Abstract P226: D-Dimer Levels and Risk of Stroke: Findings from the EPICOR Study

Background: Elevated D-dimer levels are reportedly associated with higher risk of vascular diseases. We investigated the association of baseline D-dimer levels with stroke events occurred in the European Prospective Investigation into Cancer and Nutrition-Italy cohort. Methods: Using a nested case-cohort design, a center-stratified random sample of 832 subjects (66% women, age range 35 to 71) was selected as subcohort and compared with 289 strokes in a mean follow-up of 9 years. D-dimer was measured on fresh citrated plasma by an automated latex-enhanced immunoassay (HemosIL-IL, Milan). The hazard ratios and 95% confidence intervals, adjusted by relevant confounders and stratified by center, were estimated by a Cox regression model using Prentice method. Results: Individuals in the second, third or fourth quartile compared with the lowest quartile of D-dimer had significantly higher risk of stroke (Table). The association was independent from several potential confounders, including C-Reactive protein (Table). It was evident starting from the second quartile (D-dimer >100 ng/ml) and persisted almost unchanged for higher D-dimer levels (Table). No differences were observed in men and women. The increase in risk was essentially the same both for ischemic and hemorrhagic strokes (Table). Conclusions: Our data provide a clear evidence that elevated levels of D-dimer are potential risk factors for ischemic or hemorrhagic strokes.

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High-level Exposure of Uric Acid in Asymptomatic Hyperuricemia Could Be An Isolated Risk Factors of Cardio-Cerebrovascular Diseases: A Prospective Cohort Study

10.21203/rs.3.rs-230583/v1 ◽

2021 ◽

Author(s):

Zhiyuan Cheng ◽

Tongzhang Zheng ◽

Desheng Zhang ◽

Jingli Yang ◽

Xiaobin Hu ◽

...

Keyword(s):

Cardiovascular Disease ◽

Uric Acid ◽

Cox Regression ◽

Cerebrovascular Diseases ◽

Healthy Population ◽

Incidence Risk ◽

High Level ◽

Age Range ◽

Fourth Quartile

Abstract Background: Whether the asymptomatic hyperuricemia (AH) raises the risk of cardiovascular disease with or without hyperuricemia-related comorbidities still remains contentious. Our study was aimed to quantitatively access the incidence risk of coronary heart disease (CHD) and stroke associated with AH.Methods: Multivariate-adjusted Cox regression models were applied to evaluate the risk of cardiovascular disease (CVD). Serum uric acid beyond normouricemia was quarterly stratified based on the distribution of healthy population without CVD onset.Results: 1,062 CVD first attack cases were collected among the 48,001 cohort participants (age range: 18-92, mean age: 47.2±13.9 years-old) with a mean follow-up duration of 5.78±0.83 years. 14,464 baseline population with comorbidities were excluded to further study the association between AH and CVD incidence. The AH showed overall non-association with CVD incident. However, significantly increased adjusted hazard ratio (HR) of CVD with 95% confidence interval (CI) were observed when the fourth quartile compared with normouricemia stratum in the total cohort population (CHD: 1.70, 1.34-2.16; stroke: 1.55, 1.13-2.13), male (CHD: 1.94, 1.47-2.56), female (CHD: 1.71, 1.03-2.35; stroke: 2.02, 1.14-3.58) and aged over 50 years-old population. Meanwhile, the age-standardized incidence rate of CVD in the fourth quartile was 2 to 3 time higher than the normouricemia population. Consistent results were also observed in the AH population in absence of comorbidities (CHD: 2.40, 1.39-4.14; stroke: 1.85, 1.12-3.59).Conclusion: Asymptomatic hyperuricemia patients exposed to higher level of uric acid (male>487 mmol/L, female>422 mmol/L) could significantly increase the incidence risk of CHD and stroke, with or without hyperuricemia-related comorbidities.

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Elevated levels of D-dimers increase the risk of ischaemic and haemorrhagic stroke

Thrombosis and Haemostasis ◽

10.1160/th14-04-0297 ◽

2014 ◽

Vol 112 (11) ◽

pp. 941-946 ◽

Cited By ~ 20

Author(s):

Augusto Di Castelnuovo ◽

Claudia Agnoli ◽

Amalia de Curtis ◽

Maria Concetta Giurdanella ◽

Sabina Sieri ◽

...

Keyword(s):

Cox Regression ◽

Haemorrhagic Stroke ◽

Hazard Ratio ◽

C Reactive Protein ◽

Standard Deviation Increase ◽

Study Objective ◽

Reactive Protein ◽

Stratified Sample ◽

Potential Risk Factors ◽

D Dimer

SummaryElevated D-dimer levels are reportedly associated with coronary artery disease. It was the study objective to investigate the association of baseline D-dimer levels with strokes that occurred in the European Prospective Investigation into Cancer and Nutrition-Italy cohort. Using a nested case-cohort design, a centre-–stratified sample of 832 subjects (66 % women, age 35–71) was selected as subcohort and compared with 289 strokes in a mean follow-up of nine years. D-dimers were measured by an automated latex-enhanced immunoassay (HemosIL-IL). The multivariable hazard ratios were estimated by a Cox regression model using Prentice method. Individuals with elevated D-dimer levels had significantly higher risk of incident stroke. It was evident from the second quartile (D-dimers > 100 ng/ml) and persisted almost unchanged for higher D-dimers (hazard ratio [HR] 2.10, 95 % confidence interval [CI]: 1.28–3.47; 2.42, 95 %CI: 1.44–4.09 and 2.10, 95 %CI: 1.27–3.48 for the second, third or fourth quartile compared with the lowest quartile, respectively). The association was independent of several confounders, including triglycerides and C-reactive protein. No differences were observed in men and women (P for interaction= 0.46), in hypertensive or non-hypertensive subjects (P for interaction= 0.88) or in subjects with low (< 1 mg/l) or elevated (≥ 1 mg/l) C-reactive protein (P for interaction=0.35). After stratification for stroke type, the hazard ratio for every standard deviation increase was statistically significant both for ischaemic (1.21; 95 %CI: 1.01 to 1.45) and haemorrhagic (1.24; 95 %CI: 1.00 to 1.65) strokes. In conclusion, our data provide clear evidence that elevated levels of D-dimers are potential risk factors not only for ischaemic but also for haemorrhagic strokes.

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Neutrophil:lymphocyte ratio predicts short-term outcome of COVID-19 in haemodialysis patients

Clinical Kidney Journal ◽

10.1093/ckj/sfaa194 ◽

2020 ◽

Author(s):

Prisca Mutinelli-Szymanski ◽

Iulia Hude ◽

Emilie Merle ◽

Yannis Lombardi ◽

Pascal Seris ◽

...

Keyword(s):

Cox Regression ◽

Term Outcome ◽

Multicentric Study ◽

Reactive Protein ◽

Kaplan Meier ◽

Hazard Ratios ◽

Increased Risk ◽

And Biological Markers ◽

Dialysis Facilities

Abstract Background Information regarding coronavirus disease 2019 (COVID-19) in haemodialysis (HD) patients is limited and early studies suggest a poor outcome. We aimed to identify clinical and biological markers associated with severe forms of COVID-19 in HD patients. Methods We conducted a prospective, observational and multicentric study. Sixty-two consecutive adult HD patients with confirmed COVID-19 from four dialysis facilities in Paris, France, from 19 March to 19 May 2020 were included. Blood tests were performed before diagnosis and at Days 7 and 14 after diagnosis. Severe forms of COVID-19 were defined as requiring oxygen therapy, admission in an intensive care unit or death. Cox regression models were used to compute adjusted hazard ratios (aHRs). Kaplan–Meier curves and log-rank tests were used for survival analysis. Results Twenty-eight patients (45%) displayed severe forms of COVID-19. Compared with non-severe forms, these patients had more fever (93% versus 56%, P < 0.01), cough (71% versus 38%, P = 0.02) and dyspnoea (43% versus 6%, P < 0.01) at diagnosis. At Day 7 post-diagnosis, neutrophil counts, neutrophil:lymphocyte (N:L) ratio, C-reactive protein, ferritin, fibrinogen and lactate dehydrogenase levels were significantly higher in severe COVID-19 patients. Multivariate analysis revealed an N:L ratio >3.7 was the major marker associated with severe forms, with an aHR of 4.28 (95% confidence interval 1.52–12.0; P = 0.006). After a median follow-up time of 48 days (range 27–61), six patients with severe forms died (10%). Conclusions HD patients are at increased risk of severe forms of COVID-19. An elevated N:L ratio at Day 7 was highly associated with the severe forms. Assessing the N:L ratio could inform clinicians for early treatment decisions.

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Association between selenium intake, diabetes, and mortality in adults: findings from National Health and Nutrition Examination Survey (NHANES) 2003-2014

British Journal Of Nutrition ◽

10.1017/s000711452100177x ◽

2021 ◽

pp. 1-24

Author(s):

Bushra Hoque ◽

Zumin Shi

Keyword(s):

National Health ◽

Cox Regression ◽

Inverse Association ◽

Nutrition Examination Survey ◽

Health And Nutrition ◽

Hazard Ratios ◽

The Us ◽

All Cause Mortality ◽

Cvd Mortality

Abstract Selenium (Se) is a trace mineral that has antioxidant and anti-inflammatory properties. This study aimed to investigate the association between Se intake, diabetes, all-cause and cause-specific mortality in a representative sample of US adults. Data from 18,932 adults who attended the 2003-2014 National Health and Nutrition Examination Survey (NHANES) were analysed. Information on mortality was obtained from the US mortality registry updated to 2015. Multivariable logistic regression and Cox regression were used. Cross-sectionally, Se intake was positively associated with diabetes. Comparing extreme quartiles of Se intake, the odds ratio (OR) for diabetes was 1.44 (95% CI: 1.09–1.89). During a mean of 6.6 years follow-up, there were 1627 death (312 CVD, 386 cancer). High intake of Se was associated with a lower risk of all-cause mortality. When comparing the highest with the lowest quartiles of Se intake, the hazard ratios (HRs) for all-cause, CVD mortality, cancer mortality and other mortality were: 0.77 (95% CI 0.59-1.01), 0.62 (95% CI, 0.35-1.13), 1.42 (95% CI, 0.78-2.58) and 0.60 (95% CI,0.40-0.80), respectively. The inverse association between Se intake and all-cause mortality was only found among white participants. In conclusion, Se intake was positively associated with diabetes but inversely associated with all-cause mortality. There was no interaction between Se intake and diabetes in relation to all-cause mortality.

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Plasma Vitamin B12 Levels, High-Dose Vitamin B12 Treatment, and Risk of Dementia

Journal of Alzheimer s Disease ◽

10.3233/jad-201096 ◽

2021 ◽

Vol 79 (4) ◽

pp. 1601-1612

Author(s):

Johan Frederik Håkonsen Arendt ◽

Erzsébet Horváth-Puhó ◽

Henrik Toft Sørensen ◽

Ebba Nexø ◽

Lars Pedersen ◽

...

Keyword(s):

Vitamin B12 ◽

Vascular Dementia ◽

Cox Regression ◽

Population Based ◽

High Dose ◽

Plasma Vitamin ◽

Hazard Ratios ◽

B12 Deficiency ◽

First Time

Background: It is controversial whether B12 deficiency causes dementia or B12 treatment can prevent dementia. Objective: To assess associations between low plasma (P-)B12 levels, B12 treatment, and risk of Alzheimer’s disease (AD; primary outcome) and all-cause or vascular dementia (secondary outcomes). Methods: We conducted a population-based cohort study using Danish registry data to assess associations between low P-B12 levels, high-dose injection or oral B12 treatment, and risk of dementia (study period 2000–2013). The primary P-B12 cohort included patients with a first-time P-B12 measurement whose subsequent B12 treatment was recorded. The secondary B12 treatment cohort included patients with a first-time B12 prescription and P-B12 measurement within one year before this prescription. For both cohorts, patients with low P-B12 levels (<200 pmol/L) were propensity score-matched 1:1 with patients with normal levels (200–600 pmol/L). We used multivariable Cox regression to compute 0–15-year hazard ratios for dementia. Results: For low P-B12 and normal P-B12 level groups, we included 53,089 patients in the primary P-B12 cohort and 13,656 patients in the secondary B12 treatment cohort. In the P-B12 cohort, hazard ratios for AD centered around one, regardless of follow-up period or treatment during follow-up. In the B12 treatment cohort, risk of AD was unaffected by low pre-treatment P-B12 levels, follow-up period and type of B12 treatment. Findings were similar for all-cause and vascular dementia. Conclusion: We found no associatio1n between low P-B12 levels and dementia. Associations were unaffected by B12 treatment. Results do not support routine screening for B12 deficiency in patients with suspected dementia.

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Pre-Dialytic SpO2 Measured with a Wearable Device as a Predictor of Mortality in Patients with OSA and Chronic Kidney Disease

Applied Sciences ◽

10.3390/app112210674 ◽

2021 ◽

Vol 11 (22) ◽

pp. 10674

Author(s):

Hsiao-Wei Lu ◽

Pin-Hung Kuo ◽

Cheuk-Sing Choy ◽

Chih-Yu Hsieh ◽

Jia-Feng Chang ◽

...

Keyword(s):

Multivariate Regression Analysis ◽

Wearable Device ◽

Maintenance Hemodialysis ◽

Mortality Risks ◽

Hazard Ratios ◽

Obstructive Sleep ◽

High Prevalence ◽

Potential Risk Factors ◽

Threat To Life

Hypoxemia and obstructive sleep apnea (OSA) have been recognized as a threat to life. Nonetheless, information regarding the association between pre-dialytic pulse oximeter saturation (SpO2) level, OSA and mortality risks remains mysterious in patients with maintenance hemodialysis (MHD). Bioclinical characteristics and laboratory features were recorded at baseline. Pre-dialytic SpO2 was detected using a novel microchip LED oximetry, and the Epworth Sleepiness Scale (ESS) score greater than 10 indicated OSA. Non-adjusted and adjusted hazard ratios (aHRs) of all-cause and cardiovascular (CV) mortality were analyzed for pre-dialytic SpO2, OSA and potential risk factors. During 2152.8 patient-months of follow-up, SpO2 was associated with incremental risks of all-cause and CV death (HR: 0.90 (95% CI: 0.82–0.98) and 0.88 (95% CI: 0.80–0.98), respectively). The association between OSA and CV mortality was significant (HR: 3.19 (95% CI: 1.19–9.38). In the multivariate regression analysis, pre-dialytic SpO2 still had an increase in all-cause and CV death risk (HR: 0.88 (95% CI: 0.79–0.98), 0.82 (95% CI: 0.71–0.96), respectively). Considering the high prevalence of silent hypoxia in the post COVID-19 era, a lower pre-dialytic SpO2 level and severe OSA warn clinicians to assess potential CV risks. In light of clinical accessibility, the microchip LED oximetry could be developed as a wearable device within smartphone technologies and used as a routine screen tool for patient safety in the medical system.

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Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as a risk factor for mortality in peruvian adults with chronic kidney disease.

10.22541/au.161224727.78237032/v1 ◽

2021 ◽

Author(s):

Gianfranco Umeres-Francia1 ◽

María Rojas-Fernández ◽

Percy Herrera Añazco ◽

Vicente Benites-Zapata

Keyword(s):

Risk Factor ◽

Cox Regression ◽

Outcome Variable ◽

Lymphocyte Ratio ◽

Hazard Ratios ◽

Ckd Stage ◽

All Cause Mortality ◽

The Relationship ◽

Crude Analysis

Objective: To assess the association between NLR and PLR with all-cause mortality in Peruvian patients with CKD Methods: We conducted a retrospective cohort study in adults with CKD in stages 1 to 5. The outcome variable was mortality and as variables of exposure to NLR and PLR. Both ratios were categorized as high with a cut-off point of 3.5 and 232.5; respectively. We carried out a Cox regression model and calculated crude and adjusted hazard ratios (HR) with their 95% confidence interval (95%CI). Results: We analyzed 343 participants with a median follow-up time of 2.45 years (2.08-3.08). The frequency of deaths was 17.5% (n=60). In the crude analysis, the high NLR and PLR were significantly associated with all-cause mortality (HR=2.01; 95% CI:1.11-3.66) and (HR=2.58; 95% CI:1.31-5.20). In the multivariate model, after adjusting for age, sex, serum creatinine, CKD stage, albumin and hemoglobin, the high NLR and PLR remained as an independent risk factor for all-cause mortality, (HR=2.10; 95% CI:1.11-3.95) and (HR=2.71; 95% CI:1.28-5.72). Conclusion: Our study suggests the relationship between high NLR and PLR with all-cause mortality in patients with CKD.

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Inflammatory Burden and Persistent CT Lung Abnormalities in COVID-19 Patients

10.21203/rs.3.rs-941232/v1 ◽

2021 ◽

Author(s):

Giulia Besutti ◽

Paolo Giorgi Rossi ◽

Marta Ottone ◽

Lucia Spaggiari ◽

Simone Canovi ◽

...

Keyword(s):

Mechanical Ventilation ◽

Length Of Hospital Stay ◽

Lung Damage ◽

Reactive Protein ◽

Lung Abnormalities ◽

The Relationship ◽

Lung Ct ◽

D Dimer ◽

Inflammatory Burden

Abstract Inflammatory burden is associated with COVID-19 severity and outcomes. Residual computed tomography (CT) lung abnormalities have been reported after COVID-19. The aim was to evaluate the association between inflammatory burden during COVID-19 and residual lung CT abnormalities collected on follow-up CT scans performed 2–3 and 6–7 months after COVID-19, in severe COVID-19 pneumonia survivors. C-reactive protein (CRP) curves describing inflammatory burden during the clinical course were built, and CRP peaks, velocities of increase, and integrals were calculated. Other putative determinants were age, sex, mechanical ventilation, lowest PaO2/FiO2 ratio, D-dimer peak, and length of hospital stay (LOS). Of the 259 included patients (median age 65 years; 30.5% females), 202 (78%) and 100 (38.6%) had residual, predominantly non-fibrotic, abnormalities at 2-3 and 6-7 months, respectively. In age- and sex-adjusted models, best CRP predictors for residual abnormalities were CRP peak (odds ratio [OR] for one standard deviation [SD] increase=1.79; 95% confidence interval [CI]=1.23-2.62) at 2-3 months and CRP integral (OR for one SD increase=2.24; 95%CI=1.53-3.28) at 6-7 months. Hence, inflammation is associated with short- and medium-term lung damage in COVID-19. Other severity measures, including mechanical ventilation and LOS, but not D-dimer, were mediators of the relationship between CRP and residual abnormalities.

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Perioperative changes of response to antiplatelet medication in vascular surgery patients

PLoS ONE ◽

10.1371/journal.pone.0244330 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244330

Author(s):

Thomas Hummel ◽

Saskia Hannah Meves ◽

Andreas Breuer-Kaiser ◽

Jan-Ole Düsterwald ◽

Dominic Mühlberger ◽

...

Keyword(s):

Risk Factors ◽

Platelet Count ◽

Vascular Surgery ◽

Reactive Protein ◽

Antiplatelet Medication ◽

Impedance Aggregometry ◽

Increased Risk ◽

Potential Risk Factors ◽

Artery Disease

Introduction Reduced antiplatelet activity of aspirin (ALR) or clopidogrel (CLR) is associated with an increased risk of thromboembolic events. The reported prevalence data for low-responders vary widely and there have been few investigations in vascular surgery patients even though they are at high risk for thromb-embolic complications. The aim of this prospective observational monocentric study was to elucidate possible changes in ALR or CLR after common vascular procedures. Methods Activity of aspirin and clopidogrel was measured by impedance aggregometry using a multiple electrode aggregometer (Multiplate®). Possible risk factors for ALR or CLR were identified by demographical, clinical data and laboratory parameters. In addition, a follow-up aggregometry was performed after completion of the vascular procedure to identify changes in antiplatelet response. Results A total of 176 patients taking antiplatelet medications aspirin and/or clopidogrel with peripheral artery disease (PAD) and/or carotid stenosis (CS) were included in the study. The prevalence of ALR was 13.1% and the prevalence of CLR was 32% in the aggregometry before vascular treatment. Potential risk factors identified in the aspirin group were concomitant insulin medication (p = 0.0006) and elevated C-reactive protein (CRP) (p = 0.0021). The overall ALR increased significantly postoperatively to 27.5% (p = 0.0006); however, there was no significant change in CLR that was detected. In a subgroup analysis elevation of the platelet count was associated with a post-procedure increase of ALR incidence. Conclusion The incidence of ALR in vascular surgery patients increases after vascular procedures. An elevated platelet count was detected as a risk factor. Further studies are necessary to analyse this potential influence on patency rates of vascular reconstructions.

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Reported fried food consumption and the incidence of hypertension in a Mediterranean cohort: the SUN (Seguimiento Universidad de Navarra) project

British Journal Of Nutrition ◽

10.1017/s0007114514001755 ◽

2014 ◽

Vol 112 (6) ◽

pp. 984-991 ◽

Cited By ~ 10

Author(s):

Carmen Sayon-Orea ◽

Maira Bes-Rastrollo ◽

Alfredo Gea ◽

Itziar Zazpe ◽

Francisco J. Basterra-Gortari ◽

...

Keyword(s):

Food Consumption ◽

Cox Regression ◽

University Graduates ◽

The Sun ◽

Fried Food ◽

Hazard Ratios ◽

Fried Foods ◽

Frequent Consumption ◽

Incident Cases

Reported associations between the consumption of fried foods and the incidence of obesity or weight gain make it likely that fried food consumption might also be associated with the development of hypertension. However, evidence from long-term prospective studies is scarce. Therefore, the aim of the present study was to longitudinally evaluate this association in a prospective cohort. The SUN (Seguimiento Universidad de Navarra) project is a Mediterranean cohort study of university graduates conducted in Spain, which started in December 1999 and is still ongoing. In the present study, we included 13 679 participants (5059 men and 8620 women), free of hypertension at baseline with a mean age of 36·5 (sd 10·8) years. Total fried food consumption was estimated at baseline. The outcome was the incidence of a medical diagnosis of self-reported hypertension during the follow-up period. To assess the association between the consumption of fried foods and the subsequent risk of developing incident hypertension during the follow-up period, Cox regression models were used. During a median follow-up period of 6·3 years, 1232 incident cases of hypertension were identified. After adjusting for potential confounders, the adjusted hazard ratios for developing hypertension were 1·18 (95 % CI 1·03, 1·36) and 1·21 (95 % CI 1·04, 1·41) for those consuming fried foods 2–4 and >4 times/week, respectively, compared with those consuming fried foods < 2 times/week (P for trend = 0·009). In conclusion, frequent consumption of fried foods at baseline was found to be associated with a higher risk of hypertension during the follow-up period in a Mediterranean cohort of university graduates.

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