scholarly journals Circulating miR-206 and Wnt-signaling are associated with cardiovascular complications and a history of preeclampsia in women

2020 ◽  
Vol 134 (2) ◽  
pp. 87-101 ◽  
Author(s):  
Kenny Schlosser ◽  
Amanpreet Kaur ◽  
Natalie Dayan ◽  
Duncan J. Stewart ◽  
Louise Pilote ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Wnt Signaling ◽  
Target Genes ◽  
Cardiovascular Complications ◽  
Biological Pathways ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Molecular Determinants ◽  
History Of

Abstract Women with a history of preeclampsia (PE) have increased risk of cardiovascular disease (CVD) later in life. However, the molecular determinants underlying this risk remain unclear. We sought to understand how circulating miRNA levels are affected by prior PE, and related to biological pathways underpinning cardiovascular disease. RNA sequencing was used to profile plasma levels of 2578 miRNAs in a retrospective study of women with a history of PE or normotensive pregnancy, in two independent cohorts with either acute coronary syndrome (ACS) (n = 17–18/group) or no ACS (n = 20/group). Differential miRNA alterations were assessed in relation to a history of PE (within each cohort) or ACS (across cohorts), and compared with miRNAs previously reported to be altered during PE. A history of PE was associated with altered levels of 30 and 20 miRNAs in the ACS and non-ACS cohorts, respectively, whereas ACS exposure was associated with alterations in 259 miRNAs. MiR-206 was identified at the intersection of all comparisons relating to past/current PE and ACS exposure, and has previously been implicated in atherogenic activities related to hepatocytes, vascular smooth muscle cells and macrophages. Integration of all differentially altered miRNAs with their predicted and experimentally validated targets in silico revealed a number of highly targeted genes with potential atherogenic functions (including NFAT5, CCND2 and SMAD2), and one significantly enriched KEGG biological pathway (Wnt signaling) that was shared between all exposure groups. The present study provides novel insights into miRNAs, target genes and biological pathways that may underlie the long-term cardiovascular sequelae of PE.

684 Cardiac troponins and adverse outcomes in European patients with atrial fibrillation: a report from the ESC-EHRA EORP atrial fibrillation general long-term registry

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Marrco Vitolo ◽  
Vincenzo Livio Malavasi ◽  
Marco Proietti ◽  
Igor Diemberger ◽  
Laurent Fauchier ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Cox Regression ◽  
Adverse Outcomes ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
History Of ◽  
Cardiac Troponins

Abstract Aims Cardiac troponins (cTn) have been reported to be predictors for adverse outcomes in atrial fibrillation (AF), patients, but their actual use is still unclear. To assess the factors associated with cTn testing in routine clinical practice and to evaluate the association of elevated levels of cTn with adverse outcomes in a large contemporary cohort of European AF patients. Methods and results Patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry were stratified into three groups according to cTn levels as (i) cTn not tested, (ii) cTn in range (≤99th percentile), and (iii) cTn elevated (>99th percentile). The composite outcome of any thromboembolism/any acute coronary syndrome (ACS)/cardiovascular (CV) death, defined as major adverse cardiovascular events (MACE) and all-cause death were the main endpoints. 10 445 (94.1%) AF patients were included in this analysis [median age 71 years, interquartile range (IQR): 63–77; males 59.7%]. cTn were tested in 2834 (27.1%). Overall, cTn was elevated in 904 (8.7%) and in-range in 1930 (18.5%) patients. Patients in whom cTn was tested tended to be younger (P < 0.001) and more frequently presenting with first detected AF and atypical AF-related symptoms (i.e. chest pain, dyspnoea, or syncope) (P < 0.001). On multivariable logistic regression analysis, female sex, in-hospital enrollment, first-detected AF, CV risk factors, history of coronary artery disease (CAD), and atypical AF symptoms were independently associated with cTn testing. After a median follow-up of 730 days (IQR: 692–749), 957 (9.7%) composite endpoints occurred while all-cause death was 9.5%. Kaplan–Meier analysis showed a higher cumulative risk for both outcomes in patients with elevated cTn levels (Figure) (Log Rank tests, P < 0.001). On adjusted Cox regression analysis, elevated levels of cTn were independently associated with a higher risk for MACE [hazard ratio (HR): 1.74, 95% confidence interval (CI): 1.40–2.16] and all-cause death (HR 1.45, 95% CI: 1.21–1.74). Elevated levels of cTn were independently associated with a higher occurrence of MACE, all-cause death, any ACS, CV death and hospital readmission even after the exclusion of patients with history of CAD, diagnosis of ACS at discharge, those who underwent coronary revascularization during the admission and/or who were treated with oral anticoagulants plus antiplatelet therapy. Conclusions Elevated cTn levels were independently associated with an increased risk of all-cause mortality and adverse CV events, even after exclusion of CAD patients. Clinical factors that might enhance the need to rule out CAD were associated with cTn testing.

scholarly journals High concentrations of plasma trimethylamine-n-oxide is associated with long-term cardiovascular mortality in patients with acute coronary syndrome

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Eyileten ◽  
J Jarosz-Popek ◽  
D Jakubik ◽  
M Wolska ◽  
A Fitas ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Acute Coronary Syndrome ◽  
Predictive Value ◽  
Cox Regression ◽  
Independent Predictor ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background Acute coronary syndrome (ACS) remains a leading cause of mortality worldwide [1]. Patients who experienced ACS are at high risk of future cardiovascular events and death [2–4]. Identification of reliable predictive tools could potentially improve the risk stratification [5]. Numerous studies revealed that intestinal microbial organisms (microbiota) and its metabolites, as TMAO (trimethylamine-N-oxide) may play a pathogenic role in a cardiovascular disease (CVD) and ACS [6]. Elevated concentration of circulating TMAO has been associated with increased risk of CVD and major adverse cardiac events (MACE), including myocardial infarction (MI), stroke, major bleeding and all-cause mortality [7]. Purpose To investigate the association of liver metabolite TMAO with cardiovascular disease (CV)-related and all-cause mortality in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention. Methods Our prospective observational study enrolled 292 patients with ACS. Plasma concentrations of TMAO were measured during the hospitalization for ACS. Observation period lasted 7 years in the median. Adjusted Cox-regression analysis was used for prediction of mortality. Results ROC curve analysis revealed that increasing concentrations of TMAO levels assessed at the time point of ACS significantly predicted the risk of CV mortality (c-index=0.78, p<0.001). The cut-off value of >4 μmol/L, labeled as high TMAO level (23% of study population), provided the greatest sum of sensitivity (85%) and specificity (80%) for the prediction of CV mortality and was associated with a positive predictive value of 16% and a negative predictive value of 99%. A multivariate Cox regression model revealed that high TMAO level was a strong and independent predictor of CV death (HR=11.62, 95% CI: 2.26–59.67; p=0.003). High TMAO levels as compared with low TMAO levels were associated with the highest risk of CV death in a subpopulation of patients with diabetes mellitus (27.3% vs 2.6%; p=0.004). Although increasing TMAO levels were also significantly associated with all-cause mortality, their estimates for diagnostic accuracy were low. Conclusions High TMAO level is a strong and independent predictor of long-term CV mortality among patients presenting with ACS. TMAO concentration of 4 μmol/L may be a cut-off value for prognosis of ACS patients. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Kaplan-Meier curves Table 1

scholarly journals The Interplay Between COVID-19 and Cardiovascular Disease

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Brandon Shokoples ◽  
Nathanne S. Ferreira ◽  
Kevin Comeau
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Events ◽  
Organ Damage ◽  
Healthcare Systems ◽  
Host Cells ◽  
Angiotensin Converting Enzyme 2 ◽  
Increased Risk ◽  
Rapid Spread ◽  
History Of

Introduction: The emergence of the global COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus, SARS-CoV-2, has created a substantial burden on healthcare systems worldwide. The systemic impacts of COVID-19 infection are severe and broad in their implications, and the cardiovascular system is no exception. Discussion: Patients with a history of cardiovascular disease are at an increased risk for hospitalization and mortality, and COVID-19 infection has now been demonstrated to initiate acute, but serious, episodes of cardiovascular events such as stroke. Considering the rapid spread of COVID-19 across the globe and the inability of healthcare systems to address and adequately respond to the pandemic, therein lies an increased need for understanding the interplay between COVID-19 infection and cardiovascular disease. SARS-CoV-2 relies on binding the angiotensin-converting enzyme-2 (ACE2) receptor to infect host cells, with ACE2 representing a critical regulator of blood pressure homeostasis and proper cardiovascular functioning. Conclusion: Identifying the exact role of ACE2 in COVID-19 infection will have major implications for understanding the disease; therefore, here we have reviewed ACE2’s involvement in the pathogenesis of COVID-19 infection and the resulting end-organ damage. In addition, we have summarized how COVID-19 affects cardiovascular physiology, and how COVID-19 infection can manifest in acute cardiovascular events. Finally, we examine why patients with cardiovascular disease are at an increased risk of succumbing to COVID-19 and what the long-term cardiovascular implications of COVID-19 infection could mean. Relevance: This paper discusses the cardiovascular consequences of the global COVID-19 pandemic.

Cardiovascular Risk Factors in Hematopoietic Cell Transplantation (HCT) Survivors: Role in Development of Subsequent Cardiovascular Disease

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 330-330
Author(s):  
Saro H. Armenian ◽  
Can-Lan Sun ◽  
Tabitha Shannon ◽  
Emily Blum ◽  
Liton Francisco ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cumulative Incidence ◽  
Chronic Gvhd ◽  
Allogeneic Hct ◽  
Increased Risk ◽  
History Of

Abstract Abstract 330 Introduction: Advances in transplantation strategies and supportive care have resulted in a growing number of long-term HCT survivors. In the general U.S. population, cardiovascular disease is a leading cause of morbidity and mortality, and cardiovascular risk factors (CVRFs), including diabetes hypertension and dyslipidemia are well-established modifiers of the risk. There is increasing evidence that HCT survivors may be at risk for CVRFs that can potentially result in an increased risk of cardiovascular morbidity. However, there is a paucity of knowledge regarding the magnitude of risk and associated risk factors for CVRFs after HCT, and the role these CVRFs play in the subsequent development of cardiovascular disease such as stroke, myocardial infarction, and congestive heart failure, in long-term survivors of HCT. Methods: A retrospective cohort study design was used to describe the cumulative incidence of CVRFs and cardiovascular disease in 1+year survivors of HCT, taking into consideration the competing risk of death. Cox proportional hazards regression analysis was used to calculate relative risk (RR) estimates and 95% confidence intervals (CI), adjusted for relevant covariates. Definition of CVRFs was per the National Cholesterol Education Program Adult Treatment Panel III criteria. Survivors taking immunosuppressant medication for management of graft vs. host disease (GvHD) at the time of CVRF diagnosis were excluded from the regression analysis. Cardiovascular disease was defined per the American College of Cardiology established case definitions. Results: 2041 consecutive one-year survivors who underwent HCT for hematologic malignancies between 1995 and 2004 at City of Hope were included in the analysis. Median age at HCT was 44.1 years (0.6–78.9); 57.6% were female; 62.5% were non-Hispanic white and 24.5% were Hispanic; 41% underwent allogeneic HCT; 26.5% of allogeneic HCT survivors had a history of chronic GvHD; 49.9% received total body irradiation (TBI). Cardiovascular risk factors: After 12,551 person-years of follow-up, the 10-year cumulative incidence of diabetes, hypertension, and dyslipidemia was 16.8%, 36.1% and 43.5%, respectively; 10-year cumulative incidence for multiple (2+) CVRFs was 29.5%. The cumulative incidence of CVRFs was significantly higher for allogeneic HCT recipients (Table). Multivariate analysis adjusted for gender, race/ethnicity, diagnosis, and conditioning-related exposures, revealed older age at HCT and obesity to be risk factors for all three CVRFs. Allogeneic HCT survivors with a history of chronic GvHD were at highest risk for diabetes (RR=32.4, 95% CI: 16.6–63.2, p<0.01), hypertension (RR=12.0, 95% CI: 5.5–26.1, p<0.01), and dyslipidemia (RR=7.2, 95% CI: 4.2–12.3, p<0.01) when compared to autologous HCT recipients. Cardiovascular disease occurred in 117 individuals, at a median 3.8 years following HCT (range 0.1–13.9). The 10-year cumulative incidence of cardiovascular disease was 7.4%, and was highest among survivors with multiple CVRFs (10.9% vs. 5.9% in those with <2 CVRFs, p=0.02). Furthermore, survivors with multiple CVRFs were at 1.8-fold risk (95% CI: 1.1–3.3, p=0.04) of subsequently developing cardiovascular disease when compared to survivors with <2 CVRFs. Conclusions: Allogeneic HCT survivors are at a substantially increased risk for CVRFs following HCT, and chronic GvHD and/or its treatment are critical modifiers of this risk. Survivors with multiple CVRFs are at highest risk for development of cardiovascular disease following HCT. These findings provide rationale for close monitoring and aggressive interventions for this high-risk population in order to reduce cardiovascular morbidity and mortality. Disclosures: No relevant conflicts of interest to declare.

Long-Term Metabolic Consequences in Patients with a History of Gestational Diabetes

2020 ◽  
Vol 26 (43) ◽  
pp. 5564-5572
Author(s):  
Eleni Kousta ◽  
Adamantia Kontogeorgi ◽  
Stephen Robinson ◽  
Desmond G. Johnston
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Increased Risk ◽  
Metabolic Complication ◽  
History Of

Gestational diabetes mellitus is a common metabolic complication of pregnancy. Universal guidelines on gestational diabetes have been impeded by the long-term controversies on its definition and screening strategies. The prevalence of gestational diabetes is rising all over the world, is significantly influenced by ethnicity and its rise is mainly attributed to increasing maternal obesity and age. Gestational diabetes mellitus has important long-term implications, including gestational diabetes recurrence, increased risk for developing type 2 diabetes, metabolic syndrome and cardiovascular disease for the mother. Gestational diabetes mellitus may be viewed as a chronic metabolic disorder that is identified in women during gestation and may provide a unique opportunity for the early identification and primary prevention of type 2 diabetes mellitus and cardiovascular disease in these women. In this mini-review, the evolution of screening tests for gestational diabetes and guidelines are briefly described and metabolic and cardiovascular long-term consequences of women with a history of gestational diabetes are summarized. A summary of our own St. Mary’s Hospital-UK Research series on long-term metabolic consequences of 368 women with a history of gestational diabetes of 3 different ethnic groups and 482 control women is also included. We found that approximately 2 years following delivery, 37% of women with a history of gestational diabetes had abnormal glucose concentrations, but, most importantly, even those who were normoglycaemic, postpartum displayed metabolic abnormalities on detailed testing. Future research needs to focus on the prevention of gestational diabetes long-term complications, but also in identification of pre-pregnancy predictors and risk reduction before conception.

scholarly journals Cardiac complications in patients hospitalised with COVID-19

2020 ◽  
Vol 9 (8) ◽  
pp. 817-823 ◽  
Author(s):  
Marijke Linschoten ◽  
Sanne Peters ◽  
Maarten van Smeden ◽  
Lucia S Jewbali ◽  
Jeroen Schaap ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Pulmonary Embolism ◽  
Cardiac Complications ◽  
Current Analysis ◽  
Coronary Syndrome ◽  
Hospitalised Patients ◽  
History Of ◽  
Artery Disease

Aims: To determine the frequency and pattern of cardiac complications in patients hospitalised with coronavirus disease (COVID-19). Methods and results: CAPACITY-COVID is an international patient registry established to determine the role of cardiovascular disease in the COVID-19 pandemic. In this registry, data generated during routine clinical practice are collected in a standardised manner for patients with a (highly suspected) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requiring hospitalisation. For the current analysis, consecutive patients with laboratory confirmed COVID-19 registered between 28 March and 3 July 2020 were included. Patients were followed for the occurrence of cardiac complications and pulmonary embolism from admission to discharge. In total, 3011 patients were included, of which 1890 (62.8%) were men. The median age was 67 years (interquartile range 56–76); 937 (31.0%) patients had a history of cardiac disease, with pre-existent coronary artery disease being most common ( n=463, 15.4%). During hospitalisation, 595 (19.8%) patients died, including 16 patients (2.7%) with cardiac causes. Cardiac complications were diagnosed in 349 (11.6%) patients, with atrial fibrillation ( n=142, 4.7%) being most common. The incidence of other cardiac complications was 1.8% for heart failure ( n=55), 0.5% for acute coronary syndrome ( n=15), 0.5% for ventricular arrhythmia ( n=14), 0.1% for bacterial endocarditis ( n=4) and myocarditis ( n=3), respectively, and 0.03% for pericarditis ( n=1). Pulmonary embolism was diagnosed in 198 (6.6%) patients. Conclusion: This large study among 3011 hospitalised patients with COVID-19 shows that the incidence of cardiac complications during hospital admission is low, despite a frequent history of cardiovascular disease. Long-term cardiac outcomes and the role of pre-existing cardiovascular disease in COVID-19 outcome warrants further investigation.

scholarly journals Impact of established cardiovascular disease on 10-year death after coronary revascularization for complex coronary artery disease

2021 ◽  
Author(s):  
Rutao Wang ◽  
Scot Garg ◽  
Chao Gao ◽  
Hideyuki Kawashima ◽  
Masafumi Ono ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Revascularization ◽  
Long Term Outcomes ◽  
Vital Status ◽  
Increased Risk ◽  
Artery Disease ◽  
The Impact

Abstract Aims To investigate the impact of established cardiovascular disease (CVD) on 10-year all-cause death following coronary revascularization in patients with complex coronary artery disease (CAD). Methods The SYNTAXES study assessed vital status out to 10 years of patients with complex CAD enrolled in the SYNTAX trial. The relative efficacy of PCI versus CABG in terms of 10-year all-cause death was assessed according to co-existing CVD. Results Established CVD status was recorded in 1771 (98.3%) patients, of whom 827 (46.7%) had established CVD. Compared to those without CVD, patients with CVD had a significantly higher risk of 10-year all-cause death (31.4% vs. 21.7%; adjusted HR: 1.40; 95% CI 1.08–1.80, p = 0.010). In patients with CVD, PCI had a non-significant numerically higher risk of 10-year all-cause death compared with CABG (35.9% vs. 27.2%; adjusted HR: 1.14; 95% CI 0.83–1.58, p = 0.412). The relative treatment effects of PCI versus CABG on 10-year all-cause death in patients with complex CAD were similar irrespective of the presence of CVD (p-interaction = 0.986). Only those patients with CVD in ≥ 2 territories had a higher risk of 10-year all-cause death (adjusted HR: 2.99, 95% CI 2.11–4.23, p < 0.001) compared to those without CVD. Conclusions The presence of CVD involving more than one territory was associated with a significantly increased risk of 10-year all-cause death, which was non-significantly higher in complex CAD patients treated with PCI compared with CABG. Acceptable long-term outcomes were observed, suggesting that patients with established CVD should not be precluded from undergoing invasive angiography or revascularization. Trial registration SYNTAX: ClinicalTrials.gov reference: NCT00114972. SYNTAX Extended Survival: ClinicalTrials.gov reference: NCT03417050. Graphic abstract

scholarly journals Impact of atrial fibrillation pattern on outcomes after left atrial appendage closure: lessons from the prospective LAARGE registry

2021 ◽  
Author(s):  
Shinwan Kany ◽  
Johannes Brachmann ◽  
Thorsten Lewalter ◽  
Ibrahim Akin ◽  
Horst Sievert ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial Appendage ◽  
Systemic Embolism ◽  
Long Term Outcomes ◽  
Increased Risk ◽  
History Of ◽  
One Year ◽  
The One

Abstract Background Non-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death. Methods Comparison of procedural details and long-term outcomes in patients (pts) with paroxysmal AF (PAF) against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC (LAARGE). Results A total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The total CHA2DS2-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), while HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was comparable. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77). In the three-month echo follow-up, LA thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak > 5 mm (0.0% vs 7.1%, p = 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA2DS2-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95% CI 1.02–2.72, p = 0.041). Conclusion Atrial fibrillation type did not impair periprocedural safety or in-hospital MACE patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality. Graphic abstract

scholarly journals 1110. Very Late Onset Infections Amongst Long Term Survivors of Kidney Transplantation

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S585-S585
Author(s):  
Harry Cheung ◽  
Marwan M Azar ◽  
Geliang Gan ◽  
Yanhong Deng ◽  
Elizabeth A Cohen ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Clinical Data ◽  
Opportunistic Infections ◽  
Late Onset ◽  
Retrospective Chart Review ◽  
Kidney Transplant Recipients ◽  
Increased Risk ◽  
Simple Logistic ◽  
Long Term Survivors

Abstract Background Kidney transplant recipients (KTR) are at increased risk for infections immediately post-transplant due to intense immunosuppression. However, this risk decreases over time as immunosuppression is tapered. The incidence of infection in KTR many years after transplant is not well characterized. The aim of this study was to describe these “very-late onset infections” (VLIs) ≥ 10 years after KT. Methods We performed a retrospective chart review of patients age ≥ 18 years who underwent KT between 2003 and 2009 and who survived ≥ 10 years post-KT. VLIs included opportunistic infections (OIs) and non-OIs. Demographics, comorbidities, immunosuppression, and clinical data for VLIs ≥ 10 years from KT were collected. Simple logistic regression was performed to determine characteristics associated with risk for VLIs. Results Of 332 KTR that met the inclusion criteria, the majority were male (62.0%), white (59.6%), and the largest proportion was transplanted between the ages of 50-59 (28.3%); 220 (67.9%) were on mycophenolate-based regimens. The mean Charlson Comorbidity Index (CCI) was 4.7 (S.D. 2.0). Of 332, 103 (31.0%) KTR experienced ≥ 1 VLI amounting to 187 episodes. Compared to those without VLI, KTR with VLI were more likely to have diabetes (p=0.005), cardiovascular disease (p=0.004), low ALC (p &lt; 0.001) and require dialysis (p=0.002). Of 103 KTR with VLI, 16 (15.5%) had OIs, while 87 KTR (84.5%) had non-OIs, most commonly urinary tract infection (n=85, 45.5%), pneumonia (n=35, 18.7%) and gastrointestinal infection (n=18, 9.6%). The most commonly isolated pathogens were E. coli (n=30, 16%), K. pneumoniae (n=16, 8.6%), MSSA (n=7, 3.7%), and P. aeruginosa (n=7, 3.7%). Higher CCI, diabetes, dialysis, cerebrovascular, cardiovascular disease and lower ALC were associated with increased risk for VLI (p &lt; 0.05), while living donor KTR was protective (p=0.04). Additionally, every 1 year after transplant was associated with an increased risk of VLI (OR=1.31, p &lt; 0.001). Table 1: Demographics, comorbidities, immunosuppression, and clinical data for all patients Conclusion VLIs were common in long-term survivors of KT and included both conventional and opportunistic pathogens. Every additional year from transplant incurred additional risk for VLI, particularly for those with multiple co-morbidities and lower ALC. Disclosures All Authors: No reported disclosures

scholarly journals An observational claims data analysis on the risk of maternal chronic kidney disease after preterm delivery and preeclampsia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maren Goetz ◽  
Mitho Müller ◽  
Raphael Gutsfeld ◽  
Tjeerd Dijkstra ◽  
Kathrin Hassdenteufel ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Preterm Birth ◽  
Kidney Disease ◽  
Preterm Delivery ◽  
Claims Data ◽  
Maternal Risk ◽  
Live Births ◽  
Increased Risk ◽  
History Of

AbstractWomen with complications of pregnancy such as preeclampsia and preterm birth are at risk for adverse long-term outcomes, including an increased future risk of chronic kidney disease (CKD) and end-stage kidney disease (ESKD). This observational cohort study aimed to examine the risk of CKD after preterm delivery and preeclampsia in a large obstetric cohort in Germany, taking into account preexisting comorbidities, potential confounders, and the severity of CKD. Statutory claims data of the AOK Baden-Wuerttemberg were used to identify women with singleton live births between 2010 and 2017. Women with preexisting conditions including CKD, ESKD, and kidney replacement therapy (KRT) were excluded. Preterm delivery (< 37 gestational weeks) was the main exposure of interest; preeclampsia was investigated as secondary exposure. The main outcome was a newly recorded diagnosis of CKD in the claims database. Data were analyzed using Cox proportional hazard regression models. The time-dependent occurrence of CKD was analyzed for four strata, i.e., births with (i) neither an exposure of preterm delivery nor an exposure of preeclampsia, (ii) no exposure of preterm delivery but exposure of at least one preeclampsia, (iii) an exposure of at least one preterm delivery but no exposure of preeclampsia, or (iv) joint exposure of preterm delivery and preeclampsia. Risk stratification also included different CKD stages. Adjustments were made for confounding factors, such as maternal age, diabetes, obesity, and dyslipidemia. The cohort consisted of 193,152 women with 257,481 singleton live births. Mean observation time was 5.44 years. In total, there were 16,948 preterm deliveries (6.58%) and 14,448 births with at least one prior diagnosis of preeclampsia (5.61%). With a mean age of 30.51 years, 1,821 women developed any form of CKD. Compared to women with no risk exposure, women with a history of at least one preterm delivery (HR = 1.789) and women with a history of at least one preeclampsia (HR = 1.784) had an increased risk for any subsequent CKD. The highest risk for CKD was found for women with a joint exposure of preterm delivery and preeclampsia (HR = 5.227). These effects were the same in magnitude only for the outcome of mild to moderate CKD, but strongly increased for the outcome of severe CKD (HR = 11.90). Preterm delivery and preeclampsia were identified as independent risk factors for all CKD stages. A joint exposure or preterm birth and preeclampsia was associated with an excessive maternal risk burden for CKD in the first decade after pregnancy. Since consequent follow-up policies have not been defined yet, these results will help guide long-term surveillance for early detection and prevention of kidney disease, especially for women affected by both conditions.

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