Hepatic steatosis as measured by the computed attenuation parameter predicts fibrosis in long-term methotrexate use

2021 ◽  
pp. e20200040
Author(s):  
Marcel Tomaszewski ◽  
Monica Dahiya ◽  
Seyed Amir Mohajerani ◽  
Hanaa Punja ◽  
Hin Hin Ko ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Regression Analysis ◽  
Hepatic Steatosis ◽  
Multivariate Regression ◽  
Transient Elastography ◽  
Multivariate Regression Analysis ◽  
Attenuation Parameter ◽  
Dermatologic Disease ◽  
Severe Fibrosis

Introduction: To determine predictors of hepatic steatosis by the computed attenuation parameter (CAP) and fibrosis via transient elastography (TE) in persons on methotrexate (MTX) therapy with rheumatologic and dermatologic diseases. Methods: A single-centred retrospective cohort study was performed. Patients on >6 months of MTX for a rheumatologic or dermatologic disease who had undergone TE from January 2015 to September 2019 were included. Multivariate analysis was performed to determine predictors of steatosis and fibrosis. Results: A total of 172 patients on methotrexate were included. Psoriasis was the most frequent diagnosis ( n = 55), followed by rheumatoid arthritis ( n = 45) and psoriatic arthritis ( n = 34). Steatosis (CAP ≥245 dB/m) was present in 69.8% of patients. Multivariate regression analysis revealed that diabetes mellitus (OR 10.47, 95% CI 1.42–75.35), hypertension (OR 5.15, 95% CI 1.75–15.38), and BMI ≥30 kg/m2 (OR 16.47, 95% CI 5.56–45.56) were predictors of steatosis (CAP ≥245 dB/m). Predictors of moderate to severe fibrosis (Metavir ≥F2 = TE ≥8.0kPa) by multivariate regression analysis included moderate to severe steatosis (CAP ≥270 dB/m) (OR 8.36, 95% CI 1.88–37.14), diabetes mellitus (OR 2.85, 95% CI 1.09–7.48), hypertension (OR 5.4, 95% CI 2.23–13.00), dyslipidemia (OR 3.71, 95% CI 1.50–9.18), and moderate alcohol use (OR 3.06, 95% CI 1.2–7.49). Conclusions: In patients on MTX for rheumatologic and dermatologic diseases, hepatic steatosis as measured by CAP was common and moderate to severe steatosis predicted moderate to severe fibrosis.

scholarly journals A186 HEPATIC STEATOSIS PREDICTS FIBROSIS IN LONG-TERM METHOTREXATE USE

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 57-58
Author(s):  
M Tomaszewski ◽  
M Dahiya ◽  
A Mohajerani ◽  
H Punja ◽  
H Ko ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Regression Analysis ◽  
Hepatic Steatosis ◽  
Hepatic Fibrosis ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Alcoholic Fatty Liver ◽  
Significant Fibrosis ◽  
Non Invasive

Abstract Background Methotrexate (MTX) is effective for dermatologic and rheumatologic conditions such as psoriasis (Ps), psoriatic arthritis (PsO) and rheumatoid arthritis (RA). Long-term MTX use may be complicated by hepatic fibrosis, although patient, disease factors and the mechanism remain unclear. Transient elastography (TE) is a non-invasive measure of hepatic fibrosis that is often used as surveillance in this patient population. Patients with Ps and PsO have higher rates of non-alcoholic fatty liver disease. The controlled attenuation parameter (CAP) measurement is a non-invasive test that correlates with histologic degree of steatosis. To our knowledge, no studies have evaluated hepatic steatosis via CAP scores in MTX use. Aims To determine the prevalence of steatosis and significant fibrosis (F≥stage 2) in persons on MTX therapy and to determine the predictive factors for these events. Methods A single centred retrospective cohort study was performed. Patients on >6 months of MTX for a dermatologic or rheumatologic disease who had undergone TE from January 2015 to September 2019 were included. Demographic variables, laboratory investigations, TE and CAP scores were collected. Multivariate analysis was performed to determine predictors of steatosis and fibrosis. Results A total of 177 patients on methotrexate were included. Ps was the most frequent diagnosis (n=52) followed by RA (n=50) and PsO (n=38). Steatosis (CAP≥245 dB/m) was present in 73.9% of patients. Patients with steatosis had significantly more fibrosis and a higher BMI than those without steatosis (CAP<245 dB/m). Higher CAP score was correlated with increased lifetime dose of methotrexate by Pearson correlation analysis (r=0.48, p=0.001) (n=85 patients). Multivariate regression analysis revealed that diabetes mellitus (OR 10.5, 95% CI 1.38–80.60), hypertension (OR 4.97, 95% CI 1.66–14.84), and BMI> 30 (OR 10.1, 95% CI 1.88–37.14) were predictors of steatosis (CAP≥245 dB/m). Predictors of METAVIR≥F2 (TE≥8.0 kPa) by multivariate regression analysis included CAP score of ≥270 (OR 8.36, 95% CI 1.88–37.14), diabetes mellitus (OR 2.85, 95% CI 1.09–7.48), hypertension (OR 5.4, 95% CI 2.23–13.0), dyslipidemia (OR 3.71, 95% CI 1.50–9.18) and alcohol use (OR 3.06, 95% CI 1.2–7.49). Conclusions In patients on MTX for rheumatologic and dermatologic diseases, hepatic steatosis was common and predicted significant fibrosis. Additionally, increasing MTX exposure is correlated with steatosis. Features of the metabolic syndrome including diabetes, hypertension or obesity were predictors of both steatosis and fibrosis (F≥2). Further study is needed to evaluate if steatosis is a mechanism by which fibrosis occurs in patients on MTX, or if it due to other patient factors. Funding Agencies None

Dysregulation of Hypothalamic-Pituitary-Adrenal Axis Explain the Dynamic Association Between Glucose Fluctuation and Cognitive

2020 ◽  
Vol 10 (2) ◽  
pp. 477-483
Author(s):  
Peng Wenfang ◽  
Shen Lisha ◽  
Xia Lili ◽  
Tang Yubing ◽  
Li Huihua ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Regression Analysis ◽  
Cognitive Impairment ◽  
Hpa Axis ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Glucose Fluctuation

Objective—Type 2 diabetes mellitus is a risk factor for cognitive dysfunction. However, the underlying mechanism of cognitive decline in patients with type 2 diabetes mellitus is still elusive. Dysregulation of HPA axis is related to cognitive impairment. The present study aims to calculate explanation of the association between glucose fluctuation and cognitive function by HPA axis in type 2 diabetes mellitus patients. Methods—The mean amplitude of glycemic excursion (MAGE) was analyzed by a continuous glucose monitoring system (CGMS) for 3 days in 330 elderly type 2 diabetes mellitus patients. All the subjects received a set of neuropsychological test battery for cognitive assessment. The diurnal rhythm of cortisol was also analyzed. Linear multivariate regression analysis was performed to explore the relationship between glucose fluctuation, cortisol parameters and cognitive parameters. Results—MAGE was observed to be associated with diurnal cortisol fall but with neither cortisol awakening response (CAR) nor overall mean cortisol levels (t = –2.195, P = 0.030). Linear multivariate regression analysis displayed that MAGE and average diurnal cortisol fall were uniquely associated with some cognitive parameters, such as AVLT trial, FAS, and TMT (P < 0.05). Conclusion—Glucose fluctuation was strongly associated with cognitive impairment in elderly type 2 diabetes mellitus patients. Especially in executive function, attention and processing speed. Dysregulation of HPA axis was probably the cause of cognitive dysfunction in these patients.

scholarly journals Delayed diagnosis of tuberculosis in patients with diabetes mellitus co-morbidity and its associated factors in Zhejiang Province, China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wenhui Xiao ◽  
Dajiang Huang ◽  
Saiqiong Li ◽  
Shangcheng Zhou ◽  
Xiaolin Wei ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Regression Analysis ◽  
Health System ◽  
Multivariate Regression ◽  
Diagnostic Delay ◽  
Delayed Diagnosis ◽  
Multivariate Regression Analysis ◽  
System Delay ◽  
Health System Delay ◽  
Co Morbidity

Abstract Background Tuberculosis (TB) remains a significant global public health problem. China has the second highest TB burden in the world. With a growing TB population with diabetes mellitus (DM), the TB control system faces mounting challenges. To date, evidence remains inconclusive regarding the association between TB-DM co-morbidity and delayed diagnosis of TB patients. This study aims to assess the diagnostic delay of TB patients with known DM and identify the factors associated with this delay. Methods Data was collected from China’s Tuberculosis information management system in two counties of Zhejiang province, China. Patient delay, health system delay and total diagnostic delay are defined as follows: 1) the interval between the onset of TB symptoms and first visit to any health facility; 2) from the first visit to the health facility to the confirmed TB diagnosis in the designated hospital; 3) the sum of patient and health system’s respective delays. Comparison of these delays was made between TB patients with and without DM using Mann-Whitney U test and Chi-square test. Univariate and multivariate regression analysis was used to identify factors influencing delays among TB patients with DM. Results Of 969 TB patients, 67 (7%) TB patients had DM co-morbidity. Compared with TB patients without DM, TB patients with DM experienced significantly shorter health system delays (p < 0.05), and there was a significantly lower proportion of patients whose health system delayed> 14 days (7.0% vs. 18%, p < 0.05). However, no significant difference was observed between both patient categories regarding patient delay and total diagnostic delay. The multivariate regression analysis suggested that TB patients with DM who were aged < 60 years (AOR = 3.424, 95%CI: 1.008–11.627, p < 0.05) and non-severe cases (AOR = 9.725, 95%CI: 2.582–36.626, p < 0.05) were more likely to have a total diagnostic delay of> 14 days. Conclusions Our study suggests that DM does not contribute to further diagnostic delay as expected. Instead, we observed significantly improved health system delay among TB patients with DM. The findings indicate the importance of early screening and diagnosis for TB among diabetic patients and of strengthening the integrated control and management of TB and diabetic programs.

P2504Chronotropic incompetence and exercise capacity in patients treated with beta-blockers

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Smarz ◽  
T Jaxa-Chamiec ◽  
B Zaborska ◽  
A Budaj
Keyword(s):  
Diabetes Mellitus ◽  
Regression Analysis ◽  
Exercise Capacity ◽  
Beta Blocker ◽  
Multivariate Regression ◽  
Beta Blockers ◽  
Multivariate Regression Analysis ◽  
Peak Exercise ◽  
Inclusion Criteria ◽  
Daily Dose

Abstract Background Chronotropic incompetence (CI) in patients treated with beta-blockers correlates with worse prognosis but influence of CI on exercise capacity (EC) is unclear. Aim To assess relationship between CI and EC in patients treated with beta-blockers. Methods We have analysed retrospectively data from consecutive cardiopulmonary exercise tests performed between 2008 and 2016 in our department. The inclusion criteria were: treatment with beta-blockers started at least 4 weeks before and continued on the day of the test, sinus rhythm during the test, respiratory exchange ratio ≥1.05 at peak exercise, absence of haemodynamically important valve dysfunction, pulmonary hypertension, exercise induced ischemia, pulmonary or peripheral limitations of exercise. CI was defined as chronotropic index ≤62%. Beta-blocker dose was calculated as bisoprolol equivalent dose. Included patients were divided, according to CI, in two groups: with CI and without CI. EC was assessed as percent of maximal predicted oxygen uptake achieved at peak exercise (%peakVO2). Results One hundred forty two patients (age 61±10 years, 73% males, hypertension 63%, ischemic heart disease 79%, chronic heart failure 12%, diabetes mellitus 20%, paroxysmal atrial fibrillation 10%) fulfilled the inclusion criteria. The group with CI comprised 115 and the group without CI 27 patients. Diabetes mellitus was more frequent and beta-blockers daily dose was higher in the CI group. There were no differences in other clinical parameters between groups. The group with CI had worse EC than the group without CI (69±18% vs 89±18%, p=0.ehz748.083301). In multivariate regression analysis, chronotropic index was independently related to EC (Table). Table 1. Relationship of variables to exercise capacity in multivariate regression analysis Variable Coefficient β 95% Confidence interval p Age (years) 0.242 −0.049 to 0.533 NS Sex (male vs female) 5.260 −1.344 to 11.865 NS Body mass index (kg/m2) −0.786 −1.476 to −0.095 0.05 Left ventricular ejection fraction (%) 0.353 0.116 to 0.590 0.01 Beta-blocker daily dose (mg) 0.150 −0.962 to 1.262 NS Diabetes mellitus 0.070 −7.103 to 7.243 NS Heart rate at rest (bpm) −0.238 −0.440 to −0.035 0.05 Chronotropic index 0.496 0.327 to 0.665 0.ehz748.083301 Conclusions In patients treated with beta-blockers CI was revealed as an independent factor related to worse EC.

scholarly journals Long-term effect of participation in one-month alcohol abstinence campaign on individual consumption

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Terebessy ◽  
V Pongor ◽  
Z s Horváth ◽  
J-H Ivers ◽  
M Pénzes ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Alcohol Consumption ◽  
Success Rate ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Reliable Change Index ◽  
Regression Analyses ◽  
One Year

Abstract Objective There is limited amount of evidence concerning the effect of population-based interventions. Dry November campaign asks people to go booze-free for a month. The goal of our study was to assess whether success rate of participation in the 2017 Dry November campaign leads to long-term change in alcohol consumption of participants. Methods A longitudinal study was conducted in 2017-2018 in the form of an online survey. Alcohol consumption characteristics of respondents (N = 125) were measured by the short-form AUDIT test. Participants filled out the first survey at the end of October 2017 with a one-year follow-up questionnaire. We used the reliable change index to identify participants whose c-AUDIT scores changed significantly over time. We collated participants who exhibited no change or significant decrease in c-AUDIT scores into one group, which was used as reference in our logistic regression analyses. We first conducted a series of univariate regression analyses to identify significant confounders, which were then included in the subsequent multivariate regression analysis. Results Based on our results, success rates did not differ significantly between those who exhibited a significant increase in c-AUDIT scores and those whose c-AUDIT scores did not change or decreased significantly over a one-year time period. In our multivariate regression analysis, the occurrence of alcohol consumption in the same household (OR = 3.29, 95% CI: 1.17-10.01) was the only variable significantly associated to an increase in c-AUDIT scores. Conclusions Even though success rate of participation in the 2017 Dry November campaign did not influence c-AUDIT scores significantly at follow-up, we were able to identify the occurrence of alcohol consumption in household as a significant risk factor for those who exhibited a significant increase in c-AUDIT score. Key messages A one-month alcohol-free challenge might be an effective tool for reducing alcohol consumption but further analysis is needed. The inclusion of individuals in the same household in interventions aiming to decrease alcohol intake may lead to higher success rate.

scholarly journals The Diagnosis and Treatment of Low T3 Syndrome in Neurocritical Patients

2019 ◽  
Author(s):  
Yihao Chen ◽  
Jianbo Chang ◽  
Rui Yin ◽  
Junxian Wen ◽  
Baitao Ma ◽  
...  
Keyword(s):  
Overall Survival ◽  
Regression Analysis ◽  
Mortality Risk ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Low T3 Syndrome ◽  
Low T3 ◽  
Significant Difference ◽  
Serum T3

Abstract Background Low serum T3 level is considered as a strong predictor of mortalities and poor prognosis in critical care patients. Few reports, however, focus on neurocritical patients. The application of hormone replacement therapy (HRT) in neurocritical patients with low T3 syndrome also remains controversial. We studied the role of low T3 state as a predictor in neurocritical patients and presented our experience of HRT from a single-center perspective.Methods From January 2012 to October 2018, a total of 32 neurocritical patients with low T3 syndrome were admitted to the neuro-intensive care unit (NICU) of Peking Union Medical College Hospital. Among them, 18 (56.25%) patients received HRT (HRT group) since the diagnosis of low T3 syndrome, while the other 14 (43.75%) patients did not (non-HRT group). We collected the clinical baseline and laboratory data of all the patients and conducted follow-up from 3 to 72 months. Overall survival was assessed by the Kaplan-Meier curve and compared by the log-rank test. Univariate and multivariate regression analysis was applied to estimate the prognostic power of HRT for mortality. We also performed the Mann-Whitney U test or t-test to assess the influence of HRT on the final neurological function.Results The cohort consists of 32 patients, with an average Glasgow Coma Scale (GCS) of 6.41 (HRT=6.44±3.14, non-HRT=6.36±2.06). The neurocritical events include postoperative complications (n=18), traumatic brain injury (n=8), and spontaneous intracerebral hemorrhage (n=6). A total of 15 (46.87%) deaths were recorded (HRT=7, non-HRT=8). In the HRT group, the low T3 situation in 5 patients (33.3%) was corrected and 10 (66.7%) were not. It turns out that the overall survival rate of the non-HRT group was significantly lower than that of the HRT group (P=0.034, 16.445 vs. 47.470 months). The non-HRT group has 3.322 times the mortality risk of the HRT group, according to univariate regression analysis, while the multivariate regression analysis showed no significant difference in mortality risk between the two groups (P=0.087, HR=0.340 95%CI 0.099-1.172). There was no significant difference in the short and long-term effects of HRT on neurological function (short-term GCS P=0.587, long-term GCS P=0.419, long-term GOS P=0.419).Conclusion Low T3 syndrome can significantly influence the prognosis of neurocritical patients. Therefore much attention should be paid to the changes in serum T3 level during treatment. Although it is unclear to what extent can HRT improve the short or long-term outcome of neurological function, it can significantly benefit the survival of neurocritical patients.

scholarly journals Patient-reported outcomes after corrective osteotomy for a symptomatic malunion of the distal radius

2020 ◽  
Vol 102-B (11) ◽  
pp. 1542-1548
Author(s):  
Paul H. C. Stirling ◽  
William M. Oliver ◽  
Huai Ling Tan ◽  
Iain D. M. Brown ◽  
Christopher W. Oliver ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Patient Satisfaction ◽  
Distal Radius ◽  
Multivariate Regression ◽  
Corrective Osteotomy ◽  
Multivariate Regression Analysis ◽  
Ulnar Styloid ◽  
Ulnar Styloid Fracture ◽  
Patient Reported

Aims The primary aim of this study was to describe patient satisfaction and health-related quality of life (HRQoL) following corrective osteotomy for a symptomatic malunion of the distal radius. Methods We retrospectively identified 122 adult patients from a single centre over an eight-year period who had undergone corrective osteotomy for a symptomatic malunion of the distal radius. The primary long-term outcome was the Patient-Rated Wrist Evaluation (PRWE) score. Secondary outcomes included the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, the EQ-5D-5L score, complications, and the Net Promoter Score (NPS). Multivariate regression analysis was used to determine factors associated with the PRWE score. Results Long-term outcomes were available for 89 patients (72%). The mean age was 57 years (SD 15) and 68 were female (76%). The median time from injury to corrective osteotomy was nine months (interquartile range (IQR) 6 to 13). At a mean follow-up of six years (1 to 11) the median PRWE score was 22 (IQR 7 to 40), the median QuickDASH score was 11.4 (IQR 2.3 to 31.8), and the median EQ-5D-5L score was 0.84 (IQR 0.69 to 1). The NPS was 69. Multivariate regression analysis showed that the presence of an associated ulnar styloid fracture was the only significant independent factor associated with a worse PRWE score when adjusting for confounding variables (p = 0.004). Conclusion We found that corrective osteotomy for malunion of the distal radius can result in good functional outcomes and high levels of patient satisfaction. However, the presence of an ulnar styloid fracture may adversely affect function. Level of Evidence: III (cohort study). Cite this article: Bone Joint J 2020;102-B(11):1542–1548.

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