EXPRESS: Inflammatory cytokines, high sensitivity CRP, and risk of 1-year vascular events, death and poor functional outcome after stroke and TIA

2021 ◽  
pp. 174749302199559
Author(s):  
Sarah A Coveney ◽  
Sean Murphy ◽  
Orina Belton ◽  
Tim Cassidy ◽  
Morgan Crowe ◽  
...  
Keyword(s):  
Cohort Study ◽  
Functional Outcome ◽  
Inflammatory Cytokines ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cox Regression ◽  
High Sensitivity ◽  
Stroke Recurrence ◽  
Vascular Events ◽  
Poor Functional Outcome

Background Inflammation driven by pro-inflammatory cytokines is a new therapeutic target in coronary disease. Few data exist on the association of key upstream cytokines and post-stroke recurrence. In a prospective cohort study, we investigated the association between pivotal cytokines, CRP and 1-year outcomes. Methods BIO-STROKETIA is a multi-centre prospective cohort study of non-severe ischemic stroke (mRS≤3) and TIA. Controls were patients with transient symptoms attending TIA clinics with non-ischemic final diagnosis. Exclusion criteria were severe stroke, infection and other pro-inflammatory disease. High-sensitivity serum C-reactive protein (CRP) and cytokines (interleukin [IL] 6, IL-1β, IL-8, IL-10, IL-12, interferon-γ [IFN-γ], tumor-necrosis factor-α [TNF-α]) were measured. The primary outcome was 1-year recurrent stroke/coronary events (fatal and non-fatal). Results 680 patients (439 stroke, 241 TIA) and 68 controls were included. IL-6, IL-1β, IL-8, IFN-γ, TNF-α, and CRP were higher in stroke/TIA cases (p≤0.01 for all). On multivariable Cox regression, IL-6, IL-8, and CRP independently predicted 1-year recurrent vascular events (adjusted HRs [aHR] per-quartile increase IL-6 1.31,CI 1.02-1.68, p=0.03; IL-8 1.47, CI 1.15-1.89, p=0.002; CRP 1.28 CI, 1.01-1.62, p=0.04). IL-6 (aHR 1.98, CI 1.26-3.14, p=0.003) and CRP (aHR 1.81, CI 1.20-2.74, p=0.005) independently predicted 1-year fatality. IL-6 and CRP (adjusted OR per-unit increase 1.02, CI 1.01-1.04) predicted poor functional outcome, with a trend for IL-1 (p=0.054). Conclusion Baseline inflammatory cytokines independently predicted late recurrence, supporting a rationale for randomised trials of anti-inflammatory agents for prevention after stroke and suggesting that targeted therapy to high-risk patients with high baseline inflammation may be beneficial.

scholarly journals Fibrinogen Level Predicts Prognosis of Patients with Acute Ischemic Stroke or TIA

2020 ◽  
Author(s):  
Huiqing Hou ◽  
Xianglong Xiang ◽  
Yuesong Pan ◽  
Hao Li ◽  
Xia Meng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Cox Regression ◽  
Fibrinogen Level ◽  
Stroke Recurrence ◽  
Vascular Events ◽  
Poor Functional Outcome ◽  
Stroke Registry

Abstract Background: Fibrinogen is involved in acute stroke. This study aimed to investigate the association between fibrinogen and prognosis in patients with acute ischemic stroke or transient ischemic attack (TIA). Methods: Using data from the CNSR-Ⅲ (Third China National Stroke Registry), this sub-study included 10 518 (69%) consecutive patients who had fibrinogen levels measured. The primary outcome was a poor functional outcome defined as modified Rankin Scale score of 3 to 6 within 90 days. The secondary outcomes were stroke recurrence, ischemic stroke recurrence, composite vascular events, and poor functional outcome during the 1-year follow-up and a new vascular event at 90 days. Multivariate logistic regression and Cox regression analyses were used to assess the associations between fibrinogen and prognosis of patients. Results: In total, 1446 (13.9%) patients had a poor functional outcome at 90 days. High fibrinogen levels were associated with poor functional outcome (adjusted odds ratio [OR], 1.35; 95% confidence interval [CI], 1.12-1.64) at 90 days after adjustment for confounding risk factors. High fibrinogen levels also independently predicted poor functional outcome during the 1-year follow-up. Stroke recurrence occurred in 657 (6.3%) patients at 90 days. High fibrinogen levels were associated with stroke recurrence, ischemic stroke recurrence, and composite vascular events in the crude model, but further adjustment eliminated these associations in the multivariate models. Conclusion: Our study showed that high fibrinogen level was independently associated with poor functional outcome but not with stroke recurrence in patients with acute ischemic stroke or TIA.

scholarly journals HIV diagnosis period influences ART initiation: findings from a prospective cohort study in China

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Tinglong Yang ◽  
Xueying Yang ◽  
Linghua Li ◽  
Huifang Xu ◽  
Lirui Fan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cox Regression ◽  
Hiv Diagnosis ◽  
Initiation Rate ◽  
Art Initiation ◽  
Significant Difference ◽  
New Strategy ◽  
New Treatment

Abstract Background We estimated the predictive effects of ART-related perceptions on the actual ART uptake behavior among ART naïve PLWH stratified by different time of HIV diagnosis under the new strategy. Methods A prospective cohort study was conducted among ART naïve PLWH in Guangzhou, China from June 2016 to June 2017. Cox regression model was used to evaluate the predictive effects of ART-related perceptions on ART initiation among PLWH stratified by different timepoint of HIV diagnosis (i.e., before or after the update of the new treatment policy). Results Among 411 participants, 150 and 261 were diagnosed before (pre-scaleup group) and after (post-scaleup group) the implementation of the new strategy, respectively. The ART initiation rate in the post-scaleup group (88.9%) was higher than that in the pre-scaleup group (73.3%) (p < 0.001). A significant difference of mean score was detected in each HBM construct between pre- and post-scaleup groups (p < 0.05). After adjusting for significant background variables, among all participants, only the self-efficacy [adjusted HR (HRa) = 1.23, 95% CI 1.06 to 1.43, p = 0.006], has a predictive effect on ART initiation; in pre-scaleup group, all constructs of HBM-related ART perceptions were predictors of ART initiation (HRa = 0.71 to 1.83, p < 0.05), while in post-scaleup group, no significant difference was found in each construct (p > 0.05). Conclusions The ART initiation rate was high particularly among participants who diagnosed after the new treatment strategy. The important role of the time of HIV diagnosis on ART initiation identified in this study suggested that future implementation interventions may consider to modify the ART-related perceptions for HIV patients who diagnosed before the implementation of the new ART strategy, while expand the accessibility of ART service for those who diagnosed after the implementation of the new strategy.

scholarly journals Do Acute Inflammatory Cytokines Affect 3- and 12-Month Postoperative Functional Outcomes–A Prospective Cohort Study of 12 Patients With Proximal Tibia Fractures

2021 ◽  
Author(s):  
Imran Iversen ◽  
That Minh Pham ◽  
Hagen Schmal
Keyword(s):  
Cohort Study ◽  
Clinical Outcomes ◽  
Inflammatory Cytokines ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cartilage Damage ◽  
Articular Fractures ◽  
Tibia Fractures ◽  
Anti Inflammatory ◽  
Injured Knee

Abstract BackgroundPatients with intra-articular fractures tend to develop post-traumatic osteoarthritis (PTOA). The initial inflammatory response with elevation of inflammatory cytokines following joint trauma might be responsible for triggering cartilage catabolism and degradation. We aimed to identify and quantify cytokine levels in fractured and healthy knee joints and the correlation of these cytokines with clinical outcomes.Methods In this prospective cohort study, synovial fluid and plasma were collected from 12 patients with proximal intra-articular tibia fractures before surgery. The concentration of sixteen inflammatory cytokines, two cartilage degradation products and four metabolic mediators where measured, comparing the acute injured knee with the healthy contralateral knee. Patients were evaluated 3- and 12-months after surgery with clinical parameters and radiographical scanning. Non-parametrical Wilcoxon rank-sum and Spearman tests were used for statistical analysis, and a P-value below 0.05 was considered significant.ResultsWe found an elevation of the pro-inflammatory cytokines IL-1β, IL-2, IL-6, IL-8, IL-12p70, TNF-α, IFN-y, MMP-1, MMP-3, and MMP-9 and a simultaneous elevation of the anti-inflammatory cytokines IL-1RA, IL-4, IL-10, and IL-13 in the injured knee. Several pro- and anti-inflammatory cytokines and metabolic mediators were correlated with clinical outcomes 12 months after surgery, especially with pain perception. ConclusionsOur results support that an inflammatory process occurs after intra-articular knee fractures, which is characterized by the elevation of both pro- and anti-inflammatory cytokines. There was no sign of cartilage damage within the timeframe from injury to operation. We found a correlation between the initial inflammatory reaction with clinical outcomes 12 months after surgery.

scholarly journals Dynamics of Interleukin-10 Levels in Chronic Rhinosinusitis with/without Allergy

2015 ◽  
Vol 7 (3) ◽  
pp. 163
Author(s):  
Abdul Qadar Punagi ◽  
Sutji Pratiwi Rahardjo
Keyword(s):  
Cohort Study ◽  
Chronic Rhinosinusitis ◽  
Inflammatory Cytokines ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Treatment Approach ◽  
Specific Treatment ◽  
Serum Levels ◽  
Interleukin 10 ◽  
Persistent Problem

BACKGROUND: Rhinosinusitis occurs when the lining of the nasal and sinuses gets inflamed, infected or irritated, become swollen, and create extra mucus, the swollen lining may also interfere with drainage of mucus. Chronic rhinosinusitis (CRS) is a more persistent problem that requires a specific treatment approach. Aim of this study was to determine changes in interleukin (IL)-10 as an anti-inflammatory cytokines in allergic and non-allergic CRS at Makassar. METHODS: A prospective cohort study was designed to assess the level of IL-10 for three times during two weeks of therapy. Medication of Cefadroxil 500 mg 2x1, Pseudoephedrine 30 mg 2x1, Terfenadine 40 mg 2x1 and Methylprednisolone 4 mg 3x1, was conducted during two weeks for 13 subjects in allergic CRS group and 12 subjects in non-allergic CRS group. Results were statistically analyzed with student t-test and paired t-test.RESULTS: The changes in levels of IL-10 in allergic CRS group were increased, but not significant (5.293 to 5.769, p=0.058), and in non-allergic CRS group were decreased, but not significant (6.125 to 5.475, p=0.103). CONCLUSION: The serum levels of IL-10 were not significant increased in allergic CRS group and not significant decreased in non-allergic CRS group. KEYWORDS: interleukin-10, chronic rhinosinusitis, allergy, cefadroxil, pseudoephedrine, terfenadine, methylprednisolone

Abstract P343: Relationship of Infarct Volume to Inflammation and Prognostic Significance in Patients With Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Lingling Ding ◽  
Zixiao Li ◽  
Yongjun Wang
Keyword(s):  
Ischemic Stroke ◽  
Deep Learning ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Acute Inflammation ◽  
Infarct Volume ◽  
Prognostic Significance ◽  
Stroke Recurrence ◽  
Vascular Events ◽  
Poor Functional Outcome

Background and Purpose: The diffusion weighted imaging (DWI) lesion volumes in acute ischemic stroke (AIS) can be automatically measured using deep learning-based segmentation algorithms. We aim to explore the prognostic significance of artificial intelligence-predicted infarct volume, and the association of markers of acute inflammation with the infarct volume. Methods: 12,598 AIS/TIA patients were included in this analysis. Intarct volume was automatically measured using a U-Net model for acute ischemic stroke lesion segmentation on DWI. Participants were divided into 5 subgroups according to infarct volume. Spearman’s correlations were employed to study the association between infarct volume and markers of acute inflammation. Multivariable logistic regression and Cox proportional hazards model were performed to explore the relationship between infarct volume and the incidence of poor functional outcome (modified Rankin scale score 3-6), stroke recurrence or combined vascular events at 3 months. Results: The U-Net model prediction correlated and agreed well with manual annotation ground truth for infarct volume (r=0.96; P<0.001). There were positive correlations between the infarct volume and markers of acute inflammation (neutrophil [r=0.175; P<0.001], hs-CRP [r=0.180; P<0.001], and IL-6 [r=0.225; P<0.001]). Compared with those without DWI lesions, patients with the largest infarct volume (4th Quartile) were nearly five times more likely to have poor functional outcome (mRS 3-6) (adjusted odds ratio, 4.70; 95% confidence intervals [CI], 3.29-6.72; P for trend<0.001) after adjustment for confounding factors and markers of acute inflammation. The infarct volume category was significantly associated with stroke recurrence (adjusted hazard ratios [HRs], 1.0, 1.43[0.95,2.17], 2.22[1.49,3.29], 2.06[1.40,3.05], 2.26[1.52,3.36]; P for trend<0.001) and combined vascular events(adjusted HRs, 1.0, 1.38[0.92,2.09], 2.25[1.53,3.32], 2.03[1.38,2.98], 2.28[1.54,3.36]; P for trend<0.001). Conclusions: Infarct volume measured automatically by deep learning-based tool was a strong predictor of poor functional outcome as well as stroke recurrence, with the potential for widespread adoption in both research and clinical settings.

scholarly journals Kidney transplant outcomes in recipients with visual, hearing, physical and walking impairments: a prospective cohort study

2019 ◽  
Vol 35 (7) ◽  
pp. 1262-1270
Author(s):  
Alvin G Thomas ◽  
Jessica M Ruck ◽  
Nadia M Chu ◽  
Dayawa Agoons ◽  
Ashton A Shaffer ◽  
...  
Keyword(s):  
Cohort Study ◽  
Visual Impairment ◽  
Kidney Transplant ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cox Regression ◽  
Targeted Interventions ◽  
The Us ◽  
Independent Association ◽  
Poor Outcomes

Abstract Background Disability in general has been associated with poor outcomes in kidney transplant (KT) recipients. However, disability can be derived from various components, specifically visual, hearing, physical and walking impairments. Different impairments may compromise the patient through different mechanisms and might impact different aspects of KT outcomes. Methods In our prospective cohort study (June 2013–June 2017), 465 recipients reported hearing, visual, physical and walking impairments before KT. We used hybrid registry-augmented Cox regression, adjusting for confounders using the US KT population (Scientific Registry of Transplant Recipients, N = 66 891), to assess the independent association between impairments and post-KT outcomes [death-censored graft failure (DCGF) and mortality]. Results In our cohort of 465 recipients, 31.6% reported one or more impairments (hearing 9.3%, visual 16.6%, physical 9.1%, walking 12.1%). Visual impairment was associated with a 3.36-fold [95% confidence interval (CI) 1.17–9.65] higher DCGF risk, however, hearing [2.77 (95% CI 0.78–9.82)], physical [0.67 (95% CI 0.08–3.35)] and walking [0.50 (95% CI 0.06–3.89)] impairments were not. Walking impairment was associated with a 3.13-fold (95% CI 1.32–7.48) higher mortality risk, however, visual [1.20 (95% CI 0.48–2.98)], hearing [1.01 (95% CI 0.29–3.47)] and physical [1.16 (95% CI 0.34–3.94)] impairments were not. Conclusions Impairments are common among KT recipients, yet only visual impairment and walking impairment are associated with adverse post-KT outcomes. Referring nephrologists and KT centers should identify recipients with visual and walking impairments who might benefit from targeted interventions pre-KT, additional supportive care and close post-KT monitoring.

scholarly journals Delayed Lactogenesis Is Associated with Suboptimal Breastfeeding Practices: A Prospective Cohort Study

2019 ◽  
Vol 150 (4) ◽  
pp. 894-900 ◽  
Author(s):  
Li Huang ◽  
Shangzhi Xu ◽  
Xi Chen ◽  
Qian Li ◽  
Lixia Lin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cox Regression ◽  
Normal Weight ◽  
Face To Face ◽  
Gestational Weight ◽  
Breastfeeding Practices ◽  
Suboptimal Breastfeeding ◽  
Adjusted Model

ABSTRACT Background Breastfeeding has many established health benefits to both babies and mothers. There is limited evidence on the association between delayed lactogenesis and breastfeeding practices. Objective We assessed the association between delayed lactogenesis and breastfeeding practices in women initiating breastfeeding. Design We used data from a prospective cohort study in Wuhan, China, which enrolled pregnant women at 8–16 weeks of gestation and followed up to postpartum. Women were included who had a singleton live birth, initiated breastfeeding, and provided information on infant feeding. Maternal lactogenesis status was assessed by face-to-face interview at day 4 postpartum. Breastfeeding practices (full breastfeeding and/or any breastfeeding) were queried by telephone interview at 3, 6, and 12 mo postpartum. Poisson regression and Cox regression were used to identify the association between delayed lactogenesis and breastfeeding practices. Results Delayed lactogenesis was reported by 17.9% of the 2877 participants. After adjusting for potential confounders, when compared with timely lactogenesis, delayed lactogenesis was significantly associated with higher risk of inability to sustain full breastfeeding at 3 mo postpartum (RR: 1.24, 95% CI: 1.10, 1.39) and 6 mo postpartum (RR: 1.14, 95% CI: 1.04, 1.24). Delayed lactogenesis was also significantly associated with early termination of any breastfeeding (HR: 1.15, 95% CI: 1.01, 1.30) in the adjusted model. In a combined analysis, women with higher gestational weight gain (GWG, ≥16 kg for underweight and normal weight, 15 kg for overweight/obesity) and who subsequently experienced delayed lactogenesis had the highest risk of ending any breastfeeding earlier (adjusted HR: 1.32, 95% CI: 1.11, 1.55) compared with those who gained less GWG and experienced timely lactogenesis. Conclusions This study shows that delayed lactogenesis was associated with low rate of full breastfeeding and shorter duration of any breastfeeding. Greater efforts to promote breastfeeding should be targeted towards women with delayed lactogenesis.

P6143Body-mass index, blood pressure, diabetes and cardiovascular mortality in Cuba: prospective cohort study of 146,665 participants

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B W H Lacey ◽  
N Armas ◽  
J A Burrett ◽  
R Peto ◽  
A Duenas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cox Regression ◽  
Metabolic Risk Factors ◽  
Metabolic Risk ◽  
Reverse Causality ◽  
Cvd Mortality

Abstract Background Cardiovascular disease (CVD) is a leading cause of premature death in Cuba, accounting for about one third of all deaths under age 70 years. Substantial uncertainty remains, however, about the relevance of major metabolic risk factors to CVD mortality in this population. Purpose To relate body-mass index (BMI), systolic blood pressure (SBP), and diabetes to risk of CVD death in Cuba. Methods In a prospective cohort study, 146,665 adults were recruited from the general population in five areas of Cuba between 1996 and 2002. Participants were interviewed, measured (height, weight and blood pressure) and followed up by electronic linkage to Cuban national death registries to Jan 1 2017; 24,345 participants were resurveyed between 2006 and 2008. After excluding all with missing data or chronic disease at recruitment or, to further limit reverse causality, those who died in the first 5 years, Cox regression (adjusted for age, sex, education, smoking, alcohol and, where appropriate, BMI) was used to relate mortality rate ratios (RRs) at ages 35–79 years to BMI, SBP and diabetes. Correlations of baseline and resurvey values were used to corrected RRs for regression dilution, and thereby estimate associations with long-term average (“usual”) levels of SBP and BMI. Results After exclusions, there were 117,008 participants age 35–79 (mean age 52 [SD 12]; 55% women). At recruitment, mean SBP was 124 mm Hg (SD 15), mean BMI was 24.2 kg/m2 (SD 3.6) and 5% had diabetes; mean SBP and diabetes prevalence were both strongly related to BMI. Correlations of resurvey and baseline measurements were 0.48 for SBP and 0.60 for BMI. At ages 35–79 years, there were 3780 CVD deaths (1871 ischaemic heart disease [IHD], 766 stroke, and 1143 other). CVD mortality was positively associated with BMI (down to about 22–23 kg/m2; figure), SBP and diabetes: 10 kg/m2 higher usual BMI approximately doubled CVD mortality (RR 1.90, 95% CI 1.61–2.24), as did 20 mmHg higher usual SBP (2.03, 1.88–2.20), and a prior diagnosis of diabetes (2.18, 1.97–2.42). The associations were similar in men and women. Given these associations, about one quarter (27%) of CVD deaths in this study were attributable to these metabolic risk factors combined. Conclusion These associations differ to those reported from other parts of Latin America, and are more consistent with studies in Europe and North America, highlighting the need for many more large-scale prospective studies in low and middle income countries. This study provides direct evidence for the expected benefit on CVD mortality of addressing major metabolic risk factors in Cuba. As the levels of these metabolic risk factors are increasing in Cuba, so too is their importance as determinants of premature CVD death. Acknowledgement/Funding Medical Research Council, British Heart Foundation, Cancer Research UK

scholarly journals Serum magnesium and cardiovascular mortality in peritoneal dialysis patients: a 5-year prospective cohort study

2018 ◽  
Vol 120 (4) ◽  
pp. 415-423 ◽  
Author(s):  
Hongjian Ye ◽  
Peiyi Cao ◽  
Xiaodan Zhang ◽  
Jianxiong Lin ◽  
Qunying Guo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Peritoneal Dialysis ◽  
Prospective Cohort Study ◽  
Cardiovascular Mortality ◽  
Prospective Cohort ◽  
Cox Regression ◽  
Serum Magnesium ◽  
Study Endpoint ◽  
Lower Serum ◽  
All Cause Mortality

AbstractThe aim of this study was to explore the association between serum Mg and cardiovascular mortality in the peritoneal dialysis (PD) population. This prospective cohort study included prevalent PD patients from a single centre. The primary outcome of this study was cardiovascular mortality. Serum Mg was assessed at baseline. A total of 402 patients (57 % male; mean age 49·3±14·9 years) were included. After a median of 49·9 months (interquartile range: 25·9–68·3) of follow-up, sixty-two patients (25·4 %) died of CVD. After adjustment for conventional confounders in multivariate Cox regression models, being in the lower quartile for serum Mg level was independently associated with a higher risk of cardiovascular mortality, with hazards ratios of 2·28 (95 % CI 1·04, 5·01), 1·41 (95 % CI 0·63, 3·16) and 1·62 (95 % CI 0·75, 3·51) for the lowest, second and third quartiles, respectively. A similar trend was observed when all-cause mortality was used as the study endpoint. Further analysis showed that the relationships between lower serum Mg and higher risk of cardiovascular and all-cause mortality were present only in the female subgroup, and not among male patients. The test for interaction indicated that the associations between lower serum Mg and cardiovascular and all-cause mortality differed by sex (P=0·008 andP=0·011, respectively). In conclusion, lower serum Mg was associated with a higher risk of cardiovascular and all-cause mortality in the PD population, especially among female patients.

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