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Brix Petersen ER, Pedersen M, Kristensen HT, Pedersen L, Benn M, Rasmussen OW, Brandslund I. Concerning quality demands of arterial partial pressure of oxygen. Clin Chem Lab Med 2024; 62:e72-e73. [PMID: 37728871 DOI: 10.1515/cclm-2023-1022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023]
Affiliation(s)
| | - Morten Pedersen
- DEKS, Rigshospitalet, Copenhagen University Hospital, Glostrup, Denmark
| | | | - Lise Pedersen
- Department of Clinical Biochemistry, Holbæk Hospital, Holbaek, Denmark
| | - Marianne Benn
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, København Ø, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, København, Denmark
| | | | - Ivan Brandslund
- Department of Biochemistry and Immunology, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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2
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Lukina P, Andersen IL, Eggen PT, Mjønes PG, Rønne E, Bolstad N, Klaasen RA, Warren DJ, Iversen R, Hveem K, Bernklev T, Jelsness-Jørgensen LP, Pedersen L, Jonkers I, Lagergren P, Sollid LM, Lundin K, Ness-Jensen E. Coeliac disease in the Trøndelag Health Study (HUNT), Norway, a population-based cohort of coeliac disease patients. BMJ Open 2024; 14:e077131. [PMID: 38195172 PMCID: PMC10806793 DOI: 10.1136/bmjopen-2023-077131] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/09/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE Coeliac disease (CD) is a common disorder and affects about 1% of the population worldwide. CD in the Trøndelag Health Study (HUNT) is a population-based cohort study which was established to provide new knowledge about CD that can improve the diagnostics and management, prevent the onset or progression and expand the knowledge about the role of genetics of the disease. PARTICIPANTS The cohort is based on the fourth wave of the population-based HUNT study (HUNT4), Norway, performed during 2017-2019, also including linkage to hospital records and the Norwegian Patient Registry (NPR). A total of 54 541 HUNT4 participants with available sera were screened for CD by serology. All seropositive participants were invited to a clinical assessment, including endoscopy with duodenal biopsies, during 2019-2023. FINDINGS TO DATE A total of 1107 HUNT4 participants (2%) were seropositive for CD and 1048 were eligible for clinical assessment, including biopsy. Of these, 724 participants attended the clinical assessment and 482 were identified with CD. In addition, 371 participants with CD were identified through the hospital records and NPR. In total, 853 participants in HUNT4 with biopsy-verified CD diagnosis were identified. FUTURE PLANS All participants in the study will be invited to a follow-up assessment after at least 1 year, including repeated standard serological testing, endoscopy and tissue sampling. The collected data and material will be used to establish the true population-based prevalence of CD. The consequences of CD, including symptoms, deficiencies and comorbidity, will be investigated and possible triggers and predictors, will be studied. With access to serum samples from the previous HUNT surveys in HUNT Biobank, serological signs of CD in prediagnostic samples of seropositive individuals will be used. Genetic studies will identify new CD markers, assess genotype-phenotype links and explore gene-environment correlations. REGISTRATION clinicaltrials.gov identifier: NCT04041622.
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Affiliation(s)
- Polina Lukina
- HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
| | - Ina Lervåg Andersen
- HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Petter Tinbod Eggen
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Patricia Gjertrud Mjønes
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Trøndelag, Norway
- Department of Pathology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Trøndelag, Norway
| | - Elin Rønne
- Department of Pathology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Trøndelag, Norway
| | - Nils Bolstad
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Rolf Anton Klaasen
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - David J Warren
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Rasmus Iversen
- K.G. Jebsen Centre for Coeliac Disease Research, University of Oslo, Oslo, Norway
| | - Kristian Hveem
- HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
- K.G. Jebsen Centre for Genetic Epidemiology, Norwegian University of Science and Technology, Trondheim, Trøndelag, Norway
| | - Tomm Bernklev
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- R&D Department, Vestfold Hospital Trust, Tønsberg, Vestfold, Norway
| | - Lars Petter Jelsness-Jørgensen
- Østfold University College, Halden, Østfold, Norway
- Department of Gastroenterology, Østfold Hospital Trust, Kalnes, Norway
| | | | - Iris Jonkers
- Department of Genetics, University of Groningen, Groningen, Groningen, The Netherlands
| | - Pernilla Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Stockholm, Sweden
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ludvig Magne Sollid
- K.G. Jebsen Centre for Coeliac Disease Research, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Knut Lundin
- K.G. Jebsen Centre for Coeliac Disease Research, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Eivind Ness-Jensen
- HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Stockholm, Sweden
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Hindsberger B, Lindegaard B, Rabøl Andersen L, Bastrup Israelsen S, Pedersen L, Bela Szecsi P, Benfield T. Circulating Adiponectin Levels Are Inversely Associated with Mortality and Respiratory Failure in Patients Hospitalized with COVID-19. Int J Endocrinol 2023; 2023:4427873. [PMID: 36960389 PMCID: PMC10030212 DOI: 10.1155/2023/4427873] [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] [Received: 10/13/2022] [Revised: 02/18/2023] [Accepted: 02/25/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Chronic low-grade inflammation associated with a dysregulated adipose tissue might contribute to amplifying the inflammatory response in severe COVID-19. The aim of this study was to examine the association between levels of circulating leptin and adiponectin and the severity and mortality of COVID-19. METHODS Serum levels of leptin and adiponectin were determined at admission in 123 individuals with confirmed COVID-19 and their association with 90-day mortality and respiratory failure was analyzed by logistic regression analysis and expressed as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS The median values of circulating leptin and adiponectin were 7.2 ng/mL (IQR 3.8-13.4) and 9.0 μg/mL (IQR 5.7-14.6), respectively. After adjustment for age, sex, body mass index, hypertension, diabetes, chronic obstructive pulmonary disease, and oxygen saturation at admission, a doubling of circulating adiponectin was associated with a 38% reduction in odds of 90-day mortality (OR 0.62, CI 0.43-0.89) and a 40% reduction in odds of respiratory failure (OR 0.60, CI 0.42-0.86). The association tended to be strongest in individuals below the median age of 72 years. Circulating leptin was not associated with outcomes. CONCLUSIONS Circulating adiponectin at admission was inversely associated with mortality and respiratory failure in SARS-CoV-2 infection. Further studies are needed to elucidate how exactly adipokines, especially adiponectin, are linked to the progression and prognosis of COVID-19.
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Affiliation(s)
- Bettina Hindsberger
- Center of Clinical Research and Disruption of Infectious Diseases (CREDID), Department of Infectious Diseases, Copenhagen University Hospital-Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Birgitte Lindegaard
- Department of Infectious Diseases, Copenhagen University Hospital–North Zealand, 3400 Hilleroed, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Liv Rabøl Andersen
- Center of Clinical Research and Disruption of Infectious Diseases (CREDID), Department of Infectious Diseases, Copenhagen University Hospital-Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Simone Bastrup Israelsen
- Center of Clinical Research and Disruption of Infectious Diseases (CREDID), Department of Infectious Diseases, Copenhagen University Hospital-Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Lise Pedersen
- Department of Clinical Biochemistry, Holbaek Hospital, 4300 Holbaek, Denmark
| | - Pal Bela Szecsi
- Department of Clinical Biochemistry, Holbaek Hospital, 4300 Holbaek, Denmark
| | - Thomas Benfield
- Center of Clinical Research and Disruption of Infectious Diseases (CREDID), Department of Infectious Diseases, Copenhagen University Hospital-Amager and Hvidovre, 2650 Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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Olesen AS, Miger KC, Fabricius-Bjerre A, Sandvang K, Kjesbu IE, Sajadieh A, Hoest N, Koeber N, Wamberg J, Pedersen L, Schultz HH, Abild-Nielsen AG, Wille MM, Nielsen OW. Remote dielectric sensing detects pulmonary congestion in emergency patients with dyspnoea. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1081] [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: 11/14/2022] Open
Abstract
Abstract
Background
Immediate diagnosis of acute decompensated heart failure (ADHF) is essential in patients with dyspnoea. Remote Dielectric Sensing (ReDS), an electromagnetic non-invasive technology, estimates lung fluid content fast and observer-independently. In previous studies, ReDS discriminated congested heart failure patients from normal subjects with high accuracy. But not all ADHF patients have pulmonary interstitial congestion in the real world, and it is unknown if ReDS detects ADHF in consecutive patients with acute dyspnoea.
Purpose
To examine if ReDS can detect ADHF in consecutive dyspnoeic emergency patients and to compare ReDS with other diagnostic methods.
Method
This prospective observational study included consecutive patients with dyspnoea from the emergency departments. The exclusion criteria were age below 50 years, acute coronary syndrome, conditions prohibiting a supine CT scan, and no informed consent. We examined all patients immediately with ReDS, low-dose chest CT, echocardiogram, lung ultrasound (LUS), NT-proBNP, and Boston score. The Boston score used chest X-ray and clinical signs such as orthopnoea, jugular venous elevation, lung crackles and pedal oedema, and a score ≥8 equalled definite ADHF. A “LUS-score” ≥3 with at least 3 B-lines in one zone bilaterally equalled ADHF. ReDS values >35% lung fluid content were positive for pulmonary congestion, according to previous studies.
According to ESC guidelines, an expert panel adjudicated the ADHF diagnosis based on clinical signs, chest X-ray image, NT-proBNP, echocardiographic cardiac dysfunction (HFvhd, HFrEF, HFmrEF, HFpEF), and elevated LV filling pressure. Importantly, the panel was blinded to the ReDS values. For sub-analyses, we divided ADHF patients into a “CT-congested” ADHF subgroup if an independent chest CT showed interstitial congestion. We classified ADHF patients without congestion on CT, as the “mildly-congested” subgroup.
Results
97 included patients were examined within a median of 4.8 hours from admittance: 39 (40%) had ADHF, and 25 (26%) were ReDS-positive. ADHF patients had median LVEF 48%, NT-proBNP 347 pmol/l, and 85% had echocardiographic elevated LV filling pressure. ReDS detected ADHF with 46% sensitivity, 88% specificity, and 71% accuracy. The AUC for ReDS to detect ADHF (Figure 1), on a continuous scale, was similar to the Boston score (p=0.88) and the LUS score (p=0.74), but lower than NT-proBNP (p=0.02). The 21 (22%) CT-congested ADHF patients had higher ReDS values than the 18 (19%) mildly-congested ADHF patients (Figure 2, median 38% vs 30%, p<0.001). Furthermore, the mildly-congested ADHF patients had ReDS values similar to non-ADHF patients (median 30% vs 28%, p=0.36).
Conclusion
ReDS detects ADHF similarly to the Boston score and lung ultrasound but is inferior to NT-proBNP. This study suggests that ReDS primarily identifies CT-congested ADHF patients, but not the ADHF patients without interstitial congestion.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): This work was supported by the research fund of Bispebjerg University Hospital and Holger & Ruth Hesse's Mindefond. Sensible Medical Ltd made the ReDS device available for free and provided an unrestricted grant to specifically collect the ReDS measurements. The sponsors did not affect the statistical analyses, study design, data collection, or writing of the paper.
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Affiliation(s)
- A S Olesen
- Bispebjerg University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - K C Miger
- Bispebjerg University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - A Fabricius-Bjerre
- Bispebjerg University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - K Sandvang
- Bispebjerg University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - I E Kjesbu
- Bispebjerg University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - A Sajadieh
- Bispebjerg University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - N Hoest
- Bispebjerg University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - N Koeber
- Bispebjerg University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - J Wamberg
- Bispebjerg University Hospital, Department of Emergency Medicine , Copenhagen , Denmark
| | - L Pedersen
- Bispebjerg University Hospital, Department of Respiratory Medicine , Copenhagen , Denmark
| | - H H Schultz
- Bispebjerg University Hospital, Department of Respiratory Medicine , Copenhagen , Denmark
| | - A G Abild-Nielsen
- Bispebjerg University Hospital, Department of Radiology , Copenhagen , Denmark
| | - M M Wille
- Nordsjaellands Hospital, Department of Radiology , Hilleroed , Denmark
| | - O W Nielsen
- Bispebjerg University Hospital, Department of Cardiology , Copenhagen , Denmark
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Schmidt M, Arendt-Nielsen L, Hauge EM, Soerensen HT, Pedersen L. Dose-dependency of diclofenac's cardiovascular risks: a series of nationwide emulated trials. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2730] [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
The dose dependency of the adverse effects of diclofenac remains poorly understood.
Purpose
To examine the dose-related cardiovascular risks associated with diclofenac initiation
Methods
We used Danish nationwide health registries (1999–2018) to conduct a series of emulated trials (n=285). Eligible adults had no recent NSAID fillings, contraindications, or conditions with low adherence. Individuals eligible for inclusion were ≥18 years with (1) ≥90 days continuous prescription records prior to diclofenac initiation (baseline); (2) no NSAID prescriptions ≤90 days before enrollment, and (3) no exclusion criteria. Exclusion criteria reflected likelihood of low adherence to treatment (dementia, schizophrenia, or antipsychotic drug use) and labeled contraindications (ulcer disease/anti-ulcer drugs, gastrointestinal bleeding, inflammatory bowel disease, thrombocytopenia, or heart failure). Initiators of diclofenac were compared to healthcare-seeking non-initiators, but also head-to-head for initiators of high (≥75 mg pills as proxy for ≥150 mg/daily) vs. low dose (≤50 mg pills as proxy for <150 mg/daily). Cox proportional-hazards regression was used to compute the intention-to-treat hazard ratio, as measure of the incidence rate ratio (IRR), of major adverse cardiac and cerebrovascular events (MACCE) within 30 days from initiation.
Results
Among 3,177,484 diclofenac initiatiors, 31% used high and 69% used low dose. Compared with non-initiators, diclofenac initiatiors had a 70% increased rate for MACCE (IRR 1.70, 95% CI: 1.55–1.86), reflecting for the individual MACCE components an increased IRRs of 1.66 (95% CI: 1.54–1.79) for myocardial infaction, 1.32 (1.20–1.45) for ischemic stroke, and 1.69 (1.54–1.86) for cardiac death. The effect for MACCE did not differ between initiators of high (IRR 1.73, 95% CI: 1.51–1.97) and low dose (IRR 1.68, 95% CI: 1.52–1.86) (Figure 1). When comparing high and low dose diclofenac head-to-head, we found no meaningful difference in the IRR for MACCE (1.03, 95% CI: 0.89–1.19), MI (0.99, 0.87–1.11), ischemic stroke (0.95, 0.81–1.11) or cardiac death (1.04, 0.90–1.21) (Figure 2).
Conclusion
Initiation of low- and high-dose diclofenac was associated with a consistent and comparable increase in cardiovascular risk.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Novo Nordisk Foundation
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Affiliation(s)
- M Schmidt
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - L Arendt-Nielsen
- Aalborg University, Center for Neuroplasticity and Pain , Aalborg , Denmark
| | - E M Hauge
- Aarhus University Hospital, Department of Reumatology , Aarhus , Denmark
| | - H T Soerensen
- Aarhus University Hospital, Department of Clinical Epidemiology , Aarhus , Denmark
| | - L Pedersen
- Aarhus University Hospital, Department of Clinical Epidemiology , Aarhus , Denmark
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Hansen CB, Sandholdt H, Møller MEE, Pérez-Alós L, Pedersen L, Bastrup Israelsen S, Garred P, Benfield T. Prediction of Respiratory Failure and Mortality in COVID-19 Patients Using Long Pentraxin PTX3. J Innate Immun 2022; 14:493-501. [PMID: 35066500 PMCID: PMC9059012 DOI: 10.1159/000521612] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/16/2021] [Indexed: 01/08/2023] Open
Abstract
The course of COVID-19 is unpredictable, ranging from asymptomatic to respiratory failure and death. Prognostic biomarkers are urgently needed. We hypothesized that long pentraxin PTX3 could be a valuable plasma biomarker due to its essential role in inflammatory processes. In a prospective hospitalized COVID-19 derivation cohort (n = 126) during the spring of 2020, we measured PTX3 within 4 days of admission. The predictive value of mechanical ventilation (MV) and 30-day mortality compared with clinical parameters and other markers of inflammation were assessed by logistic regression analysis and expressed as odds ratio (OR) with 95% confidence interval (CI). Analyses were repeated in a prospective validation cohort (n = 112) of hospitalized patients with COVID-19 treated with remdesivir and dexamethasone. Thirty-day mortality in the derivation cohort was 26.2%. In patients who died, the median PTX3 concentration upon admission was 19.5 ng/mL (IQR: 12.5–33.3) versus 6.6 ng/mL (IQR 2.9–12.3) (p < 0.0001) for survivors. After adjustment for covariates, the odds of 30-day mortality increased two-fold for each doubling of PTX3 (OR 2.03 [95% CI: 1.23–3.34], p = 0.006), which was also observed in the validation cohort (OR 1.70 [95% CI: 1.09–2.67], p = 0.02). Similarly, PTX3 levels were associated with MV. After adjustment for covariates, OR of MV was 2.34 (95% CI: 1.33–4.12, p = 0.003) in the derivation cohort and 1.64 (95% CI: 1.03–2.62, p = 0.04) in the validation cohort. PTX3 appears to be a useful clinical biomarker to predict 30-day respiratory failure and mortality risk in COVID-19 patients treated with and without remdesivir and dexamethasone.
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Affiliation(s)
- Cecilie Bo Hansen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Håkon Sandholdt
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | | | - Laura Pérez-Alós
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Lise Pedersen
- Department of Clinical Biochemistry, Holbaek Hospital, Holbaek, Denmark
| | - Simone Bastrup Israelsen
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Peter Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Chu G, Van Rein N, Huisman MV, Pedersen L, Cannegieter SC, Klok FA, Sorensen HT. Antithrombotic therapy and bleeding complications in patients with atrial fibrillation and active cancer. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2869] [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: 11/13/2022] Open
Abstract
Abstract
Background
Little is known about the extent to which an active cancer diagnosis increases bleeding and thromboembolic risks in atrial fibrillation (AF) patients. Data on major bleeding rates per antithrombotic management strategy are lacking in AF patients with active cancer.
Purpose
To examine the incidence rates of major bleeding per antithrombotic treatment in AF patients with active cancer and to examine whether cancer type impacts major bleeding and thromboembolic risks.
Methods
We used Danish population-based health care databases to conduct this cohort study. We included all incident AF (including atrial flutter) patients aged ≥50 years between January 1st 1995 and December 31st 2016, out of whom we identified AF patients who subsequently developed cancer. We used International Classification of Diseases 10th Revision codes to identify data on cancer type and outcomes (i.e. major bleeding, arterial and venous thromboembolism). We used Anatomical Therapeutic Chemical codes to provide information on antithrombotic treatment (e.g. no anticoagulant treatment, platelet inhibitors, vitamin K antagonists, direct oral anticoagulants, or a combination of antithrombotic drugs) which was evaluated as a time-dependent variable. The follow-up started from the incident cancer diagnosis until the occurrence of an outcome, death or the end of the two year follow-up. Incidence rates per 100 patient-years and adjusted hazard ratios were computed.
Results
22,996 AF patients with a subsequent incident cancer diagnosis were included in the study. These patients had higher major bleeding and thromboembolic risk compared to those without cancer, with adjusted HRs of 2.11 (1.99–2.23) and 1.36 (1.27–1.44), respectively (Figure 1). Highest bleeding risk was observed for intracranial and respiratory cancer, while haematological and respiratory cancer were associated with highest thromboembolic risk. Bleeding risk increased with increasing number of antithrombotic drugs and was higher in AF patients with active cancer compared to those without, across all exposure categories (Figure 2).
Conclusions
Patients with AF and active cancer are at increased risk of major bleeding and thromboembolisms than those without cancer. Treatment with dual or triple antithrombotic therapy in AF patients with active cancer showed very high bleeding rates.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Chu
- Leiden University Medical Center, Department of Medicine - Thrombosis and Haemostasis, Leiden, Netherlands (The)
| | - N Van Rein
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - M V Huisman
- Leiden University Medical Center, Department of Medicine - Thrombosis and Haemostasis, Leiden, Netherlands (The)
| | - L Pedersen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - S C Cannegieter
- Leiden University Medical Center, Department of Clinical Epidemiology, Leiden, Netherlands (The)
| | - F A Klok
- Leiden University Medical Center, Department of Medicine - Thrombosis and Haemostasis, Leiden, Netherlands (The)
| | - H T Sorensen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
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Chu G, Van Rein N, Huisman MV, Pedersen L, Klok FA, Cannegieter SC, Sorensen HT. Atrial fibrillation in patients with a history of cancer and risk of bleeding complications associated with antithrombotic therapy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2870] [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: 11/15/2022] Open
Abstract
Abstract
Background
Up to one in four patients with atrial fibrillation (AF) has a cancer diagnosis. It is largely unknown to which extent a prior cancer diagnosis affects major bleeding and thromboembolic risk in AF patients. Moreover, data on major bleeding rates per antithrombotic treatment type are lacking in these patients.
Purpose
To examine the incidence rates of major bleeding per antithrombotic treatment in AF patients with prior cancer and to examine whether cancer type and the time-interval between AF and cancer influence major bleeding and thromboembolic risks.
Methods
This nationwide population-based cohort study included incident Danish AF patients aged ≥50 years between 01–01–1995 and 31–12–2016. Data on prior cancer, major bleeding and thromboembolisms (i.e. arterial and venous) were obtained from Danish health registries via International Classification of Diseases 10th Revision codes. We stratified according to prior cancer and by time between the AF and cancer diagnosis (i.e. <1 year, 1–3 years, >3 years), and cancer type. Data on antithrombotic exposure (e.g. no anticoagulant treatment, platelet inhibitors, vitamin K antagonists, direct oral anticoagulants, or combination of antithrombotic drugs) were evaluated as a time-dependent variable. We computed incidence rates per 100 patient-years and adjusted hazard ratios in a Cox regression model.
Results
We identified 39,178 AF patients with a prior cancer diagnosis. Bleeding risk increased with increasing number of antithrombotic drugs and was higher in AF patients with a history of cancer compared to those without, across all exposure categories (Figure 1). The increased bleeding risk was similar across different time intervals between cancer and AF diagnosis. The increased thromboembolic risk steeply declined with increasing time intervals between AF and cancer diagnosis (Figure 2). Prior gastrointestinal, intracranial, haematological, respiratory and urogenital cancers were associated with an increased bleeding risk. The two latter cancer types were also associated with increased thromboembolic risks.
Conclusion
We showed that patients with atrial fibrillation and a prior history of cancer experience higher rates of bleeding than those without cancer. Both respiratory and urogenital cancers had the highest rates of bleeding and thromboembolisms.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Chu
- Leiden University Medical Center, Department of Medicine - Thrombosis and Haemostasis, Leiden, Netherlands (The)
| | - N Van Rein
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - M V Huisman
- Leiden University Medical Center, Department of Medicine - Thrombosis and Haemostasis, Leiden, Netherlands (The)
| | - L Pedersen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - F A Klok
- Leiden University Medical Center, Department of Medicine - Thrombosis and Haemostasis, Leiden, Netherlands (The)
| | - S C Cannegieter
- Leiden University Medical Center, Department of Clinical Epidemiology, Leiden, Netherlands (The)
| | - H T Sorensen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
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Miger K, Fabricius-Bjerre A, Overgaard Olesen A, Host N, Kober N, Abild A, Winkler Wille M, Wamberg J, Pedersen L, Sajadieh A, Lawaetz Schultz H, Torp-Pedersen C. Value of a chest X-ray and CT to diagnose acute heart failure in acute patients with dyspnoea: a prospective comparative diagnostic study in the emergency department. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0884] [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: 11/14/2022] Open
Abstract
Abstract
Background and purpose
Diagnosing heart failure (HF) remains difficult in the acute setting where multiple diagnoses are in play. Objective evidence of pulmonary congestion by chest X-ray (CXR) is one criteria for the recent universal definition of heart failure (UniHF). But, since CXR is known to have a low diagnostic value, we hypothesized that a chest CT (CT) would outdo the CXR to diagnose decompensated HF in acute breathless patients. This study's primary objective was to examine if the CT has higher accuracy than the CXR to diagnose HF in the acute setting; and, secondly, to identify what pre-test characteristics would predict a false negative CXR or CT.
Methods
We performed a single-centre, prospective observational study and included consecutive adult patients with dyspnoea in the emergency department. Patients underwent immediate clinical examination, blood tests, CXR, CT and an echocardiogram. Congestion on CXR and CT was defined as the congruent verdict by two expert thorax radiologists, blinded to each others reading and all other clinical data. The absence of congestion was defined as the congruent verdict of “no congestion”.
Congestion of CXR and CT was held up against UniHF ascertained by an expert panel of cardiologists where the pulmonary congestion component primarily was based on elevated filling pressures from the simultaneous comprehensive echocardiogram. Univariate- and multivariate logistic analyses identified factors associated with a false negative chest x-ray and CT.
Results
Of 228 patients with a mean age of 74,5 years, 129 (56,5%) were male, 98 (43%) had UniHF, and 139 (61.0%) had pulmonary disease. Congestion on the CXR diagnosed UniHF with a 54% sensitivity and 95% specificity, with almost similar figures for the CT with 54% and 99% respectively. A marginally better performance of the CT was shown by a significantly lower Akaike Information Criterion for pulmonary congestion by CT than for CXR. However, the net reclassification improvement by CT was 4% (p:0.5586). The CXR and CT were false negative for UniHF in 46% (45/98) for both modalities (Table 1). The only independent pre-test predictor of a false negative radiology examination in multivariable logistic regression analysis was NT-proBNP (CXR: OR 1.670 per log(BNP), p: <0.001) and CT: OR 1.693 per log(BNP), p: <0.001).
Conclusions
For the first time, CT has been directly compared with CXR to diagnose HF in consecutive breathless patients from the emergency department. The chest CT was marginally more specific than the CXR to diagnose HF, but with a similar sensitivity. Approximately half the patients obeying the universal definition of HF have no definite congestion on CXR nor CT, and these can only be identified by a high proBNP.
Funding Acknowledgement
Type of funding sources: None. Table 1
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Affiliation(s)
- K Miger
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
| | | | | | - N Host
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
| | - N Kober
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
| | - A.M Abild
- Bispebjerg University Hospital, Department of Radiology, Copenhagen, Denmark
| | | | - J Wamberg
- Bispebjerg University Hospital, Department of Emergency Medicine, Copenhagen, Denmark
| | - L Pedersen
- Bispebjerg University Hospital, Department of Respiratory Medicine, Copenhagen, Denmark
| | - A Sajadieh
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
| | - H.H Lawaetz Schultz
- Bispebjerg University Hospital, Department of Respiratory Medicine, Copenhagen, Denmark
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10
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Clausen CL, Rasmussen ÅK, Johannsen TH, Hilsted LM, Skakkebæk NE, Szecsi PB, Pedersen L, Benfield T, Juul A. Thyroid function in COVID-19 and the association with cytokine levels and mortality. Endocr Connect 2021; 10:1234-1242. [PMID: 34468398 PMCID: PMC8494417 DOI: 10.1530/ec-21-0301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/01/2021] [Indexed: 01/13/2023]
Abstract
The hypothalamic-pituitary-thyroid hormone axis might be affected in COVID-19, but existing studies have shown varying results. It has been hypothesized that hyperinflammation, as reflected by the secretion of cytokines, might induce thyroid dysfunction among patients with COVID-19. We explored thyroid hormone involvement in the acute phase of symptomatic COVID-19 and its possible associations with cytokine levels and mortality risk. This was a single-center study of 116 consecutive patients hospitalized for moderate-to-severe COVID-19 disease. Serum concentrations of thyroid-stimulating hormone (TSH), free thyroxine (T4), and 45 cytokines/chemokines were measured in all patients within 3 days of admission. Data were extracted retrospectively through a manual review of health records. At admission, 95 (81.9%) were euthyroid; while 21 (18.1%) had biochemically thyroid dysfunction including subclinical thyrotoxicosis (n = 11), overt thyrotoxicosis (n = 2), hypothyroidism (n = 1), non-thyroidal illness (n = 2), and normal TSH but high free T4 (n = 5). TSH levels were inversely correlated with IL-8 (rs = -0.248), IL-10 (rs = -0.253), IL-15 (rs = -0.213), IP-10 (rs = -0.334), and GM-CSF (rs = -0.254). Moreover, IL-8 levels, IP-10, and GM-CSF were significantly higher in patients with serum TSH < 0.4 mIU/L. Lastly, a two-fold increment of IL-8 and IL-10 was associated with significantly higher odds of having TSH < 0.4 mIU/L (odds ratio 1.86 (1.11-3.10) and 1.78 (1.03-3.06)). Serum TSH was not associated with 30- or 90-day mortality. In conclusion, this study suggests that fluctuations of TSH levels in patients with COVID-19 may be influenced by circulating IL-8, IL-10, IL-15, IP-10, and GM-CSF as previously described in autoimmune thyroid diseases.
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Affiliation(s)
- Clara Lundetoft Clausen
- Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
- Correspondence should be addressed to C L Clausen:
| | - Åse Krogh Rasmussen
- Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Copenhagen, Denmark
| | - Trine Holm Johannsen
- Department of Growth and Reproduction, Copenhagen University Hospital, Copenhagen, Denmark
| | - Linda Maria Hilsted
- Department of Clinical Biochemistry, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Erik Skakkebæk
- Department of Growth and Reproduction, Copenhagen University Hospital, Copenhagen, Denmark
| | - Pal Bela Szecsi
- Department of Clinical Biochemistry, Holbæk Hospital, Holbæk, Denmark
| | - Lise Pedersen
- Department of Clinical Biochemistry, Holbæk Hospital, Holbæk, Denmark
| | - Thomas Benfield
- Center of Research & Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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11
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Orvik AB, Andersen MR, Pedersen L, Ritz C, Stender S, Szecsi PB. Plasma fibulin-1 levels during pregnancy and delivery: a longitudinal observational study. BMC Pregnancy Childbirth 2021; 21:629. [PMID: 34535108 PMCID: PMC8447534 DOI: 10.1186/s12884-021-04110-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 08/29/2021] [Indexed: 12/20/2022] Open
Abstract
Background Fibulin-1 is an extracellular matrix protein expressed at high levels in the placenta. Elevated circulating fibulin-1 have been observed in women with severe pre-eclampsia, whereas low levels have been found in the fetal membranes, prior to membrane rupture. The aim of the study was primarily to evaluate plasma fibulin-1 during expected normal pregnancy and delivery, and secondarily to explore fibulin-1 levels in women developing pre-eclampsia or preterm premature rupture of fetal membranes (PPROM). Methods From the historical longitudinal cohort originally consisting of 801 healthy Danish women with a singleton pregnancy, 128 women (632 samples) were selected. Of these, 107 women had normal pregnancies, nine experienced PPROM, and 12 pre-eclampsia. All samples were analyzed for fibulin-1, and levels were compared with blood donors. Differences in mean fibulin-1 between groups were estimated using a linear mixed model. Results The mean concentration of fibulin-1 in 120 blood donors was 15.7 µg/mL, (25th-75th-percentiles, 12.3–18.2), with no significant difference in groups stratified by gender or age. Compared to baseline levels in week 12–20, fibulin-1 levels increased significantly from week 29–34 (estimated difference, 5.6 µg/mL; standard error, 1.7; p < 0.001) and 35–42 (12.5 µg/mL; 1.6; p < 0.001) and normalized after birth. The decrease at delivery tended to be more pronounced after elective (-7.0 µg/mL; 2.3; p = 0.002) and emergency (-5.6 µg/mL; 2.9; p = 0.05) cesarean section than after vaginal delivery (reference group). Women who developed PPROM had lower fibulin-1 levels throughout their pregnancies (-11.6 µg/mL; 4.2; p = 0.006). We did not observe a correlate between late pre-eclampsia and fibulin-1 (-0.2 µg/mL; 3.0; p = 0.9). Conclusions Fibulin-1 was above non-pregnant levels at week 12 and increased significantly throughout pregnancy. We observed an association between low levels of fibulin-1 and PPROM. Further studies are needed to examine if fibulin-1 could serve as biomarker for the risk of PPROM. However, its role in late preeclampsia is doubtful. Trial registration The study was conducted in accordance with the Declaration of Helsinki. The participants provided written informed consent, including storage for future use. The study was approved on July 18, 2005 by The Danish National Committee on Bioethics (No. KA 05065 and S-20,090,061) and the Danish Data Protection Agency. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04110-y.
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Affiliation(s)
- Astrid Bakke Orvik
- Department of Gynecology and Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Malene Rohr Andersen
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Lise Pedersen
- Department of Clinical Biochemistry, Copenhagen University Hospital Holbaek, Holbaek, Denmark
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Steen Stender
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Pal Bela Szecsi
- Department of Clinical Biochemistry, Copenhagen University Hospital Holbaek, Holbaek, Denmark.
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12
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Jørgensen LH, Sindahl CH, Pedersen L, Nielsen F, Jensen TK, Tolstrup J, Ekholm O, Grandjean P. Reference intervals for trace elements in the general Danish population and their dependence on serum proteins. Scand J Clin Lab Invest 2021; 81:523-531. [PMID: 34369211 DOI: 10.1080/00365513.2021.1959050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Reference intervals that indicate the anticipated results of clinical chemistry parameters in a healthy background population are essential for the proper interpretation of laboratory data. In the present study, we analysed major trace elements in blood samples from 400 randomly selected members of the general Danish population. Reference intervals were established for trace elements in both whole blood and serum, and associations with major plasma transport proteins were investigated. In the case of a statistically significant correlation, a corresponding protein-adjusted reference interval was established for comparison with the unadjusted interval. While several trace elements correlated with albumin, ferritin and transferrin, the overall impact of transport proteins was minor and resulted in only marginal changes in the reference intervals. In conclusion, the updated reference intervals for trace elements can be employed without adjusting for plasma protein concentrations.
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Affiliation(s)
- Louise H Jørgensen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Camilla H Sindahl
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lise Pedersen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Biochemistry, Holbaek Hospital, Holbaek, Denmark
| | - Flemming Nielsen
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Tina K Jensen
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Janne Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Philippe Grandjean
- Department of Public Health, University of Southern Denmark, Odense, Denmark
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13
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Alenkaer LK, Pedersen L, Szecsi PB, Bjerrum PJ. Evaluation of the sysmex UF-5000 fluorescence flow cytometer as a screening platform for ruling out urinary tract infections in elderly patients presenting at the Emergency Department. Scand J Clin Lab Invest 2021; 81:379-384. [PMID: 34237238 DOI: 10.1080/00365513.2021.1929441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this study, we evaluated the performance of the flow cytometer-based Sysmex UF-5000 automated urine analyzer as a screening tool for ruling out urinary tract infections in elderly patients presenting at the emergency department. A total of 1119 unselected patient samples (including 544 samples from elderly patients) submitted for urine culture were included in this study. Samples were measured on UF-5000 and dipsticks and the results were compared with interpretation of culture results, which is the gold standard. We obtained a diagnostic sensitivity of 99% and specificity of 51% with a low rate of false negatives (0.2%) and a negative predictive value of 99% at 108 colony forming bacteria/L (CFB/L). A bacterial count ≥ 50x106/L or yeast like cells ≥ 25x106/L was used as the cutoff value. At this cutoff value, 30% of the urine cultures would have been redundant. This resulted in 35% false positive samples, mainly due to particle contamination or nongrowing bacteria. In comparison, at best, the dipsticks have a diagnostic sensitivity of 89%, a specificity of 52% and a negative predictive value of 92% at 108 CFB/L.
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Affiliation(s)
- Lasse Krogh Alenkaer
- Department of Clinical Biochemistry, University of Copenhagen, Holbaek Hospital, Holbaek, Denmark
| | - Lise Pedersen
- Department of Clinical Biochemistry, University of Copenhagen, Holbaek Hospital, Holbaek, Denmark
| | - Pal Bela Szecsi
- Department of Clinical Biochemistry, University of Copenhagen, Holbaek Hospital, Holbaek, Denmark
| | - Poul Jannik Bjerrum
- Department of Clinical Biochemistry, University of Copenhagen, Holbaek Hospital, Holbaek, Denmark
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14
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Kolding L, Ehrenstein V, Pedersen L, Sandager P, Petersen OB, Uldbjerg N, Pedersen LH. Antidepressant use in pregnancy and severe cardiac malformations: Danish register-based study. BJOG 2021; 128:1949-1957. [PMID: 34036715 DOI: 10.1111/1471-0528.16772] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Studies restricted to live births may underestimate severe teratogenic effects. We address the limitation by including data from both prenatal and postnatal diagnoses of cardiac malformations. DESIGN Register-based study. SETTING Denmark. POPULATION 364 012 singleton pregnancies from 2007 to 2014. METHODS We used data from five nationwide registries. Exposure to antidepressants was measured using redeemed prescriptions. MAIN OUTCOME MEASURES Pregnancies with cardiac malformations that end in miscarriage, termination, stillbirth, postnatal death or cardiac surgery <1 year of birth were classified as severe cardiac malformations (SCM). Propensity scores with adjusted prevalence ratios (PRs) were calculated. RESULTS SCM were reported in 972 of 364 012 pregnancies overall and in 16 of 4105 exposed. For venlafaxine, the PR for SCM was 2.13 (95% confidence interval [CI] 0.89-5.13), 1.73 (95% CI 1.08-2.77) for other cardiac malformations, and there was a cluster of hypoplastic left heart syndromes (HLHS) (crude PR 17.4 [95% CI 6.41-47.2]), none of which ended in a live birth. For HLHS, the absolute risk increase was 4.4/1000 and the number needed to harm was 225. For selective serotonin reuptake inhibitors, the PRs were 1.09 (95% CI 0.52-2.30) and 1.38 (95% CI 1.00-1.92) for SCM and other cardiac malformations, respectively. CONCLUSIONS Pregnancy exposure to venlafaxine is associated with an increased risk of severe cardiac malformations but with a low absolute risk. Potential mechanisms include direct effects or confounding by indication. Venlafaxine exposure is a marker for risk pregnancies for which fetal echocardiography may be considered. TWEETABLE ABSTRACT Exposure to venlafaxine is associated with an increased risk of cardiac malformations but with a low absolute risk. TWEETABLE ABSTRACT.
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Affiliation(s)
- L Kolding
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - V Ehrenstein
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - L Pedersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - P Sandager
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - O B Petersen
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - N Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - L H Pedersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
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15
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Harritshøj LH, Gybel-Brask M, Afzal S, Kamstrup PR, Jørgensen CS, Thomsen MK, Hilsted L, Friis-Hansen L, Szecsi PB, Pedersen L, Nielsen L, Hansen CB, Garred P, Korsholm TL, Mikkelsen S, Nielsen KO, Møller BK, Hansen AT, Iversen KK, Nielsen PB, Hasselbalch RB, Fogh K, Norsk JB, Kristensen JH, Schønning K, Kirkby NS, Nielsen ACY, Landsy LH, Loftager M, Holm DK, Nilsson AC, Sækmose SG, Grum-Schwensen B, Aagaard B, Jensen TG, Nielsen DM, Ullum H, Dessau RB. Comparison of 16 Serological SARS-CoV-2 Immunoassays in 16 Clinical Laboratories. J Clin Microbiol 2021; 59:e02596-20. [PMID: 33574119 PMCID: PMC8091860 DOI: 10.1128/jcm.02596-20] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/09/2021] [Indexed: 01/09/2023] Open
Abstract
Serological assays for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are needed to support clinical diagnosis and epidemiological investigations. Recently, assays for large-scale detection of total antibodies (Ab), immunoglobulin G (IgG), and IgM against SARS-CoV-2 antigens have been developed, but there are limited data on the diagnostic accuracy of these assays. This study was a Danish national collaboration and evaluated 15 commercial and one in-house anti-SARS-CoV-2 assays in 16 laboratories. Sensitivity was evaluated using 150 samples from individuals with asymptomatic, mild, or moderate COVID-19, nonhospitalized or hospitalized, confirmed by nucleic acid amplification tests (NAAT); samples were collected 13 to 73 days either from symptom onset or from positive NAAT (patients without symptoms). Specificity and cross-reactivity were evaluated in samples collected prior to the SARS-CoV-2 epidemic from >586 blood donors and patients with autoimmune diseases, cytomegalovirus or Epstein-Barr virus infections, and acute viral infections. A specificity of ≥99% was achieved by all total-Ab and IgG assays except one, DiaSorin Liaison XL IgG (97.2%). Sensitivities in descending order were Wantai ELISA total Ab (96.7%), CUH-NOVO in-house ELISA total Ab (96.0%), Ortho Vitros total Ab (95.3%), YHLO iFlash IgG (94.0%), Ortho Vitros IgG (93.3%), Siemens Atellica total Ab (93.2%), Roche Elecsys total Ab (92.7%), Abbott Architect IgG (90.0%), Abbott Alinity IgG (median 88.0%), DiaSorin Liaison XL IgG (median 84.6%), Siemens Vista total Ab (81.0%), Euroimmun/ELISA IgG (78.0%), and Snibe Maglumi IgG (median 78.0%). However, confidence intervals overlapped for several assays. The IgM results were variable, with the Wantai IgM ELISA showing the highest sensitivity (82.7%) and specificity (99%). The rate of seropositivity increased with time from symptom onset and symptom severity.
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Affiliation(s)
- Lene H Harritshøj
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Gybel-Brask
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pia R Kamstrup
- Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Charlotte S Jørgensen
- Department of Virus & Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | | | - Linda Hilsted
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lennart Friis-Hansen
- Department of Clinical Biochemistry, Copenhagen University Hospital, Bispebjerg, and Frederiksberg Hospital, Copenhagen, Denmark
| | - Pal B Szecsi
- Department of Clinical Biochemistry, Holbæk Hospital, Holbæk, Denmark
| | - Lise Pedersen
- Department of Clinical Biochemistry, Holbæk Hospital, Holbæk, Denmark
| | - Lene Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Cecilie B Hansen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Peter Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Trine-Line Korsholm
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Susan Mikkelsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Kirstine O Nielsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Bjarne K Møller
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne T Hansen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kasper K Iversen
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Pernille B Nielsen
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Rasmus B Hasselbalch
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Kamille Fogh
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Jakob B Norsk
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Jonas Henrik Kristensen
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Kristian Schønning
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nikolai S Kirkby
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Alex C Y Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lone H Landsy
- Department of Nonclinical and Clinical Assay Sciences in Global Discovery & Development Sciences, Novo Nordisk A/S, Måløv, Denmark
| | - Mette Loftager
- Department of Nonclinical and Clinical Assay Sciences in Global Discovery & Development Sciences, Novo Nordisk A/S, Måløv, Denmark
| | - Dorte K Holm
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Anna C Nilsson
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Susanne G Sækmose
- Department of Clinical Immunology, Zealand University Hospital, Næstved Hospital, Næstved, Denmark
| | - Birgitte Grum-Schwensen
- Department of Clinical Immunology, Zealand University Hospital, Næstved Hospital, Næstved, Denmark
| | - Bitten Aagaard
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Thøger G Jensen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
- Research Unit for Clinical Microbiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Dorte M Nielsen
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse Hospital, Slagelse, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Statens Serum Institut, Copenhagen, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse Hospital, Slagelse, Denmark
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16
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Mulder F, Horvàth-Puhó E, van Es N, van Laarhoven H, Pedersen L, Buller H, Sørensen H. OC-05 Risk of venous thromboembolism in cancer patients: a cohort study. Thromb Res 2021. [DOI: 10.1016/s0049-3848(21)00147-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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17
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Ali MS, Berencsi K, Marinier K, Deltour N, Perez-Guthann S, Pedersen L, Rijnbeek P, Lapi F, Simonetti M, Reyes C, Van der Lei J, Sturkenboom M, Prieto-Alhambra D. Comparative cardiovascular safety of strontium ranelate and bisphosphonates: a multi-database study in 5 EU countries by the EU-ADR Alliance. Osteoporos Int 2020; 31:2425-2438. [PMID: 32757044 DOI: 10.1007/s00198-020-05580-0] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/30/2020] [Indexed: 11/26/2022]
Abstract
UNLABELLED Strontium ranelate use, compared with oral bisphosphonates, is not associated with increased risk of AMI in patients with no contraindications for SR use. However, current strontium ranelate (compared with current bisphosphonate) appears associated with 25-30% excess risk of VTE and 35% excess risk of CVDeath. INTRODUCTION Evaluate the risk of cardiac and thromboembolic events among new users of SR and oral BPs without contraindications for SR. METHODS We conducted three multi-national, multi-database (Aarhus-Denmark, HSD-Italy, IPCI-Netherlands, SIDIAP-Spain, THIN-UK) case-control studies nested within a cohort of new users of SR/BP. We matched cases of acute myocardial infarction (AMI), venous thromboembolism (VTE), and cardiovascular death (CVDeath), up to 10 controls on gender, year of birth, index date, and country. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs) according to current SR vs current BP use and current vs past SR use, adjusting for potential confounders. Data were pooled using random effects meta-analysis. RESULTS No excess risk of AMI (5477 cases/54,674 controls) was found with current SR vs current BP (OR 0.89 (95%CI 0.70, 1.12)) nor with current vs past SR use (0.71(0.56, 0.91)). For VTE (5614 cases/6036 controls), an excess risk was found with current SR compared with current BP use, 1.24 (0.96, 1.61), and current vs past SR use, 1.30 (1.04, 1.62). For CVDeath (3019 cases/29,871 controls), an increased risk was seen with current SR vs current BP use, 1.35 (1.02, 1.80), but not with current vs past SR use (0.68 (0.48, 0.96)). CONCLUSION In patients without contraindications for SR, we found no evidence of an increased risk of AMI but a 25-30% excess risk of VTE and a 35% excess risk of CVDeath with current SR vs current BP users. This is despite a reduction in risk in CVDeath with current vs past SR users. The latter disparity could still be partially explained by cessation of preventative therapies in end-of-life or residual confounding by indication.
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Affiliation(s)
- M S Ali
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK.
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK.
| | - K Berencsi
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - K Marinier
- Department of Pharmacoepidemiology and Real World Evidence, Servier, Suresnes, France
| | - N Deltour
- Department of Pharmacoepidemiology and Real World Evidence, Servier, Suresnes, France
| | | | - L Pedersen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - P Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - F Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - M Simonetti
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - C Reyes
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| | - J Van der Lei
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - M Sturkenboom
- Julius Global Health, University Medical Center, Utrecht, Netherlands
| | - D Prieto-Alhambra
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
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Pedersen L, Lund L, Petersen MA, Sjogren P, Groenvold M. Methylphenidate as Needed for Fatigue in Patients With Advanced Cancer. A Prospective, Double-Blind, and Placebo-Controlled Study. J Pain Symptom Manage 2020; 60:992-1002. [PMID: 32464260 DOI: 10.1016/j.jpainsymman.2020.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 02/28/2020] [Revised: 05/06/2020] [Accepted: 05/16/2020] [Indexed: 11/12/2022]
Abstract
CONTEXT Cancer-related fatigue is a highly prevalent symptom with a strong negative impact on patients' daily life. OBJECTIVES To evaluate the efficacy of methylphenidate as needed for the management of fatigue in patients with advanced cancer. METHODS A prospective, controlled, double-blind, and paired design, where the patient was her and/or his own control. Patients with advanced cancer with a tiredness score of ≥50 on a 0-100 visual analogue scale (VAS) were included. Patients were given 10 placebo and 10 methylphenidate tablets numbered 1-20 packed in blocks of four with two active and two placebo tablets (randomly arranged). Patients taking minimum three tablets were regarded evaluable. Primary effect parameters were mean differences in VAS for tiredness after two and five hours. With 28 evaluable patients, the study had a power of 0.90 to detect a mean difference of 15 between active and placebo. RESULTS Thirty-eight patients were enrolled to get 28 evaluable patients. Mean tiredness score before taking the tablets was 75 for placebo and 72 for methylphenidate on VAS (0-100). Mean changes (decrease) for methylphenidate after two and five hours were 20 and 17, respectively, and eight and five for placebo. Comparing mean differences, a significant decrease for methylphenidate compared with placebo was observed after two hours (P = 0.004) and five hours (P = 0.001), respectively. CONCLUSION In this controlled and double-blind study in patients with advanced cancer, methylphenidate as needed was significantly more effective than placebo in relieving fatigue after two and five hours.
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Affiliation(s)
- Lise Pedersen
- Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Line Lund
- Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Morten A Petersen
- Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Per Sjogren
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Section of Palliative Medicine, Department of Oncology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - Mogens Groenvold
- Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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19
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Pedersen L, Szecsi PB, Johansen PB, Bjerrum PJ. Evaluation of Therapeutic Drug Monitoring in the Clinical Management of Patients with Rheumatic Diseases: Data from a Retrospective Single-Center Cohort Study. Biologics 2020; 14:115-125. [PMID: 33162753 PMCID: PMC7643816 DOI: 10.2147/btt.s262511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/24/2020] [Indexed: 01/13/2023]
Abstract
Purpose Treatment of rheumatic diseases with tumor necrosis factor inhibitors leads to improved clinical outcomes. Therapeutic drug monitoring (TDM) may assist in guiding clinical decisions. This study investigates the impact of TDM on clinical outcome, decision-making and biologics cost expenditure. Patients and Methods In a retrospective observational study of 306 patients with rheumatic diseases treated with four different tumor necrosis factor inhibitors, drug levels and antidrug antibodies were measured over a period of one year. Primary outcomes were the clinicians’ response to each TDM result and the clinical outcome two years after TDM initiation. Outcomes were compared between the 111 TDM-guided patients and the 195 empirically guided patients. Results Treatment change occurred in 55% of the patients in the TDM group, but in only 38% in the empirically guided group. In the TDM group, 89 (79.5%) patients were in remission or had low disease activity after two years follow-up compared to 128 (65.6%) patients in the empirical group. The average cost of biologics per patient per year was lower in the TDM group than in the empirical group for patients receiving infliximab, adalimumab or etanercept at baseline but not for golimumab. Conclusion TDM-guided decision-making is useful in rheumatic patients receiving TNFi and may optimize therapeutic decisions, leading to a better control of disease activity. Proactive TDM may support decisions on dose tapering, resulting in lower drug consumption and biologics cost expenditure.
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Affiliation(s)
- Lise Pedersen
- Department of Clinical Biochemistry, University of Copenhagen, Holbæk Hospital, Holbæk, Denmark
| | - Pal Bela Szecsi
- Department of Clinical Biochemistry, University of Copenhagen, Holbæk Hospital, Holbæk, Denmark
| | - Per Birger Johansen
- Department of Rheumatology, University of Copenhagen, Holbæk Hospital, Holbæk, Denmark
| | - Poul Jannik Bjerrum
- Department of Clinical Biochemistry, University of Copenhagen, Holbæk Hospital, Holbæk, Denmark
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20
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Berencsi K, Sami A, Ali MS, Marinier K, Deltour N, Perez-Gutthann S, Pedersen L, Rijnbeek P, Van der Lei J, Lapi F, Simonetti M, Reyes C, Sturkenboom MCJM, Prieto-Alhambra D. Correction to: Impact of risk minimisation measures on the use of strontium ranelate in Europe: a multi-national cohort study in 5 EU countries by the EU-ADR Alliance. Osteoporos Int 2020; 31:799. [PMID: 32025756 DOI: 10.1007/s00198-020-05314-2] [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: 10/25/2022]
Abstract
The original version of this article, published on 26 November 2019 contained a mistake.
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Affiliation(s)
- K Berencsi
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - A Sami
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - M S Ali
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - K Marinier
- Department of Pharmacoepidemiology, Servier, Suresnes, France
| | - N Deltour
- Department of Pharmacoepidemiology, Servier, Suresnes, France
| | | | - L Pedersen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - P Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Van der Lei
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - F Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - M Simonetti
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - C Reyes
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| | | | - D Prieto-Alhambra
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK.
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain.
- Botnar Research Centre, Oxford, UK.
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21
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Berencsi K, Sami A, Ali MS, Marinier K, Deltour N, Perez-Gutthann S, Pedersen L, Rijnbeek P, Van der Lei J, Lapi F, Simonetti M, Reyes C, Sturkenboom MCJM, Prieto-Alhambra D. Impact of risk minimisation measures on the use of strontium ranelate in Europe: a multi-national cohort study in 5 EU countries by the EU-ADR Alliance. Osteoporos Int 2020; 31:721-755. [PMID: 31696274 DOI: 10.1007/s00198-019-05181-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION In May 2013 and March 2014, the European Medicines Agency (EMA) issued two decisions restricting the use of strontium ranelate (SR). These risk minimisation measures (RMM) introduced new contraindications and limited the indications of SR therapy. The EMA required an assessment of the impact of RMMs on the use of SR in Europe. Methods design: multi-national, multi-database cohort Setting: electronic medical record databases based on hospital (Denmark) and primary care provenance (Italy, Spain, the Netherlands, UK). PARTICIPANTS the database source populations were included for population-based analyses, and SR users for patient-level analyses. INTERVENTION New RMMs included contraindications (ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, uncontrolled hypertension) and restricted SR indication to severe osteoporosis with initiation by experienced physician and not as first line anti-osteoporosis therapy. METHODS Prevalence and incidence rates of SR use in the population; prevalence of contraindications and restricted indications in SR users, plus 1-year therapy persistence. Drug use measures were calculated in three periods for comparison: reference (2004 to May 2013), transition (June 2013 to March 2014) and assessment (from April 2014 to end 2016). RESULTS The study population included 143 million person-years(PY) of follow-up and 76,141 incident episodes of SR treatment. Average monthly prevalence rates of SR use dropped by 86.4% from 62.6/10,000 PY (95 CI 62.4-62.9) in the reference to 8.5 (8.5-8.6) in the assessment period. Similarly, the incidence rate of SR use fell by 97.3% from 7.4/10,000 PY (7.4-7.4) to 0.2 (0.2-0.2) between the reference and assessment period. The prevalence of any contraindication decreased, whilst the prevalence of restricted indications increased in these periods. One-year persistence decreased in the assessment compared with reference period. CONCLUSIONS Our study demonstrates a substantial impact of the regulatory action to restrict use of SR in Europe: SR utilisation overall decreased strongly. The proportion of patients fulfilling the restricted indications, without contraindications, increased after the proposed RMMs.
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Affiliation(s)
- K Berencsi
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - A Sami
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - M S Ali
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - K Marinier
- Department of Pharmacoepidemiology, Servier, Suresnes, France
| | - N Deltour
- Department of Pharmacoepidemiology, Servier, Suresnes, France
| | | | - L Pedersen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - P Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Van der Lei
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - F Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - M Simonetti
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - C Reyes
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| | | | - D Prieto-Alhambra
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK.
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain.
- Botnar Research Centre, Windmill Road, Oxford, OX37LD, UK.
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22
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Johnsen AT, Petersen MA, Sjøgren P, Pedersen L, Neergaard MA, Damkier A, Gluud C, Fayers P, Lindschou J, Strömgren AS, Nielsen JB, Higginson IJ, Groenvold M. Exploratory analyses of the Danish Palliative Care Trial (DanPaCT): a randomized trial of early specialized palliative care plus standard care versus standard care in advanced cancer patients. Support Care Cancer 2019; 28:2145-2155. [PMID: 31410598 DOI: 10.1007/s00520-019-05021-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 03/29/2019] [Accepted: 07/30/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Early and integrated specialized palliative care is often recommended but has still only been investigated in relatively few randomized clinical trials. OBJECTIVE To investigate the effect of early specialized palliative care plus standard care versus standard care on the explorative outcomes in the Danish Palliative Care Trial (DanPaCT). METHODS We conducted a randomized multicentre, parallel-group clinical trial. Consecutive patients with metastatic cancer were included if they had symptoms or problems that exceeded a predefined threshold according to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Outcomes were estimated as the differences between the intervention and the control groups in the change from baseline to the weighted mean of the 3- and 8-week follow-ups measured as areas under the curve. RESULTS In total, 145 patients were randomized to early specialized palliative care plus standard care versus 152 to standard care only. Early specialized palliative care had no significant effect on any of the symptoms or problems. Of the 21 items addressing satisfaction, specialized palliative care improved the item 'overall satisfaction with the help received from the health care system' with 9 points (95% confidence interval 3.8 to 14.2, p = 0.0006) and three other items (all p < 0.05). CONCLUSION In line with the analyses of the primary and secondary outcomes in DanPaCT, we did not find that specialized palliative care, as provided in DanPaCT, affected symptoms and problems. However, patients in the intervention group seemed more satisfied with the health care received than those in the standard care group. TRIAL REGISTRATION NCT01348048.
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Affiliation(s)
- Anna Thit Johnsen
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark. .,Department of Psychology, University of Southern Denmark, Campusvej 55, Odense, Denmark.
| | - Morten Aagaard Petersen
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Per Sjøgren
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lise Pedersen
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Anette Damkier
- Palliative Team Fyn, Odense University Hospital, Odense, Denmark
| | - Christian Gluud
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Fayers
- Institute of Applied Health Sciences, University of Aberdeen Medical School, Aberdeen, Scotland, UK.,Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jane Lindschou
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annette S Strömgren
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Irene J Higginson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
| | - Mogens Groenvold
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Thomsen RW, Nicolaisen SK, Adelborg K, Svensson E, Hasvold P, Palaka E, Pedersen L, Sørensen HT. Hyperkalaemia in people with diabetes: occurrence, risk factors and outcomes in a Danish population-based cohort study. Diabet Med 2018; 35:1051-1060. [PMID: 29790603 DOI: 10.1111/dme.13687] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2018] [Indexed: 01/28/2023]
Abstract
AIMS To examine the incidence, risk factors and clinical outcomes of hyperkalaemia in people with diabetes in a real-world setting. METHODS Using Danish health registries, we identified a population-based cohort of people with first-time drug-treated diabetes, in the period 2000-2012. First, the cumulative incidence of hyperkalaemia, defined as first blood test with potassium level >5.0 mmol/l after diabetes treatment initiation, was ascertained. Second, in a case-control analysis, risk factors were compared in people with vs without hyperkalaemia. Third, clinical outcomes were assessed among individuals with hyperkalaemia in a before-after analysis, and among people with and without hyperkalaemia in a matched cohort analysis. RESULTS Of 68 601 individuals with diabetes (median age 62 years, 47% women), 16% experienced hyperkalaemia (incidence rate 40 per 1000 person-years) during a mean follow-up of 4.1 years. People who developed hyperkalaemia had a higher prevalence of chronic kidney disease [prevalence ratio 1.74 (95% CI 1.68-1.81)], heart failure [prevalence ratio 2.35 (95% CI 2.18-2.54)], use of angiotensin-converting enzyme inhibitors [prevalence ratio 1.24 (95% CI 1.20-1.28)], use of spironolactone [prevalence ratio 2.68 (95% CI 2.48-2.88)] and potassium supplements [prevalence ratio 1.59 (95% CI 1.52-1.67)]. In people with diabetes who developed hyperkalaemia, 31% were acutely hospitalized within 6 months before hyperkalaemia, increasing to 50% 6 months after hyperkalaemia [before-after risk ratio 1.67 (95% CI 1.61-1.72)]. The 6-month mortality rate after hyperkalaemia was 20%. Compared with matched individuals without hyperkalaemia, the hazard ratio for death was 6.47 (95% CI 5.81-7.21). CONCLUSIONS One in six newly diagnosed people with diabetes experienced a hyperkalaemic event, which was associated with severe clinical outcomes and death.
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Affiliation(s)
- R W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - S K Nicolaisen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - K Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - E Svensson
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - P Hasvold
- AstraZeneca Nordic, Medical Department, Etterstad, Oslo, Norway
| | - E Palaka
- AstraZeneca, Global Payer Evidence, Cambridge, UK
| | - L Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Rasmussen PV, Dalgaard F, Brandes A, Johnsen SP, Munster AMB, Grove EL, Pedersen L, Torp-Pedersen C, Gislason GH, Pallisgaard JL, Hansen ML. P4237Gastrointestinal bleeding is associated with gastrointestinal cancer in patients with atrial fibrillation treated with anticoagulants - a nationwide study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- P V Rasmussen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - F Dalgaard
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - A Brandes
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - S P Johnsen
- Aalborg University, Department of Clinical Medicine, Aalborg, Denmark
| | - A M B Munster
- Sydvestjysk Hospital, Department of Clinical Biochemistry, Esbjerg, Denmark
| | - E L Grove
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L Pedersen
- Aalborg University Hospital, Department of Surgery, Aalborg, Denmark
| | - C Torp-Pedersen
- Aalborg University Hospital, Department of Clinical Epidemiology, Aalborg, Denmark
| | - G H Gislason
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J L Pallisgaard
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M L Hansen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
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Loft MI, Esbensen BA, Kirk K, Pedersen L, Martinsen B, Iversen H, Mathiesen LL, Poulsen I. Nursing staffs self-perceived outcome from a rehabilitation 24/7 educational programme - a mixed-methods study in stroke care. BMC Nurs 2018; 17:17. [PMID: 29719491 PMCID: PMC5921301 DOI: 10.1186/s12912-018-0285-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/19/2017] [Accepted: 04/03/2018] [Indexed: 11/14/2022] Open
Abstract
Background During the past two decades, attempts have been made to describe nurses’ contributions to the rehabilitation of inpatients following stroke. There is currently a lack of interventions that integrate the diversity of nurses’ role and functions in stroke rehabilitation and explore their effect on patient outcomes. Using a systematic evidence- and theory-based design, we developed an educational programme, Rehabilitation 24/7, for nursing staff working in stroke rehabilitation aiming at two target behaviours; working systematically with a rehabilitative approach in all aspects of patient care and working deliberately and systematically with patients’ goals. The aim of this study was to assess nursing staff members’ self-perceived outcome related to their capability, opportunity and motivation to work with a rehabilitative approach after participating in the stroke Rehabilitation 24/7 educational programme. Methods A convergent mixed-method design was applied consisting of a survey and semi-structured interviews. Data collection was undertaken between February and June 2016. Data from the questionnaires (N = 33) distributed before and after the intervention were analysed using descriptive statistics and Wilcoxon sign rank test. The interviews (N = 10) were analysed using deductive content analysis. After analysing questionnaires and interviews separately, the results were merged in a side by side comparison presented in the discussion. Results The results from both the quantitative and qualitative analyses indicate that the educational programme shaped the target behaviours that we aimed to change by addressing the nursing staff’s capability, opportunity and motivation and hence could strengthen the nursing staff’s contribution to inpatient stroke rehabilitation. A number of behaviours changed significantly, and the qualitative results indicated that the staff experienced increased focus on their role and functions in rehabilitation practice. Conclusion Our study provides an understanding of the outcome of the Rehabilitation 24/7 educational programme on nursing staff’s behaviours. A mixed-methods approach provided extended knowledge of the changes in the nursing staff members’ self-percived behaviours after the intervention. These changes suggest that educating the nursing staff on rehabilitation using the Rehabilitation 24/7 programme strengthened their knowledge and beliefs about rehabilitation, goal-setting as well as their role and functions.
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Affiliation(s)
- M I Loft
- 1Department of Neurology, Rigshospitalet, Nordre Ringvej 57, 2600 Glostrup, Denmark.,2Institute of Public Health, Department of Nursing Science, Aarhus University, Aarhus, Denmark
| | - B A Esbensen
- 3Copenhagen Centre for Arthritis Research (COPECARE), Centre for Rheumatology and Spine Diseases VRR, Head and Orthopaedics Centre, Rigshospitalet, Glostrup, Denmark.,4Falcuty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - K Kirk
- Partner PAR3(consulting firm), Copenhagen, Denmark
| | - L Pedersen
- Partner PAR3(consulting firm), Copenhagen, Denmark
| | - B Martinsen
- 2Institute of Public Health, Department of Nursing Science, Aarhus University, Aarhus, Denmark
| | - H Iversen
- 1Department of Neurology, Rigshospitalet, Nordre Ringvej 57, 2600 Glostrup, Denmark.,4Falcuty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - L L Mathiesen
- 1Department of Neurology, Rigshospitalet, Nordre Ringvej 57, 2600 Glostrup, Denmark
| | - I Poulsen
- 2Institute of Public Health, Department of Nursing Science, Aarhus University, Aarhus, Denmark.,Research Unit on Brain Injury Rehabilitation Copenhagen (RuBRIC), Clinic of Neurorehabilitaion, TBI unit Rigshospitalet, Glostrup, Denmark
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Pedersen L, Birkemose E, Gils C, Safi S, Nybo M. Sample Type and Storage Conditions Affect Calprotectin Measurements in Blood. J Appl Lab Med 2017; 2:851-856. [PMID: 33636827 DOI: 10.1373/jalm.2017.024778] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/18/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Calprotectin, a complex of calcium-binding proteins, is abundant in granulocytes. Increased levels of plasma calprotectin have been found in patients with inflammatory and autoimmune diseases. However, a number of preanalytical factors may affect calprotectin measurement in blood samples. METHODS Twelve blood samples [4 tubes, 1 each of lithium-heparin (Li-heparin), EDTA, and serum] were drawn from each of 14 healthy individuals. To evaluate the effect of temperature and storage time in the lag time between collection and centrifugation, samples were kept for 2 h at 4 °C, 20 °C, or 37 °C, before centrifugation. Leukocyte, neutrophil, and monocyte counts were measured in EDTA samples on a Sysmex XN-10 hematology analyzer to investigate the relationship between calprotectin concentrations and the granulocyte count. RESULTS Calprotectin measurements in EDTA samples were not influenced by temperature or time lag between collection and analysis. Compared to EDTA plasma, significantly higher calprotectin concentrations were found in serum and Li-heparin plasma samples. Furthermore, calprotectin concentrations increased in serum and Li-heparin samples when stored at higher temperatures. There was a linear relationship between the serum calprotectin concentration and neutrophil count in EDTA whole blood. CONCLUSIONS EDTA is the most suitable anticoagulant for determination of calprotectin in plasma, as this sample matrix does not seem to be affected by temperature or time between sample collection and analysis. Of particular note, neutrophil activation by either clotting or centrifugation should be avoided during the preanalytical process.
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Affiliation(s)
- Lise Pedersen
- Department of Clinical Biochemistry, Holbæk Hospital, Holbæk, Denmark
| | - Erling Birkemose
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Charlotte Gils
- Department of Clinical Immunology and Biochemistry, Lillebaelt Hospital, Vejle, Denmark
| | - Sara Safi
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
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Groenvold M, Petersen MA, Damkier A, Neergaard MA, Nielsen JB, Pedersen L, Sjøgren P, Strömgren AS, Vejlgaard TB, Gluud C, Lindschou J, Fayers P, Higginson IJ, Johnsen AT. Randomised clinical trial of early specialist palliative care plus standard care versus standard care alone in patients with advanced cancer: The Danish Palliative Care Trial. Palliat Med 2017; 31:814-824. [PMID: 28494643 DOI: 10.1177/0269216317705100] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND Beneficial effects of early palliative care have been found in advanced cancer, but the evidence is not unequivocal. AIM To investigate the effect of early specialist palliative care among advanced cancer patients identified in oncology departments. SETTING/PARTICIPANTS The Danish Palliative Care Trial (DanPaCT) (ClinicalTrials.gov NCT01348048) is a multicentre randomised clinical trial comparing early referral to a specialist palliative care team plus standard care versus standard care alone. The planned sample size was 300. At five oncology departments, consecutive patients with advanced cancer were screened for palliative needs. Patients with scores exceeding a predefined threshold for problems with physical, emotional or role function, or nausea/vomiting, pain, dyspnoea or lack of appetite according to the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were eligible. The primary outcome was the change in each patient's primary need (the most severe of the seven QLQ-C30 scales) at 3- and 8-week follow-up (0-100 scale). Five sensitivity analyses were conducted. Secondary outcomes were change in the seven QLQ-C30 scales and survival. RESULTS Totally 145 patients were randomised to early specialist palliative care versus 152 to standard care. Early specialist palliative care showed no effect on the primary outcome of change in primary need (-4.9 points (95% confidence interval -11.3 to +1.5 points); p = 0.14). The sensitivity analyses showed similar results. Analyses of the secondary outcomes, including survival, also showed no differences, maybe with the exception of nausea/vomiting where early specialist palliative care might have had a beneficial effect. CONCLUSION We did not observe beneficial or harmful effects of early specialist palliative care, but important beneficial effects cannot be excluded.
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Affiliation(s)
- Mogens Groenvold
- 1 The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen NV, Denmark.,2 Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Morten Aagaard Petersen
- 1 The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen NV, Denmark
| | - Anette Damkier
- 3 Palliative Team Fyn, Odense University Hospital, Odense, Denmark
| | | | | | - Lise Pedersen
- 1 The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen NV, Denmark
| | - Per Sjøgren
- 6 Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annette Sand Strömgren
- 6 Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Christian Gluud
- 8 The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jane Lindschou
- 8 The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Fayers
- 9 Institute of Applied Health Sciences, University of Aberdeen Medical School, Aberdeen, UK.,10 Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Irene J Higginson
- 11 Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Anna Thit Johnsen
- 1 The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen NV, Denmark.,12 Institute of Psychology, University of Southern Denmark, Odense, Denmark
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Schmidt M, Sorensen H, Pedersen L. 1015Cardiovascular risks associated with diclofenac initiation: a nationwide emulated randomized trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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29
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Pedersen L, Christensen LL, Pedersen SM, Andersen M. Reduction of calprotectin and phosphate during testosterone therapy in aging men: a randomized controlled trial. J Endocrinol Invest 2017; 40:529-538. [PMID: 28000180 DOI: 10.1007/s40618-016-0597-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 09/27/2016] [Accepted: 12/09/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To investigate the effect of testosterone treatment on biomarkers calprotectin, fibroblast growth factor 23 (FGF23), soluble Klotho, phosphate, calcium, parathyroid hormone, creatinine and estimated glomerular filtration rate. DESIGN Randomized, double-blinded, placebo-controlled study. SETTING Odense Androgen Study-the effect of Testim and training in hypogonadal men. PARTICIPANTS Men aged 60-78 years old with a low normal concentration of free of bioavailable testosterone <7.3 nmol/L and waist circumference >94 cm recruited from 2008 to 2009 (N = 48) by advertisement. INTERVENTION Participants were randomized to receive 5-10 g gel/50-100 mg testosterone (Testim®, Ipsen, France) or 5-10 g gel/placebo. RESULTS The plasma levels of calprotectin and phosphate were significantly reduced in the group receiving testosterone therapy (gel) compared to the placebo group (p < 0.05). Testosterone treatment did not have any significant effect on plasma levels of FGF23 or soluble Klotho. The reduction in phosphate levels was inversely associated with bioavailable testosterone. CONCLUSION Compared to the placebo group, 6 months of testosterone therapy (gel) reduced calprotectin and phosphate levels suggesting decreased inflammation and decreased cardiovascular risk.
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Affiliation(s)
- L Pedersen
- Department of Clinical Chemistry, Holbæk Hospital, Smedelundsgade 60, 4300, Holbæk, Denmark.
| | - L L Christensen
- Department of Endocrinology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - S M Pedersen
- Department of Clinical Chemistry and Pharmacology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - M Andersen
- Department of Endocrinology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
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30
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Nielsen TRH, Lausten-Thomsen U, Fonvig CE, Bøjsøe C, Pedersen L, Bratholm PS, Hansen T, Pedersen O, Holm JC. Dyslipidemia and reference values for fasting plasma lipid concentrations in Danish/North-European White children and adolescents. BMC Pediatr 2017; 17:116. [PMID: 28454530 PMCID: PMC5410076 DOI: 10.1186/s12887-017-0868-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [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: 09/29/2016] [Accepted: 04/22/2017] [Indexed: 02/08/2023] Open
Abstract
Background Dyslipidemia is reported in 27 − 43% of children and adolescents with overweight/obesity and tracks into adulthood, increasing the risk of cardiovascular morbidity. Cut-off values for fasting plasma lipid concentrations are typically set at fixed levels throughout childhood. The objective of this cross-sectional study was to generate fasting plasma lipid references for a Danish/North-European White population-based cohort of children and adolescents, and investigate the prevalence of dyslipidemia in this cohort as well as in a cohort with overweight/obesity. Methods A population-based cohort of 2141 (1275 girls) children and adolescents aged 6 − 19 (median 11.5) years was recruited from 11 municipalities in Denmark. Additionally, a cohort of children and adolescents of 1421 (774 girls) with overweight/obesity aged 6 − 19 years (median 11.8) was recruited for the study. Height, weight, and fasting plasma lipid concentrations were measured on all participants. Smoothed reference curves and percentiles were generated using the Generalized Additive Models for Location Scale and Shape package in the statistical software R. Results In the population-based cohort, plasma concentrations of total cholesterol (TC) (P < 0.05), low-density lipoprotein cholesterol (LDL) (P < 0.005), and high-density lipoprotein cholesterol (HDL) (P < 0.005) were higher in the youngest compared to the oldest tertile. Fasting plasma levels of triglycerides (TG) (P < 0.005) increased with age in both sexes. In boys, non-HDL was lower in the oldest compared to the youngest tertile (P < 0.0005). Concentrations of TC, LDL, non-HDL, and TG were higher (P < 0.05), and HDL lower (P < 0.05) in the cohort with overweight/obesity in both sexes and for all ages except for TC in the youngest girls. The overall prevalence of dyslipidemia was 6.4% in the population-based cohort and 28.0% in the cohort with overweight/obesity. The odds ratio for exhibiting dyslipidemia in the cohort with overweight/obesity compared with the population-based cohort was 6.2 (95% CI: 4.9 − 8.1, P < 2*10−16). Conclusion Fasting plasma lipid concentrations change during childhood and adolescence and differ with sex and age. Children and adolescents with obesity have increased concentrations of circulating lipids and exhibit an increased prevalence of dyslipidemia. Trial registration The study is part of The Danish Childhood Obesity Biobank; ClinicalTrials.gov ID-no.: NCT00928473 retrospectively registered on June 25th 2009. Electronic supplementary material The online version of this article (doi:10.1186/s12887-017-0868-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tenna Ruest Haarmark Nielsen
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Smedelundsgade 60, DK 4300, Holbæk, Denmark. .,Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, DK 2100, Copenhagen, Denmark.
| | - Ulrik Lausten-Thomsen
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Smedelundsgade 60, DK 4300, Holbæk, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Cilius Esmann Fonvig
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Smedelundsgade 60, DK 4300, Holbæk, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, DK 2100, Copenhagen, Denmark.,Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Christine Bøjsøe
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Smedelundsgade 60, DK 4300, Holbæk, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, DK 2100, Copenhagen, Denmark
| | - Lise Pedersen
- Department of Clinical Biochemistry, Copenhagen University Hospital Holbæk, DK 4300, Holbæk, Denmark
| | - Palle Skov Bratholm
- Department of Clinical Biochemistry, Copenhagen University Hospital Holbæk, DK 4300, Holbæk, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, DK 2100, Copenhagen, Denmark
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, DK 2100, Copenhagen, Denmark
| | - Jens-Christian Holm
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Smedelundsgade 60, DK 4300, Holbæk, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, DK 2100, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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31
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Erichsen R, Horvath-Puho E, Lund JL, Dellon ES, Shaheen NJ, Pedersen L, Davey Smith G, Sørensen HT. Mortality and cardiovascular diseases risk in patients with Barrett's oesophagus: a population-based nationwide cohort study. Aliment Pharmacol Ther 2017; 45:973-982. [PMID: 28139003 DOI: 10.1111/apt.13962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Received: 01/09/2017] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients with Barrett's oesophagus may be at increased risk of mortality overall, and cardiovascular disease has been suggested as the main underlying cause of death. AIM To examine cause-specific mortality and risk of cardiovascular events among patients with Barrett's oesophagus. METHODS Utilising existing Danish data sources (1997-2011), we identified all patients with histologically verified Barrett's oesophagus (n = 13 435) and 123 526 members of the general population matched by age, sex and individual comorbidities. We calculated cause-specific mortality rates and incidence rates of cardiovascular diseases. We then compared rates between patients with Barrett's oesophagus and the general population comparison cohort, using stratified Cox proportional hazard regression. RESULTS Patients with Barrett's oesophagus had a 71% increased risk of overall mortality. The cause-specific mortality rate per 1000 person-years for patients with Barrett's oesophagus was 8.5 for cardiovascular diseases, 14.7 for non-oesophageal cancers, and 5.4 for oesophageal cancer. Compared to the general population cohort, corresponding hazard ratios were 1.26 (95% confidence interval (CI): 1.15-1.38), 1.77 (95% CI: 1.65-1.90), and 19.4 (95% CI: 16.1-23.4), respectively. The incidence rates of cardiovascular diseases per 1000 person-years for Barrett's oesophagus patients and for persons from the general population cohort, respectively, varied from 0.4 and 0.2 for subarachnoid bleeding (hazard ratio 1.10, 95% CI: 0.87-1.39) to 8.1 and 5.9 for congestive heart failure (hazard ratio 1.33, 95% CI: 1.21-1.46). CONCLUSION Prophylactic measures targeted at cardiovascular diseases and non-oesophageal cancers potentially could be more important than measures against oesophageal cancer, for improving prognosis among patients with Barrett's oesophagus.
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Affiliation(s)
- R Erichsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - E Horvath-Puho
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - J L Lund
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - E S Dellon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, USA
| | - N J Shaheen
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, USA
| | - L Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - G Davey Smith
- MRC Integrative Epidemiology Unit (IEU), School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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32
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Thomsen RW, Baggesen LM, Søgaard M, Pedersen L, Nørrelund H, Buhl ES, Haase CL, Johnsen SP. Effectiveness of intensification therapies in Danes with Type 2 diabetes who use basal insulin: a population-based study. Diabet Med 2017; 34:213-222. [PMID: 27279380 DOI: 10.1111/dme.13168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 11/29/2022]
Abstract
AIMS To examine the usage and real-life effectiveness of intensification therapies in people with Type 2 diabetes treated with basal insulin. METHODS We used population-based healthcare databases in Denmark during 2000-2012 to identify all individuals with a first basal insulin prescription (with or without oral drugs), and evaluated subsequent intensification therapy with bolus insulin, premixed insulin or glucagon-like peptide-1 (GLP-1) receptor agonists. Poisson regression was used to compute the adjusted relative risks of reaching glycaemic control targets. RESULTS We included 7034 initiators of basal insulin (median age 64 years, diabetes duration 5.3 years, 84% with oral co-medication and median (interquartile range) pre-insulin HbA1c level 77 (65-92) mmol/mol [9.2% (8.1-10.6%)]. Of these, 3076 (43.7%) received intensification therapy after a median of 11 months: 58.5% with premixed insulin, 29.0% with bolus insulin, 10.6% with GLP-1 receptor agonists, and 1.9% with more than one add-on. Overall, 22% had attained an HbA1c level of < 53 mmol/mol (< 7%) by 3-6 months after intensification, while 38% attained an HbA1c < 58 mmol/mol (< 7.5%). Compared with premixed insulin intensification, attainment of HbA1c < 53 and < 58 mmol/mol was similar with bolus insulin add-on [adjusted relative risk 1.03 (95% CI 0.86-1.24) and 1.02 (95% CI 0.91-1.15), and higher for GLP-1 receptor agonist add-on [adjusted relative risk 1.56 (95% CI 1.27-1.92) and 1.27 (1.10-1.47)]. CONCLUSIONS Among people with Type 2 diabetes, 22 and 38% reached a target HbA1c < 53 mmol/mol (< 7%) or < 58 mmol/mol (< 7.5%), respectively, after intensification of their basal insulin therapy. Compared with premixed insulin, target attainment was similar with bolus insulin and higher with GLP-1 receptor agonists.
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Affiliation(s)
- R W Thomsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - L M Baggesen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - M Søgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - L Pedersen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - E S Buhl
- Novo Nordisk Scandinavia AB, Ørestad, Copenhagen, Denmark
| | - C L Haase
- Novo Nordisk Scandinavia AB, Ørestad, Copenhagen, Denmark
| | - S P Johnsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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33
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Bressendorff I, Hansen D, Schou M, Silver B, Pasch A, Bouchelouche P, Pedersen L, Rasmussen LM, Brandi L. Oral Magnesium Supplementation in Chronic Kidney Disease Stages 3 and 4: Efficacy, Safety, and Effect on Serum Calcification Propensity-A Prospective Randomized Double-Blinded Placebo-Controlled Clinical Trial. Kidney Int Rep 2016; 2:380-389. [PMID: 29142966 PMCID: PMC5678662 DOI: 10.1016/j.ekir.2016.12.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [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: 09/29/2016] [Revised: 11/29/2016] [Accepted: 12/23/2016] [Indexed: 02/07/2023] Open
Abstract
Introduction Chronic kidney disease (CKD) is associated with high cardiovascular morbidity and mortality. Recent evidence suggests that increases in both serum and intracellular magnesium (Mg) can slow or even prevent the development of vascular calcification seen in CKD. Serum calcification propensity (T50) is a novel functional test, which is associated with all-cause mortality in CKD and measures the ability of serum to delay the formation of crystalline nanoparticles. Theoretically, increasing serum Mg should improve T50 and thereby reduce the propensity towards ectopic calcification. Methods We conducted a randomized placebo-controlled double-blinded clinical trial to investigate the safety of 2 different doses of oral Mg supplementation in subjects with CKD stages 3 and 4 as well as their effects on intracellular Mg and T50. Thirty-six subjects with CKD stages 3 and 4 were randomized to one of 3 groups (placebo, elemental Mg 15 mmol/d or elemental Mg 30 mmol/d) given as slow-release Mg hydroxide and followed for 8 weeks. Results Thirty-four subjects completed the trial. Intracellular Mg remained stable throughout the trial despite significant increases in both serum and urine Mg. T50 increased significantly by 40 min from 256 ± 60 (mean ± SD) to 296 ± 64 minutes (95% confidence interval, 11-70, P < 0.05) in the Mg 30 mmol/d group after 8 weeks. No serious adverse events related to the study medication were reported during the study. Discussion Oral Mg supplementation was safe and well tolerated in CKD stages 3 and 4 and improved T50, but did not increase intracellular Mg. Further studies are needed to investigate the long-term effects of Mg supplementation in CKD stage 3 and 4 and whether improvement in calcification propensity is related to clinical endpoints.
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Affiliation(s)
- Iain Bressendorff
- Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital, Hillerød, Denmark
| | - Ditte Hansen
- Department of Nephrology, Herlev and Gentofte Hospital, Herlev, Denmark.,Division of Nephrology, Roskilde Hospital, Roskilde, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Burton Silver
- IntraCellular Diagnostics Inc., Medford, Oregon, USA
| | - Andreas Pasch
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | | | - Lise Pedersen
- Department of Clinical Biochemistry, Holbæk Hospital, Holbæk, Denmark
| | - Lars Melholt Rasmussen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Lisbet Brandi
- Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital, Hillerød, Denmark
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Madsen JB, Pedersen L, Kidholm CL, Rasmussen LM. Arterial Iron Content Is Increased in Patients with High Plasma Ferritin Levels. J Vasc Res 2016; 53:301-307. [PMID: 27941325 DOI: 10.1159/000452799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 10/23/2016] [Indexed: 11/19/2022] Open
Abstract
The association between increased amounts of stored iron and development of cardiovascular disease (CVD) has been recognized for many years. However, basic information on iron content in human arteries is limited. We envision that associations between body iron content and CVD are based on the accumulation of iron in the arteries, possibly leading to the dysfunction of cellular biochemical pathways. This study addresses the very fundamental question of whether there is a relation between body iron content and the level of iron accumulated in arterial tissue. The iron content in human nonatherosclerotic artery samples from patients with high and low body-iron contents estimated from the plasma ferritin concentration were determined by inductively coupled plasma mass spectroscopy in tissue extracts and by histological staining, using a modified Perls reaction to display iron deposits. We found that the arteries contained small but measurable levels of iron. The iron content was significantly higher in tissue from patients with high plasma ferritin (p = 0.026). Histological staining showed the presence of iron deposits. Our results suggest that iron does accumulate in arterial tissue in accordance to the level of stored body iron. Further studies are needed on the distribution of iron in excess to explain the relationship between stored iron and the development of atherosclerosis.
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Affiliation(s)
- Julie Bukh Madsen
- Department of Clinical Biochemistry and Pharmacology, Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark
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35
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Kjølby B, Khan A, Chuhutin A, Pedersen L, Jensen J, Jakobsen S, Zeidler D, Sangill R, Nyengaard J, Jespersen S, Hansen B. Fast diffusion kurtosis imaging of fibrotic mouse kidneys. NMR Biomed 2016; 29:1709-1719. [PMID: 27731906 PMCID: PMC5123986 DOI: 10.1002/nbm.3623] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 04/21/2016] [Revised: 07/25/2016] [Accepted: 08/17/2016] [Indexed: 05/16/2023]
Abstract
Diffusion kurtosis imaging (DKI) is sensitive to tissue microstructure and may therefore be useful in the diagnosis and monitoring of disease in brain and body organs. Generally, diffusion magnetic resonance imaging (dMRI) in the body is challenging because of the heterogeneous body composition, which can cause image artefacts as a result of chemical shifts and susceptibility differences. In addition, the abdomen possesses physiological factors (e.g. breathing, heartbeat, blood flow) which may severely reduce image quality, especially when echo planar imaging is employed, as is typical in dMRI. Collectively, these challenging measurement conditions impede the use and exploration of DKI in the body. This impediment is further exacerbated by the traditionally large amount of data required for DKI and the low signal-to-noise ratio at the b-values needed to effectively probe the kurtosis regime. Recently introduced fast DKI techniques reduce the challenge of DKI in the body by decreasing the data requirement substantially, so that, for example, triggering and breath-hold techniques may be applied for the entire DKI acquisition without causing unfeasible scan times. One common pathological condition for which body DKI may be of immediate clinical value is kidney fibrosis, which causes progressive changes in organ microstructure. With its sensitivity to microstructure, DKI is an obvious candidate for a non-invasive evaluation method. We present preclinical evidence indicating that the rapidly obtainable tensor-derived mean kurtosis ( W̅) distinguishes moderately fibrotic kidneys from healthy controls. The presence and degree of fibrosis are confirmed by histology, which also indicates fibrosis as the main driver behind the DKI differences observed between groups. We therefore conclude that fast kurtosis is a likely candidate for an MRI-based method for the detection and monitoring of renal fibrosis. We provide protocol recommendations for fast renal DKI in humans based on a b-value optimisation performed using data acquired at 3 T in normal human kidney.
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Affiliation(s)
- B.F. Kjølby
- Center of Functionally Integrative Neuroscience (CFIN) and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A.R. Khan
- Center of Functionally Integrative Neuroscience (CFIN) and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A. Chuhutin
- Center of Functionally Integrative Neuroscience (CFIN) and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - L. Pedersen
- Research Laboratory for Biochemical Pathology, Aarhus University Hospital, Department of Clinical Medicine, Aarhus, Denmark
| | - J.B. Jensen
- The PET centre, Aarhus University Hospital, Aarhus, Denmark
| | - S. Jakobsen
- The PET centre, Aarhus University Hospital, Aarhus, Denmark
| | - D. Zeidler
- Center of Functionally Integrative Neuroscience (CFIN) and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - R. Sangill
- Center of Functionally Integrative Neuroscience (CFIN) and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - J.R Nyengaard
- Stereology and Electron Microscopy Laboratory, Centre for Stochastic Geometry and Advanced Bioimaging, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - S.N. Jespersen
- Center of Functionally Integrative Neuroscience (CFIN) and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
| | - B. Hansen
- Center of Functionally Integrative Neuroscience (CFIN) and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Corresponding Author: Brian Hansen, CFIN, Aarhus University, Building 10G, 5th Floor, Nørrebrogade 44, DK-8000 Århus C, Denmark,
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Dima A, Pedersen AB, Pedersen L, Baicus C, Thomsen RW. Risk of osteonecrosis in patients with systemic lupus erythematosus: A nationwide population-based study. Eur J Intern Med 2016; 35:e23-e24. [PMID: 27425656 DOI: 10.1016/j.ejim.2016.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/07/2016] [Indexed: 11/27/2022]
Affiliation(s)
- A Dima
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy and RECIF, Bucharest, Romania.
| | - A B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - L Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - C Baicus
- Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy and RECIF, Bucharest, Romania
| | - R W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Svensson E, Baggesen LM, Thomsen RW, Lyngaa T, Pedersen L, Nørrelund H, Buhl ES, Haase CL, Johnsen SP. Patient-level predictors of achieving early glycaemic control in Type 2 diabetes mellitus: a population-based study. Diabet Med 2016; 33:1516-1523. [PMID: 27412570 DOI: 10.1111/dme.13184] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2016] [Indexed: 12/26/2022]
Abstract
AIMS To identify individual predictors of early glycaemic control in people with Type 2 diabetes mellitus after initiation of first glucose-lowering drug treatment in everyday clinical practice. METHODS Using medical registries, we identified a population-based cohort of people with a first-time glucose-lowering drug prescription in Northern Denmark in the period 2000-2012. We used Poisson regression analysis to examine patient-level predictors of success in reaching early glycaemic control [HbA1c target of < 53 mmol/mol (7%)] < 6 months after treatment start. RESULTS Among the 38 418 people (median age 63 years), 27 545 (72%) achieved early glycaemic control. The strongest predictor of achieving early control was pre-treatment HbA1c level; compared with a pre-treatment HbA1c level of ≤ 58 mmol/mol (7.5%), the adjusted relative risks of attaining early control were 0.63 (95% CI 0.61-0.64) for baseline HbA1c levels of > 58 and ≤ 75 mmol/mol (> 7.5 and ≤ 9%), and 0.58 (95% CI 0.57-0.59) for a baseline HbA1c level of > 9% (> 75 mmol/mol). All other examined predictors were only weakly associated with the chance of achieving early control. After adjustment, the only characteristics that remained independently associated with early control (in addition to high baseline HbA1c ) were being widowed (adjusted relative risk 0.95; 95% CI 0.93-0.97) and having a high Charlson comorbidity index score (score ≥ 3; adjusted relative risk 0.94; 95% CI 0.90-0.97). CONCLUSIONS In a real-world clinical setting, people with Type 2 diabetes mellitus initiating glucose-lowering medication had a similar likelihood of achieving glycaemic control, regardless of sex, age, comorbidities and other individual factors; the only strong and potentially modifiable predictor was HbA1c before therapy start.
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Affiliation(s)
- E Svensson
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - L M Baggesen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - R W Thomsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - T Lyngaa
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - L Pedersen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - H Nørrelund
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - E S Buhl
- Novo Nordisk Scandinavia AB, Ørestad, Copenhagen, Denmark
| | - C L Haase
- Novo Nordisk Scandinavia AB, Ørestad, Copenhagen, Denmark
| | - S P Johnsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Cronin-Fenton D, Dalvi T, Hedgeman E, Norgaard M, Pedersen L, Mortensen K, Midta A, Shire N, Brody R, Fryzek J, Lawrence D, Rigas J, Potter D, Walker J, Mellemgaard A, Rasmussen T, Hamilton-Dutoit S, Sørensen H. An interim assessment of key biomarkers (programmed cell death receptor ligand 1 (PD-L1) expression and epidermal growth factor receptor (EGFR) in third-line therapy non-small cell lung cancer (NSCLC) patients: A Danish cohort study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw383.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pedersen AB, Baggesen LM, Ehrenstein V, Pedersen L, Lasgaard M, Mikkelsen EM. Perceived stress and risk of any osteoporotic fracture. Osteoporos Int 2016; 27:2035-45. [PMID: 26786258 DOI: 10.1007/s00198-016-3490-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED Perceived stress is associated with several adverse health outcomes; however, little is known about the impact of stress on fracture risk. In this population-based cohort study, persons with high perceived stress have an increased 5-year risk of any osteoporotic fracture, in particular hip fracture. INTRODUCTION We conducted a population-based cohort study in Denmark to examine the association between perceived stress and risk of subsequent osteoporotic fracture. METHODS A 2006 population-based health survey in the Central Danish Region (with 1.25 million inhabitants) was used to identify 7943 persons who were 55 years or older on the survey date and completed the Perceived Stress Scale. Individuals were categorized into two groups: high level of stress and low level of stress (including no stress). We obtained information on all osteoporotic fractures through linkage to the Danish National Registry of Patients. We used Cox regression to compute hazard ratios (HRs) with 95 % confidence interval (CI) adjusted for a number of lifestyle factors, socioeconomic data, perceived general health, and prescription history, comparing high- and low-stress persons. RESULTS A total of 1799 persons (22.6 %) reported high level of perceived stress, whereas 6144 (77.4 %) reported low level or no stress. The 5-year risk of any osteoporotic fracture was 7.4 and 5.4 % in persons with high and low perceived stress, respectively, corresponding to adjusted HR of 1.37 (CI 1.00-1.89). The adjusted HR for hip fracture within 5 years associated with high perceived stress was 1.68 (CI 1.04-2.72). The associations weakened with increasing follow-up time. CONCLUSIONS Persons with high perceived stress have an increased risk of any osteoporotic fracture, in particular risk of hip fracture within 5 years of stress assessment even after adjusting for differences in lifestyle, comorbidities, osteoporosis presence, medication use, and socioeconomic status at the time of stress level evaluation. The association attenuated after longer follow-up time.
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Affiliation(s)
- A B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
| | - L M Baggesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - V Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - L Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - M Lasgaard
- Public Health and Quality Improvement, Central Denmark Region, Region House Aarhus, Olof Palmes Allé 15, 8200, Aarhus N, Denmark
- Department of Psychology, Southern University of Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - E M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
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Kim BM, Choi AL, Ha EH, Pedersen L, Nielsen F, Weihe P, Hong YC, Budtz-Jørgensen E, Grandjean P. Corrigendum to 'Effect of hemoglobin adjustment on the precision of mercury concentrations in maternal and cord blood' [Environ. Res. 132 (2014) 407-412]. Environ Res 2016; 147:630. [PMID: 27040412 DOI: 10.1016/j.envres.2016.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Byung-Mi Kim
- Department of Environmental Health, Harvard School of Public Health, Boston, MA 02115, USA; Department of Preventive Medicine, School of Medicine, Ewha Medical Research Center, Ewha Womans University, Seoul, South Korea
| | - Anna L Choi
- Department of Environmental Health, Harvard School of Public Health, Boston, MA 02115, USA
| | - Eun-Hee Ha
- Department of Preventive Medicine, School of Medicine, Ewha Medical Research Center, Ewha Womans University, Seoul, South Korea
| | - Lise Pedersen
- Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Odense, Denmark
| | - Flemming Nielsen
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Pal Weihe
- Faroese Hospital System, Torshavn, Faroe Islands
| | - Yun-Chul Hong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | | | - Philippe Grandjean
- Department of Environmental Health, Harvard School of Public Health, Boston, MA 02115, USA; Institute of Public Health, University of Southern Denmark, Odense, Denmark
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Hansen AT, Schmidt M, Horváth-Puhó E, Pedersen L, Rothman KJ, Hvas AM, Sørensen HT. Preconception venous thromboembolism and placenta-mediated pregnancy complications. J Thromb Haemost 2015; 13:1635-41. [PMID: 26178661 DOI: 10.1111/jth.13046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 04/22/2015] [Accepted: 06/19/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Placenta-mediated complications are leading causes of maternal and fetal morbidity and mortality. We hypothesized that a preconception history of venous thromboembolism (VTE) is associated with increased risk of placenta-mediated pregnancy complications. METHODS A nationwide population-based cohort study of all singleton pregnancies leading to delivery from 1997 to 2012 (n = 964 967). We obtained data on placenta-mediated pregnancy complications from the Danish Medical Birth Registry and data on VTE before pregnancy from the Danish National Patient Registry. We computed absolute risks, crude and adjusted risk differences (RDs) using a binomial regression model, and crude and adjusted risk ratios (RRs) from a modified Poisson regression model. RESULTS Overall, 1419 women had a preconception history of VTE, while 578 112 did not. Preeclampsia occurred in 4.2% of pregnancies in the VTE group and in 2.7% of pregnancies in a comparison cohort (adjusted RD = 1.3%, 95% confidence interval (CI) 0.6-2.0%; adjusted RR = 1.5, 95% CI 1.3-1.8). Stillbirth occurred in 0.7% of pregnancies in the VTE group and in 0.4% of pregnancies in the comparison cohort (adjusted RD = 0.3%, 95% CI 0.02-0.6%; adjusted RR = 1.8, 95% CI 1.1-3.0). Placental abruption occurred in 0.8% of pregnancies in the VTE group and in 0.5% of pregnancies in the comparison cohort (adjusted RD = 0.3%, 95% CI - 0.05-0.6%; adjusted RR = 1.6, 95% CI 1.1-2.4). Small-for-gestational-age infants accounted for 10.9% of live births in the VTE group and 9.8% of live births in the comparison cohort (adjusted RD = 0.6%, 95% CI - 0.5-1.7%; adjusted RR = 1.1, 95% CI 0.9-1.3). CONCLUSION Women with a history of VTE were at increased risk of placenta-mediated complications.
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Affiliation(s)
- A T Hansen
- Department of Clinical Epidemiology, Center for Haemophilia and Thrombosis, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Biochemistry, Center for Haemophilia and Thrombosis, Aarhus University Hospital, Aarhus, Denmark
| | - M Schmidt
- Department of Clinical Epidemiology, Center for Haemophilia and Thrombosis, Aarhus University Hospital, Aarhus, Denmark
| | - E Horváth-Puhó
- Department of Clinical Epidemiology, Center for Haemophilia and Thrombosis, Aarhus University Hospital, Aarhus, Denmark
| | - L Pedersen
- Department of Clinical Epidemiology, Center for Haemophilia and Thrombosis, Aarhus University Hospital, Aarhus, Denmark
| | - K J Rothman
- Department of Clinical Epidemiology, Center for Haemophilia and Thrombosis, Aarhus University Hospital, Aarhus, Denmark
- RTI Health Solutions, Research Triangle Institute, Research Triangle Park, NC, USA
| | - A M Hvas
- Department of Clinical Biochemistry, Center for Haemophilia and Thrombosis, Aarhus University Hospital, Aarhus, Denmark
| | - H T Sørensen
- Department of Clinical Epidemiology, Center for Haemophilia and Thrombosis, Aarhus University Hospital, Aarhus, Denmark
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Thomsen RW, Baggesen LM, Svensson E, Pedersen L, Nørrelund H, Buhl ES, Haase CL, Johnsen SP. Early glycaemic control among patients with type 2 diabetes and initial glucose-lowering treatment: a 13-year population-based cohort study. Diabetes Obes Metab 2015; 17:771-80. [PMID: 25929277 DOI: 10.1111/dom.12484] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 01/24/2015] [Revised: 04/14/2015] [Accepted: 04/28/2015] [Indexed: 11/29/2022]
Abstract
AIM To examine real-life time trends in early glycaemic control in patients with type 2 diabetes between 2000 and 2012. METHODS We used population-based medical databases to ascertain the association between achievement of glycaemic control with initial glucose-lowering treatment in patients with incident type 2 diabetes in Northern Denmark. Success in reaching glycated haemoglobin (HbA1c) goals within 3-6 months was examined using regression analysis. RESULTS Of 38 418 patients, 91% started with oral glucose-lowering drugs in monotherapy. Metformin initiation increased from 32% in 2000-2003 to 90% of all patients in 2010-2012. Pretreatment (interquartile range) HbA1c levels decreased from 8.9 (7.6-10.7)% in 2000-2003 to 7.0 (6.5-8.1)% in 2010-2012. More patients achieved an HbA1c target of <7% (<53 mmol/mol) in 2010-2012 than in 2000-2003 [80 vs 60%, adjusted relative risk (aRR) 1.10, 95% confidence interval (CI) 1.08-1.13], and more achieved an HbA1c target of <6.5% [(<48 mmol/mol) 53 vs 37%, aRR 1.07 95% CI 1.03-1.11)], with similar success rates observed among patients aged <65 years without comorbidities. Achieved HbA1c levels were similar for different initiation therapies, with reductions of 0.8% (from 7.3 to 6.5%) on metformin, 1.5% (from 8.1 to 6.6%) on sulphonylurea, 4.0% (from 10.4 to 6.4%) on non-insulin combination therapies, and 3.8% (from 10.3 to 6.5%) on insulin monotherapy. CONCLUSIONS Pretreatment HbA1c levels in patients with incident type 2 diabetes have decreased substantially, which is probably related to earlier detection and treatment in accordance with changing guidelines. Achievement of glycaemic control has improved, but 20% of patients still do not attain an HbA1c level of <7% within the first 6 months of initial treatment.
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Affiliation(s)
- R W Thomsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - L M Baggesen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - E Svensson
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - L Pedersen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - H Nørrelund
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - E S Buhl
- Novo Nordisk Scandinavia AB, Ørestad, Copenhagen, Denmark
| | - C L Haase
- Novo Nordisk Scandinavia AB, Ørestad, Copenhagen, Denmark
| | - S P Johnsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Lund Rasmussen C, Klee Olsen M, Thit Johnsen A, Petersen MA, Lindholm H, Andersen L, Villadsen B, Groenvold M, Pedersen L. Effects of melatonin on physical fatigue and other symptoms in patients with advanced cancer receiving palliative care: A double-blind placebo-controlled crossover trial. Cancer 2015; 121:3727-36. [PMID: 26178160 DOI: 10.1002/cncr.29563] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 03/25/2015] [Revised: 05/27/2015] [Accepted: 06/17/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients with advanced cancer often experience fatigue and other symptoms that negatively impact their quality of life. The current trial investigated the effect of melatonin on fatigue and other symptoms in patients with advanced cancer. METHODS Patients who were aged ≥18 years, had a histologically confirmed stage IV cancer (TNM Classification), and who reported feeling significantly tired were recruited from the palliative care unit at the study institution. The study was a double-blind, randomized, placebo-controlled crossover trial. Patients received 1 week of melatonin at a dose of 20 mg or a placebo orally each night, before crossing over and receiving the opposite treatment for 1 week. Between the 2 periods, a washout period of 2 days was implemented. Outcomes were measured using the Multidimensional Fatigue Inventory (MFI-20) and The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Physical fatigue from the MFI-20 was the primary outcome. The primary analysis was a complete complier analysis (ie, it included only those patients who had consumed at least 5 capsules per week and who had answered the MFI-20 on days 1, 7, 10, and 17). Sensitivity analysis using multiple imputations including all randomized patients and all patients completing the intervention were conducted. RESULTS A total of 72 patients were randomized. Fifty patients completed the intervention and 44 patients were complete compliers. No significant differences between the placebo and melatonin periods were found for physical fatigue, secondary outcomes, or explorative outcomes. CONCLUSIONS In the current study, oral melatonin at a dose of 20 mg was not found to improve fatigue or other symptoms in patients with advanced cancer.
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Affiliation(s)
| | - Marc Klee Olsen
- Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Anna Thit Johnsen
- Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Helena Lindholm
- Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Line Andersen
- Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Birgit Villadsen
- Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Mogens Groenvold
- Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark.,Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lise Pedersen
- Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
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Sundbøll J, Schmidt M, Horváth-Puhó E, Christiansen CF, Pedersen L, Bøtker HE, Sørensen HT. Preadmission use of ACE inhibitors or angiotensin receptor blockers and short-term mortality after stroke. J Neurol Neurosurg Psychiatry 2015; 86:748-54. [PMID: 25209418 DOI: 10.1136/jnnp-2014-308948] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 07/04/2014] [Accepted: 08/18/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM The prognostic impact of ACE inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) on stroke mortality remains unclear. We aimed to examine whether prestroke use of ACE-Is or ARBs was associated with improved short-term mortality following ischaemic stroke, intracerebral haemorrhage (ICH) and subarachnoid haemorrhage (SAH). METHODS We conducted a nationwide population-based cohort study using medical registries in Denmark. We identified all first-time stroke patients during 2004-2012 and their comorbidities. We defined ACE-I/ARB use as current use (last prescription redemption <90 days before admission for stroke), former use and non-use. Current use was further classified as new or long-term use. We used Cox regression modelling to compute 30-day mortality rate ratios (MRRs) with 95% CIs, controlling for potential confounders. RESULTS We identified 100 043 patients with a first-time stroke. Of these, 83 736 patients had ischaemic stroke, 11 779 had ICH, and 4528 had SAH. For ischaemic stroke, the adjusted 30-day MRR was reduced in current users compared with non-users (0.85, 95% CI 0.81 to 0.89). There was no reduction in the adjusted 30-day MRR for ICH (0.95, 95% CI 0.87 to 1.03) or SAH (1.01, 95% CI 0.84 to 1.21), comparing current users with non-users. No association with mortality was found among former users compared with non-users. No notable modification of the association was observed within sex or age strata. CONCLUSIONS Current use of ACE-Is/ARBs was associated with reduced 30-day mortality among patients with ischaemic stroke. We found no association among patients with ICH or SAH.
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Affiliation(s)
- J Sundbøll
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - M Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - E Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - C F Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - L Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
| | - H E Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
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Abstract
OBJECTIVES To examine the risk of a subsequent pulmonary or extra-pulmonary cancer diagnosis following a first-time hospital-based diagnosis of pneumonia. DESIGN Population-based cohort study using Danish medical registries. SETTING All hospitals in Denmark. SUBJECTS A total of 342,609 patients with a first-time hospital-based (inpatient, emergency room or outpatient clinic) diagnosis of pneumonia between 1995 and 2011. MAIN OUTCOME MEASURES We quantified the excess risk of various cancers amongst pneumonia patients compared to the expected risk in the general population, using relative [standardised incidence ratios (SIRs)] and absolute risk calculations. Follow-up started 1 month after a hospital-based diagnosis of pneumonia and ended on 31 December 2011. RESULTS A total of 28,496 cancers were observed, compared with 21,625 expected, amongst 342,609 pneumonia patients followed for a median of 4.2 years. The absolute risk of a cancer diagnosis 1 to <6 months following a pneumonia diagnosis was 1.4%, with a corresponding SIR of 2.48 [95% confidence interval (CI) 2.41-2.55]. This was mainly due to an increased risk of lung cancer (eightfold) and haematological cancers (fourfold). The SIR for any cancer remained increased at 1.35 (95% CI 1.30-1.40) during 6-12 months of follow-up, and 1.20 (95% CI 1.18-1.22) during 1-5 years of follow-up. Beyond 5 years, an increased risk was maintained for lung, oesophageal, liver and bladder cancers, squamous cell carcinoma of the skin, lymphoma and multiple myeloma. CONCLUSIONS A hospital-based pneumonia diagnosis was associated with an increased risk of a cancer diagnosis, especially in the ensuing months, but the absolute risk was small.
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Affiliation(s)
- K K Søgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Holland-Bill L, Christiansen CF, Gammelager H, Mortensen RN, Pedersen L, Sørensen HT. Chronic liver disease and 90-day mortality in 21,359 patients following peptic ulcer bleeding--a Nationwide Cohort Study. Aliment Pharmacol Ther 2015; 41:564-72. [PMID: 25588862 DOI: 10.1111/apt.13073] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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] [Received: 09/05/2014] [Revised: 09/15/2014] [Accepted: 12/19/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bleeding is a serious and frequent complication of peptic ulcer disease. Hepatic dysfunction can cause coagulopathy and increases the risk of peptic ulcer bleeding. However, whether chronic liver disease increases mortality after peptic ulcer bleeding remains unclear. AIM To examine the prognostic impact of chronic liver disease on mortality after peptic ulcer bleeding. METHODS We used population-based medical registries to conduct a cohort study of all Danish residents hospitalised with incident peptic ulcer bleeding from 2004 through 2011. We identified patients diagnosed with liver cirrhosis or non-cirrhotic chronic liver disease before their admission for peptic ulcer bleeding. We then computed 90-day mortality after peptic ulcer bleeding based on the Kaplan-Meier method (1 - survival function) and used a Cox regression model to estimate mortality rate ratios (MRRs), controlling for potential confounders. RESULTS We identified 21,359 patients hospitalised with peptic ulcer bleeding. Among these, 653 (3.1%) had a previous diagnosis of liver cirrhosis and 474 (2.2%) had a history of non-cirrhotic chronic liver disease. Patients with liver cirrhosis and non-cirrhotic chronic liver disease had a cumulative 90-day mortality of 25.3% and 20.7%, respectively, compared to 18.3% among patients without chronic liver disease. Liver cirrhosis was associated with an adjusted 90-day MRR of 2.38 (95% CI: 2.02-2.80), compared to 1.49 (95% CI: 1.22-1.83) among patients with non-cirrhotic chronic liver disease. CONCLUSION Patients with chronic liver disease, particularly liver cirrhosis, are at increased risk of death within 90 days after hospitalisation for peptic ulcer bleeding compared to patients without chronic liver disease.
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Affiliation(s)
- L Holland-Bill
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; California Pacific Medical Center Research Institute, California Pacific Medical Center, San Francisco, CA, USA
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Cu TTT, Nguyen TX, Triolo JM, Pedersen L, Le VD, Le PD, Sommer SG. Biogas production from vietnamese animal manure, plant residues and organic waste: influence of biomass composition on methane yield. Asian-Australas J Anim Sci 2015; 28:280-9. [PMID: 25557826 PMCID: PMC4283175 DOI: 10.5713/ajas.14.0312] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/10/2014] [Accepted: 07/28/2014] [Indexed: 11/27/2022]
Abstract
Anaerobic digestion is an efficient and renewable energy technology that can produce biogas from a variety of biomasses such as animal manure, food waste and plant residues. In developing countries this technology is widely used for the production of biogas using local biomasses, but there is little information about the value of these biomasses for energy production. This study was therefore carried out with the objective of estimating the biogas production potential of typical Vietnamese biomasses such as animal manure, slaughterhouse waste and plant residues, and developing a model that relates methane (CH4) production to the chemical characteristics of the biomass. The biochemical methane potential (BMP) and biomass characteristics were measured. Results showed that piglet manure produced the highest CH4 yield of 443 normal litter (NL) CH4 kg(-1) volatile solids (VS) compared to 222 from cows, 177 from sows, 172 from rabbits, 169 from goats and 153 from buffaloes. Methane production from duckweed (Spirodela polyrrhiza) was higher than from lawn grass and water spinach at 340, 220, and 110.6 NL CH4 kg(-1) VS, respectively. The BMP experiment also demonstrated that the CH4 production was inhibited with chicken manure, slaughterhouse waste, cassava residue and shoe-making waste. Statistical analysis showed that lipid and lignin are the most significant predictors of BMP. The model was developed from knowledge that the BMP was related to biomass content of lipid, lignin and protein from manure and plant residues as a percentage of VS with coefficient of determination (R-square) at 0.95. This model was applied to calculate the CH4 yield for a household with 17 fattening pigs in the highlands and lowlands of northern Vietnam.
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Affiliation(s)
- T T T Cu
- University of Southern Denmark, Faculty of Engineering, Institute of Chemical Engineering, Biotechnology and Environmental Engineering, 5230 Odense M, Denmark
| | - T X Nguyen
- University of Southern Denmark, Faculty of Engineering, Institute of Chemical Engineering, Biotechnology and Environmental Engineering, 5230 Odense M, Denmark
| | - J M Triolo
- University of Southern Denmark, Faculty of Engineering, Institute of Chemical Engineering, Biotechnology and Environmental Engineering, 5230 Odense M, Denmark
| | - L Pedersen
- University of Southern Denmark, Faculty of Engineering, Institute of Chemical Engineering, Biotechnology and Environmental Engineering, 5230 Odense M, Denmark
| | - V D Le
- University of Southern Denmark, Faculty of Engineering, Institute of Chemical Engineering, Biotechnology and Environmental Engineering, 5230 Odense M, Denmark
| | - P D Le
- Hue University of Agriculture and Forestry, Hue City 47000, Vietnam
| | - S G Sommer
- University of Southern Denmark, Faculty of Engineering, Institute of Chemical Engineering, Biotechnology and Environmental Engineering, 5230 Odense M, Denmark
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Pedersen L, Nybo M, Poulsen MK, Henriksen JE, Dahl J, Rasmussen LM. Plasma calprotectin and its association with cardiovascular disease manifestations, obesity and the metabolic syndrome in type 2 diabetes mellitus patients. BMC Cardiovasc Disord 2014; 14:196. [PMID: 25527236 PMCID: PMC4289556 DOI: 10.1186/1471-2261-14-196] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 12/16/2014] [Indexed: 01/16/2023] Open
Abstract
Background Plasma calprotectin is a potential biomarker of cardiovascular disease (CVD), insulin resistance (IR), and obesity. We examined the relationship between plasma calprotectin concentrations, CVD manifestations and the metabolic syndrome (MetS) in patients with type 2 diabetes mellitus (T2DM) in order to evaluate plasma calprotectin as a risk assessor of CVD in diabetic patients without known CVD. Methods An automated immunoassay for determination of plasma calprotectin was developed based on a fecal Calprotectin ELIA, and a reference range was established from 120 healthy adults. Plasma calprotectin concentrations were measured in 305 T2DM patients without known CVD. They were screened for carotid arterial disease, peripheral arterial disease (PAD), and myocardial ischemia (MI) by means of carotid artery ultrasonography, peripheral ankle and toe systolic blood pressure measurements, and myocardial perfusion scintigraphy. Results The reference population had a median plasma calprotectin concentration of 2437 ng/mL (2.5-97.5% reference range: 1040–4262 ng/mL). The T2DM patients had significantly higher concentrations (3754 ng/mL, p < 0.0001), and within this group plasma calprotectin was significantly higher in patients with MetS (p < 0.0001) and also in patients with autonomic neuropathy, PAD, and MI compared with patients without (p < 0.001, p = 0.021 and p = 0.043, respectively). Plasma calprotectin was by linear regression analysis found independently associated with BMI, C-reactive protein, and HDL cholesterol. However, plasma calprotectin did not predict autonomic neuropathy, PAD, MI or CVD when these variables entered the multivariable regression analysis as separate outcome variables. Conclusion T2DM patients had higher concentrations of plasma calprotectin, which were associated with obesity, MetS status, autonomic neuropathy, PAD, and MI. However, plasma calprotectin was not an independent predictor of CVD, MI, autonomic neuropathy or PAD. Trial registration number NCT00298844
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Affiliation(s)
- Lise Pedersen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Sdr, Boulevard 29, 5000 Odense C, Denmark.
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Pedersen L, Fredheim OMS. Opioids for Chronic Noncancer Pain: Still No Evidence for Superiority of Sustained-Release Opioids. Clin Pharmacol Ther 2014; 97:114-5. [DOI: 10.1002/cpt.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- L Pedersen
- National Competence Centre for Complex Symptom Disorders; Trondheim Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Department of Internal Medicine; Sørlandet Hospital Kristiansand; Kristiansand Norway
| | - OMS Fredheim
- National Competence Centre for Complex Symptom Disorders; Trondheim Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Centre of Palliative Medicine; Akershus University Hospital; Lørenskog Norway
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