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Teaima T, Carlini GB, Gajjar RA, Aziz I, Shoura SJ, Shilbayeh AR, Battikh N, Alyousef T. Rates, predictors, and causes of readmission after transcatheter aortic valve replacement in patients with chronic kidney disease. World J Cardiol 2024; 16:402-411. [DOI: 10.4330/wjc.v16.i7.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/09/2024] [Accepted: 06/06/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is a revolutionary procedure for severe aortic stenosis. The coexistence of chronic kidney disease (CKD) and TAVR introduces a challenge that significantly impacts patient outcomes.
AIM To define readmission rates, predictors, and causes after TAVR procedure in CKD stage 1-4 patients.
METHODS We used the national readmission database 2018 and 2020 to look into readmission rates, causes and predictors after TAVR procedure in patients with CKD stage 1-4.
RESULTS Out of 24758 who underwent TAVR and had CKD, 7892 (32.4%) patients were readmitted within 90 days, and had higher adjusted odds of being females (adjusted odds ratio: 1.17, 95%CI: 1.02-1.31, P = 0.02) with longer length of hospital stay > 6 days, and more comorbidities including but not limited to diabetes mellitus, anemia, and congestive heart failure (CHF).
CONCLUSION Most common causes of readmission included CHF (18.0%), sepsis, and complete atrioventricular block. Controlling readmission predictors with very close follow-up is warranted to prevent such high rate of readmission.
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Affiliation(s)
- Taha Teaima
- Division of Cardiology, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Gianfranco Bittar Carlini
- Division of Cardiology, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Rohan A Gajjar
- Division of Cardiology, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Imran Aziz
- Division of Cardiology, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Sami J Shoura
- Division of Cardiology, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Abdul-Rahim Shilbayeh
- Division of Cardiology, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Naim Battikh
- Division of Cardiology, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, United States
| | - Tareq Alyousef
- Division of Cardiology, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, United States
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do Nascimento MK, Costa Pereira JPD, de Araújo JO, Gonzalez MC, Fayh APT. Exploring the role of body mass index-adjusted calf circumference within the SARC-CalF screening tool among older patients with cancer. J Nutr Health Aging 2024; 28:100251. [PMID: 38677077 DOI: 10.1016/j.jnha.2024.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/02/2024] [Accepted: 04/17/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES This study aimed to assess and compare the frequency of positive scores using unadjusted SARC-CalF with the scores derived from SARC-CalF after adjusting calf circumference (CC) for body mass index (BMI). The secondary aim was to assess the prognostic value of SARC-CalF after BMI adjustment, for length of hospital stay (LOS) and mortality. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis of a prospective cohort study, included both outpatients and inpatients of an oncology unit hospital in Brazil. MEASUREMENTS BMI and CC were measured. Patients with excess weight had their CC adjusted for BMI by subtracting 3 cm, 7 cm, and 12 cm from the unadjusted CC values for respective BMI categories. SARC-CalF was used to screen for sarcopenia. Scores ≥11 were indicative of sarcopenia, considering both unadjusted and BMI-adjusted CC values. Clinical outcomes included prolonged LOS and both short- and long-term mortality. RESULTS Our study included 206 subjects, with a median age of 69 years, and the majority were males (52.1%). The prevalence of low CC increased from 65% to 84% after BMI adjustment. Positive unadjusted SARC-CalF scores (≥11) were observed in 51% of the population and this prevalence increased to 65% using BMI-adjusted SARC-CalF criteria (≥11). Higher scores on BMI-adjusted SARC-CalF but not unadjusted SARC-CalF were independently associated with prolonged LOS [adjusted HR: 1.26 (1.03-1.53)], and 6-month mortality [adjusted HR: 1.42 (1.07-1.87)]. Both unadjusted and BMI-adjusted SARC-CalF were independently associated with 12-month mortality. CONCLUSION BMI-adjusted SARC-CalF may be a promising strategy to enhance the detection of older patients with cancer and excess weight at risk of sarcopenia, and it may serve a dual role as a prognostic tool, as it was independently associated with prolonged LOS and mortality.
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Affiliation(s)
- Maria Karolainy do Nascimento
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Jarson Pedro da Costa Pereira
- Postgraduate Program in Nutrition and Public Health, Department of Nutrition, Federal University of Pernambuco, Recife, PE, Brazil
| | - Janaína Oliveira de Araújo
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - M Cristina Gonzalez
- Postgraduate Program in Nutrition and Food, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Ana Paula Trussardi Fayh
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil; PesqClin Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH), Federal University of Rio Grande do Norte, Natal, RN, Brazil.
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Machado Scott L, Potrick Stefani G, Soares CH, Scortegagna Crestani M, Steemburgo T. Low Calf Circumference is Associated with Prolonged Hospital Stay in Older Patients with Solid Tumors: A Secondary Analysis of a Cohort Study. Nutr Cancer 2024:1-10. [PMID: 38909290 DOI: 10.1080/01635581.2024.2364390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/31/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Older patients with cancer present intense loss of muscle mass (MM). Calf circumference (CC) is a simple measurement that assesses MM. This study analyzed the accuracy and association between low CC and negative outcomes in older patients with solid tumors. METHODS A secondary analysis of a prospective cohort study of inpatients with cancer was conducted. Low CC was defined as CC ≤34 cm in males and ≤33 cm in females. The CC was adjusted for body mass index by reducing 3 or 7 cm for BMI (in kg/m2) of 25-29.9 and 30-39.9, respectively. Accuracy tests and regression analyses were performed to evaluate the criterion validity of low CC for predicting length of stay (LOS) and readmission. RESULTS A total of 248 inpatients were evaluated (69.7 [standard deviation (SD) 7.2]; 59.7% men). Among them, 31% had a low CC. A low CC (crude and adjusted for BMI) showed poor performance in predicting LOS and readmission. In the adjusted analysis, older patients with low CC had a 2.45-fold increased risk of LOS ≥ 4 days. CONCLUSION Low CC did not perform well in predicting negative outcomes in older patients with solid tumors. However, low CC was positively associated with LOS.
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Affiliation(s)
- Laura Machado Scott
- Department of Nutrition, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Giovanna Potrick Stefani
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Camilla Horn Soares
- Department of Nutrition, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Mariana Scortegagna Crestani
- Department of Nutrition, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Thais Steemburgo
- Department of Nutrition, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Costa Pereira JPD, Gonzalez MC, Prado CM, Cabral PC, Nascimento TGD, Nascimento MKD, Diniz ADS, Ramiro CPSP, Fayh APT. Body mass index-adjusted calf circumference is associated with mortality in hospitalized older patients with excess weight. Nutrition 2024; 125:112505. [PMID: 38981374 DOI: 10.1016/j.nut.2024.112505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES Given the innovative nature of the method, our study aimed to assess the prognostic significance of body mass index (BMI)-adjusted calf circumference (CC) in older patients who are hospitalized. METHODS This was a unique analysis as part of other cohorts comprising general hospitalized patients aged 60 years or older of both sexes. Only patients with excess weight (BMI ≥ 25 kg/m2) were included. CC was adjusted by reducing 3, 7, or 12 cm for BMI (in kg/m2) within 25-29.9, 30-39.9, and ≥40 kg/m2, respectively. CC was considered low if ≤ 34 cm for males and ≤ 33 cm for females. Clinical outcomes included prolonged length of hospital stay (LOS) and mortality. RESULTS A total of 222 patients were included. After BMI adjustments, 72.1% of the patients were reclassified from a normal CC category to a low CC category. The frequency of low CC increased from 33.8% to 81.9% following BMI adjustments. Among those reclassified to the low CC, 11 died, compared to only 2 patients in the group that maintained a normal CC classification. BMI-adjusted CC was inversely associated with mortality (HR adjusted 0.84, 95% CI 0.73 to 0.95), but not with prolonged LOS. CONCLUSIONS Our novel study highlights the prognostic value of BMI-adjusted CC. As an anthropometric marker of muscle mass, it proved to be a predictor of mortality in older patients with high BMI. This adjustment is further important because it may help to better detect low muscle mass in these patients where such conditions might be masked.
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Affiliation(s)
- Jarson Pedro da Costa Pereira
- Postgraduate Program in Nutrition and Public Health, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Maria Cristina Gonzalez
- Postgraduate Program in Nutrition and Food, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Poliana Coelho Cabral
- Postgraduate Program in Nutrition and Public Health, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Tais Galdencio do Nascimento
- Postgraduate Program in Nutrition and Public Health, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Maria Karolainy do Nascimento
- Postgraduate Program in Health Science, Health Science Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Alcides da Silva Diniz
- Postgraduate Program in Nutrition and Public Health, Department of Nutrition, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Claudia Porto Sabino Pinho Ramiro
- Hospital of Clinics, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Brazilian Company of Hospital Services, EBSERH, Recife, Pernambuco, Brazil; Emergency Cardiology Unit of the University of Pernambuco, Recife, Pernambuco, Brazil
| | - Ana Paula Trussardi Fayh
- Postgraduate Program in Health Science, Health Science Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; PesqClin Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH), Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
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Araújo VA, Souza JS, Giglio BM, Lobo PCB, Pimentel GD. Association of Calf Circumference with Clinical and Biochemical Markers in Older Adults with COVID-19 Admitted at Intensive Care Unit: A Retrospective Cross-Sectional Study. Diseases 2024; 12:97. [PMID: 38785752 PMCID: PMC11119336 DOI: 10.3390/diseases12050097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND COVID-19 is an infectious disease characterized by a severe catabolic and inflammatory state, leading to loss of muscle mass. The assessment of muscle mass can be useful to identify nutritional risk and assist in early management, especially in older adults who have high nutritional risks. The aim of this study was to evaluate the association of calf circumference (CC) with clinical and biochemical markers and mortality in older adults with COVID-19 admitted to the intensive care unit (ICU). METHODS A retrospective cross-sectional study was conducted in a public hospital. CC was adjusted for body mass index (BMI), reducing 3, 7, or 12 cm for a BMI of 25-29.9, 30-39.9, and ≥40 kg/m2, respectively, and classified as reduced when <33 cm for women and <34 cm for men. Pearson's correlation between BMI and CC was performed to assess the association between variables. Regression analysis was adjusted for sex, age, and BMI variables. Cox regression was used to assess survival related to CC. RESULTS A total of 208 older adults diagnosed with COVID-19 admitted to ICU were included, of which 84% (n = 176) were classified as having reduced CC. These patients were older, with lower BMI, higher nutritional risk, malnourished, and higher concentration of urea and urea-creatinine ratio (UCR) compared with the group with normal CC. There was an association between edematous patients at nutritional risk and malnourished with reduced CC in the Cox regression, either adjusted or not for confounding. CONCLUSIONS CC was not associated with severity, biochemical markers, or mortality in older adults with COVID-19 admitted to the ICU, but it was associated with moderately malnourished patients assessed by subjective global assessment (SGA).
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Affiliation(s)
| | | | | | | | - Gustavo D. Pimentel
- Faculty of Nutrition, Federal University of Goiás, Goiânia 74605080, Brazil; (V.A.A.); (J.S.S.); (B.M.G.); (P.C.B.L.)
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Bernardes S, Stello BB, Milanez DSJ, Razzera EL, Silva FM. Absence of association between low calf circumference, adjusted or not for adiposity, and ICU mortality in critically ill adults: A secondary analysis of a cohort study. JPEN J Parenter Enteral Nutr 2024; 48:291-299. [PMID: 38142302 DOI: 10.1002/jpen.2595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/08/2023] [Accepted: 12/15/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Despite its correlation with skeletal muscle mass and its predictive value for adverse outcomes in clinical settings, calf circumference is a metric underexplored in intensive care. We aimed to determine whether adjusting low calf circumference for adiposity provides prognostic value superior to its unadjusted measurement for intensive care unit (ICU) mortality and other clinical outcomes in critically ill patients. METHODS In a secondary analysis of a cohort study across five ICUs, we assessed critically ill patients within 24 h of ICU admission. We adjusted calf circumference for body mass index (BMI) (25-29.9, 30-39.9, and ≥40) by subtracting 3, 7, or 12 cm from it, respectively. Values ≤34 cm for men and ≤33 cm for women identified low calf circumference. RESULTS We analyzed 325 patients. In the primary risk-adjusted analysis, the ICU death risk was similar between the low and preserved calf circumference (BMI-adjusted) groups (hazard ratio, 0.90; 95% CI, 0.47-1.73). Low calf circumference (unadjusted) increased the odds of ICU readmission 2.91 times (95% CI, 1.40-6.05). Every 1-cm increase in calf circumference as a continuous variable reduced ICU readmission odds by 12%. Calf circumference showed no significant association with other clinical outcomes. CONCLUSION BMI-adjusted calf circumference did not exhibit independent associations with ICU and in-hospital death, nor with ICU and in-hospital length of stay, compared with its unadjusted measurement. However, low calf circumference (unadjusted and BMI-adjusted) was independently associated with ICU readmission, mainly when analyzed as a continuous variable.
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Affiliation(s)
- Simone Bernardes
- Nutrition Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Bruna Barbosa Stello
- Nutrition Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | | | - Elisa Loch Razzera
- Nutrition Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Flávia Moraes Silva
- Nutrition Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Alves VA, Fayh APT, Queiroz SA, Gonzalez MC, de Sousa IM. Muscle mass evaluation in hospitalized patients: Comparison between doubly indirect methods. Clin Nutr ESPEN 2024; 59:188-193. [PMID: 38220375 DOI: 10.1016/j.clnesp.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Loss of muscle mass (MM) in hospitalized patients has been associated with negative outcomes, thus, evaluating this biomarker is important to stratify risk. Although studies have been showing that calf circumference (CC) and bioelectrical impedance analysis (BIA) are valid for estimating MM in hospitalized patients, we do not know if they are associated. The aim of this study was to evaluate the associations between CC and BIA in hospitalized patients. METHODS A cross-sectional study, in hospitalized patients' post-acute cardiac event. We collected sociodemographic, clinical, and anthropometric data. CC measurement was adjusted according to the BMI. Spearman's correlations and associations between the methods were performed for the total sample, according to sex and stage of life (older adults or not). RESULTS We included 177 patients, mean age of 60.5 ± 12.4 years old, the majority males (75 %). Median BMI was 26.2 kg/m2 (23.8-29.2 kg/m2), most of them overweight (41.8 %). The median of CC was lower in females and older adults, and majority of the patients had low CC (87.6 %). Higher values of fat-free mass (FFM) by BIA were observed in males and younger adults, and 5.6 % presented low FFMI. We found a positive and moderate correlation between fat-free mass index (FFMI) and CC (rho = 0.532). Males had higher correlations (rho = 0.481). An increase of 1 kg in the FFM represented an increase of 1.16 cm (crude analysis) to 1.59 cm (adjusted analysis) in CC (p < 0.001). FFM explained 37 % in the variability of CC, and together with BMI, sex and age, explained 60 % in the variability. CONCLUSIONS Raw values of FFM obtained by BIA and CC presented a weak to moderate correlation in cardiac patients. Changes in one measure impact on the other one.
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Affiliation(s)
- Viviane Andrade Alves
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ana Paula Trussardi Fayh
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil; Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
| | - Sandra Azevedo Queiroz
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | | | - Iasmin Matias de Sousa
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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