Impact of major depression on cardiovascular outcomes for individuals with hypertension: prospective survival analysis in UK Biobank

ObjectivesTo assess whether a history of major depressive disorder (MDD) in middle-aged individuals with hypertension influences first-onset cardiovascular disease outcomes.DesignProspective cohort survival analysis using Cox proportional hazards regression with a median follow-up of 63 months (702 902 person-years). Four mutually exclusive groups were compared: hypertension only (n=56 035), MDD only (n=15 098), comorbid hypertension plus MDD (n=12 929) and an unaffected (no hypertension, no MDD) comparison group (n=50 798).SettingUK Biobank.ParticipantsUK Biobank participants without cardiovascular disease aged 39–70 who completed psychiatric questions relating International Classification of Diseases-10 Revision (ICD-10) diagnostic criteria on a touchscreen questionnaire at baseline interview in 2006–2010 (n=134 860).Primary and secondary outcome measuresFirst-onset adverse cardiovascular outcomes leading to hospital admission or death (ICD-10 codes I20–I259, I60–69 and G45–G46), adjusted in a stepwise manner for sociodemographic, health and lifestyle features. Secondary analyses were performed looking specifically at stroke outcomes (ICD-10 codes I60–69 and G45–G46) and in gender-separated models.ResultsRelative to controls, adjusted HRs for adverse cardiovascular outcomes were increased for the hypertension only group (HR 1.36, 95% CI 1.22 to 1.52) and were higher still for the comorbid hypertension plus MDD group (HR 1.66, 95% CI 1.45 to 1.9). HRs for the comorbid hypertension plus MDD group were significantly raised compared with hypertension alone (HR 1.22, 95% CI 1.1 to 1.35). Interaction measured using relative excess risk due to interaction (RERI) and likelihood ratios (LRs) were identified at baseline (RERI 0.563, 95% CI 0.189 to 0.938; LR p=0.0116) but not maintained during the follow-up.LimitationsPossible selection bias in UK Biobank and inability to assess for levels of medication adherence.ConclusionsComorbid hypertension and MDD conferred greater hazard than hypertension alone for adverse cardiovascular outcomes, although evidence of interaction between hypertension and MDD was inconsistent over time. Future cardiovascular risk prediction tools may benefit from the inclusion of questions about prior history of depressive disorders.

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Risk Factors of Thrombosis in Adults with Primary Immune Thrombocytopenia. a French Nationwide Cohort Study

Blood ◽

10.1182/blood-2018-99-112506 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 3745-3745

Author(s):

Guillaume Moulis ◽

Bérangère Baricault ◽

Charlotta Ekstrand ◽

Margaux Lafaurie ◽

Christian Fynbo Christiansen ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Research Funding ◽

Immune Thrombocytopenia ◽

Additional Risk Factor ◽

Discharge Diagnosis ◽

Additional Risk ◽

Icd 10 ◽

History Of

Abstract Background: Immune thrombocytopenia (ITP) is associated with an increased risk of venous and arterial thrombosis (VT and AT, respectively) as compared with the general population. However, the impact of thrombosis risk factors and of ITP treatments, particularly of thrombopoietin-receptor agonists (TPORAs), is not well known in the routine clinical practice. Aim: The objective of this cohort study was to assess the risk factors of VT and AT in adults with primary ITP, including ITP treatments. Methods: The population was the cohort of all incident primary ITP adults in France during 2009-2015 built within the national health insurance database (French Adult Immune Thrombocytopenia - FAITH - cohort; NCT03429660). Incident ITP patients were identified using a validated algorithm combining drug exposures and diagnosis codes according to the international classification of diseases, version 10 (ICD-10). Risks of first hospitalization with a validated primary discharge diagnosis code of VT and AT (coded with the ICD-10) were assessed separately. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI). Variables included in multivariable models were: age, sex, history of AT and of VT, diabetes, cardiovascular disease, chronic kidney disease, chronic liver disease, cancer; exposures to antihypertensive, lipid-lowering, antiplatelet, anticoagulant drugs and ITP treatments including splenectomy were modeled as time-dependent variables. Results: The cohort included 7225 adult patient with incident primary ITP: 3807 (52.7%) were ≥60 year-old, 3199 (44.3%) were males, 692 (9.6%) had a history of cardiovascular disease, 937 (13.0%) had diabetes. During the follow-up, 5737 (79.4%) were exposed to corticosteroids, 3364 (46.6%) to intravenous immunoglobulin (IVIg), 995 (13.8%) to TPORAs, and 755 (10.4%) were splenectomized. During the follow-up (23 852 patient-years in total; mean follow-up: 39.5 months), 174 patients had a hospitalization with a primary discharge diagnosis of VT and 333 of AT, leading to incidences of 7.4 (95% CI: 6.4-8.6) and 14.4 (95% CI:12.9-16.0)/1000 patient-years, respectively. In multivariable Cox models, the most important risk factors for VT were higher age (≥60 years vs. <40 years: HR: 2.22, 95% CI: 1.39-3.53), a history of VT (HR: 4.38, 95% CI: 1.07-18.02), splenectomy (HR: 3.22, 95% CI: 2.06-3.03), exposure to IVIg (HR: 2.30, 95% CI: 1.41-3.75), corticosteroids (HR: 3.29, 95% CI: 2.39-4.53) and TPORAs (HR: 3.16, 95% CI: 2.04-4.88). All classical baseline cardiovascular risk factors listed above as covariables were associated with the risk of AT. The HRs for AT were 0.97 (95% CI: 0.59-1.61) for splenectomy, 1.05 (95% CI: 0.80-1.40) for corticosteroids, 2.35 (95%CI: 1.58-3.50) for IVIg, 1.25 (95%CI: 0.46-3.37) for danazol and 1.31 (95%CI: 0.84-2.06) for TPORAs. It is of note that among the 25 patients who had a VT while treated by TPORA, 18 (72.0%) were>50 year-old, 14 (56.0%) were women, 6 (24.0%) were splenectomized, 9 (36.0%) were concomitantly exposed to corticosteroids and 3 (12.0%) to IVIg; only 3 women aged<50 years had no additional risk factor. Among the 21 patients who had an AT while treated by TPORA, 18 (85.7%) were>50 year-old, 15 (71.4%) were men, 8 (38.1%) were splenectomized, 5 (23.8%) were concomitantly exposed to corticosteroids and one to IVIg; only one 48-year-old man had no additional risk factor for AT. Conclusions: Baseline risk factors for VT and AT were highly associated with VT and AT occurrence in adults with primary ITP. Splenectomy, corticosteroids, IVIg and TPORAs were risk factors for VT. Most patients who had a thrombosis while treated by TPORA had additional risk factors. These findings help choosing a tailored treatment strategy for a given patient depending on his/her risk profile for VT and AT. Disclosures Christiansen: Amgen: Research Funding. Bahmanyar:Amgen: Research Funding.

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Genetic variants associated with inherited cardiovascular disorders among 13,131 asymptomatic older adults of European descent

npj Genomic Medicine ◽

10.1038/s41525-021-00211-x ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Paul Lacaze ◽

Robert Sebra ◽

Moeen Riaz ◽

Jodie Ingles ◽

Jane Tiller ◽

...

Keyword(s):

Cardiovascular Disease ◽

Genetic Testing ◽

Long Qt Syndrome ◽

Polymorphic Ventricular Tachycardia ◽

Prior History ◽

Cardiovascular Disorders ◽

Long Qt ◽

History Of ◽

Qt Syndrome

AbstractGenetic testing is used to optimise the management of inherited cardiovascular disorders that can cause sudden cardiac death. Yet more genotype–phenotype correlation studies from populations not ascertained on clinical symptoms or family history of disease are required to improve understanding of gene penetrance. We performed targeted sequencing of 25 genes used routinely in clinical genetic testing for inherited cardiovascular disorders in a population of 13,131 asymptomatic older individuals (mean age 75 years) enrolled in the ASPREE trial. Participants had no prior history of cardiovascular disease events, dementia or physical disability at enrolment. Variants were classified following ACMG/AMP standards. Sudden and rapid cardiac deaths were clinically adjudicated as ASPREE trial endpoints, and assessed during mean 4.7 years of follow-up. In total, 119 participants had pathogenic/deleterious variants in one of the 25 genes analysed (carrier rate of 1 in 110 or 0.9%). Participants carried variants associated with hypertrophic cardiomyopathy (N = 24), dilated cardiomyopathy (N = 29), arrhythmogenic right-ventricular cardiomyopathy (N = 22), catecholaminergic polymorphic ventricular tachycardia (N = 4), aortopathies (N = 1), and long-QT syndrome (N = 39). Among 119 carriers, two died from presumed sudden/rapid cardiac deaths during follow-up (1.7%); both with pathogenic variants in long-QT syndrome genes (KCNQ1, SCN5A). Among non-carriers, the rate of sudden/rapid cardiac deaths was significantly lower (0.08%, 11/12936, p < 0.001). Variants associated with inherited cardiovascular disorders are found in asymptomatic individuals aged 70 years and older without a history of cardiovascular disease.

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Surgically resected skull base meningiomas demonstrate a divergent postoperative recurrence pattern compared with non–skull base meningiomas

Journal of Neurosurgery ◽

10.3171/2015.7.jns15546 ◽

2016 ◽

Vol 125 (2) ◽

pp. 431-440 ◽

Cited By ~ 20

Author(s):

Alireza Mansouri ◽

George Klironomos ◽

Shervin Taslimi ◽

Alex Kilian ◽

Fred Gentili ◽

...

Keyword(s):

Skull Base ◽

Recurrence Rate ◽

Postoperative Recurrence ◽

Prior History ◽

Skull Base Tumors ◽

Who Grade ◽

Predictors Of Recurrence ◽

History Of ◽

Skull Base Meningiomas

OBJECTIVE The objective of this study was to identify the natural history and clinical predictors of postoperative recurrence of skull base and non–skull base meningiomas. METHODS The authors performed a retrospective hospital-based study of all patients with meningioma referred to their institution from September 1993 to January 2014. The cohort constituted both patients with a first-time presentation and those with evidence of recurrence. Kaplan-Meier curves were constructed for analysis of recurrence and differences were assessed using the log-rank test. Cox proportional hazard regression was used to identify potential predictors of recurrence. RESULTS Overall, 398 intracranial meningiomas were reviewed, including 269 (68%) non–skull base and 129 (32%) skull base meningiomas (median follow-up 30.2 months, interquartile range [IQR] 8.5–76 months). The 10-year recurrence-free survival rates for patients with gross-total resection (GTR) and subtotal resection (STR) were 90% and 43%, respectively. Skull base tumors were associated with a lower proliferation index (0.041 vs 0.062, p = 0.001), higher likelihood of WHO Grade I (85.3% vs 69.1%, p = 0.003), and younger patient age (55.2 vs 58.3 years, p = 0.01). Meningiomas in all locations demonstrated an average recurrence rate of 30% at 100 months of follow-up. Subsequently, the recurrence of skull base meningiomas plateaued whereas non–skull base lesions had an 80% recurrence rate at 230 months follow-up (p = 0.02). On univariate analysis, a prior history of recurrence (p < 0.001), initial WHO grade following resection (p < 0.001), and the inability to obtain GTR (p < 0.001) were predictors of future recurrence. On multivariate analysis a prior history of recurrence (p = 0.02) and an STR (p < 0.01) were independent predictors of a recurrence. Assessing only patients with primary presentations, STR and WHO Grades II and III were independent predictors of recurrence (p < 0.001 for both). CONCLUSIONS Patients with skull base meningiomas present at a younger age and have less aggressive lesions overall. Extent of resection is a key predictor of recurrence and long-term follow-up of meningiomas is necessary, especially for non–skull base tumors. In skull base meningiomas, recurrence risk plateaus approximately 100 months after surgery, suggesting that for this specific cohort, follow-up after 100 months can be less frequent.

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Abstract P011: Heart Failure and the Obesity Paradox Among Participants in the in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.127.suppl_12.ap011 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Raegan W Durant ◽

Todd M Brown ◽

Emily B Levitan ◽

Joshua S Richman ◽

Nicole Redmond ◽

...

Keyword(s):

Heart Failure ◽

Health Behaviors ◽

Normal Weight ◽

Community Dwelling ◽

Prior History ◽

Central Adiposity ◽

All Cause Mortality ◽

History Of ◽

Regards Study

Background: Overweight and obese adults living with heart failure (HF) have lower mortality compared to those of normal weight. However, the specific relationships of overall weight status and central adiposity with mortality among those with HF are less well-defined. We examined the relationships among body mass index (BMI), waist circumference (WC) and mortality among patients hospitalized for HF in the REGARDS Study. Methods: REGARDS is a national cohort of US community-dwelling adults aged >45 recruited from 2003 to 2007. We measured all-cause mortality rates among 565 participants hospitalized with HF who were normal weight (BMI 18.5-24.9 kg/m 2 ), overweight (BMI 25.0-29.9 kg/m 2 ), or obese (BMI > 30.0 kg/m 2 ) at baseline. Underweight participants (BMI < 18.5 kg/m 2 ) were excluded. Baseline WC, weight, and height were measured during an in-home exam. Index HF hospitalizations during follow-up were adjudicated by a panel of experts. Vital status was determined using the Social Security Death Index or the National Death Index. Cox proportional models estimated hazard ratios for all-cause mortality following the index HF hospitalization. Models were sequentially adjusted for WC, sociodemographics, HF severity (EF and BNP during HF hospitalization, prior history of HF, prior history of diastolic dysfunction), comorbidities, and health behaviors. Results: Among 565 participants hospitalized for HF, 116 (21%) were normal weight, 209 (37%) overweight, and 240 (42%) obese at baseline. Over a mean follow-up of 2.5 years, 253 deaths occurred. In multivariable analyses, overweight was associated with lower all-cause mortality in all models (Table). Each 1-cm increase in WC was associated with higher risk of all-cause mortality, but the relationship was not statistically significant after health behaviors were added in the final model. . Conclusions: Among adults hospitalized for HF, overweight as assessed by BMI may be associated with lower risk for mortality. However, central adiposity may confer higher risk of mortality.

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Real world treatment patterns in chronic myeloid leukemia patients newly initiated on tyrosine kinase inhibitors in an U.S. integrated healthcare system

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155217697484 ◽

2017 ◽

Vol 24 (4) ◽

pp. 253-263

Author(s):

Nazia Rashid ◽

Han A Koh ◽

Kathy J Lin ◽

Brian Stwalley ◽

Eugene Felber

Keyword(s):

Chronic Myelogenous Leukemia ◽

Index Date ◽

Stem Cell Transplant ◽

Study Time ◽

Myelogenous Leukemia ◽

Prior History ◽

Cell Transplant ◽

Time Period ◽

History Of

Purpose To evaluate treatment patterns in patients diagnosed with incident chronic myelogenous leukemia (CML) newly initiating therapy with imatinib, dasatinib, or nilotinib. Patients were followed to determine switching and discontinuation rates. Factors associated with switching or discontinuation from index TKI therapy, reasons for discontinuation based on electronic chart notes, and frequency of laboratory monitoring were assessed during the follow-up period. Methods A retrospective cohort study was conducted in chronic myelogenous leukemia patients aged ≥ 18 years who were identified from the Kaiser Permanente Southern California (KPSC) Cancer Registry database during the study time period of 1 January 2007 to 12 December 2013. The index date was defined as the date of the first TKI prescription (imatinib, dasatinib, or nilotinib) identified during the study time period with no prior history of TKI use within 12 months. Patients had to have continuous membership with drug benefit eligibility and no prior history of stem cell transplant (SCT) or other cancers during the 12 months prior to the index date. Baseline characteristics were identified during 12 months prior to the index date and outcomes were identified during the follow-up period after the index date. All patients were followed from index TKI therapy until end of study time period (12 December 2014), death, stem cell transplant, or disenrollment from the health plan unless one of the following occurred first: a patient switched their index therapy, or a patient discontinued their index therapy. Forward stepwise selection multivariable logistic regression models were used to evaluate factors associated with patients who continued therapy compared to those who switched or discontinued therapy with the index TKI. Chart notes were reviewed 30 days prior and 30 days post index TKI discontinuation to evaluate reasons for discontinuation. Molecular and cytogenetic testing frequency was also assessed during the follow-up period among the different patient groups. Results Two hundred sixteen patients were identified with incident chronic myelogenous leukemia and use of TKI therapy: 189 (87.5%) received imatinib, 19 (8.8%) received dasatinib, and 8 (3.7%) received nilotinib. The mean age on index date was 53 years and 63% were male; 103 patients (48%) continued on their index therapy, while 62 patients (28%) switched, and 51 patients (24%) discontinued.

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Abstract WP226: The Association of Green Tea and Coffee Consumption With Mortality From Cardiovascular Disease and All Causes Among Persons With and Without History of Stroke or Myocardial Infarction: The JACC Study

Stroke ◽

10.1161/str.51.suppl_1.wp226 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Masayuki Teramoto ◽

Isao Muraki ◽

Kokoro Shirai ◽

Akiko Tamakoshi ◽

Hiroyasu Iso

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

General Population ◽

Green Tea ◽

Coffee Consumption ◽

Tea Consumption ◽

Food Frequency ◽

All Cause Mortality ◽

History Of

Background: Both green tea and coffee consumption have been associated with lower risks of mortality from cardiovascular disease (CVD) and all causes in general population, but little is known about those impact on persons with history of CVD. We examined the association of those consumption with these mortalities among persons with and without history of stroke or myocardial infarction in general population. Methods: The study subjects were 60,664 participants (896 stroke and 1751 myocardial infarction survivors and 58,017 persons with no history of stroke or myocardial infarction), aged 40-79 years at the baseline (1988-1990), who completed a lifestyle and medical history questionnaire including self-administered food frequency under the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). Results: During the median follow-up of 18.5 years, a total of 12,745 (7,458 men and 5,287 women) deaths including 3,737 CVD deaths were documented. Green tea and coffee consumption were inversely associated with CVD and all-cause mortality among myocardial infarction survivors as well as persons without history of stroke or myocardial infarction. After adjustment for known cardiovascular risk factors, the lower risks of mortality from CVD and all-causes associated with frequent green tea consumption (5-6 and ≥7 cups/day) or coffee consumption (≥2 cups/day) remained statistical. Conclusions: Both green tea and coffee consumption were inversely associated with risks of CVD and all-cause mortality among myocardial infarction survivors and persons without history of stroke or myocardial infarction.

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Abstract 16539: Heart Failure With Mid-Range or Improved Ejection Fraction Improves Cardiovascular Outcomes

Circulation ◽

10.1161/circ.142.suppl_3.16539 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Matthew Cefalu ◽

Jasneet Devgun ◽

Samuel Kennedy ◽

Jeremy Slivnick ◽

Zachary Garrett ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Multivariable Analysis ◽

Cardiovascular Outcomes ◽

Rank Test ◽

Prior History ◽

Reduced Ejection Fraction ◽

Log Rank Test ◽

History Of ◽

The Ohio State University

Heart failure with improved ejection fraction (HFiEF) is a unique and developing clinical entity among the heart failure (HF) spectrum. Prior studies suggest the characteristics, therapy, and prognosis of HFiEF are distinctive from HF with reduced ejection fraction (HFrEF) or mid-range ejection fraction (HFmrEF). We hypothesized that patients diagnosed with acute HF who later progressed to HFiEF would have improved cardiovascular outcomes compared to HFrEF. Our retrospective study included 295 adult patients with no prior history of HF at The Ohio State University diagnosed with acute HF. We defined HFrEF as a persistent ejection fraction < 40%, HFmrEF as persistent ejection fraction 40-49%, and HFiEF as improvement from baseline ejection fraction by > 5%. Nearly 74% of patients were found to have HFiEF while 12% and 14% were classified as HFrEF and HFmrEF respectively. Using a log-rank test, the time to first cardiovascular rehospitalization was significantly longer in HFiEF compared to HFrEF or HFmrEF (p=0.0192, Figure 1). Multivariable analysis, controlled for age and gender, indicated HFiEF had a trend towards significance as an independent predictor for time to cardiovascular hospitalization (p=0.053). Notably amyloid HF, valvular HF, and ischemic HF were all significant independent predictors. Survival analysis demonstrated that HFmrEF had significantly longer survival on log-rank test compared to HFrEF (p=0.0367). Multivariable analysis shows significantly lower hazard of mortality for those with HFmrEF (HR 0.57, 95% CI [0.36-0.92], p=0.017). Our exciting data indicates the progression to HFiEF after the diagnosis of acute HF is associated with reduced cardiovascular rehospitalization, and HFmrEF is associated with increased survival. These data have implications in patient surveillance and risk stratification as well as defining the natural history of HFiEF and HFmrEF as unique entities.

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Analyzing the effects of depression among patients with head and neck cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18038 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18038-e18038

Author(s):

Muhammad Usman Zafar ◽

Zahid Tarar ◽

Ghulam Ghous ◽

Umer Farooq ◽

Masood Anwar

Keyword(s):

Head And Neck Cancer ◽

Length Of Stay ◽

Head And Neck ◽

Neck Cancer ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Secondary Outcome ◽

Prior History ◽

Lower Odds ◽

History Of

e18038 Background: Patients with head and neck cancer carry the prospect of facial disfigurement in addition to the effects on speech, smell, sight, and taste. As such they are at a higher risk of acquiring emotional distress. Despite this, depression is underreported in this population. We review the National Inpatient Sample (NIS) to understand the effects of depression in patients admitted with any diagnosis of head and neck cancer. Methods: We designed a retrospective study and utilized NIS data for the year 2018. We identified patients with any history of Head and Neck cancer using their specific ICD-10 codes. We also identified codes for depressive disorders. Primary outcome was effect of depression on comorbidities. Secondary outcome was hospital length of stay. Utilizing STATA MP 16.1 we performed multivariate logistic regression analysis. Various comorbidities including previous history of coronary artery disease, congestive heart failure, stroke, smoking, hyperlipidemia, and chemotherapy were incorporated into the analysis. Results: The study population included 15,689 patients that were 18 years or older. Mean age was 64 years. Only 28% of the population was females. The mean hospital length of stay was approximately 7 days. In this group of patients, 12% had a history of depression. Among the different types of head and neck cancers oropharyngeal cancers had the highest percentage of depression rates (14%). In multivariable analysis, patients with depression had a higher comorbidity index but this result did not reach statistical significance (Odds Ratio (OR) 1.02, p = 0.054, 95% Confidence Intervals (CI) 0.999 – 1.045). Patients had higher odds of having depression if they also had a history of stroke (OR 1.4, 95% CI 1.13 – 1.73), prior history of chemotherapy (OR 1.25, 95% CI 1.09 – 1.43), history of hyperlipidemia (OR 1.31, 95% CI 1.16 – 1.48) or were admitted over the weekend (OR 1.21, 95% CI 1.07 – 1.38). Younger age was associated with lower odds of depression (OR 0.98, 95% CI 0.98 – 0.99). Women had higher odds of having depression (OR 1.68, 95% CI 1.51 – 1.88). When compared with white people, people from the following demographics had lower odds of depression – Black (OR 0.56, 95% CI 0.47 – 0.68), Hispanic (OR 0.64, 95% CI 0.49 – 0.83), Asian (OR 0.26, 95% CI 0.17 – 0.43), and others (OR 0.53, 95% CI 0.35 – 0.79). Hospital length of stay was higher among patients with depression (OR 0.7, 95% CI 0.2 – 1.15). Conclusions: Among patients with head and neck cancer, odds of having depression are higher in the white population, older patients, females and patients with prior history of chemotherapy. Depression is associated with higher hospital length of stay. These findings help understand the effect of depression on this susceptible population and identify at risk patients for appropriate screening.

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Abstract 13274: Predictors of Mortality in Critically Ill Covid-19 Patients - A Multicenter Prospective Analysis of 159 Patients

Circulation ◽

10.1161/circ.142.suppl_3.13274 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Randy Ip ◽

Zulfiqar Qutrio Baloch ◽

manel boumegouas ◽

Abdullah Al abcha ◽

Steven Do ◽

...

Keyword(s):

Atrial Fibrillation ◽

Critically Ill ◽

Demographic Data ◽

Prior History ◽

Multivariable Logistic Regression Analysis ◽

Elevated Troponin ◽

Ischemic Disease ◽

Patient Status ◽

History Of

Introduction: Certain patient demographics and biomarkers have been shown to predict survival in patients infected with COVID-19. However, predictors of outcome in patients who are critically ill and require advanced respiratory support are unclear. Methods: We performed a multicenter analysis of 159 consecutive patients with confirmed COVID-19 who were admitted to Intensive Care Unit (ICU) between March 01, 2020 and April 30, 2020. Patients were then followed until May 23, 2020. Demographic data (age, sex, race, BMI) and past medical history (hypertension, diabetes, COPD, CKD, history of cardiac ischemic disease, atrial fibrillation and heart failure) were recorded. Laboratory values (troponin, CPK, pro-BNP, ferritin, LDH and d-dimer) were analyzed. Patient status was classified as either alive or deceased at hospital discharge or the end of follow up period. Results: Mean patient age was 66+/-15 and 53% were male. Mean BMI was 31+/- 9. Mean hospital ICU stay was 11+/-8 days. Mortality rate of this ICU cohort at the end of follow-up was 63%. Fifty-five (34%) patients were discharged from the hospital. A multivariable logistic regression analysis identified four factors (age, prior history of diabetes, prior history of atrial fibrillation and elevated troponin) that had significant and independent contributions to the likelihood of survival. Each increase in decade of age above 40 (p = 0.010) was predicted to reduce survival by 30%, the presence of diabetes (p = 0.041) by 57%, a prior history of atrial fibrillation (p= 0.011) by 75%, and each increase of 0.1 ng/mL of troponin above 0.05 ng/ml (p = 0.001) by 55%. Conclusion: Mortality of critically ill COVID-19 patients is high. Early aggressive treatment of high-risk patients identified in this study (advanced age, history of diabetes and atrial fibrillation and elevated troponin) could improve clinical outcome. The highly predictive value of elevated troponin levels on survival may indicate cardiac involvement of COVID-19 infection as a determinant of mortality. Additionally, of available published literature at this time, this is the first study that suggests a relationship between atrial fibrillation and increased mortality from COVID-19. Larger studies are needed to confirm these findings.

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Fibroblast Growth Factor 21 and Metabolic Dysfunction in Women with a Prior Glucose-Intolerant Pregnancy

American Journal of Perinatology ◽

10.1055/s-0040-1712966 ◽

2020 ◽

Author(s):

Celeste Durnwald ◽

Lisa Mele ◽

Mark B. Landon ◽

Michael W. Varner ◽

Brian M. Casey ◽

...

Keyword(s):

Metabolic Syndrome ◽

Growth Factor ◽

Fibroblast Growth Factor ◽

Fibroblast Growth Factor 21 ◽

Prior History ◽

Metabolic Dysfunction ◽

Fibroblast Growth ◽

Index Pregnancy ◽

History Of

Abstract Objective We sought to determine if there is an association between fibroblast growth factor 21 (FGF21) levels and a history of gestational diabetes mellitus (GDM) in women with and without metabolic dysfunction, defined as a diagnosis of metabolic syndrome or type 2 diabetes (T2DM), 5 to 10 years following participation in a multiple cohort GDM study. Study Design At 5 to 10 years after index pregnancy, women underwent a follow-up visit and were categorized as having no metabolic syndrome, metabolic syndrome, or T2DM. FGF21 levels were compared between women who did and did not have a history of GDM using multivariable linear regression. Results Among 1,889 women, 950 underwent follow-up and 796 had plasma samples analyzed (413 GDM and 383 non-GDM). Total 30.7% of women had been diagnosed with T2DM or metabolic syndrome. Overall, there was no difference in median FGF21 levels in pg/mL between the prior GDM and non-GDM groups (p = 0.12), and the lack of association was observed across all three metabolic categories at follow-up (p for interaction = 0.70). Conclusion There was no association between FGF21 levels and prior history of mild GDM in women with and without metabolic dysfunction 5 to 10 years after the index pregnancy (ClinicalTrials.gov number, NCT00069576, original trial).

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