Predicting the outcome of COVID-19 infection in kidney transplant recipients

Abstract Background We aimed to present the demographic characteristics, clinical presentation, and outcomes of our multicenter cohort of adult KTx recipients with COVID-19. Methods We conducted a multicenter, retrospective study using data of patients hospitalized for COVID-19 collected from 34 centers in Turkey. Demographic characteristics, clinical findings, laboratory parameters (hemogram, CRP, AST, ALT, LDH, and ferritin) at admission and follow-up, and treatment strategies were reviewed. Predictors of poor clinical outcomes were analyzed. The primary outcomes were in-hospital mortality and the need for ICU admission. The secondary outcome was composite in-hospital mortality and/or ICU admission. Results One hundred nine patients (male/female: 63/46, mean age: 48.4 ± 12.4 years) were included in the study. Acute kidney injury (AKI) developed in 46 (42.2%) patients, and 4 (3.7%) of the patients required renal replacement therapy (RRT). A total of 22 (20.2%) patients were admitted in the ICU, and 19 (17.4%) patients required invasive mechanical ventilation. 14 (12.8%) of the patients died. Patients who were admitted in the ICU were significantly older (age over 60 years) (38.1% vs 14.9%, p = 0.016). 23 (21.1%) patients reached to composite outcome and these patients were significantly older (age over 60 years) (39.1% vs. 13.9%; p = 0.004), and had lower serum albumin (3.4 g/dl [2.9–3.8] vs. 3.8 g/dl [3.5–4.1], p = 0.002), higher serum ferritin (679 μg/L [184–2260] vs. 331 μg/L [128–839], p = 0.048), and lower lymphocyte counts (700/μl [460–950] vs. 860 /μl [545–1385], p = 0.018). Multivariable analysis identified presence of ischemic heart disease and initial serum creatinine levels as independent risk factors for mortality, whereas age over 60 years and initial serum creatinine levels were independently associated with ICU admission. On analysis for predicting secondary outcome, age above 60 and initial lymphocyte count were found to be independent variables in multivariable analysis. Conclusion Over the age of 60, ischemic heart disease, lymphopenia, poor graft function were independent risk factors for severe COVID-19 in this patient group. Whereas presence of ischemic heart disease and poor graft function were independently associated with mortality.

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Gender-Related Determinants of Adherence to the Mediterranean Diet in Adults with Ischemic Heart Disease

Nutrients ◽

10.3390/nu12030759 ◽

2020 ◽

Vol 12 (3) ◽

pp. 759

Author(s):

Valeria Raparelli ◽

Giulio Romiti ◽

Valeria Spugnardi ◽

Marco Borgi ◽

Roberto Cangemi ◽

...

Keyword(s):

Heart Disease ◽

Ischemic Heart Disease ◽

Mediterranean Diet ◽

Perceived Stress ◽

Smoking Habit ◽

Multivariable Analysis ◽

Ischemic Heart ◽

Related Factors ◽

Diet Adherence ◽

The Mediterranean

Background: The reasons behind low adherence to the Mediterranean diet (Med-diet) are still not entirely known. We aimed to evaluate the effect of biological (i.e., sex-related) and psycho-socio-cultural (i.e., gender-related) factors on Med-diet adherence. Methods: Baseline Med-diet adherence was measured using a self-administered questionnaire among adults with ischemic heart disease (IHD) from the EVA (Endocrine Vascular Disease Approach) study. A multivariable analysis was performed to estimate the effect of sex- and gender-related factors (i.e., identity, roles, relations, and institutionalized gender) on low adherence. Results: Among 366 participants (66 ± 11 years, 31% women), 81 (22%) adults with low adherence demonstrated higher rates of diabetes, no smoking habit, lower male BSRI (Bem Sex Role Inventory) (median (IQR) 4.8 (4.1 to 5.5) vs. 5.1 (4.5 to 5.6) and p = 0.048), and higher Perceived Stress Scale 10 items (PSS-10) (median (IQR) 19 (11 to 23) vs. 15 (11 to 20) and p = 0.07) scores than those with medium-high adherence. In the multivariable analysis, only active smoking (odds ratio, OR = 2.10, 95% confidence interval, CI 1.14 to 3.85 and p = 0.017), PPS-10 (OR = 1.04, 95% CI 1.00 to 1.08, and p = 0.038) and male BSRI scores (OR = 0.70, 95% CI 0.52 to 0.95, and p = 0.021) were independently associated with low adherence. Conclusions: Male personality traits and perceived stress (i.e., gender identity) were associated with low Med-diet adherence regardless of the sex, age, and comorbidities. Therefore, gender-sensitive interventions should be explored to improve adherence in IHD.

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Hospitalization Expenses and Influencing Factors for Inpatients with Ischemic Heart Disease in Iran: A Retrospective Study

Health Scope ◽

10.5812/jhealthscope.117711 ◽

2022 ◽

Vol In Press (In Press) ◽

Author(s):

Maryam Shirvani Shiri ◽

Sara Emamgholipour ◽

Rajabali Daroudi ◽

Maryam Tatary ◽

Zohreh Kazemi ◽

...

Keyword(s):

Heart Disease ◽

Ischemic Heart Disease ◽

Influencing Factors ◽

Financial Burden ◽

First Grade ◽

Ischemic Heart ◽

Icu Admission ◽

Medical Supplies ◽

Hospitalization Costs ◽

The Mean

Background: Ischemic heart disease (IHD) is the leading cause of death and disability worldwide and in Iran, which imposes a heavy financial burden both on patient’s family and society. Objectives: This study aimed to analyze the direct medical costs of inpatients with IHD and its influencing factors in Iran in 2020. Methods: The sample of this cross-sectional study included 41,357 patients with IHD selected from the hospital information system (HIS) of the Iran Health Insurance Organization from August 23, 2019, to June 20, 2020. The study used the claims data of these patients, which included their demographics, length of stay (LOS), intensive care unit (ICU) admission, hospital accreditation grade, hospital ownership type, and patient discharge status. The multiple linear regression model was employed to evaluate the relationship between hospitalization costs and the associated factors. All statistical tests were conducted at the significance level of P < 0.05 using the R 3.6.3 software. Results: The mean age of patients was 63.95 ± 12.63 years old, and most of them were male (54.4%). The mean hospitalization cost per patient and per day was 586.42 ± 472.51 USD and 103.64 ± 100.29 USD, respectively. Moreover, the mean LOS was 4.92 days. Drugs and consumable medical supplies, as well as nursing and hoteling services, had the highest shares of hospitalization costs (29.54% and 29.4%, respectively). The hospitalization costs of patients with IHD were higher among men (β = 1.24), age 61 - 70 years (β = 1.38), LOS ≥ 5 (β = 2.92), ICU admission (β = 1.62), Iranian health fund (β = 1.21), and private hospitals (β = 1.91). Top-grade and first-grade hospitals had higher costs compared to grade 2 (β = 0.67), grade 3 (β = 0.35), and grade 4 (β = 0.72) hospitals. Deceased patients had also higher costs than patients with complete recovery (β = 0.63), relative recovery (β = 0.59), follow-up (β = 0.51), transfer to other medical centers (β = 0.44), and discharge against medical advice (DAMA) (β = 0.62). Conclusions: According to the results, shortening the LOS and controlling the high costs of drugs and consumable medical supplies are among the main strategies to reduce high hospitalization costs.

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Symptoms of fatigue and depression in ischemic heart disease are driven by personality characteristics rather than disease stage: a comparison of CAD and CHF patients

European Journal of Cardiovascular Prevention & Rehabilitation ◽

10.1097/hjr.0b013e3283083e17 ◽

2008 ◽

Vol 15 (5) ◽

pp. 583-588 ◽

Cited By ~ 17

Author(s):

Otto R.F. Smith ◽

Susanne S. Pedersen ◽

Ron T. Van Domburg ◽

Johan Denollet

Keyword(s):

Heart Disease ◽

Ischemic Heart Disease ◽

Early Stage ◽

Multivariable Analysis ◽

Type D Personality ◽

Ischemic Heart ◽

Disease Stage ◽

Type D ◽

The Impact

Background Symptoms of fatigue and depression are prevalent across stages of ischemic heart disease (IHD). We examined (i) the effect of both the IHD stage and type-D personality on fatigue and depressive symptoms at 12-month follow-up, and (ii) whether the effect of type-D personality on these symptoms is moderated by IHD stage. Methods Two different samples of patients were included to represent IHD stage: 401 percutaneous coronary intervention patients (early-stage IHD) and 105 ischemic chronic heart failure patients (end-stage IHD) completed the DS14 Type-D Scale at baseline. Logistic regression analysis was used to examine the impact of IHD stage and type-D personality on fatigue and depression at follow-up. Results Disease stage was neither associated with symptoms of fatigue ( P = 0.99) nor depression ( P = 0.29) at 12 months. In contrast, type-D personality was shown to predict both symptoms of fatigue [odds ratio (OR) = 2.96; 95% confidence interval (CI): 1.92–4.58, P < 0.001] and depression (OR = 4.91; 95% CI: 3.16–7.65, P < 0.001) at follow-up; the effect of type-D personality on these symptoms was not moderated by disease stage. In multivariable analysis, type-D remained a significant predictor of symptoms of fatigue (OR = 3.14; 95% CI: 1.98–4.99, P < 0.001) and depression (OR = 5.90; 95% CI: 3.60–9.67, P < 0.001), also after controlling for symptom levels at baseline. Conclusion Type-D personality but not disease stage predicted symptoms of fatigue and depression at 12-month follow-up.

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Impact of Serum Uric Acid Level on Systemic Endothelial Dysfunction in Patients with a Broad Spectrum of Ischemic Heart Disease

Journal of Clinical Medicine ◽

10.3390/jcm10194530 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4530

Author(s):

Takashi Hiraga ◽

Yuichi Saito ◽

Naoto Mori ◽

Kazuya Tateishi ◽

Hideki Kitahara ◽

...

Keyword(s):

Uric Acid ◽

Heart Disease ◽

Endothelial Dysfunction ◽

Endothelial Function ◽

Ischemic Heart Disease ◽

Serum Uric Acid ◽

Broad Spectrum ◽

Multivariable Analysis ◽

Ischemic Heart ◽

Coronary Syndrome

Previous studies indicated that serum uric acid (SUA) level is a marker of endothelial function in subsets of ischemic heart disease (IHD). In the present study, we aimed to evaluate the relation between the SUA level and endothelial function in patients with a broad spectrum of IHD, including obstructive coronary artery disease (CAD) and ischemia with no obstructive CAD (INOCA). Three prospective studies and one retrospective study were pooled, in which the SUA level was measured, and systemic endothelial function was assessed using the reactive hyperemia index (RHI). The primary endpoint of the present study was a correlation of the SUA level with RHI. A total of 181 patients with a broad spectrum of IHD were included, among whom, 46 (25%) had acute coronary syndrome presentation and 15 (8%) had INOCA. Overall, the SUA level was negatively correlated with the RHI (r = −0.22, p = 0.003). Multivariable analysis identified the SUA level and INOCA as significant factors associated with RHI values. In conclusion, in patients with a broad spectrum of IHD, including obstructive epicardial CAD (chronic and acute coronary syndromes) and INOCA, the SUA level was significantly and negatively correlated with systemic endothelial function assessed with the RHI. INOCA, rather than obstructive CAD, was more associated with endothelial dysfunction.

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Abstract 15492: The Prognostic Role of Education Attainment Level in Individuals With Ischemic Heart Disease: Analysis From the Endocrine Vascular Approach Study

Circulation ◽

10.1161/circ.142.suppl_3.15492 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Valeria Raparelli ◽

Claudia Tucci ◽

Marco Proietti ◽

Floriana Santonemma ◽

Andrea Lenzi ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Adverse Outcomes ◽

Ischemic Heart ◽

Secondary Outcome ◽

Major Adverse Cardiovascular Events ◽

Fatal Stroke ◽

The Impact ◽

Fatal Myocardial Infarction

Introduction: Although adverse outcomes from cardiovascular disease (CVD) have been on a linear decline, the burden remains high. Addressing the social determinants of health in the care of CVD patients is emerging as a strategy for improving outcomes. Educational attainment level (EAL), a proxy of socioeconomic status, has been associated with both cardiovascular risk and patient’s ability to self-manage the complex cardiovascular treatment. Objective: To assess the impact of EAL on major adverse cardiovascular events (MACE) and all-cause death in patients with ischemic heart disease (IHD). Methods: Endocrine Vascular disease Approach (EVA) is a prospective observational study recruiting hospitalized patients with IHD undergoing coronary angiography and/or percutaneous coronary interventions. Socio-demographics and clinical data, including the level of multimorbidity defined by a Charlson Comorbidity Index≥ 4, were collected. A low-EAL, assessed through a self-reported questionnaire, was defined if at least elementary/middle school education was completed. The primary outcome was the occurrence of MACE (i.e. cardiovascular death, non-fatal myocardial infarction, non-fatal stroke) and a secondary composite endpoint (i.e. all-cause death, non-fatal myocardial infarction, non-fatal stroke) was also analyzed. Results: Among 460 individuals (mean age 67±11, 30% women) with IHD, 252 (55%) had a low-EAL. Individuals with low-EAL were younger and more likely to have heart failure, vascular encephalopathy, and high multimorbidity. A low-EAL was associated with a higher risk of MACE compared with higher EAL (Log-rank=12.29, p<0.001) with similar results for the secondary outcome (Log-rank=9.45, p=0.002). In the adjusted multivariate regression analysis, low EAL was independently associated with MACE [Hazard Ration (HR): 2.31, 95% Confidence Interval (CI): 1.23-4.34, p=0.010] and secondary outcome [HR: 1.73, 95%CI 1.02-2.92, p=0.042] compared to high-EAL. Conclusion: Individuals with IHD and low-EAL had a higher risk of MACE and all-cause death. Interventions that specifically address health literacy and cognition should be tested among these high-risk patients to improve outcomes.

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Association Between the Level of Plasma B-type Natriuretic Peptide and in-hospital Mortality in Patients With Acute Exacerbation of COPD Without a History of Coronary Ischemic Heart Disease: A Retrospective Study

10.21203/rs.3.rs-135746/v1 ◽

2020 ◽

Author(s):

Jiyun Cui ◽

Jie Liu ◽

Jing Wang ◽

Yanbiao Chu ◽

Meng Lv ◽

...

Keyword(s):

Heart Disease ◽

Hospital Mortality ◽

Ischemic Heart Disease ◽

Partial Pressure ◽

Ischemic Heart ◽

Secondary Outcome ◽

Composite Outcome ◽

Arterial Partial Pressure ◽

History Of ◽

Secondary Outcomes

Abstract BackgroundPrevious studies suggested that plasma B-type natriuretic peptide (BNP) level was often elevated in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and was associated with increased mortality. However, most studies did not consider the fact that conditions such as coronary ischemic heart disease can also increase BNP level. Therefore, we aimed to explore the association between BNP level and in-hospital mortality in patients with AECOPD without a history of coronary ischemic heart disease.MethodsIn this retrospective cohort study, data on patients with AECOPD but without a history of coronary ischemic heart disease who were admitted in a comprehensive hospital from January 2017 to December 2019 and were identified using International Statistical Classification of Diseases and Related Health Problems, Nineth Revision (ICD-9) codes were included. BNP level was determined within 24 hours after admission, and the value was log2 transformed. The primary outcome was in-hospital mortality, and the secondary outcome was a composite outcome of in-hospital mortality or invasive mechanical ventilation.ResultsA total of 300 patients were included in this study (mean ages, 76.88 years; SD, 9.87; men, 63.33%). Sixteen patients (5.33%) showed in-hospital mortality; 29(9.67%) and 22 (6.67%) patients were assisted with invasive mechanical ventilators and noninvasive positive pressure ventilators, respectively. Univariate cox regression analysis showed that the unadjusted HRs of the primary and secondary outcomes were 1.85 (95% CI, 1.39-2.47) and 1.42 (95% CI, 1.19-1.71), respectively. After adjustment for age, sex, past medical history, smoking status, drinking status, CURB65 (Confusion, Urea > 7mmol/L, Respiratory rate≥30/min, Blood pressure systolic < 90 mmHg or diastolic <60 mmHg and age > 65 years), arterial partial pressure of O2(PaO2), arterial partial pressure of CO2 (PaCO2), neutrophil count, and D-dimer level (only secondary outcome), the adjusted HRs of the primary and secondary outcomes were 2.44 (95% CI, 1.43-4.14) and 1.36 (95% CI, 1.07-1.74), respectively. The results of subgroup analysis by age, sex, and lung function were robust.ConclusionsThe plasma log2BNP level was significantly associated with in-hospital mortality and a composite outcome of in-hospital mortality or invasive mechanical ventilation

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Risk Factor Analysis of Orthotopic Heart Transplantation

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230301100109 ◽

2003 ◽

Vol 11 (1) ◽

pp. 33-36 ◽

Cited By ~ 5

Author(s):

Tadashi Omoto ◽

Kazutomo Minami ◽

Dietmar Böthig ◽

Ulrich Schütt ◽

Gero Tenderich ◽

...

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Early Mortality ◽

Ischemic Heart ◽

Long Term Results ◽

Donor Age ◽

Ischemic Time ◽

Independent Risk Factors

From March 1989 to December 1999, 1,013 heart transplantations were carried out in this center. Univariate analysis of potential risk factors for early death was followed by stepwise logistic regression to determine independent risk factors. Long-term results were assessed by the Kaplan-Meier method. Multivariate comparisons of long-term results were performed using Cox's proportional hazards model. Early mortality was 8.6%. Actuarial survival was 78.1%, 69.4%, and 53.1% at 1, 5, and 10 years, respectively. Mean total ischemic time was 194 minutes. Independent risk factors of early mortality were female recipient, donor age over 50 years, and ischemic heart disease in the recipient. The precise mechanism of the increased early mortality in female recipients should be studied in the future. Although older donor age was a predictor of early mortality, because of the donor shortage, older hearts should not be excluded from the donor pool. Survival was better in patients with dilative cardiomyopathy than in those with ischemic heart disease.

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