Establishment of a Pig Influenza Challenge Model for Evaluation of Monoclonal Antibody Delivery Platforms

mAbs are a possible adjunct to vaccination and drugs in treatment of influenza virus infection. However, questions remain whether small animal models accurately predict efficacy in humans. We have established the pig, a large natural host animal for influenza, with many physiological similarities to humans, as a robust model for testing mAbs. We show that a strongly neutralizing mAb (2-12C) against the hemagglutinin head administered prophylactically at 15 mg/kg reduced viral load and lung pathology after pandemic H1N1 influenza challenge. A lower dose of 1 mg/kg of 2-12C or a DNA plasmid-encoded version of 2-12C reduced pathology and viral load in the lungs but not viral shedding in nasal swabs. We propose that the pig influenza model will be useful for testing candidate mAbs and emerging delivery platforms prior to human trials.

Ge-Sb-S-Se-Te amorphous chalcogenide thin films towards on-chip nonlinear photonic devices

Thanks to their unique optical properties Ge–Sb–S–Se–Te amorphous chalcogenide materials and compounds offer tremendous opportunities of applications, in particular in near and mid-infrared range. This spectral range is for instance of high interest for photonics or optical sensors. Using co-sputtering technique of chalcogenide compound targets in a 200 mm industrial deposition tool, we show how by modifying the amorphous structure of GeSb_wS_xSe_yTe_z chalcogenide thin films one can significantly tailor their linear and nonlinear optical properties. Modelling of spectroscopic ellipsometry data collected on the as-deposited chalcogenide thin films is used to evaluate their linear and nonlinear properties. Moreover, Raman and Fourier-transform infrared spectroscopies permitted to get a description of their amorphous structure. For the purpose of applications, their thermal stability upon annealing is also evaluated. We demonstrate that depending on the GeSb_wS_xSe_yTe_z film composition a trade-off between a high transparency in near- or mid-infrared ranges, strong nonlinearity and good thermal stability can be found in order to use such materials for applications compatible with the standard CMOS integration processes of microelectronics and photonics.

1058 Modeling Self-reported Sleep Duration And Hypertension Using Deep Learning Network: Analysis Of The National Health And Nutrition Examination Survey Data

Introduction

Epidemiologic data show strong associations between self-reported sleep duration and hypertension (HTN). Modeling these associations is suboptimal when utilizing traditional logistic regressions. In this study, we modeled the associations of sleep duration and HTN using Deep Learning Network.

Methods

Data were extracted from participants (n=38,540) in the National Health and Nutrition Examination Survey (2006-2016), a nationally representative study of the US civilian non-institutionalized population. Self-reported demographic, medical history and sleep duration were determined from household interview questions. HTN was determined as SBP ≥ 130 mmHg and DBP ≥ 80 mmHg. We used a deep neural network architecture with three hidden layers with two input features and one binary output to model associations of sleep duration with HTN. The input features are the hours of sleep (limited to between 4 and 10 hours) and its square; and the output variable HTN. Probability predictions were generated 100 times from resampled (with replacement) data and averaged.

Results

Participants ranged from 18 to 85 years old; 51% Female, 41% white, 22% black, 26% Hispanic, 46% married, and 25% < high school. The model showed that sleeping 7 hours habitually was associated with the least observed HTN probabilities (P=0.023%). HTN probabilities increased as sleep duration decreased (6hrs=0.05%; 5hrs=0.110%; 4hrs=0.16%); HTN probabilities for long sleepers were: (8hrs=0.027; 9hrs=0.024; 10hrs=0.022). Whites showed sleeping 7hrs or 9hrs was associated with lowest HTN probabilities (0.008 vs. 0.005); blacks showed the lowest HTN probabilities associated with sleeping 8hrs (0.07), and Hispanics showed the lowest HTN probabilities sleeping 7hrs (0.04).

Conclusion

We found that sleeping 7 hours habitually confers the least amount of risk for HTN. Probability of HTN varies as a function of individual’s sex and race/ethnicity. Likewise, the finding that blacks experience the lowest HTN probability when they sleep habitually 8 hours is of great public health importance.

Support

This study was supported by funding from the NIH: R01MD007716, R01HL142066, R01AG056531, T32HL129953, K01HL135452, and K07AG052685.

Blood CD9+ B cell, a biomarker of bronchiolitis obliterans syndrome after lung transplantation

Bronchiolitis obliterans syndrome is the main limitation for long-term survival after lung transplantation. Some specific B cell populations are associated with long-term graft acceptance. We aimed to monitor the B cell profile during early development of bronchiolitis obliterans syndrome after lung transplantation. The B cell longitudinal profile was analyzed in peripheral blood mononuclear cells from patients with bronchiolitis obliterans syndrome and patients who remained stable over 3 years of follow-up. CD24^hi CD38^hi transitional B cells were increased in stable patients only, and reached a peak 24 months after transplantation, whereas they remained unchanged in patients who developed a bronchiolitis obliterans syndrome. These CD24^hi CD38^hi transitional B cells specifically secrete IL-10 and express CD9. Thus, patients with a total CD9⁺ B cell frequency below 6.6% displayed significantly higher incidence of bronchiolitis obliterans syndrome (AUC = 0.836, PPV = 0.75, NPV = 1). These data are the first to associate IL-10-secreting CD24^hi CD38^hi transitional B cells expressing CD9 with better allograft outcome in lung transplant recipients. CD9-expressing B cells appear as a contributor to a favorable environment essential for the maintenance of long-term stable graft function and as a new predictive biomarker of bronchiolitis obliterans syndrome-free survival.

P5712Research Network in Africa (RNA): quality assessment of antihypertensive generic drugs in 10 African countries

Introduction

Hypertension results in more deaths than any other risk factor and has been on the rise in Sub-Saharan Africa over the past few decades. Generic drugs have helped improve accessibility and affordability of antihypertensive therapy in developing countries. However, assessment of quality standards of these products is important.

Purpose

We performed a quality assessment of five commonly used antihypertensive generic drugs in ten Sub-Saharan African countries and studied the impact of price on quality.

Methods

Drug samples were prospectively collected using standardized methods between 2012 and 2014. We developed a validated reversed-phase liquid chromatography with tandem mass spectrometry method to accurately quantify the active ingredient in a certified public laboratory. Quality was defined based on the percentage ratio of measured to expected dosage of active ingredient.

Results

A total of 1185 samples were assessed, of which 70.0% were generic (n=830). Among the generic drugs, the percentage of poor quality drugs was 24.3% (n=202/830). The percentage ratio of measured to expected dosage of active ingredient ranged from 49.2% to 111.3%; the majority (81.7%) of the poor quality samples had insufficient quantity of the active ingredient. Moreover, poor quality was not associated with purchase price of the drug.

Conclusion

In this study from ten Sub-Saharan African countries, nearly one-quarter of the available generic antihypertensive drugs were found to be of poor quality. Concerted measures to improve the quality of antihypertensive drugs could lead to major improvements in hypertension control with attendant reduction of its deleterious consequences in low and middle income countries.

Figure 1. Percentage of poor quality in generic antihypertensive drugs according to the country of purchase.

Acknowledgement/Funding

Grant AAP-2014-042, ANSM (Agence Nationale Sécurité du Médicament

Efficacy of DiaLife, an education program for relatives of adult patients with diabetes - study protocol of a cluster randomized controlled trial

Background

The global prevalence of diabetes mellitus (DM) has been increasing over recent decades. In Germany, the prevalence for DM type 1 and type 2 in adults is estimated at about 7.7%. Hence, diabetes has to be classified as a serious public health concern. Being diagnosed with DM and facing possible sequelae might have a negative impact on patients’ mental and physical well-being. However, diabetes not only affects patients themselves, but also their close relatives. To improve the quality of life for patients and relatives alike, the German Association of Diabetes Nurses and Education experts (VDBD) elaborated the first education program tailor-made for relatives of diabetes patients. This article describes the concept and design of the trial evaluating the efficacy of this education program called “DiaLife—Living Together with Diabetes”.

Methods

This evaluation study is a cluster randomized controlled trial, in which the study centers will be randomly assigned either to the intervention group or the control group. Study centers will recruit relatives of and patients with DM type 1 and type 2. Members of the intervention group will participate in the education program DiaLife, whereas participants randomized in the control group will act as waiting-list controls. The study will assess the efficacy of DiaLife by comparing diabetes-related knowledge between the intervention and control groups as the primary outcome for participants. As the primary outcome in patients, the Hba1c value will be assessed. In addition, diabetes-related distress, family interaction, and other secondary endpoints will be considered as secondary outcomes. Long-term efficacy will be assessed 6 and 12 months after intervention. Hierarchical regression models will be used to analyze effects over time.

Discussion

While there is scientific evidence for the efficacy of education programs addressed to (diabetes) patients, there is a research gap with regard to intervention studies evaluating the efficacy of education programs designed for patients’ relatives. The study results will provide information on the efficacy of the DiaLife education program. In addition, factors that might hinder a successful implementation of an education program for relatives will be identified.

Trial registration

German Clinical Trials Register, DRKS00015157. Registered on 24 August 2018.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3600-4) contains supplementary material, which is available to authorized users.

Assessment of proximal femur microarchitecture using ultra-high field MRI at 7 Tesla

PURPOSE

The purpose of this study was to investigate bone microarchitecture of cadaveric proximal femurs using ultra-high field (UHF) 7-Tesla magnetic resonance imaging (MRI) and to compare the corresponding metrics with failure load assessed during mechanical compression test and areal bone mineral density (ABMD) measured using dual-energy X-ray absorptiometry.

MATERIALS AND METHODS

ABMD of ten proximal femurs from five cadavers (5 women; mean age=86.2±3.8 (SD) years; range: 82.5-90 years) were investigated using dual-energy X-ray absorptiometry and the bone volume fraction, trabecular thickness, trabecular spacing, fractal dimension, Euler characteristics, connectivity density and degree of anisotropy of each femur was quantified using UHF MRI. The whole set of specimens underwent mechanical compression tests to failure. The inter-rater reliability of microarchitecture characterization was assessed with the intraclass correlation coefficient (ICC). Associations were searched using correlation tests and multiple regression analysis.

RESULTS

The inter-rater reliability for bone microarchitecture parameters measurement was good with ICC ranging from 0.80 and 0.91. ABMD and the whole set of microarchitecture metrics but connectivity density significantly correlated with failure load. Microarchitecture metrics correlated to each other but did not correlate with ABMD. Multiple regression analysis disclosed that the combination of microarchitecture metrics and ABMD improved the association with failure load.

CONCLUSION

Femur bone microarchitecture metrics quantified using UHF MRI significantly correlated with biomechanical parameters. The multimodal assessment of ABMD and trabecular bone microarchitecture using UHF MRI provides more information about fracture risk of femoral bone and might be of interest for future investigations of patients with undetected osteoporosis.

[Treatment of degenerative meniscal lesions : From eminence to evidence-based medicine]

BACKGROUND

The treatment of degenerative meniscal lesions has received increased attention since the publication of several Level 1 studies over the last few years. The following review of literature including the consensus statement given by ESSKA reports on the management of patients with degenerative meniscal lesions.

MATERIAL AND METHODS

The analysis includes the literature of Level 1 to 4 studies and the statement of the consensus group of ESSKA concerning the surgical or conservative management of these patients.

RESULTS

Meniscal lesions cause progression in osteoarthritis. Patients presenting a combination of degenerative meniscal lesion and osteoarthritis show inferior clinical outcome. The average clinical outcome after surgical treatment was 70 points based on the Lysholm score. Level 1 studies show no difference in clinical outcome. However, over 30% of these patients require arthroscopy at the second stage after an interval of 3 to 6 months. Patients presenting a flap tear or complaining about mechanical symptoms show poor outcome after conservative treatment.

DISCUSSION

Level 1 studies have focused on very selected patients. These patients do not represent the daily practice of orthopaedic surgeons. The findings of the level 1 studies should, therefore, not be generalized. According to the consensus statement of ESSKA, the treatment of degenerative meniscal lesions should start with conservative management. In the case of persistent symptoms, surgery should be considered after 3 months. In the case of mechanical symptoms, arthroscopy might be indicated earlier. Arthroscopy in advanced osteoarthritic knees is not indicated due to inferior clinical outcome.

Effect of increasing the proportion of chicory in forage-based diets on intake and digestion by sheep

There is a lot of evidence that chicory could be a highly palatable and nutritious source of forage for ruminants, well adapted to climate change and dry conditions in summer, thanks to its resistance to drought and high water content. This study aimed to describe the effect of incorporating chicory to ryegrass or to a ryegrass-white clover mixture on feeding behaviour, digestive parameters, nitrogen (N) balance and methane (CH4) emissions in sheep. In total, three swards of ryegrass, white clover and chicory were established and managed in a manner ensuring the forage use at a constant vegetative stage throughout the experiment. In all, four dietary treatments (pure ryegrass; binary mixture: 50% ryegrass-50% chicory; ternary mixture: 50% ryegrass-25% white clover-25% chicory; and pure chicory) were evaluated in a 4×4 replicated Latin square design with eight young castrated Texel sheep. Each experimental period consisted of an 8-day diet adaptation phase, followed by a 6-day measuring phase during which intake dynamics, chewing activity, digestibility, rumen liquid passage rate, fermentation end-products, N balance and CH4 emissions were determined. Data were analysed using a mixed model and orthogonal contrasts were used to detect the potential associative effects between ryegrass and chicory. The daily voluntary dry matter intake was lower for pure ryegrass than for diets containing chicory (P<0.001) and increased quadratically from 1.39 to 1.74 kg/day with increasing proportion of chicory. Huge positive quadratic effects (P<0.001) between ryegrass and chicory were detected on eating time and eating rate just after feeding indicating an increase of the motivation to eat with mixtures, whereas rumination activity decreased linearly with the proportion of chicory (P<0.001). The organic matter digestibility was similar among treatments (around 80%), but a strong positive quadratic P<0.001) effect was observed on liquid passage rate suggesting that chicory allowed fast particle breakdown in the rumen. Animals fed with the ryegrass-white clover-chicory mixture had the higher urinary N losses (P<0.001), whereas retained N per day or per g N intake was greater when the proportion of chicory was at least 50% (P<0.001) being ~40% greater than for the other treatments. The CH4 yield was lower with pure chicory than with the other treatments (P<0.001) for which emissions were similar. In conclusion, mixing ryegrass and chicory in equal proportions produces a synergy on voluntary intake and an improved N use efficiency likely due to complementarity in chemical composition, increased motivation to eat and faster ruminal particle breakdown.

Kinetically Enhanced Fabrication of Homogeneous Biomimetic and Functional Emulsion Droplets

Characterized by a fluid and deformable interface, ligand-functionalized emulsion droplets are used as model probes to address biophysical, biological, and developmental questions. Functionalization protocols usually rely on the use of headgroup-modified phospholipids that are dissolved in the oil phase prior to emulsification, leading to a broad range of surface densities within a given droplet population. With the aim to coat particles homogeneously with biologically relevant lipids and proteins (streptavidin, immunoglobulins, etc.), we developed a reliable surface decoration protocol based on the use of polar cosolvents to dissolve the lipids in the aqueous phase after the droplet production. We show that the surface density of the lipids at the interface has a narrow normal distribution for droplets having the same size. We performed titration isotherms for lipids and biologically relevant proteins on these drops. Then, we studied the influence of the presence of surfactants in the medium on lipid insertion and compared the results for a range of polar cosolvents of increasing polarity. To assess both the generality and the biocompatibility of the method, we show that we can produce more sophisticated, monodisperse functional magnetic emulsions with a very high surface homogeneity. Using an oil denser than the surrounding culture medium, we show that IgG-coated droplets can be used as probes for phagocytosis experiments.

Chemistry of resistivity changes in TiTe/Al2O3 conductive-bridge memories

We report the chemical phenomena involved in the reverse forming (negative bias on top electrode) and reset of a TaN/TiTe/Al2O3/Ta memory stack. Hard X-ray photoelectron spectroscopy was used to conduct a non-destructive investigation of the critical interfaces between the electrolyte (Al2O3) and the TiTe top and Ta bottom electrodes. During reverse forming, Te accumulates at the TiTe/Al2O3 interface, the TiOx layer between the electrolyte and the electrode is reduced and the TaOx at the interface with Al2O3 is oxidized. These interfacial redox processes are related to an oxygen drift toward the bottom electrode under applied bias, which may favour Te transport into the electrolyte. Thus, the forming processes is related to both Te release and also to the probable migration of oxygen vacancies inside the alumina layer. The opposite phenomena are observed during the reset. TiOx is oxidized near Al2O3 and TaOx is reduced at the Al2O3/Ta interface, following the O2- drift towards the top electrode under positive bias while Te is driven back into the TiTe electrode.

Active cushing syndrome patients have increased ectopic fat deposition and bone marrow fat content compared to cured patients and healthy subjects: a pilot 1H-MRS study

OBJECTIVE

Glucocorticoid excess is one of the most important causes of bone disorders. Bone marrow fat (BMF) has been identified as a l new mediator of bone metabolism. Cushing syndrome (CS), is a main regulator of adipose tissue distribution but its impact on BMF is unknown. The objective of the study was to evaluate the effect of chronic hypercortisolism on BMF.

DESIGN

This was a cross-sectional study. Seventeen active and seventeen cured ACTH-dependent CS patients along with seventeen controls (matched with the active group for age and sex) were included.

METHODS

the BMF content of the femoral neck and L3 vertebrae were measured by 1H-MRS on a 3-Tesla wide-bore magnet. BMD was evaluated in patients using dual-energy X-ray absorptiometry.

RESULTS

Active CS patients had higher BMF content both in the femur (82.5±2.6%) and vertebrae (70.1±5.1%) compared to the controls (70.8±3.6%, p=0.013 and 49.0±3.7% p=0.005, respectively). In cured CS patients (average remission time of 43 months), BMF content was not different from controls at both sites (72.3±2.9% (femur) and 46.7%±5.3% (L3)). BMF content was positively correlated with age, fasting plasma glucose, HbA1c, triglycerides and visceral adipose tissue in the whole cohort and negatively correlated with BMD values in the CS patients .

CONCLUSIONS

Accumulation of BMF is induced by hypercortisolism. In remission patients BMF reached values of controls. Further studies are needed to determine whether this increase in marrow adiposity in CS is associated with bone loss.

Distribution of left ventricular trabeculation across age and gender in 140 healthy Caucasian subjects on MR imaging

PURPOSE

The purpose of this study was to quantify the distribution of trabeculated (T) and compact (C) left ventricular (LV) myocardium masses in a healthy Caucasian population against age, gender and LV parameters, and to provide normal values for T, C and T/C.

MATERIALS AND METHODS

One hundred and forty healthy subjects were prospectively recruited and underwent cardiac MRI at 1.5T with a stack of short-axis cine sequences covering the entire LV. End-diastolic volume (EDV), C and T masses were quantified using a semi-automatic method. Ejection fraction (EF) and T/C ratio were computed.

RESULTS

We included 70 men and 70 women with a mean age of 44±14 (SD) years (range: 20-69 years). The mean EF was 63.7±6.3 (SD) % (range: 50.7-82.0%), the mean EDV was 75.9±16.2 (SD) mL/m² (range: 36.4-112.2mL/m²), the mean C mass was 53.9±11.2 (SD) g/m² (range: 26.5-93.4g/m²) and the mean T mass was 4.9±2.4 (SD) g/m² (range: 1.1-11.4g/m²). The T/C ratio was 9.2±4.5% (range: 2.0-29.4%). Multivariate ANOVA test showed that the compact mass was influenced by EDV (P<0.0001), EF (P=0.001) and gender (P<0.0001), and the trabeculated mass depended on EDV (P<0.0001), gender (P=0.002) and age (P<0.0001), while the T/C ratio was only influenced by age (P=0.0003). Spearman test showed a correlation between EDV and C (r=0.60; P<0.0001),T (r=0.46; P<0.0001) and T/C ratio (r=0.26; P=0.0023).T and T/C ratio correlated with EF (r=-0.18, P=0.0373; r=-0.18, P=0.0321, respectively).

CONCLUSION

While the compact and trabeculated myocardium masses appear to relate separately to the cardiac function, age and gender, their ratio T/C appears to only decrease with age. Furthermore, we propose here normal values for T, C and T/C in a cohort of healthy Caucasians subjects.

Hyponatremia and activation of vasopressin secretion are both independently associated with 30-day mortality: results of a multicenter, observational study

BACKGROUND

Hyponatremia is a common feature of acute illness and associated with increased mortality. This may be explained by a stress-mediated activation of the vasopressin system with an increase in free-water reabsorption.

OBJECTIVES

To investigate whether the association between hyponatremia and mortality could be explained by activation of the vasopressin system.

METHODS

We prospectively enrolled adult, medical patients seeking emergency care in three centres in Switzerland, France and the United States. We investigated associations between admission plasma sodium and copeptin, a stable portion of the vasopressin-precursor peptide, with 30-day mortality. We performed uni- and multivariate regression analysis.

RESULTS

Of 6962 included patients, 18% had hyponatremia (sodium ≤135 mmol L^-1 ), which doubled their risk for mortality compared to patients with normonatremia (8.3% vs. 3.8%). This association was confirmed in a multivariate-adjusted logistic regression analysis [adjusted odds ratio (OR) 1.47, 95% CI 1.12-1.93, P = 0.005]. Vasopressin levels, mirrored by copeptin, were also increased in nonsurvivors and strongly associated with mortality (adjusted OR 3.42, 95% CI 2.76-4.25, P < 0.001). The association between hyponatremia and mortality remained unchanged when adding copeptin levels to the regression model (fully adjusted OR 1.53, 95% CI 1.16-2.00, P = 0.002).

CONCLUSION

This prospective study including medical patients upon emergency room admission found hyponatremia as well as an activation of the vasopressin system to be independently associated with mortality. This suggests that stress- and vasopressin-independent mechanisms are responsible for the association of low sodium levels with mortality.

Abstract P5-22-23: Electrochemotherapy : A new local therapy for cutaneous metastases of breast cancer

Background : Electrochemotherapy (ECT) is a new local therapy combining the administration of an intravenous chemotherapy (bleomycin) followed by the direct application of electric pulses by an electrode to the treated areas. Electric pulses transiently permeabilize the membrane of the tumor cell ( electroporation), improving intracellular diffusion of a poorly permeant chemotherapeutic agent, ithereby ncreasing its cytotoxicity and decreasing systemic toxicity.

ECT can be offered to patients with cutaneous or subutaneous metastases of breast cancer who are no longer suitable for extensive surgery or radiotherapy ( e.g. due to past irradiation of the breast or chest wall).

ECT 's applications are palliative. It is -, delivered with the aim of local control of the tumor, relief of symptoms associated with cutaneous recurrence -(ulceration, bleeding, pain),i and mproving patients'quality of life.

The aim of this study is to demonstrate that ECT has a high efficacity and a low toxicity profile making it an interesting alternative to conventional therapies.

Material and methods : our study is a retrospective study (approved by our local ethics committee) which included 8 patients between June 2013 and June 2016. The patients had histologically proven cutaneous and or subcutaneous metastases of their breast cancer, without any sign of lymphangitis. All the tumors expressed ER and /or PgR and 2 of them were HER2 positive tumors. The patients received a single or multiple courses of ECT ; the outcomes were clinical response, toxicity, local and distant recurrence. The two patients whose tumors expressed HER2, also had synchronous controlateral axillary nodal metastases. They underwent axillary dissection performed during ECT course. Among the six other patients, no other metastases than cutaneous lesions were observed.

Results : The 8 included patients had already received chest wall irradiation for the treatment of their primary breast cancer. A total of 37 nodules were treated (mean : 4.5 per patient), whose mean size was 17mm (10-34mm). Six patients(75%) had a complete response after a single course of ECT. Two patients exhibited a partial response and underwent a second course of ECT at 6 months. The two patients with Her2 positive tumors received taxane-based chemotherapy and anti HER2 agents. All the patients were also given endocrine therapy. After a median follow up of 26 months (11-47 months), no patient had a local cutaneous recurrence. Overall survival rate was 75% : 2 patients died following progression of systemic disease (pulmonary and hepatic metastases).

No complications due to toxicity were observed.

Discussion and conclusion :In selected patients with ( cutaneous and subcutaneous metastases of breast cancer with no sign of lymphangitis), ECT offers a very good rate of clinical response and a durable control of metastases. This innovative technique has the advantage of being minimally –invasive and well –tolerated.

Citation Format: Berliere M, Raguzzi E, Bernard M, Gerday A, Coyette M, Piette P, Duhoux F, Lengele B. Electrochemotherapy : A new local therapy for cutaneous metastases of breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-22-23.

The association of admission hyperglycaemia and adverse clinical outcome in medical emergencies: the multinational, prospective, observational TRIAGE study

AIMS

The clinical relevance of hyperglycaemia in an emergency department population remains incompletely understood. We investigated the association between admission blood glucose levels and adverse clinical outcomes in a large emergency department cohort.

METHODS

We prospectively enrolled 7132 adult medical patients seeking emergency department care in three tertiary care hospitals in Switzerland, France and the USA. We used adjusted multivariable logistic regression models to examine the association between admission blood glucose levels and 30-day mortality, as well as adverse clinical course stratified by pre-existing diabetes and principal medical diagnoses.

RESULTS

In 6044 people without diabetes (84.7%), severe hyperglycaemia, defined as a glucose level of > 11.1 mmol/l (200 mg/dl), was associated with a doubling in the risk of 30-day mortality [adjusted odds ratio (OR) 1.9; 95% confidence interval (95% CI), 1.1 to 3.3; P = 0.018] and a three-fold increase in the risk of intensive care unit admission (adjusted OR 3.0; 95% CI, 1.9 to 4.9; P < 0.001). These associations were similar among different diagnoses. In the population with diabetes (n = 1088), no association with 30-day mortality was found (adjusted OR 1.0; 95% CI, 0.6 to 1.8; P for interaction = 0.001), whereas the association with intensive care unit admission was weaker (adjusted OR 2.4; 95% CI, 1.5 to 4.1; P for interaction = 0.011). Overall 30-day mortality was higher in those with diabetes than in those without (6.1 vs. 4.4%, P = 0.015).

CONCLUSIONS

In this large medical emergency department patient cohort, admission hyperglycaemia was strongly associated with adverse clinical course in people without diabetes. (Clinical Trial Registry No: NCT01768494).