Blood Hemoglobin Substantially Modulates the Impact of Gender, Morbid Obesity, and Hyperglycemia on COVID-19 Death Risk: A Multicenter Study in Italy and Spain

BackgroundHyperglycemia and obesity are associated with a worse prognosis in subjects with COVID-19 independently. Their interaction as well as the potential modulating effects of additional confounding factors is poorly known. Therefore, we aimed to identify and evaluate confounding factors affecting the prognostic value of obesity and hyperglycemia in relation to mortality and admission to the intensive care unit (ICU) due to COVID-19.MethodsConsecutive patients admitted in two Hospitals from Italy (Bologna and Rome) and three from Spain (Barcelona and Girona) as well as subjects from Primary Health Care centers. Mortality from COVID-19 and risk for ICU admission were evaluated using logistic regression analyses and machine learning (ML) algorithms.ResultsAs expected, among 3,065 consecutive patients, both obesity and hyperglycemia were independent predictors of ICU admission. A ML variable selection strategy confirmed these results and identified hyperglycemia, blood hemoglobin and serum bilirubin associated with increased mortality risk. In subjects with blood hemoglobin levels above the median, hyperglycemic and morbidly obese subjects had increased mortality risk than normoglycemic individuals or non-obese subjects. However, no differences were observed among individuals with hemoglobin levels below the median. This was particularly evident in men: those with severe hyperglycemia and hemoglobin concentrations above the median had 30 times increased mortality risk compared with men without hyperglycemia. Importantly, the protective effect of female sex was lost in subjects with increased hemoglobin levels.ConclusionsBlood hemoglobin substantially modulates the influence of hyperglycemia on increased mortality risk in patients with COVID-19. Monitoring hemoglobin concentrations seem of utmost importance in the clinical settings to help clinicians in the identification of patients at increased death risk.

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Postural Stability in Obese Preoperative Bariatric Patients Using Static and Dynamic Evaluation

Obesity Facts ◽

10.1159/000509163 ◽

2020 ◽

Vol 13 (5) ◽

pp. 499-513

Author(s):

Gabriel M. Pagnotti ◽

Amna Haider ◽

Ariel Yang ◽

Kathryn E. Cottell ◽

Catherine M. Tuppo ◽

...

Keyword(s):

Postural Stability ◽

Postural Sway ◽

Center Of Pressure ◽

Postural Instability ◽

Patient Specific ◽

Morbidly Obese ◽

Tissue Quality ◽

Eyes Closed ◽

Obese Subjects ◽

The Impact

Introduction: Globally, 300 million adults have clinical obesity. Heightened adiposity and inadequate musculature secondary to obesity alter bipedal stance and gait, diminish musculoskeletal tissue quality, and compromise neuromuscular feedback; these physiological changes alter stability and increase injury risk from falls. Studies in the field focus on obese patients across a broad range of body mass indices (BMI >30 kg/m2) but without isolating the most morbidly obese subset (BMI ≥40 kg/m2). We investigated the impact of obesity in perturbing postural stability in morbidly obese subjects elected for bariatric intervention, harboring a higher-spectrum BMI. Subjects and Methods: Traditional force plate measurements and stabilograms are gold standards employed when measuring center of pressure (COP) and postural sway. To quantify the extent of postural instability in subjects with obesity before bariatric surgery, we assessed 17 obese subjects with an average BMI of 40 kg/m2 in contrast to 13 nonobese subjects with an average BMI of 30 kg/m2. COP and postural sway were measured from static and dynamic tasks. Involuntary movements were measured when patients performed static stances, with eyes either opened or closed. Two additional voluntary movements were measured when subjects performed dynamic, upper torso tasks with eyes opened. Results: Mean body weight was 85% (p < 0.001) greater in obese than nonobese subjects. Following static balance assessments, we observed greater sway displacement in the anteroposterior (AP) direction in obese subjects with eyes open (87%, p < 0.002) and eyes closed (76%, p = 0.04) versus nonobese subjects. Obese subjects also exhibited a higher COP velocity in static tests when subjects’ eyes were open (47%, p = 0.04). Dynamic tests demonstrated no differences between groups in sway displacement in either direction; however, COP velocity in the mediolateral (ML) direction was reduced (31%, p < 0.02) in obese subjects while voluntarily swaying in the AP direction, but increased in the same cohort when swaying in the ML direction (40%, p < 0.04). Discussion and Conclusion: Importantly, these data highlight obesity’s contribution towards increased postural instability. Obese subjects exhibited greater COP displacement at higher AP velocities versus nonobese subjects, suggesting that clinically obese individuals show greater instability than nonobese subjects. Identifying factors contributory to instability could encourage patient-specific physical therapies and presurgical measures to mitigate instability and monitor postsurgical balance improvements.

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Longitudinal study on the effect of surgical weight loss on beat-to-beat blood pressure variability in patients undergoing bariatric surgery: a study protocol

BMJ Open ◽

10.1136/bmjopen-2021-050957 ◽

2021 ◽

Vol 11 (10) ◽

pp. e050957

Author(s):

Souha Fares ◽

Nour-Mounira Z Bakkar ◽

Ramzi Alami ◽

Issam Lakkis ◽

Kamal Badr

Keyword(s):

Blood Pressure ◽

Bariatric Surgery ◽

Longitudinal Study ◽

Blood Pressure Variability ◽

Morbidly Obese ◽

Study Results ◽

Non Linear ◽

Obese Subjects ◽

Normotensive Subjects ◽

The Impact

IntroductionAlterations in linear and non-linear parameters of beat-to-beat blood pressure variability (BPV) have been shown to predict disease prognosis and distinguish between risk categories in various pathological conditions, independently of average blood pressure levels. Obesity places subjects at elevated risk of vascular diseases, including hypertension, resulting in serious cardiac, respiratory and cerebral events. However, little is known about the status of vascular dynamics in obese and morbidly obese adults.Methods and analysisIn this present quasi-experimental longitudinal study, changes in beat-to-beat BPV, using continuous, non-invasive blood pressure monitoring, in obese subjects undergoing bariatric surgery are characterised. The capacity of linear and non-linear measures of BPV to detect differences between hypertensive, prehypertensive and normotensive obese subjects prebariatric and postbariatric surgery are tested. Additionally, potential correlations between beat-to-beat BPV and age, body mass index, gender and comorbidities will be investigated. In parallel, the impact of the unsteady fluctuations of beat-to-beat blood pressure on the dynamic stresses imparted by blood flow on blood vessel walls will be explored. We expect to find altered BPV profiles in hypertensive and prehypertensive subjects as compared with normotensive subjects. We also expect to see differential normalisation in BPV profiles between hypertensive, prehypertensive and normotensive subjects over time.Ethics and disseminationThe study has been approved by the Institutional Review Board at the American University of Beirut (IRB ID: BIO-2018-0040). Study results will be made available to the public through publications in peer-reviewed journals and conference papers and/or presentations.

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Obesity alters regional ventilation in lateral decubitus position

Journal of Applied Physiology ◽

10.1152/jappl.1985.59.3.774 ◽

1985 ◽

Vol 59 (3) ◽

pp. 774-783 ◽

Cited By ~ 21

Author(s):

A. N. Hurewitz ◽

H. Susskind ◽

W. H. Harold

Keyword(s):

Body Position ◽

Left Lung ◽

Control Group ◽

Morbidly Obese ◽

Dependent Lung ◽

Regional Ventilation ◽

Factors Affecting ◽

Obese Subjects ◽

Lateral Decubitus ◽

Left And Right

Alterations of regional ventilation were determined as a function of body position in five morbidly obese subjects using 81mKr to assess ventilation (V) and 127Xe at equilibrium to determine lung volume (V). With subjects in seated and supine positions, the left lung contributed an average of 43% of the total V/V. When the apical-basal gradient within each lung was examined in subjects in the seated position, V/V was greatest in the dependent (basal) regions in half of the subjects, whereas the others showed greater V/V near the upper lung regions. All obese subjects preferentially ventilated the nondependent lung in both the left and right lateral decubitus positions. In a control group of three nonobese subjects, V/V was found to be equally distributed between left and right lungs in both the seated and supine positions. In contrast with the results in the obese group, V/V was slightly greater in the dependent lung in both lateral decubitus positions. Although the combination of 127Xe images and He-dilution measurement of functional residual capacity in the lateral decubitus positions indicated a reduction in the volume of the dependent lung of the obese when compared with values in the seated position, other factors affecting the mechanical function of either the diaphragm or the intercostal muscles could also have produced these positional alterations of ventilation.

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P0562DIFFERENT POTENTIAL INTERPRETATIONS OF CRITERIA FOR AKI WHEN USING AUTOMATED DECISION SUPPORT: IMPACT ON ASSOCIATED MORTALITY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0562 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Wim Van Biesen ◽

Johan Steen ◽

Johan Decruyenaere ◽

Dominique Benoit ◽

Eric Adriaan J Hoste ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Serum Creatinine ◽

Mortality Risk ◽

Sofa Score ◽

Kidney Injury ◽

Baseline Serum ◽

Icu Admission ◽

Definition Of ◽

The Impact

Abstract Background and Aims The reported associated mortality risks of Acute Kidney Injury (AKI) in the intensive care unit (ICU) are variable. Although the Kidney Disease Improving Global Outcome (K-DIGO) improved harmonisation of the definition, there is remaining variability in the actual implementation of this AKI definition, with variable use of the urinary output (UO) criterion, and different interpretations of the baseline serum creatinine (Screa). This hampers progress of our understanding of the clinical concept AKI and leads to confusion and unclarity when interpreting models to predict AKI associated outcomes. With the advent of big data and artificial intelligence based decision algorithms, this problem will only become more of interest, as the user will not know what exactly the construct AKI in the application used means. Therefore, we intended to explore the impact of different interpretations of the Screa and the UO criterium as presented in the K-DIGO definition on the associated ICU mortality risk of AKI stage 2 in the ICU. Method We included all patients of an electronic health data system applied in a tertiary ICU between 2013 and 2017. Sequential Organ Failure Assessment (SOFA) score was calculated, and gender, age, weight and mortality at ICU and in hospital were extracted. All serum creatinine (sCrea) values during ICU stay and hospitalisation were extracted, as were UO data, with their time stamps. In addition, all Screa data up to 1 year before ICU admission were retrieved from a dataset external to ICU. AKI was defined according to KDIGO stage 2, using different possible interpretations of the Screa and/or the UO criterion. For the evolution of Screa as compared to a baseline value, we either used a value directly available to ICU staff (def 1), a presumed eGFR of 75ml/min (def 2), the first available value after admission to ICU (def 3), the lowest value during the current hospitalisation before ICU admission (def 4), the lowest value before the hospitalisation episode as found in an external dataset (def 5). For the UO criterion, we used either (in line with K-DIGO stage 2) a UO below 6ml/kg during a 12 hour block (def 6) or a UO below 0.5ml/kg/hour during each of 12 consecutive one hour intervals (def 7). Definition 8 and 9 identified patients who complied with at least one out of the Screa criteria 1-5 (def 8) or out of the UO criteria (def 9). Definition 10 identified patients who complied both with at least one Screa and one UO criterium. Results Our dataset comprised 16433 admissions (34.7% female, age 60.7±16.4 years). Overall, 8.1% of patients died in Intensive Care Unit (ICU). The SOFA score at admission was 6.9±4.1. The mortality risk associated with AKI according to the stage 2 definition of K-DIGO varied according to the interpretation of the diagnostic criteria (table). Most important, associated mortality risk was comparable whether a UO (RR 2.31, 95% CI 1.90-2.81) or a Screa (RR 2.00, 95% CI 1.57-2.55) criterium was used, and was highest in patients who complied with both at least one UO and one Screa criterium (RR 7.28, 95% CI 6.12-8.65). Conclusion Unclarity on the actual interpretation of the Screa and UO criteria used in the K-DIGO definition of AKI leads to substantial differences in AKI associated mortality risk. Omitting the UO criterium leads to substantial underestimation of associated risk.

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Partial restoration of normal intestinal microbiota in morbidly obese women six months after bariatric surgery

PeerJ ◽

10.7717/peerj.10442 ◽

2020 ◽

Vol 8 ◽

pp. e10442

Author(s):

Jukka Koffert ◽

Leo Lahti ◽

Lotta Nylund ◽

Seppo Salminen ◽

Jarna C. Hannukainen ◽

...

Keyword(s):

Bariatric Surgery ◽

Intestinal Microbiota ◽

Energy Restriction ◽

Morbidly Obese ◽

Obese Women ◽

Partial Restoration ◽

Obese Subjects ◽

And Gender ◽

The Impact

We studied the impact of bariatric surgery on the intestinal microbiota of morbidly obese study subjects. A total of 13 morbidly obese women (five of which had type 2 diabetes) and 14 healthy age- and gender-matched controls were recruited and the microbiota composition of fecal samples were determined by using a phylogenetic microarray. Sampling of the patients took place just one month before and 6 months after the operation. Within six months after bariatric surgery, the obese subjects had lost on average a quarter of their weight whereas four of the five of the diabetic subjects were in remission. Bariatric surgery was associated with an increased microbial community richness and Bacteroidetes/Firmicutes ratio. In addition, we observed an increased relative abundance of facultative anaerobes, such as Streptococcus spp., and a reduction in specific butyrate-producing Firmicutes. The observed postoperative alterations in intestinal microbiota reflect adaptation to the changing conditions in the gastrointestinal tract, such as energy restriction and the inability to process fiber-rich foods after bariatric surgery.

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Differential Effects of Bariatric Surgery on Plasma Levels of ANGPTL3 and ANGPTL4.

10.21203/rs.3.rs-1017161/v1 ◽

2021 ◽

Author(s):

Simone Bini ◽

Laura D’Erasmo ◽

Brenno Astiarraga ◽

Ilenia Minicocci ◽

Maria Palumbo ◽

...

Keyword(s):

Bariatric Surgery ◽

Insulin Sensitivity ◽

Fat Mass ◽

Plasma Levels ◽

Fold Increase ◽

Morbidly Obese ◽

Euglycemic Hyperinsulinemic Clamp ◽

Obese Subjects ◽

The Impact ◽

Fat Mass Loss

Abstract Introduction: Angiopoietin-like protein 3 (ANGPTL3) and 4 (ANGPTL4) are regulators of triglycerides storage and utilization. Bariatric surgery (BS) determines profound changes in adipose tissue composition and energy metabolism. We evaluated the impact of BS on plasma levels of ANGPTL3 and ANGPTL4.Method: Twenty-seven morbidly obese subjects with or without type 2 diabetes (T2D) underwent Roux-en-Y gastric bypass (RYGB) and 18 patients with advanced T2D received Biliopancreatic Diversion (BPD). Fasting ANGPTLs levels, insulin sensitivity (evaluated by euglycemic hyperinsulinemic clamp), total bile acids (TBA) and free fatty acids (FFA) were measured at baseline and 1year after surgery.Results: Both surgical procedures resulted in fat mass loss, improved glucose control, and a ~2-fold increase of insulin sensitivity. ANGPTL4 levels decreased significantly with both RYGB (26.6 ± 0.6 to 24.4 ± 0.3 ng/mL, p=0.001) and BPD (27.9 ± 1.5 to 24.0 ± 0.5 ng/mL, p=0.003). In contrast, ANGPTL3 concentrations did not change after RYGB but rose following BPD (225 ± 20 to 300 ± 15 ng/mL, p=0.003). By multiple regression analysis, changes in ANGPTL4 were independently associated with those of blood glucose, p=0.0169) whereas changes in ANGPTL3 after BPD were associated with variations in FFA (p=0.008) and insulin sensitivity (p=0.0427). Discussion: Circulating ANGPTL4 is reduced by BS probably due to the loss of fat mass and improved insulin sensitivity. Conversely, ANGPTL3 levels increased after BPD, presumably because of the metabolic changes induced by the malabsorptive effect of this surgical procedure.

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The protective association of endogenous immunoglobulins against sepsis mortality is restricted to patients with moderate organ failure

10.1101/116665 ◽

2017 ◽

Author(s):

Ignacio Martin-Loeches ◽

Arturo Muriel-Bombín ◽

Ricard Ferrer ◽

Antonio Artigas ◽

Jordi Sole-Violan ◽

...

Keyword(s):

Hospital Mortality ◽

Organ Failure ◽

Mortality Risk ◽

Multivariate Logistic Regression Analysis ◽

Predictive Ability ◽

Simultaneous Presence ◽

Icu Mortality ◽

Icu Admission ◽

The Impact ◽

Immunoglobulin Levels

AbstractBackgroundpre-evaluation of endogenous immunoglobulin levels is a potential strategy to improve the results of intravenous immunoglobulins in sepsis, but more work has to be done to identify those patients who could benefit the most from this treatment. The objective of this study was to evaluate the impact of endogenous immunoglobulins on the mortality risk in sepsis depending on disease severity.Methodsthis was a retrospective observational study including 278 patients admitted to the ICU with sepsis fulfilling the SEPSIS-3 criteria, coming from the Spanish GRECIA and ABISS-EDUSEPSIS cohorts. Patients were distributed into two groups depending on their Sequential Organ Failure Assessment score al ICU admission (SOFA < 8, n = 122 and SOFA ≥ 8, n = 156) and the association between immunoglobulin levels at ICU admission with mortality was studied in each group by Kaplan Meier and multivariate logistic regression analysis.ResultsICU / hospital mortality in the SOFA < 8 group was 14.8% / 23.0%, compared to 30.1 % / 35.3% in the SOFA ≥ 8 group. In the group with SOFA < 8, the simultaneous presence of total IgG <407 mg/dl, IgM < 43 mg/dl and IgA < 219 mg/dl was associated to a reduction in the survival mean time of 6.6 days in the first 28 days, and was a robust predictor of mortality risk either during the acute and the post-acute phase of the disease (OR for ICU mortality: 13.79; OR for hospital mortality: 7.98). This predictive ability remained in the absence of prior immunosupression (OR for ICU mortality: 17.53; OR for hospital mortality: 5.63). Total IgG <407 mg/dl or IgG1 < 332 mg/dl was also an independent predictor of ICU mortality in this group. In contrast, in the SOFA ≥ 8 group, we found no immunoglobulin thresholds associated to neither ICU nor to hospital mortality.Conclusionsendogenous immunoglobulin levels may have a different impact on the mortality risk of sepsis patients based on their severity. In patients with moderate organ failure, the simultaneous presence of low levels of IgG, IgA and IgM was a consistent predictor of both acute and post-acute mortality.

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Understanding the Determinants of Weight-Related Quality of Life among Bariatric Surgery Candidates

Journal of Obesity ◽

10.1155/2012/713426 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

Annie Tessier ◽

Gerald S. Zavorsky ◽

Do Jun Kim ◽

Franco Carli ◽

Nicolas Christou ◽

...

Keyword(s):

Quality Of Life ◽

Arterial Oxygen ◽

Morbidly Obese ◽

Walking Capacity ◽

Related Quality ◽

Health Related ◽

Obese Subjects ◽

6 Minute Walk Test ◽

The Impact

Obesity and its relation to quality of life are multifaceted. The purpose of this paper was to contribute evidence to support a framework for understanding the impact of obesity on quality of life in 42 morbidly obese subjects considering a wide number of potential determinants. A model of weight-related quality of life (WRQL) was developed based on the Wilson-Cleary model, considering subjects' weight characteristics, arterial oxygen pressure (PaO2), walking capacity (6-minute walk test, 6MWT), health-related quality of life (HRQL; Physical and Mental Component Summaries of the SF-36 PCS/MCS), and WRQL. The model of WRQL was tested with linear regressions and a path analysis, which showed that as PaO2at rest increased 6MWT increased. 6MWT was positively associated with the PCS, which in turn was positively related to WRQL along with the MCS. The model showed good fit and explained 38% of the variance in WRQL.

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DAMPAK KEBIJAKAN FISKAL TERHADAP KINERJA SEKTOR PERTANIAN DI SULAWESI TENGGARA

Jurnal Sosio Agribisnis ◽

10.33772/jsa.v1i1.1826 ◽

2017 ◽

Vol 1 (1) ◽

Author(s):

La Ode Jabuddin ◽

Ayub M Padangaran ◽

Azhar Bafadal Bafadal

Keyword(s):

Fiscal Policy ◽

Interest Rates ◽

Agricultural Sector ◽

Simultaneous Equations ◽

Poor People ◽

Land Area ◽

Factors Affecting ◽

Historical Simulation ◽

The Impact ◽

Direct Expenditure

This study aims to: (1) Knowing the dynamics of fiscal policy and the performance of the agricultural sector, (2) Analyze the factors that influence fiscal policy and the performance of the agricultural sector, and (3) Analyzing the impact of fiscal policy on the performance of the agricultural sector. The data used in this study were pooled 2005-2013 data in the aggregate. Econometric model the impact of fiscal policy on the performance of the agricultural sector is built in the form of simultaneous equations, consisting of 7 equations with 25 total variables in the model, 7 endogenous variables, 12 exogenous variables, and 6 variables lag. The model is estimated by 2SLS method SYSLIN procedures and historical simulation with SIMNLIN procedure.The results showed that: (1) The development of fiscal policy in Southeast Sulawesi from year to year tends to increase, (2) The performance of the agricultural sector from the aspect of GDP has decreased, from the aspect of labor is still consistent, in terms of investment to grow positively, and assign roles which means to decrease the number of poor people, (3) factors affecting fiscal policy is local revenues, equalization funds, other revenues, as well as the lag fiscal policy, (4) the factors that affect the performance of the agricultural sector from the aspect GDP is labor, direct expenditure and GDP lag; from the aspect of labor is the total labor force, investment, land area, direct expenditure, as well as the lag of labor; from the aspect of investment is influenced by GDP per capita, land area, interest rates and investment lag; as well as from the aspect of poor people, are affected by population, investments, direct expenditure and poverty lag, (5). Fiscal policy impact on the agricultural sector GDP increase, a decrease in the number of poor, declining agricultural laborers, and a decrease in the amount of investment in the agricultural sector.Keywords: Fiscal policy, the performance of the agricultural sector, the simultaneous equations

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Structural Model of Service Quality Factors Affecting Loyalty Sustainability

International Journal of Sustainable Construction Engineering Technology ◽

10.30880/ijscet.2020.11.02.026 ◽

2020 ◽

Vol 11 (2) ◽

Author(s):

Eman Al-erqi ◽

◽

Mohd Lizam Mohd Diah ◽

Najmaddin Abo Mosali ◽

◽

...

Keyword(s):

International Students ◽

Service Quality ◽

Goodness Of Fit ◽

Structural Model ◽

Quality Factors ◽

Factors Affecting ◽

Measurement Models ◽

Confirmatory Factor ◽

The University ◽

The Impact

This study seeks to address the impact of service quality affecting international student's satisfaction towards loyalty tothe Universiti Tun Hussein Onn Malaysia(UTHM). The aim of thestudy is to develop relationship between service quality factor and loyalty to the university from the international students’ perspectives. The study adopted quantitative approach where data was collected through questionnaire survey and analysed statistically. A total of 246 responses were received and found to be valid. The model was developed and analysed using AMOS-SEM software. Confirmatory factor analysis (CFA) function of the software was to assessed the measurement models and found that all the models achieved goodness of fit. Then path analysis function was used to assessed structural model and found that service qualityfactors have a significant effect on the students’ satisfaction and thus affecting the loyaltyto the university. Hopefully the outcome form this study will benefit the university in providing services especially to the international students.

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