Development of additional pituitary hormone deficiencies in pediatric patients originally diagnosed with idiopathic isolated GH deficiency

ObjectiveWe assessed the characteristics of children initially diagnosed with idiopathic isolated GH deficiency (IGHD) who later developed additional (multiple) pituitary hormone deficiencies (MPHD).DesignData were analyzed for 5805 pediatric patients with idiopathic IGHD, who were GH-naïve at baseline and GH-treated in the multinational, observational Genetics and Neuroendocrinology of Short Stature International Study.MethodsDevelopment of MPHD was assessed from investigator diagnoses, adverse events, and concomitant medications. Analyses were performed for all patients and for those who developed MPHD within 4.5 years or had ≥3.5 years, follow-up and continued to have IGHD (4-year cohort).ResultsMPHD developed in 118/5805 (2.0%) children overall, and in 96/1757 (5.5%) in the 4-year cohort. Patients who developed MPHD had more profound GHD, with decreased height SDS, IGF1 SDS and peak stimulated GH, and greater height decrement vs target, compared with children who continued to have IGHD (P<0.001 for each variable). Delivery complications, congenital anomalies, and perinatal/neonatal adverse events occurred more frequently in patients who developed MPHD. The most frequent additional deficiency was TSH (82 patients overall); four patients developed two pituitary hormone deficiencies and one developed three deficiencies. Multivariable logistic regression indicated that years of follow-up (odds ratio 1.55), baseline age (1.17), baseline height SDS (0.69), and peak stimulated GH (0.64) were associated with the development of MPHD.ConclusionsMPHD is more likely to develop in patients with more severe idiopathic IGHD. Older baseline age, lower baseline height SDS, and longer follow-up duration are associated with increased risk of development of MPHD.

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O06 Baseline predictors of methotrexate-related adverse events in methotrexate-naïve patients with RA

Rheumatology ◽

10.1093/rheumatology/keab246.005 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Ahmad A Sherbini ◽

James M Gwinnutt ◽

Kimme L Hyrich ◽

Suzanne M M Verstappen ◽

Keyword(s):

Rheumatoid Arthritis ◽

Adverse Events ◽

Health Assessment ◽

Prevalence Rates ◽

Clinical Predictors ◽

Research Support ◽

Related Data ◽

Increased Risk ◽

One Year

Abstract Background/Aims Methotrexate (MTX) is the most common treatment for rheumatoid arthritis (RA). The prevalence of adverse events (AEs) associated with MTX treatment for RA have been studied extensively, but there are limited data on the predictors of these AEs. This study aims to summarise the prevalence rates of MTX AEs, including gastrointestinal (GI), neurological, mucocutaneous, and elevated alanine transaminase (ALT) enzyme, and to identify baseline demographic and clinical predictors of these AEs. Methods The Rheumatoid Arthritis Medication Study (RAMS) is a UK multi-centre prospective cohort study of patients with RA starting MTX for the first time. Relevant demographic, medication, clinical and disease related data were collected at baseline. AEs were reported at six and twelve months follow-ups. The prevalence rates of AEs were calculated based on the proportions of patients who reported having had an AE within one year of follow-up. The associations between candidate baseline predictors and AEs were assessed using multivariable logistic regression. Results A total of 2,089 patients were included with a mean age of 58.4 (standard deviation: 13.5) years, 1390 (66.5%) were women. 1,814 and 1,579 patients completed the 6 and 12 months follow-up visits, respectively. The prevalence rates of the AEs within one year of follow-up were: GI = 777 (40.6%), mucocutaneous = 441 (23.1%), neurological = 487 (25.5%), elevated ALT (> upper limit of normal [ULN]) = 286 (15.5%). Younger age and being a woman were associated with increased risk of GI AEs, (age: OR 0.97 per year increase in age, 95% CI 0.98, 1.00; male sex: OR 0.58 vs female, 95% CI 0.46, 0.74) (Table 1). Higher baseline Health Assessment Questionnaire (HAQ) score was an independent predictor of GI, mucocutaneous, and neurological AEs. Furthermore, having ALT >1xULN at baseline or history of diabetes was associated with increased risk of subsequent ALT elevation during the study follow-up. Conclusion In patients with RA starting MTX, GI AEs were the most commonly reported AEs during the first year of follow-up. The identified predictors of AEs may facilitate discussions between clinicians and patients prior to commencing MTX, and may lead to increased adherence and consequently improved effectiveness. Disclosure A.A. Sherbini: None. J.M. Gwinnutt: Grants/research support; BMS. K.L. Hyrich: Member of speakers’ bureau; Abbvie. Grants/research support; Pfizer, UCB, BMS. S.M.M. Verstappen: Consultancies; Celltrion. Member of speakers’ bureau; Pfizer. Grants/research support; BMS.

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ESTROGEN AFTER ISCHEMIC STROKE: Effect of estrogen replacement on risk of recurrent stroke and death in the Women’s Estrogen for Stroke Trial (WEST)

Stroke ◽

10.1161/str.32.suppl_1.329 ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 329-329

Author(s):

Catherine M Viscoli ◽

Lawrence M Brass ◽

Walter N Kernan ◽

Philip M Sarrel ◽

Ralph Horwitz

Keyword(s):

Adverse Events ◽

Cerebrovascular Disease ◽

Observational Research ◽

Baseline Risk ◽

Breast Cancers ◽

Estrogen Replacement ◽

Vascular Events ◽

Fatal Stroke ◽

Increased Risk

71 Introduction: Observational research has produced conflicting findings concerning the effect of estrogen replacement therapy (ERT) on reducing risk for vascular events or death in women. To test the effect of ERT in women with established cerebrovascular disease, we designed a randomized trial of estradiol-17β(1 mg/day) vs. placebo. Methods: Participants were identified from 20 hospitals in New England. Eligibility criteria included age over 44, at least 1 year since last menstrual period, and TIA or non-disabling stroke within 90 days of entry. Randomization was stratified by baseline risk group and hospital. Primary trial outcomes were non-fatal stroke and all-cause death. Results: From December 1993-May 1998, 652 women were randomized (332 estradiol, 320 placebo). Index event was TIA in 164 subjects and stroke in 488. Mean age of subjects was 71 years (range 46–91); 84% were white, 13% black, and 4% other. Mean follow-up was 2.7 years (range: 18 days-5.8 years). At 1 year, 76% of subjects assigned to estradiol were on study drug. In the estradiol group, adverse events were diagnosed during follow-up in 8 subjects (1 pulmonary embolus (PE), 1 deep venous thrombosis (DVT), 5 breast cancers, 1 endometrial cancer) compared with 7 events in placebo subjects (2 PE, 1 DVT, and 4 breast cancers). Non-fatal strokes were confirmed in 51 subjects in the estradiol group vs. 52 in placebo subjects (rates at 3 years[R]: 16.8% estradiol vs. 17.4% placebo; logrank p-value[p]=.83). Death occurred in 46 estradiol subjects vs. 38 placebo subjects (R=13.0% vs. 12.6%, p=.89). At 3 years, combined rate of non-fatal stroke or death was 27.6% in the estradiol group vs. 27.7% in placebo [p=.80]. Conclusion: During an average follow-up of 2.7 years, estradiol treatment did not protect against recurrent cerebral ischemia or reduce all-cause mortality in postmenopausal women with pre-existing cerebrovascular disease. No increased risk for adverse events associated with estrogen was observed. This trial adds to the growing body of evidence that fails to confirm a protective role for ERT in populations with known vascular disease.

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Morbidity After Symptomatic Hemorrhage of Cerebral Cavernous Malformation

Stroke ◽

10.1161/strokeaha.120.029942 ◽

2020 ◽

Vol 51 (10) ◽

pp. 2997-3006

Author(s):

Li Ma ◽

Shuo Zhang ◽

Zongze Li ◽

Chun-Xue Wu ◽

Zhaozhao Wang ◽

...

Keyword(s):

Calibration Curve ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Cavernous Malformation ◽

Cerebral Cavernous Malformation ◽

Developmental Venous Anomaly ◽

Venous Anomaly ◽

Discriminative Ability ◽

Increased Risk

Background and Purpose: Symptomatic hemorrhage contributes to an increased risk of repeated bleeding and morbidity in cerebral cavernous malformation (CCM). A better understanding of morbidity after CCM hemorrhage would be helpful to identify patients of higher risk for unfavorable outcome and tailor individualized management. Methods: We identified 282 consecutive patients who referred to our institute from 2014 to 2018 for CCM with symptomatic hemorrhage and had an untreated follow-up period over 6 months after the first hemorrhage. The morbidity after hemorrhage was described in CCM of different features. Nomogram to predict morbidity was formulated based on the multivariable model of risk factors. The predictive accuracy and discriminative ability of nomogram were determined with concordance index (C-index) and calibration curve, and further validated in an independent CCM cohort of a prospective multicenter study from 2019 to 2020. Results: The overall morbidity of CCM was 26.2% after a mean follow-up of 1.9 years (range 0.5–3.5 years) since the first hemorrhage. The morbidity during untreated follow-up was associated with hemorrhage ictus (adjusted odds ratio per ictus increase, 4.17 [95% CI, 1.86–9.33]), modified Rankin Scale score at initial hemorrhage (adjusted odds ratio per point increase, 2.57 [95% CI, 1.82–3.63]), brainstem location (adjusted odds ratio, 2.93 [95% CI, 1.28–6.68]), and associated developmental venous anomaly (adjusted odds ratio, 2.21 [95% CI, 1.01–4.83]). Subgroup analysis revealed similar findings in brainstem and non-brainstem CCM. Nomogram was contracted based on these features. The calibration curve showed good agreement between nomogram prediction and actual observation. The C-index of nomogram predicting morbidity was 0.83 (95% CI, 0.77–0.88). In validation cohort, the nomogram maintained the discriminative ability (C-index, 0.87 [95% CI, 0.78–0.96]). Conclusions: Multiple symptomatic hemorrhages, initial neurological function after hemorrhage, brainstem location, and associated developmental venous anomaly were associated with morbidity of CCM hemorrhage. The nomogram represented a practical approach to provide individualized risk assessment for CCM patients. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT04076449.

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Role of UGT1A1 and ADH gene polymorphisms in pegvisomant-induced liver toxicity in acromegalic patients

Acta Endocrinologica ◽

10.1530/eje-13-0657 ◽

2014 ◽

Vol 170 (2) ◽

pp. 247-254 ◽

Cited By ~ 12

Author(s):

M Filopanti ◽

A M Barbieri ◽

G Mantovani ◽

S Corbetta ◽

V Gasco ◽

...

Keyword(s):

Liver Toxicity ◽

Tertiary Care ◽

Somatostatin Analogs ◽

Liver Function Tests ◽

Regression Analyses ◽

Increased Risk ◽

Adh Gene ◽

Concomitant Medications

ContextHepatotoxicity is one of the most serious adverse effects in acromegalic patients treated with pegvisomant (PEG-V). Recent studies have found an association between this adverse event and the UGT1A1 allele 28 polymorphism associated with Gilbert's syndrome.ObjectiveTo determine whether UGT1A1*28 and alcohol dehydrogenase (ADH) polymorphisms influence liver toxicity during PEG-V treatment.Design and settingMulticenter observational retrospective study conducted in 13 tertiary care endocrinology units in Italy.PatientsA total of 112 patients with active disease resistant to somatostatin analogs (SSTa) and 108 controls were enrolled.InterventionsClinical and biochemical data were recorded by electronic clinical reporting forms. Blood or DNA samples were sent to the coordinating center for genotyping.ResultsNo differences in genotypes between patients and controls were found. During PEG-V therapy liver function tests (LFT), abnormalities and overt hepatotoxicity developed in 17 and 4.5% of patients respectively. Logistic and linear regression analyses showed an association between LFT abnormalities during the follow-up visit and prior events of LFT abnormalities in medical history (odds ratio=1.25;P=0.04) and the number of concomitant medications, other than SSTa (B=3.9;P=0.03). No correlation between LFT alterations and UGT1A1 allele 28 as well as ADH1C and B polymorphisms was found.ConclusionsUGT1A1 allele 28 and ADH1C and B polymorphisms do not predict increased risk of hepatotoxicity during PEG-V therapy. Conversely, patients with multi-therapies and with previous episodes of liver disease should be carefully managed, due to the observed association between these conditions and LFT abnormalities during PEG-V therapy.

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Adverse Events and Factors Associated with Potentially Avoidable Use of General Anesthesia in Cesarean Deliveries

Anesthesiology ◽

10.1097/aln.0000000000002629 ◽

2019 ◽

Vol 130 (6) ◽

pp. 912-922 ◽

Cited By ~ 20

Author(s):

Jean Guglielminotti ◽

Ruth Landau ◽

Guohua Li

Keyword(s):

Adverse Events ◽

General Anesthesia ◽

Cesarean Delivery ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Neuraxial Anesthesia ◽

General Anesthetics ◽

Factors Associated ◽

Increased Risk ◽

Anesthesia Complications

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Compared with neuraxial anesthesia, general anesthesia for cesarean delivery is associated with increased risk of maternal adverse events. Reducing avoidable general anesthetics for cesarean delivery may improve safety of obstetric anesthesia care. This study examined adverse events, trends, and factors associated with potentially avoidable general anesthetics for cesarean delivery. Methods This retrospective study analyzed cesarean delivery cases without a recorded indication for general anesthesia or contraindication to neuraxial anesthesia in New York State hospitals, 2003 to 2014. Adverse events included anesthesia complications (systemic, neuraxial-related, and drug-related), surgical site infection, venous thromboembolism, and the composite of death or cardiac arrest. Anesthesia complications were defined as severe if associated with death, organ failure, or prolonged hospital stay. Results During the study period, 466,014 cesarean deliveries without a recorded indication for general anesthesia or contraindication to neuraxial anesthesia were analyzed; 26,431 were completed with general anesthesia (5.7%). The proportion of avoidable general anesthetics decreased from 5.6% in 2003 to 2004 to 4.8% in 2013 to 2014 (14% reduction; P < 0.001). Avoidable general anesthetics were associated with significantly increased risk of anesthesia complications (adjusted odds ratio, 1.6; 95% CI, 1.4 to 1.9), severe complications (adjusted odds ratio, 2.9; 95% CI, 1.6 to 5.2), surgical site infection (adjusted odds ratio, 1.7; 95% CI, 1.5 to 2.1), and venous thromboembolism (adjusted odds ratio, 1.9; 95% CI, 1.3 to 3.0), but not of death or cardiac arrest. Labor neuraxial analgesia rate was one of the most actionable hospital-level factors associated with avoidable general anesthetics. Relative to hospitals with a rate greater than or equal to 75%, the adjusted odds ratio of avoidable general anesthetics increased to 1.3 (95% CI, 1.2 to 1.4), 1.6 (95% CI, 1.5 to 1.7), and 3.2 (95% CI, 3.0 to 3.5) as the rate decreased to 50 to 74.9%, 25 to 49.9%, and less than 25%, respectively. Conclusions Compared with neuraxial anesthesia, avoidable general anesthetics are associated with increased risk of adverse maternal outcomes.

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Increased fasting total homocysteine plasma levels as a risk factor for thromboembolism in children

Thrombosis and Haemostasis ◽

10.1160/th03-02-0038 ◽

2004 ◽

Vol 91 (02) ◽

pp. 308-314 ◽

Cited By ~ 24

Author(s):

Achim Heinecke ◽

Karin Kurnik ◽

Christine Heller ◽

Ulrike Nowak-Göttl ◽

Andrea Kosch ◽

...

Keyword(s):

Risk Factor ◽

Odds Ratio ◽

Thromboembolic Event ◽

Pediatric Patients ◽

Thromboembolic Disease ◽

Thromboembolic Events ◽

Thcy Level ◽

Increased Risk ◽

Total Homocysteine ◽

Mild Hyperhomocysteinemia

SummaryElevated total homocysteine (tHcy) concentrations are an inde- pendent risk factor for thromboembolic events in adults. In children with moderate hyperhomocysteinemia data are sparse. Therefore, between 1995 and 2002 we consecutively recruited 163 white pediatric patients with a first symptomatic thromboembolic event and 255 healthy controls (mean age: 6.4 years in patients vs. 6.6 years in controls, range: 3 months to 18 years) and measured fasting tHcy levels. Median tHcy levels in patients were significantly higher (6.6 µmol/l, range 2.9-20.4 µmol/l) than in controls (5.7 µmol/l, 2.0-14.0 µmol/l, p<0.0001). 48 of the 163 patients with thromboembolism (29.5%) versus 26 of the 255 controls (10.2%) had tHcy levels above the age- specific normal 90th percentile (OR 2.9, 95%CI: 1.7-4.8). The odds ratio for children in the highest quintile compared to chil- dren with levels in the lowest quintile was 4.3 (1.6-8.1; highest quintile: median tHcy level 9.6 µmol, range 8.0-20.4), showing a significantly increased risk for thromboembolic disease with even mild hyperhomocysteinemia. We conclude that hyperho- mocysteinemia above the age-specific cut-off values is a risk fac- tor for thromboembolic events in children. Therefore, screen- ing for elevated fasting tHcy levels of patients with thromboem- bolism is recommended to stratify the risk of thromboembo- lism.

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Stent-Associated Flow Remodeling Causes Further Occlusion of Incompletely Coiled Aneurysms

Neurosurgery ◽

10.1227/neu.0b013e3182181c2b ◽

2011 ◽

Vol 69 (3) ◽

pp. 598-604 ◽

Cited By ~ 89

Author(s):

Matthew F. Lawson ◽

William C. Newman ◽

Yueh-Yun Chi ◽

J. D. Mocco ◽

Brian L. Hoh

Keyword(s):

Multivariate Analysis ◽

Confidence Interval ◽

Packing Density ◽

Odds Ratio ◽

Senior Author ◽

Neck Size ◽

Increased Risk ◽

Coil Occlusion ◽

Stented Group

Abstract BACKGROUND: Incomplete coil occlusion is associated with increased risk of aneurysm recurrence. We hypothesize that intracranial stents can cause flow remodeling, which promotes further occlusion of an incompletely coiled aneurysm. OBJECTIVE: To study our hypothesis by comparing the follow-up angiographic outcomes of stented and nonstented incompletely coiled aneurysms. METHODS: From January 2006 through December 2009, the senior author performed 324 initial coilings of previously untreated aneurysms, 145 of which were Raymond classification 2 and 3. Follow-up angiographic studies were available for 109 of these aneurysms (75%). Angiographic outcomes for stented vs nonstented incompletely coiled aneurysms were compared. A multivariate analysis was performed to identify factors related to the progression of occlusion at follow-up, with adjustment for aneurysm location, size, neck size, Hunt-Hess grade, stent use, initial Raymond score, packing density, age, sex, and medical comorbidities. RESULTS: Of the 109 aneurysms, 37 were stented and 72 were not stented. With a median follow-up time of 15.4 months, 33 stented aneurysms (89%) progressed to complete occlusion compared with 29 nonstented aneurysms (40%). Recanalization rates were lower in the stented group (8.1%) compared with the nonstented group (37.5%; P < .001). On multivariate analysis, stent use (odds ratio, 18.5; 95% confidence interval, 4.3-76.9) and packing density (odds ratio, 1.093; 95% confidence interval, 1.021-1.170) were significant predictors of the progression of occlusion. Aneurysm size was negatively correlated with the progression of occlusion (odds ratio, 0.844; 95% confidence interval, 0.724-0.983). CONCLUSION: Stent-assisted coiling causes progression of occlusion, possibly by a flow remodeling effect. The odds of progression of occlusion of stent-coiled aneurysms were 18.5 times that of nonstented aneurysms.

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Imatinib Long Term Effects (ILTE) Study: An Independent, International Study in CML Patients.

Blood ◽

10.1182/blood.v112.11.1099.1099 ◽

2008 ◽

Vol 112 (11) ◽

pp. 1099-1099

Author(s):

Carlo Gambacorti-Passerini ◽

Dong-Wook Kim ◽

François-Xavier Mahon ◽

Giuseppe Saglio ◽

Fabrizio Pane ◽

...

Keyword(s):

Adverse Events ◽

International Study ◽

Imatinib Treatment ◽

Long Term Effects ◽

First Line ◽

Eligibility Criteria ◽

Serious Adverse Events ◽

Second Cancers

Abstract Imatinib is an effective first line therapy for chronic myeloid leukemia (CML) and has substantially changed its biological and clinical behavior. Durable complete cytogenetic responses (CCyR) were reported in the majority of patients, with a rather benign side effect profile, despite the ‘off target’ inhibition of several other kinases, including Kit, PDGFR and Lck. Since available information is largely based on industry-sponsored trials and long-term field studies are lacking, the ILTE study was conceived as an industryindependent, academic, multicenter trial supported by the Italian Drug Safety Agency (AIFA). ILTE is an international study on a retrospective cohort and includes 31 centers in Europe, North/South America, Africa and Asia; therefore it is uniquely positioned to present a global picture of imatinib long-term effects. Consecutive patients with Ph+ CML who started imatinib between 01 September 1999 and 31 December 2004 were eligible if they were in Complete Cytogenetic Response (CCyR) after two years of imatinib treatment. Study endpoints were survival, serious adverse events (SAE, including second cancers), toxicities not qualifying as SAE (NSAE) but judged by the referring physician as substantially impacting quality of life, loss of CCyR, and development of PCR negativity. A total of 957 patients were enrolled, 92% of which met eligibility criteria. The median age of eligible patients was 50 (range 15–92) years; 59% of patients were males and the median follow-up was 3.1 years (excluding the first 2 years of treatment). As of Dec. 31 2007, 2564 person years were available for analysis. Eleven deaths were observed (only 3 of them caused by relapsed CML), with a standardized rate of 0.4/100 person years and an observed/expected ratio of 0.48 (95% CI = 0.24–0.85). One-hundred SAE were recorded (rate 3.9/100 person years, most frequent type “heart failure”), with 21% being considered related to imatinib. Second cancers were documented in 28 patients (rate 1.1/100 person years), with an observed/expected ratio of 1.27 (95% CI = 0.84–1.84). Among the 576 NSAE recorded (0.65/patient) the most frequent types were “edema, cramps, skin fragility, diarrhea”; 71% of them were related to imatinib. A total of 12 patients (1.4 %) discontinued imatinib because of toxicities during the period of observation. Thirty-four patients lost CCyR, corresponding to a rate of 1.4/100 person years (1.0 in patients with imatinib as first-line treatment, 1.5 in patients who were treated with imatinib >6 months after diagnosis), with stable or increasing rates over time. Finally, 214 patients (24.5%) developed durable (> 1 year) PCR negativity. In conclusion, the first report from ILTE shows that CML patients on imatinib die unfrequently of CML related causes, do not appear to have substantially higher second cancer rates than the general population, have mortality rates lower than expected in an age/sex matched population and do not show new types of imatinib-related adverse events. They also experience a low but steady rate of loss of CCyR and develop PCR negativity in approximately ¼ of cases. Follow-up and further analysis are ongoing. (Presented on behalf of the ILTE Investigators group)

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Growth hormone replacement does not increase serum prostate-specific antigen in hypopituitary men over 50 years

Acta Endocrinologica ◽

10.1530/eje.0.1470059 ◽

2002 ◽

pp. 59-63 ◽

Cited By ~ 4

Author(s):

CW le Roux ◽

PJ Jenkins ◽

SL Chew ◽

C Camacho-Hubner ◽

AB Grossman ◽

...

Keyword(s):

Prostate Specific Antigen ◽

Gh Deficiency ◽

Hormone Replacement ◽

Specific Antigen ◽

Prospective Longitudinal Study ◽

Serum Prostate Specific Antigen ◽

Increased Risk ◽

Igf I ◽

Prospective Longitudinal

OBJECTIVE: Epidemiological studies have shown an increased risk for prostate carcinoma in men with serum IGF-I in the upper part of the age-related reference range. Recombinant human GH (rhGH) is widely used in patients with GH deficiency, usually raising the serum IGF-I levels into the normal range: safety surveillance is therefore mandatory, with particular regard to neoplasia. The aim was to examine whether rhGH replacement in hypopituitary adults is associated with changes in serum prostate-specific antigen (PSA) as a surrogate marker of changes in prostatic growth. DESIGN AND METHODS: A prospective longitudinal study was used with a median follow-up of 22 (range 2.5-32) months, in which 41 men aged over 50 years with adult onset hypopituitarism and GH deficiency during rhGH replacement were examined. Serum PSA and IGF-I were measured at baseline and at latest follow-up. RESULTS: Mean serum PSA remained unchanged during rhGH replacement, with a median follow-up of 2 years. No correlation was found between the individual changes in serum IGF-I and changes in serum PSA. CONCLUSIONS: These data are reassuring thus far regarding the safety of GH replacement in relation to the prostate in this patient group.

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Thirty-Day Readmission Rates After Takotsubo Syndrome With or Without Malignancy: A Nationwide Readmissions Database Analysis

10.21203/rs.3.rs-87272/v1 ◽

2020 ◽

Author(s):

Sun-Joo Jang ◽

Ilhwan Yeo ◽

Chanel Jonas ◽

Parag Goyal ◽

Jim W. Cheung ◽

...

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Readmission Rate ◽

Takotsubo Syndrome ◽

Database Analysis ◽

Readmission Rates ◽

Increased Risk ◽

All Cause Mortality ◽

Baseline Characteristics

Abstract Background: Association of malignancy with readmission after TTS hospitalization has not been fully described. We sought to examine the rates, cause and cost of 30-day readmissions and 30-day all-cause mortality of Takotsubo syndrome (TTS) patients with or without malignancy. Methods: The Nationwide Readmissions Databases from 2010 to 2014 were queried to identify and compare baseline characteristics and outcomes of patients hospitalized for TTS with and without malignancy. Results: We identified 61,588 index hospitalizations for TTS. TTS patients with malignancy were older (70.6 ± 0.2 vs. 66.1 ± 0.1, p < 0.001), and the overall burden of comorbidities was higher than in those without malignancy. TTS patients with malignancy had significantly higher 30-day readmission rates than those without malignancy (15.9% vs. 11.0%; odds ratio [OR], 1.35; 95% confidence interval [CI], 1.18 - 1.56). Majority (75.5%) of the etiologies for readmissions were non-cardiac, with infection being most common (20.1%). The 30-day readmission rate due to the recurrent TTS was similar in both groups (0.4% and 0.5%, respectively; p = 0.47). Importantly, 30-day all-cause mortality was higher in TTS with vs. without malignancy (4.8% vs 2.5%; OR, 1.62; 95% CI, 1.25 - 2.10). The total costs (index admission + readmission) were higher by 25% (p < 0.001) in TTS patients with malignancy vs. without malignancy. Conclusions: In patients hospitalized with TTS, the presence of malignancy was associated with increased risk of 30-day readmission, mostly attributable to non-cardiac etiologies. Importantly, the 30-day all-cause mortality and cost were also significantly higher. These findings highlight the importance of optimization of treatment and follow up in patients with malignancy after hospitalizations for TTS.

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