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Maas AFG, Wyers C, Dielis A, Barten DG, van Kampen VEM, van der Krieken TE, de Kruif M, Simsek S, Spaetgens B, van Haaps T, Appelman B, Gritters NC, Doornbos S, Moeniralam HS, Noordzij PG, Reidinga A, Douma RA, Nossent EJ, Beudel M, Elbers P, Middeldorp S, van Es N, van den Bergh JPW, van Osch FHM. The Incidence of Pulmonary Embolism in Hospitalized Non-ICU Patients with COVID-19 during the First Wave: A Multicenter Retrospective Cohort Study in the Netherlands. J Vasc Res 2024:1-8. [PMID: 38631294 DOI: 10.1159/000538312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/05/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION During the first COVID-19 outbreak in 2020 in the Netherlands, the incidence of pulmonary embolism (PE) appeared to be high in COVID-19 patients admitted to the intensive care unit (ICU). This study was performed to evaluate the incidence of PE during hospital stay in COVID-19 patients not admitted to the ICU. METHODS Data were retrospectively collected from 8 hospitals in the Netherlands. Patients admitted between February 27, 2020, and July 31, 2020, were included. Data extracted comprised clinical characteristics, medication use, first onset of COVID-19-related symptoms, admission date due to COVID-19, and date of PE diagnosis. Only polymerase chain reaction (PCR)-positive patients were included. All PEs were diagnosed with computed tomography pulmonary angiography (CTPA). RESULTS Data from 1,852 patients who were admitted to the hospital ward were collected. Forty patients (2.2%) were diagnosed with PE within 28 days following hospital admission. The median time to PE since admission was 4.5 days (IQR 0.0-9.0). In all 40 patients, PE was diagnosed within the first 2 weeks after hospital admission and for 22 (55%) patients within 2 weeks after onset of symptoms. Patient characteristics, pre-existing comorbidities, anticoagulant use, and laboratory parameters at admission were not related to the development of PE. CONCLUSION In this retrospective multicenter cohort study of 1,852 COVID-19 patients only admitted to the non-ICU wards, the incidence of CTPA-confirmed PE was 2.2% during the first 4 weeks after onset of symptoms and occurred exclusively within 2 weeks after hospital admission.
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Affiliation(s)
- Arno F G Maas
- VieCuri Medical Center, Department of Internal Medicine, Venlo, The Netherlands
| | - Caroline Wyers
- VieCuri Medical Center, Department of Internal Medicine, Venlo, The Netherlands
| | - Arne Dielis
- VieCuri Medical Center, Department of Internal Medicine, Venlo, The Netherlands
| | - Dennis G Barten
- VieCuri Medical Center, Department of Emergency Medicine, Venlo, The Netherlands
| | | | | | - Martijn de Kruif
- Zuyderland Hospital, Department of Pulmonology, Heerlen, The Netherlands
| | - Suat Simsek
- Northwest Clinics, Department of Internal Medicine, Alkmaar, The Netherlands
- Department of Internal Medicine/Endocrinology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Bart Spaetgens
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Thijs van Haaps
- Amsterdam University Medical Center, Department of Vascular Medicine, Amsterdam, The Netherlands
| | - Brent Appelman
- Center for Experimental and Molecular Medicine, Amsterdam UMC Location University of Amsterdam, Department(s), Amsterdam, The Netherlands
| | - Niels C Gritters
- Treant Zorggroep, Department of Intensive Care, Emmen, The Netherlands
| | - Stefan Doornbos
- Treant Zorggroep, Department of Intensive Care, Emmen, The Netherlands
| | - Hazra S Moeniralam
- St Antonius Hospital, Department of Internal Medicine, Nieuwegein, The Netherlands
| | - Peter G Noordzij
- St Antonius Hospital, Department of Intensive Care, Nieuwegein, The Netherlands
| | - Auke Reidinga
- Department of Intensive Care, Martini Ziekenhuis, Groningen, The Netherlands
| | - Renée A Douma
- Flevo Hospital, Department of Internal Medicine, Almere, The Netherlands
| | - Esther J Nossent
- Department of Pulmonary Medicine, Free University Amsterdam, Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam, The Netherlands
| | - Paul Elbers
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Institute for Infection and Immunity, Vrije Universiteit, Amsterdam, The Netherlands
| | - Saskia Middeldorp
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Nick van Es
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Joop P W van den Bergh
- VieCuri Medical Center, Department of Internal Medicine, Venlo, The Netherlands
- Maastricht University, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Frits H M van Osch
- Maastricht University, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
- VieCuri Medical Center, Department of Clinical Epidemiology, Venlo, The Netherlands
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Verlaat L, Rijks N, Dilai J, Admiraal M, Beudel M, de Bie RM, van der Zwaag W, Schuurman R, van den Munckhof P, Bot M. 7-Tesla Magnetic Resonance Imaging Scanning in Deep Brain Stimulation for Parkinson's Disease: Improving Visualization of the Dorsolateral Subthalamic Nucleus. Mov Disord Clin Pract 2024; 11:373-380. [PMID: 38385792 PMCID: PMC10982587 DOI: 10.1002/mdc3.13982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/14/2023] [Accepted: 01/05/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Identifying the dorsolateral subthalamic nucleus (STN) for deep brain stimulation (DBS) in Parkinson's disease (PD) can be challenging due to the size and double-oblique orientation. Since 2015 we implemented 7-Tesla T2 weighted magnetic resonance imaging (7 T T2) for improving visualization and targeting of the dorsolateral STN. We describe the changes in surgical planning and outcome since implementation of 7 T T2 for DBS in PD. METHODS By comparing two cohorts of STN DBS patients in different time periods we evaluated the influence of 7 T T2 on STN target planning, the number of microelectrode recording (MER) trajectories, length of STN activity and the postoperative motor (UPDRS) improvement. RESULTS From February 2007 to January 2014, 1.5 and 3-Tesla T2 guided STN DBS with 3 MER channels was performed in 76 PD patients. Average length of recorded STN activity in the definite electrode trajectory was 3.9 ± 1.5 mm. From January 2015 to January 2022 7 T T2 and MER-guided STN DBS was performed in 182 PD patients. Average length of recorded STN activity in the definite electrode trajectory was 5.1 ± 1.3 mm and used MER channels decreased from 3 to 1. Average UPDRS improvement was comparable. CONCLUSION Implementation of 7 T T2 for STN DBS enabled a refinement in targeting. Combining classical DBS targeting with dorsolateral STN alignment may be used to determine the optimal trajectory. The improvement in dorsolateral STN visualization can be used for further target refinements, for example adding probabilistic subthalamic connectivity, to enhance clinical outcome of STN DBS.
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Affiliation(s)
- Lisa Verlaat
- Department of NeurosurgeryUniversity Medical Centers, Academic Medical CenterAmsterdamthe Netherlands
| | - Niels Rijks
- Department of NeurosurgeryUniversity Medical Centers, Academic Medical CenterAmsterdamthe Netherlands
| | - José Dilai
- Department of Neurology and Clinical NeurophysiologyUniversity Medical Centers, Academic Medical CenterAmsterdamthe Netherlands
| | - Marjolein Admiraal
- Department of Neurology and Clinical NeurophysiologyUniversity Medical Centers, Academic Medical CenterAmsterdamthe Netherlands
| | - Martijn Beudel
- Department of Neurology and Clinical NeurophysiologyUniversity Medical Centers, Academic Medical CenterAmsterdamthe Netherlands
| | - Rob M.A. de Bie
- Department of Neurology and Clinical NeurophysiologyUniversity Medical Centers, Academic Medical CenterAmsterdamthe Netherlands
| | - Wietske van der Zwaag
- Spinoza Centre for Neuroimaging, Royal Netherlands Academy of Arts and SciencesAmsterdamthe Netherlands
| | - Rick Schuurman
- Department of NeurosurgeryUniversity Medical Centers, Academic Medical CenterAmsterdamthe Netherlands
| | - Pepijn van den Munckhof
- Department of NeurosurgeryUniversity Medical Centers, Academic Medical CenterAmsterdamthe Netherlands
| | - Maarten Bot
- Department of NeurosurgeryUniversity Medical Centers, Academic Medical CenterAmsterdamthe Netherlands
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Swinnen BEKS, Lotfalla V, Scholten MN, Prins RHN, Goes KM, de Vries S, Geytenbeek JJM, Dijk JM, Odekerken VJ, Bot M, van den Munckhof P, Schuurman PR, de Bie RMA, Beudel M. Programming Algorithm for the Management of Speech Impairment in Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease. Neuromodulation 2024; 27:528-537. [PMID: 37452799 DOI: 10.1016/j.neurom.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/19/2023] [Accepted: 05/28/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES Deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease (PD) has an ambiguous relation to speech. Speech impairment can be a stimulation-induced side effect, and parkinsonian dysarthria can improve with STN-DBS. Owing to the lack of an up-to-date and evidence-based approach, DBS reprogramming for speech impairment is largely blind and greatly relies on the physician's experience. In this study, we aimed to establish an evidence- and experience-based algorithm for managing speech impairment in patients with PD treated with STN-DBS. MATERIALS AND METHODS We performed a single-center retrospective study to identify patients with STN-DBS and speech impairment. Onset of speech impairment, lead localization, and assessment of DBS-induced nature of speech impairment were collected. When DBS settings were adjusted for improving speech, the magnitude and duration of effect were collected. We also performed a systematic literature review to identify studies describing the effects of parameter adjustments aimed at improving speech impairment in patients with PD receiving STN-DBS. RESULTS In the retrospective study, 245 of 631 patients (38.8%) with STN-DBS had significant speech impairment. The probability of sustained marked improvement upon reprogramming was generally low (27.9%). In the systematic review, 23 of 662 identified studies were included. Only two randomized controlled trials have been performed, providing evidence for interleaving-interlink stimulation only. Considerable methodologic heterogeneity precluded the conduction of a meta-analysis. CONCLUSIONS Speech impairment in STN-DBS for PD is frequent, but high-quality evidence regarding DBS parameter adjustments is scarce, and the probability of sustained improvement is low. To improve this outcome, we propose an evidence- and experience-based approach to address speech impairment in STN-DBS that can be used in clinical practice.
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Affiliation(s)
- Bart E K S Swinnen
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Veronia Lotfalla
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Marije N Scholten
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Rosanne H N Prins
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Kelly M Goes
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Stefanie de Vries
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Joke J M Geytenbeek
- Department of Rehabilitation, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Joke M Dijk
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Vincent J Odekerken
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten Bot
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter R Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Rob M A de Bie
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn Beudel
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.
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Beudel M. Comment on: "A Transatlantic Viewpoint on the Role of Pallidal Stimulation for Parkinson's Disease". Mov Disord 2024; 39:223-224. [PMID: 38294045 DOI: 10.1002/mds.29696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
- Martijn Beudel
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
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5
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Spruit JR, Jansen RWMM, de Groot JR, de Vries TAC, Hemels MEW, Douma RA, de Haan LR, Brinkman K, Moeniralam HS, de Kruif M, Dormans T, Appelman B, Reidinga AC, Rusch D, Gritters van den Oever NC, Schuurman RJ, Beudel M, Simsek S. Does atrial fibrillation affect prognosis in hospitalised COVID-19 patients? A multicentre historical cohort study in the Netherlands. BMJ Open 2023; 13:e071137. [PMID: 38070891 PMCID: PMC10729035 DOI: 10.1136/bmjopen-2022-071137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 10/09/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES The aim of this multicentre COVID-PREDICT study (a nationwide observational cohort study that aims to better understand clinical course of COVID-19 and to predict which COVID-19 patients should receive which treatment and which type of care) was to determine the association between atrial fibrillation (AF) and mortality, intensive care unit (ICU) admission, complications and discharge destination in hospitalised COVID-19 patients. SETTING Data from a historical cohort study in eight hospitals (both academic and non-academic) in the Netherlands between January 2020 and July 2021 were used in this study. PARTICIPANTS 3064 hospitalised COVID-19 patients >18 years old. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the incidence of new-onset AF during hospitalisation. Secondary outcomes were the association between new-onset AF (vs prevalent or non-AF) and mortality, ICU admissions, complications and discharge destination, performed by univariable and multivariable logistic regression analyses. RESULTS Of the 3064 included patients (60.6% men, median age: 65 years, IQR 55-75 years), 72 (2.3%) patients had prevalent AF and 164 (5.4%) patients developed new-onset AF during hospitalisation. Compared with patients without AF, patients with new-onset AF had a higher incidence of death (adjusted OR (aOR) 1.71, 95% CI 1.17 to 2.59) an ICU admission (aOR 5.45, 95% CI 3.90 to 7.61). Mortality was non-significantly different between patients with prevalent AF and those with new-onset AF (aOR 0.97, 95% CI 0.53 to 1.76). However, new-onset AF was associated with a higher incidence of ICU admission and complications compared with prevalent AF (OR 6.34, 95% CI 2.95 to 13.63, OR 3.04, 95% CI 1.67 to 5.55, respectively). CONCLUSION New-onset AF was associated with an increased incidence of death, ICU admission, complications and a lower chance to be discharged home. These effects were far less pronounced in patients with prevalent AF. Therefore, new-onset AF seems to represent a marker of disease severity, rather than a cause of adverse outcomes.
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Affiliation(s)
| | | | - Joris R de Groot
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | | | - Martin E W Hemels
- Department of Cardiology, Rijnstate, Arnhem, Arnhem, Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Renee A Douma
- Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
- Flevo Hospital, Almere, Netherlands
| | - Lianne R de Haan
- Flevo Hospital, Almere, Netherlands
- Medical Centre Alkmaar, Alkmaar, Netherlands
| | - Kees Brinkman
- Department of Internal Medicine, OLVG, Amsterdam, Netherlands
| | - Hazra S Moeniralam
- Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Martijn de Kruif
- Department of Pulmonary Medicine, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands
| | - Tom Dormans
- Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Brent Appelman
- Amsterdam UMC Locatie Meibergdreef, Amsterdam, Netherlands
| | - Auke C Reidinga
- Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Daisy Rusch
- Research, Martini Ziekenhuis, Groningen, Netherlands
| | | | | | - Martijn Beudel
- Neurology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
- Department of Internal Medicine, Section of Endocrinology, Amsterdam UMC - Locatie VUMC, Amsterdam, Netherlands
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6
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Bot M, Pauwels R, van den Munckhof P, de Win M, Odekerken VJJ, Beudel M, Dijk J, de Bie RMA, Schuurman PR. The Fast Gray Matter Acquisition T1 Inversion Recovery Sequence in Deep Brain Stimulation: Introducing the Rubral Wing for Dentato-Rubro-Thalamic Tract Depiction and Tremor Control. Neuromodulation 2023; 26:1705-1713. [PMID: 35088745 DOI: 10.1016/j.neurom.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/26/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The dentato-rubro-thalamic tract (DRT) is currently considered as a potential target in deep brain stimulation (DBS) for various types of tremor. However, tractography depiction can vary depending on the included brain regions. The fast gray matter acquisition T1 inversion recovery (FGATIR) sequence, with excellent delineation of gray and white matter, possibly provides anatomical identification of rubro-thalamic DRT fibers. OBJECTIVE This study aimed to evaluate the FGATIR sequence by comparison with DRT depiction, electrode localization, and effectiveness of DBS therapy. MATERIALS AND METHODS In patients with DBS therapy because of medication-refractory tremor, the FGATIR sequence was evaluated for depiction of the thalamus, red nucleus (RN), and rubro-thalamic connections. Deterministic tractography of the DRT, electrode localization, and tremor control were compared. The essential tremor rating scale was used to assess (hand) tremor. Tremor control was considered successful when complete tremor suppression (grade 0) or almost complete suppression (grade 1) was observed. RESULTS In the postoperative phase, we evaluated 14 patients who underwent DRT-guided DBS: 12 patients with essential tremor, one with tremor-dominant Parkinson disease, and one with multiple sclerosis, representing 24 trajectories. Mean follow-up was 11.3 months (range 6-19 months). The FGATIR sequence provided a clear delineation of a hypointense white matter tract within the hyperintense thalamus. In coronal plane, this tract was most readily recognizable as a "rubral wing," with the round RN as base and lateral triangular convergence. The deterministic DRT depiction was consistently situated within the rubral wing. The number of active contacts located within the DRT (and rubral wing) was 22 (92%), of which 16 (73%) showed successful tremor control. CONCLUSIONS The FGATIR sequence offers visualization of the rubro-thalamic connections that form the DRT, most readily recognizable as a "rubral wing" in coronal plane. This sequence contributes to tractographic depiction of DRT and provides a direct anatomical DBS target area for tremor control.
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Affiliation(s)
- Maarten Bot
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - Rik Pauwels
- Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Maartje de Win
- Department of Radiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Vincent J J Odekerken
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Martijn Beudel
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Joke Dijk
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Rob M A de Bie
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - P Richard Schuurman
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
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de Haan L, Ten Wolde M, Beudel M, Olde Engberink RHG, Appelman B, Haspels-Hogervorst EK, Rusch D, Gritters van den Oever NC, Simsek S, Paternotte N, van den Bergh JP, Wyers CE, de Kruif MD, Dormans T, Moeniralam H, Bokhizzou N, Brinkman K, Douma R. What is the aetiology of dysnatraemia in COVID-19 and how is this related to outcomes in patients admitted during earlier and later COVID-19 waves? A multicentre, retrospective observational study in 11 Dutch hospitals. BMJ Open 2023; 13:e075232. [PMID: 37963704 PMCID: PMC10649520 DOI: 10.1136/bmjopen-2023-075232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/15/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES To evaluate the relationship among dysnatraemia at hospital presentation and duration of admission, risk of intensive care unit (ICU) admission and all-cause mortality and to assess the underlying pathophysiological mechanism of hyponatraemia in patients with COVID-19. Our hypothesis is that both hyponatraemia and hypernatraemia at presentation are associated with adverse outcomes. DESIGN Observational study. SETTING Secondary care; 11 Dutch hospitals (2 university and 9 general hospitals). PARTICIPANTS An analysis was performed within the retrospective multicentre cohort study COVIDPredict. 7811 patients were included (60% men, 40% women) between 24 February 2020 and 9 August 2022. Patients who were ≥18 years with PCR-confirmed COVID-19 or CT with COVID-19 reporting and data system score≥4 and alternative diagnosis were included. Patients were excluded when serum sodium levels at presentation were not registered in the database or when they had been transferred from another participating hospital. OUTCOME MEASURES We studied demographics, medical history, symptoms and outcomes. Patients were stratified according to serum sodium concentration and urinary sodium excretion. RESULTS Hyponatraemia was present in 2677 (34.2%) patients and hypernatraemia in 126 (1.6%) patients. Patients with hyponatraemia presented more frequently with diarrhoea, lower blood pressure and tachycardia. Hyponatraemia was, despite a higher risk for ICU admission (OR 1.27 (1.11-1.46; p<0.001)), not associated with mortality or the risk for intubation. Patients with hypernatraemia had higher mortality rates (OR 2.25 (1.49-3.41; p<0.001)) and were at risk for ICU admission (OR 2.89 (1.83-4.58)) and intubation (OR 2.95 (1.83-4.74)). CONCLUSIONS Hypernatraemia at presentation was associated with adverse outcomes in patients with COVID-19. Hypovolaemic hyponatraemia was found to be the most common aetiology of hyponatraemia. Hyponatraemia of unknown aetiology was associated with a higher risk for ICU admission and intubation and longer duration of admission.
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Affiliation(s)
- Lianne de Haan
- Department of Internal Medicine, Flevo Hospital, Almere, The Netherlands
- Department of Internal Medicine, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - Marije Ten Wolde
- Department of Internal Medicine, Flevo Hospital, Almere, The Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Rik H G Olde Engberink
- Center of Experimental and Molecular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Brent Appelman
- Center of Experimental and Molecular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | | | - Daisy Rusch
- Department of Intensive Care, Martini Hospital, Groningen, The Netherlands
| | | | - Suat Simsek
- Department of Internal Medicine, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - Nienke Paternotte
- Department of Pulmonology, Northwest Hospital Group, Alkmaar, The Netherlands
| | | | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - Martijn D de Kruif
- Department of Pulmonary Medicine, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Tom Dormans
- Department of Intensive Care, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Hazra Moeniralam
- Department of Internal Medicine, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Neyma Bokhizzou
- Department of Internal Medicine, Bovenij Hospital, Amsterdam, The Netherlands
| | - Kees Brinkman
- Department of Internal Medicine, OLVG, Amsterdam, The Netherlands
| | - Renee Douma
- Department of Internal Medicine, Flevo Hospital, Almere, The Netherlands
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8
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Kremer NI, Roberts MJ, Potters WV, Dilai J, Mathiopoulou V, Rijks N, Drost G, van Laar T, van Dijk JMC, Beudel M, de Bie RMA, van den Munckhof P, Janssen MLF, Schuurman PR, Bot M. Dorsal subthalamic nucleus targeting in deep brain stimulation: microelectrode recording versus 7-Tesla connectivity. Brain Commun 2023; 5:fcad298. [PMID: 38025271 PMCID: PMC10664414 DOI: 10.1093/braincomms/fcad298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/02/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Connectivity-derived 7-Tesla MRI segmentation and intraoperative microelectrode recording can both assist subthalamic nucleus targeting for deep brain stimulation in Parkinson's disease. It remains unclear whether deep brain stimulation electrodes placed in the 7-Tesla MRI segmented subdivision with predominant projections to cortical motor areas (hyperdirect pathway) achieve superior motor improvement and whether microelectrode recording can accurately distinguish the motor subdivision. In 25 patients with Parkinson's disease, deep brain stimulation electrodes were evaluated for being inside or outside the predominantly motor-connected subthalamic nucleus (motor-connected subthalamic nucleus or non-motor-connected subthalamic nucleus, respectively) based on 7-Tesla MRI connectivity segmentation. Hemi-body motor improvement (Movement Disorder Society Unified Parkinson's Disease Rating Scale, Part III) and microelectrode recording characteristics of multi- and single-unit activities were compared between groups. Deep brain stimulation electrodes placed in the motor-connected subthalamic nucleus resulted in higher hemi-body motor improvement, compared with electrodes placed in the non-motor-connected subthalamic nucleus (80% versus 52%, P < 0.0001). Multi-unit activity was found slightly higher in the motor-connected subthalamic nucleus versus the non-motor-connected subthalamic nucleus (P < 0.001, receiver operating characteristic 0.63); single-unit activity did not differ between groups. Deep brain stimulation in the connectivity-derived 7-Tesla MRI subthalamic nucleus motor segment produced a superior clinical outcome; however, microelectrode recording did not accurately distinguish this subdivision within the subthalamic nucleus.
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Affiliation(s)
- Naomi I Kremer
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
| | - Mark J Roberts
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht 6211 LK, The Netherlands
| | - Wouter V Potters
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
| | - José Dilai
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
| | - Varvara Mathiopoulou
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
| | - Niels Rijks
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
| | - Gea Drost
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
| | - J Marc C van Dijk
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
| | - Martijn Beudel
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
| | - Rob M A de Bie
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
| | - Marcus L F Janssen
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht 6229 HX, The Netherlands
| | - P Richard Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
| | - Maarten Bot
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
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9
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Brinke TRT, Jergas H, Sisodia V, Barbe MT, Odekerken VJJ, Verbaan D, Dijk JM, Bot M, Beudel M, van den Munckhof P, Schuurman PR, de Bie RMA. Directional versus ring-mode deep brain stimulation for Parkinson's disease: protocol of a multi-centre double-blind randomised crossover trial. BMC Neurol 2023; 23:372. [PMID: 37853327 PMCID: PMC10583384 DOI: 10.1186/s12883-023-03387-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/12/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The effectiveness of Deep Brain Stimulation (DBS) therapy for Parkinson's disease can be limited by side-effects caused by electrical current spillover into structures adjacent to the target area. The objective of the STEEred versus RING-mode DBS for Parkinson's disease (STEERING) study is to investigate if directional DBS for Parkinson's disease results in a better clinical outcome when compared to ring-mode DBS. METHODS The STEERING study is a prospective multi-centre double-blind randomised crossover trial. Inclusion criteria are Parkinson's disease, subthalamic nucleus DBS in a 'classic' ring-mode setting for a minimum of six months, and optimal ring-mode settings have been established. Participants are categorised into one of two subgroups according to their clinical response to the ring-mode settings as 'responders' (i.e., patient with a satisfactory effect of ring-mode DBS) or 'non-responder' (i.e., patient with a non-satisfactory effect of ring-mode DBS). A total of 64 responders and 38 non-responders will be included (total 102 patients). After an optimisation period in which an optimal directional setting is found, participants are randomised to first receive ring-mode DBS for 56 days (range 28-66) followed by directional DBS for 56 days (28-66) or vice-versa. The primary outcome is the difference between ring-mode DBS and directional DBS settings on the Movement Disorders Society Unified Parkinson's Disease Rating Scale - Motor Evaluation (MDS-UPDRS-ME) in the off-medication state. Secondary outcome measures consist of MDS-UPDRS-ME in the on-medication state, MDS-UPDRS Activities of Daily Living, MDS-UPDRS Motor Complications-Dyskinesia, disease related quality of life measured with the Parkinson's Disease Questionnaire 39, stimulation-induced side-effects, antiparkinsonian medication use, and DBS-parameters. Participants' therapy preference is measured at the end of the study. Outcomes will be analysed for both responder and non-responder groups, as well as for both groups pooled together. DISCUSSION The STEERING trial will provide insights into whether or not directional DBS should be standardly used in all Parkinson's disease DBS patients or if directional DBS should only be used in a case-based approach. TRIAL REGISTRATION This trial was registered on the Netherlands Trial Register, as trial NL6508 ( NTR6696 ) on June 23, 2017.
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Affiliation(s)
- Timo R Ten Brinke
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Hannah Jergas
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Vibuthi Sisodia
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Michael T Barbe
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Vincent J J Odekerken
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Dagmar Verbaan
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Joke M Dijk
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Maarten Bot
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Martijn Beudel
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Pepijn van den Munckhof
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - P Rick Schuurman
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - Rob M A de Bie
- Amsterdam UMC, University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands.
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands.
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10
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Michels EHA, Appelman B, de Brabander J, van Amstel RBE, Chouchane O, van Linge CCA, Schuurman AR, Reijnders TDY, Sulzer TAL, Klarenbeek AM, Douma RA, Bos LDJ, Wiersinga WJ, Peters-Sengers H, van der Poll T, van Agtmael M, Algera AG, Appelman B, van Baarle F, Beudel M, Bogaard HJ, Bomers M, Bonta P, Bos L, Botta M, de Brabander J, de Bree G, de Bruin S, Bugiani M, Bulle E, Buis DTP, Chouchane O, Cloherty A, Dijkstra M, Dongelmans DA, Dujardin RWG, Elbers P, Fleuren L, Geerlings S, Geijtenbeek T, Girbes A, Goorhuis B, Grobusch MP, Hagens L, Hamann J, Harris V, Hemke R, Hermans SM, Heunks L, Hollmann M, Horn J, Hovius JW, de Jong HK, de Jong MD, Koning R, Lemkes B, Lim EHT, van Mourik N, Nellen J, Nossent EJ, Olie S, Paulus F, Peters E, Pina-Fuentes DAI, van der Poll T, Preckel B, Prins JM, Raasveld J, Reijnders T, de Rotte MCFJ, Schinkel M, Schultz MJ, Schrauwen FAP, Schuurman A, Schuurmans J, Sigaloff K, Slim MA, Smeele P, Smit M, Stijnis CS, Stilma W, Teunissen C, Thoral P, Tsonas AM, Tuinman PR, van der Valk M, Veelo DP, Volleman C, de Vries H, Vught LA, van Vugt M, Wouters D, Zwinderman AHK, Brouwer MC, Wiersinga WJ, Vlaar APJ, van de Beek D. Age-related changes in plasma biomarkers and their association with mortality in COVID-19. Eur Respir J 2023; 62:2300011. [PMID: 37080568 PMCID: PMC10151455 DOI: 10.1183/13993003.00011-2023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19)-induced mortality occurs predominantly in older patients. Several immunomodulating therapies seem less beneficial in these patients. The biological substrate behind these observations is unknown. The aim of this study was to obtain insight into the association between ageing, the host response and mortality in patients with COVID-19. METHODS We determined 43 biomarkers reflective of alterations in four pathophysiological domains: endothelial cell and coagulation activation, inflammation and organ damage, and cytokine and chemokine release. We used mediation analysis to associate ageing-driven alterations in the host response with 30-day mortality. Biomarkers associated with both ageing and mortality were validated in an intensive care unit and external cohort. RESULTS 464 general ward patients with COVID-19 were stratified according to age decades. Increasing age was an independent risk factor for 30-day mortality. Ageing was associated with alterations in each of the host response domains, characterised by greater activation of the endothelium and coagulation system and stronger elevation of inflammation and organ damage markers, which was independent of an increase in age-related comorbidities. Soluble tumour necrosis factor receptor 1, soluble triggering receptor expressed on myeloid cells 1 and soluble thrombomodulin showed the strongest correlation with ageing and explained part of the ageing-driven increase in 30-day mortality (proportion mediated: 13.0%, 12.9% and 12.6%, respectively). CONCLUSIONS Ageing is associated with a strong and broad modification of the host response to COVID-19, and specific immune changes likely contribute to increased mortality in older patients. These results may provide insight into potential age-specific immunomodulatory targets in COVID-19.
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Affiliation(s)
- Erik H A Michels
- Amsterdam UMC, location University of Amsterdam, Center for Experimental and Molecular Medicine (CEMM), Amsterdam, The Netherlands
| | - Brent Appelman
- Amsterdam UMC, location University of Amsterdam, Center for Experimental and Molecular Medicine (CEMM), Amsterdam, The Netherlands
| | - Justin de Brabander
- Amsterdam UMC, location University of Amsterdam, Center for Experimental and Molecular Medicine (CEMM), Amsterdam, The Netherlands
| | - Rombout B E van Amstel
- Amsterdam UMC, location University of Amsterdam, Department of Intensive Care Medicine, Amsterdam, The Netherlands
| | - Osoul Chouchane
- Amsterdam UMC, location University of Amsterdam, Center for Experimental and Molecular Medicine (CEMM), Amsterdam, The Netherlands
| | - Christine C A van Linge
- Amsterdam UMC, location University of Amsterdam, Center for Experimental and Molecular Medicine (CEMM), Amsterdam, The Netherlands
| | - Alex R Schuurman
- Amsterdam UMC, location University of Amsterdam, Center for Experimental and Molecular Medicine (CEMM), Amsterdam, The Netherlands
| | - Tom D Y Reijnders
- Amsterdam UMC, location University of Amsterdam, Center for Experimental and Molecular Medicine (CEMM), Amsterdam, The Netherlands
| | - Titia A L Sulzer
- Amsterdam UMC, location University of Amsterdam, Center for Experimental and Molecular Medicine (CEMM), Amsterdam, The Netherlands
| | - Augustijn M Klarenbeek
- Amsterdam UMC, location University of Amsterdam, Center for Experimental and Molecular Medicine (CEMM), Amsterdam, The Netherlands
| | - Renée A Douma
- Flevo Hospital, Department of Internal Medicine, Almere, The Netherlands
| | - Lieuwe D J Bos
- Amsterdam UMC, location University of Amsterdam, Department of Intensive Care Medicine, Amsterdam, The Netherlands
| | - W Joost Wiersinga
- Amsterdam UMC, location University of Amsterdam, Center for Experimental and Molecular Medicine (CEMM), Amsterdam, The Netherlands
- Amsterdam UMC, location University of Amsterdam, Division of Infectious Diseases, Amsterdam, The Netherlands
| | - Hessel Peters-Sengers
- Amsterdam UMC, location University of Amsterdam, Center for Experimental and Molecular Medicine (CEMM), Amsterdam, The Netherlands
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam, The Netherlands
| | - Tom van der Poll
- Amsterdam UMC, location University of Amsterdam, Center for Experimental and Molecular Medicine (CEMM), Amsterdam, The Netherlands
- Amsterdam UMC, location University of Amsterdam, Division of Infectious Diseases, Amsterdam, The Netherlands
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11
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Beudel M, Macerollo A, Brown MJN, Chen R. Editorial: The role of the basal ganglia in somatosensory-motor interactions: evidence from neurophysiology and behavior, volume II. Front Hum Neurosci 2023; 17:1211465. [PMID: 37266324 PMCID: PMC10230070 DOI: 10.3389/fnhum.2023.1211465] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 06/03/2023] Open
Affiliation(s)
- Martijn Beudel
- Department of Neurology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Antonella Macerollo
- The Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Matt J. N. Brown
- Department of Kinesiology, California State University Sacramento, Sacramento, CA, United States
| | - Robert Chen
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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12
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Boumaza X, Bonneau B, Roos-Weil D, Pinnetti C, Rauer S, Nitsch L, Del Bello A, Jelcic I, Sühs KW, Gasnault J, Goreci Y, Grauer O, Gnanapavan S, Wicklein R, Lambert N, Perpoint T, Beudel M, Clifford D, Sommet A, Cortese I, Martin-Blondel G. Progressive Multifocal Leukoencephalopathy Treated by Immune Checkpoint Inhibitors. Ann Neurol 2023; 93:257-270. [PMID: 36151879 PMCID: PMC10092874 DOI: 10.1002/ana.26512] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/01/2022] [Accepted: 09/16/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Our aim was to assess the real-world effectiveness of immune checkpoint inhibitors for treatment of patients with progressive multifocal leukoencephalopathy (PML). METHODS We conducted a multicenter survey compiling retrospective data from 79 PML patients, including 38 published cases and 41 unpublished cases, who received immune checkpoint inhibitors as add-on to standard of care. One-year follow-up data were analyzed to determine clinical outcomes and safety profile. Logistic regression was used to identify variables associated with 1-year survival. RESULTS Predisposing conditions included hematological malignancy (n = 38, 48.1%), primary immunodeficiency (n = 14, 17.7%), human immunodeficiency virus/acquired immunodeficiency syndrome (n = 12, 15.2%), inflammatory disease (n = 8, 10.1%), neoplasm (n = 5, 6.3%), and transplantation (n = 2, 2.5%). Pembrolizumab was most commonly used (n = 53, 67.1%). One-year survival was 51.9% (41/79). PML-immune reconstitution inflammatory syndrome (IRIS) was reported in 15 of 79 patients (19%). Pretreatment expression of programmed cell death-1 on circulating T cells did not differ between survivors and nonsurvivors. Development of contrast enhancement on follow-up magnetic resonance imaging at least once during follow-up (OR = 3.16, 95% confidence interval = 1.20-8.72, p = 0.02) was associated with 1-year survival. Cerebrospinal fluid JC polyomavirus DNA load decreased significantly by 1-month follow-up in survivors compared to nonsurvivors (p < 0.0001). Thirty-two adverse events occurred among 24 of 79 patients (30.4%), and led to treatment discontinuation in 7 of 24 patients (29.1%). INTERPRETATION In this noncontrolled retrospective study of patients with PML who were treated with immune checkpoint inhibitors, mortality remains high. Development of inflammatory features or overt PML-IRIS was commonly observed. This study highlights that use of immune checkpoint inhibitors should be strictly personalized toward characteristics of the individual PML patient. ANN NEUROL 2023;93:257-270.
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Affiliation(s)
- Xavier Boumaza
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, Toulouse, France
| | - Baptiste Bonneau
- Department of Medical Pharmacology, CIC 1436, Toulouse University Hospital, Toulouse, France
| | - Damien Roos-Weil
- Department of Hematology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Carmela Pinnetti
- HIV/AIDS Clinical Unit, National Institute for Infectious Disease "L. Spallanzani", Rome, Italy
| | - Sebastian Rauer
- Department of Neurology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Louisa Nitsch
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.,Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR1291, CNRS UMR5051, Toulouse III University, Toulouse, France
| | - Ilijas Jelcic
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Kurt-Wolfram Sühs
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Jacques Gasnault
- Unit of Rehabilitation of Neuroviral Diseases, Bicêtre Hospital, APHP, Le Kremlin-Bicêtre, France.,INSERM U1186, Paul Brousse Hospital, Paris Saclay University, Villejuif, France
| | - Yasemin Goreci
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - Oliver Grauer
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Sharmilee Gnanapavan
- Department of Neurology, Barts Health NHS Trust and Queen Mary University of London, London, UK
| | - Rebecca Wicklein
- Department of Neurology, Technical University of Munich, Munich, Germany
| | - Nicolas Lambert
- Department of Neurology, University Hospital of Liège, Liège, Belgium
| | - Thomas Perpoint
- Department of Infectious and Tropical Diseases, Lyon University Hospital, Lyon, France
| | - Martijn Beudel
- Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Department of Neuroscience, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - David Clifford
- Department of Neurology, Washington University in St Louis, St Louis, MO, USA
| | - Agnès Sommet
- Department of Medical Pharmacology, CIC 1436, Toulouse University Hospital, Toulouse, France
| | - Irene Cortese
- Experimental Immunotherapeutics Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | - Guillaume Martin-Blondel
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, Toulouse, France.,Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR1291, CNRS UMR5051, Toulouse III University, Toulouse, France.,European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Infections of the Brain (ESGIB), Basel, Switzerland
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13
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Stam MJ, van Wijk BCM, Sharma P, Beudel M, Piña-Fuentes DA, de Bie RMA, Schuurman PR, Neumann WJ, Buijink AWG. A comparison of methods to suppress electrocardiographic artifacts in local field potential recordings. Clin Neurophysiol 2023; 146:147-161. [PMID: 36543611 DOI: 10.1016/j.clinph.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/06/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Local field potential (LFP) recordings from deep brain stimulation (DBS) electrodes are often contaminated with electrocardiographic (ECG) artifacts that hinder the detection of disease-specific electrical brain activity. METHODS Three ECG suppression methods were evaluated: (1) QRS interpolation of the Perceive toolbox, (2) template subtraction, and (3) singular value decomposition (SVD). LFPs were recorded with the Medtronic PerceptTM PC system in nine Parkinson's disease patients with stimulation OFF ("OFF-DBS"; anode disconnected) and ON at 0 mA ("ON-DBS 0 mA"; anode connected). Findings were verified with simulated ECG-contaminated time series. RESULTS ECG artifacts were present in 10 out of 18 ON-DBS 0 mA recordings. All ECG suppression methods drastically reduced artifact-induced beta band (13-35 Hz) power and at least partly recovered the beta peak and beta burst dynamics. Using external ECG recordings and lengthening artifact epoch length improved the performance of the suppression methods. Increasing epoch length, however, elevated the risk of flattening the beta peak and losing beta burst dynamics. CONCLUSIONS The SVD method formed the preferred trade-off between artifact cleaning and signal loss, as long as its parameter settings are adequately chosen. SIGNIFICANCE ECG suppression methods enable analysis of disease-specific neural activity from signals affected by ECG artifacts.
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Affiliation(s)
- M J Stam
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - B C M van Wijk
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands; Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - P Sharma
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Department of Electrical Engineering and Information Technology, Otto von Guericke University, Magdeburg, Germany
| | - M Beudel
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - D A Piña-Fuentes
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - R M A de Bie
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - P R Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - W-J Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A W G Buijink
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.
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14
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Garofalo M, Beudel M, Dijk J, Bonouvrié L, Buizer A, Geytenbeek J, Prins R, Schuurman P, van de Pol L. Elective and Emergency Deep Brain Stimulation in Refractory Pediatric Monogenetic Movement Disorders Presenting with Dystonia: Current Practice Illustrated by Two Cases. Neuropediatrics 2022; 54:44-52. [PMID: 36223877 PMCID: PMC9842449 DOI: 10.1055/a-1959-9088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Dystonia is characterized by sustained or intermittent muscle contractions, leading to abnormal posturing and twisting movements. In pediatric patients, dystonia often negatively influences quality of life. Pharmacological treatment for dystonia is often inadequate and causes adverse effects. Deep brain stimulation (DBS) appears to be a valid therapeutic option for pharmacoresistant dystonia in children. METHODS To illustrate the current clinical practice, we hereby describe two pediatric cases of monogenetic movement disorders presenting with dystonia and treated with DBS. We provide a literature review of similar previously described cases and on different clinical aspects of DBS in pediatric dystonia. RESULTS The first patient, a 6-year-old girl with severe dystonia, chorea, and myoclonus due to an ADCY5 gene mutation, received DBS in an elective setting. The second patient, an 8-year-old boy with GNAO1-related dystonia and chorea, underwent emergency DBS due to a pharmacoresistant status dystonicus. A significant amelioration of motor symptoms (65% on the Burke-Fahn-Marsden Dystonia Rating Scale) was observed postoperatively in the first patient and her personal therapeutic goals were achieved. DBS was previously reported in five patients with ADCY5-related movement disorders, of which three showed objective improvement. Emergency DBS in our second patient resulted in the successful termination of his GNAO1-related status dystonicus, this being the eighth case reported in the literature. CONCLUSION DBS can be effective in monogenetic pediatric dystonia and should be considered early in the disease course. To better evaluate the effects of DBS on patients' functioning, patient-centered therapeutic goals should be discussed in a multidisciplinary approach.
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Affiliation(s)
- M. Garofalo
- Department of Child Neurology, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - M. Beudel
- Department of Neurology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands,Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - J.M. Dijk
- Department of Neurology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands,Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - L.A. Bonouvrié
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam, the Netherlands,Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands
| | - A.I. Buizer
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam, the Netherlands,Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands
| | - J. Geytenbeek
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam, the Netherlands
| | - R.H.N. Prins
- Department of Neurology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - P.R. Schuurman
- Department of Neurosurgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - L.A. van de Pol
- Department of Child Neurology, Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands,Department of Child Neurology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Address for correspondence L.A. van de Pol, MD, PhD Department of Child Neurology, Emma Children's Hospital, Amsterdam University Medical Centers, Vrije UniversiteitBoelelaan 1117, 1081 HV Amsterdamthe Netherlands
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15
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Wallert E, Letort E, van der Zant F, Winogrodzka A, Berendse H, Beudel M, de Bie R, Booij J, Raijmakers P, van de Giessen E. Comparison of [ 18F]-FDOPA PET and [ 123I]-FP-CIT SPECT acquired in clinical practice for assessing nigrostriatal degeneration in patients with a clinically uncertain parkinsonian syndrome. EJNMMI Res 2022; 12:68. [PMID: 36273088 PMCID: PMC9588108 DOI: 10.1186/s13550-022-00943-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/15/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose Two commonly used imaging techniques to aid in the diagnosis of neurodegenerative parkinsonian syndromes are dopamine transporter (DAT) imaging with [123I]-FP-CIT single-photon emission computed tomography (DAT-SPECT) and positron emission tomography with [18F]-FDOPA (FDOPA-PET). This paper provides a unique series of parkinsonian patients who received both FDOPA-PET and DAT-SPECT in routine clinical practice and compares the reported results to assess potential differences between these two imaging techniques. Methods We present 11 patients with a clinically uncertain parkinsonian syndrome (CUPS), who received both FDOPA-PET and DAT-SPECT. All patients received an FDOPA-PET scan and DAT-SPECT as part of routine clinical care. Results The median time between the F-DOPA-PET scan and DAT-SPECT scan was 6 months (range 0–15 months). There was a discrepancy in the reported results of the FDOPA-PET and DAT-SPECT scans in nine patients, including 7 patients whose FDOPA-PET scan was reportedly normal, whereas their DAT-SPECT scan was abnormal. Conclusions In this case series of CUPS patients, DAT-SPECT was more often rated as abnormal than FDOPA-PET. The striatal loss of FDOPA uptake can be less pronounced than that of DAT binding in CUPS patients in early disease stages. Consequently, the interpretation of FDOPA-PET scans in CUPS can sometimes be challenging in routine practice. Supplementary Information The online version contains supplementary material available at 10.1186/s13550-022-00943-6.
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Affiliation(s)
- Elon Wallert
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Erwann Letort
- Department of Nuclear Medicine, Northwest Clinics, Location Alkmaar, Wilhelminalaan 12, Alkmaar, The Netherlands.,Department of Radiology & Nuclear Medicine, Spaarne Gasthuis, Location Haarlem, Boerhaavelaan 22, Haarlem, The Netherlands
| | - Friso van der Zant
- Department of Nuclear Medicine, Northwest Clinics, Location Alkmaar, Wilhelminalaan 12, Alkmaar, The Netherlands
| | - Ania Winogrodzka
- Department of Neurology, Northwest Clinics, Location Alkmaar, Wilhelminalaan 12, Alkmaar, The Netherlands
| | - Henk Berendse
- Department of Neurology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Rob de Bie
- Department of Neurology, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jan Booij
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Pieter Raijmakers
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Elsmarieke van de Giessen
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Radiology & Nuclear Medicine, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
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16
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Swinnen B, Beudel M, Schuurman P, de Bie R. Parkinsonism in GPi‐DBS for dystonia; when to suspect degenerative parkinsonism? Mov Disord Clin Pract 2022; 9:990-991. [PMID: 36247904 PMCID: PMC9547129 DOI: 10.1002/mdc3.13552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/21/2022] [Accepted: 08/16/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- B.E.K.S. Swinnen
- Amsterdam UMC location University of Amsterdam, Department of Neurology and Clinical Neurophysiology, Meibergdreef 9 Amsterdam The Netherlands
| | - M. Beudel
- Amsterdam UMC location University of Amsterdam, Department of Neurology and Clinical Neurophysiology, Meibergdreef 9 Amsterdam The Netherlands
| | - P.R. Schuurman
- Amsterdam UMC location University of Amsterdam, Department of Neurosurgery, Meibergdreef 9 Amsterdam The Netherlands
| | - R.M.A. de Bie
- Amsterdam UMC location University of Amsterdam, Department of Neurology and Clinical Neurophysiology, Meibergdreef 9 Amsterdam The Netherlands
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17
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Smeele PJ, Vermunt L, Blok S, Duitman JW, van Agtmael M, Algera AG, Appelman B, van Baarle F, Bax D, Beudel M, Bogaard HJ, Bomers M, Bonta P, Bos L, Botta M, de Brabander J, de Bree G, de Bruin S, Buis DTP, Bugiani M, Bulle E, Chekrouni N, Chouchane O, Cloherty A, Dijkstra M, Dongelmans DA, Duijvelaar E, Dujardin RWG, Elbers P, Fleuren L, Geerlings S, Geijtenbeek T, Girbes A, Goorhuis B, Grobusch MP, Hafkamp F, Hagens L, Hamann J, Harris V, Hemke R, Hermans SM, Heunks L, Hollmann M, Horn J, Hovius JW, de Jong MD, Koning R, Lim EHT, van Mourik N, Nellen J, Nossent EJ, Olie S, Paulus F, Peters E, Pina-Fuentes DAI, van der Poll T, Preckel B, Raasveld J, Reijnders T, de Rotte MCFJ, Schippers JR, Schinkel M, Schultz MJ, Schrauwen FAP, Schuurman A, Schuurmans J, Sigaloff K, Slim MA, Smeele P, Smit M, Stijnis CS, Stilma W, Teunissen C, Thoral P, Tsonas AM, Tuinman PR, van der Valk M, Veelo D, Volleman C, de Vries H, Vught LA, van Vugt M, Wouters D, Zwinderman AH(K, Brouwer MC, Wiersinga WJ, Vlaar APJ, van de Beek D, Nossent EJ, van Agtmael MA, Heunks LMA, Horn J, Bogaard HJ, Teunissen CE. Neurofilament light increases over time in severe COVID-19 and is associated with delirium. Brain Commun 2022; 4:fcac195. [PMID: 35938070 PMCID: PMC9351727 DOI: 10.1093/braincomms/fcac195] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/05/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Neurological monitoring in sedated Intensive Care Unit patients is constrained by the lack of reliable blood-based biomarkers. Neurofilament light is a cross-disease biomarker for neuronal damage with potential clinical applicability for monitoring Intensive Care Unit patients. We studied the trajectory of neurofilament light over a month in Intensive Care Unit patients diagnosed with severe COVID-19 and explored its relation to clinical outcomes and pathophysiological predictors. Data were collected over a month in 31 Intensive Care Unit patients (166 plasma samples) diagnosed with severe COVID-19 at Amsterdam University Medical Centre, and in the first week after emergency department admission in 297 patients with COVID-19 (635 plasma samples) admitted to Massachusetts General hospital. We observed that Neurofilament light increased in a non-linear fashion in the first month of Intensive Care Unit admission and increases faster in the first week of Intensive Care Unit admission when compared with mild-moderate COVID-19 cases. We observed that baseline Neurofilament light did not predict mortality when corrected for age and renal function. Peak neurofilament light levels were associated with a longer duration of delirium after extubation in Intensive Care Unit patients. Disease severity, as measured by the sequential organ failure score, was associated to higher neurofilament light values, and tumour necrosis factor alpha levels at baseline were associated with higher levels of neurofilament light at baseline and a faster increase during admission. These data illustrate the dynamics of Neurofilament light in a critical care setting and show associations to delirium, disease severity and markers for inflammation. Our study contributes to determine the clinical utility and interpretation of neurofilament light levels in Intensive Care Unit patients.
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Affiliation(s)
- Patrick J Smeele
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC , Amsterdam , the Netherlands
- Department of Pulmonary Medicine, Amsterdam University Medical Centre , Amsterdam 1081 HV , the Netherlands
| | - Lisa Vermunt
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC , Amsterdam , the Netherlands
| | - Siebe Blok
- Department of Pulmonary Medicine, Amsterdam University Medical Centre , Amsterdam 1081 HV , the Netherlands
| | - Jan Willem Duitman
- Department of Pulmonary Medicine, Amsterdam University Medical Centre , Amsterdam 1081 HV , the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Esther J Nossent
- Department of Pulmonary Medicine, Amsterdam University Medical Centre , Amsterdam 1081 HV , the Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, Amsterdam University Medical Centre , Amsterdam 1081 HV , the Netherlands
| | - Leo M A Heunks
- Department of Intensive Care Medicine, Amsterdam University Medical Centre , Amsterdam 1081 HV , the Netherlands
| | - Janneke Horn
- Department of Intensive Care Medicine, Amsterdam University Medical Centre , Amsterdam 1081 HV , the Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam University Medical Centre , Amsterdam 1081 HV , the Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC , Amsterdam , the Netherlands
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18
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Ulubas M, Gelauff J, Beudel M. Treat by Suggestion: The potential use of N=1 trials in Functional Neurological Disorders. Mov Disord Clin Pract 2022; 9:843-845. [PMID: 35937493 PMCID: PMC9346240 DOI: 10.1002/mdc3.13496] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/03/2022] [Accepted: 05/22/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Merve Ulubas
- Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam PO Box 22660 Amsterdam 1100DD the Netherlands
| | - Jeannette Gelauff
- Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam PO Box 22660 Amsterdam 1100DD the Netherlands
| | - Martijn Beudel
- Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam PO Box 22660 Amsterdam 1100DD the Netherlands
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19
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Wallert ED, van de Giessen E, Knol RJJ, Beudel M, de Bie RMA, Booij J. Imaging Dopaminergic Neurotransmission in Neurodegenerative Disorders. J Nucl Med 2022; 63:27S-32S. [PMID: 35649651 PMCID: PMC9165729 DOI: 10.2967/jnumed.121.263197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/25/2022] [Indexed: 12/14/2022] Open
Abstract
Imaging of dopaminergic transmission in neurodegenerative disorders such as Parkinson disease (PD) or dementia with Lewy bodies plays a major role in clinical practice and in clinical research. We here review the role of imaging of the nigrostriatal pathway, as well as of striatal receptors and dopamine release, in common neurodegenerative disorders in clinical practice and research. Imaging of the nigrostriatal pathway has a high diagnostic accuracy to detect nigrostriatal degeneration in disorders characterized by nigrostriatal degeneration, such as PD and dementia with Lewy bodies, and disorders of more clinical importance, namely in patients with clinically uncertain parkinsonism. Imaging of striatal dopamine D2/3 receptors is not recommended for the differential diagnosis of parkinsonian disorders in clinical practice anymore. Regarding research, recently the European Medicines Agency has qualified dopamine transporter imaging as an enrichment biomarker for clinical trials in early PD, which underlines the high diagnostic accuracy of this imaging tool and will be implemented in future trials. Also, imaging of the presynaptic dopaminergic system plays a major role in, for example, examining the extent of nigrostriatal degeneration in preclinical and premotor phases of neurodegenerative disorders and to examine subtypes of PD. Also, imaging of postsynaptic dopamine D2/3 receptors plays a role in studying, for example, the neuronal substrate of impulse control disorders in PD, as well as in measuring endogenous dopamine release to examine, for example, motor complications in the treatment of PD. Finally, novel MRI sequences as neuromelanin-sensitive MRI are promising new tools to study nigrostriatal degeneration in vivo.
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Affiliation(s)
- Elon D Wallert
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Elsmarieke van de Giessen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Remco J J Knol
- Department of Nuclear Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands; and
| | - Martijn Beudel
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rob M A de Bie
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Booij
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands;
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20
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Collard D, Stronks K, Harris V, Coyer L, Brinkman K, Beudel M, Bokhizzou N, Douma RA, Elbers P, Galenkamp H, Wolde MT, Prins M, van den Born BJH, Agyemang C. Ethnic Differences in Coronavirus Disease 2019 Hospitalization and Hospital Outcomes in a Multiethnic Population in the Netherlands. Open Forum Infect Dis 2022; 9:ofac257. [PMID: 35783684 PMCID: PMC9129177 DOI: 10.1093/ofid/ofac257] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Evidence from the United States and United Kingdom suggests that ethnic minority populations are at an increased risk for developing severe coronavirus disease 2019 (COVID-19); however, data from other West-European countries are scarce. Methods We analyzed data from 1439 patients admitted between February 2020 and January 2021 to 4 main hospitals in Amsterdam and Almere, the Netherlands. Differences in the risk for hospitalization were assessed by comparing demographics to the general population. Using a population-based cohort as reference, we determined differences in the association between comorbidities and COVID-19 hospitalization. Outcomes after hospitalization were analyzed using Cox regression. Results The hospitalization risk was higher in all ethnic minority groups than in those of Dutch origin, with age-adjusted odds ratios ranging from 2.2 (95% confidence interval [CI], 1.7-2.6) in Moroccans to 4.5 (95% CI, 3.2-6.0) in Ghanaians. Hypertension and diabetes were similarly associated with COVID-19 hospitalization. For all other comorbidities, we found differential associations. Intensive care unit admission and mortality during 21-day follow-up after hospitalization was comparable between ethnicities. Conclusions The risk of COVID-19 hospitalization was higher in all ethnic minority groups compared to the Dutch, but the risk of adverse outcomes after hospitalization was similar. Our results suggest that these inequalities may in part be attributable to comorbidities that can be prevented by targeted public health prevention measures. More work is needed to gain insight into the role of other potential factors such as social determinants of health, which might have contributed to the ethnic inequalities in COVID-19 hospitalization.
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Affiliation(s)
- Didier Collard
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Vanessa Harris
- Department of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Global Health, Amsterdam Institute of Global Health and Development, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Liza Coyer
- Department of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Kees Brinkman
- Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Nejma Bokhizzou
- Internal Medicine, BovenIJ Hospital, Amsterdam, the Netherlands
| | - Renee A Douma
- Internal Medicine, Flevo Hospital, Almere, the Netherlands
| | - Paul Elbers
- Department of Intensive Care, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Maria Prins
- Department of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Bert Jan H van den Born
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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21
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Swinnen BEKS, Bot M, Goes KM, Beudel M, Schuurman RP, de Bie RMA. Directional stimulation improves stimulation-induced dysgeusia in DBS for essential tremor. Brain Stimul 2022; 15:680-682. [PMID: 35483590 DOI: 10.1016/j.brs.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/23/2022] [Accepted: 04/21/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- B E K S Swinnen
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, the Netherlands.
| | - M Bot
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - K M Goes
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - M Beudel
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - R P Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - R M A de Bie
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
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22
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Swinnen BEKS, Buijink AW, Piña-Fuentes D, de Bie RMA, Beudel M. Diving into the Subcortex: The Potential of Chronic Subcortical Sensing for Unravelling Basal Ganglia Function and Optimization of Deep Brain STIMULATION. Neuroimage 2022; 254:119147. [PMID: 35346837 DOI: 10.1016/j.neuroimage.2022.119147] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Subcortical structures are a relative neurophysiological 'terra incognita' owing to their location within the skull. While perioperative subcortical sensing has been performed for more than 20 years, the neurophysiology of the basal ganglia in the home setting has remained almost unexplored. However, with the recent advent of implantable pulse generators (IPG) that are able to record neural activity, the opportunity to chronically record local field potentials (LFPs) directly from electrodes implanted for deep brain stimulation opens up. This allows for a breakthrough of chronic subcortical sensing into fundamental research and clinical practice. In this review an extensive overview of the current state of subcortical sensing is provided. The widespread potential of chronic subcortical sensing for investigational and clinical use is discussed. Finally, status and future perspectives of the most promising application of chronic subcortical sensing -i.e., adaptive deep brain stimulation (aDBS)- are discussed in the context of movement disorders. The development of aDBS based on both chronic subcortical and cortical sensing has the potential to dramatically change clinical practice and the life of patients with movement disorders. However, several barriers still stand in the way of clinical implementation. Advancements regarding IPG and lead technology, physiomarkers, and aDBS algorithms as well as harnessing artificial intelligence, multimodality and sensing in the naturalistic setting are needed to bring aDBS to clinical practice.
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Affiliation(s)
- Bart E K S Swinnen
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical, Centers, Amsterdam Neuroscience, University of Amsterdam, PO Box 22660, Amsterdam 1100DD, the Netherland.
| | - Arthur W Buijink
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical, Centers, Amsterdam Neuroscience, University of Amsterdam, PO Box 22660, Amsterdam 1100DD, the Netherland
| | - Dan Piña-Fuentes
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical, Centers, Amsterdam Neuroscience, University of Amsterdam, PO Box 22660, Amsterdam 1100DD, the Netherland
| | - Rob M A de Bie
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical, Centers, Amsterdam Neuroscience, University of Amsterdam, PO Box 22660, Amsterdam 1100DD, the Netherland
| | - Martijn Beudel
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical, Centers, Amsterdam Neuroscience, University of Amsterdam, PO Box 22660, Amsterdam 1100DD, the Netherland
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23
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Lim EHT, Vlaar APJ, Bos LDJ, van Vught LA, Boer AMTD, Dujardin RWG, Habel M, Xu Z, Brouwer MC, van de Beek D, de Bruin S, Algera AG, Appelman B, van Baarle F, Beudel M, Bogaard HJ, Bomers M, Bonta P, Bos LDJ, Botta M, de Brabander J, Bree G, Bugiani M, Bulle E, Chouchane O, Cloherty A, Buis DTP, de Rotte MCFJ, Dijkstra M, Dongelmans DA, Elbers P, Fleuren L, Geerlings S, Geijtenbeek T, Girbes A, Goorhuis B, Grobusch MP, Hagens L, Hamann J, Harris V, Hemke R, Hermans SM, Heunks L, Hollmann M, Horn J, Hovius JW, de Jong MD, Koning R, van Mourik N, Nellen J, Nossent EJ, Paulus F, Peters E, Piña-Fuentes DAI, van der Poll T, Preckel B, Prins JM, Raasveld J, Reijnders T, Schinkel M, Schrauwen FAP, Schultz MJ, Schuurman A, Schuurmans J, Sigaloff K, Slim MA, Smeele P, Smit M, Stijnis CS, Stilma W, Teunissen C, Thoral P, Tsonas AM, Tuinman PR, van der Valk M, Veelo D, Volleman C, de Vries H, van Vugt M, Wouters D, Zwinderman AH, Wiersinga WJ. Anti-C5a antibody vilobelimab treatment and the effect on biomarkers of inflammation and coagulation in patients with severe COVID-19: a substudy of the phase 2 PANAMO trial. Respir Res 2022; 23:375. [PMID: 36566174 PMCID: PMC9789513 DOI: 10.1186/s12931-022-02278-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
We recently reported in the phase 3 PANAMO trial that selectively blocking complement 5a (C5a) with vilobelimab led to improved survival in critically ill COVID-19 patients. C5a is an important contributor to the innate immune system and can also activate the coagulation system. High C5a levels have been reported in severely ill COVID-19 patients and correlate with disease severity and mortality. Previously, we assessed the potential benefit and safety of vilobelimab in severe COVID-19 patients. In the current substudy of the phase 2 PANAMO trial, we aim to explore the effects of vilobelimab on various biomarkers of inflammation and coagulation. Between March 31 and April 24, 2020, 17 patients with severe COVID-19 pneumonia were enrolled in an exploratory, open-label, randomised phase 2 trial. Blood markers of complement, endothelial activation, epithelial barrier disruption, inflammation, neutrophil activation, neutrophil extracellular trap (NET) formation and coagulopathy were measured using enzyme-linked immunosorbent assay (ELISA) or utilizing the Luminex platform. During the first 15 days after inclusion, change in biomarker concentrations between the two groups were modelled with linear mixed-effects models with spatial splines and compared. Eight patients were randomized to vilobelimab treatment plus best supportive care (BSC) and nine patients were randomized to BSC only. A significant decrease over time was seen in the vilobelimab plus BSC group for C5a compared to the BSC only group (p < 0.001). ADAMTS13 levels decreased over time in the BSC only group compared to the vilobelimab plus BSC group (p < 0.01) and interleukin-8 (IL-8) levels were statistically more suppressed in the vilobelimab plus BSC group compared to the BSC group (p = 0.03). Our preliminary results show that C5a inhibition decreases the inflammatory response and hypercoagulability, which likely explains the beneficial effect of vilobelimab in severe COVID-19 patients. Validation of these results in a larger sample size is warranted.
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Affiliation(s)
- Endry H. T. Lim
- grid.7177.60000000084992262Department of Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands ,Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Amsterdam, The Netherlands ,grid.7177.60000000084992262Department of Neurology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands ,grid.484519.5Amsterdam Neuroscience, Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Department of Intensive Care Medicine, Amsterdam UMC, Location AMC, Room C3-421, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Alexander P. J. Vlaar
- grid.7177.60000000084992262Department of Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands ,Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Amsterdam, The Netherlands
| | - Lieuwe D. J. Bos
- grid.7177.60000000084992262Department of Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands ,Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Amsterdam, The Netherlands
| | - Lonneke A. van Vught
- grid.7177.60000000084992262Department of Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands ,grid.7177.60000000084992262Center for Experimental and Molecular Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Anita M. Tuip-de Boer
- grid.7177.60000000084992262Department of Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands ,Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Amsterdam, The Netherlands
| | - Romein W. G. Dujardin
- grid.7177.60000000084992262Department of Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands ,Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Amsterdam, The Netherlands
| | | | - Zhongli Xu
- grid.476439.bInflaRx GmbH, Jena, Germany
| | - Matthijs C. Brouwer
- grid.7177.60000000084992262Department of Neurology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands ,grid.484519.5Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Diederik van de Beek
- grid.7177.60000000084992262Department of Neurology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands ,grid.484519.5Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Sanne de Bruin
- grid.7177.60000000084992262Department of Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands ,Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Amsterdam, The Netherlands
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Fleuren LM, Dam TA, Tonutti M, de Bruin DP, Lalisang RCA, Gommers D, Cremer OL, Bosman RJ, Rigter S, Wils EJ, Frenzel T, Dongelmans DA, de Jong R, Peters M, Kamps MJA, Ramnarain D, Nowitzky R, Nooteboom FGCA, de Ruijter W, Urlings-Strop LC, Smit EGM, Mehagnoul-Schipper DJ, Dormans T, de Jager CPC, Hendriks SHA, Achterberg S, Oostdijk E, Reidinga AC, Festen-Spanjer B, Brunnekreef GB, Cornet AD, van den Tempel W, Boelens AD, Koetsier P, Lens J, Faber HJ, Karakus A, Entjes R, de Jong P, Rettig TCD, Arbous S, Vonk SJJ, Fornasa M, Machado T, Houwert T, Hovenkamp H, Noorduijn Londono R, Quintarelli D, Scholtemeijer MG, de Beer AA, Cinà G, Kantorik A, de Ruijter T, Herter WE, Beudel M, Girbes ARJ, Hoogendoorn M, Thoral PJ, Elbers PWG. Predictors for extubation failure in COVID-19 patients using a machine learning approach. Crit Care 2021; 25:448. [PMID: 34961537 PMCID: PMC8711075 DOI: 10.1186/s13054-021-03864-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/13/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Determining the optimal timing for extubation can be challenging in the intensive care. In this study, we aim to identify predictors for extubation failure in critically ill patients with COVID-19. METHODS We used highly granular data from 3464 adult critically ill COVID patients in the multicenter Dutch Data Warehouse, including demographics, clinical observations, medications, fluid balance, laboratory values, vital signs, and data from life support devices. All intubated patients with at least one extubation attempt were eligible for analysis. Transferred patients, patients admitted for less than 24 h, and patients still admitted at the time of data extraction were excluded. Potential predictors were selected by a team of intensive care physicians. The primary and secondary outcomes were extubation without reintubation or death within the next 7 days and within 48 h, respectively. We trained and validated multiple machine learning algorithms using fivefold nested cross-validation. Predictor importance was estimated using Shapley additive explanations, while cutoff values for the relative probability of failed extubation were estimated through partial dependence plots. RESULTS A total of 883 patients were included in the model derivation. The reintubation rate was 13.4% within 48 h and 18.9% at day 7, with a mortality rate of 0.6% and 1.0% respectively. The grandient-boost model performed best (area under the curve of 0.70) and was used to calculate predictor importance. Ventilatory characteristics and settings were the most important predictors. More specifically, a controlled mode duration longer than 4 days, a last fraction of inspired oxygen higher than 35%, a mean tidal volume per kg ideal body weight above 8 ml/kg in the day before extubation, and a shorter duration in assisted mode (< 2 days) compared to their median values. Additionally, a higher C-reactive protein and leukocyte count, a lower thrombocyte count, a lower Glasgow coma scale and a lower body mass index compared to their medians were associated with extubation failure. CONCLUSION The most important predictors for extubation failure in critically ill COVID-19 patients include ventilatory settings, inflammatory parameters, neurological status, and body mass index. These predictors should therefore be routinely captured in electronic health records.
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Affiliation(s)
- Lucas M. Fleuren
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Tariq A. Dam
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | | | | | | | - Diederik Gommers
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Olaf L. Cremer
- Department of Intensive Care, UMC Utrecht, Utrecht, The Netherlands
| | | | - Sander Rigter
- Department of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Tim Frenzel
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dave A. Dongelmans
- Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Remko de Jong
- Intensive Care, Bovenij Ziekenhuis, Amsterdam, The Netherlands
| | - Marco Peters
- Intensive Care, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | | | | | - Ralph Nowitzky
- Intensive Care, HagaZiekenhuis, Den Haag, The Netherlands
| | | | - Wouter de Ruijter
- Department of Intensive Care Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Ellen G. M. Smit
- Intensive Care, Spaarne Gasthuis, Haarlem en Hoofddorp, The Netherlands
| | | | - Tom Dormans
- Intensive Care, Zuyderland MC, Heerlen, The Netherlands
| | | | | | | | | | | | | | - Gert B. Brunnekreef
- Department of Intensive Care, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Alexander D. Cornet
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Walter van den Tempel
- Department of Intensive Care, Ikazia Ziekenhuis Rotterdam, Rotterdam, The Netherlands
| | | | - Peter Koetsier
- Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Judith Lens
- ICU, IJsselland Ziekenhuis, Capelle Aan Den IJssel, The Netherlands
| | | | - A. Karakus
- Department of Intensive Care, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Robert Entjes
- Department of Intensive Care, Adrz, Goes, The Netherlands
| | - Paul de Jong
- Department of Anesthesia and Intensive Care, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | - Thijs C. D. Rettig
- Department of Anesthesiology, Intensive Care and Pain Medicine, Amphia Ziekenhuis, Breda, The Netherlands
| | - Sesmu Arbous
- Department of Intensive Care, LUMC, Leiden, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Martijn Beudel
- Department of Neurology, Amsterdam UMC, Universiteit Van Amsterdam, Amsterdam, The Netherlands
| | - Armand R. J. Girbes
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mark Hoogendoorn
- Quantitative Data Analytics Group, Department of Computer Science, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands
| | - Patrick J. Thoral
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Paul W. G. Elbers
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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25
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Nurmohamed NS, Collard D, Reeskamp LF, Kaiser Y, Kroon J, Tromp TR, van den Born BJH, Coppens M, Vlaar APJ, Beudel M, van de Beek D, van Es N, Moriarty PM, Tsimikas S, Stroes ESG. Lipoprotein(a), venous thromboembolism and COVID-19: A pilot study. Atherosclerosis 2021; 341:43-49. [PMID: 34995986 PMCID: PMC8690577 DOI: 10.1016/j.atherosclerosis.2021.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 07/19/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 12/24/2022]
Abstract
Background and aims Thrombosis is a major driver of adverse outcome and mortality in patients with Coronavirus disease 2019 (COVID-19). Hypercoagulability may be related to the cytokine storm associated with COVID-19, which is mainly driven by interleukin (IL)-6. Plasma lipoprotein(a) [Lp(a)] levels increase following IL-6 upregulation and Lp(a) has anti-fibrinolytic properties. This study investigated whether Lp(a) elevation may contribute to the pro-thrombotic state hallmarking COVID-19 patients. Methods Lp(a), IL-6 and C-reactive protein (CRP) levels were measured in 219 hospitalized patients with COVID-19 and analyzed with linear mixed effects model. The baseline biomarkers and increases during admission were related to venous thromboembolism (VTE) incidence and clinical outcomes in a Kaplan-Meier and logistic regression analysis. Results Lp(a) levels increased significantly by a mean of 16.9 mg/dl in patients with COVID-19 during the first 21 days after admission. Serial Lp(a) measurements were available in 146 patients. In the top tertile of Lp(a) increase, 56.2% of COVID-19 patients experienced a VTE event compared to 18.4% in the lowest tertile (RR 3.06, 95% CI 1.61–5.81; p < 0.001). This association remained significant after adjusting for age, sex, IL-6 and CRP increase and number of measurements. Increases in IL-6 and CRP were not associated with VTE. Increase in Lp(a) was strongly correlated with increase in IL-6 (r = 0.44, 95% CI 0.30–0.56, p < 0.001). Conclusions Increases in Lp(a) levels during the acute phase of COVID-19 were strongly associated with VTE incidence. The acute increase in anti-fibrinolytic Lp(a) may tilt the balance to VTE in patients hospitalized for COVID-19.
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Affiliation(s)
- Nick S Nurmohamed
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Didier Collard
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Laurens F Reeskamp
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Yannick Kaiser
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeffrey Kroon
- Department of Experimental Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Tycho R Tromp
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Bert-Jan H van den Born
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Michiel Coppens
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Nick van Es
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick M Moriarty
- Division of Clinical Pharmacology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sotirios Tsimikas
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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26
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Guo L, Schurink B, Roos E, Nossent EJ, Duitman JW, Vlaar APJ, van der Valk P, Vaz FM, Yeh SR, Geeraerts Z, Dijkhuis A, van Vught L, Bugiani M, Lutter R, van Agtmael M, Algera AG, Appelman B, van Baarle F, Bax D, Beudel M, Bogaard HJ, Bomers M, Bonta P, Bos L, Botta M, de Brabander J, Bree G, de Bruin S, Bugiani M, Bulle E, Chouchane O, Cloherty A, David BTP, de Rotte MCFJ, Dijkstra M, Dongelmans DA, Dujardin RWG, Elbers P, Fleuren L, Geerlings S, Geijtenbeek T, Girbes A, Goorhuis B, Grobusch MP, Hafkamp F, Hagens L, Hamann J, Hamann J, Harris V, Hemke R, Hermans SM, Heunks L, Hollmann M, Horn J, Hovius JW, de Jong MD, Koning R, Lim EHT, van Mourik N, Nellen J, Nossent EJ, Paulus F, Peters E, Piña-Fuentes DAI, van der Poll T, Preckel B, Prins JM, Raasveld J, Reijnders T, Schinkel M, Schrauwen FAP, Schultz MJ, Schuurmans A, Schuurmans J, Sigaloff K, Slim MA, Smit M, Stijnis CS, Stilma W, Teunissen C, Thoral P, Tsonas AM, Tsonas A, van der Valk M, Veelo D, Volleman C, de Vries H, Vught LA, van Vugt M, Wouters D, Zwinderman AHK, Brouwer MC, Wiersinga WJ, Vlaar APJ, van de Beek D. Indoleamine 2,3-dioxygenase (IDO)-1 and IDO-2 activity and severe course of COVID-19. J Pathol 2021; 256:256-261. [PMID: 34859884 PMCID: PMC8897979 DOI: 10.1002/path.5842] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/12/2021] [Accepted: 11/30/2021] [Indexed: 11/06/2022]
Abstract
COVID-19 is a pandemic with high morbidity and mortality. In an autopsy cohort of COVID-19 patients, we found extensive accumulation of the tryptophan degradation products 3-hydroxy anthranilic acid and quinolinic acid in lungs, heart, and brain. This was not related to the expression of the tryptophan-catabolizing indoleamine 2,3-dioxygenase (IDO)-1, but rather to that of its isoform IDO-2, which otherwise is expressed rarely. Bioavailability of tryptophan is an absolute requirement for proper cell functioning and synthesis of hormones, whereas its degradation products can cause cell death. Markers of apoptosis and severe cellular stress were associated with IDO-2 expression in large areas of lung and heart tissue, whereas affected areas in brain were more restricted. Analyses of tissue, cerebrospinal fluid, and sequential plasma samples indicate early initiation of the kynurenine/aryl-hydrocarbon receptor/IDO-2 axis as a positive feedback loop, potentially leading to severe COVID-19 pathology. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lihui Guo
- Dept. Experimental Immunology, Amsterdam University Medical Centers (UMC) and Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Bernadette Schurink
- Dept. Pathology, Amsterdam UMC, VU University Amsterdam, Amsterdam, Netherlands
| | - Eva Roos
- Dept. Pathology, Amsterdam UMC, VU University Amsterdam, Amsterdam, Netherlands
| | - Esther J Nossent
- Dept. Respiratory Medicine, Amsterdam UMC, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Jan Willem Duitman
- Dept. Respiratory Medicine, Amsterdam UMC, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Alexander P J Vlaar
- Dept. Intensive Care and Center for Experimental Molecular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul van der Valk
- Dept. Pathology, Amsterdam UMC, VU University Amsterdam, Amsterdam, Netherlands
| | - Frédéric M Vaz
- Laboratory Genetic Metabolic Diseases, Core Facility Metabolomics, Department of Clinical Chemistry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Syun-Ru Yeh
- Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Zachary Geeraerts
- Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Annemiek Dijkhuis
- Dept. Experimental Immunology, Amsterdam University Medical Centers (UMC) and Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Lonneke van Vught
- Dept. Intensive Care and Center for Experimental Molecular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marianna Bugiani
- Dept. Pathology, Amsterdam UMC, VU University Amsterdam, Amsterdam, Netherlands
| | - René Lutter
- Dept. Experimental Immunology, Amsterdam University Medical Centers (UMC) and Amsterdam Infection and Immunity Institute, University of Amsterdam, Amsterdam, The Netherlands.,Dept. Respiratory Medicine, Amsterdam UMC, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
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27
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Veldhuis L, Ridderikhof ML, Schinkel M, van den Bergh J, Beudel M, Dormans T, Douma R, Gritters van den Oever N, de Haan L, Koopman K, de Kruif MD, Noordzij P, Reidinga A, de Ruijter W, Simsek S, Wyers C, Nanayakkara PW, Hollmann M. Early warning scores to assess the probability of critical illness in patients with COVID-19. Emerg Med J 2021; 38:901-905. [PMID: 34706897 PMCID: PMC8553424 DOI: 10.1136/emermed-2020-211054] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 10/06/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Validated clinical risk scores are needed to identify patients with COVID-19 at risk of severe disease and to guide triage decision-making during the COVID-19 pandemic. The objective of the current study was to evaluate the performance of early warning scores (EWS) in the ED when identifying patients with COVID-19 who will require intensive care unit (ICU) admission for high-flow-oxygen usage or mechanical ventilation. METHODS Patients with a proven SARS-CoV-2 infection with complete resuscitate orders treated in nine hospitals between 27 February and 30 July 2020 needing hospital admission were included. Primary outcome was the performance of EWS in identifying patients needing ICU admission within 24 hours after ED presentation. RESULTS In total, 1501 patients were included. Median age was 71 (range 19-99) years and 60.3% were male. Of all patients, 86.9% were admitted to the general ward and 13.1% to the ICU within 24 hours after ED admission. ICU patients had lower peripheral oxygen saturation (86.7% vs 93.7, p≤0.001) and had a higher body mass index (29.2 vs 27.9 p=0.043) compared with non-ICU patients. National Early Warning Score 2 (NEWS2) ≥ 6 and q-COVID Score were superior to all other studied clinical risk scores in predicting ICU admission with a fair area under the receiver operating characteristics curve of 0.740 (95% CI 0.696 to 0.783) and 0.760 (95% CI 0.712 to 0.800), respectively. NEWS2 ≥6 and q-COVID Score ≥3 discriminated patients admitted to the ICU with a sensitivity of 78.1% and 75.9%, and specificity of 56.3% and 61.8%, respectively. CONCLUSION In this multicentre study, the best performing models to predict ICU admittance were the NEWS2 and the Quick COVID-19 Severity Index Score, with fair diagnostic performance. However, due to the moderate performance, these models cannot be clinically used to adequately predict the need for ICU admission within 24 hours in patients with SARS-CoV-2 infection presenting at the ED.
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Affiliation(s)
- Lars Veldhuis
- Emergency Medicine, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
| | | | - Michiel Schinkel
- Internal Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
| | - Joop van den Bergh
- Internal Medicine, VieCuri Medical Centre, Venlo, Limburg, The Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
| | - Tom Dormans
- Intensive Care, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
| | - Renee Douma
- Internal Medicine, Flevoziekenhuis, Almere, Flevoland, The Netherlands
| | | | - Lianne de Haan
- Internal Medicine, Flevoziekenhuis, Almere, Flevoland, The Netherlands
| | - Karen Koopman
- Intensive Care, Martini Ziekenhuis, Groningen, Groningen, The Netherlands
| | - Martijn D de Kruif
- Intensive Care, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
| | - Peter Noordzij
- Intensive Care, Saint Antonius, Nieuwegein, The Netherlands
| | - Auke Reidinga
- Intensive Care, Martini Ziekenhuis, Groningen, Groningen, The Netherlands
| | - Wouter de Ruijter
- Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar, Noord-Holland, The Netherlands
| | - Suat Simsek
- Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar, Noord-Holland, The Netherlands
| | - Caroline Wyers
- Internal Medicine, VieCuri Medical Centre, Venlo, Limburg, The Netherlands
| | - Prabath Wb Nanayakkara
- Section Acute Medicine, Department of Internal Medicine, Amsterdam Universitair Medische Centra, Amsterdam, Noord-Holland, The Netherlands
| | - Markus Hollmann
- Anaesthesiology, Amsterdam UMC - Locatie AMC, Amsterdam, The Netherlands
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28
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Habets JGV, Herff C, Fasano AA, Beudel M, Kocabicak E, Schnitzler A, Snineh MA, Kalia SK, Ramirez-Gómez C, Hodaie M, Munhoz RP, Rouleau E, Yildiz O, Linetsky E, Schuurman R, Hartmann CJ, Lozano AM, De Bie RMA, Temel Y, Janssen MLF. Multicenter Validation of Individual Preoperative Motor Outcome Prediction for Deep Brain Stimulation in Parkinson's Disease. Stereotact Funct Neurosurg 2021; 100:121-129. [PMID: 34823246 DOI: 10.1159/000519960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/20/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Subthalamic nucleus deep brain stimulation (STN DBS) is an established therapy for Parkinson's disease (PD) patients suffering from motor response fluctuations despite optimal medical treatment, or severe dopaminergic side effects. Despite careful clinical selection and surgical procedures, some patients do not benefit from STN DBS. Preoperative prediction models are suggested to better predict individual motor response after STN DBS. We validate a preregistered model, DBS-PREDICT, in an external multicenter validation cohort. METHODS DBS-PREDICT considered eleven, solely preoperative, clinical characteristics and applied a logistic regression to differentiate between weak and strong motor responders. Weak motor response was defined as no clinically relevant improvement on the Unified Parkinson's Disease Rating Scale (UPDRS) II, III, or IV, 1 year after surgery, defined as, respectively, 3, 5, and 3 points or more. Lower UPDRS III and IV scores and higher age at disease onset contributed most to weak response predictions. Individual predictions were compared with actual clinical outcomes. RESULTS 322 PD patients treated with STN DBS from 6 different centers were included. DBS-PREDICT differentiated between weak and strong motor responders with an area under the receiver operator curve of 0.76 and an accuracy up to 77%. CONCLUSION Proving generalizability and feasibility of preoperative STN DBS outcome prediction in an external multicenter cohort is an important step in creating clinical impact in DBS with data-driven tools. Future prospective studies are required to overcome several inherent practical and statistical limitations of including clinical decision support systems in DBS care.
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Affiliation(s)
- Jeroen G V Habets
- Department of Neurosurgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Christian Herff
- Department of Neurosurgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alfonso A Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Krembil Brain Institute, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Martijn Beudel
- Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Ersoy Kocabicak
- Neuromodulation Center and Department of Neurosurgery, Ondokuz Mayıs University, Samsun, Turkey
| | - Alfons Schnitzler
- Department of Neurology, Institute of Clinical Neuroscience and Medical Psychology, Centre for Movement Disorders and Neuromodulation, Medical Faculty, Universitatsklinikum Duesseldorf, Duesseldorf, Germany
| | - Muneer Abu Snineh
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Suneil K Kalia
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Krembil Brain Institute, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Carolina Ramirez-Gómez
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Krembil Brain Institute, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Krembil Brain Institute, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery, University Health Network and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Renato P Munhoz
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Krembil Brain Institute, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Eline Rouleau
- Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Onur Yildiz
- Neuromodulation Center and Department of Neurosurgery, Ondokuz Mayıs University, Samsun, Turkey
| | - Eduard Linetsky
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Rick Schuurman
- Department of Neurosurgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Christian J Hartmann
- Department of Neurology, Institute of Clinical Neuroscience and Medical Psychology, Centre for Movement Disorders and Neuromodulation, Medical Faculty, Universitatsklinikum Duesseldorf, Duesseldorf, Germany
| | - Andres M Lozano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Krembil Brain Institute, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Rob M A De Bie
- Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Yasin Temel
- Department of Neurosurgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marcus L F Janssen
- Department of Neurology and Clinical Neurophysiology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
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29
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Nibourg S, Beudel M, Trip J. Isolated proximal weakness of the legs due to neuroborreliosis. BMJ Case Rep 2021; 14:e244431. [PMID: 34782374 PMCID: PMC8593606 DOI: 10.1136/bcr-2021-244431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/03/2022] Open
Abstract
Proximal muscle weakness of the legs is a symptom with a broad differential diagnosis. It is mainly caused by neuromuscular disorders and is often a diagnostic challenge. Here, we present a 73-year-old man with isolated proximal weakness of the legs due to lumbar root involvement on the basis of neuroborreliosis. After treatment with intravenous antibiotics he recovered completely. This is the first described case with isolated proximal muscle weakness of the legs due to neuroborreliosis. Despite the fact neuroborreliosis is a rare cause of proximal muscle weakness of the legs, clinicians should include it in their differential diagnosis, especially since it is a treatable condition.
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Affiliation(s)
- Simone Nibourg
- Neurology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Martijn Beudel
- Neurology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Jeroen Trip
- Neurology, Isala Zwolle, Zwolle, The Netherlands
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30
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Bot M, van Rootselaari AF, Odekerken V, Dijk J, de Bie RMA, Beudel M, van den Munckhof P, Schuurman PR. Evaluating and Optimizing Dentato-Rubro-Thalamic-Tract Deterministic Tractography in Deep Brain Stimulation for Essential Tremor. Oper Neurosurg (Hagerstown) 2021; 21:533-539. [PMID: 34562007 DOI: 10.1093/ons/opab324] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/18/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Dentato-rubro-thalamic tract (DRT) deep brain stimulation (DBS) suppresses tremor in essential tremor (ET) patients. However, DRT depiction through tractography can vary depending on the included brain regions. Moreover, it is unclear which section of the DRT is optimal for DBS. OBJECTIVE To evaluate deterministic DRT tractography and tremor control in DBS for ET. METHODS After DBS surgery, DRT tractography was conducted in 37 trajectories (20 ET patients). Per trajectory, 5 different DRT depictions with various regions of interest (ROI) were constructed. Comparison resulted in a DRT depiction with highest correspondence to intraoperative tremor control. This DRT depiction was subsequently used for evaluation of short-term postoperative adverse and beneficial effects. RESULTS Postoperative optimized DRT tractography employing the ROI motor cortex, posterior subthalamic area (PSA), and ipsilateral superior cerebellar peduncle and dentate nucleus best corresponded with intraoperative trajectories (92%) and active DBS contacts (93%) showing optimal tremor control. DRT tractography employing a red nucleus or ventral intermediate nucleus of the thalamus (VIM) ROI often resulted in a more medial course. Optimal stimulation was located in the section between VIM and PSA. CONCLUSION This optimized deterministic DRT tractography strongly correlates with optimal tremor control. This technique is readily implementable for prospective evaluation in DBS target planning for ET.
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Affiliation(s)
- Maarten Bot
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Anne-Fleur van Rootselaari
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Vincent Odekerken
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Joke Dijk
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Rob M A de Bie
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Martijn Beudel
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | - P Richard Schuurman
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
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31
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van Haaps TF, Collard D, van Osch FHM, Middeldorp S, Coppens M, de Kruif MD, Vlot EA, Douma RA, Ten Cate H, Juffermans NP, Gritters N, Vlaar AP, Reidinga AC, Heuvelmans MA, Oudkerk M, Büller HR, van den Bergh JPW, Maas A, Ten Wolde M, Simsek S, Beudel M, van Es N. Pre-admission anticoagulant therapy and mortality in hospitalized COVID-19 patients: A retrospective cohort study. Thromb Res 2021; 208:35-38. [PMID: 34688100 PMCID: PMC8518131 DOI: 10.1016/j.thromres.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/30/2021] [Accepted: 10/08/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Thijs F van Haaps
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, the Netherlands.
| | - Didier Collard
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Frits H M van Osch
- Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, the Netherlands & NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Saskia Middeldorp
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Internal Medicine & Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Michiel Coppens
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Martijn D de Kruif
- Department of Pulmonary Medicine, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Eline A Vlot
- Department of Anaesthesiology, Intensive Care and Pain Medicine, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Renée A Douma
- Department of Internal Medicine, Flevo Hospital, Almere, the Netherlands
| | - Hugo Ten Cate
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM) and Maastricht University Medical Center, Maastricht, the Netherlands
| | - Nicole P Juffermans
- Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands; Department of Intensive Care Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Niels Gritters
- Department of Intensive Care Medicine, Treant Zorggroep, Emmen, the Netherlands
| | - Alexander P Vlaar
- Department of Intensive Care Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Auke C Reidinga
- Department of Anaesthesiology, Martini Hospital, Groningen, the Netherlands
| | | | - Matthijs Oudkerk
- Institute of Diagnostic Accuracy (iDNA), Groningen, the Netherlands
| | - Harry R Büller
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | - Arno Maas
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Marije Ten Wolde
- Department of Internal Medicine, Flevo Hospital, Almere, the Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Northwest Clinic, Alkmaar, the Netherlands
| | | | - Martijn Beudel
- Department of Neurology, Amsterdam UMC, Amsterdam Neuroscience Institute, Amsterdam, the Netherlands
| | - Nick van Es
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Holewijn RA, Verbaan D, van den Munckhof PM, Bot M, Geurtsen GJ, Dijk JM, Odekerken VJ, Beudel M, de Bie RMA, Schuurman PR. General Anesthesia vs Local Anesthesia in Microelectrode Recording-Guided Deep-Brain Stimulation for Parkinson Disease: The GALAXY Randomized Clinical Trial. JAMA Neurol 2021; 78:1212-1219. [PMID: 34491267 DOI: 10.1001/jamaneurol.2021.2979] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance It is unknown if there is a difference in outcome in asleep vs awake deep brain stimulation (DBS) of the subthalamic nucleus for advanced Parkinson disease. Objective To determine the difference in adverse effects concerning cognition, mood, and behavior between awake and asleep DBS favoring the asleep arm of the study. Design, Setting, and Participants This study was a single-center prospective randomized open-label blinded end point clinical trial. A total of 187 persons with Parkinson disease were referred for DBS between May 2015 to March 2019. Analysis took place from January 2016 to January 2020. The primary outcome follow-up visit was conducted 6 months after DBS. Interventions Bilateral subthalamic nucleus DBS was performed while the patient was asleep (under general anesthesia) in 1 study arm and awake in the other study arm. Both arms of the study used a frame-based intraoperative microelectrode recording technique to refine final target placement of the DBS lead. Main Outcomes and Measures The primary outcome variable was the between-group difference in cognitive, mood, and behavioral adverse effects as measured by a composite score. The secondary outcomes included the Movement Disorders Society Unified Parkinson's Disease Rating Scale, the patient assessment of surgical burden and operative time. Results A total of 110 patients were randomized to awake (local anesthesia; n = 56; mean [SD] age, 60.0 (7.4) years; 40 [71%] male) or to asleep (general anesthesia; n = 54; mean [SD] age, 61.3 [7.9] years; 38 [70%] male) DBS surgery. The 6-month follow-up visit was completed by 103 participants. The proportion of patients with adverse cognitive, mood, and behavioral effects on the composite score was 15 of 52 (29%) after awake and 11 of 51 (22%) after asleep DBS (odds ratio, 0.7 [95% CI, 0.3-1.7]). There was no difference in improvement in the off-medication Movement Disorders Society Unified Parkinson's Disease Rating Scale Motor Examination scores between groups (awake group: mean [SD], -27.3 [17.5] points; asleep group: mean [SD], -25.3 [14.3] points; mean difference, -2.0 [95% CI, -8.1 to 4.2]). Asleep surgery was experienced as less burdensome by patients and was 26 minutes shorter than awake surgery. Conclusions and Relevance There was no difference in the primary outcome of asleep vs awake DBS. Future large randomized clinical trials should examine some of the newer asleep based DBS technologies because this study was limited to frame-based microelectrode-guided procedures. Trial Registration trialregister.nl Identifier: NTR5809.
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Affiliation(s)
- Rozemarije A Holewijn
- Department of Neurosurgery, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Dagmar Verbaan
- Department of Neurosurgery, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Pepijn M van den Munckhof
- Department of Neurosurgery, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Maarten Bot
- Department of Neurosurgery, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Gert J Geurtsen
- Department of Neurology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Joke M Dijk
- Department of Neurology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Vincent J Odekerken
- Department of Neurology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Rob M A de Bie
- Department of Neurology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - P Rick Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
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Fleuren LM, Dam TA, Tonutti M, de Bruin DP, Lalisang RCA, Gommers D, Cremer OL, Bosman RJ, Rigter S, Wils EJ, Frenzel T, Dongelmans DA, de Jong R, Peters M, Kamps MJA, Ramnarain D, Nowitzky R, Nooteboom FGCA, de Ruijter W, Urlings-Strop LC, Smit EGM, Mehagnoul-Schipper DJ, Dormans T, de Jager CPC, Hendriks SHA, Achterberg S, Oostdijk E, Reidinga AC, Festen-Spanjer B, Brunnekreef GB, Cornet AD, van den Tempel W, Boelens AD, Koetsier P, Lens J, Faber HJ, Karakus A, Entjes R, de Jong P, Rettig TCD, Arbous S, Vonk SJJ, Fornasa M, Machado T, Houwert T, Hovenkamp H, Noorduijn-Londono R, Quintarelli D, Scholtemeijer MG, de Beer AA, Cina G, Beudel M, Herter WE, Girbes ARJ, Hoogendoorn M, Thoral PJ, Elbers PWG. The Dutch Data Warehouse, a multicenter and full-admission electronic health records database for critically ill COVID-19 patients. Crit Care 2021; 25:304. [PMID: 34425864 PMCID: PMC8381710 DOI: 10.1186/s13054-021-03733-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/16/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) pandemic has underlined the urgent need for reliable, multicenter, and full-admission intensive care data to advance our understanding of the course of the disease and investigate potential treatment strategies. In this study, we present the Dutch Data Warehouse (DDW), the first multicenter electronic health record (EHR) database with full-admission data from critically ill COVID-19 patients. METHODS A nation-wide data sharing collaboration was launched at the beginning of the pandemic in March 2020. All hospitals in the Netherlands were asked to participate and share pseudonymized EHR data from adult critically ill COVID-19 patients. Data included patient demographics, clinical observations, administered medication, laboratory determinations, and data from vital sign monitors and life support devices. Data sharing agreements were signed with participating hospitals before any data transfers took place. Data were extracted from the local EHRs with prespecified queries and combined into a staging dataset through an extract-transform-load (ETL) pipeline. In the consecutive processing pipeline, data were mapped to a common concept vocabulary and enriched with derived concepts. Data validation was a continuous process throughout the project. All participating hospitals have access to the DDW. Within legal and ethical boundaries, data are available to clinicians and researchers. RESULTS Out of the 81 intensive care units in the Netherlands, 66 participated in the collaboration, 47 have signed the data sharing agreement, and 35 have shared their data. Data from 25 hospitals have passed through the ETL and processing pipeline. Currently, 3464 patients are included in the DDW, both from wave 1 and wave 2 in the Netherlands. More than 200 million clinical data points are available. Overall ICU mortality was 24.4%. Respiratory and hemodynamic parameters were most frequently measured throughout a patient's stay. For each patient, all administered medication and their daily fluid balance were available. Missing data are reported for each descriptive. CONCLUSIONS In this study, we show that EHR data from critically ill COVID-19 patients may be lawfully collected and can be combined into a data warehouse. These initiatives are indispensable to advance medical data science in the field of intensive care medicine.
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Affiliation(s)
- Lucas M. Fleuren
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Tariq A. Dam
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | | | | | | | - Diederik Gommers
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Sander Rigter
- Department of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Tim Frenzel
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dave A. Dongelmans
- Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Remko de Jong
- Intensive Care, Bovenij Ziekenhuis, Amsterdam, The Netherlands
| | - Marco Peters
- Intensive Care, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | | | | | - Ralph Nowitzky
- Intensive Care, HagaZiekenhuis, Den Haag, The Netherlands
| | | | - Wouter de Ruijter
- Department of Intensive Care Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Ellen G. M. Smit
- Intensive Care, Spaarne Gasthuis, Haarlem en Hoofddorp, The Netherlands
| | | | - Tom Dormans
- Intensive Care, Zuyderland MC, Heerlen, The Netherlands
| | | | | | | | | | | | | | - Gert B. Brunnekreef
- Department of Intensive Care, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Alexander D. Cornet
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Walter van den Tempel
- Department of Intensive Care, Ikazia Ziekenhuis Rotterdam, Rotterdam, The Netherlands
| | - Age D. Boelens
- Anesthesiology, Antonius Ziekenhuis Sneek, Sneek, The Netherlands
| | - Peter Koetsier
- Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Judith Lens
- ICU, ICU, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
| | | | - A. Karakus
- Department of Intensive Care, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Robert Entjes
- Department of Intensive Care, Admiraal De Ruyter Ziekenhuis, Goes, The Netherlands
| | - Paul de Jong
- Department of Anesthesia and Intensive Care, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | | | - Sesmu Arbous
- Department of Intensive Care, LUMC, Leiden, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | - Martijn Beudel
- Department of Neurology, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | | | - Armand R. J. Girbes
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mark Hoogendoorn
- Quantitative Data Analytics Group, Department of Computer Science, Faculty of Science, Vrjie Universiteit, Amsterdam, The Netherlands
| | - Patrick J. Thoral
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Paul W. G. Elbers
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Johnson V, Wilt R, Gilron R, Anso J, Perrone R, Beudel M, Piña-Fuentes D, Saal J, Ostrem JL, Bledsoe I, Starr P, Little S. Embedded adaptive deep brain stimulation for cervical dystonia controlled by motor cortex theta oscillations. Exp Neurol 2021; 345:113825. [PMID: 34331900 DOI: 10.1016/j.expneurol.2021.113825] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/08/2021] [Accepted: 07/26/2021] [Indexed: 12/23/2022]
Abstract
Dystonia is a disabling movement disorder characterized by excessive muscle contraction for which the underlying pathophysiology is incompletely understood and treatment interventions limited in efficacy. Here we utilize a novel, sensing-enabled, deep brain stimulator device, implanted in a patient with cervical dystonia, to record local field potentials from chronically implanted electrodes in the sensorimotor cortex and subthalamic nuclei bilaterally. This rechargeable device was able to record large volumes of neural data at home, in the naturalistic environment, during unconstrained activity. We confirmed the presence of theta (3-7 Hz) oscillatory activity, which was coherent throughout the cortico-subthalamic circuit and specifically suppressed by high-frequency stimulation. Stimulation also reduced the duration, rate and height of theta bursts. These findings motivated a proof-of-principle trial of a new form of adaptive deep brain stimulation - triggered by theta-burst activity recorded from the motor cortex. This facilitated increased peak stimulation amplitudes without induction of dyskinesias and demonstrated improved blinded clinical ratings compared to continuous DBS, despite reduced total electrical energy delivered. These results further strengthen the pathophysiological role of low frequency (theta) oscillations in dystonia and demonstrate the potential for novel adaptive stimulation strategies linked to cortico-basal theta bursts.
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Affiliation(s)
- Vinith Johnson
- Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA
| | - Robert Wilt
- Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA
| | - Roee Gilron
- Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA
| | - Juan Anso
- Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA
| | - Randy Perrone
- Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA
| | - Martijn Beudel
- Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Dan Piña-Fuentes
- Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jeremy Saal
- Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA
| | - Jill L Ostrem
- Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA
| | - Ian Bledsoe
- Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA
| | - Philip Starr
- Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA
| | - Simon Little
- Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA.
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Ottenhoff MC, Ramos LA, Potters W, Janssen MLF, Hubers D, Hu S, Fridgeirsson EA, Piña-Fuentes D, Thomas R, van der Horst ICC, Herff C, Kubben P, Elbers PWG, Marquering HA, Welling M, Simsek S, de Kruif MD, Dormans T, Fleuren LM, Schinkel M, Noordzij PG, van den Bergh JP, Wyers CE, Buis DTB, Wiersinga WJ, van den Hout EHC, Reidinga AC, Rusch D, Sigaloff KCE, Douma RA, de Haan L, Gritters van den Oever NC, Rennenberg RJMW, van Wingen GA, Aries MJH, Beudel M. Predicting mortality of individual patients with COVID-19: a multicentre Dutch cohort. BMJ Open 2021; 11:e047347. [PMID: 34281922 PMCID: PMC8290951 DOI: 10.1136/bmjopen-2020-047347] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/16/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Develop and validate models that predict mortality of patients diagnosed with COVID-19 admitted to the hospital. DESIGN Retrospective cohort study. SETTING A multicentre cohort across 10 Dutch hospitals including patients from 27 February to 8 June 2020. PARTICIPANTS SARS-CoV-2 positive patients (age ≥18) admitted to the hospital. MAIN OUTCOME MEASURES 21-day all-cause mortality evaluated by the area under the receiver operator curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value. The predictive value of age was explored by comparison with age-based rules used in practice and by excluding age from the analysis. RESULTS 2273 patients were included, of whom 516 had died or discharged to palliative care within 21 days after admission. Five feature sets, including premorbid, clinical presentation and laboratory and radiology values, were derived from 80 features. Additionally, an Analysis of Variance (ANOVA)-based data-driven feature selection selected the 10 features with the highest F values: age, number of home medications, urea nitrogen, lactate dehydrogenase, albumin, oxygen saturation (%), oxygen saturation is measured on room air, oxygen saturation is measured on oxygen therapy, blood gas pH and history of chronic cardiac disease. A linear logistic regression and non-linear tree-based gradient boosting algorithm fitted the data with an AUC of 0.81 (95% CI 0.77 to 0.85) and 0.82 (0.79 to 0.85), respectively, using the 10 selected features. Both models outperformed age-based decision rules used in practice (AUC of 0.69, 0.65 to 0.74 for age >70). Furthermore, performance remained stable when excluding age as predictor (AUC of 0.78, 0.75 to 0.81). CONCLUSION Both models showed good performance and had better test characteristics than age-based decision rules, using 10 admission features readily available in Dutch hospitals. The models hold promise to aid decision-making during a hospital bed shortage.
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Affiliation(s)
- Maarten C Ottenhoff
- Department of Neurosurgery, Maastricht University, Maastricht, The Netherlands
| | - Lucas A Ramos
- Department of Biomedical Engineering and Physics/Department of Epidemiology & Data Science, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Wouter Potters
- Department of Neurology, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Marcus L F Janssen
- Department of Clinical Neurophysiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Deborah Hubers
- Department of Intensive Care, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Shi Hu
- Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Egill A Fridgeirsson
- Department of Psychiatry, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Dan Piña-Fuentes
- Department of Neurology, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Rajat Thomas
- Department of Psychiatry, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Christian Herff
- Department of Neurosurgery, Maastricht University, Maastricht, The Netherlands
| | - Pieter Kubben
- Department of Neurosurgery, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Paul W G Elbers
- Department of Intensive Care, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics/Department of Epidemiology & Data Science, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Max Welling
- Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
- Department of Internal Medicine, Section of Endocrinology, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands
| | - Martijn D de Kruif
- Department of Pulmonary Medicine, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Tom Dormans
- Vascular Medicine, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Lucas M Fleuren
- Department of Intensive Care, Amsterdam University Medical Centres, Duivendrecht, Noord-Holland, The Netherlands
| | - Michiel Schinkel
- Center for Experimental and Molecular Medicine (C.E.M.M.), Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Peter G Noordzij
- Department of Anesthesiology and Intensive Care, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - David T B Buis
- Department of Internal Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - W Joost Wiersinga
- Department of Internal Medicine, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
- Center for Experimental and Molecular Medicine (C.E.M.M.), Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Ella H C van den Hout
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Auke C Reidinga
- Department of Intensive Care, Martini Ziekenhuis, Groningen, The Netherlands
| | - Daisy Rusch
- Research, Martini Ziekenhuis, Groningen, The Netherlands
| | - Kim C E Sigaloff
- Department of Internal Medicine, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Renee A Douma
- Department of Internal Medicine, Flevoziekenhuis, Almere, Flevoland, The Netherlands
| | - Lianne de Haan
- Department of Internal Medicine, Flevoziekenhuis, Almere, Flevoland, The Netherlands
| | | | - Roger J M W Rennenberg
- Department of Internal Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Guido A van Wingen
- Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel J H Aries
- Department of Intensive Care, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
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Beudel M, Rövekamp F, van de Beek D, Brouwer M. Single-Dose Pembrolizumab Treatment for Progressive Multifocal Leukoencephalopathy. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/4/e1021. [PMID: 34039733 PMCID: PMC8159157 DOI: 10.1212/nxi.0000000000001021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/31/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Martijn Beudel
- From the Department of Neurology (M. Beudel, D.v.d.B., M. Brouwer), Amsterdam Neuroscience Institute, Amsterdam University Medical Centers, the Netherlands; and Department of Neurology (F.R.), Northwest Hospitals, Alkmaar, the Netherlands.
| | - Fleur Rövekamp
- From the Department of Neurology (M. Beudel, D.v.d.B., M. Brouwer), Amsterdam Neuroscience Institute, Amsterdam University Medical Centers, the Netherlands; and Department of Neurology (F.R.), Northwest Hospitals, Alkmaar, the Netherlands
| | - Diederik van de Beek
- From the Department of Neurology (M. Beudel, D.v.d.B., M. Brouwer), Amsterdam Neuroscience Institute, Amsterdam University Medical Centers, the Netherlands; and Department of Neurology (F.R.), Northwest Hospitals, Alkmaar, the Netherlands
| | - Matthijs Brouwer
- From the Department of Neurology (M. Beudel, D.v.d.B., M. Brouwer), Amsterdam Neuroscience Institute, Amsterdam University Medical Centers, the Netherlands; and Department of Neurology (F.R.), Northwest Hospitals, Alkmaar, the Netherlands
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Viddeleer AR, Raaphorst J, Min M, Beenen LF, Scheerder MJ, Vlaar AP, Beudel M, Hemke R. Intramuscular adipose tissue at level Th12 is associated with survival in COVID-19. J Cachexia Sarcopenia Muscle 2021; 12:823-827. [PMID: 33939338 PMCID: PMC8200446 DOI: 10.1002/jcsm.12696] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Alain R. Viddeleer
- Department of Radiology, Medical Imaging CenterUniversity Medical Center GroningenGroningenThe Netherlands
| | - Joost Raaphorst
- Department of Neurology, Amsterdam Neuroscience InstituteAmsterdam University Medical Centers, location AMCAmsterdamThe Netherlands
| | - Minoesch Min
- Department of Neurology, Amsterdam Neuroscience InstituteAmsterdam University Medical Centers, location AMCAmsterdamThe Netherlands
| | - Ludo F.M. Beenen
- Department of Radiology and Nuclear Medicine, Amsterdam Movement SciencesAmsterdam University Medical Centers, location AMCAmsterdamThe Netherlands
| | - Maeke J. Scheerder
- Department of Radiology and Nuclear Medicine, Amsterdam Movement SciencesAmsterdam University Medical Centers, location AMCAmsterdamThe Netherlands
| | - Alexander P.J. Vlaar
- Department of Intensive Care MedicineAmsterdam University Medical Centers, location AMCAmsterdamThe Netherlands
| | | | - Martijn Beudel
- Department of Neurology, Amsterdam Neuroscience InstituteAmsterdam University Medical Centers, location AMCAmsterdamThe Netherlands
| | - Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam Movement SciencesAmsterdam University Medical Centers, location AMCAmsterdamThe Netherlands
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Abstract
BACKGROUND A relation between coronavirus disease 2019 (COVID-19) and acute pancreatitis has been suggested. However, the incidence and clinical relevance of this relation remain unclear. OBJECTIVE We aimed to investigate the incidence, severity and clinical impact of acute pancreatitis in patients with COVID-19. METHODS This is a cross-sectional study of a prospective, observational cohort concerning all COVID-19 patients admitted to two Dutch university hospitals between 4 March 2020 and 26 May 2020. Primary outcome was acute pancreatitis potentially related to COVD-19 infection. Acute pancreatitis was defined according to the revised Atlanta Classification. Potential relation with COVID-19 was defined as the absence of a clear aetiology of acute pancreatitis. RESULTS Among 433 patients with COVID-19, five (1.2%) had potentially related acute pancreatitis according to the revised Atlanta Classification. These five patients suffered from severe COVID-19 infection; all had (multiple) organ failure and 60% died. None of the patients developed necrotizing pancreatitis. Moreover, development of acute pancreatitis did not lead to major treatment consequences. CONCLUSIONS In contrast with previous research, our study demonstrated that COVID-19 related acute pancreatitis is rare and of little clinical impact. It is therefore debatable if acute pancreatitis in COVID-19 patients requires specific screening. We hypothesize that acute pancreatitis occurs in patients with severe illness due to COVID-19 infection as a result of transient hypoperfusion and pancreatic ischemia, not as a direct result of the virus.
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Affiliation(s)
- Margo C Bulthuis
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lotte Boxhoorn
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul W G Elbers
- Department of Intensive Care Medicine, Research VUmc Intensive Care, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marnix P M Kop
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Roy L J van Wanrooij
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rogier P Voermans
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Chatterjee A, Wu G, Primakov S, Oberije C, Woodruff H, Kubben P, Henry R, Aries MJH, Beudel M, Noordzij PG, Dormans T, Gritters van den Oever NC, van den Bergh JP, Wyers CE, Simsek S, Douma R, Reidinga AC, de Kruif MD, Guiot J, Frix AN, Louis R, Moutschen M, Lovinfosse P, Lambin P. Can predicting COVID-19 mortality in a European cohort using only demographic and comorbidity data surpass age-based prediction: An externally validated study. PLoS One 2021; 16:e0249920. [PMID: 33857224 PMCID: PMC8049248 DOI: 10.1371/journal.pone.0249920] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/26/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To establish whether one can build a mortality prediction model for COVID-19 patients based solely on demographics and comorbidity data that outperforms age alone. Such a model could be a precursor to implementing smart lockdowns and vaccine distribution strategies. METHODS The training cohort comprised 2337 COVID-19 inpatients from nine hospitals in The Netherlands. The clinical outcome was death within 21 days of being discharged. The features were derived from electronic health records collected during admission. Three feature selection methods were used: LASSO, univariate using a novel metric, and pairwise (age being half of each pair). 478 patients from Belgium were used to test the model. All modeling attempts were compared against an age-only model. RESULTS In the training cohort, the mortality group's median age was 77 years (interquartile range = 70-83), higher than the non-mortality group (median = 65, IQR = 55-75). The incidence of former/active smokers, male gender, hypertension, diabetes, dementia, cancer, chronic obstructive pulmonary disease, chronic cardiac disease, chronic neurological disease, and chronic kidney disease was higher in the mortality group. All stated differences were statistically significant after Bonferroni correction. LASSO selected eight features, novel univariate chose five, and pairwise chose none. No model was able to surpass an age-only model in the external validation set, where age had an AUC of 0.85 and a balanced accuracy of 0.77. CONCLUSION When applied to an external validation set, we found that an age-only mortality model outperformed all modeling attempts (curated on www.covid19risk.ai) using three feature selection methods on 22 demographic and comorbid features.
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Affiliation(s)
- Avishek Chatterjee
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology, Maastricht University, Maastricht, The Netherlands
| | - Guangyao Wu
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology, Maastricht University, Maastricht, The Netherlands
| | - Sergey Primakov
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology, Maastricht University, Maastricht, The Netherlands
| | - Cary Oberije
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology, Maastricht University, Maastricht, The Netherlands
| | - Henry Woodruff
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology, Maastricht University, Maastricht, The Netherlands
| | - Pieter Kubben
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ronald Henry
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marcel J. H. Aries
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Peter G. Noordzij
- Department of Anesthesiology and Intensive Care, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Tom Dormans
- Department of Intensive Care, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | | | - Caroline E. Wyers
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - Renée Douma
- Department of Internal Medicine, Flevoziekenhuis, Almere, The Netherlands
| | - Auke C. Reidinga
- Department of Intensive Care, Martiniziekenhuis, Groningen, The Netherlands
| | - Martijn D. de Kruif
- Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Julien Guiot
- Department of Respiratory Medicine, CHU of Liège, Liège, Belgium
| | - Anne-Noelle Frix
- Department of Respiratory Medicine, CHU of Liège, Liège, Belgium
| | - Renaud Louis
- Department of Respiratory Medicine, CHU of Liège, Liège, Belgium
| | | | - Pierre Lovinfosse
- Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liège, Liège, Belgium
| | - Philippe Lambin
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology, Maastricht University, Maastricht, The Netherlands
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Collard D, Nurmohamed NS, Kaiser Y, Reeskamp LF, Dormans T, Moeniralam H, Simsek S, Douma R, Eerens A, Reidinga AC, Elbers PWG, Beudel M, Vogt L, Stroes ESG, van den Born BJH. Cardiovascular risk factors and COVID-19 outcomes in hospitalised patients: a prospective cohort study. BMJ Open 2021; 11:e045482. [PMID: 33619201 PMCID: PMC7902321 DOI: 10.1136/bmjopen-2020-045482] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/24/2020] [Accepted: 01/07/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Recent reports suggest a high prevalence of hypertension and diabetes in COVID-19 patients, but the role of cardiovascular disease (CVD) risk factors in the clinical course of COVID-19 is unknown. We evaluated the time-to-event relationship between hypertension, dyslipidaemia, diabetes and COVID-19 outcomes. DESIGN We analysed data from the prospective Dutch CovidPredict cohort, an ongoing prospective study of patients admitted for COVID-19 infection. SETTING Patients from eight participating hospitals, including two university hospitals from the CovidPredict cohort were included. PARTICIPANTS Admitted, adult patients with a positive COVID-19 PCR or high suspicion based on CT-imaging of the thorax. Patients were followed for major outcomes during the hospitalisation. CVD risk factors were established via home medication lists and divided in antihypertensives, lipid-lowering therapy and antidiabetics. PRIMARY AND SECONDARY OUTCOMES MEASURES The primary outcome was mortality during the first 21 days following admission, secondary outcomes consisted of intensive care unit (ICU) admission and ICU mortality. Kaplan-Meier and Cox regression analyses were used to determine the association with CVD risk factors. RESULTS We included 1604 patients with a mean age of 66±15 of whom 60.5% were men. Antihypertensives, lipid-lowering therapy and antidiabetics were used by 45%, 34.7% and 22.1% of patients. After 21-days of follow-up; 19.2% of the patients had died or were discharged for palliative care. Cox regression analysis after adjustment for age and sex showed that the presence of ≥2 risk factors was associated with increased mortality risk (HR 1.52, 95% CI 1.15 to 2.02), but not with ICU admission. Moreover, the use of ≥2 antidiabetics and ≥2 antihypertensives was associated with mortality independent of age and sex with HRs of, respectively, 2.09 (95% CI 1.55 to 2.80) and 1.46 (95% CI 1.11 to 1.91). CONCLUSIONS The accumulation of hypertension, dyslipidaemia and diabetes leads to a stepwise increased risk for short-term mortality in hospitalised COVID-19 patients independent of age and sex. Further studies investigating how these risk factors disproportionately affect COVID-19 patients are warranted.
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Affiliation(s)
- Didier Collard
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Nick S Nurmohamed
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Yannick Kaiser
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Laurens F Reeskamp
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Tom Dormans
- Department of Intensive Care, Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen, The Netherlands
| | - Hazra Moeniralam
- Internal Medicine, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Renee Douma
- Internal Medicine, Flevoziekenhuis, Almere, Flevoland, The Netherlands
| | - Annet Eerens
- Oncology, Treant Healthcare Group, Amsterdam, The Netherlands
| | - Auke C Reidinga
- Intensive Care, Martini Ziekenhuis, Groningen, Groningen, The Netherlands
| | - Paul W G Elbers
- Department of Intensive Care, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Liffert Vogt
- Department of Nephrology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert-Jan H van den Born
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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Ariës MJH, van den Bergh JP, Beudel M, Boersma W, Dormans T, Douma RA, Eerens A, Elbers PWG, Fleuren LM, Gritters van den Oever NC, de Haan L, van der Horst IJCC, Hu S, Hubers D, Janssen MLF, de Kruif M, Kubben PL, van Kuijk SMJ, Noordzij PG, Ottenhoff M, Piña-Fuentes DAI, Potters WV, Reidinga AC, Renckens RSC, Rigter S, Rusch D, Schinkel M, Sigaloff KCE, Simsek S, Stassen P, Stassen R, Thomas RM, van Wingen GA, Vonk Noordegraaf A, Welling M, Wiersinga WJ, Wolvers MDJ, Wyers CE. [Clinical course of COVID-19 in the Netherlands: an overview of 2607 patients in hospital during the first wave]. Ned Tijdschr Geneeskd 2021; 165:D5085. [PMID: 33651497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To systematically collect clinical data from patients with a proven COVID-19 infection in the Netherlands. DESIGN Data from 2579 patients with COVID-19 admitted to 10 Dutch centers in the period February to July 2020 are described. The clinical data are based on the WHO COVID case record form (CRF) and supplemented with patient characteristics of which recently an association disease severity has been reported. METHODS Survival analyses were performed as primary statistical analysis. These Kaplan-Meier curves for time to (early) death (3 weeks) have been determined for pre-morbid patient characteristics and clinical, radiological and laboratory data at hospital admission. RESULTS Total in-hospital mortality after 3 weeks was 22.2% (95% CI: 20.7% - 23.9%), hospital mortality within 21 days was significantly higher for elderly patients (> 70 years; 35, 0% (95% CI: 32.4% - 37.8%) and patients who died during the 21 days and were admitted to the intensive care (36.5% (95% CI: 32.1% - 41.3%)). Apart from that, in this Dutch population we also see a risk of early death in patients with co-morbidities (such as chronic neurological, nephrological and cardiac disorders and hypertension), and in patients with more home medication and / or with increased urea and creatinine levels. CONCLUSION Early death due to a COVID-19 infection in the Netherlands appears to be associated with demographic variables (e.g. age), comorbidity (e.g. cardiovascular disease) but also disease char-acteristics at admission.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Shi Hu
- Universiteit van Amsterdam
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van Son J, Oussaada SM, Şekercan A, Beudel M, Dongelmans DA, van Assen S, Eland IA, Moeniralam HS, Dormans TPJ, van Kalkeren CAJ, Douma RA, Rusch D, Simsek S, Liu L, Kootte RS, Wyers CE, IJzerman RG, van den Bergh JP, Stehouwer CDA, Nieuwdorp M, Ter Horst KW, Serlie MJ. Overweight and Obesity Are Associated With Acute Kidney Injury and Acute Respiratory Distress Syndrome, but Not With Increased Mortality in Hospitalized COVID-19 Patients: A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2021; 12:747732. [PMID: 34970220 PMCID: PMC8713548 DOI: 10.3389/fendo.2021.747732] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/17/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To evaluate the association between overweight and obesity on the clinical course and outcomes in patients hospitalized with COVID-19. DESIGN Retrospective, observational cohort study. METHODS We performed a multicenter, retrospective, observational cohort study of hospitalized COVID-19 patients to evaluate the associations between overweight and obesity on the clinical course and outcomes. RESULTS Out of 1634 hospitalized COVID-19 patients, 473 (28.9%) had normal weight, 669 (40.9%) were overweight, and 492 (30.1%) were obese. Patients who were overweight or had obesity were younger, and there were more women in the obese group. Normal-weight patients more often had pre-existing conditions such as malignancy, or were organ recipients. During admission, patients who were overweight or had obesity had an increased probability of acute respiratory distress syndrome [OR 1.70 (1.26-2.30) and 1.40 (1.01-1.96)], respectively and acute kidney failure [OR 2.29 (1.28-3.76) and 1.92 (1.06-3.48)], respectively. Length of hospital stay was similar between groups. The overall in-hospital mortality rate was 27.7%, and multivariate logistic regression analyses showed that overweight and obesity were not associated with increased mortality compared to normal-weight patients. CONCLUSION In this study, overweight and obesity were associated with acute respiratory distress syndrome and acute kidney injury, but not with in-hospital mortality nor length of hospital stay.
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Affiliation(s)
- Jamie van Son
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Sabrina M Oussaada
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Aydin Şekercan
- Department of Surgery, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Martijn Beudel
- Department of Neurology, Amsterdam University Medical Centre (UMC), Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Dave A Dongelmans
- Department of Intensive Care, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Sander van Assen
- Department of Internal Medicine/Infectious Diseases, Treant Zorggroep, Emmen, Netherlands
| | - Ingo A Eland
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Hazra S Moeniralam
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Tom P J Dormans
- Department of Intensive Care, Zuyderland Medical Center, Heerlen, Netherlands
| | | | - Renée A Douma
- Department of Internal Medicine, Flevo Hospital, Almere, Netherlands
| | - Daisy Rusch
- Department of Intensive Care Medicine, Martini Hospital, Groningen, Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar, Netherlands
- Department of Internal Medicine/Endocrinology, Amsterdam University Medical Centre (UMC), VU (Vrije Universiteit) University Medical Centre, Amsterdam, Netherlands
| | - Limmie Liu
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, Netherlands
| | - Ruud S Kootte
- Department of Acute Internal Medicine, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, Viecuri Medical Center, Noord-Limburg, Venlo, Netherlands
| | - Richard G IJzerman
- Department of Internal Medicine, Amsterdam University Medical Centre (UMC), Diabetes Centre, Vrije Universiteit (VU) University Medical Centre, Amsterdam, Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, Viecuri Medical Center, Noord-Limburg, Venlo, Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Kasper W Ter Horst
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Mireille J Serlie
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centre (UMC), University of Amsterdam, Amsterdam, Netherlands
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Pinto-Sietsma SJ, Flossdorf M, Buchholz VR, Offerhaus J, Bleijendaal H, Beudel M, Volders PGA, Ter Bekke RMA, Dormans T, Zwetsloot PP, de Jager P, Massberg S, Rämer P, Wendtner C, Hoffmann E, Rothe K, Feihl S, Kessler T, Pinto YM, Schunkert H. Antihypertensive drugs in COVID-19 infection. Eur Heart J Cardiovasc Pharmacother 2020; 6:415-416. [PMID: 32501477 PMCID: PMC7314060 DOI: 10.1093/ehjcvp/pvaa058] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/11/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023]
Affiliation(s)
| | - Michael Flossdorf
- Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, Deutsches Zentrum für Infektionsforschung, München, Germany
| | - Veit R Buchholz
- Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, Deutsches Zentrum für Infektionsforschung, München, Germany
| | | | | | | | | | | | - Tom Dormans
- Zuyderland Hospital, Heerlen, The Netherlands
| | | | - Peter de Jager
- Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Steffen Massberg
- Department of Cardiology. Klinikum der Ludwig-Maximilians-Universität and Deutsches Zentrum für Herz-Kreislauf-Forschung, München, Germany
| | - Patrick Rämer
- Department of Hospital Hygiene and infection prevention, Munich Municipal Hospital Group, München, Germany
| | - Clemens Wendtner
- Department of Hospital Hygiene and infection prevention, Munich Municipal Hospital Group, München, Germany
| | - Ellen Hoffmann
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Englschalkinger Str. 77, Munich, Germany
| | - Kathrin Rothe
- Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, Deutsches Zentrum für Infektionsforschung, München, Germany
| | - Susanne Feihl
- Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - Thorsten Kessler
- Department of Cardiology, Technische Universität München, Deutsches Zentrum für Herz-Kreislauf-Forschung, Munich Heart Alliance; München, Germany
| | | | - Heribert Schunkert
- Department of Cardiology, Technische Universität München, Deutsches Zentrum für Herz-Kreislauf-Forschung, Munich Heart Alliance; München, Germany
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Peters EJ, Collard D, Van Assen S, Beudel M, Bomers MK, Buijs J, De Haan LR, De Ruijter W, Douma RA, Elbers PW, Goorhuis A, Gritters van den Oever NC, Knarren LG, Moeniralam HS, Mostard RL, Quanjel MJ, Reidinga AC, Renckens R, Van Den Bergh JP, Vlasveld IN, Sikkens JJ. Outcomes of persons with coronavirus disease 2019 in hospitals with and without standard treatment with (hydroxy)chloroquine. Clin Microbiol Infect 2020; 27:264-268. [PMID: 33068758 PMCID: PMC7554450 DOI: 10.1016/j.cmi.2020.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 07/08/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 01/08/2023]
Abstract
Objective To compare survival of individuals with coronavirus disease 2019 (COVID-19) treated in hospitals that either did or did not routinely treat patients with hydroxychloroquine or chloroquine. Methods We analysed data of COVID-19 patients treated in nine hospitals in the Netherlands. Inclusion dates ranged from 27 February to 15 May 2020, when the Dutch national guidelines no longer supported the use of (hydroxy)chloroquine. Seven hospitals routinely treated patients with (hydroxy)chloroquine, two hospitals did not. Primary outcome was 21-day all-cause mortality. We performed a survival analysis using log-rank test and Cox regression with adjustment for age, sex and covariates based on premorbid health, disease severity and the use of steroids for adult respiratory distress syndrome, including dexamethasone. Results Among 1949 individuals, 21-day mortality was 21.5% in 1596 patients treated in hospitals that routinely prescribed (hydroxy)chloroquine, and 15.0% in 353 patients treated in hospitals that did not. In the adjusted Cox regression models this difference disappeared, with an adjusted hazard ratio of 1.09 (95% CI 0.81–1.47). When stratified by treatment actually received in individual patients, the use of (hydroxy)chloroquine was associated with an increased 21-day mortality (HR 1.58; 95% CI 1.24–2.02) in the full model. Conclusions After adjustment for confounders, mortality was not significantly different in hospitals that routinely treated patients with (hydroxy)chloroquine compared with hospitals that did not. We compared outcomes of hospital strategies rather than outcomes of individual patients to reduce the chance of indication bias. This study adds evidence against the use of (hydroxy)chloroquine in hospitalised patients with COVID-19.
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Affiliation(s)
- Edgar Jg Peters
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands.
| | - Didier Collard
- Amsterdam UMC, University of Amsterdam, Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Sander Van Assen
- Treant Zorggroep, Department of Internal Medicine/Infectious Diseases, Emmen, the Netherlands
| | - Martijn Beudel
- Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam, the Netherlands
| | - Marije K Bomers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
| | - Jacqueline Buijs
- Zuyderland Medical Center, Department of Internal Medicine, Heerlen/Sittard, the Netherlands
| | - Lianne R De Haan
- Flevoziekenhuis, Department of Internal Medicine, Almere, the Netherlands
| | - Wouter De Ruijter
- Noordwest Ziekenhuisgroep, Intensive Care Unit, Alkmaar, the Netherlands
| | - Renée A Douma
- Flevoziekenhuis, Department of Internal Medicine, Almere, the Netherlands
| | - Paul Wg Elbers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
| | - Abraham Goorhuis
- Amsterdam UMC, University of Amsterdam, Department of Infectious Diseases, Amsterdam, the Netherlands
| | | | - Lieve Ghh Knarren
- Viecuri MC Noord-Limburg, Department of Internal Medicine, Venlo, the Netherlands
| | - Hazra S Moeniralam
- St Antonius Ziekenhuis, Department of Internal Medicine and Intensive Care Unit, Nieuwegein, the Netherlands
| | - Remy Lm Mostard
- Zuyderland Medical Center, Department of Pulmonology, Heerlen/Sittard, the Netherlands
| | - Marian Jr Quanjel
- St Antonius Ziekenhuis, Department of Pulmonology, Nieuwegein, the Netherlands
| | - Auke C Reidinga
- Martini Hospital, Intensive Care Unit, Groningen, the Netherlands
| | - Roos Renckens
- Noordwest Ziekenhuisgroep, Department of Internal Medicine, Alkmaar, the Netherlands
| | | | - Imro N Vlasveld
- Martini Hospital, Intensive Care Unit, Groningen, the Netherlands; Martini Hospital, Department of Internal Medicine, Groningen, the Netherlands
| | - Jonne J Sikkens
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
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Piña-Fuentes D, Beudel M, Van Zijl J, Van Egmond M, Oterdoom D, Van Dijk J, Tijssen M. Low-frequency oscillation suppression in dystonia: Implications for adaptive deep brain stimulation. Parkinsonism Relat Disord 2020; 79:105-109. [DOI: 10.1016/j.parkreldis.2020.08.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 02/08/2023]
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Bogdan ID, van Laar T, Oterdoom DM, Drost G, van Dijk JMC, Beudel M. Optimal Parameters of Deep Brain Stimulation in Essential Tremor: A Meta-Analysis and Novel Programming Strategy. J Clin Med 2020; 9:jcm9061855. [PMID: 32545887 PMCID: PMC7356338 DOI: 10.3390/jcm9061855] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 01/10/2023] Open
Abstract
The programming of deep brain stimulation (DBS) parameters for tremor is laborious and empirical. Despite extensive efforts, the end-result is often suboptimal. One reason for this is the poorly understood relationship between the stimulation parameters’ voltage, pulse width, and frequency. In this study, we aim to improve DBS programming for essential tremor (ET) by exploring a new strategy. At first, the role of the individual DBS parameters in tremor control was characterized using a meta-analysis documenting all the available parameters and tremor outcomes. In our novel programming strategy, we applied 10 random combinations of stimulation parameters in eight ET-DBS patients with suboptimal tremor control. Tremor severity was assessed using accelerometers and immediate and sustained patient-reported outcomes (PRO’s), including the occurrence of side-effects. The meta-analysis showed no substantial relationship between individual DBS parameters and tremor suppression. Nevertheless, with our novel programming strategy, a significantly improved (accelerometer p = 0.02, PRO p = 0.02) and sustained (p = 0.01) tremor suppression compared to baseline was achieved. Less side-effects were encountered compared to baseline. Our pilot data show that with this novel approach, tremor control can be improved in ET patients with suboptimal tremor control on DBS. In addition, this approach proved to have a beneficial effect on stimulation-related complications.
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Affiliation(s)
- I. Daria Bogdan
- Department of Neurology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (I.D.B.); (G.D.)
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (D.L.M.O.); (J.M.C.v.D.)
| | - Teus van Laar
- Department of Neurology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (I.D.B.); (G.D.)
- Correspondence:
| | - D.L. Marinus Oterdoom
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (D.L.M.O.); (J.M.C.v.D.)
| | - Gea Drost
- Department of Neurology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (I.D.B.); (G.D.)
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (D.L.M.O.); (J.M.C.v.D.)
| | - J. Marc C. van Dijk
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (D.L.M.O.); (J.M.C.v.D.)
| | - Martijn Beudel
- Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Center, 1007 MB Amsterdam, The Netherlands;
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Beudel M, Macerollo A, Brown MJN, Chen R. Editorial: The Role of the Basal Ganglia in Somatosensory-Motor Interactions: Evidence From Neurophysiology and Behavior. Front Hum Neurosci 2020; 13:451. [PMID: 31969811 PMCID: PMC6960399 DOI: 10.3389/fnhum.2019.00451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/06/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Martijn Beudel
- Department of Neurology, Amsterdam Neuroscience Institute, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | | | - Matt J N Brown
- Department of Kinesiology, California State University Sacramento, Sacramento, CA, United States
| | - Robert Chen
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Vochteloo M, Tijssen MAJ, Beudel M. A Clinical Applicable Smartwatch Application for Measuring Hyperkinetic Movement Disorder Severity. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:5867-5870. [PMID: 31947185 DOI: 10.1109/embc.2019.8857869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Measuring the severity of hyperkinetic movement disorders like tremor and myoclonus is challenging. Although many accelerometers are available to quantify movements, the vast majority lacks real-time analysis and an interface that makes it possible to real-time adjust therapy like deep brain stimulation (DBS). Here, we developed a smartwatch/smartphone application that is capable of real-time analysing movement disorder severity. Movement analysis was realised by integrating acceleration values, to velocity and subsequently to distance. Measured distances were compared with a validated accelerometer already applied for quantifying movement disorders. Further validation was done by quantitative assessment of simulated movement disorders in 10 healthy volunteers. Finally, the approach was tested in two patients treated with DBS to quantify the effect of different DBS settings on myoclonus and tremor severity, respectively. The distance measured with the application had a 96% accuracy. This was non-inferior (p = 0.76) compared to accelerometers already clinically applied. Furthermore, (simulated) movement disorder severity could be classified correctly in 93% of the cases. Finally, the method was capable of distinguishing effective from non-effective DBS parameters in two patients. In summary, with our approach we realised an instantaneous and reliable estimation of the severity of movement disorders which can assist in real time titrating therapy like DBS.
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Piña-Fuentes D, Beudel M, Little S, van Zijl J, Elting JW, Oterdoom DLM, van Egmond ME, van Dijk JMC, Tijssen MAJ. Toward adaptive deep brain stimulation for dystonia. Neurosurg Focus 2019; 45:E3. [PMID: 30064317 DOI: 10.3171/2018.5.focus18155] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The presence of abnormal neural oscillations within the cortico-basal ganglia-thalamo-cortical (CBGTC) network has emerged as one of the current principal theories to explain the pathophysiology of movement disorders. In theory, these oscillations can be used as biomarkers and thereby serve as a feedback signal to control the delivery of deep brain stimulation (DBS). This new form of DBS, dependent on different characteristics of pathological oscillations, is called adaptive DBS (aDBS), and it has already been applied in patients with Parkinson's disease. In this review, the authors summarize the scientific research to date on pathological oscillations in dystonia and address potential biomarkers that might be used as a feedback signal for controlling aDBS in patients with dystonia.
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Affiliation(s)
- Dan Piña-Fuentes
- Departments of1Neurosurgery and.,2Neurology, University Medical Center Groningen, University of Groningen
| | - Martijn Beudel
- 2Neurology, University Medical Center Groningen, University of Groningen.,3Department of Neurology, Isala Klinieken, Zwolle, The Netherlands; and
| | - Simon Little
- 4Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Jonathan van Zijl
- 2Neurology, University Medical Center Groningen, University of Groningen
| | - Jan Willem Elting
- 2Neurology, University Medical Center Groningen, University of Groningen
| | | | | | | | - Marina A J Tijssen
- 2Neurology, University Medical Center Groningen, University of Groningen
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50
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Beudel M, Oterdoom DLM, van Egmond ME, van Laar T, de Koning-Tijssen MAJ, van Dijk JMC. [Deep brain stimulation for movement disorders]. Ned Tijdschr Geneeskd 2019; 163:D3758. [PMID: 31386315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Deep brain stimulation (DBS) is a treatment which uses high-frequency electric stimulation to suppress pathological brain activity. DBS has been applied for over 30 years now, particularly in patients with severe movement disorders, such as Parkinson's disease, dystonia and tremor. Although there is clearly scientific evidence for the effectiveness of DBS in these three movement disorders, the effect size of the treatment remains limited. Furthermore, DBS is not curative and can only be applied in a select subset of patients. In this article, we discuss the key indications and contraindications for DBS, and the outcomes achieved when it is applied in the aforementioned movement disorders. We discuss the most notable controversies and new developments in the field of deep brain stimulation, in order to offer referrers and fellow healthcare professionals an accessible introduction to this mode of therapy.
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Affiliation(s)
- Martijn Beudel
- Amsterdam UMC, locatie AMC, afd. Neurologie, Amsterdam
- Contact: M. Beudel
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