Adjunctive Corticosteroids for COVID-19: A Retrospective Cohort Study

Background: Coronavirus disease 2019 (COVID-19) is associated with severe pneumonia, respiratory failure and death. We aim to evaluate the efficacy of adjunctive corticosteroids in the management of COVID-19. Methods: This is a retrospective cohort study of hospitalized adults (≥18 years) who were diagnosed with COVID-19 and were given treatment. Treatment included hydroxycholoroquine and lopinavir-ritonavir. Corticosteroids were included as adjunctive therapy in mid-April, 2020. We compared composite outcomes of clinical progression and invasive mechanical ventilation (MV) or death between group that received treatment only (Group A) versus group that received adjunctive corticosteroids (Group B). Entropy balancing was used to generate stabilized weight for covariates between treatment groups. Unweighted Kaplan-Meir curves, weighted and adjusted Cox regression analysis were used to estimate effect of adjunctive corticosteroids on composite outcomes. Subgroup analysis was performed on those with pneumonia. Results: Of 1046 patients with COVID-19, 57 received treatment alone (Group A) and 35 received adjunctive corticosteroids in addition to treatment (Group B). Median day of illness at treatment initiation was 5 day. There were 44 patients with pneumonia; 68.9% of them were not requiring supplemental oxygen at treatment initiation. Overall, 17 (18.5%) of 92 patients had clinical progression including 13 (22.8%) of 57 patients in Group A versus 4 (11.4%) of 35 patients in Group B (p=0.172). Unweighted Kaplan-Meier estimates showed no significant difference in the proportion of patients who had clinical progression or invasive MV or death between the 2 treatment groups. However in those with pneumonia, there were lower proportions of patients in Group B with clinical progression (11.1% , 95% CI 0.0 - 22.2 versus 58.8%, 95% CI 27.3 - 76.7, log rank p<0.001 ); and invasive MV or death (11.3%, 95% CI 0.0 - 22.5 versus 41.2%, 95% CI 12.4. - 60.5, log rank p=0.016). In weighted and adjusted cox regression analysis, patients in Group B were less likely to have clinical progression, (adjusted HR [aHR] 0.08, 95% CI 0.01-0.99, p=0.049) but there was no statistical significant difference in risk of requiring invasive MV or death (aHR 0.22, 95%CI 0.02 - 2.54, p=0.22). In subgroup with pneumonia, patients in Group B were significantly at lower risk of clinical progression (aHR 0.15, 95% CI 0.06 - 0.39, p<0.001) and requiring invasive MV compared to Group A (aHR 0.30, 0.10-0.87, p=0.029). Conclusions: Use of adjunctive corticosteroids is associated with lower risk of clinical progression and invasive MV or death, especially in those with pneumonia. Concurrent use of antivirals and corticosteroids should be considered in the management of COVID-19 related pneumonia.

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Hemodialysis Adequacy and Its Impact on Long-Term Patient Survival in Demographically, Socially, and Culturally Homogeneous Patients

International Journal of Nephrology ◽

10.1155/2020/9857123 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Reza Hekmat

Keyword(s):

Cox Regression ◽

Patient Survival ◽

Underlying Disease ◽

Chronic Hemodialysis ◽

Historical Cohort ◽

Cox Regression Analysis ◽

Group A ◽

One Year ◽

Group B ◽

Iranian Patients

Background. Impact of hemodialysis adequacy on patient survival is extensively studied. The current study compares the survival of chronic hemodialyzed, undocumented, uninsured, Afghan immigrant patients with that of a group of insured Iranian patients matched for underlying disease, age, weight, level of education, marital status, income, and number of comorbid conditions. Methods. Eighty chronic hemodialysis patients (mean age 42.8 ± 10.5 years) entered this historical cohort study in Mashhad, Iran, between January 2012 and January 2015. Half of the patients were undocumented, uninsured, Afghan immigrants (Group A) matched with forty insured Iranian patients (Group B). To compare the survival rate of the two patient groups, Kaplan–Meir survival analysis test was used. Results. Group A patients were underdialyzed with a weekly Kt/V which was significantly less in comparison with that of Group B (1.63 ± 0.63 versus 2.54 ± 0.12, p value = 0.01). While Group A’s number of hemodialysis sessions per week was fewer than that of Group B (1.45 ± 0.56 versus 2.8 ± 0.41, p value = 0.04), the mean of Kt/V in each hemodialysis session was higher in them, in comparison with Group B (1.43 ± 0.25 versus 1.3 ± 0.07, p value = 0.045). In Group B and Group A patients, one-year survival was 70% versus 50%, two-year survival was 55% versus 30%, and three-year survival was 40% versus 20%, respectively (p values = 0.04, 0.02 and 0.04, respectively). In Cox regression analysis, hemodialysis adequacy and uninsurance were factors impacting patients’ survival (OR = 1.193 and 0.333, respectively). Conclusions. Undocumented, uninsured, inadequately hemodialyzed, Afghan patients had a significantly lower one-, two-, and three-year survival as opposed to their Iranian counterparts, probably due to lack of insurance.

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P1166DOES PERITONEAL PROTEIN LOSS AFFECT CARDIOVASCULAR MORTALITY OF PERITONEAL DIALYSIS PATIENTS ?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1166 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Marios Theodoridis ◽

Stylianos Panagoutsos ◽

Ioannis Neofytou ◽

Konstantia Kantartzi ◽

Efthimia Mourvati ◽

...

Keyword(s):

Regression Analysis ◽

Peritoneal Dialysis ◽

Cardiovascular Mortality ◽

Cox Regression ◽

Dialysis Patients ◽

Protein Loss ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Group A ◽

Group B

Abstract Background and Aims Peritoneal protein loss (PPL) through peritoneal effluent has been a well-recognized detrimental result of peritoneal dialysis (PD). The amount of protein lost will depend on dialysis time, protein size, its serum concentration and other factors including patients’ clinical status. Peritoneal protein loss may be a manifestation of endothelial dysfunction, as with another type of capillary protein leakage, microalbuminuria, a recognized endothelial dysfunction marker. The aim of this study was to retrospectively evaluate the influence of PPL on cardiovascular mortality of peritoneal dialysis patients Method This is a single center retrospective study of 84 PD patients (m=54, f=30) with mean age of 65.2±17 years, mean PD duration of 43.2±24.9 months conducted for the time period from 2006 to 2019 (13 years). The patients were divided into two groups according to the amount of protein excreted during the modified Peritoneal Equilibration Test (PET) procedure using PD solution of 3.86% DW, 2 Lt infusion volume for total time of 4 hours. The total amount of proteins excreted was calculate from PET by multiplying the concentration of proteins at the end of the test with the total volume of PD fluid at the same time. Group A excreted a total amount of proteins < 1.55 gr (median value) at the end of PET test and Group B > 1.55 gr. The cumulative all-cause and cardiovascular survival of the PD patients was calculated by Kaplan Meier while the possible effect of any parameter in survival rates was evaluated by using Cox Regression analysis Results There was not any statistically significant difference between the two groups according to PD duration, age, dialysis adequacy targets, Residual Renal Function(RRF), BMI, ultrafiltration volume during PET and their transport status. The cumulative all-cause survival using Kaplan-Meier analysis revealed no statistically significant deference between the two groups (Log Rank p=0.55) even though mortality risk was adjusted for several factors (Cox Regression). When cardiovascular survival, using Cox Regression analysis, was adjusted for age, sex, Diabetes, PD modality, dialysis Kt/V and RRF we found that Group A (with protein excretion < 1.55 gr) had statistically significant better cardiovascular survival (p=0.029) compared to Group B. We confirm these results while trying to find among the total of our patients the possible risk factors for cardiovascular mortality. Using Cox Regression analysis, the amount of protein excreted during PET procedure and the type of PD solutions (high or low in GDPs) used were statistically significant (p=0.019 and p=0.04 respectively) independent risk factors for cardiovascular survival in our patients. Conclusion These results indicate that protein loss during peritoneal dialysis procedure has negative impact on cardiovascular mortality and survival of PD patients. Additionally, the use of PD solutions with low Glucose Degradation Products (GDPs) and AGEs may improve PD patient’s cardiovascular survival. Randomized interventional studies are encouraged to address the pathological concern of PPL in the future, namely its effects on cardiovascular conditions or its role as marker and effort to reduce PPL using ACE inhibitors or vit D should be considered only if it diminishes cardiovascular morbidity or mortality.

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Proactive Infliximab Monitoring Following Reactive Testing is Associated With Better Clinical Outcomes Than Reactive Testing Alone in Patients With Inflammatory Bowel Disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjy039 ◽

2018 ◽

Vol 12 (7) ◽

pp. 804-810 ◽

Cited By ~ 43

Author(s):

Konstantinos Papamichael ◽

Ravy K Vajravelu ◽

Byron P Vaughn ◽

Mark T Osterman ◽

Adam S Cheifetz

Keyword(s):

Inflammatory Bowel Disease ◽

Treatment Failure ◽

Bowel Disease ◽

Cox Regression ◽

Drug Discontinuation ◽

Cox Regression Analysis ◽

Loss Of Response ◽

Group A ◽

Inflammatory Bowel ◽

Group B

Abstract Background and Aims Reactive testing has emerged as the new standard of care for managing loss of response to infliximab in inflammatory bowel disease [IBD]. Recent data suggest that proactive infliximab monitoring is associated with better therapeutic outcomes in IBD. Nevertheless, there are no data regarding the clinical utility of proactive infliximab monitoring after first reactive testing. We aimed to evaluate long-term outcomes of proactive infliximab monitoring following reactive testing compared with reactive testing alone in patients with IBD. Methods This was a retrospective multicenter cohort study of consecutive IBD patients on infliximab maintenance therapy receiving a first reactive testing between September 2006 and January 2015. Patients were divided into two groups; Group A [proactive infliximab monitoring after reactive testing] and Group B [reactive testing alone]. Patients were followed through December 2015. Time-to-event analysis for treatment failure and IBD-related surgery and hospitalization was performed. Treatment failure was defined as drug discontinuation due to either loss of response or serious adverse event. Results The study population consisted of 102 [n = 70, 69% with CD] patients [Group A, n = 33 and Group B, n = 69] who were followed for (median, interquartile range [IQR]) 2.7 [1.4–3.8] years. Multiple Cox regression analysis identified proactive following reactive TDM as independently associated with less treatment failure (hazard ratio [HR] 0.15; 95% confidence interval [CI] 0.05–0.51; p = 0.002) and fewer IBD-related hospitalizations [HR: 0.18; 95% CI 0.05–0.99; p = 0.007]. Conclusions This study showed that proactive infliximab monitoring following reactive testing was associated with greater drug persistence and fewer IBD-related hospitalizations than reactive testing alone.

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Krebs von den Lungen 6 levels in COVID-19 ICU Patients are Associated with Mortality

10.1101/2021.11.17.21266464 ◽

2021 ◽

Author(s):

Giuliana Scarpati ◽

Daniela Baldassarre ◽

Graziella Lacava ◽

Filomena Oliva ◽

Gabriele Pascale ◽

...

Keyword(s):

Cox Regression ◽

Icu Patients ◽

Cox Regression Analysis ◽

Alveolar Epithelial ◽

Type Ii Pneumocytes ◽

Group A ◽

Predictive Role ◽

Fraction Of Inspired Oxygen ◽

Group B

Rationale Krebs von den Lungen 6 (KL-6) is a high molecular weight mucin-like glycoprotein produced by type II pneumocytes and bronchial epithelial cells. Elevated circulating levels of KL-6 may denote disorder of the alveolar epithelial lining. Objective Aim of this study was to verify if KL-6 values may help to risk stratify and triage severe COVID-19 patients. Methods We performed a retrospective prognostic study on 110 COVID-19 ICU patients, evaluating the predictive role of KL-6 for mortality. Measurements and Main Results The study sample was divided in two groups related according to the median KL-6 value [Group A (KL-6 lower than the log-transformed median (6.73)) and Group B (KL-6 higher than the log-transformed median)]. In both linear and logistic multivariate analyses, ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (P/F) was significantly and inversely related to KL-6. Death rate was higher in group B than in group A (80.3 versus 45.9%) (p<0.001), Accordingly, the Cox regression analysis showed a significant prognostic role of KL-6 on mortality in the whole sample as well as in the subgroup with SOFA lower than its median value. Conclusions At ICU admission, KL-6 serum level was significantly lower in the survivors group. Our findings shown that, in severe COVID19 patients, elevated KL-6 was strongly associated with mortality in ICU.

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Risk of brain herniation after craniotomy with lumbar spinal drainage: a propensity score analysis

Journal of Neurosurgery ◽

10.3171/2017.12.jns172215 ◽

2019 ◽

Vol 130 (5) ◽

pp. 1710-1720 ◽

Cited By ~ 3

Author(s):

Yasushi Motoyama ◽

Tsukasa Nakajima ◽

Yoshiaki Takamura ◽

Tsutomu Nakazawa ◽

Daisuke Wajima ◽

...

Keyword(s):

Propensity Score ◽

Cox Regression ◽

Propensity Score Analysis ◽

Control Group ◽

Deep Approach ◽

Brain Herniation ◽

Cox Regression Analysis ◽

Group A ◽

Group B ◽

Lumbar Spinal

OBJECTIVELumbar spinal drainage (LSD) during neurosurgery can have an important effect by facilitating a smooth procedure when needed. However, LSD is quite invasive, and the pathology of brain herniation associated with LSD has become known recently. The objective of this study was to determine the risk of postoperative brain herniation after craniotomy with LSD in neurosurgery overall.METHODSIncluded were 239 patients who underwent craniotomy with LSD for various types of neurological diseases between January 2007 and December 2016. The authors performed propensity score matching to establish a proper control group taken from among 1424 patients who underwent craniotomy and met the inclusion criteria during the same period. The incidences of postoperative brain herniation between the patients who underwent craniotomy with LSD (group A, n = 239) and the matched patients who underwent craniotomy without LSD (group B, n = 239) were compared.RESULTSBrain herniation was observed in 24 patients in group A and 8 patients in group B (OR 3.21, 95% CI 1.36–8.46, p = 0.005), but the rate of favorable outcomes was higher in group A (OR 1.79, 95% CI 1.18–2.76, p = 0.005). Of the 24 patients, 18 had uncal herniation, 5 had central herniation, and 1 had uncal and subfalcine herniation; 8 patients with other than subarachnoid hemorrhage were included. Significant differences in the rates of deep approach (OR 5.12, 95% CI 1.8–14.5, p = 0.002) and temporal craniotomy (OR 10.2, 95% CI 2.3–44.8, p = 0.002) were found between the 2 subgroups (those with and those without herniation) in group A. In 5 patients, brain herniation proceeded even after external decompression (ED). Cox regression analysis revealed that the risk of brain herniation related to LSD increased with ED (hazard ratio 3.326, 95% CI 1.491–7.422, p < 0.001). Among all 1424 patients, ED resulted in progression or deterioration of brain herniation more frequently in those who underwent LSD than it did in those who did not undergo LSD (OR 9.127, 95% CI 1.82–62.1, p = 0.004).CONCLUSIONSBrain herniation downward to the tentorial hiatus is more likely to occur after craniotomy with LSD than after craniotomy without LSD. Using a deep approach and craniotomy involving the temporal areas are risk factors for brain herniation related to LSD. Additional ED would aggravate brain herniation after LSD. The risk of brain herniation after placement of a lumbar spinal drain during neurosurgery must be considered even when LSD is essential.

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Splinting in Carpal Tunnel Syndrome: The Optimal Duration

Military Medicine ◽

10.1093/milmed/usaa222 ◽

2020 ◽

Vol 185 (11-12) ◽

pp. e2049-e2054

Author(s):

Michele A Gatheridge ◽

Elsa A Sholty ◽

Alexander Inman ◽

Meghan Pattillo ◽

Frank Mindrup ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

The United States ◽

Functional Improvement ◽

Treatment Groups ◽

Significant Difference ◽

Group A ◽

Tunnel Syndrome ◽

Group B ◽

Wrist Splint

Abstract Introduction The purpose of this study was to evaluate optimal neutral wrist splint duration in treatment-naive mild and mild to moderate carpal tunnel syndrome (CTS). Neutral wrist splinting is a conservative treatment for CTS; however, no clear guidelines exist for how long splinting should be prescribed for optimal outcomes. Materials and Methods In this prospective clinical trial subjects were assigned to wear a neutral wrist splint for 6 (group A) or 12 weeks (group B). Symptom and functional outcomes were assessed by questionnaire at baseline, 6 and 12 weeks. Median nerve sensory and motor latencies were recorded at baseline and 12 weeks. Pretreatment, midtreatment, and posttreatment measures were compared within and between treatment groups where applicable. This study was approved by the United States Air Force Academy institutional review board. Results A total of 30 subjects (37 hands) were randomized to 2 treatment groups. Mean symptom severity and median sensory peak latency significantly improved in both groups at 12 weeks, without a significant difference between groups. Mean functional severity significantly improved only in group A. Conclusion Neutral wrist splint for 6 weeks resulted in better clinical improvements in patients with untreated mild and mild to moderate CTS. There was no additional benefit in extending splinting 6 additional weeks. This is the first study to compare duration of wrist splint use beyond 8 weeks. A larger sample size is needed to identify the reason for lack of functional improvement in group B. Long-term follow-up of this cohort will be helpful to determine the natural history of initial wrist splint use.

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Efficacy of Jatropha curcas Latex Cream in The Epithelialization Phase of Wound Healing in Mice Skin

E3S Web of Conferences ◽

10.1051/e3sconf/202015101038 ◽

2020 ◽

Vol 151 ◽

pp. 01038

Author(s):

Muhammad N. Salim ◽

Moma Silvia ◽

Dwinna Aliza ◽

Dian Masyitha ◽

Cut D. Iskandar ◽

...

Keyword(s):

Wound Healing ◽

Quantitative Data ◽

Statistical Test ◽

Wound Therapy ◽

Treatment Groups ◽

Significant Difference ◽

Group A ◽

Group B ◽

Incision Wound ◽

Made In

The objective of the present research was to find out the efficacy of Jatropha latex cream in the epithelialization phase of wound healing in mice skin. A total of 9 male mice aged 2-3 months old and the bodyweight of 25-40 g were divided into three treatment groups. Group A was given basic cream, group B was given Jatropha latex cream (10%), and group C was given sulfadiazine. The 2 cm incision wound was made in the paravertebral area. Wound therapy was carried out twice a day for 7 days. All quantitative data were measured using ANOVA then followed by the Duncan test. The number of angiogenesis on A, B, and C was 4.67±1.20; 12.78±2.52; and 11.33±2.33, while a number of fibroblasts were 179.56±12.69; 90.56±8.23; and 99.11±7.04, respectively. The average deposition of collagen was 1.46±0.12; 1.89±0.10; and 1.74±0.06, respectively. The statistical test showed that the number of angiogenesis, fibroblast, and deposition of collagen on group B was significantly different (P<0.05) compared to group A and showed no significant difference compared to group C (P>0.05). In conclusion, Jatropha latex cream (10%) able to accelerate the epithelialization phase of wound healing in mice skin.

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Real-world discontinuation rate of teriflunomide and dimethyl fumarate in multiple sclerosis

Multiple Sclerosis Journal - Experimental Translational and Clinical ◽

10.1177/20552173211022027 ◽

2021 ◽

Vol 7 (2) ◽

pp. 205521732110220

Author(s):

Hilde Norborg ◽

Trond Riise ◽

Kjell-Morten Myhr ◽

Nina Grytten ◽

Stig Wergeland

Keyword(s):

Side Effects ◽

Treatment Failure ◽

Lower Risk ◽

Cox Regression ◽

Dimethyl Fumarate ◽

University Hospital ◽

Discontinuation Rate ◽

Treatment Groups ◽

Significant Difference ◽

Treatment Naïve

Background For patients with MS, medication switches increase the risk of disease reactivation. Objective Compare discontinuation rates due to treatment failure or side effects between teriflunomide and dimethyl fumarate, and investigate clinical variables affecting discontinuation rates. Methods All patients who received teriflunomide or dimethyl fumarate at Haukeland University Hospital from 2013 until 2018 were identified. Clinical and demographic variables were extracted from the Norwegian MS Registry. Cause-specific Cox regression models estimated the rate of discontinuation due to treatment failure or side effects. Results We included 354 patients treated with either dimethyl fumarate ( n = 185) or teriflunomide ( n = 169). We found 38% lower risk of discontinuation because of treatment failure for patients using dimethyl fumarate compared to teriflunomide ( p < 0.05). In a treatment-naive subgroup ( n = 183), we found a 38% reduced risk of discontinuation for any reason among patients using dimethyl fumarate ( p < 0.05). There was no significant difference between treatment groups in discontinuation rate due to side effects, although more patients reported side effects when treated with dimethyl fumarate. Conclusion Our findings suggests that dimethyl fumarate has a lower risk of discontinuation because of treatment failure among both treatment-experienced and treatment-naive patients.

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Parenteral Nutrition-Associated Liver Disease: a Retrospective Study of Ursodeoxycholic Acid Use in Neonates

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-19.1.42 ◽

2014 ◽

Vol 19 (1) ◽

pp. 42-48 ◽

Cited By ~ 4

Author(s):

Maxime Thibault ◽

Jessica McMahon ◽

Guillaume Faubert ◽

Julie Charbonneau ◽

Josianne Malo ◽

...

Keyword(s):

Liver Disease ◽

Weight Gain ◽

Parenteral Nutrition ◽

Ursodeoxycholic Acid ◽

Retrospective Cohort ◽

Treatment Initiation ◽

Cox Regression ◽

Cox Regression Analysis ◽

Rate Of Decline ◽

Conjugated Bilirubin

OBJECTIVES To verify the effect of ursodeoxycholic acid (UDCA) on the duration of neonatal parenteral nutrition-associated liver disease. METHODS Retrospective cohort study of neonates in intensive care between 2004 and 2007 presenting with parenteral nutrition-associated liver disease. RESULTS Of 118 eligible infants, 64 received UDCA. Cholestasis lasted longer in the UDCA group (79 vs. 50 days, p=0.001). However, treatment was delayed for a median of 24 days after cholestasis onset. Multivariate Cox regression analysis showed no association between UDCA and cholestasis duration. The rate of decline of conjugated bilirubin was greater in treated patients (median 0.084 mg/dL/day vs. 0.60 mg/dL/day; p=0.009) and weight gain was greater (22.8 vs. 17.7 g/kg/day, p=0.010). CONCLUSIONS UDCA therapy was not associated with the duration of parenteral nutrition-associated liver disease. A delay in treatment initiation might explain this result. UDCA therapy was associated with a faster decline of conjugated bilirubin and greater weight gain.

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Impact of previous insulin therapy on the prognosis of diabetic patients with acute coronary syndromes

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302010000700005 ◽

2010 ◽

Vol 54 (7) ◽

pp. 612-619 ◽

Cited By ~ 2

Author(s):

Natália António ◽

Francisco Soares ◽

Carolina Lourenço ◽

Fátima Saraiva ◽

Francisco Gonçalves ◽

...

Keyword(s):

Acute Coronary Syndromes ◽

Insulin Treatment ◽

Cox Regression ◽

Atherosclerotic Disease ◽

Diabetic Patients ◽

Cardiac Events ◽

Cox Regression Analysis ◽

Group A ◽

Coronary Syndromes ◽

Group B

OBJECTIVE: To determine whether previous insulin treatment independently influences subsequent outcomes in diabetic patients with ACS (acute coronary syndromes). SUBJECTS AND METHODS: 375 diabetic patients with ACS, divided in 2 groups: Group A (n = 69) - previous insulin and Group B (n = 306) - without previous insulin. Predictors of 1-year mortality and major adverse cardiac events (MACE) were analyzed by Cox regression analysis. RESULTS: Group A had more previous stroke (17.4% vs. 9.2%, p = 0.047) and peripheral artery disease (13.0% vs. 3.6%, p = 0.005). They had significantly higher admission glycemia and lower LDL cholesterol. There were no significant differences in the type of ACS, in 1-year mortality (18.2% vs. 10.4%, p = 0.103) or MACE (32.1% vs. 23.0%, p = 0.146) between groups. In multivariate analysis, insulin treatment was neither an independent predictor of 1-year mortality nor of MACE. CONCLUSION: Despite the more advanced atherosclerotic disease, diabetics under insulin had similar outcomes to those without insulin. Insulin may protect diabetics from the expected poor adverse outcome of an advanced atherosclerotic disease.

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