Individual risk factors of metabolic syndrome in adult patients with GH deficiency: a cross-sectional case-control study

Abstract Background: Periprosthetic joint infection (PJI) is a severe complication following knee arthroplasty. Therapeutic strategies comprise a combination of surgical and antibiotic treatment modalities and aim to eradicate the infection. Sometimes control of the disease can only be attained by above-knee amputation (AKA). While a vast amount of literature exists illuminating predisposing factors for PJI, risk factors favoring the endpoint AKA in this context are sparsely known. Methods: The purpose of this investigation was to delineate whether patients with PJI of the knee present specific risk factors for AKA. In a retrospective case-control study 11 cases of PJI treated with AKA were juxtaposed to 57 cases treated with limb salvage (LS). The minimum follow-up was two years. Comorbidities, signs and symptoms of the current infection, factors related to previous surgeries and the implant, microbiology, as well as therapy related factors were recorded. Comparative analysis was performed using student’s t-test, chi-square test or Fisher’s exact test. Binary differences were calculated using odds ratio (OR). Reoperation frequency was compared using Mann-Whitney U test. In-depth descriptive analysis of 11 amputees was carried out. Results: A total of 68 cases aged 71±11.2 years were examined, hereof 11 with AKA and 57 with LS. Severe comorbidities (p=0.009), alcohol abuse (p=0.015), and preoperative anemia (p=0.022) were more frequently associated with AKA. Preoperative anemia was found in all 11 amputees (100%) and in 33 of 57 LS patients (58%) with an average preoperative hemoglobin of 99.9±15.1 g/dl compared to 118.2±19.9 g/dl (p=0.011). No other parameters differed significantly. AKA patients underwent a median of eight (range 2-24) reoperations, LS patients a median of five (range 2-15).Conclusion: Factors potentially influencing the outcome of knee PJI are diverse. The indication of AKA in this context remains a rarity and a case-by-case decision. Patient-intrinsic systemic factors such as alcohol abuse, severe comorbidities and preoperative anemia may elevate the individual risk for AKA in the setting of PJI. We recommend that anemia, being a condition well amenable to therapeutic measures, should be given special consideration in management of PJI patients. Trial registration: This study was registered with Kantonale Ethikkommission Zürich, (BASEC-No. 2016-01048).

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Genetic variants associated with persistent central obesity and the metabolic syndrome in a 12-year longitudinal study

Acta Endocrinologica ◽

10.1530/eje-10-0902 ◽

2011 ◽

Vol 164 (3) ◽

pp. 381-388 ◽

Cited By ~ 23

Author(s):

Chloe Y Y Cheung ◽

Annette W K Tso ◽

Bernard M Y Cheung ◽

Aimin Xu ◽

K L Ong ◽

...

Keyword(s):

Metabolic Syndrome ◽

Genetic Risk ◽

Chinese Population ◽

Central Obesity ◽

Case Control Study ◽

Case Control ◽

Cross Sectional ◽

The Metabolic Syndrome ◽

Control Study

ObjectiveCentral obesity predisposes to various cardiometabolic diseases and is a key component of the metabolic syndrome (MetS). We have previously demonstrated that three obesity-susceptible single nucleotide polymorphisms (SNPs), rs10938397 (GNPDA2), rs8050136 (FTO) and rs17782313 (MC4R), were associated with obesity and waist circumference in cross-sectional studies in the Chinese population. In this study, we investigate whether these SNPs could also predict the persistence of central obesity and MetS in subjects from the Hong Kong Cardiovascular Risk Factors Prevalence Study (CRISPS) cohort.Design and methodsWe genotyped these SNPs in i) 354 subjects with and 994 subjects without central obesity at both baseline and a 12-year follow-up, ii) 2214 subjects (816 cases and 1398 controls) in an MetS cross-sectional case–control study and iii) 225 subjects with and 1221 subjects without MetS at both baseline and the 12-year follow-up.ResultsBoth FTO rs8050136 (Page, sex-adjusted=0.019; odds ratio (OR) (95% confidence intervals (CI)): 1.35 (1.05, 1.73)) and GNPDA2 rs10938397 (Page, sex-adjusted=3×10−3; OR (95% CI): 1.34 (1.11, 1.63)) were significantly associated with persistent central obesity. GNPDA2 rs10938397 was also significantly associated with MetS (Page, sex-adjusted=0.011, OR (95% CI): 1.20 (1.04, 1.38)) in the case–control study. However, none of these SNPs showed an individual association with persistent MetS. In the combined genetic risk analyses for persistent central obesity and persistent MetS, the combined genetic risk score of the three SNPs showed an OR of 1.25 (95% CI: 1.10, 1.42; Page, sex-adjusted=4.92×10−3) and 1.19 (95% CI: 1.03, 1.38; Page, sex-adjusted=0.019) for each additional risk allele respectively.ConclusionThis study demonstrated that FTO and GNPDA2 variants predicted persistent central obesity in the Chinese population, further supporting their importance as obesity-susceptible genes.

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