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Koop PH, Schwenzer C, Clusmann J, Vell MS, Jaeger J, Gui W, Trautwein C, Koch A, Bruns T, Schneider CV, Schneider KM. Comorbidities, mortality and metabolic profile in individuals with primary biliary cholangitis-A Phenome-Wide-Association-Study. Liver Int 2024. [PMID: 38661318 DOI: 10.1111/liv.15945] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/05/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND AIMS Primary biliary cholangitis (PBC) is a chronic, immune-mediated liver disease that can lead to fibrosis and cirrhosis. In this cohort study, we aimed to investigate morbidity and mortality in conjunction with metabolomic changes of PBC in a UK population-based cohort. METHODS 454 participants with PBC and 908 propensity score (age, sex, BMI, ethnicity) matched controls without liver disease were included in the study. A subset of participants with PBC and controls were analysed for their metabolomic profile. Further, PBC-associated comorbidities were investigated by PheWAS analysis. Lastly, we assessed causes of death in individuals with PBC using a Fine and Grey competing-risks regression model. RESULTS Compared to the control group, various pathways associated with the metabolism of amino acids, lipids, and liver biochemistry were significantly enriched in individuals with PBC. We found reduced levels of S-HDL-cholesterol and Glycoprotein Acetyls in individuals with PBC as well as an association with diseases of the circulatory system. Notably, PBC individuals had a higher prevalence of digestive diseases, autoimmune diseases, cardiovascular diseases, anaemias, mental disorders, and urinary tract infections compared to the control group. Strikingly, the overall mortality was almost three times higher in the PBC group compared to the control group, with diseases of the digestive system accounting for a significant elevation of the death rate. A subsequent analysis, enhanced by propensity score matching that included the APRI score, demonstrated that the observed morbidity could not be exclusively attributed to advanced hepatic disease. CONCLUSIONS Our study provides a detailed perspective on the morbidity of individuals with PBC. The exploration of potential effects of disease state on morbidity suggest that early detection and early treatment of PBC could enhance patient prognosis and prevent the onset of comorbid diseases. Finally, the metabolomic alterations could represent a link between the pathophysiological processes underlying PBC development, progression, and associated morbidity.
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Affiliation(s)
- Paul-Henry Koop
- Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Constanze Schwenzer
- Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Clusmann
- Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Mara S Vell
- Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Julius Jaeger
- Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Wenfang Gui
- Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Christian Trautwein
- Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Alexander Koch
- Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Tony Bruns
- Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Carolin V Schneider
- Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
- The Institute for Translational Medicine and Therapeutics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kai Markus Schneider
- Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
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Kabak E, Clusmann J, Abu Jhaisha S, Hohlstein P, Adams J, Kernbach J, Drexler S, Schneider CV, Schwenzer C, Wirtz TH, Hamesch K, Saritas T, Trautwein C, Pollmanns MR, Koch A. An unusual case of intracerebral hemorrhage: exploring the link with Sneddon's syndrome. Med Klin Intensivmed Notfmed 2024; 119:66-68. [PMID: 37702782 DOI: 10.1007/s00063-023-01059-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 09/14/2023]
Affiliation(s)
- Elena Kabak
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine (Medical Clinic III), RWTH Aachen University, Aachen, Germany
| | - Jan Clusmann
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine (Medical Clinic III), RWTH Aachen University, Aachen, Germany
| | - Samira Abu Jhaisha
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine (Medical Clinic III), RWTH Aachen University, Aachen, Germany
| | - Philipp Hohlstein
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine (Medical Clinic III), RWTH Aachen University, Aachen, Germany
| | - Jule Adams
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine (Medical Clinic III), RWTH Aachen University, Aachen, Germany
| | - Julius Kernbach
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | - Stephan Drexler
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine (Medical Clinic III), RWTH Aachen University, Aachen, Germany
| | - Carolin Victoria Schneider
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine (Medical Clinic III), RWTH Aachen University, Aachen, Germany
| | - Constanze Schwenzer
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine (Medical Clinic III), RWTH Aachen University, Aachen, Germany
| | - Theresa H Wirtz
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine (Medical Clinic III), RWTH Aachen University, Aachen, Germany
| | - Karim Hamesch
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine (Medical Clinic III), RWTH Aachen University, Aachen, Germany
| | - Turgay Saritas
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine (Medical Clinic III), RWTH Aachen University, Aachen, Germany
- Division of Nephrology and Clinical Immunology, RWTH Aachen University, Aachen, Germany
- Institute of Experimental Medicine and Systems Biology, RWTH Aachen University, Aachen, Germany
| | - Christian Trautwein
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine (Medical Clinic III), RWTH Aachen University, Aachen, Germany
| | - Maike R Pollmanns
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine (Medical Clinic III), RWTH Aachen University, Aachen, Germany
| | - Alexander Koch
- Department for Gastroenterology, Metabolic Disorders and Intensive Care Medicine (Medical Clinic III), University Hospital RWTH Aachen, RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
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Clusmann J, Kolbinger FR, Muti HS, Carrero ZI, Eckardt JN, Laleh NG, Löffler CML, Schwarzkopf SC, Unger M, Veldhuizen GP, Wagner SJ, Kather JN. The future landscape of large language models in medicine. Commun Med (Lond) 2023; 3:141. [PMID: 37816837 PMCID: PMC10564921 DOI: 10.1038/s43856-023-00370-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [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: 02/15/2023] [Accepted: 09/21/2023] [Indexed: 10/12/2023] Open
Abstract
Large language models (LLMs) are artificial intelligence (AI) tools specifically trained to process and generate text. LLMs attracted substantial public attention after OpenAI's ChatGPT was made publicly available in November 2022. LLMs can often answer questions, summarize, paraphrase and translate text on a level that is nearly indistinguishable from human capabilities. The possibility to actively interact with models like ChatGPT makes LLMs attractive tools in various fields, including medicine. While these models have the potential to democratize medical knowledge and facilitate access to healthcare, they could equally distribute misinformation and exacerbate scientific misconduct due to a lack of accountability and transparency. In this article, we provide a systematic and comprehensive overview of the potentials and limitations of LLMs in clinical practice, medical research and medical education.
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Affiliation(s)
- Jan Clusmann
- Else Kroener Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Fiona R Kolbinger
- Else Kroener Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
| | - Hannah Sophie Muti
- Else Kroener Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
| | - Zunamys I Carrero
- Else Kroener Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany
| | - Jan-Niklas Eckardt
- Else Kroener Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany
- Department of Medicine I, University Hospital Dresden, Dresden, Germany
| | - Narmin Ghaffari Laleh
- Else Kroener Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Chiara Maria Lavinia Löffler
- Else Kroener Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany
- Department of Medicine I, University Hospital Dresden, Dresden, Germany
| | - Sophie-Caroline Schwarzkopf
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
| | - Michaela Unger
- Else Kroener Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany
| | - Gregory P Veldhuizen
- Else Kroener Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany
| | - Sophia J Wagner
- Helmholtz Munich-German Research Center for Environment and Health, Munich, Germany
- School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
| | - Jakob Nikolas Kather
- Else Kroener Fresenius Center for Digital Health, TUD Dresden University of Technology, Dresden, Germany.
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany.
- Department of Medicine I, University Hospital Dresden, Dresden, Germany.
- Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany.
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Wizenty J, Koop PH, Clusmann J, Tacke F, Trautwein C, Schneider KM, Sigal M, Schneider CV. Association of Helicobacter pylori Positivity With Risk of Disease and Mortality. Clin Transl Gastroenterol 2023; 14:e00610. [PMID: 37367296 PMCID: PMC10522101 DOI: 10.14309/ctg.0000000000000610] [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: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Helicobacter pylori colonizes the human stomach. Infection causes chronic gastritis and increases the risk of gastroduodenal ulcer and gastric cancer. Its chronic colonization in the stomach triggers aberrant epithelial and inflammatory signals that are also associated with systemic alterations. METHODS Using a PheWAS analysis in more than 8,000 participants in the community-based UK Biobank, we explored the association of H. pylori positivity with gastric and extragastric disease and mortality in a European country. RESULTS Along with well-established gastric diseases, we dominantly found overrepresented cardiovascular, respiratory, and metabolic disorders. Using multivariate analysis, the overall mortality of H. pylori -positive participants was not altered, while the respiratory and Coronovirus 2019-associated mortality increased. Lipidomic analysis for H. pylori -positive participants revealed a dyslipidemic profile with reduced high-density lipoprotein cholesterol and omega-3 fatty acids, which may represent a causative link between infection, systemic inflammation, and disease. DISCUSSION Our study of H. pylori positivity demonstrates that it plays an organ- and disease entity-specific role in the development of human disease and highlights the importance of further research into the systemic effects of H. pylori infection.
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Affiliation(s)
- Jonas Wizenty
- Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Paul-Henry Koop
- Department for Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Clusmann
- Department for Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Trautwein
- Department for Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Kai Markus Schneider
- Department for Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Sigal
- Department of Hepatology and Gastroenterology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Carolin V. Schneider
- Department for Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
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