Results We identified 270 Read codes linked to SMI and used them to identify cases in the database. We observed that our approach identified cases that would have been missed with a simpler approach using SMI registers defined within the UK Quality and Outcomes Framework. Conclusion We described a framework for researchers of Electronic Health Records databases, for identifying patients with a particular condition or matching certain clinical criteria. The method is invariant to coding system or database and can be used with SNOMED CT, ICD or other medical classification code-lists.
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Affiliation(s)
- Ivan Olier
- Institute of Biotechnology, University of Manchester, Manchester, United Kingdom
- Centre for Primary Care, NIHR School of Primary Care Research, Institute of Population Health, University of Manchester, Manchester, United Kingdom
| | - David A. Springate
- Centre for Primary Care, NIHR School of Primary Care Research, Institute of Population Health, University of Manchester, Manchester, United Kingdom
- Centre for Biostatistics, NIHR School of Primary Care Research, Institute of Population Health, University of Manchester, Manchester, United Kingdom
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, University of Manchester, Manchester, United Kingdom
| | - Tim Doran
- Department of Health Sciences, University of York, York, United Kingdom
| | - David Reeves
- Centre for Primary Care, NIHR School of Primary Care Research, Institute of Population Health, University of Manchester, Manchester, United Kingdom
- Centre for Biostatistics, NIHR School of Primary Care Research, Institute of Population Health, University of Manchester, Manchester, United Kingdom
| | - Claire Planner
- Centre for Primary Care, NIHR School of Primary Care Research, Institute of Population Health, University of Manchester, Manchester, United Kingdom
| | - Siobhan Reilly
- Division of Health Research, University of Lancaster, Lancaster, United Kingdom
| | - Evangelos Kontopantelis
- Centre for Primary Care, NIHR School of Primary Care Research, Institute of Population Health, University of Manchester, Manchester, United Kingdom
- Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, United Kingdom
- * E-mail:
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Kontopantelis E, Olier I, Planner C, Reeves D, Ashcroft DM, Gask L, Doran T, Reilly S. Primary care consultation rates among people with and without severe mental illness: a UK cohort study using the Clinical Practice Research Datalink. BMJ Open 2015; 5:e008650. [PMID: 26674496 PMCID: PMC4691766 DOI: 10.1136/bmjopen-2015-008650] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [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] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Little is known about service utilisation by patients with severe mental illness (SMI) in UK primary care. We examined their consultation rate patterns and whether they were impacted by the introduction of the Quality and Outcomes Framework (QOF), in 2004. DESIGN Retrospective cohort study using individual patient data collected from 2000 to 2012. SETTING 627 general practices contributing to the Clinical Practice Research Datalink, a large UK primary care database. PARTICIPANTS SMI cases (346,551) matched to 5 individuals without SMI (1,732,755) on age, gender and general practice. OUTCOME MEASURES Consultation rates were calculated for both groups, across 3 types: face-to-face (primary outcome), telephone and other (not only consultations but including administrative tasks). Poisson regression analyses were used to identify predictors of consultation rates and calculate adjusted consultation rates. Interrupted time-series analysis was used to quantify the effect of the QOF. RESULTS Over the study period, face-to-face consultations in primary care remained relatively stable in the matched control group (between 4.5 and 4.9 per annum) but increased for people with SMI (8.8-10.9). Women and older patients consulted more frequently in the SMI and the matched control groups, across all 3 consultation types. Following the introduction of the QOF, there was an increase in the annual trend of face-to-face consultation for people with SMI (average increase of 0.19 consultations per patient per year, 95% CI 0.02 to 0.36), which was not observed for the control group (estimates across groups statistically different, p=0.022). CONCLUSIONS The introduction of the QOF was associated with increases in the frequency of monitoring and in the average number of reported comorbidities for patients with SMI. This suggests that the QOF scheme successfully incentivised practices to improve their monitoring of the mental and physical health of this group of patients.
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Affiliation(s)
- Evangelos Kontopantelis
- Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK
- NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Ivan Olier
- Manchester Institute of Biotechnology, University of Manchester, Manchester, UK
| | - Claire Planner
- NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - David Reeves
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, University of Manchester, Manchester, UK
| | - Linda Gask
- NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Tim Doran
- Department of Health Sciences, University of York, York, UK
| | - Siobhan Reilly
- Division of Health Research, University of Lancaster, Lancaster, UK
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Reilly S, Olier I, Planner C, Doran T, Reeves D, Ashcroft DM, Gask L, Kontopantelis E. Inequalities in physical comorbidity: a longitudinal comparative cohort study of people with severe mental illness in the UK. BMJ Open 2015; 5:e009010. [PMID: 26671955 PMCID: PMC4679912 DOI: 10.1136/bmjopen-2015-009010] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [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] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Little is known about the prevalence of comorbidity rates in people with severe mental illness (SMI) in UK primary care. We calculated the prevalence of SMI by UK country, English region and deprivation quintile, antipsychotic and antidepressant medication prescription rates for people with SMI, and prevalence rates of common comorbidities in people with SMI compared with people without SMI. DESIGN Retrospective cohort study from 2000 to 2012. SETTING 627 general practices contributing to the Clinical Practice Research Datalink, a UK primary care database. PARTICIPANTS Each identified case (346,551) was matched for age, sex and general practice with 5 randomly selected control cases (1,732,755) with no diagnosis of SMI in each yearly time point. OUTCOME MEASURES Prevalence rates were calculated for 16 conditions. RESULTS SMI rates were highest in Scotland and in more deprived areas. Rates increased in England, Wales and Northern Ireland over time, with the largest increase in Northern Ireland (0.48% in 2000/2001 to 0.69% in 2011/2012). Annual prevalence rates of all conditions were higher in people with SMI compared with those without SMI. The discrepancy between the prevalence of those with and without SMI increased over time for most conditions. A greater increase in the mean number of additional conditions was observed in the SMI population over the study period (0.6 in 2000/2001 to 1.0 in 2011/2012) compared with those without SMI (0.5 in 2000/2001 to 0.6 in 2011/2012). For both groups, most conditions were more prevalent in more deprived areas, whereas for the SMI group conditions such as hypothyroidism, chronic kidney disease and cancer were more prevalent in more affluent areas. CONCLUSIONS Our findings highlight the health inequalities faced by people with SMI. The provision of appropriate timely health prevention, promotion and monitoring activities to reduce these health inequalities are needed, especially in deprived areas.
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Affiliation(s)
- Siobhan Reilly
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Ivan Olier
- Manchester Institute of Biotechnology, University of Manchester, Manchester, UK
| | - Claire Planner
- NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Tim Doran
- Department of Health Sciences, University of York, York, UK
| | - David Reeves
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, University of Manchester, Manchester, UK
| | - Linda Gask
- NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
- Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK
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Springate DA, Kontopantelis E, Ashcroft DM, Olier I, Parisi R, Chamapiwa E, Reeves D. ClinicalCodes: an online clinical codes repository to improve the validity and reproducibility of research using electronic medical records. PLoS One 2014; 9:e99825. [PMID: 24941260 PMCID: PMC4062485 DOI: 10.1371/journal.pone.0099825] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 05/19/2014] [Indexed: 01/24/2023] Open
Abstract
Lists of clinical codes are the foundation for research undertaken using electronic medical records (EMRs). If clinical code lists are not available, reviewers are unable to determine the validity of research, full study replication is impossible, researchers are unable to make effective comparisons between studies, and the construction of new code lists is subject to much duplication of effort. Despite this, the publication of clinical codes is rarely if ever a requirement for obtaining grants, validating protocols, or publishing research. In a representative sample of 450 EMR primary research articles indexed on PubMed, we found that only 19 (5.1%) were accompanied by a full set of published clinical codes and 32 (8.6%) stated that code lists were available on request. To help address these problems, we have built an online repository where researchers using EMRs can upload and download lists of clinical codes. The repository will enable clinical researchers to better validate EMR studies, build on previous code lists and compare disease definitions across studies. It will also assist health informaticians in replicating database studies, tracking changes in disease definitions or clinical coding practice through time and sharing clinical code information across platforms and data sources as research objects.
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Affiliation(s)
- David A. Springate
- Centre for Primary Care, Institute for Population Health, University of Manchester, Manchester, United Kingdom
- Centre for Biostatistics, Institute for Population Health, University of Manchester, Manchester, United Kingdom
- * E-mail:
| | - Evangelos Kontopantelis
- Centre for Primary Care, Institute for Population Health, University of Manchester, Manchester, United Kingdom
- Centre for Health Informatics, Institute for Population Health, University of Manchester, Manchester, United Kingdom
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety Research, Manchester Pharmacy School, University of Manchester, Manchester, United Kingdom
| | - Ivan Olier
- Manchester Institute for Biotechnology, University of Manchester, Manchester, United Kingdom
| | - Rosa Parisi
- Centre for Pharmacoepidemiology and Drug Safety Research, Manchester Pharmacy School, University of Manchester, Manchester, United Kingdom
| | - Edmore Chamapiwa
- Centre for Primary Care, Institute for Population Health, University of Manchester, Manchester, United Kingdom
| | - David Reeves
- Centre for Primary Care, Institute for Population Health, University of Manchester, Manchester, United Kingdom
- Centre for Biostatistics, Institute for Population Health, University of Manchester, Manchester, United Kingdom
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Reeves D, Springate DA, Ashcroft DM, Ryan R, Doran T, Morris R, Olier I, Kontopantelis E. Can analyses of electronic patient records be independently and externally validated? The effect of statins on the mortality of patients with ischaemic heart disease: a cohort study with nested case-control analysis. BMJ Open 2014; 4:e004952. [PMID: 24760353 PMCID: PMC4010839 DOI: 10.1136/bmjopen-2014-004952] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 01/28/2014] [Revised: 03/12/2014] [Accepted: 03/13/2014] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To conduct a fully independent and external validation of a research study based on one electronic health record database, using a different electronic database sampling the same population. DESIGN Using the Clinical Practice Research Datalink (CPRD), we replicated a published investigation into the effects of statins in patients with ischaemic heart disease (IHD) by a different research team using QResearch. We replicated the original methods and analysed all-cause mortality using: (1) a cohort analysis and (2) a case-control analysis nested within the full cohort. SETTING Electronic health record databases containing longitudinal patient consultation data from large numbers of general practices distributed throughout the UK. PARTICIPANTS CPRD data for 34 925 patients with IHD from 224 general practices, compared to previously published results from QResearch for 13 029 patients from 89 general practices. The study period was from January 1996 to December 2003. RESULTS We successfully replicated the methods of the original study very closely. In a cohort analysis, risk of death was lower by 55% for patients on statins, compared with 53% for QResearch (adjusted HR 0.45, 95% CI 0.40 to 0.50; vs 0.47, 95% CI 0.41 to 0.53). In case-control analyses, patients on statins had a 31% lower odds of death, compared with 39% for QResearch (adjusted OR 0.69, 95% CI 0.63 to 0.75; vs OR 0.61, 95% CI 0.52 to 0.72). Results were also close for individual statins. CONCLUSIONS Database differences in population characteristics and in data definitions, recording, quality and completeness had a minimal impact on key statistical outputs. The results uphold the validity of research using CPRD and QResearch by providing independent evidence that both datasets produce very similar estimates of treatment effect, leading to the same clinical and policy decisions. Together with other non-independent replication studies, there is a nascent body of evidence for wider validity.
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Affiliation(s)
- David Reeves
- NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - David A Springate
- NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety Research, Manchester Pharmacy School, University of Manchester, Manchester, UK
| | - Ronan Ryan
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Tim Doran
- Department of Health Sciences, University of York, York, UK
| | - Richard Morris
- Department of Primary Care and Population Health, Institute of Epidemiology and Health, University College London, London, UK
| | - Ivan Olier
- NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
- Institute of Biotechnology, School of Computer Science, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
- Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester, UK
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