scholarly journals Frailty predicts a higher risk of incident urolithiasis in 525 368 patients with diabetes mellitus: a population-based study

2020 ◽  
Vol 8 (1) ◽  
pp. e000755 ◽  
Author(s):  
Chia-Ter Chao ◽  
Jui Wang ◽  
Jenq-Wen Huang ◽  
Kuan-Yu Hung ◽  
Kuo-Liong Chien
Keyword(s):  
Renal Stones ◽  
Population Based ◽  
Diabetic Patients ◽  
Proportional Hazard ◽  
Hazard Regression ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Cox Proportional Hazard Regression

ObjectivePatients with diabetes have an increased risk for urolithiasis, but the associated risk factors remain an active area of research. We investigated whether frailty influenced the probability of patients with diabetes developing urolithiasis.Research design and methodsUsing data from the Longitudinal Cohort of Diabetic Patients from 2004 to 2010, we identified those without and with frailty based on a validated, modified FRAIL scale. Patients were followed until they developed urolithiasis, and we used Kaplan-Meier and Cox proportional hazard regression analyses to examine the relationship between frailty, its severity, and the risk of urolithiasis, accounting for demographic profiles, comorbidities, frailty status changes over follow-up, and medications, with risk competition by mortality.ResultsAmong 525 368 patients with diabetes, 64.4% were not frail, while 28.5%, 6.6%, and 0.6% had 1, 2, and ≥3 FRAIL items at baseline. After 4.2 years of follow-up, 13.4% experienced incident urolithiasis. Cox proportional hazard regression analysis showed that patients with diabetes having at least one FRAIL criterion exhibited a significantly higher risk for urolithiasis compared with non-frail patients (for 1, 2, and ≥3 items, hazard ratio (HR)s: 1.04, 1.23, and 1.46; 95% confidence intervals (CIs) 0.99 to 1.09, 1.12 to 1.35, and 1.12 to 1.91, respectively). This increase in urolithiasis risk remained significant if we restricted analyses to renal stones or recurrent urolithiasis as the study outcomes.ConclusionsFrailty may pose a risk for incident urolithiasis in patients with diabetes. Treating frailty may potentially reduce their risk for urolithiasis.

scholarly journals Pediatric Ischemic Stroke and Epilepsy: A Nationwide Cohort Study

Stroke ◽  
2021 ◽  
Author(s):  
Heléne E.K. Sundelin ◽  
Torbjörn Tomson ◽  
Johan Zelano ◽  
Jonas Söderling ◽  
Peter Bang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Population Based ◽  
Proportional Hazard ◽  
Future Planning ◽  
Population Based Study ◽  
First Degree Relatives ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression

Background and Purpose: The risk of epilepsy after stroke has not been thoroughly explored in pediatric ischemic stroke. We examined the risk of epilepsy in children with ischemic stroke as well as in their first-degree relatives. Methods: In Swedish National Registers, we identified 1220 children <18 years with pediatric ischemic stroke diagnosed 1969 to 2016, alive 7 days after stroke and with no prior epilepsy. We used 12 155 age- and sex-matched individuals as comparators. All first-degree relatives to index individuals and comparators were also identified. The risk of epilepsy was estimated in children with ischemic stroke and in their first-degree relatives using Cox proportional hazard regression model. Results: Through this nationwide population-based study, 219 (18.0%) children with ischemic stroke and 91 (0.7%) comparators were diagnosed with epilepsy during follow-up corresponding to a 27.8-fold increased risk of future epilepsy (95% CI, 21.5–36.0). The risk of epilepsy was still elevated after 20 years (hazard ratio [HR], 7.9 [95% CI, 3.3–19.0]), although the highest HR was seen in the first 6 months (HR, 119.4 [95% CI, 48.0–297.4]). The overall incidence rate of epilepsy was 27.0 per 100 000 person-years (95% CI, 21.1–32.8) after ischemic stroke diagnosed ≤day 28 after birth (perinatal) and 11.6 per 100 000 person-years (95% CI, 9.6–13.5) after ischemic stroke diagnosed ≥day 29 after birth (childhood). Siblings and parents, but not offspring, to children with ischemic stroke were at increased risk of epilepsy (siblings: HR, 1.64 [95% CI, 1.08–2.48] and parents: HR, 1.41 [95% CI, 1.01–1.98]). Conclusions: The risk of epilepsy after ischemic stroke in children is increased, especially after perinatal ischemic stroke. The risk of epilepsy was highest during the first 6 months but remained elevated even 20 years after stroke which should be taken into account in future planning for children affected by stroke.

3043Endotrophin, a fragment of collagen type VI, is correlated to IMT and associated with cardiovascular events in patients with atherosclerosis and diabetes: the IMI-SUMMIT cohort

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Holm Nielsen ◽  
I Goncalves ◽  
A Shore ◽  
A Natali ◽  
F Khan ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Collagen Type ◽  
Atherosclerotic Disease ◽  
Proportional Hazard ◽  
Hazard Regression ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Collagen Type Vi ◽  
Cox Proportional Hazard Regression

Abstract Background/Introduction Patients with micro- and macrovascular diseases, including atherosclerosis, have increased risk of cardiovascular events and early mortality. The atherosclerotic disease is characterised by accumulation of lipids, cells and proteins in the arterial wall, which includes remodelling of the extracellular matrix (ECM). Collagen type VI (COL6) is known to be over-expressed in patients with atherosclerosis. The biomarker PRO-C6, known as endotrophin, is a COL6 fragment that reflects formation of collagen type VI, and possess pro-inflammatory and pro-fibrotic activities. Purpose We explored whether increased endotrophin levels, measured by PRO-C6, were associated with intima-media thickness (IMT) and mortality in the IMI-SUMMIT cohort. Methods Circulating protein levels of PRO-C6 were measured in EDTA plasma from 1500 patients enrolled at four European University Hospitals, using an enzyme-linked immunosorbent assay. Follow-up data were available up to three years after sample collection. Associations between PRO-C6 and incidence of cardiovascular (CV) events and all-cause mortality were assessed by Kaplan-Meier curves and Cox proportional hazard regression analyses. Pearson correlation was performed to explore the association of PRO-C6, IMT and clinical variables. Known confounders defined by the Framingham Heart study (age, gender and diabetes) were included in the Cox proportional hazard regression analysis. Results Plasma PRO-C6 was significantly correlated with IMT in both the common carotid artery and the carotid bulb (r=0.09, p=0.002 and r=0.11, p=0.0003, respectively), HbA1c (r=0.11, p<0.0001) and C-reactive protein (r=0.14, p<0.0001). A total of 145 patients suffered from fatal or non-fatal cardiovascular events during the three-year follow-up period. Patients in the highest PRO-C6 tertile had a two-fold increased risk of experiencing a CV event during follow-up (p=0.002), independently of age, presence of CVD at baseline, type 2 diabetes, smoking and statin treatment in a regression model. Conclusion The present findings demonstrate that circulating levels of PRO-C6 are associated with atherosclerosis severity and increased incidence of cardiovascular events. Since PRO-C6 detects the signaling molecule endotrophin, the results may indicate that endotrophin is not only a biomarker of atherosclerotic disease, but may have a role in promoting disease progression. Acknowledgement/Funding This work was supported by the Danish Research Foundation, The Danish innovation foundation and the IMI-SUMMIT participants

scholarly journals Metformin Attenuates Osteoporosis in Diabetic Patients with Carcinoma in Situ: A Nationwide, Retrospective, Matched-Cohort Study in Taiwan

2020 ◽  
Vol 9 (9) ◽  
pp. 2839 ◽  
Author(s):  
Chieh-Hua Lu ◽  
Chi-Hsiang Chung ◽  
Feng-Chih Kuo ◽  
Kuan-Chan Chen ◽  
Chia-Hao Chang ◽  
...  
Keyword(s):  
Carcinoma In Situ ◽  
Diabetic Patients ◽  
Research Database ◽  
Proportional Hazard ◽  
Metformin Therapy ◽  
Cox Proportional Hazard ◽  
Metformin Group ◽  
Patients With Diabetes

Patients with diabetes are at increased risk of cancer development and osteoporosis. Metformin is an effective agent for diabetes management. Epidemiological studies have identified an association between metformin use and cancer prevention. This article outlines the potential for metformin to attenuate the rate of osteoporosis in diabetic patients with carcinoma in situ (CIS). From the National Health Insurance Research Database of Taiwan, 7827 patients with diabetes with CIS who were receiving metformin therapy were selected, along with 23,481 patients as 1:3 sex-, age- and index year-matched controls, who were not receiving metformin therapy. A Cox proportional hazard analysis was used to compare the rate of osteoporosis during an average of 15-year follow-up. Of the subjects who were enrolled, 801 (2.56%) had osteoporosis, including 168 from the metformin group (2.15%) and 633 from the without metformin group (2.70%). The metformin group presented a lower rate of osteoporosis at the end of follow-up (p = 0.009). The Cox proportional hazard regression analysis revealed a lower rate of osteoporosis for the metformin group (adjusted hazard ratio of 0.820; 95% confidence interval = 0.691–0.972, p = 0.022). Diabetic patients with CIS under metformin therapy presented lower osteoporosis rate than those who were not receiving metformin therapy.

scholarly journals N-Terminal Pro-Brain Natriuretic Peptide Predicts Long-Term Technique Failure in Patients Undergoing Peritoneal Dialysis

2018 ◽  
Vol 7 (12) ◽  
pp. 557 ◽  
Author(s):  
Chia-Ter Chao ◽  
Chih-Kang Chiang ◽  
Jenq-Wen Huang ◽  
and Kuan-Yu Hung
Keyword(s):  
Peritoneal Dialysis ◽  
Natriuretic Peptide ◽  
Hydration Status ◽  
Proportional Hazard ◽  
Hazard Regression ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression ◽  
Technique Failure

: It is unclear whether N-terminal pro-brain type natriuretic peptide (NT-proBNP) level can be a biomarker for technique failure among long-term peritoneal dialysis (PD) patients. We prospectively included end-stage renal disease patients undergoing PD from a single center between December 2011 and December 2017. We divided the cohort into high or low NT-proBNP groups and analyzed the risk factors associated with the incidence of technique failure using Cox proportional hazard regression analysis. A total of 258 chronic PD patients (serum NT-proBNP, 582 ± 1216 ng/mL) were included. After a mean follow-up of 3.6 years, 49.6% of PD patients developed technique failure and switched to hemodialysis, while 15.5% died. Cox proportional hazard regression analyses accounting for age, gender, diabetes, renal clearance, C-reactive protein, and hydration status, showed that higher natural log transformed NT-proBNP levels (hazard ratio [HR] 1.13, p < 0.01) were predictive of an increased risk of technique failure, and were also predictive of an increased risk of mortality (HR 1.56, p < 0.01). Consequently, NT-proBNP might be an under-recognized biomarker for estimating the risk of technique failure, and regular monitoring NT-proBNP levels among PD patients may assist in their care.

scholarly journals Positive Association of Dietary Inflammatory Index with Incidence of Cardiovascular Disease: Findings from a Korean Population-Based Prospective Study

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 588
Author(s):  
Imran Khan ◽  
Minji Kwon ◽  
Nitin Shivappa ◽  
James R. Hébert ◽  
Mi Kyung Kim
Keyword(s):  
Cardiovascular Disease ◽  
Positive Association ◽  
Population Based ◽  
Proportional Hazard ◽  
Dietary Inflammatory Index ◽  
Cvd Risk ◽  
Inflammatory Index ◽  
Cox Proportional Hazard ◽  
Increased Risk

Recently, diets with higher inflammatory potentials based on the dietary inflammatory index (DII®) have been shown to be associated with increased cardiovascular disease (CVD) risk in the general population. We aimed to prospectively investigate the association between the DII and CVD risk in the large Korean Genome and Epidemiology Study_Health Examination (KoGES_HEXA) cohort comprised of 162,773 participants (men 55,070; women 107,703). A validated semi-quantitative food frequency questionnaire (SQ-FFQ) was used to calculate the DII score. Statistical analyses were performed by using a multivariable Cox proportional hazard model. During the mean follow-up of 7.4 years, 1111 cases of CVD were diagnosed. Higher DII score was associated with increased risk of CVD in men (hazard ratio [HR]Quintile 5 vs. 1 1.43; 95% CI 1.04–1.96) and in women (HRQuintile 5 vs. 1 1.19; 95% CI 0.85–1.67), although not significant for women. The risk of CVD was significantly higher in physically inactive men (HRQuintile 5 vs. 1 1.80; 95% CI 1.03–3.12), obese men (HRQuintile 5 vs. 1 1.77; 95% CI 1.13–2.76) and men who smoked (HRQuintile 5 vs. 1 1.60; 95% CI 1.10–2.33), respectively. The risk of developing stroke was significantly higher for men (HRQuintile 5 vs. 1 2.06; 95% CI 1.07–3.98; p = 0.003), but not for women. A pro-inflammatory diet, as indicated by higher DII scores, was associated with increased risk of CVD and stroke among men.

Leucocyte Telomere Length and Risk of Cardiovascular Disease in a Cohort of 1,397 Danish Men and Women

Cardiology ◽  
2015 ◽  
Vol 133 (3) ◽  
pp. 173-177 ◽  
Author(s):  
Hanne Ellehoj ◽  
Laila Bendix ◽  
Merete Osler
Keyword(s):  
Telomere Length ◽  
Regression Models ◽  
Proportional Hazard ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Men And Women ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression

Objectives: Short leucocyte telomere length (LTL) might be a risk factor for cardiovascular diseases (CVD). The present study examines the relation between LTL and incident fatal or non-fatal CVD, ischaemic heart disease (IHD) and stroke in a Danish cohort followed for 29 years. Methods: In total, 1,397 men and women who participated in health examinations with blood sampling in 1981-1984 were followed for CVD outcomes until the end of 2012 by linkage to national registers. Cox proportional hazard regression models were used to analyse the relation between LTL and CVD adjusting for potential confounding CVD risk factors. Results: During the follow-up, 603 participants experienced an incident fatal or non-fatal CVD. The survival analysis showed that baseline LTL was not associated with CVD outcomes. In the subanalysis with IHD as outcome, those with middle and short LTL had an increased hazard rate ratio of 1.97 (95% CI 1.31-2.93) and 1.55 (95% CI 1.02-2.35), respectively, which was attenuated when confounding factors were adjusted for. For stroke, the pattern of associations was similar but less precisely estimated. Conclusions: In this study short, LTL was not associated with an increased risk of CVD, but modestly associated with an increased risk of IHD.

scholarly journals Interface of Multiple Sclerosis, Depression, Vascular Disease, and Mortality

Neurology ◽  
2021 ◽  
Vol 97 (13) ◽  
pp. e1322-e1333 ◽  
Author(s):  
Raffaele Palladino ◽  
Jeremy Chataway ◽  
Azeem Majeed ◽  
Ruth Ann Marrie
Keyword(s):  
Multiple Sclerosis ◽  
Vascular Disease ◽  
Population Based ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Depression Status ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Cox Proportional Hazard Regression

Background and ObjectivesTo assess whether the association among depression, vascular disease, and mortality differs in people with multiple sclerosis (MS) compared with age-, sex-, and general practice–matched controls.MethodsWe conducted a population-based retrospective matched cohort study between January 1, 1987, and September 30, 2018, that included people with MS and matched controls without MS from England, stratified by depression status. We used time-varying Cox proportional hazard regression models to test the association among MS, depression, and time to incident vascular disease and mortality. Analyses were also stratified by sex.ResultsWe identified 12,251 people with MS and 72,572 matched controls. At baseline, 21% of people with MS and 9% of controls had depression. Compared with matched controls without depression, people with MS had an increased risk of incident vascular disease regardless of whether they had comorbid depression. The 10-year hazard of all-cause mortality was 1.75-fold greater in controls with depression (95% confidence interval [CI] 1.59–1.91), 3.88-fold greater in people with MS without depression (95% CI 3.66–4.10), and 5.43-fold greater in people with MS and depression (95% CI 4.88–5.96). Overall, the interaction between MS status and depression was synergistic, with 14% of the observed effect attributable to the interaction. Sex-stratified analyses confirmed differences in hazard ratios.DiscussionDepression is associated with increased risks of incident vascular disease and mortality in people with MS, and the effects of depression and MS on all-cause mortality are synergistic. Further studies should evaluate whether effectively treating depression is associated with a reduced risk of vascular disease and mortality.

scholarly journals Increased risk of non-multiple sclerosis demyelinating syndromes in patients with preexisting septicaemia: a nationwide retrospective cohort study

2019 ◽  
Vol 95 (1124) ◽  
pp. 307-313
Author(s):  
Chung-Hsing Chou ◽  
Jiunn-Tay Lee ◽  
Chia-Kuang Tsai ◽  
Li-Ming Lien ◽  
Jiu-Haw Yin ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Epidemiological Data ◽  
Population Based ◽  
Research Database ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression ◽  
The Relationship

BackgroundGrowing evidence shows links between septicaemia and non-multiple sclerosis demyelinating syndromes (NMSDS); nevertheless, epidemiological data are still very limited. This study aimed to explore the relationship between septicaemia and NMSDS in a general population.MethodsThe study included 482 781 individuals diagnosed with septicaemia and 1 892 825 age/sex-matched non-septicaemia patients for the comparison. Data were drawn from a population-based nationwide National Health Insurance Research Database Taiwan, from 1 January 2002 to 31 December 2011. The two cohorts of patients with and without septicaemia were followed up for the occurrence of NMSDS. The Cox-proportional hazard regression model was performed to estimate adjusted HR after multivariate adjustment.ResultsIndividuals with septicaemia had a 4.17-fold (95% CI 3.21 to 5.4, p < 0.001) higher risk to develop NMSDS compared with those without septicaemia. Patients aged <65 years had a greater NMSDS risk (<45 years: HR = 6.41, 95% CI 3.65 to 11.3, p < 0.001; 45–64 years: HR = 6.66, 95% CI 3.98 to 11.2, p < 0.001). Furthermore, females with septicaemia and individuals with higher severity of septicaemia were associated with increased risks of developing NMSDS.ConclusionsOur results indicated that patients with septicaemia were likely to develop NMSDS. A possible contributing role of septicaemia in increasing the hazard of NMSDS is proposed, based on the outcome that individuals with higher severity of septicaemia carried elevated threat of encountering NMSDS.

scholarly journals Association between Autoimmune Rheumatic Diseases and the Risk of Dementia

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Kang Lu ◽  
Hao-Kuang Wang ◽  
Chih-Ching Yeh ◽  
Chih-Yuan Huang ◽  
Pi-Shan Sung ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Proportional Hazard ◽  
Vascular Events ◽  
Autoimmune Rheumatic Diseases ◽  
Multiple Organs ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression ◽  
Insurance Database

Aim. Autoimmune rheumatic diseases (ARD) are characterized by systemic inflammation and may affect multiple organs and cause vascular events such as ischemic stroke and acute myocardial infarction. However, the association between ARD and increased risk of dementia is uncertain. This is a retrospective cohort study to investigate and compare the risk of dementia between patients clinically diagnosed with ARD and non-ARD patients during a 5-year follow-up period.Methods. Data were obtained from the Longitudinal Health Insurance Database 2000 (LHID2000). We included 1221 patients receiving ambulatory or hospitalization care and 6105 non-ARD patients; patients were matched by sex, age, and the year of index use of health care. Each patient was studied for 5 years to identify the subsequent manifestation of dementia. The data obtained were analyzed by Cox proportional hazard regression.Results. During the 5-year follow-up period, 30 ARD (2.48%) and 141 non-ARD patients (2.31%) developed dementia. During the 5-year follow-up period, there were no significant differences in the risks of any type of dementia (adjusted hazard ratio (HR), 1.18; 95% CI, 0.79–1.76) in the ARD group after adjusting for demographics and comorbidities.Conclusions. Within the 5-year period, patients with and without ARD were found to have similar risks of developing dementia.

scholarly journals Low serum parathyroid hormone is a risk factor for peritonitis episodes in incident peritoneal dialysis patients: a retrospective study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yuqi Yang ◽  
Jingjing Da ◽  
Yi Jiang ◽  
Jing Yuan ◽  
Yan Zha
Keyword(s):  
Risk Factor ◽  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Proportional Hazard ◽  
Serum Parathyroid Hormone ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Regression ◽  
Gram Negative Organisms ◽  
Serum Pth

Abstract Background Serum parathyroid hormone (PTH) levels have been reported to be associated with infectious mortality in peritoneal dialysis (PD) patients. Peritonitis is the most common and fatal infectious complication, resulting in technique failure, hospital admission and mortality. Whether PTH is associated with peritonitis episodes remains unclear. Methods We examined the association of PTH levels and peritonitis incidence in a 7-year cohort of 270 incident PD patients who were maintained on dialysis between January 2012 and December 2018 using Cox proportional hazard regression analyses. Patients were categorized into three groups by serum PTH levels as follows: low-PTH group, PTH < 150 pg/mL; middle-PTH group, PTH 150-300 pg/mL; high-PTH group, PTH > 300 pg/mL. Results During a median follow-up of 29.5 (interquartile range 16–49) months, the incidence rate of peritonitis was 0.10 episodes per patient-year. Gram-positive organisms were the most common causative microorganisms (36.2%), and higher percentage of Gram-negative organisms was noted in patients with low PTH levels. Low PTH levels were associated with older age, higher eGFR, higher hemoglobin, calcium levels and lower phosphate, alkaline phosphatase levels. After multivariate adjustment, lower PTH levels were identified as an independent risk factor for peritonitis episodes [hazard ratio 1.643, 95% confidence interval 1.014–2.663, P = 0.044]. Conclusions Low PTH levels are independently associated with peritonitis in incident PD patients.

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