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Shi Z, Wei J, Rifkin AS, Wang CH, Billings LK, Woo JSH, Talamonti MS, Vogel TJ, Moore E, Brockstein BE, Khandekar JD, Dunnenberger HM, Hulick PJ, Duggan D, Zheng SL, Lee CJ, Helfand BT, Tafur AJ, Xu J. Cancer-associated thrombosis by cancer sites and inherited factors in a prospective population-based cohort. Thromb Res 2023; 229:69-72. [PMID: 37419004 DOI: 10.1016/j.thromres.2023.06.023] [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] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/23/2023] [Accepted: 06/23/2023] [Indexed: 07/09/2023]
Abstract
Cancer-associated thrombosis (CAT) is common and associated with mortality. We estimated CAT rate by cancer sites and inherited factors among cancer patients from the UK Biobank (N =70,406). The 12-month CAT rate after cancer diagnosis was 2.37% overall but varied considerably among cancer sites. Among the 10 cancer sites classified as 'high-risk' of CAT by the National Comprehensive Cancer Network guidelines, 6 had CAT rate <5%. In contrast, 5 cancer sites classified as 'average-risk' by the guidelines had CAT rate >5%. For inherited risk factors, both known mutation carriers in two genes (F5/F2) and polygenic score for venous thromboembolism (VTE) (PGSVTE) were independently associated with increased CAT risk. While F5/F2 identified 6% patients with high genetic-risk for CAT, adding PGSVTE identified 13 % patients at equivalent/higher genetic-risk to CAT than that of F5/F2 mutations. Findings from this large prospective study, if confirmed, provide critical data to update guidelines for CAT risk assessment.
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Affiliation(s)
- Zhuqing Shi
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Jun Wei
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Andrew S Rifkin
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Chi-Hsiung Wang
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Liana K Billings
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, USA; University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Jonathan S H Woo
- Division of Hospital Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Mark S Talamonti
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | | | - Elena Moore
- Kellogg Cancer Center, NorthShore University HealthSystem, Evanston, IL, USA
| | - Bruce E Brockstein
- Kellogg Cancer Center, NorthShore University HealthSystem, Evanston, IL, USA
| | - Janardan D Khandekar
- Kellogg Cancer Center, NorthShore University HealthSystem, Evanston, IL, USA; Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Henry M Dunnenberger
- Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Peter J Hulick
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, USA; Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - David Duggan
- Affiliate of City of Hope, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - S Lilly Zheng
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA
| | - Cheong Jun Lee
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Brian T Helfand
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA; University of Chicago Pritzker School of Medicine, Chicago, IL, USA; Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Alfonso J Tafur
- Cardiovascular Institute, NorthShore University HealthSystem, Evanston, IL, USA.
| | - Jianfeng Xu
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, USA; University of Chicago Pritzker School of Medicine, Chicago, IL, USA; Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA; Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL, USA.
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McElligott B, Shi Z, Rifkin AS, Wei J, Zheng SL, Helfand BT, Woo JSH, Xu J. Assessing the performance of genetic risk score for stratifying risk of post-sepsis cardiovascular complications. Front Cardiovasc Med 2023; 10:1076745. [PMID: 36926049 PMCID: PMC10011112 DOI: 10.3389/fcvm.2023.1076745] [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: 10/21/2022] [Accepted: 02/08/2023] [Indexed: 03/04/2023] Open
Abstract
Background Patients with sepsis are at increased risk for cardiovascular complications, including myocardial infarction (MI), ischemic stroke (IS), and venous thromboembolism (VTE). Our objective is to assess whether genetic risk score (GRS) can differentiate risk for these complications. Methods A population-based prospective cohort of 483,177 subjects, derived from the UK Biobank, was followed for diagnosis of sepsis and its complications (MI, IS, and VTE) after the study recruitment. GRS for each complication was calculated based on established risk-associated single nucleotide polymorphisms (SNPs). Time to incident MI, IS, and VTE was compared between subjects with or without sepsis and GRS risk groups using Kaplan-Meier log-rank test and Cox-regression analysis. Results During an average of 12.6 years of follow-up, 10,757 (2.23%) developed sepsis. Patients with sepsis had an overall higher risk than non-sepsis subjects for each complication, but the risk differed by time after a sepsis diagnosis; exceedingly high in short-term (0-30 days), considerably high in mid-term (31 days to 2 years), and reduced in long-term (>2 years). Furthermore, in White subjects, GRS was a significant predictor of complications, independent of sepsis and other risk factors. For example, GRSMI further differentiated their risk in patients with sepsis; 3.49, 4.73, and 9.03% in those with low- (<0.5), intermediate- (0.5-1.99), high- GRSMI (≥2.0), Ptrend < 0.001. Conclusion Risk for post-sepsis cardiovascular complications differed considerably by time after a sepsis diagnosis and GRS. These findings, if confirmed in other ancestry-specific populations, may guide personalized management for preventing post-sepsis cardiovascular complications.
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Affiliation(s)
- Brian McElligott
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, United States
| | - Zhuqing Shi
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, United States
| | - Andrew S Rifkin
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, United States
| | - Jun Wei
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, United States
| | - S Lilly Zheng
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, United States
| | - Brian T Helfand
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States.,Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Jonathan S H Woo
- Department of Medicine, NorthShore University HealthSystem, Evanston, IL, United States
| | - Jianfeng Xu
- Program for Personalized Cancer Care, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Surgery, NorthShore University HealthSystem, Evanston, IL, United States.,Pritzker School of Medicine, University of Chicago, Chicago, IL, United States.,Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL, United States
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