scholarly journals Prognostic Value of the Acute-to-Chronic Glycemic Ratio at Admission in Heart Failure: A Prospective Study

2021 ◽  
Vol 11 (1) ◽  
pp. 6
Author(s):  
Mª José Carrera ◽  
Pedro Moliner ◽  
Gemma Llauradó ◽  
Cristina Enjuanes ◽  
Laura Conangla ◽  
...  
Keyword(s):  
Heart Failure ◽  
Multivariable Analysis ◽  
Acute Hyperglycemia ◽  
Glucose Levels ◽  
Long Term Prognosis ◽  
Shape Curve ◽  
A Prospective Study ◽  
The Impact ◽  
The Relationship

Acute hyperglycemia has been associated with worse prognosis in patients hospitalized for heart failure (HF). Nevertheless, studies evaluating the impact of glycemic control on long-term prognosis have shown conflicting results. Our aim was to assess the relationship between acute-to-chronic (A/C) glycemic ratio and 4-year mortality in a cohort of subjects hospitalized for acute HF. A total of 1062 subjects were consecutively included. We measured glycaemia at admission and estimated average chronic glucose levels and the A/C glycemic ratio were calculated. Subjects were stratified into groups according to the A/C glycemic ratio tertiles. The primary endpoint was 4-year mortality. Subjects with diabetes had higher risk for mortality compared to those without (HR 1.35 [95% CI: 1.10–1.65]; p = 0.004). A U-shape curve association was found between glucose at admission and mortality, with a HR of 1.60 [95% CI: 1.22–2.11]; p = 0.001, and a HR of 1.29 [95% CI: 0.97–1.70]; p = 0.078 for the first and the third tertile, respectively, in subjects with diabetes. Additionally, the A/C glycemic ratio was negatively associated with mortality (HR 0.76 [95% CI: 0.58–0.99]; p = 0.046 and HR 0.68 [95% CI: 0.52–0.89]; p = 0.005 for the second and third tertile, respectively). In multivariable analysis, the A/C glycemic ratio remained an independent predictor. In conclusion, in subjects hospitalized for acute HF, the A/C glycemic ratio is significantly associated with mortality, improving the ability to predict mortality compared with glucose levels at admission or average chronic glucose concentrations, especially in subjects with diabetes.

scholarly journals Association of liver cirrhosis with the prognosis of patients with intrahepatic cholangiocarcinoma: a SEER-based cohort study

2020 ◽  
Author(s):  
Wei Li ◽  
Hong Wu ◽  
Yange Zhang
Keyword(s):  
Liver Cirrhosis ◽  
Intrahepatic Cholangiocarcinoma ◽  
Multivariable Analysis ◽  
Fibrosis Score ◽  
Multivariable Analyses ◽  
Long Term Prognosis ◽  
The Impact ◽  
The Relationship ◽  
Interaction Test

Abstract Background The association of liver cirrhosis with the prognosis of intrahepatic cholangiocarcinoma (ICC) remains controversial. We aimed to evaluate the relationship between liver cirrhosis (fibrosis score) and the long-term prognosis of patients with ICC. Methods SEER 18 registry from 2004 to 2015 was queried for this study. Propensity score matching (PSM) was performed to eliminate possible bias. In addition, multivariable analysis was utilized to adjust for potential confounders. The interaction test was performed to explore the impact of each stratified factor on the relationship between FS and patient survival. Overall survival (OS) and disease-specific survival (DSS) were the major endpoints. Results During the study period, 359 patients (66.5%) with lower fibrosis score (LFS; F0-4) and 181 patients (33.5%) with higher fibrosis score (HFS; F5-6) were enrolled. In the multivariable adjusted cohort (OS: n = 540; DSS: n = 417), patients with HFS had worse OS (HR, 1.43; 95% CI, 1.10 to 1.85; P = 0.007) and DSS (HR, 1.46; 95% CI, 1.08 to 1.97; P = 0.013) compared to patients with LFS. In the propensity-matched cohort, patients with HFS still had worse OS (HR, 1.50; 95% CI, 1.08 to 2.09; P = 0.016) and DSS (HR, 1.54; 95% CI, 1.05 to 2.26; P = 0.026) compared to patients with LFS. In multivariable analyses stratified by clinicopathologic features, patients with HFS were found to have significantly worse OS and DSS compared to those with LFS across all the subgroups. Conclusion Our outcomes indicated that fibrosis score is an independent risk factor for both overall and tumor-specific survival of ICC patients.

Depression in heart failure

2019 ◽  
Vol 14 (6) ◽  
pp. 1-11 ◽  
Author(s):  
John Sharp ◽  
Monica McCowat
Keyword(s):  
Heart Failure ◽  
Epidemiological Studies ◽  
Life Outcomes ◽  
Cardiac Health ◽  
Prevalence Of Depression ◽  
The Uk ◽  
The Impact ◽  
The Relationship

Heart failure is one of the most prevalent long-term physical health conditions. It is suggested that up to 26 million people are living with it worldwide including approximately 920 000 people in the UK. Evidence has consistently demonstrated the links between cardiac health and mental health; therefore, this article will explain depression and its presentation in heart failure, as these two conditions have been strongly and consistently linked. The prevalence of depression in heart failure will be reviewed from epidemiological studies and an overview of the impact of comorbid depression in heart failure will be provided, with a particular focus on mortality, morbidity and quality of life outcomes. The relationship between depression and heart failure will be discussed by examining pathophysiological and behavioural mechanisms, as well as evidence regarding the appropriate identification and subsequent management of heart failure depression will be reviewed.

scholarly journals THE PROGNOSTIC SIGNIFICANCE OF CD3+, CD68+, CD20+ INTERSTITIAL CELLS IN PATIENTS WITH KIDNEY ALLOGRAFT GLOMERULITIS

2018 ◽  
Vol 22 (6) ◽  
pp. 47-55
Author(s):  
V. A. Dobronravov ◽  
A. O. Mukhametdinova ◽  
M. S. Khrabrova ◽  
A. Nabokow ◽  
H. -J. Gröne ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Cox Proportional Hazards ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Long Term Prognosis ◽  
The Impact ◽  
The Relationship

THE OBJECTIVEof the study was to assess the impact of the count of interstitial CD3+, CD68+ and CD20+ cells on long-term prognosis of renal allograft (RA).PATIENTS AND METHODS.86 RA recipients with biopsy-proven according to the Banff 2013- 2017 criteria glomerulitis were enrolled in this retrospective study. The patients were subdivided into the following groups: 1) isolated glomerulitis with negative donor-specific antibodies (DSA) at the biopsy (n=53); 2) glomerulitis with positive DSA (n=22); 3) glomerulitis with undetermined DSA (n=11). Quantitative assay of interstitial positive cells was performed after immunohistochemical staining for CD68+, CD3+, CD20+. The Kaplan-Meier method and Cox proportional hazards regression model were used for the analysis of the relationship between interstitial CD3+, CD68+, CD20+ cells and risk of RA loss.RESULTS.CD68+ and CD3+ cells prevailed in interstitium in RA glomerulitis. CD20+ infiltrates were found in 60% of cases. CD20+ cells tended to form infiltrates, in 9 cases these infiltrates reached large sizes (≥ 50 CD20+ lymphocytes) and formed nodular structures. There was no difference in the count of interstitial CD3+ and CD68+ cells and in the presence of CD20+ infiltrates between DSA subgroups. Interstitial CD68+ ≥ 5 cells per field of view (FOV) (x400) and CD3+ ≥ 8 cells per FOV (x400), as well as the presence of large CD20+ infiltrates were associated with a lower RA survival (plog-rank < 0,05). Interstitial CD68+ (≥ 5 cells/FOV), CD3 + (≥ 8 cells/FOV) and the presence of large CD20+ interstitial infiltrates were independently associated with the risk of RA loss in the multivariable Cox regression analysis adjusted for DSA, cold and warm ischemia time (p < 0.05). CONCLUSION. Grade of interstitial infiltration by CD68+, CD3+ and CD20+ cells in RA glomerulitis could be independent predictor of RA loss.

Effect of Pancreatic Fistula on Recurrence and Long-Term Prognosis of Periampullary Adenocarcinomas after Pancreaticoduodenectomy

2016 ◽  
Vol 82 (12) ◽  
pp. 1187-1195 ◽  
Author(s):  
Pablo E. Serrano ◽  
Dowan Kim ◽  
Peter T. Kim ◽  
Paul D. Greig ◽  
Carol-Anne Moulton ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Pancreatic Fistula ◽  
Multivariable Analysis ◽  
Disease Free Survival ◽  
Tumor Grade ◽  
Free Survival ◽  
Resection Margin Status ◽  
Long Term Prognosis ◽  
The Impact

Pancreatic fistula (PF) is common after pancreaticoduodenectomy (PD). Its effect on recurrence and survival is not known. Retrospective study of patients undergoing PD for periampullary adenocarcinomas (2000–2012). Standard statistical analyses were performed to determine the impact of PF on disease-free survival (DFS) and overall survival (OS). There were 634 PDs (pancreatic adenocarcinoma: 347, other periampullary adenocarcinomas: 287). Any-grade PF developed in 81/634 (13%). Perioperative mortality rate was 1.7 per cent (11/634), higher in patients with PF (10 vs 0.5%, P < 0.001). In multivariable analysis, PF significantly reduced DFS in pancreatic [hazard ratio (HR) = 1.6, 95% confidence-interval (CI): 1.1–2.6, P = 0.043] but not in other periampullary adenocarcinomas [HR = 1.3 (95% CI: 0.8–2.2), P = 0.45]. Positive lymph nodes, margins, and high-grade histology were associated with decreased DFS and OS. Adjuvant therapy was associated with improved OS in pancreatic [HR = 0.7 (95% CI: 0.5–0.9), P = 0.02] but not in other periampullary adenocarcinomas [HR = 1.14 (95% CI: 0.8–1.7), P = 0.49]. PF did not alter OS in either group. After PD, PF is associated with decreased DFS in pancreatic but not in other periampullary adenocarcinomas. This decrease DFS did not alter OS. Tumor grade, lymph nodes, and resection margin status are associated with DFS and OS.

scholarly journals Associated Factors and Long-Term Prognosis of 24-Hour Worsening of Arterial Patency After Ischemic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (10) ◽  
pp. 2752-2760 ◽  
Author(s):  
João Pedro Marto ◽  
Dimitris Lambrou ◽  
Ashraf Eskandari ◽  
Stefania Nannoni ◽  
Davide Strambo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Multivariable Analysis ◽  
Vascular Imaging ◽  
Stroke Severity ◽  
Modified Rankin Scale ◽  
Long Term Outcome ◽  
Long Term Prognosis ◽  
The Impact ◽  
Arterial Patency

Background and Purpose— Early arterial recanalization in acute ischemic stroke is strongly associated with better outcomes. However, early worsening of arterial patency was seldom studied. We investigated potential predictors and long-term prognosis of worsening of arterial patency at 24 hours after stroke onset. Methods— Patients from the Acute Stroke Registry and Analysis of Lausanne registry including admission and 24-hour vascular imaging (computed tomography or magnetic resonance angiography) were included. Worsening of arterial patency was defined as a new occlusion and significant stenosis in any extracranial or intracranial artery, comparing 24 hours with admission imaging. Variables associated with worsening of arterial patency were assessed by stepwise multiple logistic regression. The impact of arterial worsening on 3-month outcome was investigated with an adjusted modified Rankin Scale shift analysis. Results— Among 2152 included patients, 1387 (64.5%) received intravenous thrombolysis and endovascular treatment, and 65 (3.0%) experienced 24-hour worsening of arterial patency. In multivariable analysis, history of hypertension seemed protective (adjusted odds ratio [aOR], 0.45; 95% CI, 0.27–0.75) while higher admission National Institutes of Health Stroke Scale (aOR, 1.06; 95% CI, 1.02–1.10), intracranial (aOR, 4.78; 95% CI, 2.03–11.25) and extracranial stenosis (aOR, 3.67; 95% CI, 1.95–6.93), and good collaterals (aOR, 3.71; 95% CI, 1.54–8.95) were independent predictors of worsening of arterial patency. Its occurrence was associated with a major unfavorable shift in the distribution of the modified Rankin Scale at 3 months (aOR, 5.97; 95% CI, 3.64–9.79). Conclusions— Stroke severity and admission vascular imaging findings may help to identify patients at a higher risk of developing worsening of arterial patency at 24 hours. The impact of worsening of arterial patency on long-term outcome warrants better methods to detect and prevent this early complication.

Evaluation of the impact of community-acquired pneumonia on short-term and long-term prognosis in a patient with chronic decompensated heart failure

2016 ◽  
Vol 88 (9) ◽  
pp. 17-22 ◽  
Author(s):  
D S Polyakov ◽  
I V Fomin ◽  
F Yu Valikulova ◽  
A R Vaisberg ◽  
N Kraiem
Keyword(s):  
Heart Failure ◽  
Fatal Outcome ◽  
Decompensated Heart Failure ◽  
Community Acquired Pneumonia ◽  
Chronic Obstructive ◽  
Short Term ◽  
Risk Of Death ◽  
Long Term Prognosis ◽  
The Impact

Aim. To evaluate the impact of community-acquired pneumonia (CAP) on short-term and long-term prognosis in patients hospitalized with signs of chronic decompensated heart failure (CDHF). Subjects and methods. A total of 852 cases were admitted to therapy/cardiology hospital with signs of CDHF during a year. Results. Among the patients hospitalized with signs of CDHF, the prevalence of CAP was 16.5%. This indicator did not depend on the age of hospitalized patients. Among the multisystem disorders, hypertension, different forms of coronary heart disease, diabetes mellitus, and chronic obstructive pulmonary disease were more common in the patients with CAP. The presence of the latter in a patient with CDHF statistically significantly increased the length of hospital stay (13.1 versus 11.9 days; p = 0.009) and also the probability of rehospitalization during a year (odds ratio (OR) 1.9; p = 0.02). The presence of CAP in a patient with CDHF resulted in an increase in mortality rates (OR 13.5; p < 0.001); moreover, the highest risk of a fatal outcome was noted on day 1 of hospitalization (12.7%). During one-year follow-up, the risk of death in patients hospitalized with CDHF and concomitant pneumonia proved to be higher (OR 4.8; p < 0.001) than in those without pneumonia.

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