Suicide Attempts and Adolescents: The Need for Specialized Resources at Adult Trauma Centers

Background: Suicide is the second leading cause of adolescent death and suicide attempts outnumber deaths 50:1 for adolescents 15 to 19 years of age. This study examines differences in outcomes between adolescents and adults treated at an adult trauma center in an effort to guide recovery and prevention strategies following an adolescent suicide attempt. Methods: Retrospective review of patients aged >14 years treated at an urban, Level 1 trauma center for self-inflicted injuries between 2009 and 2018 was performed. The cohort was divided into adolescents (14-19 years) and adults (>20 years) and into group A (economically distressed) and group B (non-distressed). Demographics, injury, outcomes, and geospatial analysis were compared. Results: Among 723 patients, 60 (8%) were adolescents of which 92% were male, 55% black, 47% blunt injuries, and 53% penetrating. In adults, 76% were male, 41% black, 28% blunt injuries, and 72% penetrating. Mortality estimates for adolescents and adults were 35% and 24%, respectively (p=0.09). Most adolescent deaths occurred within 3 days after admission, while adult deaths occurred further into hospitalization (p<0.01). Cox regression analysis found higher mortality with self-pay compared to private insurance (HR 2.6; p<0.001), and penetrating vs. blunt/other injuries (HR 2.4; p<0.001). Psychiatric care was administered in 64% of adolescents (n=39) and 84% of adults (p< 0.01). Conclusions: Inpatient psychiatric care for adolescents who attempted suicide was limited at an adult trauma center. The high incidence of suicide attempts and community-level distress in adolescents require immediate attention and resources.

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Parental post-traumatic stress and psychiatric care utilisation among refugee adolescents

European Child & Adolescent Psychiatry ◽

10.1007/s00787-021-01827-1 ◽

2021 ◽

Author(s):

Lisa Berg ◽

Edith de Montgomery ◽

Monica Brendler-Lindquist ◽

Ellenor Mittendorfer-Rutz ◽

Anders Hjern

Keyword(s):

Traumatic Stress ◽

Psychiatric Care ◽

Cox Regression ◽

Psychiatric Morbidity ◽

Refugee Children ◽

Care Utilization ◽

Post Traumatic Stress ◽

Cox Regression Analysis ◽

Family Approach ◽

Post Traumatic

AbstractParental psychiatric morbidity related to experiences of war and trauma has been associated with adverse psychological outcomes for children. The aim of this study was to investigate parental post-traumatic stress in relation to psychiatric care utilization among children of refugees with particular attention on the child’s own refugee status, sex of both child and parents, and specific psychiatric diagnoses. This was a register study in a population of 16 143 adolescents from refugee families in Stockholm County born 1995–2000 and followed between 2011 and 2017 (11–18 years old). Parental post-traumatic stress, identified in three levels of care, was analysed in relation to child and adolescent psychiatric care use. Cox regression analysis was used to estimate hazard ratios (HR) and 95% confidence intervals (CI), adjusted for duration of residence and demographic and socioeconomic variables. Having a mother with post-traumatic stress was associated with higher psychiatric care utilization, with adjusted HR 2.44 (95% CI 1.90–3.14) among foreign-born refugee children and HR 1.77 (1.33–2.36) among Swedish-born children with refugee parents, with particularly high risks for children with less than five years of residence (HR 4.03; 2.29–7.10) and for diagnoses of anxiety and depression (HR 2.71; 2.11–3.48). Having a father with post-traumatic stress was not associated with increased HRs of psychiatric care utilization. Similar results were seen for boys and girls. Treatment for post-traumatic stress should be made available in refugee reception programmes. These programmes should use a family approach that targets both parents and children.

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Hemodialysis Adequacy and Its Impact on Long-Term Patient Survival in Demographically, Socially, and Culturally Homogeneous Patients

International Journal of Nephrology ◽

10.1155/2020/9857123 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Reza Hekmat

Keyword(s):

Cox Regression ◽

Patient Survival ◽

Underlying Disease ◽

Chronic Hemodialysis ◽

Historical Cohort ◽

Cox Regression Analysis ◽

Group A ◽

One Year ◽

Group B ◽

Iranian Patients

Background. Impact of hemodialysis adequacy on patient survival is extensively studied. The current study compares the survival of chronic hemodialyzed, undocumented, uninsured, Afghan immigrant patients with that of a group of insured Iranian patients matched for underlying disease, age, weight, level of education, marital status, income, and number of comorbid conditions. Methods. Eighty chronic hemodialysis patients (mean age 42.8 ± 10.5 years) entered this historical cohort study in Mashhad, Iran, between January 2012 and January 2015. Half of the patients were undocumented, uninsured, Afghan immigrants (Group A) matched with forty insured Iranian patients (Group B). To compare the survival rate of the two patient groups, Kaplan–Meir survival analysis test was used. Results. Group A patients were underdialyzed with a weekly Kt/V which was significantly less in comparison with that of Group B (1.63 ± 0.63 versus 2.54 ± 0.12, p value = 0.01). While Group A’s number of hemodialysis sessions per week was fewer than that of Group B (1.45 ± 0.56 versus 2.8 ± 0.41, p value = 0.04), the mean of Kt/V in each hemodialysis session was higher in them, in comparison with Group B (1.43 ± 0.25 versus 1.3 ± 0.07, p value = 0.045). In Group B and Group A patients, one-year survival was 70% versus 50%, two-year survival was 55% versus 30%, and three-year survival was 40% versus 20%, respectively (p values = 0.04, 0.02 and 0.04, respectively). In Cox regression analysis, hemodialysis adequacy and uninsurance were factors impacting patients’ survival (OR = 1.193 and 0.333, respectively). Conclusions. Undocumented, uninsured, inadequately hemodialyzed, Afghan patients had a significantly lower one-, two-, and three-year survival as opposed to their Iranian counterparts, probably due to lack of insurance.

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P1166DOES PERITONEAL PROTEIN LOSS AFFECT CARDIOVASCULAR MORTALITY OF PERITONEAL DIALYSIS PATIENTS ?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1166 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Marios Theodoridis ◽

Stylianos Panagoutsos ◽

Ioannis Neofytou ◽

Konstantia Kantartzi ◽

Efthimia Mourvati ◽

...

Keyword(s):

Regression Analysis ◽

Peritoneal Dialysis ◽

Cardiovascular Mortality ◽

Cox Regression ◽

Dialysis Patients ◽

Protein Loss ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Group A ◽

Group B

Abstract Background and Aims Peritoneal protein loss (PPL) through peritoneal effluent has been a well-recognized detrimental result of peritoneal dialysis (PD). The amount of protein lost will depend on dialysis time, protein size, its serum concentration and other factors including patients’ clinical status. Peritoneal protein loss may be a manifestation of endothelial dysfunction, as with another type of capillary protein leakage, microalbuminuria, a recognized endothelial dysfunction marker. The aim of this study was to retrospectively evaluate the influence of PPL on cardiovascular mortality of peritoneal dialysis patients Method This is a single center retrospective study of 84 PD patients (m=54, f=30) with mean age of 65.2±17 years, mean PD duration of 43.2±24.9 months conducted for the time period from 2006 to 2019 (13 years). The patients were divided into two groups according to the amount of protein excreted during the modified Peritoneal Equilibration Test (PET) procedure using PD solution of 3.86% DW, 2 Lt infusion volume for total time of 4 hours. The total amount of proteins excreted was calculate from PET by multiplying the concentration of proteins at the end of the test with the total volume of PD fluid at the same time. Group A excreted a total amount of proteins < 1.55 gr (median value) at the end of PET test and Group B > 1.55 gr. The cumulative all-cause and cardiovascular survival of the PD patients was calculated by Kaplan Meier while the possible effect of any parameter in survival rates was evaluated by using Cox Regression analysis Results There was not any statistically significant difference between the two groups according to PD duration, age, dialysis adequacy targets, Residual Renal Function(RRF), BMI, ultrafiltration volume during PET and their transport status. The cumulative all-cause survival using Kaplan-Meier analysis revealed no statistically significant deference between the two groups (Log Rank p=0.55) even though mortality risk was adjusted for several factors (Cox Regression). When cardiovascular survival, using Cox Regression analysis, was adjusted for age, sex, Diabetes, PD modality, dialysis Kt/V and RRF we found that Group A (with protein excretion < 1.55 gr) had statistically significant better cardiovascular survival (p=0.029) compared to Group B. We confirm these results while trying to find among the total of our patients the possible risk factors for cardiovascular mortality. Using Cox Regression analysis, the amount of protein excreted during PET procedure and the type of PD solutions (high or low in GDPs) used were statistically significant (p=0.019 and p=0.04 respectively) independent risk factors for cardiovascular survival in our patients. Conclusion These results indicate that protein loss during peritoneal dialysis procedure has negative impact on cardiovascular mortality and survival of PD patients. Additionally, the use of PD solutions with low Glucose Degradation Products (GDPs) and AGEs may improve PD patient’s cardiovascular survival. Randomized interventional studies are encouraged to address the pathological concern of PPL in the future, namely its effects on cardiovascular conditions or its role as marker and effort to reduce PPL using ACE inhibitors or vit D should be considered only if it diminishes cardiovascular morbidity or mortality.

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D-dimer daily continuous tendency predicts the short-term prognosis for COVID-19 independently: A retrospective study from Northeast China

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-201071 ◽

2021 ◽

pp. 1-9

Author(s):

Yinting Xing ◽

Wei Yang ◽

Yingyu Jin ◽

Chao Wang ◽

Xiuru Guan

Keyword(s):

Cox Regression ◽

Short Term ◽

Cox Regression Analysis ◽

Prognosis Group ◽

The Difference ◽

Group B ◽

The Relationship ◽

Worse Prognosis ◽

D Dimer

BACKGROUND AND OBJECTIVE: To study whether D-dimer daily continuous tendency could predict the short-term prognosis of COVID-19. PATIENTS AND METHODES: According to the short-term prognosis, 81 COVID-19 patients were divided into two groups, one of worse prognosis (Group W) and the other of better prognosis (Group B). The slope of D-dimer linear regression during hospitalization (SLOPE) was calculated as an indicator of D-dimer daily continuous tendency. The SLOPE difference between Group W and Group B was compared. The difference between the discharge results and the 3-month follow-up results was also compared. COX regression analysis was used to analyze the relationship between SLOPE and short-term prognosis of COVID-19. RESULTS: There were 16 patients in Group W and 65 patients in Group B. Group W had more critical proportion (p < 0.0001), indicating that the symptoms of its patients were more severe during hospitalization. ARDS, the most visible cause of worse prognosis, accounted for up to 68.75%, and many symptoms merged and resulted in worse prognosis. The D-dimer levels of Group W not only were significantly higher (p < 0.0001), but also showed an increasing trend. In addition, the D-dimer levels at discharge were significantly higher than those at follow-up (p = 0.0261), and the mean difference was as high as 0.7474. SLOPE significantly correlated with the short-term prognosis of COVID-19 independently (RR: 1.687, 95% CI: 1.345–2.116, P < 0.0001). The worst prognosis occurred most likely during the first month after COVID-19 diagnosis. CONCLUSION: Our study found that D-dimer daily continuous tendency independently correlates with worse prognosis and can be used as an independent predictor of the short-term prognosis for COVID-19.

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Association of cytoreductive nephrectomy and survival in the immune checkpoint inhibitor era.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.748 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 748-748

Author(s):

Joseph Miccio ◽

Sung Jun Ma ◽

Oluwadamilola Temilade Oladeru ◽

Daniel X. Yang ◽

Gabrielle W. Peters ◽

...

Keyword(s):

Immune Checkpoint ◽

Immune Checkpoint Inhibitor ◽

Cox Regression ◽

Checkpoint Inhibitor ◽

Private Insurance ◽

Cytoreductive Nephrectomy ◽

Fuhrman Grade ◽

Cox Regression Analysis ◽

Academic Center ◽

Income Insurance

748 Background: Cytoreductive nephrectomy (CN) for patients (pts) with metastatic renal cell carcinoma (mRCC) improved overall survival (OS) in the interferon (IFN) era, but the benefit of CN in the immune checkpoint inhibitor (ICI) era is unknown. Methods: We identified pts with mRCC receiving immunotherapy (IT) from 2004-2015 in the National Cancer Database (NCDB). Pts with partial nephrectomy or ablation were excluded. The ICI era was defined as 2013-2015 based on a high-profile publication in 2012 demonstrating efficacy of ICI in mRCC and the IFN era was defined as 2004-2005 due to FDA approval of sorafenib in 12/2005. Pts receiving CN with TKI were excluded, as prior NCDB study showed an OS benefit to CN in contrast to the results of the CARMENA trial. Univariable (UVA) and multivariable (MVA) associates with OS during each era were identified using Cox regression analysis including age, sex, race, income, insurance, treatment facility type, treatment location, clinical T stage (cT), clinical N stage (cN), histology, Fuhrman grade (FG), other metastectomy, and CN. Results: There was a 65% decline in mRCC pts receiving IT from 2005 to 2006 (end of the IFN era), which remained low (11% rise from 2006-2012) until a 93% rise from 2012 to 2013 (start of the ICI era). 128 of 422 (30.3%) pts in the IFN era received CN compared to 218 of 526 (41.4%) patients in the ICI era, p<0.001. Pts in each era were balanced with respect to median age, race, income, location, cT, and histology, but the ICI era had higher proportions of pts with private insurance, treatment at an academic center, N0 disease, FG 3-4, and other metastatectomy (p<0.05). Most pts with CN in the ICI era had IT after CN (89.9%); this was not coded in the IFN era. In the IFN era, CN compared to IT alone was associated with improved OS on UVA (HR 0.59, 95% CI 0.47-0.73, p<0.001) and MVA (HR 0.62, 95% CI 0.47-0.83, p=0.001). In the ICI era, CN compared to IT alone was associated with improved OS on UVA (HR 0.63, 95% CI 0.49-0.81, p<0.001) but not on MVA (0.82, 95% CI 0.58-1.14, p=0.234). Conclusions: Despite increased utilization of CN for US pts with mRCC treated with IT during the ICI era, the lack of OS benefit in recent years suggests a need for prospective reevaluation of the value CN and its timing with ICI.

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Proactive Infliximab Monitoring Following Reactive Testing is Associated With Better Clinical Outcomes Than Reactive Testing Alone in Patients With Inflammatory Bowel Disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjy039 ◽

2018 ◽

Vol 12 (7) ◽

pp. 804-810 ◽

Cited By ~ 43

Author(s):

Konstantinos Papamichael ◽

Ravy K Vajravelu ◽

Byron P Vaughn ◽

Mark T Osterman ◽

Adam S Cheifetz

Keyword(s):

Inflammatory Bowel Disease ◽

Treatment Failure ◽

Bowel Disease ◽

Cox Regression ◽

Drug Discontinuation ◽

Cox Regression Analysis ◽

Loss Of Response ◽

Group A ◽

Inflammatory Bowel ◽

Group B

Abstract Background and Aims Reactive testing has emerged as the new standard of care for managing loss of response to infliximab in inflammatory bowel disease [IBD]. Recent data suggest that proactive infliximab monitoring is associated with better therapeutic outcomes in IBD. Nevertheless, there are no data regarding the clinical utility of proactive infliximab monitoring after first reactive testing. We aimed to evaluate long-term outcomes of proactive infliximab monitoring following reactive testing compared with reactive testing alone in patients with IBD. Methods This was a retrospective multicenter cohort study of consecutive IBD patients on infliximab maintenance therapy receiving a first reactive testing between September 2006 and January 2015. Patients were divided into two groups; Group A [proactive infliximab monitoring after reactive testing] and Group B [reactive testing alone]. Patients were followed through December 2015. Time-to-event analysis for treatment failure and IBD-related surgery and hospitalization was performed. Treatment failure was defined as drug discontinuation due to either loss of response or serious adverse event. Results The study population consisted of 102 [n = 70, 69% with CD] patients [Group A, n = 33 and Group B, n = 69] who were followed for (median, interquartile range [IQR]) 2.7 [1.4–3.8] years. Multiple Cox regression analysis identified proactive following reactive TDM as independently associated with less treatment failure (hazard ratio [HR] 0.15; 95% confidence interval [CI] 0.05–0.51; p = 0.002) and fewer IBD-related hospitalizations [HR: 0.18; 95% CI 0.05–0.99; p = 0.007]. Conclusions This study showed that proactive infliximab monitoring following reactive testing was associated with greater drug persistence and fewer IBD-related hospitalizations than reactive testing alone.

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Krebs von den Lungen 6 levels in COVID-19 ICU Patients are Associated with Mortality

10.1101/2021.11.17.21266464 ◽

2021 ◽

Author(s):

Giuliana Scarpati ◽

Daniela Baldassarre ◽

Graziella Lacava ◽

Filomena Oliva ◽

Gabriele Pascale ◽

...

Keyword(s):

Cox Regression ◽

Icu Patients ◽

Cox Regression Analysis ◽

Alveolar Epithelial ◽

Type Ii Pneumocytes ◽

Group A ◽

Predictive Role ◽

Fraction Of Inspired Oxygen ◽

Group B

Rationale Krebs von den Lungen 6 (KL-6) is a high molecular weight mucin-like glycoprotein produced by type II pneumocytes and bronchial epithelial cells. Elevated circulating levels of KL-6 may denote disorder of the alveolar epithelial lining. Objective Aim of this study was to verify if KL-6 values may help to risk stratify and triage severe COVID-19 patients. Methods We performed a retrospective prognostic study on 110 COVID-19 ICU patients, evaluating the predictive role of KL-6 for mortality. Measurements and Main Results The study sample was divided in two groups related according to the median KL-6 value [Group A (KL-6 lower than the log-transformed median (6.73)) and Group B (KL-6 higher than the log-transformed median)]. In both linear and logistic multivariate analyses, ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (P/F) was significantly and inversely related to KL-6. Death rate was higher in group B than in group A (80.3 versus 45.9%) (p<0.001), Accordingly, the Cox regression analysis showed a significant prognostic role of KL-6 on mortality in the whole sample as well as in the subgroup with SOFA lower than its median value. Conclusions At ICU admission, KL-6 serum level was significantly lower in the survivors group. Our findings shown that, in severe COVID19 patients, elevated KL-6 was strongly associated with mortality in ICU.

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Risk of brain herniation after craniotomy with lumbar spinal drainage: a propensity score analysis

Journal of Neurosurgery ◽

10.3171/2017.12.jns172215 ◽

2019 ◽

Vol 130 (5) ◽

pp. 1710-1720 ◽

Cited By ~ 3

Author(s):

Yasushi Motoyama ◽

Tsukasa Nakajima ◽

Yoshiaki Takamura ◽

Tsutomu Nakazawa ◽

Daisuke Wajima ◽

...

Keyword(s):

Propensity Score ◽

Cox Regression ◽

Propensity Score Analysis ◽

Control Group ◽

Deep Approach ◽

Brain Herniation ◽

Cox Regression Analysis ◽

Group A ◽

Group B ◽

Lumbar Spinal

OBJECTIVELumbar spinal drainage (LSD) during neurosurgery can have an important effect by facilitating a smooth procedure when needed. However, LSD is quite invasive, and the pathology of brain herniation associated with LSD has become known recently. The objective of this study was to determine the risk of postoperative brain herniation after craniotomy with LSD in neurosurgery overall.METHODSIncluded were 239 patients who underwent craniotomy with LSD for various types of neurological diseases between January 2007 and December 2016. The authors performed propensity score matching to establish a proper control group taken from among 1424 patients who underwent craniotomy and met the inclusion criteria during the same period. The incidences of postoperative brain herniation between the patients who underwent craniotomy with LSD (group A, n = 239) and the matched patients who underwent craniotomy without LSD (group B, n = 239) were compared.RESULTSBrain herniation was observed in 24 patients in group A and 8 patients in group B (OR 3.21, 95% CI 1.36–8.46, p = 0.005), but the rate of favorable outcomes was higher in group A (OR 1.79, 95% CI 1.18–2.76, p = 0.005). Of the 24 patients, 18 had uncal herniation, 5 had central herniation, and 1 had uncal and subfalcine herniation; 8 patients with other than subarachnoid hemorrhage were included. Significant differences in the rates of deep approach (OR 5.12, 95% CI 1.8–14.5, p = 0.002) and temporal craniotomy (OR 10.2, 95% CI 2.3–44.8, p = 0.002) were found between the 2 subgroups (those with and those without herniation) in group A. In 5 patients, brain herniation proceeded even after external decompression (ED). Cox regression analysis revealed that the risk of brain herniation related to LSD increased with ED (hazard ratio 3.326, 95% CI 1.491–7.422, p < 0.001). Among all 1424 patients, ED resulted in progression or deterioration of brain herniation more frequently in those who underwent LSD than it did in those who did not undergo LSD (OR 9.127, 95% CI 1.82–62.1, p = 0.004).CONCLUSIONSBrain herniation downward to the tentorial hiatus is more likely to occur after craniotomy with LSD than after craniotomy without LSD. Using a deep approach and craniotomy involving the temporal areas are risk factors for brain herniation related to LSD. Additional ED would aggravate brain herniation after LSD. The risk of brain herniation after placement of a lumbar spinal drain during neurosurgery must be considered even when LSD is essential.

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Erhöhtes Risiko für psychiatrische Nebenwirkungen unter Infliximab-Therapie?

Karger Kompass Autoimmun ◽

10.1159/000511309 ◽

2020 ◽

Vol 2 (4) ◽

pp. 163-164

Author(s):

Bertram Bengsch

Keyword(s):

Rheumatoid Arthritis ◽

Adverse Events ◽

Psychotic Disorders ◽

Suicide Attempts ◽

Hospital Admissions ◽

Cox Regression ◽

Case Reports ◽

Discharge Abstract Database ◽

Historical Cohort ◽

Cox Regression Analysis

Introduction: Infliximab (IFX) was the first anti-tumor necrosis factor (TNFα) antibody to be used in the treatment of severe chronic inflammatory diseases, such as Crohn’s disease and rheumatoid arthritis. A number of serious adverse drug reactions are known to be associated with IFX use; they include infections, malignancies, and injection site reactions. Although a few case reports have described potential psychiatric adverse events (including suicide attempts and manic episodes), the latter are barely mentioned in IFX’s summary of product characteristics. The objective of the present retrospective study was to detect potential psychiatric adverse events associated with IFX treatment by analyzing a national discharge abstract database. Materials and methods: We performed an historical cohort study by analyzing data from the French national hospital discharge abstract database (PMSI) between 2008 and 2014. All patients admitted with one of the five diseases treated with IFX were included. Results: Of the 325,319 patients included in the study, 7,600 had been treated with IFX. The proportion of hospital admissions for one or more psychiatric events was higher among IFX-exposed patients (750 out of 7,600; 9.87%) than among non-exposed patients (17,456 out of 317,719; 5.49%). After taking account of potential confounders in the cohort as a whole, a semi-parametric Cox regression analysis gave an overall hazard ratio (HR) [95% confidence interval] (CI) of 4.5 [3.95; 5.13] for a hospital admission with a psychiatric adverse event during treatment with IFX. The HR (95%CI) for a depressive disorder was 4.97 (7.35; 6.68). Even higher risks were observed for certain pairs of adverse events and underlying pathologies: psychotic disorders in patients treated for ulcerative colitis (HR = 5.43 [2.01; 14.6]), manic episodes in patients treated for severe psoriasis (HR = 12.6 [4.65; 34.2]), and suicide attempts in patients treated for rheumatoid arthritis (HR = 4.45 [1.11; 17.9]). Discussion: The present retrospective, observational study confirmed that IFX treatment is associated with an elevated risk of psychiatric adverse events. Depending on the disease treated, physicians should be aware of these potential adverse events.

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Impact of previous insulin therapy on the prognosis of diabetic patients with acute coronary syndromes

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302010000700005 ◽

2010 ◽

Vol 54 (7) ◽

pp. 612-619 ◽

Cited By ~ 2

Author(s):

Natália António ◽

Francisco Soares ◽

Carolina Lourenço ◽

Fátima Saraiva ◽

Francisco Gonçalves ◽

...

Keyword(s):

Acute Coronary Syndromes ◽

Insulin Treatment ◽

Cox Regression ◽

Atherosclerotic Disease ◽

Diabetic Patients ◽

Cardiac Events ◽

Cox Regression Analysis ◽

Group A ◽

Coronary Syndromes ◽

Group B

OBJECTIVE: To determine whether previous insulin treatment independently influences subsequent outcomes in diabetic patients with ACS (acute coronary syndromes). SUBJECTS AND METHODS: 375 diabetic patients with ACS, divided in 2 groups: Group A (n = 69) - previous insulin and Group B (n = 306) - without previous insulin. Predictors of 1-year mortality and major adverse cardiac events (MACE) were analyzed by Cox regression analysis. RESULTS: Group A had more previous stroke (17.4% vs. 9.2%, p = 0.047) and peripheral artery disease (13.0% vs. 3.6%, p = 0.005). They had significantly higher admission glycemia and lower LDL cholesterol. There were no significant differences in the type of ACS, in 1-year mortality (18.2% vs. 10.4%, p = 0.103) or MACE (32.1% vs. 23.0%, p = 0.146) between groups. In multivariate analysis, insulin treatment was neither an independent predictor of 1-year mortality nor of MACE. CONCLUSION: Despite the more advanced atherosclerotic disease, diabetics under insulin had similar outcomes to those without insulin. Insulin may protect diabetics from the expected poor adverse outcome of an advanced atherosclerotic disease.

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