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Tischler EH, McDermott JR, Wolfert AJ, Krasnyanskiy B, Ibrahim I, Malik AN, Gross JM, Suneja N. Predictors of 30-day mortality, unplanned related readmission and reoperation among isolated closed femoral shaft fractures. J Orthop 2024; 55:91-96. [PMID: 38665991 PMCID: PMC11039340 DOI: 10.1016/j.jor.2023.10.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 04/28/2024] Open
Abstract
Background Isolated, closed, femoral shaft fractures are dangerous injuries that commonly occur in the setting of high energy trauma or among older patients with significant comorbidities. Despite their prevalence, relatively little data exists connecting patient independent risk factors to the time to 30-day mortality, unplanned reoperations and unplanned readmissions in these fractures. Methods Using National Surgical Quality Improvement Program (NSQIP) database, isolated close femoral shaft fractures were identified using ICD-10 codes. Patient demographics, perioperative course and adverse events were identified. Categorical and binary variables were analyzed among procedure cohorts using Chi2 analysis. Univariate and multivariate analysis were conducted to identify independent risk factors associated with primary outcomes. Results Between 2010 and 2019, 1346 closed isolated femoral shaft fracture patients with a mean age of 66.7 were identified, of whom 30.6% and 69.4% were male and female, respectively. Surgical procedures included: 915 (68.0%) intramedullary nail (IMN); 428 (31.8%) open reduction internal fixation (ORIF); and 3 (0.2%) external fixator (Ex-fix). Patients who underwent ORIF reported 3.19 (OR: 3.19; CI: 1.45-7.03; p = 0.004) and 2.12 (OR: 2.12; CI: 1.10-4.09; p = 0.024) increased odds of mortality and unplanned related readmission compared to patients who received IMN. Transfusion, DVT, and PE rates were 34.2%, 1.4%, and 1.1%, respectively. Furthermore, 50% of mortality cases occurred within 6 days of surgery. Patients requiring reintubation reported 61.8 (OR: 61.8; CI: 15.7-242.40; p < 0.001) increased odds of mortality compared to patients not requiring reintubation. Conclusion Patients with femoral shaft fractures who require reintubation have increased odds of mortality than those successfully extubated. In addition to precautions prior to extubation, patients with femoral shaft fractures should also be carefully monitored for the development of DVT or PE, and they should be definitively fixed with IMN whenever possible.
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Affiliation(s)
- Eric H. Tischler
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jake R. McDermott
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Adam J. Wolfert
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Benjamin Krasnyanskiy
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Ishaq Ibrahim
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Aden N Malik
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Jonathan M. Gross
- Department of Orthopaedic Surgery, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Nishant Suneja
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
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Chen LK. The grip on healthspan: Handgrip strength as a vital sign of aging. Arch Gerontol Geriatr 2024; 122:105436. [PMID: 38584043 DOI: 10.1016/j.archger.2024.105436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan.
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Pahwa B, Kazim SF, Vellek J, Alvarez-Crespo DJ, Shah S, Tarawneh O, Dicpinigaitis AJ, Grandhi R, Couldwell WT, Schmidt MH, Bowers CA. Frailty as a predictor of poor outcomes in patients with chronic subdural hematoma (cSDH): A systematic review of literature. World Neurosurg X 2024; 23:100372. [PMID: 38638610 PMCID: PMC11024655 DOI: 10.1016/j.wnsx.2024.100372] [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: 03/04/2023] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/20/2024] Open
Abstract
Objective In recent years, frailty has been reported to be an important predictive factor associated with worse outcomes in neurosurgical patients. The purpose of the present systematic review was to analyze the impact of frailty on outcomes of chronic subdural hematoma (cSDH) patients. Methods We performed a systematic review of literature using the PubMed, Cochrane library, Wiley online library, and Web of Science databases following PRISMA guidelines of studies evaluating the effect of frailty on outcomes of cSDH published until January 31, 2023. Results A comprehensive literature search of databases yielded a total of 471 studies. Six studies with 4085 patients were included in our final qualitative systematic review. We found that frailty was associated with inferior outcomes (including mortality, complications, recurrence, and discharge disposition) in cSDH patients. Despite varying frailty scales/indices used across studies, negative outcomes occurred more frequently in patients that were frail than those who were not. Conclusions While the small number of available studies, and heterogenous methodology and reporting parameters precluded us from conducting a pooled analysis, the results of the present systematic review identify frailty as a robust predictor of worse outcomes in cSDH patients. Future studies with a larger sample size and consistent frailty scales/indices are warranted to strengthen the available evidence. The results of this work suggest a strong case for using frailty as a pre-operative risk stratification measure in cSDH patients.
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Affiliation(s)
- Bhavya Pahwa
- Medical Student, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - John Vellek
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | | | - Smit Shah
- Department of Neurology, PRISMA Health/University of South Carolina School of Medicine, Columbia, SC, USA
| | - Omar Tarawneh
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | | | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - William T. Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Meic H. Schmidt
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Christian A. Bowers
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
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Nadeem A, Siddiqui T, Rais T, Munsab R, Habib A, Afridi EK, Shariq F. Comparing surgical outcomes: Craniotomy versus decompressive craniectomy in acute subdural hematoma - A systematic review and meta-analysis. World Neurosurg X 2024; 23:100368. [PMID: 38623315 PMCID: PMC11017056 DOI: 10.1016/j.wnsx.2024.100368] [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: 12/31/2023] [Accepted: 03/20/2024] [Indexed: 04/17/2024] Open
Abstract
Introduction Acute subdural hematomas (SDH) pose a significant health risk, often resulting from traumatic head injuries. The choice between surgical interventions, craniotomy, and decompressive craniectomy, remains a subject of debate. This meta-analysis aims to compare outcomes and guide clinical decision-making. Methods Following PRISMA guidelines, a comprehensive literature search was conducted in databases such as Ovid Medline, PubMed, and Cochrane, up to December 2023. Selection criteria included studies comparing craniotomy and decompressive craniectomy for acute SDH. Data extraction utilized the Newcastle-Ottawa Quality Assessment Tool, and statistical analysis employed the random-effects model. Results The meta-analysis included 17 studies and 6848 patients. Craniotomy demonstrated a significant reduction in mortality rates (RR 0.80, 95% CI 0.73-0.89, P < 0.0001). GCS scores favored craniotomy for severe cases. GOS outcomes showed a trend favoring craniotomy, particularly in good recovery (RR 1.34, 95% CI 1.04-1.74, P = 0.03). Additional factors explored included co-existing sub-epidural hematoma, mydriasis, extracranial injuries, residual SDH, revision rates, and intracranial pressure. Conclusion The meta-analysis suggests that craniotomy may be a favorable surgical strategy for acute SDH, displaying a significant decrease in mortality rates and a lower risk of raised intracranial pressure. However, the nuanced nature of outcomes emphasizes the need for a tailored approach, considering broader clinical contexts. Future research should address limitations and provide a basis for well-informed clinical decision-making.
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Affiliation(s)
- Abdullah Nadeem
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Taruba Rais
- Dow University of Health Sciences, Mission Road, Karachi, Pakistan
| | - Rabbia Munsab
- Dow University of Health Sciences, Mission Road, Karachi, Pakistan
| | - Ashna Habib
- Dow University of Health Sciences, Mission Road, Karachi, Pakistan
| | | | - Fariha Shariq
- Karachi Medical and Dental College, Karachi, Pakistan
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Hu K, Wang S, Fei F, Song J, Chen F, Zhao Q, Shen Y, Fu J, Zhang Y, Cheng J, Zhong J, Yang X, Wu J. Modifying temperature-related cardiovascular mortality through green-blue space exposure. Environ Sci Ecotechnol 2024; 20:100408. [PMID: 38560758 PMCID: PMC10979139 DOI: 10.1016/j.ese.2024.100408] [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] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 04/04/2024]
Abstract
Green-blue spaces (GBS) are pivotal in mitigating thermal discomfort. However, their management lacks guidelines rooted in epidemiological evidence for specific planning and design. Here we show how various GBS types modify the link between non-optimal temperatures and cardiovascular mortality across different thermal extremes. We merged fine-scale population density and GBS data to create novel GBS exposure index. A case time series approach was employed to analyse temperature-cardiovascular mortality association and the effect modifications of type-specific GBSs across 1085 subdistricts in south-eastern China. Our findings indicate that both green and blue spaces may significantly reduce high-temperature-related cardiovascular mortality risks (e.g., for low (5%) vs. high (95%) level of overall green spaces at 99th vs. minimum mortality temperature (MMT), Ratio of relative risk (RRR) = 1.14 (95% CI: 1.07, 1.21); for overall blue spaces, RRR = 1.20 (95% CI: 1.12, 1.29)), while specific blue space types offer protection against cold temperatures (e.g., for the rivers at 1st vs MMT, RRR = 1.17 (95% CI: 1.07, 1.28)). Notably, forests, parks, nature reserves, street greenery, and lakes are linked with lower heat-related cardiovascular mortality, whereas rivers and coasts mitigate cold-related cardiovascular mortality. Blue spaces provide greater benefits than green spaces. The severity of temperature extremes further amplifies GBS's protective effects. This study enhances our understanding of how type-specific GBS influences health risks associated with non-optimal temperatures, offering valuable insights for integrating GBS into climate adaptation strategies for maximal health benefits.
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Affiliation(s)
- Kejia Hu
- School of Public Health, Zhejiang University, Hangzhou, 310058, China
- Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, 310058, China
| | - Shiyi Wang
- College of Agriculture and Biotechnology, Zhejiang University, Hangzhou, 310058, China
| | - Fangrong Fei
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Jinglu Song
- Department of Urban Planning and Design, Xi'an Jiaotong-Liverpool University, Suzhou, 215123, China
| | - Feng Chen
- Zhejiang Institute of Meteorological Sciences, Hangzhou, 310008, China
| | - Qi Zhao
- School of Public Health, Shandong University, Jinan, 250012, China
| | - Yujie Shen
- School of Public Health, Zhejiang University, Hangzhou, 310058, China
| | - Jingqiao Fu
- Ocean College, Zhejiang University, Zhoushan, 316021, China
| | - Yunquan Zhang
- School of Public Health, Wuhan University of Science and Technology, Wuhan, 430065, China
| | - Jian Cheng
- School of Public Health, Anhui Medical University, Hefei, 230032, China
| | - Jieming Zhong
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, 310051, China
| | - Xuchao Yang
- Ocean College, Zhejiang University, Zhoushan, 316021, China
| | - Jiayu Wu
- College of Agriculture and Biotechnology, Zhejiang University, Hangzhou, 310058, China
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Wang S, Xiao W, Duan Z, Fu Y, Fang J, Xu T, Yang D, Li G, Guan Y, Zhang Y. Depression heightened the association of the systemic immune-inflammation index with all-cause mortality among osteoarthritis patient. J Affect Disord 2024; 355:239-246. [PMID: 38552917 DOI: 10.1016/j.jad.2024.03.127] [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: 08/23/2023] [Revised: 03/04/2024] [Accepted: 03/23/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Systemic immune-inflammatory index (SII) has been recognized as a novel inflammatory indicator in numerous diseases. It remains unknown how SII affects all-cause mortality among patients with osteoarthritis (OA). In this prospective cohort study, we intended to examine the relationship of SII with all-cause mortality among OA populations and assess the interaction between depression and SII. METHODS Data was collected from National Health and Nutrition Examination Survey (NHANES) in 2005-2018. The National Death Index (NDI) provided vital status records. Multivariable Cox regression analyses with cubic spines were applied to estimate the association between SII and all-cause and CVD mortality. Stratified analysis and interaction tests assessed the interaction of SII and depression on all-cause mortality. RESULTS In total 3174 OA adults were included. The lowest quartile Q1 (HR:1.44, 95%CI:1.02-2.04) and highest quartile Q4 (HR:1.44, 95%CI:1.02-2.04) of SII presented a higher risk of death compared with those in second quartile Q2 (Ref.) and third quartile Q3 (HR:1.23, 95%CI:0.89-1.68. Restricted cubic splines analysis revealed a U-shaped association of SII with all-cause mortality, the inflection points were 412.93 × 109/L. The interaction test observed a more significant relationship of SII with all-cause mortality in depression patients than in non-depression patients, indicating that depression can modify this association. LIMITATIONS First, the observational study design failed to make causal inferences. Second, the baseline SII cannot reflect the long-term level of inflammation. Finally, there may be potential bias. CONCLUSION SII was U-shaped associated with all-cause mortality in OA patients, and this association was significantly heightened by depression.
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Affiliation(s)
- Sen Wang
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Wenyu Xiao
- Department of Orthopaedics, Shanghai Tenth People's Hospital Chongming Branch, School of Medicine, Tongji University, Shanghai 202157, China
| | - Zhengwei Duan
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Yuesong Fu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Jiaqi Fang
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Tianyang Xu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Dong Yang
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Guodong Li
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Yonghao Guan
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
| | - Yiwei Zhang
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.
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Feng X, Qiu F, Zheng L, Zhang Y, Wang Y, Wang M, Xia H, Tang B, Yan C, Liang R. Exposure to volatile organic compounds and mortality in US adults: A population-based prospective cohort study. Sci Total Environ 2024; 928:172512. [PMID: 38636853 DOI: 10.1016/j.scitotenv.2024.172512] [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] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/25/2024] [Accepted: 04/14/2024] [Indexed: 04/20/2024]
Abstract
Volatile organic compounds (VOCs) are ubiquitous in both indoor and outdoor environments. Evidence on the associations of individual and joint VOC exposure with all-cause and cause-specific mortality is limited. Measurements of 15 urinary VOC metabolites were available to estimate exposure to 12 VOCs in the National Health and Nutritional Examination Survey (NHANES) 2005-2006 and 2011-2018. The environment risk score (ERS) was calculated using LASSO regression to reflect joint exposure to VOCs. Follow-up data on death were obtained from the NHANES Public-Use Linked Mortality File through December 31, 2019. Cox proportional hazard models and restricted cubic spline models were applied to evaluate the associations of individual and joint VOC exposures with all-cause and cause-specific mortality. Population attributable fractions were calculated to assess the death burden attributable to VOC exposure. During a median follow-up of 6.17 years, 734 (8.34 %) deaths occurred among 8799 adults. Urinary metabolites of acrolein, acrylonitrile, 1,3-butadiene, and ethylbenzene/styrene were significantly associated with all-cause, cardiovascular disease (CVD), respiratory disease (RD), and cancer mortality in a linear dose-response manner. Linear and robust dose-response relationships were also observed between ERS and all-cause and cause-specific mortality. Each 1-unit increase in ERS was associated with a 33.6 %, 39.1 %, 109.8 %, and 67.8 % increase for all-cause, CVD, RD, and cancer mortality risk, respectively. Moreover, joint exposure to VOCs contributed to 17.95 % of all-cause deaths, 13.49 % of CVD deaths, 35.65 % of RD deaths, and 33.85 % of cancer deaths. Individual and joint exposure to VOCs may enhance the risk of all-cause and cause-specific mortality. Reducing exposure to VOCs may alleviate the all-cause and cause-specific death burden.
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Affiliation(s)
- Xiaobing Feng
- Department of Medical Records Statistics, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430016, China
| | - Feng Qiu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Ling Zheng
- Department of Medical Records Statistics, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430016, China
| | - Yue Zhang
- Department of Medical Records Statistics, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430016, China
| | - Yuji Wang
- Department of Medical Records Statistics, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430016, China
| | - Min Wang
- Department of Medical Records Statistics, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430016, China
| | - Han Xia
- Department of Medical Records Statistics, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430016, China
| | - Bingrong Tang
- Department of Medical Records Statistics, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430016, China
| | - Chunxiang Yan
- Department of Medical Records Statistics, Wuhan Children's Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430016, China.
| | - Ruyi Liang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
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Raghubeer N, Lahri S, Hendrikse C. The value of electrocardiography in predicting inpatient mortality in patients with acute pulmonary embolism: A cross sectional analysis. Afr J Emerg Med 2024; 14:65-69. [PMID: 38425642 PMCID: PMC10899042 DOI: 10.1016/j.afjem.2024.01.004] [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: 09/18/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Pulmonary embolism (PE) is a significant global cause of mortality, ranking third after myocardial infarction and stroke. ECG findings may play a valuable role in the prognostication of patients with PE, with various ECG abnormalities proving to be reasonable predictors of haemodynamic decompensation, cardiogenic shock, and even mortality. This study aims to assess the value of electrocardiography in predicting inpatient mortality in patients with acute pulmonary embolism, as diagnosed with computed tomography pulmonary angiogram. Method This study was a cross sectional analysis based at Tygerberg Hospital, Cape Town, South Africa. Eligible patients were identified from all CT-PA performed between 1 January 2017 and 31 December 2019 (2 years). The ECGs were independently screened by two blinded emergency physicians for predetermined signs that are associated with right heart strain and higher pulmonary artery pressures, and these findings were analysed to in-hospital mortality. Results Of the included 81 patients, 61 (75 %) were female. Of the 41 (51 %) patients with submassive PE and 8 (10 %) with massive PE, 7 (17 %) and 3 (38 %) suffered inpatient mortality (p = 0.023) respectively. Univariate ECG analysis revealed that complete right bundle branch block (OR, 8.6; 95 % CI, 1.1 to 69.9; p = 0.044) and right axis deviation (OR, 5.6; 95 % CI, 1.4 to 22.4; p = 0.015) were significant predictors of inpatient mortality. Conclusion Early identification of patients with pulmonary embolism at higher risk of clinical deterioration and in-patient mortality remains a challenge. Even though no clinical finding or prediction tool in isolation can reliably predict outcomes in patients with pulmonary embolism, this study demonstrated two ECG findings at presentation that were associated with a higher likelihood of inpatient mortality. This single-centre observational study with a small sample precludes concrete conclusions and a large follow-up multi-centre study is advised.
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Affiliation(s)
- Nishen Raghubeer
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Sa'ad Lahri
- Division of Emergency Medicine, University of Stellenbosch, Stellenbosch, South Africa
| | - Clint Hendrikse
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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Lee DYX, Yau CE, Pek MPP, Xu H, Lim DYZ, Earnest A, Ong MEH, Ho AFW. Socioeconomic disadvantage and long-term survival duration in out-of-hospital cardiac arrest patients: A population-based cohort study. Resusc Plus 2024; 18:100610. [PMID: 38524148 PMCID: PMC10960127 DOI: 10.1016/j.resplu.2024.100610] [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] [Indexed: 03/26/2024] Open
Abstract
Background Socioeconomic status (SES) is a well-established determinant of cardiovascular health. However, the relationship between SES and clinical outcomes in long-term out-of-hospital cardiac arrest (OHCA) is less well-understood. The Singapore Housing Index (SHI) is a validated building-level SES indicator. We investigated whether SES as measured by SHI is associated with long-term OHCA survival in Singapore. Methods We conducted an open cohort study with linked data from the Singapore Pan-Asian Resuscitation Outcomes Study (PAROS), and the Singapore Registry of Births and Deaths (SRBD) from 2010 to 2020. We fitted generalized structural equation models, calculating hazard ratios (HRs) using a Weibull model. We constructed Kaplan-Meier survival curves and calculated the predicted marginal probability for each SHI category. Results We included 659 cases. In both univariable and multivariable analyses, SHI did not have a significant association with survival. Indirect pathways of SHI mediated through covariates such as Emergency Medical Services (EMS) response time (HR of low-medium, high-medium and high SHI when compared to low SHI: 0.98 (0.88-1.10), 1.01 (0.93-1.11), 1.02 (0.93-1.12) respectively), and age of arrest (HR of low-medium, high-medium and high SHI when compared to low SHI: 1.02 (0.75-1.38), 1.08 (0.84-1.38), 1.18 (0.91-1.54) respectively) had no significant association with OHCA survival. There was no clear trend in the predicted marginal probability of survival among the different SHI categories. Conclusions We did not find a significant association between SES and OHCA survival outcomes in residential areas in Singapore. Among other reasons, this could be due to affordable healthcare across different socioeconomic classes.
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Affiliation(s)
- Dawn Yi Xin Lee
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Chun En Yau
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Maeve Pin Pin Pek
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Hanzhang Xu
- Department of Family Medicine and Community Health, Duke University, North Carolina, USA
| | - Daniel Yan Zheng Lim
- Data Science and Artificial Intelligence Lab, Singapore General Hospital, Singapore, Singapore
- Department of Gastroenterology, Singapore General Hospital, Singapore, Singapore
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
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Wu J, Ling Y. A review regarding the article 'Impact of tricuspid regurgitation severity on mortality in pulmonary hypertension patients: A comprehensive analysis. Curr Probl Cardiol 2024; 49:102535. [PMID: 38521290 DOI: 10.1016/j.cpcardiol.2024.102535] [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: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
Pulmonary hypertension (PH) presents as a complex hemodynamic and pathophysiologic state present in many cardiovascular, respiratory, and systemic diseases. PH is considered to have a higher risk of cardiovascular events and mortality. The most common type of functional tricuspid regurgitation (TR) is associated with PH. Secondary TR, resulting not from intrinsic valvular pathology but from distortion of the valve apparatus due to right ventricular remodeling and dilation, is commonly seen in the setting of PH. It has been increasingly recognized as not merely a bystander but a significant contributor to the worsening of symptoms and decline in functional status. However, the extent to which TR impacts the clinical course and mortality in PH remains a subject of active investigation. The simultaneous presence of PH and secondary tricuspid regurgitation (STR) portends particularly poor outcomes. However, not all patients with PH develop significant TR, and the mechanisms and clinical implications underlying this phenomenon remain unclear. TR is a highly prevalent echocardiographic finding in the general population. Historically considered as the "forgotten valve disease" by clinicians and interventional cardiologists, TR has become a hot topic in cardiovascular interventions over recent years. If left untreated until severe, as often occurs, TR correlates with consistent morbidity and mortality, and a variety of surgical and percutaneous treatments have therefore been proposed. Mortality from isolated surgical repair of TR remains higher than that from surgery of any other valve insufficiency and a large number of patients are often deemed not eligible for surgical repair.
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Affiliation(s)
- Juan Wu
- Out-patient Department, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan 610041, China
| | - Yunfei Ling
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, No. 37 GuoXue Xiang, Chengdu, Sichuan 610041, China.
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Diaz-Toro F, Nazar G, Araya AX, Petermann-Rocha F. Predictive ability of both the healthy aging index and the frailty index for all-cause mortality. GeroScience 2024; 46:3471-3479. [PMID: 38388917 PMCID: PMC11009179 DOI: 10.1007/s11357-024-01097-0] [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: 11/08/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
AIM We aimed to develop and assess a modified healthy aging index (HAI) among Chileans aged 60 years and older and compare its predictive ability for all-cause mortality risk with the frailty index (FI). METHODS This prospective study analyzed data from the Chilean National Health Survey (CNHS) conducted in 2009-2010. We included 847 adults with complete data to construct the HAI and FI. The HAI comprised five indicators (lung function, systolic blood pressure, fasting glucose, cognitive status, and glomerular filtration rate), while the FI assessed frailty using a 36-item scale. HAI scores were calculated by summing the indicator scores, ranging from 0 to 10, with higher scores indicating poorer health. Receiver operating curves (ROC) and area under the curve (AUC) were used to assess predictive validity. Associations with all-cause mortality were assessed using Cox proportional hazard models adjusted by confounders. RESULTS The mean HAI score was 4.06, while the FI score was 0.24. The AUC for mortality was higher for the HAI than the FI (0.640, 95% confidence interval (CI) 0.601 to 0.679 vs. 0.586, 95% CI 0.545 to 0.627). After adjusting for confounders, the FI showed a higher mortality risk compared to the HAI (2.63, 95% CI 1.76 to 3.51 vs. 1.16, 95% CI 1.08 to 1.26). CONCLUSION The FI and HAI were valid predictors for all-cause mortality in the Chilean population. Integrating these indices into research and clinical practice can significantly enhance our capacity to identify at-risk individuals.
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Affiliation(s)
- Felipe Diaz-Toro
- Facultad de Enfermería, Escuela de Enfermería, Universidad Andrés Bello, Santiago, Chile
- Millennium Institute for Care Research (MICARE), Santiago, Chile
| | - Gabriela Nazar
- Department of Psychology, Universidad de Concepción, Casilla, 160-C, Concepción, Chile
| | - Alejandra-Ximena Araya
- Facultad de Enfermería, Escuela de Enfermería, Universidad Andrés Bello, Santiago, Chile
- Millennium Institute for Care Research (MICARE), Santiago, Chile
| | - Fanny Petermann-Rocha
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile.
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12
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Anthony G, Aronson J, Brittain R, Heneghan C, Richards G. Preventable suicides involving medicines: A systematic case series of coroners' reports in England and Wales. Public Health Pract (Oxf) 2024; 7:100491. [PMID: 38628605 PMCID: PMC11019265 DOI: 10.1016/j.puhip.2024.100491] [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: 10/25/2023] [Revised: 03/05/2024] [Accepted: 03/22/2024] [Indexed: 04/19/2024] Open
Abstract
Background In England and Wales coroners have a duty to write a report, called a Prevention of Future Deaths report or PFD, when they believe that actions should be taken to prevent future deaths. Coroners send PFDs to individuals and organisations who are required to respond within 56 days. Despite the increase in mental health concerns and growing use of medicines, deaths reported by coroners that have involved medicine-related suicides had not yet been explored. Therefore, this study aimed to systematically assess coroners' PFD reports involving suicides in which a medicine caused or contributed to the death to identify lessons for suicide prevention. Methods Using the Preventable Deaths Tracker database (https://preventabledeathstracker.net/), 3037 coroners' PFD reports in England and Wales were screened for eligibility between July 2013 and December 2019. Reports were included if they involved suicide or intentional self-harm and prescribed or over-the-counter medication; illicit drugs were excluded. Following data extraction, descriptive statistics, document and content analysis were performed to assess coroners' concerns and the recipients of reports. Results There were 734 suicide-related coroner reports, with 100 (14%) reporting a medicine. Opioids (40%) were the most common class involved, followed by antidepressants (30%). There was wide geographical variation in the writing of reports; coroners in Manchester wrote the most (18%). Coroners expressed 237 concerns; the most common were procedural inadequacies (14%, n = 32), inadequate documentation and communication (10%, n = 22), and inappropriate prescription access (9%, n = 21). 203 recipients received the PFDs, with most sent to NHS trusts (31%), clinical commissioning groups (10%), and general practices (10%), of which only 58% responded to the coroner. Conclusions One in four coroner reports in England and Wales involved suicides, with one in seven suicide-related deaths involving a medicine. Concerns raised by coroners highlighted gaps in care that require action from the Government, health services, and prescribers to aid suicide prevention. Coroner reports should be routinely used and monitored to inform public health policy, disseminated nationally, and responses to coroners should be transparently enforced so that actions are taken to prevent future suicides.
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Affiliation(s)
- G. Anthony
- Oxford University Medical School, John Radcliffe Hospital, Headington, University of Oxford, Oxford, OX3 9DU, UK
| | - J.K. Aronson
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - R. Brittain
- St Pancras Coroner's Court, London, N1C 4PP, UK
| | - C. Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - G.C. Richards
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
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13
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Tian H, Kong X, Han F, Xing F, Zhu S, Xu T, Wang W, Song N, Wu Y. Liver Iron Overload Drives COVID-19 Mortality: a Two-Sample Mendelian Randomization Study. Biol Trace Elem Res 2024; 202:2509-2517. [PMID: 37814169 DOI: 10.1007/s12011-023-03878-8] [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: 07/23/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023]
Abstract
Iron overload has been associated with an increased risk of COVID-19 severity and mortality in observational studies, but it remains unclear whether these associations represent causal effects. We performed a two-sample Mendelian randomization (MR) to determine associations between genetic liability to iron overload and the risk of COVID-19 severity and mortality. From genome-wide association studies of European ancestry, single-nucleotide polymorphisms associated with liver iron (n = 32,858) and ferritin (n = 23,986) were selected as exposure instruments, and summary statistics of the hospitalization (n = 16,551) and mortality (n = 15,815) of COVID-19 were utilized as the outcome. We used the inverse-variance weighted (IVW) method as the primary analysis to estimate causal effects, and other alternative approaches as well as comprehensive sensitivity analysis were conducted for estimating the robustness of identified associations. Genetically predicted high liver iron levels were associated with an increased risk of COVID-19 mortality based on the results of IVW analysis (OR = 1.38, 95% CI: 1.05-1.82, P = 0.02). Likewise, sensitivity analyses showed consistent and robust results in general (all P > 0.05). A higher risk of COVID-19 hospitalization trend was also observed in patients with high liver iron levels without statistical significance. This study suggests that COVID-19 mortality might be partially driven by the iron accumulation in the liver, supporting the classification of iron overload as one of the independent death risk factors. Therefore, avoiding iron overload and maintaining normal iron levels may be a powerful measure to reduce COVID-19 mortality.
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Affiliation(s)
- Huimin Tian
- Zhonglou District Center for Disease Control and Prevention, Changzhou, Jiangsu, China.
| | - Xiangjie Kong
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, Shandong, China
| | - Fulei Han
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, Shandong, China
| | - Fangjie Xing
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, Shandong, China
| | - Shuai Zhu
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, Shandong, China
| | - Tao Xu
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Weijing Wang
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, Shandong, China
| | - Ning Song
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorder, School of Basic Medicine, Qingdao University, Qingdao, Shandong, China
| | - Yili Wu
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao, Shandong, China
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Cuschieri S. Exploring the determinants associated with adult mortality in Malta: A cohort study between 2014 and 2020. Public Health Pract (Oxf) 2024; 7:100500. [PMID: 38707676 PMCID: PMC11066676 DOI: 10.1016/j.puhip.2024.100500] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 04/08/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024] Open
Abstract
Objective The study set to explore the mortality causes across six years and identify potential mortality determinates at a population level in Malta. Study design and methods A longitudinal follow-up of a Malta based cross-sectional national representative study across 6 years (2014-2020) was carried out. The study population was cross-linked to the mortality register and causes of death obtained. Population characteristics gathered during initial examination were analysed through univariant and multivariant logistic regressions. Results A total of 66 adults, mostly male (65.15 % n = 43) died, with commonest cause being cancer (42.42 % CI95 %: 31.24-54.45) mostly due to malignant neoplasm of bronchus and lung. This was followed by cardiac pathologies including acute myocardial infarction, ischaemic cardiomyopathy, and cardiomegaly (25.76 % CI95 %: 16.67-37.51). Multivariant logistic regression analyses revealed positive associations between age (OR: 1.99 p = 0.02), history of coronary heart disease (OR: 11.78 p=<0.001), smoking for 31 years or more (OR: 8.22 p=<0.001) and presence of multimorbidity (OR: 1.32 p = 0.02). Conclusion It is evident that occurrence of cancers is a concern in Malta, and it requires targeted action including the reduction of smoking habits. Understanding the mortality causes and the associated determining factors at a population level enable the institution of preventive actions while strengthening healthcare services to safeguard the population from premature mortality and co-morbidity.
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Affiliation(s)
- Sarah Cuschieri
- Faculty of Medicine and Surgery, University of Malta, RM 425 Biomedical Building, Msida, MSD2080, Malta
- Department of Epidemiology and Biostatistics, Western University, London, Canada
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15
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Filtz A, Parihar S, Greenberg GS, Park CM, Scotti A, Lorenzatti D, Badimon JJ, Soffer DE, Toth PP, Lavie CJ, Bittner V, Virani SS, Slipczuk L. New approaches to triglyceride reduction: Is there any hope left? Am J Prev Cardiol 2024; 18:100648. [PMID: 38584606 PMCID: PMC10998004 DOI: 10.1016/j.ajpc.2024.100648] [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: 12/17/2023] [Revised: 02/29/2024] [Accepted: 03/09/2024] [Indexed: 04/09/2024] Open
Abstract
Triglycerides play a crucial role in the efficient storage of energy in the body. Mild and moderate hypertriglyceridemia (HTG) is a heterogeneous disorder with significant association with atherosclerotic cardiovascular disease (ASCVD), including myocardial infarction, ischemic stroke, and peripheral artery disease and represents an important component of the residual ASCVD risk in statin treated patients despite optimal low-density lipoprotein cholesterol reduction. Individuals with severe HTG (>1,000 mg/dL) rarely develop atherosclerosis but have an incremental incidence of acute pancreatitis with significant morbidity and mortality. HTG can occur from a combination of genetic (both mono and polygenic) and environmental factors including poor diet, low physical activity, obesity, medications, and diseases like insulin resistance and other endocrine pathologies. HTG represents a potential target for ASCVD risk and pancreatitis risk reduction, however data on ASCVD reduction by treating HTG is still lacking and HTG-associated acute pancreatitis occurs too rarely to effectively demonstrate treatment benefit. In this review, we address the key aspects of HTG pathophysiology and examine the mechanisms and background of current and emerging therapies in the management of HTG.
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Affiliation(s)
- Annalisa Filtz
- Cardiology Division, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Siddhant Parihar
- Cardiology Division, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Garred S Greenberg
- Cardiology Division, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christine M Park
- Cardiology Division, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrea Scotti
- Cardiology Division, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel Lorenzatti
- Cardiology Division, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Juan J Badimon
- Cardiology Department, Hospital General Jaen, Jaen, Spain
- Atherothrombosis Research Unit, Mount Sinai School of Medicine, New York, New York, USA
| | - Daniel E Soffer
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter P Toth
- CGH Medical Center, Sterling, Illinois
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the UQ School of Medicine, New Orleans, Louisiana, USA
| | - Vera Bittner
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, The Aga Khan University, Karachi, Pakistan
- Section of Cardiology, Texas Heart Institute & Baylor College of Medicine, Houston, TX, USA
| | - Leandro Slipczuk
- Cardiology Division, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Farmer JG, Specht A, Punshon T, Jackson BP, Bidlack FB, Bakalar CA, Mukherjee R, Davis M, Steadman DW, Weisskopf MG. Lead exposure across the life course and age at death. Sci Total Environ 2024; 927:171975. [PMID: 38547974 PMCID: PMC11069331 DOI: 10.1016/j.scitotenv.2024.171975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Lead (Pb) exposure has been associated with an increased risk of all-cause mortality, even at low levels. Little is known about how the timing of Pb exposure throughout life may influence these relationships. Quantifying the amount of Pb present in various tissues of the body provides measurements of exposure from different periods of life. These include bone, tooth enamel, which is the hard outer layer of the crown, and tooth cementum, which is the calcified connective tissue covering the tooth root. The purpose of the study was to examine Pb exposure at multiple periods throughout life, including childhood (enamel), adulthood (cementum), and later life (bone), and to estimate their associations with age at death. METHODS 208 skeleton donors (born 1910-1960) from an ongoing case-control study were included in this study. Pb was measured in tibia (shin), bone using X-Ray Florescence and in teeth using Laser-Ablation Inductively Coupled Plasma Mass Spectroscopy. After excluding unusually high measurements (>2sd), this resulted in a final sample of 111 with all exposure measures. Correlations across measures were determined using partial Spearman correlations. Associations between Pb exposure and age at death were estimated using Multivariable Linear Regression. RESULTS Pb measures across exposure periods were all significantly correlated, with the highest correlation between cementum and tibia measures (r = 0.61). Donors were largely female (63.0 %), White (97.3 %), and attended some college (49.5 %). Single exposure models found that higher tooth cementum Pb (-1.27; 95 % CI: -2.48, -0.06) and tibia bone Pb (-0.91; 95 % CI: -1.67, -0.15) were significantly associated with an earlier age at death. When considered simultaneously, only cementum Pb remained significant (-1.51; 95 % CI: -2.92, -0.11). Secondary analyses suggest that the outer cementum Pb may be especially associated with an earlier age at death. CONCLUSION Results suggest that higher Pb exposure is associated with an earlier age at death, with adulthood as the life period of most relevance. Additional studies using Pb exposure measures from different life stages should be conducted.
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Affiliation(s)
- Justin G Farmer
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA, United States.
| | - Aaron Specht
- School of Health Sciences, Purdue University, 550 W Stadium Ave, West Lafayette, IN, United States
| | - Tracy Punshon
- Department of Biological Sciences, Dartmouth College, Hanover, NH, United States
| | - Brian P Jackson
- Department of Earth Sciences, Dartmouth College, Hanover, NH, United States
| | | | - Charlotte A Bakalar
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA, United States
| | - Rajarshi Mukherjee
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA, United States
| | - Mary Davis
- Department of Anthropology, University of Tennessee Knoxville, 1621 Cumberland Avenue, Knoxville, TN, United States
| | - Dawnie W Steadman
- Department of Anthropology, University of Tennessee Knoxville, 1621 Cumberland Avenue, Knoxville, TN, United States
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA, United States
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Mohanty S, Cossrow N, Yu KC, Ye G, White M, Gupta V. Clinical and economic burden of invasive pneumococcal disease and noninvasive all-cause pneumonia in hospitalized US adults: A multicenter analysis from 2015 to 2020. Int J Infect Dis 2024; 143:107023. [PMID: 38555060 DOI: 10.1016/j.ijid.2024.107023] [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: 11/21/2023] [Revised: 02/12/2024] [Accepted: 03/23/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES To evaluate the clinical and economic outcomes in adults hospitalized with invasive pneumococcal disease (IPD) and noninvasive all-cause pneumonia (ACP) overall and by antimicrobial resistance (AMR) status. METHODS Hospitalized adults from the BD Insights Research Database with an ICD10 code for IPD, noninvasive ACP or a positive Streptococcus pneumoniae culture/urine antigen test were included. Descriptive statistics and multivariable analyses were used to evaluate outcomes (in-hospital mortality, length of stay [LOS], cost per admission, and hospital margin [costs - payments]). RESULTS The study included 88,182 adult patients at 90 US hospitals (October 2015-February 2020). Most (98.6%) had noninvasive ACP and 40.2% were <65 years old. Of 1450 culture-positive patients, 37.7% had an isolate resistant to ≥1 antibiotic class. Observed mortality, median LOS, cost per admission, and hospital margins were 8.3%, 6 days, $9791, and $11, respectively. Risk factors for mortality included ≥50 years of age, higher risk of pneumococcal disease (based on chronic or immunocompromising conditions), and intensive care unit admission. Patients with IPD had similar mortality rates and hospital margins compared with noninvasive ACP, but greater costs per admission and LOS. CONCLUSION IPD and noninvasive ACP are associated with substantial clinical and economic burden across all adult age groups. Expanded pneumococcal vaccination programs may help reduce disease burden and decrease hospital costs.
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Affiliation(s)
| | | | - Kalvin C Yu
- Becton, Dickinson & Company, Franklin Lakes, NJ, USA
| | - Gang Ye
- Becton, Dickinson & Company, Franklin Lakes, NJ, USA
| | | | - Vikas Gupta
- Becton, Dickinson & Company, Franklin Lakes, NJ, USA
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Neppala S, Chigurupati HD, Mopuru NN, Alle NR, James A, Bhalodia A, Shaik S, Bandaru RR, Nanjundappa A, Sunkara P, Gummadi J, Desai R. Impact Of body Mass Index on Cardiopulmonary Outcomes of COVID-19 Hospitalizations Complicated by Severe Sepsis. Obes Pillars 2024; 10:100101. [PMID: 38435542 PMCID: PMC10905037 DOI: 10.1016/j.obpill.2024.100101] [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] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/05/2024]
Abstract
Background Body Mass Index (BMI) has a significant impact on Coronavirus disease (COVID-19) patient outcomes; however, major adverse cardiac and cerebrovascular outcomes in patients with severe sepsis have been poorly understood. Our study aims to explore and provide insight into its association. Methods This is an observational study looking at the impact of BMI on COVID-19-severe sepsis hospitalizations. The primary outcomes are adjusted odds of all-cause in-hospital mortality, respiratory failure, and major adverse cardiac and cerebrovascular events (MACCE), which include acute myocardial infarction, cardiac arrest, and acute ischemic stroke. The secondary outcome was healthcare resource utilization. Coexisting comorbidities and patient features were adjusted with multivariable regression analyses. Results Of 51,740 patients with severe COVID-19-sepsis admissions, 11.4% were overweight, 24.8% had Class I obesity (BMI 30-34.9), 19.8% had Class II obesity (BMI 35-39.9), and 43.9% had the categorization of Class III obesity (BMI >40) cohorts with age>18 years. The odds of MACCE in patients with class II obesity and class III obesity (OR 1.09 and 1.54; 95CI 0.93-1.29 and 1.33-1.79) were significantly higher than in overweight (p < 0.001). Class I, Class II, and Class III patients with obesity revealed lower odds of respiratory failure compared to overweight (OR 0.89, 0.82, and 0.82; 95CI 0.75-1.05, 0.69-0.97, and 0.70-0.97), but failed to achieve statistical significance (p = 0.079). On multivariable regression analysis, all-cause in-hospital mortality revealed significantly higher odds in patients with Class III obesity, Class II, and Class I (OR 1.56, 1.17, and 1.06; 95CI 1.34-1.81, 0.99-1.38, and 0.91-1.24) vs. overweight patients (p < 0.001). Conclusions Patients with Class II and Class III obesity had significantly higher odds of MACCE and in-hospital mortality in COVID-19-severe sepsis admissions.
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Affiliation(s)
| | - Himaja Dutt Chigurupati
- Department of Medicine, New York Medical College at Saint Michael's Medical Center, Newark, NJ, USA
| | - Nikhilender Nag Mopuru
- Department of Medicine, Kamineni Academy of medical sciences and research Centre, Hyderabad, India
| | | | - Alpha James
- Department of Medicine, Bukovinian State Medical University, Chernivitsi, Ukraine
| | - Ami Bhalodia
- Department of Medicine, Pandit Deendayal Upadhyay Medical College, Gujrat, India
| | - Sajida Shaik
- Department of Medicine, Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Andhra Pradesh, India
| | | | | | - Praveena Sunkara
- Department of Medicine, Medstar Medical group, Charlotte Hall, MD, USA
| | - Jyotsna Gummadi
- Department of Medicine, MedStar Franklin Square Medical Center, Baltimore, MD, USA
| | - Rupak Desai
- Independent Outcomes Researcher, Atlanta, GA, USA
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Nilsen DW, Aarsetoey R, Poenitz V, Ueland T, Aukrust P, Michelsen AE, Brugger-Andersen T, Staines H, Grundt H. Chemokine ligand 18 predicts all-cause mortality in patients hospitalized with chest pain of suspected coronary origin. Int J Cardiol Cardiovasc Risk Prev 2024; 21:200264. [PMID: 38596196 PMCID: PMC11002648 DOI: 10.1016/j.ijcrp.2024.200264] [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] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/21/2024] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
Introduction Chemokines mediate recruitment and activation of leucocytes. Chemokine ligand 18 (CCL18) is mainly expressed by monocytes/macrophages and dendritic cells. It is highly expressed in chronic inflammatory diseases, and locally in atherosclerotic plaques, particularly at sites of reduced stability, and systemically in acute coronary syndrome patients. Reports on its prognostic utility in the latter condition, including myocardial infarction (MI), are scarce. Aim To assess the utility of CCL18 as a prognostic marker of recurrent cardiovascular events in patients hospitalized with chest pain of suspected coronary origin. Methods The population consisted of 871 consecutive chest-pain patients, of whom 386 were diagnosed with acute myocardial infarction (AMI) based on Troponin-T (TnT) levels >50 ng/L. Stepwise Cox regression models, applying normalized continuous loge/SD values, were fitted for the biomarkers with cardiac mortality within 2 years and total mortality within 2 and 7 years as the dependent variables. Results Plasma samples from 849 patients were available. By 2 years follow-up, 138 (15.8%) patients had died, of which 86 were cardiac deaths. Univariate analysis showed a positive, significant association between CCL18 and total death [HR 1.55 (95% 1.30-1.83), p < 0.001], and for cardiac death [HR 1.32 (95% 1.06-1.64), p = 0.013]. Associations after adjustment were non-significant. By 7 years follow-up, 332 (38.1%) patients had died. CLL18 was independently associated with all-cause mortality [HR 1.14 (95% CI, 1.01-1.29), p = 0.030], but not with MI (n = 203) or stroke (n = 55). Conclusion CCL18 independently predicts long-term all-cause mortality but had no independent prognostic bearing on short-term cardiac death and CVD events.
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Affiliation(s)
- Dennis W.T. Nilsen
- Stavanger University Hospital, Department of Cardiology, Stavanger, Norway
- University of Bergen, Department of Clinical Science, Bergen, Norway
| | - Reidun Aarsetoey
- Stavanger University Hospital, Department of Cardiology, Stavanger, Norway
| | - Volker Poenitz
- Stavanger University Hospital, Department of Cardiology, Stavanger, Norway
| | - Thor Ueland
- Department of Clinical Medicine, Thrombosis Research Center, UiT - The Arctic University of Norway, Tromsø, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Pål Aukrust
- University of Oslo, Faculty of Medicine, Oslo, Norway
- Oslo University Hospital, Rikshospitalet, Research Institute of Internal Medicine, Oslo, Norway
- Oslo University Hospital, Rikshospitalet, Section of Clinical Immunology and Infectious Diseases, Oslo, Norway
| | - Annika E. Michelsen
- University of Oslo, Faculty of Medicine, Oslo, Norway
- Oslo University Hospital, Rikshospitalet, Research Institute of Internal Medicine, Oslo, Norway
| | | | - Harry Staines
- Sigma Statistical Services, Balmullo, Northern Ireland, United Kingdom
| | - Heidi Grundt
- Stavanger University Hospital, Department of Cardiology, Stavanger, Norway
- Stavanger University Hospital, Department of Respiratory Medicine, Stavanger, Norway
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20
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Alamri FF, Almarghalani DA, Alraddadi EA, Alharbi A, Algarni HS, Mulla OM, Alhazmi AM, Alotaibi TA, Beheiry DH, Alsubaie AS, Alkhiri A, Alatawi Y, Alzahrani MS, Hakami AY, Alamri A, Al Sulaiman K. The utility of serum glucose potassium ratio as a predictive factor for haemorrhagic transformation, stroke recurrence, and mortality among ischemic stroke patients. Saudi Pharm J 2024; 32:102082. [PMID: 38690210 PMCID: PMC11059537 DOI: 10.1016/j.jsps.2024.102082] [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: 03/03/2024] [Accepted: 04/21/2024] [Indexed: 05/02/2024] Open
Abstract
Background and Objective Glucose-Potassium Ratio (GPR) has emerged as a biomarker in several pathophysiological conditions. However, the association between GPR and long-term outcomes in stroke patients has not been investigated. Our study evaluated the applicability of baseline GPR as a predictive prognostic tool for clinical outcomes in ischemic stroke patients. Methods The multicenter retrospective cohort study included acute-subacute adult ischemic stroke patients who had their baseline serum GPR levels measured. Eligible patients were categorized into two sub-cohorts based on the baseline GPR levels (<1.67 vs. ≥ 1.67). The primary outcome was the incidence of 30-day hemorrhagic transformation, while stroke recurrence, and all-cause mortality within twelve months, were considered secondary. Results Among 4083 patients screened, 1047 were included in the current study. In comparison with GPR < 1.67 group, patients with ≥ 1.67 GPR had a significantly higher ratio of all-cause mortality within twelve months (aHR 2.07 [95 % CI 1.21-3.75] p = 0.01), and higher ratio of 30-day hemorrhagic transformation but failed to reach the statistical significance (aHR 1.60 [95 % CI 0.95-2.79], p = 0.08). Conclusion Overall, baseline GPR serum is an independent predictor of all-cause mortality within twelve months in patients with acute and subacute ischemic stroke. Further clinical studies are necessary to validate these findings.
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Affiliation(s)
- Faisal F. Alamri
- Department of Basic Sciences, College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Salman Center for Disability Research, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Daniyah A. Almarghalani
- Department of Pharmacology and Toxicology, College of Pharmacy, Taif University, P.O. Box 11099, Taif 21944 Saudi Arabia
- Stroke Research Unit, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Eman A. Alraddadi
- Department of Basic Sciences, College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdullah Alharbi
- Department of Neurology, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Hajar S. Algarni
- College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Oyoon M. Mulla
- College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | | | - Deema H. Beheiry
- College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdullah S. Alsubaie
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed Alkhiri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Yasser Alatawi
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | - Mohammad S. Alzahrani
- Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Alqassem Y. Hakami
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Aser Alamri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Khalid Al Sulaiman
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard – Health Affairs., Riyadh, Saudi Arabia
- Saudi Critical Care Pharmacy Research (SCAPE) Platform., Riyadh, Saudi Arabia
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21
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Metri A, Bush N, Singh VK. Predicting the severity of acute pancreatitis: Current approaches and future directions. Surg Open Sci 2024; 19:109-117. [PMID: 38650599 PMCID: PMC11033200 DOI: 10.1016/j.sopen.2024.03.012] [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: 06/20/2023] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
Acute pancreatitis (AP) is a sudden-onset inflammatory disease of the pancreas. The severity of AP is classified into mild, moderate, and severe categories based on the presence and persistence of organ failure. Severe acute pancreatitis (SAP) can be associated with significant morbidity and mortality. It requires early recognition for appropriate timely management. Prognostic scores for predicting SAP incorporating many clinical, laboratory, and radiological parameters have been developed in the past. However, all of these prognostic scores have low positive predictive value for SAP and some of these scores require >24 h for assessment. There is a need to develop biomarkers that can accurately identify patients at risk for SAP early in the course of the presentation. In this review, we aim to provide a summary of the most commonly utilized prognostic scores for AP and discuss future directions.
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Affiliation(s)
- Aida Metri
- Department of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Nikhil Bush
- Department of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Vikesh K. Singh
- Department of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
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Roberts GW, Krinsley JS, Preiser JC, Quinn S, Rule PR, Brownlee M, Umpierrez GE, Hirsch IB. Malglycemia in the critical care setting. Part III: Temporal patterns, relative potencies, and hospital mortality. J Crit Care 2024; 81:154537. [PMID: 38364665 DOI: 10.1016/j.jcrc.2024.154537] [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: 11/16/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION The relationship between critical care mortality and combined impact of malglycemia remains undefined. METHODS We assessed the risk-adjusted relationship (n = 4790) between hospital mortality with malglycemia, defined as hypergycemia (hours Glycemic Ratio ≥ 1.1, where GR is quotient of mean ICU blood glucose (BG) and estimated average BG), absolute hypoglycemia (hours BG < 70 mg/dL) and relative hypoglycemia (excursions GR < 0.7 in those with HbA1c ≥ 8%). RESULTS Each malglycemia was independently associated with mortality - hyperglycemia (OR 1.0020/h, 95%CI 1.0009-1.0031, p = 0.0004), absolute hypoglycemia (OR 1.0616/h, 95%CI 1.0190-1.1061, p = 0.0043), and relative hypoglycemia (OR 1.2813/excursion, 95%CI 1.0704-1.5338, p = 0.0069). Absolute (7.4%) and relative hypoglycemia (6.7%) exposure dominated the first 24 h, decreasing thereafter. While hyperglycemia had lower risk association with mortality, it was persistently present across the length-of-stay (68-76% incidence daily), making it the dominant form of malglycemia. Relative contributions in the first five days from hyperglycemia, absolute hypoglycemia and relative hypoglycemia were 60%, 21% and 19% respectively. CONCLUSIONS Absolute and relative hypoglycemia occurred largely in the first 24 h. Relative to all hypoglycemia, the associated mortality from the seemingly less potent but consistently more prevalent hyperglycemia steadily accumulated with increasing length-of-stay. This has important implications for interpretation of study results.
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Affiliation(s)
- Gregory W Roberts
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA 5042, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia.
| | - James S Krinsley
- Division of Critical Care, Department of Medicine, Stamford Hospital, and the Columbia Vagelos College of Physicians and Surgeons, Stamford, CT, USA
| | | | - Stephen Quinn
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia.
| | | | - Michael Brownlee
- Diabetes Research Emeritus, Biomedical Sciences Emeritus, Einstein Diabetes Research Center, Department of Medicine and Pathology Emeritus, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Guillermo E Umpierrez
- Department of Medicine, Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA.
| | - Irl B Hirsch
- Division of Metabolism, Endocrinology and Nutrition, University of Washington Medicine Diabetes Institute, Seattle, WA, USA.
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Trifi A, Tlili B, Kallel Sellami M, Feki M, Mehdi A, Seghir E, Messaoud L, Abdellatif S, Ben Lakhal S. Immunologic effect and clinical impact of erythromycin in septic patients: A randomized clinical trial. J Crit Care 2024; 81:154533. [PMID: 38359518 DOI: 10.1016/j.jcrc.2024.154533] [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: 11/11/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
To investigate the potential regulatory effect of erythromycin added to standard care in septic patients on sepsis biomarkers and clinical outcome. It was a single-blind randomized trial including critical septic patients. The primary endpoint was the change in the TNF/IL-10 ratio between days 0 and 6. Changes in other biomarkers, vasopressor use, and 28-day mortality were secondary endpoints. One hundred and ten patients were examined (erythromycin group, n = 55 versus placebo group, n = 55). Clinical features of the groups were well matched. Erythromycin addition had no beneficial effects on the TNF/IL-10 ratio or mortality (51% vs. 47%, p = 0.62). Both groups' serum TNF/IL-10 ratios did not significantly rise (from 0.48 [0.34-1.18] to 0.59 [0.21-1.10] vs. 0.65 [0.25-1.14] to 0.93 [0.24-1.88] in the erythromycin and placebo groups, respectively; p values = 0.86 and 0.12). Serum Procalcitonin (PCT) and CRP dropped considerably in the Erythromycin group, whereas only PCT showed a drop in the placebo group. On day 6, the non-survivors' serum TNF/IL-10 ratio was lower than that of the survivors (0.55 [0.17-1.04] vs 1.08 [0.4-2.28], p = 0.029). Neither the pro/anti-inflammatory imbalance nor the mortality were impacted by the addition of erythromycin to standard care in septic patients (ClinicalTrials.gov ID: NCT04665089 (11/12/2020)).
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Affiliation(s)
- Ahlem Trifi
- Medical Intensive Care Unit, La Rabta Teaching Hospital, Rue Jabbari, 1007 Tunis, Tunisia.
| | - Badis Tlili
- Medical Intensive Care Unit, La Rabta Teaching Hospital, Rue Jabbari, 1007 Tunis, Tunisia
| | | | - Moncef Feki
- Biochemistry Laboratory, La Rabta Teaching Hospital, Rue Jabbari, 1007 Tunis, Tunisia
| | - Asma Mehdi
- Medical Intensive Care Unit, La Rabta Teaching Hospital, Rue Jabbari, 1007 Tunis, Tunisia
| | - Eya Seghir
- Medical Intensive Care Unit, La Rabta Teaching Hospital, Rue Jabbari, 1007 Tunis, Tunisia
| | - Lynda Messaoud
- Medical Intensive Care Unit, La Rabta Teaching Hospital, Rue Jabbari, 1007 Tunis, Tunisia
| | - Sami Abdellatif
- Medical Intensive Care Unit, La Rabta Teaching Hospital, Rue Jabbari, 1007 Tunis, Tunisia
| | - Salah Ben Lakhal
- Medical Intensive Care Unit, La Rabta Teaching Hospital, Rue Jabbari, 1007 Tunis, Tunisia
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24
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Huang ST, Loh CH, Lin CH, Hsiao FY, Chen LK. Trends in dementia incidence and mortality, and dynamic changes in comorbidity and healthcare utilization from 2004 to 2017: A Taiwan national cohort study. Arch Gerontol Geriatr 2024; 121:105330. [PMID: 38341955 DOI: 10.1016/j.archger.2024.105330] [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: 02/16/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/13/2024]
Abstract
AIMS This study aims to ascertain dementia incidence from 2004 to 2017 in Taiwan, and to examine the disease course in comorbidity, treatments, healthcare usage, and mortality among older people with incident dementia preceding the diagnosis of dementia and afterwards. METHODS Taiwan National Health Insurance data on people aged ≥ 65 years with incident dementia from January 2004 to December 2017 were excerpted to estimate annual incidence rates and annualized percentage changes(APCs). For people diagnosed before 2013, annual mortality rates and causes of death during 5-years' follow-up were determined. Changes in 22 diseases/conditions, hospital visits and admissions, and psychotropic medication prescriptions commonly associated with dementia, were examined from 3 years preceding the index diagnosis until 5 years afterwards. RESULTS From 2004 to 2017, the annual incidence of dementia in Taiwan increased from 30,606 to 50,651, and by > 90 % in women; age-standardized annual incidence increased significantly, with an APC of 0.4 %(p = 0.02). For 372,203 incident cases from 2004 to 2013, annual mortality was∼12 % during 5-years' follow-up. The prevalence of most comorbidities increased by 65-150 % after being diagnosed with dementia. People with incident dementia had increased healthcare usage 1 year before diagnosis, which peaked 1 year afterwards. Psychotropic medication prescriptions increased gradually over 3 years before diagnosis, peaked 3 months afterwards, gradually declined during the next 2 years, then remained stable. CONCLUSION The incidence of dementia in Taiwan has increased gradually over time, with an annual mortality risk of∼12 %. Older people with dementia had more healthcare needs and comorbid conditions after dementia diagnosis, highlighting the exigency of person-centered dementia care.
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Affiliation(s)
- Shih-Tsung Huang
- Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Hui Loh
- Center for Healthy Longevity, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chi-Hung Lin
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
| | - Liang-Kung Chen
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.
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25
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Blodgett JM, Pérez-Zepeda MU, Godin J, Kehler DS, Andrew MK, Kirkland S, Rockwood K, Theou O. Prognostic accuracy of 70 individual frailty biomarkers in predicting mortality in the Canadian Longitudinal Study on Aging. GeroScience 2024; 46:3061-3069. [PMID: 38182858 PMCID: PMC11009196 DOI: 10.1007/s11357-023-01055-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024] Open
Abstract
The frailty index (FI) uses a deficit accumulation approach to derive a single, comprehensive, and replicable indicator of age-related health status. Yet, many researchers continue to seek a single "frailty biomarker" to facilitate clinical screening. We investigated the prognostic accuracy of 70 individual biomarkers in predicting mortality, comparing each with a composite FI. A total of 29,341 individuals from the comprehensive cohort of the Canadian Longitudinal Study on Aging were included (mean, 59.4 ± 9.9 years; 50.3% female). Twenty-three blood-based biomarkers and 47 test-based biomarkers (e.g., physical, cardiac, cardiology) were examined. Two composite FIs were derived: FI-Blood and FI-Examination. Mortality status was ascertained using provincial vital statistics linkages and contact with next of kin. Areas under the curve were calculated to compare prognostic accuracy across models (i.e., age, sex, biomarker, FI) in predicting mortality. Compared to an age-sex only model, the addition of individual biomarkers demonstrated improved model fit for 24/70 biomarkers (11 blood, 13 test-based). Inclusion of FI-Blood or FI-Examination improved mortality prediction when compared to any of the 70 biomarker-age-sex models. Individual addition of seven biomarkers (walking speed, chair rise, time up and go, pulse, red blood cell distribution width, C-reactive protein, white blood cells) demonstrated an improved fit when added to the age-sex-FI model. FI scores had better mortality risk prediction than any biomarker. Although seven biomarkers demonstrated improved prognostic accuracy when considered alongside an FI score, all biomarkers had worse prognostic accuracy on their own. Rather than a single biomarker test, implementation of routine FI assessment in clinical settings may provide a more accurate and reliable screening tool to identify those at increased risk of adverse outcomes.
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Affiliation(s)
- Joanna M Blodgett
- Division of Geriatric Medicine, Dalhousie University and Nova Scotia Health, Halifax, NS, Canada.
- Division of Surgery Interventional Science, Institute of Sport Exercise and Health, University College London, London, UK.
| | - Mario Ulisses Pérez-Zepeda
- Division of Geriatric Medicine, Dalhousie University and Nova Scotia Health, Halifax, NS, Canada
- Instituto Nacional de Geriatría, Mexico City, Mexico
- Centro de Investigación en Ciencias de La Salud (CICSA), FCS, Universidad Anáhuac México Campus Norte, Huixquilucan, Edo. de México, Lomas Anahuac, Mexico
| | - Judith Godin
- Division of Geriatric Medicine, Dalhousie University and Nova Scotia Health, Halifax, NS, Canada
| | - Dustin Scott Kehler
- Division of Geriatric Medicine, Dalhousie University and Nova Scotia Health, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Melissa K Andrew
- Division of Geriatric Medicine, Dalhousie University and Nova Scotia Health, Halifax, NS, Canada
| | - Susan Kirkland
- Division of Geriatric Medicine, Dalhousie University and Nova Scotia Health, Halifax, NS, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University and Nova Scotia Health, Halifax, NS, Canada
| | - Olga Theou
- Division of Geriatric Medicine, Dalhousie University and Nova Scotia Health, Halifax, NS, Canada
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
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Evbayekha E, Antia A, Dixon B, Reiss C, LaRue S. Predictors of mortality and burden of arrhythmias in endstage heart failure. Curr Probl Cardiol 2024; 49:102541. [PMID: 38521289 DOI: 10.1016/j.cpcardiol.2024.102541] [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: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Heart failure (HF) is a significant cause of morbidity and mortality in the United States, contributing to approximately 1 in 8 deaths. Individuals with end-stage HF (eHF) experience debilitating symptoms leading to poor quality of life (QoL). METHODS We used the ICD-10 code for eHF (I5084) from the National Inpatient Sample (NIS) (2016-2020) to identify all patients with eHF. We used a multivariable logistic regression model to adjust for confounders and estimate the mortality probability in each arrhythmia cohort. Our primary outcome was in-hospital mortality risk in each group. A p-value of 0.05 was deemed significant. RESULTS There were 22,703 hospitalizations with eHF (mean age 67 years ±16). Men represented 66.5 % (15,091) of the population. In this cohort, 59 % (13,018) were Caucasians, 27.2 % (6,017) were Blacks, 8.7 % (1,924) were Hispanics, and 2.9 % (505) were Asians. Of these individuals, 50.4 % (11,434) had atrial fibrillation (AFIB). The majority of the arrhythmia subgroups had independent associations with mortality, with adjusted odds ratio (aOR) for VFIB 5.8 (4.6-7.1), AFIB 4.3 (3.9-4.5), SVT 1.9 (1.6-2.4), and VT 1.2 (1.1-1.4), p < 0.0001, each. CONCLUSION This analysis revealed that approximately half of the hospitalized population with end-stage heart failure are burdened with atrial fibrillation. Ventricular and atrial fibrillation, supraventricular tachycardia, and ventricular tachycardia each carried an independent mortality risk, with ventricular fibrillation having the highest risk.
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Abbasi M, Anzali BC, Mehryar HR. Liver enzymes as a predictor of mortality in patients with COVID-19? A cross-sectional study. Toxicol Rep 2024; 12:266-270. [PMID: 38433765 PMCID: PMC10906505 DOI: 10.1016/j.toxrep.2024.02.004] [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: 01/22/2024] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Liver injury in patients with COVID-19 infection may directly result from viral infection of liver cells, immune-mediated inflammation such as cytokine storm, and hypoxia resulting from pneumonia. Additionally, liver injury may occur due to drug toxicity and may lead to liver failure in critically ill COVID-19 patients. Given the significance of the liver and its vulnerability in COVID-19 patients, this study aimed to investigate the correlation of serum liver enzymes with the prognosis of hospitalized COVID-19 patients at Imam Khomeini Hospital in Urmia. This descriptive-analytical study involved hospitalized COVID-19 patients at Imam Khomeini Hospital in Urmia. Patient data were extracted from medical records and recorded in checklists, including demographic characteristics (age and gender), serum levels of Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST), and patient outcomes (recovery and mortality). Subsequently, the serum levels of AST and ALT in recovered and discharged patients were compared with those of deceased patients. The mean AST level was higher in deceased patients compared to recovered and discharged patients, and this difference was statistically significant (P <0.033). Therefore, overall, higher AST levels in COVID-19 patients may indicate a worse prognosis. Similarly, the mean ALT level was higher in deceased patients compared to recovered and discharged patients, and this difference was statistically significant (P <0.015). Thus, higher ALT levels in COVID-19 patients may generally indicate a worse prognosis. Continuous monitoring of liver enzymes in patients with a poor prognosis can lead to early identification and, to the extent possible, prevention of complications and mortality through enhanced care.
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Affiliation(s)
- Mansour Abbasi
- Department of Medicine, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Babak Choobi Anzali
- Emergency Medicine, Department of Emergency Medicine, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamid Reza Mehryar
- Emergency Medicine, Department of Emergency Medicine, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
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Khan S, Ahmad K, Farooq M, Ahmad S, Nazir MA, Khalid A, Khan MN, Iman A, Arif M, Sabir HM, Mazari FA. Investigating the teratogenic potential of diclofenac sodium on chick embryos: A warning for pregnant women. Toxicol Rep 2024; 12:292-298. [PMID: 38495471 PMCID: PMC10943025 DOI: 10.1016/j.toxrep.2024.02.010] [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: 01/09/2024] [Revised: 02/14/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
Teratogenic and embryotoxic effect of diclofenac sodium (DS) on different developmental stages of the chick-embryos was investigated by examining different parameters such as its mortality rate, hatching, morphological measurements, weighing its internal organs and calculation of different indices. Experiment was divided into four trials with different dose (0.1 mL, 0.2 mL, 0.3 mL in groups A, B, and C, respectively and group D received 0.3 mL saline solution (0.9% NaCl) and group E remained un-injected) administration and observation. Results of first and second trial showed statistically (p<0.01) significant difference in bodyweight, body-length, forelimb and hindlimb length between experimental and control groups. In third trial, diclofenac sodium administration showed a statistically (p<0.01) significant difference in the bodyweight, body-length, forelimb, hindlimb length, liver weight, egg weight (EE ratio) and kidney somatic index (KSI). The beak-size, heart weight, kidney weight, cardiac somatic index (CSI) and hepato somatic index (HSI) were not significant (p>0.05) when compared with the control groups. In trial 4, forelimb, hindlimb length, heart weight, CSI and HSI were statistically (p<0.01) significant. Body-length and liver weight were significant (p<0.05). While bodyweight, beak size, kidney weight and KSI were non-significant (p>0.05). The mortality rate was increased with increase dose of DS and also affected the hatching. DS effect on chick embryos can be applied to humans because the early development of mammals and birds are closely related. So, it was concluded that DS should be used with caution during pregnancy especially during first trimester of pregnancy.
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Affiliation(s)
- Sana Khan
- Department of Zoology, Ghazi University, Dera Ghazi Khan, Pakistan
| | - Khalil Ahmad
- Department of Chemistry, Emerson University Multan (EUM), 60000, Pakistan
| | - Muhammad Farooq
- Department of Zoology, Ghazi University, Dera Ghazi Khan, Pakistan
| | - Shakeel Ahmad
- Institute of Zoology, Bahauddin Zakariya University Multan, Pakistan
| | - Muhammad Altaf Nazir
- Institute of Chemistry, The Islamia University of Bahawalpur, Bahawalpur, 63100, Punjab Pakistan
| | - Awais Khalid
- Department of Physics, College of Science and Humanities in Al-Kharj, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | | | - Ayesha Iman
- Department of Zoology, Ghazi University, Dera Ghazi Khan, Pakistan
| | - Muhammad Arif
- Department of Zoology, Ghazi University, Dera Ghazi Khan, Pakistan
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Wang AP, Husain N, Penk J, Laternser C, Magnetta D, Watanabe K, Hauck A. Prognostic Value of RV Function Analysis During the Interstage Period in Patients with Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2024; 45:1120-1128. [PMID: 38519623 DOI: 10.1007/s00246-024-03463-3] [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: 12/10/2023] [Accepted: 02/26/2024] [Indexed: 03/25/2024]
Abstract
Cardiac dysfunction is associated with mortality in children with hypoplastic left heart syndrome (HLHS). We evaluated the ability of qualitative and quantitative RV functional parameters to predict outcomes in HLHS patients. In this retrospective, single-center study, echocardiograms from 3 timepoints (pre-stage 1 palliation, 4-8 weeks post-stage 1 palliation, and pre-Glenn) were analyzed in infants with HLHS. Patients were stratified into two groups based on outcome of transplant-free survival post-Glenn (survivors) versus mortality or transplantation prior to Fontan (non-survivors). Images were retrospectively reviewed to obtain RV global longitudinal strain (RVGLS), RV-free wall strain (RVFWS), fractional area change (FAC), tricuspid annular systolic plane excursion (TAPSE), tissue motion annular displacement of the tricuspid valve (TMAD-TV) and qualitative systolic function assessment during the predetermined timepoints. An equal variance t-test and chi-square were used to determine significant differences and ROC curve analysis was performed to derive optimal cutoff values to predict mortality/transplant. A total of 47 patients met inclusion criteria, of which, 21 patients met composite endpoint. There were no significant differences in any RV functional parameter during the pre- or post-stage 1 palliation timepoints. The absolute values of RVFWS, RVGLS, and TMAD-TV were significantly greater in survivors than non-survivors during the pre-Glenn timepoint. A pre-Glenn RVGLS > -15.6 (AUC 0.79), RVFWS > -18.6 (AUC 0.75), and TMAD-TV < 12.6% (AUC 0.82) were sensitive and specific for predicting death or need for transplantation prior to Fontan completion. RVGLS, RVFWS, and TMAD-TV may help identify higher-risk HLHS patients during the interstage period.
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Affiliation(s)
- Alan P Wang
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Nazia Husain
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jamie Penk
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Christina Laternser
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Defne Magnetta
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Kae Watanabe
- Lillie Frank Abercrombie Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Amanda Hauck
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Ishii S. A major step towards utilization of administrative data in the field of dementia. Arch Gerontol Geriatr 2024; 121:105416. [PMID: 38548528 DOI: 10.1016/j.archger.2024.105416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
- Shinya Ishii
- Department of Medicine for Integrated Approach to Social Inclusion, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan.
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Ma KZ, Hu CJ. Trends in incidence, mortality, dynamic needs and rapid evolution of healthcare in dementia. Arch Gerontol Geriatr 2024; 121:105389. [PMID: 38448314 DOI: 10.1016/j.archger.2024.105389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Affiliation(s)
- Ke-Zong Ma
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli County, Taiwan.
| | - Chaur-Jong Hu
- Department of Neurology and Dementia Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Zhou D, Lv Y, Wang C, Li D. The early change in pH values after out-of-hospital cardiac arrest is not associated with neurological outcome at hospital discharge. Resusc Plus 2024; 18:100650. [PMID: 38711912 PMCID: PMC11070929 DOI: 10.1016/j.resplu.2024.100650] [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: 02/22/2024] [Revised: 04/10/2024] [Accepted: 04/19/2024] [Indexed: 05/08/2024] Open
Abstract
Background The association between pH values and outcome for patients after out-of-hospital cardiac arrest (OHCA) was not fully elucidated; besides, the relationship of change in pH values and neurological outcome was unknown. The aim was to explore the association of pH values as well as change in pH values and neurological outcome for OHCA cardiac patients. Methods The adult patients with non-traumatic out-of-hospital cardiac arrest, shock-refractory ventricular fibrillation or pulseless ventricular tachycardia, and at least two arterial blood gases analysis recorded after admission were included. The change in pH values is calculated as the difference between the second and first pH value, and divided by time interval got the rate of change in pH values. The primary outcome was modified Rankin Score (mRS), dichotomized to good (mRS 0-3) and poor (mRS 4-6) outcomes at hospital discharge. The independent relationship of the first pH value, second pH value, and changes in pH values with neurological outcome was investigated with multivariable logistic regression models, respectively. Results A total of 1388 adult patients were included for analysis, of which 514 (37%) had good neurological outcome. The median first pH value and second pH value after admission were 7.21 (interquartile range [IQR] 7.09-7.29) and 7.28 (IQR 7.20-7.36), respectively. The median absolute, relative change, and rate of changes in pH values were 0.08 (IQR 0.01-0.16), 1.10% (IQR 0.11-2.22%), and 0.02 (IQR 0-0.06) per hour, respectively. After adjusting for confounders, the higher first pH value (odds ratio [OR] 3.81, confidence interval [CI] 1.60-9.24, P = 0.003) and higher second pH value (OR 9.54, CI 3.45-26.87, P < 0.001) after admission were associated with good neurological outcome, respectively. The absolute (OR 1.58, CI 0.58-4.30, P = 0.368) and relative (OR 1.03, CI 0.96-1.11, P = 0.399) change as well as the rate of change (OR 0.98, CI 0.33-2.71, P = 974) in pH values were not associated with neurological outcome. Conclusions For OHCA patients, abnormality in pH values was very common, with a more acidic pH value indicating poor neurological outcome. However, the change in pH values was not associated with outcomes.
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Affiliation(s)
- Dawei Zhou
- Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yi Lv
- Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chao Wang
- Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dan Li
- Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Moreno-Torres V, Martínez-Urbistondo M, Durán-del Campo P, Tutor P, Rodríguez B, Castejón R, Mellor-Pita S. Sarcoidosis and lymphoma mortality risk: An observational study from the Spanish National Registry. J Transl Autoimmun 2024; 8:100236. [PMID: 38426202 PMCID: PMC10901907 DOI: 10.1016/j.jtauto.2024.100236] [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: 12/13/2023] [Revised: 02/18/2024] [Accepted: 02/18/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Patients with sarcoidosis have a lower survival rate than the general population, in part due to cardiovascular disease, infections and neoplasms. Our objective was to evaluate the impact of haematological neoplasms (HN) and lymphomas on sarcoidosis patient mortality in a nation-wide analysis conducted in Spain, a country with a population of 47 million. Methods Retrospective and observational comparison of the HN related deaths in sarcoidosis patients and the general Spanish population reported in the Spanish Hospital Discharge Database. To determine the impact of sarcoidosis on the risk of dying from each HN lineage, a binary logistic regression considering age, female sex, tobacco and alcohol consumption, was performed. Results In the period 2016 and 2019, 139,531 in-hospital deaths from neoplasms were certified in Spain (77 in patients with sarcoidosis). Patients with sarcoidosis died at younger age than the general Spanish population (72.9 vs 77.6, p<0.001). Sarcoidosis patients presented a higher mortality risk from HN (20.8% vs 8.9%, p=0.001, OR=2.64, 95% CI 1.52-4.59), attributable to the higher proportion of deaths from non-Hodgkin lymphoma (NHL), (9.2% vs 2.9%, p=0.006, OR= 3.33, 95% CI 1.53-7.25) from both B cell (6.6% vs 2.5%, p=0.044, OR= 2.62, 95% 1.06-6.5) and T/NK cell lineages (2.6% vs 0.3%, p=0.024, OR= 7.88, 95% CI 1.92-32.29) as well as HN with uncertain behavior and myeloproliferative disorders (2.6% vs 0.3%, p=0.018, OR= 11.88, 95% CI 2.88-49.02). The mean age of sarcoidosis patients who died from HN (63.6 vs 71.9, p=0.032) and non-Hodgkin lymphoma (56.9 vs 71, p=0.009) was lower than that of the general population. Conclusion Patients with sarcoidosis present a higher risk of premature death from HN, including NHL from B, T/NK cell lineage and myeloproliferative disorders in comparison with the general Spanish population. In addition to developing strategies that might help to attenuate their occurrence and impact, such as decreasing the immunosuppressive burden, specific early-detection programs for these conditions should be investigated and considered carefully.
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Affiliation(s)
- Víctor Moreno-Torres
- Internal Medicine Department, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHIM) Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- UNIR Health Sciences School and Medical Center, Madrid, Spain
| | - María Martínez-Urbistondo
- Internal Medicine Department, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHIM) Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Pedro Durán-del Campo
- Internal Medicine Department, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHIM) Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Pablo Tutor
- Internal Medicine Department, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHIM) Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Begoña Rodríguez
- Nuclear Medicine Department, Internal Medicine Department, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHIM) Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Raquel Castejón
- Internal Medicine Department, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHIM) Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Susana Mellor-Pita
- Internal Medicine Department, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHIM) Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Pellegrino R, Paganelli R, Di Iorio A, Bandinelli S, Moretti A, Iolascon G, Sparvieri E, Tarantino D, Tanaka T, Ferrucci L. Neutrophil, lymphocyte count, and neutrophil to lymphocyte ratio predict multimorbidity and mortality-results from the Baltimore Longitudinal Study on Aging follow-up study. GeroScience 2024; 46:3047-3059. [PMID: 38183599 PMCID: PMC11009209 DOI: 10.1007/s11357-023-01034-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/02/2023] [Indexed: 01/08/2024] Open
Abstract
Immunosenescence is the age-related changes in the immune system, namely, progressively higher levels of circulating inflammatory markers, characteristics changes of circulating immune subset cells and altered immune function. The neutrophil to lymphocyte ratio (NL ratio) has been identified as a prognostic indicator for neoplastic disease progression, in predicting chronic degenerative diseases, and as a potential indirect marker of healthy aging. This study aims to examine the longitudinal association of neutrophil, lymphocyte absolute count, and their ratio with longitudinal risk for multimorbidity and mortality. The Baltimore Longitudinal Study of Aging (BLSA) is an open observational cohort study of community-dwelling volunteers that are followed every 1-4 years depending on their age. The sample considered in the study consists of 1769 participants (5090 follow-ups) with completed data for physical examination, health history assessment, and donated a blood sample. The NL ratio increased with age and was associated with a higher risk of mortality, while a lower NL ratio was inversely correlated with multimorbidity. Neutrophils increased with aging and an increase in their absolute number predicted mortality risk. However, the absolute number of lymphocytes was associated with age only in a cross-sectional analysis. In conclusion, this study supports the importance of the NL ratio and absolute neutrophil count as markers of aging health status, and as significant predictors of all-cause mortality and multimorbidity in aging individuals. It remains to be demonstrated whether interventions contrasting these trends in circulating cells may result in improved health outcomes.
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Affiliation(s)
- Raffaello Pellegrino
- Department of Scientific Research, Off-Campus Semmelweis University, Campus Ludes, 6912, Lugano-Pazzallo, Switzerland
- Santa Chiara Institute, 73100, Lecce, Italy
| | - Roberto Paganelli
- Saint Camillus International, University of Health and Medical Sciences, Rome, Italy
| | - Angelo Di Iorio
- Department of Innovative Technologies in Medicine & Dentistry, University "G. d'Annunzio", 66100, Chieti-Pescara, Italy.
| | | | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | | | - Domiziano Tarantino
- Department of Public Health, University of Naples Federico II, 80131, Naples, Italy
| | - Toshiko Tanaka
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute On Aging, National Institutes of Health, Baltimore, MD, 21224, USA
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute On Aging, National Institutes of Health, Baltimore, MD, 21224, USA
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Moura de Araújo MF, Moreira Barros L, Moura de Araújo T, de Souza Teixeira CR, Alves de Oliveira R, Almeida Barros E, Stabnow Santos F, Pascoal LM, Pereira de Jesus Costa AC, Santos Neto M. Influence of simultaneous comorbidities on COVID-associated acute respiratory distress syndrome mortality in people with diabetes. J Taibah Univ Med Sci 2024; 19:492-499. [PMID: 38562915 PMCID: PMC10982560 DOI: 10.1016/j.jtumed.2024.03.006] [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: 06/28/2023] [Revised: 02/05/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives This study analyzed the influence of 23 comorbidities on COVID-associated acute distress respiratory syndrome (CARDS) mortality in people with a history of diabetes mellitus. Methods An observational, analytical, cross sectional study was utilized to investigate data from 6723 health services in Brazil, comprising 5433 people with diabetes. Adjusted logistic regression models for demographic factors such as age, sex, and race were used to analyze the association between CARDS mortality and comorbidities. Results Persons with two (p < 0.001), three (p < 0.001), four (p < 0.001), and five (p < 0.001) simultaneous comorbidities had a higher chance of dying. We identified that diabetes patients who had concomitant metabolic diseases (p = 0.019), neurological disorders (p < 0.001), or were smokers (p < 0.001) had a higher predicted mortality risk based on CADRS. Conclusion The number of comorbidities plays a determining role in CARDS mortality in people with diabetes, especially those who suffer from smoking and neurological diseases simultaneously.
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Affiliation(s)
| | - Lívia Moreira Barros
- Health Science Institute, University for International Integration of the Afro Brazilian Lusophony (UNILAB), Redenção, Brazil
| | - Thiago Moura de Araújo
- Health Science Institute, University for International Integration of the Afro Brazilian Lusophony (UNILAB), Redenção, Brazil
| | - Carla R. de Souza Teixeira
- Ribeirão Preto School of Nursing and World Health Organization Collaborating Center, University of São Paulo, Brazil
| | - Rayanne Alves de Oliveira
- Center for Social Science, Health and Technology, Federal University of Maranhão (UFMA), Imperatriz, Brazil
| | - Ezequiel Almeida Barros
- Center for Social Science, Health and Technology, Federal University of Maranhão (UFMA), Imperatriz, Brazil
| | - Floriacy Stabnow Santos
- Center for Social Science, Health and Technology, Federal University of Maranhão (UFMA), Imperatriz, Brazil
| | - Livia Maia Pascoal
- Center for Social Science, Health and Technology, Federal University of Maranhão (UFMA), Imperatriz, Brazil
| | | | - Marcelino Santos Neto
- Center for Social Science, Health and Technology, Federal University of Maranhão (UFMA), Imperatriz, Brazil
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Strandberg TE, Pitkälä KH, Kivimäki M. Sleep duration in midlife and old age and risk of mortality over a 48-year follow-up: The Helsinki businessmen study (HBS) cohort. Maturitas 2024; 184:107964. [PMID: 38471293 DOI: 10.1016/j.maturitas.2024.107964] [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: 11/02/2023] [Revised: 02/19/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVES Both short and long sleep duration have been associated with increased mortality, but there are few truly long-term studies. STUDY DESIGN This is a cohort study of 2504 men born between 1919 and 1934. In 1974-1975 (mean age 48), participants underwent baseline clinical examinations and sleep duration assessments. A follow-up examination took place 35 years later, in 2010 (mean age 82). MAIN OUTCOME MEASURE All-cause mortality data from baseline and from old age were collected through to December 31, 2022. RESULTS At baseline, short sleep duration (≤6 h per night), normal sleep duration (>6 and ≤ 8 h), and long sleep duration (>8 h) was reported by 266, 2019 and 219 men, respectively. Men with short sleep duration had higher levels of smoking, alcohol consumption, body mass index, and poorer self-rated health than those with normal sleep duration. During the 48-year follow-up, 2287 men died. The unadjusted hazard ratio for mortality was 1.20 (95 % confidence interval [CI] 1.05-1.37) for short compared with normal sleep duration, but this association vanished after adjustments (1.01, 95 % CI 0.87-1.17). In old age, the corresponding hazard ratios were 1.41 (1.16-1.72) and 1.19 (0.94-1.51) for short sleep duration and 1.33 (1.09-1.63) and 1.31 (1.02-1.67) for long sleep duration. CONCLUSIONS In a comprehensive lifespan follow-up, the modestly increased mortality among men with short sleep duration in midlife was attributed to unhealthy lifestyle factors. In old age both long and short sleep duration seemed to be associated with modestly increased mortality. CLINICALTRIALS gov identifier for the HBS: NCT02526082.
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Affiliation(s)
- Timo E Strandberg
- University of Helsinki and Helsinki University Hospital, PO Box 340, 00029 Helsinki, Finland.
| | - Kaisu H Pitkälä
- University of Helsinki and Helsinki University Hospital, PO Box 340, 00029 Helsinki, Finland.
| | - Mika Kivimäki
- University of Helsinki and Helsinki University Hospital, PO Box 340, 00029 Helsinki, Finland; UCL Brain Sciences, University College London, London, UK.
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Ung GA, Nguyen KH, Hui A, Wong ND, Dineen EH. Impact of cardiorespiratory fitness and diabetes status on cardiovascular disease and all-cause mortality: An NHANES retrospective cohort study. Am Heart J Plus 2024; 42:100395. [PMID: 38689681 PMCID: PMC11059329 DOI: 10.1016/j.ahjo.2024.100395] [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] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/04/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024]
Abstract
High cardiorespiratory fitness (CRF) is associated with decreased mortality in people with pre-diabetes (pre-DM) and diabetes mellitus (DM); however, the degree to which CRF attenuates the risk of cardiovascular disease (CVD)-related and all-cause mortality is unclear. Study objective We examined the impact of CRF status on CVD-related morbidity and all-cause mortality in non-DM, Pre-DM, and DM populations. Design and setting 13,968 adults from the Third US National Health and Nutrition Examination Survey (NHANES III) were stratified into non-DM, pre-DM, or DM groups based on HbA1c levels. VO2Max was calculated using the Fitness Registry and Importance of Exercise: A National Database (FRIEND) equation. Participants Participants were categorized into tertiles of VO2Max; first VO2Max tertile was the lowest VO2Max and third VO2Max tertile was the highest. Main outcome measures Cox regression was used to analyze the relationship between glycemic levels, VO2Max, and CVD-related and all-cause mortality. Results Those with DM in the highest fitness tertile had CVD (HR 0.13; 95 % CI 0.06, 0.27; p < 0.0001) and all cause (HR 0.28; 95 % CI 0.21, 0.38; p < 0.0001) mortality rates as low or lower than those with pre-DM (CVD HR 1.02; 95 % CI 0.78, 1.33 p < 0.892; all cause HR 0.96; 95 % CI 0.83, 1.12; p < 0.5496) or non-DM (CVD HR 0.65; 95 % CI 0.52, 0.80; p < 0.0001; all cause HR 0.61; 95 % CI 0.55, 0.68; p < 0.0001) at lower fitness levels. Regardless of DM status, there was lower all-cause mortality with higher CRF levels. Conclusions Higher fitness levels in DM individuals are associated with total and CVD mortality rates as low or lower than those without DM with lower fitness.
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Affiliation(s)
- Gwendolyn A. Ung
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Pomona, CA, United States of America
| | - Kevin H. Nguyen
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Pomona, CA, United States of America
| | - Alvin Hui
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific-Pomona, CA, United States of America
| | - Nathan D. Wong
- Division of Cardiology, University of California, Irvine School of Medicine, Irvine, CA, United States of America
| | - Elizabeth H. Dineen
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL, United States of America
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Franchini M, Casadevall A, Cruciani M, Joyner MJ, Pirofski LA, Senefeld JW, Shoham S, Sullivan DJ, Focosi D. Convalescent plasma: An unexpected new therapeutic option for critically ill COVID-19 patients coming from the past. J Clin Anesth 2024; 94:111411. [PMID: 38335905 DOI: 10.1016/j.jclinane.2024.111411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/08/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Massimo Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy.
| | - Arturo Casadevall
- Johns Hopkins Bloomberg School of Public Health, Department of Molecular Microbiology and Immunology, Baltimore, MD, USA
| | - Mario Cruciani
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Liise-Anne Pirofski
- Division of Infectious Diseases, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Jonathon W Senefeld
- Department of Kinesiology and Community Healthy, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Shmuel Shoham
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David J Sullivan
- Johns Hopkins Bloomberg School of Public Health, Department of Molecular Microbiology and Immunology, Baltimore, MD, USA
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Italy
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Braz LG, Braz JRC, Tiradentes TAA, Soares JVA, Corrente JE, Modolo NSP, do Nascimento Junior P, Braz MG. Global neonatal perioperative mortality: A systematic review and meta-analysis. J Clin Anesth 2024; 94:111407. [PMID: 38325248 DOI: 10.1016/j.jclinane.2024.111407] [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: 08/10/2023] [Revised: 12/05/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
STUDY OBJECTIVE There are large differences in health care among countries. A higher perioperative mortality rate (POMR) in neonates than in older children and adults has been recognized worldwide. The aim of this study was to provide a systematic review of published 24-h and 30-day POMRs in neonates from 2011 to 2022 in countries with different Human Development Index (HDI) levels. DESIGN AND SETTING A systematic review with a meta-analysis of studies that reported 24-h and 30-day POMRs in neonates was performed. We searched the databases from January 2011 to July 30, 2022. MEASUREMENTS The POMRs (per 10,000 procedures under anesthesia) were analyzed according to country HDI. The HDI levels ranged from 0 to 1, representing the lowest and highest levels, respectively (very-high-HDI: ≥ 0.800, high-HDI: 0.700-0.799, medium-HDI: 0.550-0.699, and low-HDI: < 0.550). The magnitude of the POMRs by country HDI was studied using meta-analysis. MAIN RESULTS Eighteen studies from 45 countries were included. The 24-h (n = 96 deaths) and 30-day (n = 459 deaths) POMRs were analyzed from 33,729 anesthetic procedures. The odds ratios (ORs) of the 24-h POMR in low-HDI countries were higher than those in very-high- (OR 8.4, 95% CI 1.7-40.4; p = 0.008), high- (OR 7.3, 95% CI 2.2-24.4; p = 0.001) and medium-HDI countries (OR 7.7, 95% CI 3.1-18.7; p < 0.0001) but with no odds differences between very-high- and high-HDI countries (p = 0.879), very-high- and medium-HDI countries (p = 0.915) and high- and medium-HDI countries (p = 0.689). The odds of a 30-day POMR in low-HDI countries were higher than those in very-high-HDI countries (OR 6.9, 95% CI 1.9-24.6; p = 0.002) but not in high-HDI countries (OR 1.4, 95% CI 0.6-3.0; p = 0.396). CONCLUSIONS The review demonstrated very high global POMRs in a surgical population of neonates independent of the country HDI level. We identified differences in 24-h and 30-day POMRs between low-HDI countries and other countries with higher HDI levels.
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Affiliation(s)
- Leandro G Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil.
| | - Jose Reinaldo C Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Teofilo Augusto A Tiradentes
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Joao Vitor A Soares
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Jose E Corrente
- Department of Biostatistics, Institute of Biosciences, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Norma Sueli P Modolo
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Paulo do Nascimento Junior
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Mariana G Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
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Zeng L, Zhong Y, Chen Y, Zhou M, Zhao S, Wu J, Dong B, Dou Q. Effect of long-term care insurance in a pilot city of China: Health benefits among 12,930 disabled older adults. Arch Gerontol Geriatr 2024; 121:105358. [PMID: 38341956 DOI: 10.1016/j.archger.2024.105358] [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: 10/26/2023] [Revised: 01/18/2024] [Accepted: 01/29/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND The surge of disabled older people have brought enormous burdens to society. The aim of this study was to examine the impact of long-term care insurance (LTCI) implementation on mortality and changes in physical ability among disabled older adults. METHODS This was a prospective observational study based on data from the government-led LTCI program in a pilot city of China from 2017 to 2021. Administrative data included the application survey of activities of daily living (ADL), the baseline characteristics and all-cause mortality. Return visit surveys of ADL were conducted between August 2021 and December 2021. A regression discontinuity model was used to analyze the impact of LTCI on mortality. RESULTS A total of 12,930 individuals older than 65 years were included in this study, and 10,572 individuals were identified with severe disability and participated in the LTCI program. LTCI implementation significantly reduced mortality by 5.10 % (95 % CI, -9.30 % to -0.90 %) and extended the survival time by 33.74 days (95 % CI, 13.501 to 53.970). The ADL scores of the LTCI group dropped by 2.5 points on average, while the ADL scores of those did not participated in LTCI dropped by 25.0 points. The heterogeneity analysis revealed that the impact of LTCI on mortality reduction was more significant among females, individuals of lower age, those who were married, cared for by family members, and who lived in districts with rich care resources. CONCLUSIONS LTCI implementation had a favorable impact on the mortality and physical ability of participants.
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Affiliation(s)
- Lijun Zeng
- Laboratory of Heart Valve Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Zhong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuxiao Chen
- School of Politics and Public Administration, Zhengzhou University, Zhengzhou, China
| | - Mei Zhou
- School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China
| | - Shaoyang Zhao
- School of Economics, Sichuan University, Chengdu, China
| | - Jinhui Wu
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu 610041, China
| | - Birong Dong
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu 610041, China
| | - Qingyu Dou
- National Clinical Research Center for Geriatrics, Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu 610041, China.
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Hassan AR, Itsura PM, Rosen BP, Covens AL, Shaffi AF, Odongo EB, Mburu AW, Smith WL, Moturi SK, Too RK, Ayeah CM, Tonui PK. Mortality factors in high and ultra-high-risk gestational trophoblastic neoplasia at moi teaching & referral hospital: A decade-long observation in kenya. Gynecol Oncol Rep 2024; 53:101392. [PMID: 38694708 PMCID: PMC11061241 DOI: 10.1016/j.gore.2024.101392] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 05/04/2024] Open
Affiliation(s)
- Amina R. Hassan
- Moi University/ Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Peter M. Itsura
- Moi University/ Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Allan L. Covens
- University of Toronto, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Afrin F. Shaffi
- Moi University/ Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | | | - Wilmot L. Smith
- Moi University/ Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Sharon K. Moturi
- Moi University/ Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Ronald K. Too
- Moi University/ Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Chia M. Ayeah
- Moi University/ Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Philiph K. Tonui
- Moi University/ Moi Teaching and Referral Hospital, Eldoret, Kenya
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Sanivarapu RR, Arjun S, Otero J, Munshi R, Akella J, Iqbal J, Zaki K. In-hospital outcomes of pulmonary hypertension in HIV patients: A population based cohort study. Int J Cardiol 2024; 403:131900. [PMID: 38403203 DOI: 10.1016/j.ijcard.2024.131900] [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: 12/21/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Pulmonary hypertension (PH) is a known complication of HIV infection. Outcomes of HIV-infected patients with PH (HIV-PH) have not been well established. We aim to assess various in-hospital outcomes such as mortality, resource utilization, and health care burden associated with HIV patients with concurrent PH. MATERIALS AND METHODS We used National Inpatient Sample (NIS) 2015 Quarter 4 through 2019 for this study. We identified patients using International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnostic codes with both HIV and pulmonary hypertension. Cohorts were weighted by NIS-provided algorithm which allows for national estimates. Univariate and multivariate regression analyses were used to determine odds ratios. RESULTS A total of 910,120 patients were identified with HIV, among which 28,175 (3.19%) were identified to have concurrent PH. When compared to HIV alone, HIV-PH patients were older (54.53(±11.61) vs. 49.44(±13.11), predominantly black (64.45% vs. 51.8%%), more often male (57.2%), all p < 0.001. HIV-PH cohort had higher comorbidities with higher Charlson Comorbidity Index (CCI) (7.07(±3.53) vs. 5.17(±3.65), had slightly longer LOS [adjusted mean difference (aMD) 0.79], higher healthcare burden corrected for inflation (aMD $17,065); all p < 0.001. In univariate regression analysis, patients with HIV-PH had significantly higher rates of developing heart failure (aOR 10.44), cardiogenic shock (aOR 5.67), cardiomyopathy (aOR 4.97), in-hospital cardiac arrest (aOR 1.94), respiratory failure (aOR 3.29), invasive mechanical ventilation (aOR 1.71), aspiration pneumonia (aOR 1.29), acute kidney injury (aOR 2.14). Lastly, patients with HIV-PH had higher in-hospital mortality within 30 days of admission (aOR 1.28) & overall in-hospital mortality (aOR 1.23); p < 0.005). CONCLUSION In patients with concomitant HIV and PH, there is a higher burden of comorbidities, and is associated with worse outcomes including mortality. Through this study, we highlight outcomes that will better risk stratifying patients with concurrent HIV and PH.
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Affiliation(s)
- Raghavendra R Sanivarapu
- Department of Pulmonary & Critical Care Medicine, Texas Tech University Health Science Center, Permian Basin, TX, United States of America.
| | - Shiva Arjun
- Department of Pulmonary & Critical Care Medicine, Nassau University Medical Center, East Meadow, NY, United States of America
| | - Jonathan Otero
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, NY, United States of America
| | - Rez Munshi
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, NY, United States of America
| | - Jagadish Akella
- Department of Pulmonary & Critical Care Medicine, Nassau University Medical Center, East Meadow, NY, United States of America
| | - Javed Iqbal
- Department of Pulmonary & Critical Care Medicine, Nassau University Medical Center, East Meadow, NY, United States of America
| | - Khawaja Zaki
- Department of Pulmonary & Critical Care Medicine, Nassau University Medical Center, East Meadow, NY, United States of America
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Wang Z, Lu B, Wu M, Gu T, Xu M, Tang F, Zhang L, Bai S, Zhong S, Yang Q. Reduced sensitivity to thyroid hormones is associated with lung function in euthyroid individuals. Heliyon 2024; 10:e30309. [PMID: 38711649 PMCID: PMC11070858 DOI: 10.1016/j.heliyon.2024.e30309] [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: 12/28/2023] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/08/2024] Open
Abstract
Background The thyroid gland exhibits a subtle interconnection with the lungs. We further investigated the correlation between thyroid hormone sensitivity and lung function in euthyroid individuals. Methods Data on spirometry and mortality for participants aged 19-79 years were extracted from the NHANES database. Obstructive lung function was defined as a forced expiratory volume in 1 s to forced vital capacity ratio (FEV1/FVC) < 0.70, while restrictive lung function was considered when FEV1/FVC ≥0.70 and baseline FVC <80 % predicted. Central and peripheral sensitivities to thyroid hormones were mainly evaluated by Thyroid Feedback Quantile-based Index (TFQI) and Free Triiodothyronine/Free thyroxine (FT3/FT4) ratio. Logistic regression and subgroup analysis were used to examine potential associations between thyroid hormone sensitivity and lung function. The association between TFQI and all-cause mortality risk was also investigated. Results A total of 6539 participants were analyzed, 900 with obstructive lung function and 407 with restrictive lung function. The prevalence of impaired lung function, both obstructive and restrictive, increased with higher TFQI levels. Logistic regression analysis showed that increased TFQI and decreased FT3/FT4 levels were independent risk factors for obstructive and restrictive lung function (P < 0.05). After adjusting for the impact of lung function, TFQI (HR = 1.25, 95 % CI 1.00-1.56, P = 0.048) was an independent risk factor for all-cause mortality. Conclusion Reduced sensitivity to thyroid hormones has been linked to impaired lung function. TFQI and FT3/FT4 are potential epidemiological tools to quantify the role of central and peripheral thyroid resistance in lung function.
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Affiliation(s)
- Zhaoxiang Wang
- Department of Endocrinology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, 215300, China
| | - Bing Lu
- Department of Endocrinology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, 215300, China
| | - Menghuan Wu
- Department of Cardiology, Xuyi People's Hospital, Xuyi, Jiangsu, 211700, China
| | - Tian Gu
- Department of Endocrinology, Affiliated Wujin Hospital of Jiangsu University, Changzhou, Jiangsu, 213017, China
- Departmant of Endocrinology, Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, 213017, China
| | - Mengjiao Xu
- Department of Endocrinology, Affiliated Wujin Hospital of Jiangsu University, Changzhou, Jiangsu, 213017, China
- Departmant of Endocrinology, Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, 213017, China
| | - Fengyan Tang
- Department of Endocrinology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, 215300, China
| | - Li Zhang
- Department of Endocrinology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, 215300, China
| | - Song Bai
- Department of Cardiology, Xuyi People's Hospital, Xuyi, Jiangsu, 211700, China
| | - Shao Zhong
- Department of Endocrinology, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, Jiangsu, 215300, China
| | - Qichao Yang
- Department of Endocrinology, Affiliated Wujin Hospital of Jiangsu University, Changzhou, Jiangsu, 213017, China
- Departmant of Endocrinology, Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, 213017, China
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Dong L, Liu P, Qi Z, Lin J, Duan M. Development and validation of a machine-learning model for predicting the risk of death in sepsis patients with acute kidney injury. Heliyon 2024; 10:e29985. [PMID: 38699001 PMCID: PMC11064448 DOI: 10.1016/j.heliyon.2024.e29985] [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: 09/22/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/05/2024] Open
Abstract
The mortality rate of patients with sepsis-induced acute kidney injury (S-AKI) is notably elevated. The initial categorization of prognostic indicators has a beneficial impact on elucidating and enhancing disease outcomes. This study aimed to predict the mortality risk of S-AKI patients by employing machine learning techniques. The sample size determined by a four-step procedure yielded 1508 samples. The research design necessitated the inclusion of individuals with S-AKI from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The patients were initially admitted to the Intensive Care Unit (ICU) for their hospital stay. Additionally, these patients (aged from 18 to 89 years old) had encountered S-AKI on the day of their admittance. Forty-two predictive factors were analyzed, with hospitalization death as the outcome variable. The training set (4001 cases) consisted of 70 % of the participants, and the remaining (1714 cases) participants were allocated to the validation set. Furthermore, an additional validation set (MIMIC-III) consisted of 1757 patients from the MIMIC-III database. Moreover, an external validation set from the Intensive Care Department of Beijing Friendship Hospital (BFH) comprised 72 patients. Six machine learning models were employed in the prediction, namely the logistic, lasso, rpart, random forest, xgboost, and artificial neural network models. The comparative efficacy of the newly developed model in relation to the APACHE II model for predicting mortality risk was also assessed. The XGBoost model exhibited a superior performance with the training set. With the internal validation set and the two external validation sets (MIMIC-III and BFH), the xgboost algorithm demonstrated the highest performance. Meanwhile, APACHE II performed poorly at predicting the mortality risk with the BFH validation set. The mortality risk was influenced by three primary clinical parameters: urine volume, lactate, and Glasgow Coma Scale (GCS) score. Thus, we developed a prediction model for the risk of death among S-AKI patients that has an improved performance compared to previous models and is a potentially valuable tool for S-AKI prediction and treatment in the clinic.
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Affiliation(s)
- Lei Dong
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Pei Liu
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Zhili Qi
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jin Lin
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Raktong W, Sawaddisan R, Peeyananjarassri K, Suwanrath C, Geater A. Predictors and a scoring model for maternal near-miss and maternal death in Southern Thailand: a case-control study. Arch Gynecol Obstet 2024:10.1007/s00404-024-07539-6. [PMID: 38713295 DOI: 10.1007/s00404-024-07539-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE To identify predictors and develop a scoring model to predict maternal near-miss (MNM) and maternal mortality. METHODS A case-control study of 1,420 women delivered between 2014 and 2020 was conducted. Cases were women with MNM or maternal death, controls were women who had uneventful deliveries directly after women in the cases group. Antenatal characteristics and complications were reviewed. Multivariate logistic regression and Akaike information criterion were used to identify predictors and develop a risk score for MNM and maternal mortality. RESULTS Predictors for MNM and maternal mortality (aOR and score for predictive model) were advanced age (aOR 1.73, 95% CI 1.25-2.39, 1), obesity (aOR 2.03, 95% CI 1.22-3.39, 1), parity ≥ 3 (aOR 1.75, 95% CI 1.27-2.41, 1), history of uterine curettage (aOR 5.13, 95% CI 2.47-10.66, 3), history of postpartum hemorrhage (PPH) (aOR 13.55, 95% CI 1.40-130.99, 5), anemia (aOR 5.53, 95% CI 3.65-8.38, 3), pregestational diabetes (aOR 5.29, 95% CI 1.27-21.99, 3), heart disease (aOR 13.40, 95%CI 4.42-40.61, 5), multiple pregnancy (aOR 5.57, 95% CI 2.00-15.50, 3), placenta previa and/or placenta-accreta spectrum (aOR 48.19, 95% CI 22.75-102.09, 8), gestational hypertension/preeclampsia without severe features (aOR 5.95, 95% CI 2.64-13.45, 4), and with severe features (aOR 16.64, 95% CI 9.17-30.19, 6), preterm delivery <37 weeks (aOR 1.65, 95%CI 1.06-2.58, 1) and < 34 weeks (aOR 2.71, 95% CI 1.59-4.62, 2). A cut-off score of ≥4 gave the highest chance of correctly classified women into high risk group with 74.4% sensitivity and 90.4% specificity. CONCLUSIONS We identified predictors and proposed a scoring model to predict MNM and maternal mortality with acceptable predictive performance.
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Affiliation(s)
- Wipawan Raktong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Rapphon Sawaddisan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
| | - Krantarat Peeyananjarassri
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chitkasaem Suwanrath
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Alan Geater
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla, University, Songkhla, Thailand
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Sundet M, Sundin U, Godø A, Sydnes K, Valland H, Sexton J, Martinsen M, Paus M, Rasmussen HS, Lillegraven S. Use of direct-acting anticoagulants (DOACs) delays surgery and is associated with increased mortality in hip fracture patients. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02532-9. [PMID: 38713220 DOI: 10.1007/s00068-024-02532-9] [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: 02/22/2024] [Accepted: 04/19/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Treatment with direct-acting oral anticoagulants (DOACs) is increasing among hip-fracture patients, with accompanying safety concerns regarding spinal anesthesia (SA). The aim of this study was to investigate if DOAC use is associated with increased waiting time before surgery, increased mortality, or other adverse events. METHODS Registry data on surgically treated hip-fracture cases at a single hospital between 2015 and 2021 were analyzed. Multivariable regression analyses were performed with DOAC-status and choice of anesthesia as exposures, and waiting time, length of stay, transfusion, and mortality as outcomes. RESULTS 2885 cases were included, 467 patients (16%) were using DOACs. DOAC users were older (86.3 vs. 82.2 years, p < 0.001), had a higher Charlson Comorbidity Index (2.1 vs. 1.5, p < 0.001) and had longer median time to surgery than non-DOAC cases (36 h vs 17 h, p < 0.001). General anesthesia (GA) was used in 19.3% of DOAC patients and in 3.0% of non-DOAC patients. DOAC-patients had an increased risk of one-month mortality (Adjusted Odds Ratio (AOR) 1.6 (1.1-2.3)) and one-year mortality (AOR 1.4 (1.1-1.8)). There were no differences in risk of blood transfusion. Patients on DOAC operated under GA had a lower risk of one-year mortality (AOR 0.5 (0.3-0.9)), but a similar one-month mortality to DOAC-patients operated under SA. CONCLUSION DOAC users had a longer waiting time to surgery, indicating postponement of surgery due to concerns of the safety of SA. The clinical practice should be changed to allow earlier surgery for DOAC patients.
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Affiliation(s)
- Mads Sundet
- Department of Orthopedic Surgery, Diakonhjemmet Hospital, Vinderen, Box 23, N-0319, Oslo, Norway.
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
| | - Ulf Sundin
- Department of Orthopedic Surgery, Diakonhjemmet Hospital, Vinderen, Box 23, N-0319, Oslo, Norway
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Aasmund Godø
- Department of Anesthesia, Diakonhjemmet Hospital, Vinderen, Box 23, N-0319, Oslo, Norway
| | - Kristian Sydnes
- Department of Orthopedic Surgery, Diakonhjemmet Hospital, Vinderen, Box 23, N-0319, Oslo, Norway
| | - Haldor Valland
- Department of Orthopedic Surgery, Diakonhjemmet Hospital, Vinderen, Box 23, N-0319, Oslo, Norway
| | - Joseph Sexton
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Mette Martinsen
- Department of Orthopedic Surgery, Diakonhjemmet Hospital, Vinderen, Box 23, N-0319, Oslo, Norway
| | - Maren Paus
- Department of Orthopedic Surgery, Diakonhjemmet Hospital, Vinderen, Box 23, N-0319, Oslo, Norway
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hans Schmidt Rasmussen
- Department of Anesthesia, Diakonhjemmet Hospital, Vinderen, Box 23, N-0319, Oslo, Norway
| | - Siri Lillegraven
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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Guedes M, Gathara D, López-Hernández I, Pérez-Crespo PMM, Pérez-Rodríguez MT, Sousa A, Plata A, Reguera-Iglesias JM, Boix-Palop L, Dietl B, Blanco JS, Castillo CA, Galán-Sánchez F, Kindelán CN, Jover-Saenz A, Aguirre JG, Alemán AA, Ciordia TM, Del Arco Jiménez A, Fernandez-Suarez J, Lopez-Cortes LE, Rodríguez-Baño J. Differences in clinical outcomes of bloodstream infections caused by Klebsiella aerogenes, Klebsiella pneumoniae and Enterobacter cloacae: a multicentre cohort study. Ann Clin Microbiol Antimicrob 2024; 23:42. [PMID: 38711045 DOI: 10.1186/s12941-024-00700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/27/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Klebsiella aerogenes has been reclassified from Enterobacter to Klebsiella genus due to its phenotypic and genotypic similarities with Klebsiella pneumoniae. It is unclear if clinical outcomes are also more similar. This study aims to assess clinical outcomes of bloodstreams infections (BSI) caused by K. aerogenes, K. pneumoniae and Enterobacter cloacae, through secondary data analysis, nested in PRO-BAC cohort study. METHODS Hospitalized patients between October 2016 and March 2017 with monomicrobial BSI due to K. aerogenes, K. pneumoniae or E. cloacae were included. Primary outcome was a composite clinical outcome including all-cause mortality or recurrence until 30 days follow-up. Secondary outcomes were fever ≥ 72 h, persistent bacteraemia, and secondary device infection. Multilevel mixed-effect Poisson regression was used to estimate the association between microorganisms and outcome. RESULTS Overall, 29 K. aerogenes, 77 E. cloacae and 337 K. pneumoniae BSI episodes were included. Mortality or recurrence was less frequent in K. aerogenes (6.9%) than in E. cloacae (20.8%) or K. pneumoniae (19.0%), but statistical difference was not observed (rate ratio (RR) 0.35, 95% CI 0.08 to 1.55; RR 0.42, 95% CI 0.10 to 1.71, respectively). Fever ≥ 72 h and device infection were more common in K. aerogenes group. In the multivariate analysis, adjusted for confounders (age, sex, BSI source, hospital ward, Charlson score and active antibiotic therapy), the estimates and direction of effect were similar to crude results. CONCLUSIONS Results suggest that BSI caused by K. aerogenes may have a better prognosis than E. cloacae or K. pneumoniae BSI.
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Affiliation(s)
- Mariana Guedes
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Departamento de Medicina, Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Seville, Spain.
- Infection and Antimicrobial Resistance Control and Prevention Unit, Hospital Epidemiology Centre, Centro Hospitalar Universitário São João, Porto, Portugal.
| | - David Gathara
- London School of Hygiene and Tropical Medicine, MARCH Centre, London, UK
| | - Inmaculada López-Hernández
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Departamento de Medicina, Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Seville, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - María Teresa Pérez-Rodríguez
- Unidad de Enfermedades Infecciosas, Departamento de Medicina Interna, Complexo Hospitalario Universitario de Vigo/Galicia Sur Health Research Institute, Vigo, Spain
| | - Adrian Sousa
- Unidad de Enfermedades Infecciosas, Departamento de Medicina Interna, Complexo Hospitalario Universitario de Vigo/Galicia Sur Health Research Institute, Vigo, Spain
| | - Antonio Plata
- Servicio de Enfermedades Infecciosas, Hospital Regional Universitario de Málaga, IBIMA Málaga, Málaga, Spain
| | - Jose María Reguera-Iglesias
- Servicio de Enfermedades Infecciosas, Hospital Regional Universitario de Málaga, IBIMA Málaga, Málaga, Spain
| | - Lucía Boix-Palop
- Servicio de Enfermedades Infecciosas, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Beatriz Dietl
- Servicio de Enfermedades Infecciosas, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Juan Sevilla Blanco
- Unidad de Enfermedades Infecciosas y Microbiologia Clinica, Hospital Universitario Jerez De La Frontera, Jerez De La Frontera, Cádiz, Spain
| | - Carlos Armiñanzas Castillo
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Fátima Galán-Sánchez
- Unidad de Gestión Clínica de Microbiología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Clara Natera Kindelán
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofia, Cordoba, Spain
| | - Alfredo Jover-Saenz
- Unidad de Infección Nosocomial, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | | | - Ana Alemán Alemán
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario de Burgos, Burgos, Spain
| | - Teresa Marrodán Ciordia
- Departamento de Microbiología Clínica, Complejo Asistencial Universitario de León (CAULE), León, Spain
| | - Alfonso Del Arco Jiménez
- Grupo Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Spain
| | - Jonathan Fernandez-Suarez
- Unidad de Microbiología, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Luis Eduardo Lopez-Cortes
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Departamento de Medicina, Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Seville, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Departamento de Medicina, Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Seville, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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Osborne NJ, Amoatey P, Selvey L, Phung D. Temporal changes in temperature-related mortality in relation to the establishment of the heat-health alert system in Victoria, Australia. Int J Biometeorol 2024:10.1007/s00484-024-02691-9. [PMID: 38709342 DOI: 10.1007/s00484-024-02691-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/08/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024]
Abstract
Extreme heat alerts are the most common form of weather forecasting services used in Australia, yet very limited studies have documented their effectiveness in improving health outcomes. This study aimed to examine the temporal changes in temperature-related mortality in relation to the activation of the heat-health alert and response system (HARS) in the State of Victoria, Australia. We examined the relationship between temperatures and mortality using quasi-Poisson regression and the distributed lag non-linear model (dlnm) and compared the temperature-mortality association between the two periods: period 1- prior-HARS (1992-2009) and period 2- post-HARS (2010-2019). Since the HARS heavily weights heatwave effects, we also compared the main effects of heatwave events between the two periods. The heatwaves were defined for three levels, including 3 consecutive days at 97th, 98th, and 99th percentiles. We also controlled the potential confounding effect of seasonality by including a natural cubic B-spline of the day of the year with equally spaced knots and 8 degrees of freedom per year. The exposure-response curve reveals the temperature mortality was reduced in period 2 in comparison with period 1. The relative risk ratios (RRR) of Period 2 over Period 1 were all less than one and gradually decreased from 0.86 (95% CI, 0.72-1.03) to 0.64 (95% CI, 0.33-1.22), and the differences in attributable risk percent increased from 13.2 to 25.3%. The reduction in the risk of heatwave-related deaths decreased by 3.4% (RRp1 1.068, 95% CI, 1.024-1.112 versus RRp2 1.034, 95% CI, 0.986-1.082) and 10% (RRp1 1.16, 95% CI, 1.10-1.22 versus RRp2 1.06, 95% CI, 1.002-1.119) for all groups of people. The study indicated a decrease in heat-related mortality following the operation of HARS in Victoria under extreme heat and high-intensity heatwaves conditions. Further studies could investigate the extent of changes in mortality among populations of differing socio-economic groups during the operation of the heat-health alert system.
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Affiliation(s)
- Nicholas J Osborne
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
- Queensland Alliance for Environmental Health Sciences, University of Queensland, 266 Herston Rd, 4006, Herston, QLD, Australia
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
- European Centre for Environment and Human Health (ECEHH), University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, UK
| | - Patrick Amoatey
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Linda Selvey
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Dung Phung
- School of Public Health, University of Queensland, Brisbane, QLD, Australia.
- Queensland Alliance for Environmental Health Sciences, University of Queensland, 266 Herston Rd, 4006, Herston, QLD, Australia.
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Tosounidis T, Chalidis B. Management of geriatric acetabular fractures: Contemporary treatment strategies. World J Clin Cases 2024; 12:2151-2156. [DOI: 10.12998/wjcc.v12.i13.2151] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/15/2024] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
Acetabular fractures in the geriatric population are typically low-energy fractures resulting from a fall from standing height. Compromised bone quality in the elderly, as well as this population’s concomitant medical comorbidities, render the management of such fractures challenging and controversial. Non-operative management remains the mainstay of treatment, although such a choice is associated with numerous and serious complications related to both the hip joint as well as the general condition of the patient. On the other hand, operatively treating acetabular fractures (e.g., with osteosynthesis or total hip arthroplasty) is gaining popularity. Osteosynthesis can be performed with open reduction and internal fixation or with minimally invasive techniques. Total hip arthroplasty could be performed either in the acute phase combined with osteosynthesis or as a delayed procedure after a period of non-operative management or after failed osteosynthesis of the acetabulum. Regardless of the implemented treatment, orthogeriatric co-management is considered extremely crucial, and it is currently one of the pillars of a successful outcome after an acetabular fracture.
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Affiliation(s)
- Theodoros Tosounidis
- Academic Department of Orthopaedic Surgery, Heraklion University Hospital, University of Crete, Greece, Heraklion 71500, Greece
| | - Byron Chalidis
- 1st Department of Orthopaedic, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
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Jieru P, Zhang S, Cai L, Long W, Wang Y, Zhang L, Dong Y, Zhang W, Liao J, Yang C. Dietary choline intake and health outcomes in U.S. adults: exploring the impact on cardiovascular disease, cancer prevalence, and all-cause mortality. J Health Popul Nutr 2024; 43:59. [PMID: 38711145 DOI: 10.1186/s41043-024-00528-0] [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] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/16/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Choline, an indispensable nutrient, plays a pivotal role in various physiological processes. The available evidence regarding the nexus between dietary choline intake and health outcomes, encompassing cardiovascular disease (CVD), cancer, and all-cause mortality, is limited and inconclusive. This study aimed to comprehensively explore the relationship between dietary choline intake and the aforementioned health outcomes in adults aged > 20 years in the U.S. METHODS This study utilized data from the National Health and Nutrition Examination Survey between 2011 and 2018. Dietary choline intake was evaluated using two 24-h dietary recall interviews. CVD and cancer status were determined through a combination of standardized medical status questionnaires and self-reported physician diagnoses. Mortality data were gathered from publicly available longitudinal Medicare and mortality records. The study utilized survey-weighted logistic and Cox regression analyses to explore the associations between choline consumption and health outcomes. Restricted cubic spline (RCS) analysis was used for dose‒response estimation and for testing for nonlinear associations. RESULTS In our study of 14,289 participants (mean age 48.08 years, 47.71% male), compared with those in the lowest quintile (Q1), the adjusted odds ratios (ORs) of CVD risk in the fourth (Q4) and fifth (Q5) quintiles of choline intake were 0.70 (95% CI 0.52, 0.95) and 0.65 (95% CI 0.47, 0.90), respectively (p for trend = 0.017). Each 100 mg increase in choline intake was associated with a 9% reduced risk of CVD. RCS analysis revealed a linear correlation between choline intake and CVD risk. Moderate choline intake (Q3) was associated with a reduced risk of mortality, with an HR of 0.75 (95% CI 0.60-0.94) compared with Q1. RCS analysis demonstrated a significant nonlinear association between choline intake and all-cause mortality (P for nonlinearity = 0.025). The overall cancer prevalence association was nonsignificant, except for colon cancer, where each 100 mg increase in choline intake indicated a 23% reduced risk. CONCLUSION Elevated choline intake demonstrates an inverse association with CVD and colon cancer, while moderate consumption exhibits a correlated reduction in mortality. Additional comprehensive investigations are warranted to elucidate the broader health implications of choline.
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Affiliation(s)
- Peng Jieru
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Shanshan Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lin Cai
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Non-communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wencheng Long
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yueshan Wang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lu Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yao Dong
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wenqi Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Juan Liao
- Department of Gastroenterology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
- Non-communicable Diseases Research Center, West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Chunxia Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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