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Tay HY, Wu WT, Peng CH, Liu KL, Yu TC, Chen IH, Yao TK, Chang CM, Chua JY, Wang JH, Yeh KT. COVID-19 Infection Was Associated with the Functional Outcomes of Hip Fracture among Older Adults during the COVID-19 Pandemic Apex. Medicina (Kaunas) 2023; 59:1640. [PMID: 37763759 PMCID: PMC10534880 DOI: 10.3390/medicina59091640] [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] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/21/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Hip fractures are associated with mortality and poor functional outcomes. The COVID-19 pandemic has affected patterns of care and health outcomes among fracture patients. This study aimed to determine the influence of COVID-19 infection on hip fracture recovery. Materials and Methods: We prospectively collected data on patients with hip fractures who presented at Hualien Tzu Chi Hospital between 9 March 2022 and 9 September 2022. The data included demographic information and functional scores taken before, during, and after surgery. The patients were divided into two groups: COVID-19 (+) and COVID-19 (-). Results: This study recruited 85 patients, 12 of whom (14.12%) were COVID-19 (+). No significant differences in preoperative or perioperative parameters between the two groups were observed. The postoperative Barthel index score was significantly impacted by COVID-19 infection (p = 0.001). The incidence of postoperative complications was significantly correlated with general anesthesia (p = 0.026) and the length of stay (p = 0.004) in hospital. Poor postoperative functional scores were associated with lower preoperative Barthel index scores (p < 0.001). Male sex (p = 0.049), old age (p = 0.012), a high American Society of Anesthesiologists grade (p = 0.029), and a high Charlson comorbidity index score (p = 0.028) were associated with mortality. Conclusions: Hip fracture surgeries were not unduly delayed in our hospital during the COVID-19 pandemic, but the patients' postoperative Barthel index scores were significantly influenced by COVID-19 (+). The preoperative Barthel index score may be a good predictive tool for the postoperative functional recovery of these patients.
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Affiliation(s)
- Hua-Yong Tay
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
- Department of Medical Education, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan
| | - Wen-Tien Wu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Cheng-Huan Peng
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
| | - Kuan-Lin Liu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Tzai-Chiu Yu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
| | - Ing-Ho Chen
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Ting-Kuo Yao
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
| | - Chia-Ming Chang
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
| | - Jian-Yuan Chua
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan;
| | - Kuang-Ting Yeh
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan; (H.-Y.T.); (W.-T.W.); (C.-H.P.); (K.-L.L.); (T.-C.Y.); (I.-H.C.); (T.-K.Y.); (C.-M.C.); (J.-Y.C.)
- Department of Medical Education, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
- Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien 970374, Taiwan
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Sock Hwee T, Koh HWL, Chua JY, Yang XX, Ong CC, Teo L, Choi HW, Pilbrow AP, Pickering JW, Troughton RW, Doughty RN, Richards AM, Chan MY. P5719Plasma proteomics identify plaque-related proteins that predict long-term recurrent coronary events in patients with acute coronary syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Coronary plaque burden and composition drive recurrent ischaemic events in coronary artery disease.
Purpose
We first investigated the association between plasma proteins and coronary plaque characteristics in a cohort of asymptomatic individuals with low-intermediate Framingham Risk Score. Plaque-related proteins were further evaluated in a second cohort of patients with acute coronary syndrome (ACS) to determine their prognostic value for predicting future myocardial infarction (MI).
Methods
We profiled 1305 plasma proteins using an aptamer-based array (SOMAscan) in asymptomatic individuals who had undergone 384-slice coronary computed tomography angiography. Plaques were categorized by composition as calcified or non-calcified. First, we identified proteins that were different (based on multiple testing adjusted p-values: q-value <0.05) between 250 ACS patients who suffered a recurrent MI event on follow-up compared with another 250 ACS patients who remained event-free using Mann-Whitney U test. Next, protein candidates that also correlated (Pearson's p<0.05) with specific categories of plaque composition were evaluated using a cox proportional hazards model to determine the risk of recurrent MI, adjusting for potential confounders in the second cohort.
Results
A total of 65 and 120 plasma proteins were significantly associated with calcified and non-calcified plaques respectively in the asymptomatic cohort (N=79). Of these 185 proteins, 23 proteins were differentially expressed (DE) between ACS patients with and without recurrent MI events (median follow-up 1811 days). The top three up-and down-regulated proteins in the recurrent MI group were macrophage-capping protein, trefoil factor 3 and cystatin-SN (median FC 1.22, 1.17 and 1.17; q-value 4.34x10–6, 2.18x10–4, 3.17x10–3 respectively) and fibroblast growth factor 20, lymphotoxin a2/b1 and vascular endothelial growth factor receptor 2 (median FC 0.92, 0.94 and −0.090; q-value 1.31x10–3, 9.45x10–3 and 3.90x10–3) respectively. The quartiles of these protein concentrations were also associated with risk of recurrent MI, (log-rank test p-value range from 2.71x10–7 to 0.04). Of the DE proteins, the adjusted hazards ratio (HR) of cystatin-SN in the highest quartile (Q4) was 1.44 times that of the first quartile (Q1) (adjusted HR: 1.44, 95% CI: 0.93–2.2) and higher plasma concentration of cystatin-SN was associated with increasing risk of recurrent MI events (Trend test p=0.004). On the other hand, the highest quartile of fibroblast growth factor 20 was associated with 44% reduction in risks of recurrent MI adjusted HR: 0.56, 95% CI of HR: 0.35–0.87), with significant trend test (p=0.0096).
Conclusions
Large-scale plasma proteomics identified novel plaque-related proteins predictive of recurrent coronary events in patients with ACS. Further studies may help unravel the biological underpinnings of these circulating proteins and their potential as novel prognostic biomarkers.
Acknowledgement/Funding
This work was supported by grant NMRC/CSA-INV/0001/2016 from the National Medical Research Council, Singapore.
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Affiliation(s)
- T Sock Hwee
- National University of Singapore, Singapore, Singapore
| | - H W L Koh
- National University of Singapore, Singapore, Singapore
| | - J Y Chua
- National University Heart Centre, Singapore, Singapore
| | - X X Yang
- National University of Singapore, Singapore, Singapore
| | - C C Ong
- National University Heart Centre, Singapore, Singapore
| | - L Teo
- National University Heart Centre, Singapore, Singapore
| | - H W Choi
- National University of Singapore, Singapore, Singapore
| | - A P Pilbrow
- University of Otago Christchurch, Christchurch, New Zealand
| | - J W Pickering
- University of Otago Christchurch, Christchurch, New Zealand
| | - R W Troughton
- University of Otago Christchurch, Christchurch, New Zealand
| | - R N Doughty
- The University of Auckland, Department of Medicine, Auckland, New Zealand
| | - A M Richards
- National University of Singapore, Singapore, Singapore
| | - M Y Chan
- National University of Singapore, Singapore, Singapore
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