A More Important Role of Diabetes Mellitus in Mortality in Elderly Critical COVID-19 Patients: a Single-center Retrospective Study

Abstract BackgroundCOVID-19 has been circulating worldwide since December 2019. However, its independent risk factors of mortality need further insights in elderly critical COVID-19 patients.MethodsTotally 48 elderly and critically ill COVID-19 patients with clear end point were enrolled when the data were collected, with 16 discharged and 32 died. Kaplan-Meier analysis and Cox regression were performed to identify the risk factors of mortality in elderly critical COVID-19 patients. Survival curve was conducted to present the impact of Diabetes Mellitus on mortality. Mann-Whitney U and t tests were used to 39 clinical variates between the survivor and non-survivor groups.ResultsAs Kaplan-Meier analysis confirmed, only three variates Diabetes Mellitus, chronic obstructive pulmonary disease and family aggregation showed significant difference between the survivor and non-survivor groups. However, only variate Diabetes Mellitus presented significance in Cox regression. Higher C-reaction protein, interleukin-2 (IL-2), IL-8 and creatinine were detected in survivor group than non-survivor group, which was reverse to estimated glomerular filtration rate. The other laboratory finding showed no significant difference between survivor and non-survivor groups.ConclusionsDiabetes Mellitus, chronic obstructive pulmonary disease and family aggregation can contribute to mortality by COVID-19 while Diabetes Mellitus also reduces the survival time of elderly and critically ill COVID-19 patients, highlighting the more important role of Diabetes Mellitus. Laboratory findings could not serve as good predictors of death for elderly and critically ill COVID-19 patients.

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Abstract 258: Significant Predictors of Survival Following Endovascular Abdominal Aortic Aneurysm Repair

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.35.suppl_1.258 ◽

2015 ◽

Vol 35 (suppl_1) ◽

Author(s):

Albeir Y Mousa ◽

Mike Broce ◽

Michael Yacoub ◽

Mark Bates ◽

Ali AbuRahma

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Cox Regression ◽

Abdominal Aortic Aneurysm Repair ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Kaplan Meier ◽

Surgery Patient ◽

Abdominal Aortic ◽

One Year

Objective: To identify significant predictors of survival after abdominal aortic aneurysm (AAA) repair. Methods: A retrospective review of the prospective endovascular aortic repair (EVAR) patient registry of the “Virginia’s group” maintained by the Society for Vascular Surgery Patient Safety Organization. Patients were classified into normal (eGFR ≥60 mL/min/1.73 m 2 ), moderate chronic renal insufficiency (CRI; eGFR ≥30-59) or severe CRI (eGFR <30). Kaplan-Meier and Cox-regression were used to measure and determine the predictors of survival. Results: A total of 6410 EVAR patients were included with an age of 73.5 ± 8.4 years (majority were male 81.2%), with an average follow-up of 2.3 ± 2.0 years. Compared to patients with eGFR 30-59 and >60, those with the lowest eGFR <30 had the highest rate of post-op MI (3.8 vs. 2.2 and 0.8%;p<0.001) and stroke+MI+30-day mortality (3.8 vs. 2.4 and 0.8%; p<0.001). One year mortality was the highest in patients with the lowest eGFR (<30) (5.7 vs. 2.1 and 1.0%, respectively). Overall, 5-year survival was 80.6%. Significant predictors of decreased survival were, unstable angina (Hazard Ratio (HR), 2.5; P =0.007), age (by decade) (HR, 1.6; p<0.001, oxygen-dependent chronic obstructive pulmonary disease (HR, 3.3; P<0.001), eGFR <30 (HR, 2.4; P<0.001) and eGFR 30-59 (HR, 1.5; p<0.001), while pre-operative statin and aspirin use were associated with increased survival (HR, 0.79 and 0.78; both p=0.014, respectively). Conclusion: Reduced renal function at baseline was found to be associated with increased post operative cardiovascular events and long-term mortality following EVAR. Increased monitoring of patients with CRI seems warranted.

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The role of radiotherapy in neuroendocrine cervical cancer: SEER-based study

Science Progress ◽

10.1177/00368504211009336 ◽

2021 ◽

Vol 104 (2) ◽

pp. 003685042110093

Author(s):

Meilian Dong ◽

Xiaobin Gu ◽

Taoran Ma ◽

Yin Mi ◽

Yonggang Shi ◽

...

Keyword(s):

Cervical Cancer ◽

Cox Regression ◽

Local Treatment ◽

Seer Database ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Significant Difference ◽

Chi Squared ◽

Seer Data

Background: There are few randomised prospective data or guidelines for the treatment of neuroendocrine cervical cancer (NECC). In addition, the role of radiotherapy (RT) in NECC remains controversial. We used the Surveillance Epidemiology and End Results (SEER) database to investigate the role of RT for the treatment of NECC. Particular attention was paid to the different role of RT in patients with or without a metastasis (M1 or M0). Methods: The SEER database was queried for studies on NECC. We limited the year of diagnosis to the years 2000 to 2015. A Pearson’s two-sided Chi-squared test, the Kaplan–Meier method and Cox regression analysis models were used for statistical analyses. The overall survival (OS) was studied for the overall group and between-subgroup groups. Results: NECC was an aggressive disease with a mean OS of only 46.3 months (range of 0–196 months, median of 23 months). No significant differences were shown between the surgery (S) and S + RT groups ( p = 0.146) in the M0 (without metastasis) arm. However, there was a statistically significant difference in OS between the S and S + RT groups in the M1 (with metastasis) arm (median of 44.6 months for the S group and 80.9 months for the S + RT group), p = 0.004. The mean survival was significantly longer for M0 patients than for M1 patients when treated with S only (S arm), that is, 82.1 months versus 44.6 months, respectively (log-rank p = 0.000). We also noted that when patients received adjuvant RT (S + RT arm), there were no significant differences between the M0 and M1 groups (median of 90.6 and 81.0 months, p = 0.704, respectively). Age at diagnosis, chemotherapy, T stage and N stage were significant factors for OS in the M0 arm. Interestingly, radiotherapy was the only significant factor for OS with a multivariate HR for death of 0.502 (95% CI 0.206–0.750, p = 0.006) in the M1 arm. Conclusions: RT may be carefully used in patients who are negative for metastases. Using SEER data, we identified a significant survival advantage with the combination of radiotherapy and surgery in NECC with metastases. This suggests that active local treatment should be conducted and has a significant impact on OS, even if a distant metastasis has occurred.

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Epidemiological profile of deaths from COVID-19 at a reference cardiology hospital and indication for palliative care during the pandemic

Journal of Transcatheter Interventions ◽

10.31160/jotci202129a20210017 ◽

2021 ◽

Vol 29 ◽

pp. 1-5

Author(s):

Louis Ohe ◽

Italo Ferreira ◽

Mateus Prata ◽

Kelvin Vilava ◽

Felipe Gindri ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Palliative Care ◽

Pulmonary Disease ◽

Cause Of Death ◽

Chronic Obstructive ◽

Imaging Data ◽

Obstructive Pulmonary Disease ◽

Significant Difference ◽

Epidemiological Profile

Background Palliative care is a set of procedures for patients and families facing terminal or advanced illnesses. Numerous studies have already evaluated the role of palliative care and indications in outpatient or emergency settings. Nonetheless, data referring to the role of palliative care during a pandemic, such as COVID-19, are lacking. This study aimed to analyze the profile of deaths by COVID-19 at a tertiary reference cardiology hospital, and to identify the factors associated with more frequent indication of palliative care during patient management. Methods From March 1 to July 31, 2020, all deaths due to confirmed COVID-19 were analyzed, and their clinical, epidemiological, laboratory and imaging data were obtained. Results Considering the deaths, 26.8% of patients had received palliative care during hospitalization. When the groups were compared (standard care versus palliative care), there was a statistically significant difference for age (67.1±12.1 versus 73.5±9.1 years), presence of chronic obstructive pulmonary disease (3.2% versus 14.7%), and hypoxemia as cause of death (17.2% versus 55.9%). Conclusion In this analysis of patients admitted to the emergency room of a tertiary cardiology hospital during the pandemic period, the determining factors for higher indication for palliative care were age and previous chronic obstructive pulmonary disease. The main cause of death was hypoxemia, which was more prevalent in the palliative group.

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The Role of Hyponatraemia Before Surgery in Patients With Radical Resected Pancreatic Cancer

Clinical Medicine Insights Oncology ◽

10.1177/1179554920936605 ◽

2020 ◽

Vol 14 ◽

pp. 117955492093660

Author(s):

Rossana Berardi ◽

Silvia Rinaldi ◽

Giulio Belfiori ◽

Stefano Partelli ◽

Stefano Crippa ◽

...

Keyword(s):

Pancreatic Ductal Adenocarcinoma ◽

Cox Regression ◽

Radical Surgery ◽

Ductal Adenocarcinoma ◽

Fisher Exact Test ◽

Exact Test ◽

Kaplan Meier ◽

Negative Prognostic Factor ◽

Significant Difference

Objectives: Hyponatraemia represents a negative prognostic factor in patients with cancer. The aim of this study was to assess, for the first time, the role of hyponatraemia in patients undergoing radical surgery for pancreatic ductal adenocarcinoma. Methods: A total of 89 patients with stage I-III pancreatic ductal adenocarcinoma underwent radical surgery between November 2012 and October 2014. Relapse-free survival (RFS) and disease-specific survival (DSS) were estimated using Kaplan-Meier method. A Cox regression model was carried out for univariate and multivariate analyses. Fisher exact test was used to estimate correlation between variables. Results: In total, 12 patients (14%) presented with hyponatraemia at diagnosis. The median DSS was 20 months in patients with hyponatraemia and not reached in patients with eunatraemia ( P < .1073), while a statistical significant difference was observed in terms of median RFS (10 months vs 17 months, respectively; P = .0233). Considering clinical features (hyponatraemia, smoke and alcoholic habit, diabetes, pain, and jaundice), patients with 4 or more of these factors had a worse prognosis (mDSS: 30 months vs not reached; hazard ratio [HR]: 0.40, 95% confidence interval [CI] = 0.16-0.80; P = .0120). Conclusions: The presence of hyponatraemia and its prompt correction at the diagnosis time should be considered for the correct management of patients with pancreatic carcinoma.

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The role of counterinsular hormones in the regulation of glucose homeostasis and the pathogenesis of type 2 diabetes mellitus in COPD

Problems of Endocrinology ◽

10.14341/probl12566 ◽

2021 ◽

Vol 67 (2) ◽

pp. 93-101

Author(s):

V. I. Kobylyansky

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Significant Role ◽

Glucose Homeostasis ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

The Impact

The frequent combination of type 2 diabetes mellitus (T2DM) and chronic obstructive pulmonary disease (COPD) is an important socially significant and far from being studied problem. However, only a few works are devoted to it. To solve this problem, we analyzed the possible pathogenetic mechanisms from the standpoint of the impact on glucose homeostasis of the main hormones — insular and contrainsular.The analysis was carried out using various literature databases, including Index Medicus, Scopus, Pub Med, Embase, Cochrane and others for the period, with rare exceptions, for 2000–2020, of which the works devoted directly to the aspect considered in this work were published in the last 5 years.The analysis revealed a mutual aggravating effect of COPD and T2DM, in which COPD plays an initiating role. It also revealed a significant role of counterinsular hormones, which largely determines the nature of the pathogenesis of T2DM in COPD.In addition, the article draws attention to the possible role of genetic factors that can be common for COPD and T2DM and have a significant role in the comorbidity of COPD and T2DM. The data obtained can be used for both diagnostic and therapeutic purposes in the correction of disorders of carbohydrate metabolism in COPD, which is the lot of further research.

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Pack Years and Lower Lung Function is Associated With Ultra-short Telomeres in Copd: Evidence From Lung Tissue

10.21203/rs.3.rs-37099/v1 ◽

2020 ◽

Author(s):

Huseyin Cagsin ◽

Nedime Serakinci ◽

Ali Uzan ◽

Finn Rasmussen

Keyword(s):

Lung Function ◽

Telomere Length ◽

Lung Tissue ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Significant Difference ◽

Lower Lung ◽

Bronchial Washing

Abstract BackgroundChronic obstructive pulmonary disease (COPD) is driven by a complicated mix of factors such as lifestyle and environmental exposures. Tobacco smoking is the main risk factor for forming chronic inflammation in COPD. Association between cigarette smoking and the role of telomere shortening in COPD has been studied mainly based on the assessment of mean telomere length on leukocytes instead of lung tissue where the primary damage occurs. Here we investigate this association in bronchoalveolar samples by using a new assay that specifically evaluates critically short telomeres, namely, ultra-short telomeres that have sizes less than 1.5kb.MethodsThe study was carried out on materials from the patients eligible for bronchoscopy as well as mild to severe persistent airway obstruction, defined as a post-bronchodilator ratio of less than 70%. Bronchial washing (BW) and leukocyte samples were collected from 32 patients diagnosed with COPD. Telomere length evaluation was done with isolated DNA using Universal STELA to specifically identify the presence of ultra-short telomeres in samples. A t-Student, ANOVA, Chi2, and Paired Sample T-test were used to test differences in means and proportions in statistical analysis. Two-tailed p-values ≤ 0.05 were considered significantResultsThe location of BW did not show a significant difference when compared in terms of the presence of ultra-short telomeres (p>0.05). Higher total pack-years was found amongst patients with ultra-short telomeres (32 packyears versus 16 packyears; p=0.045), lower lung function (FEV1%) (51% versus 82%; p<0.001) when compared with subjects with telomere length more than 1.5kbs in BW. An increasing number of total pack-years, older age and lower FEV1% was observed through the groups comprising subjects with ultra-short telomeres in both BW and leukocytes, subjects with ultra-short telomeres only in BW and subjects with telomeres longer than 1.5kbs(all p<0.01) ConclusionsOur results emphasize the role of ultra-short telomeres in COPD, in vivo, especially when the lung tissue instead of leukocytes is investigated. Additionally, our results demonstrated a dose-response association between pack-years of smoking, low lung function, and ultra-short telomere length in COPD.

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Role of exhaled nitric oxide in predicting steroid response in chronic obstructive pulmonary disease

Orvosi Hetilap ◽

10.1556/oh.2010.28972 ◽

2010 ◽

Vol 151 (51) ◽

pp. 2083-2088 ◽

Cited By ~ 5

Author(s):

Balázs Antus

Keyword(s):

Nitric Oxide ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Exhaled Nitric Oxide ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Steroid Response

A kilégzett levegőben mérhető nitrogén-monoxid a legszélesebb körben vizsgált légúti biomarker. A stabil állapotú krónikus obstruktív tüdőbetegségben a kilégzett nitrogén-monoxid-szint hasonló vagy csak kismértékben emelkedett az egészségesekhez képest. Mivel a nitrogén-monoxid-szint szoros összefüggést mutat a légúti eosinophilia mértékével, és mivel az eosinophil típusú légúti gyulladás szteroidokra érzékenyebb, az emelkedett nitrogén-monoxid-szinttel rendelkező betegek jobb válaszkészséget mutatnak az inhalációs vagy szisztémás kortikoszteroidkezelésre. A krónikus obstruktív tüdőbetegség akut exacerbatiója során a kilégzett nitrogén-monoxid szintje megemelkedik, majd ennek kezelése után csökken. Mivel a nitrogén-monoxid-szint és a kezelés során elért légzésfunkciós javulás szoros korrelációt mutat egymással, a nitrogén-monoxid-méréssel a terápiás válasz megjósolható. Összefoglalva: a nitrogén-monoxid-méréssel a krónikus obstruktív tüdőbetegségben szenvedő betegek olyan alcsoportját lehet elkülöníteni, amelynek szteroidérzékenysége nagyobb. Orv. Hetil., 2010, 151, 2083–2088.

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Participation of ABCA1 transporter in development of chronic obstructive pulmonary disease

I P Pavlov Russian Medical Biological Herald ◽

10.23888/pavlovj2020283360-370 ◽

2020 ◽

Vol 28 (3) ◽

pp. 360-370

Author(s):

Stanislav N. Kotlyarov ◽

Anna A. Kotlyarova

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Significant Contribution ◽

Modern Medicine ◽

Lipid Homeostasis ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Reverse Transport ◽

Current Paradigm

Despite all achievements of the modern medicine, the problem of chronic obstructive pulmonary disease (COPD) does not lose its relevance. The current paradigm suggests a key role of macrophages in inflammation in COPD. Macrophages are known to be heterogeneous in their functions. This heterogeneity is determined by their immunometabolic profile and also by peculiarities of lipid homeostasis of cells. Aim. To analyze the role of the ABCA1 transporter, a member of the ABC A subfamily, in the pathogenesis of COPD. The expression of ABCA1 in lung tissues is on the second place after the liver, which shows the important role of the carrier and of lipid homeostasis in the function of lungs. Analysis of the literature shows that participation of the transporter in inflammation consists in regulation of the content of cholesterol in the lipid rafts of the membranes, in phagocytosis and apoptosis. Conclusion. Through regulation of the process of reverse transport of cholesterol in macrophages of lungs, ABCA1 can change their inflammatory response, which makes a significant contribution to the pathogenesis of COPD.

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