scholarly journals Outcomes of Hospitalized Patients with Glucocorticoid-Induced Hyperglycemia—A Retrospective Analysis

2020 ◽  
Vol 9 (12) ◽  
pp. 4079
Author(s):  
Neele Delfs ◽  
Tristan Struja ◽  
Sandra Gafner ◽  
Thaddaeus Muri ◽  
Ciril Baechli ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Cardiovascular Events ◽  
Adjusted Odds Ratio ◽  
Adverse Outcome ◽  
Hospitalized Patients ◽  
Secondary Outcome ◽  
Treat To Target ◽  
Inclusion Criteria ◽  
Future Studies ◽  
Target Treatment

Background: Glucocorticoid (GC)-induced hyperglycemia is a frequent side effect in hospitalized patients. Guidelines recommend treat-to-target treatment between 6–10 mmol/L (108–180 mg/dL) with insulin, but data on outcome is scarce. We investigated the 30-day outcome in hospitalized patients receiving GCs. Methods: All patient records of hospitalized patients between January 2014 and April 2018 were screened for GC administration and consecutive hyperglycemia. The primary combined endpoint consisted of death, cardiovascular events, and infections until 30 days after admission. Hypoglycemia was a secondary outcome. Results: Of the 2424 hospitalized patients (9.6% of all hospitalized patients) who received systemic GCs and met inclusion criteria, the overall incidence for GC-induced hyperglycemia was 812 (33.5%), and 89 (3.7%) had at least one documented hypoglycemia during their hospital stay. Compared to patients with normoglycemia, GC-induced hyperglycemia had an adjusted-odds ratio of 1.68 (95% CI 1.25–2.26) for the combined primary endpoint. Hypoglycemia even had an odds ratio of 1.95 (95% CI 1.2–3.17). Conclusions: Mortality, cardiovascular events, and rate of infections were markedly higher in patients with GC-induced hyperglycemia as compared to patients with normoglycemia. Importantly, hypoglycemia was associated with a doubled risk for adverse outcome. Future studies should evaluate whether optimized glucose control by minimizing the risk for hypoglycemia has a beneficial effect on clinical outcomes in patients with GC-induced hyperglycemia.

scholarly journals MON-650 Glucocorticoid- Induced Hyperglycemia, Higher Mortality and Morbidity? a Retrospective Analysis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Neele Delfs ◽  
Tristan Struja ◽  
Sandra Gafner ◽  
Thaddäus Muri ◽  
Ciril Bächli ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Odds Ratio ◽  
Cardiovascular Events ◽  
Hospitalized Patients ◽  
Treatment Modalities ◽  
Patient Specific ◽  
Treat To Target ◽  
Mortality And Morbidity ◽  
Retrospective Data Analysis ◽  
Specific Outcome

Abstract Introduction: Glucocorticoid (GC)-induced hyperglycemia is a frequent side effect in hospitalized patients. Guidelines recommend treat-to-target treatment between 6-10 mmol/l with insulin, but patient-specific outcome has not been well-studied. Methods: In this retrospective data analysis, all patient records of a Medical University Clinic from January 2014 to April 2018 were screened for GC administration. We investigated the incidence of hyperglycemia in hospitalized patients after administration of at least 10 mg prednisolone equivalents daily and a minimal length of stay of 3 days. The primary combined endpoint consisted of mortality, cardiovascular events, and infections until 30 days after admission. Results: 2424 hospitalized patients received systemic GCs and met the inclusion criteria, of which 511 patients (21%) had an underlying diagnosis of diabetes. The overall incidence for GC-induced hyperglycemia was 33.5% (812 patients) and 3.7% of patients (n=89) had at least one documented hypoglycemia during the hospital stay. Compared to normoglycemic patients, GC-induced hyperglycemia was associated with a 40% increase in the risk for the combined primary endpoint (unadjusted odds ratio 1.39, 95%CI 1.16-1.66). This was also true after adjusting the analysis for age, Charlson comorbidity index and GC dose (adjusted odds ratio 1.68, 95% CI 1.25-2.26). Hypoglycemia was also associated with a doubling in the risk for the combined primary endpoint (odds ratio 1.95, 95% CI 1.2-3.17). Discussion/Conclusion: Mortality, cardiovascular events and rate of infections were markedly higher in patients with GC-induced hyperglycemia compared to normoglycemic patients. Hypoglycemia was infrequent, but also associated with higher risk for adverse outcome. Future studies should evaluate whether glucose control with novel treatment modalities has a beneficial effect on clinical outcomes in patients with GC-induced hyperglycemia.

scholarly journals Invasive Candidiasis in Hospitalized Patients with Major Burns

2022 ◽  
Vol 12 (1) ◽  
pp. 47
Author(s):  
Yi-Ling Lin ◽  
I-Chen Chen ◽  
Jung-Hsing Yen ◽  
Chih-Sheng Lai ◽  
Yueh-Chi Tsai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Invasive Candidiasis ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Total Body Surface Area ◽  
Reference Value ◽  
Hospitalized Patients ◽  
Research Database ◽  
Specific Population ◽  
Total Body

Background: Invasive candidiasis (IC) is a major cause of morbidities and mortality in patients hospitalized with major burns. This study investigated the incidence of IC in this specific population and analyzed the possible risk factors. Materials and Methods: We retrospectively analyzed data from the National Health Insurance Research Database (NHIRD) of Taiwan. We identified 3582 patients hospitalized with major burns on over 20% of their total body surface area (TBSA) during 2000–2013; we further analyzed possible risk factors. Result: IC was diagnosed in 452 hospitalized patients (12.6%) with major burns. In the multivariate analysis, patients older than 50 years (adjusted odds ratio (OR) = 1.96, 95% confidence interval (CI) 1.36–2.82), those of female sex (adjusted OR = 1.33, 95% CI 1.03–1.72), those with burns on the head (adjusted OR = 1.33, 95% CI 1.02–1.73), and those with burns over a greater TBSA had higher risks of IC. Conclusion: Treating IC is crucial in healthcare for major burns. Our study suggests that several risk factors are associated with IC in patients hospitalized with major burns, providing reliable reference value for clinical decisions.

scholarly journals Temporal Trends and Clinical Trial Characteristics Associated With the Inclusion of Women in Heart Failure Trial Steering Committees: A Systematic Review

2021 ◽  
Author(s):  
Yousif Eliya ◽  
Sera Whitelaw ◽  
Lehana Thabane ◽  
Adriaan A. Voors ◽  
Pamela S. Douglas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Temporal Trends ◽  
The Self ◽  
Gender Composition ◽  
Controlled Trials ◽  
Inclusion Criteria ◽  
Randomized Controlled ◽  
Heart Failure Trial

Background: Trial steering committees (TSCs) steer the conduct of randomized controlled trials (RCTs). We examined the gender composition of TSCs in impactful heart failure RCTs and explored whether trial leadership by a woman was independently associated with the inclusion of women in TSCs. Methods: We systematically searched MEDLINE, EMBASE, and CINAHL for heart failure RCTs published in journals with impact factor ≥10 between January 2000 and May 2019. We used the Jonckheere-Terpstra test to assess temporal trends and multivariable logistic regression to explore trial characteristics associated with TSC inclusion of women. Results: Of 403 RCTs that met inclusion criteria, 127 (31.5%) reported having a TSC but 20 of these (15.7%) did not identify members. Among 107 TSCs that listed members, 56 (52.3%) included women and 6 of these (10.7%) restricted women members to the RCT leaders. Of 1213 TSC members, 11.1% (95% CI, 9.4%–13.0%) were women, with no change in temporal trends ( P =0.55). Women had greater odds of TSC inclusion in RCTs led by women (adjusted odds ratio, 2.48 [95% CI, 1.05–8.72], P =0.042); this association was nonsignificant when analysis excluded TSCs that restricted women to the RCT leaders (adjusted odds ratio 1.46 [95% CI, 0.43–4.91], P =0.36). Conclusions: Women were included in 52.3% of TSCs and represented 11.1% of TSC members in 107 heart failure RCTs, with no change in trends since 2000. RCTs led by women had higher adjusted odds of including women in TSCs, partly due to the self-inclusion of RCT leaders in TSCs.

Effect of a treat-to-target intervention of cardiovascular risk factors on subclinical and clinical atherosclerosis in rheumatoid arthritis: a randomised clinical trial

2019 ◽  
pp. annrheumdis-2018-214075 ◽  
Author(s):  
Benjamin Burggraaf ◽  
Deborah F van Breukelen-van der Stoep ◽  
Marijke A de Vries ◽  
Boudewijn Klop ◽  
Anho H Liem ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Usual Care ◽  
Cardiovascular Events ◽  
Target Group ◽  
Secondary Outcome ◽  
Treat To Target ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Increased Risk

BackgroundPatients with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease (CVD). No long-term intervention trials on CVD risk factors have been published, and a debate on the efficacy of controlling traditional risk factors in RA is ongoing. We aimed to evaluate a treat-to-target approach versus usual care regarding traditional CVD risk factors in patients with RA.MethodsIn this open-label, randomised controlled trial, patients with RA aged <70 years without prior CVD or diabetes mellitus were randomised 1:1 to either a treat-to-target approach or usual care of traditional CVD risk factors. The primary outcome was defined as change in carotid intima media thickness (cIMT) over 5 years, and the secondary outcome was a composite of first occurrence of fatal and non-fatal cardiovascular events.ResultsA total of 320 patients (mean age 52.4 years; 69.7% female) with RA underwent randomisation and 219 patients (68.4%) completed 5 years of follow-up. The mean cIMT progression was significantly reduced in the treat-to-target group compared with usual care (0.023 [95% CI 0.011 to 0.036] mm vs 0.045 [95% CI 0.030 to 0.059] mm; p=0.028). Cardiovascular events occurred in 2 (1.3%) of the patients in the treat-to-target group vs 7 (4.7%) in those receiving usual care (p=0.048 by log-rank test).ConclusionThis study provides evidence on the benefit of a treat-to-target approach of traditional CVD risk factors for primary prevention in patients with well-treated RA.Trial registration numberNTR3873.

scholarly journals Timing of β-Blocker Reintroduction and the Occurrence of Postoperative Atrial Fibrillation after Cardiac Surgery

2020 ◽  
Vol 132 (2) ◽  
pp. 267-279 ◽  
Author(s):  
Camille Couffignal ◽  
Julien Amour ◽  
Nora Ait-Hamou ◽  
Bernard Cholley ◽  
Jean-Luc Fellahi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Postoperative Atrial Fibrillation ◽  
Secondary Outcome ◽  
Outcome Relationship ◽  
History Of ◽  
Β Blocker ◽  
Β Blockers

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background For cardiac surgery patients under chronic β-blocker therapy, guidelines recommend their early postoperative reintroduction to decrease the incidence of postoperative atrial fibrillation. The authors hypothesized that the timing of β-blocker reintroduction affects their effectiveness on the incidence of postoperative atrial fibrillation. Methods This multicenter prospective French cohort study included patients on β-blockers (more than 30 days before surgery) in sinus rhythm without a pacemaker. The primary outcome, time sequence of β-blocker reintroduction, was analyzed for 192 h after surgery. The secondary outcome, relationship between the occurrence of postoperative atrial fibrillation and timing of β-blocker reintroduction, was analyzed based on pre- and intraoperative predictors (full and selected sets) according to landmark times (patients in whom atrial fibrillation occurred before a given landmark time were not analyzed). Results Of 663 patients, β-blockers were reintroduced for 532 (80%) but for only 261 (39%) patients in the first 48 h after surgery. Median duration before reintroduction was 49.5 h (95% CI, 48 to 51.5 h). Postoperative atrial fibrillation or death (N = 4) occurred in 290 (44%) patients. After performing a landmark analysis to take into account the timing of β-blocker reintroduction, the adjusted odds ratios (95% CI) for predictor full and selected (increased age, history of paroxysmal atrial fibrillation, and duration of aortic cross clamping) sets for the occurrence of postoperative atrial fibrillation were: adjusted odds ratio (full) = 0.87 (0.58 to 1.32; P = 0.517) and adjusted odds ratio (selected) = 0.84 (0.58 to 1.21; P = 0.338) at 48 h; adjusted odds ratio (full) = 0.64 (0.39 to 1.05; P = 0.076) and adjusted odds ratio (selected) = 0.58 (0.38 to 0.89; P = 0.013) at 72 h; adjusted odds ratio (full) = 0.58 (0.31 to 1.07; P = 0.079) and adjusted odds ratio (selected) = 0.53 (0.31 to 0.91; P = 0.021) at 96 h. Conclusions β-Blockers were reintroduced early (after less than 48 h) in fewer than half of the cardiac surgery patients. Reintroduction decreased postoperative atrial fibrillation occurrence only at later time points and only in the predictor selected set model. These results are an incentive to optimize (timing, doses, or titration) β-blocker reintroduction after cardiac surgery.

scholarly journals Pharmacogenomic associations of adverse drug reactions in asthma: systematic review and research prioritisation

2020 ◽  
Vol 20 (5) ◽  
pp. 621-628 ◽  
Author(s):  
Charlotte King ◽  
Amanda McKenna ◽  
Niloufar Farzan ◽  
Susanne J. Vijverberg ◽  
Marc P. van der Schee ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Drug Reactions ◽  
Adrenal Suppression ◽  
Secondary Outcome ◽  
Drug Reactions ◽  
Inclusion Criteria ◽  
Mineral Density ◽  
Future Studies ◽  
Leukotriene Receptor ◽  
Pharmacogenomic Studies

Abstract A systematic review of pharmacogenomic studies capturing adverse drug reactions (ADRs) related to asthma medications was undertaken, and a survey of Pharmacogenomics in Childhood Asthma (PiCA) consortia members was conducted. Studies were eligible if genetic polymorphisms were compared with suspected ADR(s) in a patient with asthma, as either a primary or secondary outcome. Five studies met the inclusion criteria. The ADRs and polymorphisms identified were change in lung function tests (rs1042713), adrenal suppression (rs591118), and decreased bone mineral density (rs6461639) and accretion (rs9896933, rs2074439). Two of these polymorphisms were replicated within the paper, but none had external replication. Priorities from PiCA consortia members (representing 15 institution in eight countries) for future studies were tachycardia (SABA/LABA), adrenal suppression/crisis and growth suppression (corticosteroids), sleep/behaviour disturbances (leukotriene receptor antagonists), and nausea and vomiting (theophylline). Future pharmacogenomic studies in asthma should collect relevant ADR data as well as markers of efficacy.

scholarly journals Acute myocardial infarction versus other cardiovascular events in community-acquired pneumonia

2015 ◽  
Vol 1 (1) ◽  
pp. 00020-2015 ◽  
Author(s):  
Stefano Aliberti ◽  
Julio Ramirez ◽  
Roberto Cosentini ◽  
Vincenzo Valenti ◽  
Antonio Voza ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Neurological Disease ◽  
Odds Ratio ◽  
Cardiovascular Events ◽  
Adjusted Odds Ratio ◽  
Community Acquired Pneumonia ◽  
Female Sex ◽  
Severity Of The Disease

The aim of the present study was to define the prevalence, characteristics, risk factors and impact on clinical outcomes of acute myocardial infarction (AMI) versus other cardiovascular events (CVEs) in patients with community-acquired pneumonia (CAP).This was an international, multicentre, observational, prospective study of CAP patients hospitalised in eight hospitals in Italy and Switzerland. Three groups were identified: those without CVEs, those with AMI and those with other CVEs.Among 905 patients, 21 (2.3%) patients experienced at least one AMI, while 107 (11.7%) patients experienced at least one other CVE. Patients with CAP and either AMI or other CVEs showed a higher severity of the disease than patients with CAP alone. Female sex, liver disease and the presence of severe sepsis were independent predictors for the occurrence of AMI, while female sex, age >65 years, neurological disease and the presence of pleural effusion predicted other CVEs. In-hospital mortality was significantly higher among those who experienced AMI in comparison to those experiencing other CVEs (43% versus 21%, p=0.039). The presence of AMI showed an adjusted odds ratio for in-hospital mortality of 3.57 (p=0.012) and for other CVEs of 2.63 (p=0.002).These findings on AMI versus other CVEs as complications of CAP may be important when planning interventional studies on cardioprotective medications.

scholarly journals Association of subclinical hypercortisolism with type 2 diabetes mellitus: a case-control study in hospitalized patients

2005 ◽  
Vol 153 (6) ◽  
pp. 837-844 ◽  
Author(s):  
Iacopo Chiodini ◽  
Massimo Torlontano ◽  
Alfredo Scillitani ◽  
Maura Arosio ◽  
Simonetta Bacci ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Plasma Cortisol ◽  
Adjusted Odds Ratio ◽  
Hospitalized Patients ◽  
Diabetic Patients ◽  
Subclinical Hypercortisolism ◽  
Free Cortisol

Objective: Subclinical hypercortisolism (SH) may play a role in several metabolic disorders, including diabetes. No data are available on the relative prevalence of SH in type 2 diabetes (T2D). In order to compare the prevalence of SH in T2D and matched non-diabetic control individuals, we performed a case-controlled, multicenter, 12-month study, enrolling 294 consecutive T2D inpatients (1.7% dropped out the study) with no evidence of clinical hypercortisolism and 189 consecutive age- and body mass index-matched non-diabetic inpatients (none of whom dropped out). Design and methods: Ascertained SH (ASH) was diagnosed in individuals (i) with plasma cortisol after 1 mg overnight dexamethasone suppression >1.8 μg/dl (50 nmol/l), (ii) with more than one of the following: (a) urinary free cortisol >60.0 μg/24 h (165.6 nmol/24 h), (b) plasma ACTH <10.0 pg/ml (2.2 pmol/l) or (c) plasma cortisol >7.5 μg/dl (207 nmol/l) at 24:00 h or >1.4 μg/dl (38.6 nmol/l) after dexamethasone-CRH (serum cortisol after corticotrophin-releasing hormone stimulus during dexamethasone administration) test, and (iii) in whom the source of glucocorticoid excess was suggested by imaging and by additional biochemical tests (for ACTH-dependent ASH). Results: Prevalence of ASH was higher in diabetic individuals than in controls (9.4 versus 2.1%; adjusted odds ratio, 4.8; 95% confidence interval, 1.6–14.1; P = 0.004). In our population the proportion of T2D which is statistically attributable to ASH was approx. 7%. Among diabetic patients, the presence of severe diabetes (as defined by the coexistence of hypertension, dyslipidaemia and insulin treatment) was significantly associated with SH (adjusted odds ratio, 3.8; 95% confidence interval, 1.4–10.2; P = 0.017). Conclusions: In hospitalized patients, SH is associated with T2D.

scholarly journals Prevalence of Current Smoking and Association with Adverse Outcome in Hospitalized COVID-19 Patients: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Konstantinos Farsalinos ◽  
Konstantinos Poulas ◽  
Riccardo Polosa ◽  
Anastasia Barbouni ◽  
Pasquale Caponnetto ◽  
...  
Keyword(s):  
Systematic Review ◽  
Odds Ratio ◽  
Adverse Outcome ◽  
Smoking Status ◽  
Meta Analysis ◽  
Hospitalized Patients ◽  
Adverse Outcomes ◽  
Prevalence Odds Ratio ◽  
Current Smoking ◽  
Former Smokers

Background: The purpose of this study was to examine the prevalence and effects of current smoking on adverse outcomes among hospitalized COVID-19 patients. Methods: We performed a systematic review of the literature (PubMed) for studies published until April 25. Studies were included into the analysis if they satisfied all of the following criteria: 1. To present hospitalized patients with COVID-19. 2. To classify patients into less and more severe disease, irrespective of the severity definition (defined as &ldquo;adverse ourtcome&rdquo;). 3. To present data on the smoking status, separately for each severity classification. We identified 18 (from a total of 1398) relevant studies. Pooled current smoking prevalence was compared with the gender-adjusted, population-based expected prevalence by calculating Prevalence Odds Ratio (POR). The association between current, compared to non-current and former, smoking and adverse outcome was examined by calculating Odds Ratio (OR). All analyses were performed using random-effects meta-analysis. Results: Among 6515 patients, 440 of whom were current smokers, the pooled prevalence of current smoking was 6.8% (95%CI: 4.8-9.1%) and the POR was 0.21 (95%CI: 0.16-0.26, P &lt; 0.001). In Chinese studies only, the POR was 0.22 (95%CI: 0.17-0.27, P &lt; 0.001). Current smokers were more likely to have an adverse outcome compared to non-current smokers (OR: 1.53, 95%CI: 1.06-2.20, P = 0.022). However, they were less likely to have an adverse outcome compared to former smokers (OR: 0.42, 95%CI: 0.27-0.74, P = 0.003). Conclusion: An unexpectedly low prevalence of current smoking was observed among hospitalized patients with COVID-19. Hospitalized current smokers had higher odds compared to non-current smokers but lower odds compared to former smokers for an adverse outcome. The possibility that nicotine may have a protective effect in COVID-19 which may be masked by smoking-related toxicity and by the abrupt cessation of nicotine intake when smokers are hospitalized should be explored.

scholarly journals Effect of Recanalization on Cerebral Edema in Ischemic Stroke Treated With Thrombolysis and/or Endovascular Therapy

Stroke ◽  
2020 ◽  
Vol 51 (1) ◽  
pp. 216-223 ◽  
Author(s):  
Magnus Thorén ◽  
Anand Dixit ◽  
Irene Escudero-Martínez ◽  
Zuzana Gdovinová ◽  
Lukas Klecka ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Edema ◽  
Odds Ratio ◽  
Lower Risk ◽  
Adjusted Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Secondary Outcome ◽  
Stroke Treatment ◽  
Blood Brain Barrier Disruption

Background and Purpose— A large infarct and expanding cerebral edema (CED) due to a middle cerebral artery occlusion confers a 70% mortality unless treated surgically. Reperfusion may cause blood-brain barrier disruption and a risk for cerebral edema and secondary parenchymal hemorrhage (PH). We aimed to investigate the effect of recanalization on development of early CED and PH after recanalization therapy. Methods— From the SITS-International Stroke Treatment Registry, we selected patients with signs of artery occlusion at baseline (either Hyperdense Artery Sign or computed tomography/magnetic resonance imaging angiographic occlusion). We defined recanalization as the disappearance of radiological signs of occlusion at 22 to 36 hours. Primary outcome was moderate to severe CED and secondary outcome was PH on 22- to 36-hour imaging scans. We used logistic regression with adjustment for baseline variables and PH. Results— Twenty two thousand one hundred eighty-four patients fulfilled the inclusion criteria (n=18 318 received intravenous thrombolysis, n=3071 received intravenous thrombolysis+thrombectomy, n=795 received thrombectomy). Recanalization occurred in 64.1%. Median age was 71 versus 71 years and National Institutes of Health Stroke Scale score 15 versus 16 in the recanalized versus nonrecanalized patients respectively. Recanalized patients had a lower risk for CED (13.0% versus 23.6%), adjusted odds ratio (aOR), 0.52 (95% CI, 0.46–0.59), and a higher risk for PH (8.9% versus 6.5%), adjusted odds ratio, 1.37 (95% CI, 1.22–1.55), than nonrecanalized patients. Conclusions— In patients with acute ischemic stroke, recanalization was associated with a lower risk for early CED even after adjustment for higher rate for PH in recanalized patients.

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