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Wu A, Yue H, Huang F, Chen J, Xie F, Wang J, Wu J, Geng Z. Serum β2-microglobulin is closely associated with 3-month outcome of acute intracerebral hemorrhage: a retrospective cohort study. Ir J Med Sci 2023; 192:1875-1881. [PMID: 36169913 DOI: 10.1007/s11845-022-03170-z] [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: 08/14/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is a frequent type of hemorrhagic stroke. Numerous studies have suggested that inflammation plays an important role in the injury and recovery of ICH. β2-microglobulin (β2M) is an inflammatory indicator with an unclear association with ICH development. This study aimed to explore the role of β2M in the outcome of patients with ICH after 3 months of ICH onset. METHODS The β2M and other baseline information of 231 patients with ICH were assessed (83 females and 148 males). We followed up with all patients 3 months after ICH onset, and severe disability or a worse outcome was our main focus. We collected the serum β2M levels, National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores, and other relevant baseline information of each patient. We used multiple regression analysis to explore the association between β2M levels and follow-up outcomes. RESULTS Our results indicated that the β2M level of the good outcome (2.35 ± 0.84 mg/l) group was significantly lower than that of the poor outcome group (3.06 ± 1.71 mg/l) (P < 0.001). Further multiple regression analysis showed that β2M was regarded as a risk factor that was closely associated with the poor outcome 3 months after ICH onset (odds ratio = 2.26, 95% confidence interval = 1.22-4.19, P = 0.009). Further correlation analysis revealed that β2M was significantly correlated with NIHSS scores (r = 0.187, P = 0.004) and follow-up mRS scores (r = 0.25, P < 0.001). CONCLUSION β2M was a risk factor for early outcome after ICH onset, and high β2M level was associated with short-time poor prognosis of ICH patients.
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Affiliation(s)
- Aimei Wu
- Department of Neurology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
| | - Hong Yue
- Department of Neurology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
| | - Fang Huang
- Department of Neurology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
| | - Jing Chen
- Department of Neurology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
| | - Fei Xie
- Department of Neurology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
| | - Juan Wang
- Department of Neurology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
| | - Juncang Wu
- Department of Neurology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China
| | - Zhi Geng
- Department of Neurology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, 230011, Anhui, China.
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, 230022, China.
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, 230022, China.
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Zhang L, Chen Y, Liu J, Yu Y, Cui H, Chen Q, Chen K, Yang C, Yang Y. Novel physical performance-based models for activities of daily living disability prediction among Chinese older community population: a nationally representative survey in China. BMC Geriatr 2022; 22:267. [PMID: 35361135 PMCID: PMC8974010 DOI: 10.1186/s12877-022-02905-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Physical performances including upper and lower limb functions have predictive roles in activities of daily living (ADL) disability, but they have rarely been incorporated into prediction models. This study primarily aimed to develop and validate novel physical performance-based models for ADL disability among Chinese older adults. Comparisons of predictive performance across multiple models were performed, and model simplification was further explored. Methods Data were obtained from the China Health and Retirement Longitudinal Study in the 2011 and 2015 waves, containing 2192 older adults over 60 years old. Our models were constructed by logistic regression analysis, using a backward stepwise selection. Model performance was internally validated by discrimination, calibration, and clinical utility. Integrated Discrimination Improvement (IDI) and Net Reclassification Improvement (NRI) were used to assess the incremental benefit of the extended models. Moreover, nomograms were built for visualization. Results We selected gender, age, smoking, self-report health condition, BMI, depressive symptoms, and cognitive function into the fundamental model (Model 1). Based on Model 1, five novel prediction models were constructed by adding handgrip strength (Model 2), Short Physical Performance Battery (SPPB) (Model 3), gait speed (Model 4), handgrip strength plus SPPB (Model 5), and handgrip strength plus gait speed (Model 6), respectively. Significant improvement in predictive values were observed for all five novel models compared with Model 1 (C-index = 0.693). The lower limb model (Model 3 SPPB model: C-index = 0.731) may play a key role in the prediction of ADL disability, reflecting a comparable predictive value to the comprehensive models combining both upper and lower limbs (Model 5 handgrip strength + SPPB model: C-index = 0.732). When we simplified the lower limb models by replacing SPPB with gait speed, the predictive values attenuated slightly (C-index: Model 3 vs Model 4: 0.731 vs 0.714; Model 5 vs Model 6: 0.732 vs 0.718), but still better than the upper limb model (Model 2 handgrip strength model: C-index = 0.701). Conclusions Physical performance-based models, especially lower limb model, provided improved prediction for ADL disability among Chinese older adults, which may help guide the targeted intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02905-y.
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Affiliation(s)
- Li Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17 Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Yueqiao Chen
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17 Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Jing Liu
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17 Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Yifan Yu
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17 Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Huijie Cui
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17 Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Qiuzhi Chen
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17 Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Kejin Chen
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17 Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Chunxia Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17 Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Yanfang Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17 Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China.
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Flores AM, Schuler A, Eberhard AV, Olin JW, Cooke JP, Leeper NJ, Shah NH, Ross EG. Unsupervised Learning for Automated Detection of Coronary Artery Disease Subgroups. J Am Heart Assoc 2021; 10:e021976. [PMID: 34845917 PMCID: PMC9075403 DOI: 10.1161/jaha.121.021976] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/14/2021] [Indexed: 12/24/2022]
Abstract
Background The promise of precision population health includes the ability to use robust patient data to tailor prevention and care to specific groups. Advanced analytics may allow for automated detection of clinically informative subgroups that account for clinical, genetic, and environmental variability. This study sought to evaluate whether unsupervised machine learning approaches could interpret heterogeneous and missing clinical data to discover clinically important coronary artery disease subgroups. Methods and Results The Genetic Determinants of Peripheral Arterial Disease study is a prospective cohort that includes individuals with newly diagnosed and/or symptomatic coronary artery disease. We applied generalized low rank modeling and K-means cluster analysis using 155 phenotypic and genetic variables from 1329 participants. Cox proportional hazard models were used to examine associations between clusters and major adverse cardiovascular and cerebrovascular events and all-cause mortality. We then compared performance of risk stratification based on clusters and the American College of Cardiology/American Heart Association pooled cohort equations. Unsupervised analysis identified 4 phenotypically and prognostically distinct clusters. All-cause mortality was highest in cluster 1 (oldest/most comorbid; 26%), whereas major adverse cardiovascular and cerebrovascular event rates were highest in cluster 2 (youngest/multiethnic; 41%). Cluster 4 (middle-aged/healthiest behaviors) experienced more incident major adverse cardiovascular and cerebrovascular events (30%) than cluster 3 (middle-aged/lowest medication adherence; 23%), despite apparently similar risk factor and lifestyle profiles. In comparison with the pooled cohort equations, cluster membership was more informative for risk assessment of myocardial infarction, stroke, and mortality. Conclusions Unsupervised clustering identified 4 unique coronary artery disease subgroups with distinct clinical trajectories. Flexible unsupervised machine learning algorithms offer the ability to meaningfully process heterogeneous patient data and provide sharper insights into disease characterization and risk assessment. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00380185.
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Affiliation(s)
- Alyssa M. Flores
- Division of Vascular SurgeryDepartment of SurgeryStanford University School of MedicineStanfordCA
| | - Alejandro Schuler
- Center for Biomedical Informatics ResearchStanford UniversityStanfordCA
| | - Anne Verena Eberhard
- Division of Vascular SurgeryDepartment of SurgeryStanford University School of MedicineStanfordCA
| | - Jeffrey W. Olin
- Zena and Michael A. Wiener Cardiovascular InstituteMarie‐Josée and Henry R. Kravis Center for Cardiovascular HealthIcahn School of Medicine at Mount SinaiNew YorkNY
| | - John P. Cooke
- Department of Cardiovascular SciencesHouston Methodist Research InstituteHoustonTX
| | - Nicholas J. Leeper
- Division of Vascular SurgeryDepartment of SurgeryStanford University School of MedicineStanfordCA
- Division of Cardiovascular MedicineDepartment of MedicineStanford University School of MedicineStanfordCA
- Stanford Cardiovascular InstituteStanfordCA
| | - Nigam H. Shah
- Center for Biomedical Informatics ResearchStanford UniversityStanfordCA
| | - Elsie G. Ross
- Division of Vascular SurgeryDepartment of SurgeryStanford University School of MedicineStanfordCA
- Center for Biomedical Informatics ResearchStanford UniversityStanfordCA
- Stanford Cardiovascular InstituteStanfordCA
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Singh A, Dai DL, Ioannou K, Chen V, Lam KK, Hollander Z, Wilson-McManus JE, Assadian S, Toma M, Ng R, Virani S, Ignaszewski A, Tebbutt S, Bennett M, McManus BM. Ensembling Electrical and Proteogenomics Biomarkers for Improved Prediction of Cardiac-Related 3-Month Hospitalizations: A Pilot Study. Can J Cardiol 2019; 35:471-479. [DOI: 10.1016/j.cjca.2018.12.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/29/2018] [Accepted: 12/30/2018] [Indexed: 01/29/2023] Open
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Beta 2-Microglobulin and the Severity of Coronary Stenosis in Patients With Acute Coronary Syndrome. Heart Lung Circ 2019; 28:575-582. [DOI: 10.1016/j.hlc.2018.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 02/20/2018] [Indexed: 11/23/2022]
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Hilt ZT, Pariser DN, Ture SK, Mohan A, Quijada P, Asante AA, Cameron SJ, Sterling JA, Merkel AR, Johanson AL, Jenkins JL, Small EM, McGrath KE, Palis J, Elliott MR, Morrell CN. Platelet-derived β2M regulates monocyte inflammatory responses. JCI Insight 2019; 4:122943. [PMID: 30702442 PMCID: PMC6483513 DOI: 10.1172/jci.insight.122943] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 01/25/2019] [Indexed: 12/13/2022] Open
Abstract
β-2 Microglobulin (β2M) is a molecular chaperone for the major histocompatibility class I (MHC I) complex, hemochromatosis factor protein (HFE), and the neonatal Fc receptor (FcRn), but β2M may also have less understood chaperone-independent functions. Elevated plasma β2M has a direct role in neurocognitive decline and is a risk factor for adverse cardiovascular events. β2M mRNA is present in platelets at very high levels, and β2M is part of the activated platelet releasate. In addition to their more well-studied thrombotic functions, platelets are important immune regulatory cells that release inflammatory molecules and contribute to leukocyte trafficking, activation, and differentiation. We have now found that platelet-derived β2M is a mediator of monocyte proinflammatory differentiation through noncanonical TGFβ receptor signaling. Circulating monocytes from mice lacking β2M only in platelets (Plt-β2M-/-) had a more proreparative monocyte phenotype, in part dependent on increased platelet-derived TGFβ signaling in the absence of β2M. Using a mouse myocardial infarction (MI) model, Plt-β2M-/- mice had limited post-MI proinflammatory monocyte responses and, instead, demonstrated early proreparative monocyte differentiation, profibrotic myofibroblast responses, and a rapid decline in heart function compared with WT mice. These data demonstrate a potentially novel chaperone-independent, monocyte phenotype-regulatory function for platelet β2M and that platelet-derived 2M and TGFβ have opposing roles in monocyte differentiation that may be important in tissue injury responses.
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Affiliation(s)
| | | | | | - Amy Mohan
- Aab Cardiovascular Research Institute
| | | | - Akua A. Asante
- Center for Pediatric Biomedical Research, Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York, USA
| | | | - Julie A. Sterling
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Department of Cancer Biology, Medicine, Division of Clinical Pharmacology, Bone Biology Center, and Biomedical Engineering, and
- Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee, USA
| | - Alyssa R. Merkel
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Department of Cancer Biology, Medicine, Division of Clinical Pharmacology, Bone Biology Center, and Biomedical Engineering, and
- Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee, USA
| | | | | | | | - Kathleen E. McGrath
- Center for Pediatric Biomedical Research, Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York, USA
| | - James Palis
- Center for Pediatric Biomedical Research, Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York, USA
| | - Michael R. Elliott
- Department of Microbiology and Immunology, University of Rochester School of Medicine, Rochester, New York, USA
| | - Craig N. Morrell
- Aab Cardiovascular Research Institute
- Department of Microbiology and Immunology, University of Rochester School of Medicine, Rochester, New York, USA
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Hu Y, Liu H, Du L, Wan J, Li X. Serum Cystatin C Predicts AKI and the Prognosis of Patients in Coronary Care Unit: a Prospective, Observational Study. Kidney Blood Press Res 2017; 42:961-973. [PMID: 29179178 DOI: 10.1159/000485341] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 11/16/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Acute Kidney Injury (AKI) is a serious clinical state associated with high morbidity and mortality, particularly in critical ill patients. We investigated the hypothesis that serum Cystatin C (sCysC) is a good predictor for AKI and may affect the short-term prognosis of coronary care unit (CCU) patients. METHODS In this prospective, observational study, we screened 412 adults admitted to the CCU from January 1, 2014 to June 1, 2015 at Zhongnan Hospital of Wuhan University. Serum samples were obtained at the time of admission, and sCysC was quantified through nephelometry. AKI was defined based on KDIGO-AKI criteria. After the patients' hospital discharge, the survivors in this study were followed up for up to 2 years. The primary endpoint was the incidence of AKI stratified by severity stage, while the second endpoints included 2-year mortality, rehospitalization and failure in renal recovery rates, as well as the progression of AKI to CKD. RESULTS According to the KDIGO-AKI criteria, AKI occurred in 130 (31.6%) patients. After multivariate adjustments, the highest quartile of sCysC was associated with a 9-fold increased risk of incident AKI compared with the lowest quartile. For predicting AKI, sCysC [area under the receiver operating characteristic curve (AUC=0.842)] outperformed β2-micro globulin (AUC=0.813) and the clinical model (AUC=0.777), and a cutoff of 1.255 mg/L yielded good sensitivity and specificity. After a median 19.8-month follow-up, 112 (27.2%) patients died within 2 years after admission. The sCysC independently predicted the risk of 2-year mortality [adjusted odds ratio (OR), 4.955; 95% confidence interval (95% CI), 2.853 to 8.603] and rehospitalization (OR, 3.128; 95% CI, 2.011 to 4.867), as well as renal recovery failure (OR, 3.618, 95% CI, 1.753 to 7.463). CONCLUSIONS Serum CysC is a strong predictor of AKI and the short-term prognosis of CCU patients.
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Affiliation(s)
- Yugang Hu
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Huilan Liu
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Liguo Du
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jing Wan
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaoning Li
- Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, China
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You L, Xie R, Hu H, Gu G, Zheng H, Zhang J, Yang X, He X, Cui W. High levels of serum β2-microglobulin predict severity of coronary artery disease. BMC Cardiovasc Disord 2017; 17:71. [PMID: 28249620 PMCID: PMC5333396 DOI: 10.1186/s12872-017-0502-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 02/14/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The identification of new risk factors for coronary artery disease (CAD) is increasingly sought in an effort to tackle this threatening disease. β2-microglobulin (B2M) is reported to associate with peripheral arterial disease and adverse cardiovascular outcomes. However, the association between B2M and cardiovascular disease remains under-researched. This study evaluated the effects of B2M on CAD without renal dysfunction. METHODS One thousand seven hundred sixty-two subjects (403 non-CAD subjects and 1,359 CAD subjects) were investigated. Fasting samples were collected to determine B2M level. The Gensini and SYNTAX scores were used to assess the severity of CAD. RESULTS CAD subjects were significantly higher in serum B2M level comparing with non-CAD subjects (1.25 ± 0.46 vs 1.14 ± 0.28 mg/L, p < 0.001). Serum B2M level was a risk factor of CAD after adjusting potential confounders (Odds Ratio (OR) = 2.363, 95% confidence interval (CI): 1.467-3.906, p = 0.001). Receiver operating characteristics (ROC) showed B2M level moderately predicted diagnosis of CAD (the area under the ROC curve (AUC) = 0.608, 95% CI: 0.577-0.639, p < 0.001). Furthermore, serum B2M level was positively associated with Gensini score system, SYNTAX score system and the number of disease vessels (NDV ≥ 2). CONCLUSIONS The significant association between serum B2M and CAD suggests that B2M could be a biomarker for CAD.
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Affiliation(s)
- Ling You
- Division of Cardiology, The Second Hospital of Hebei Medical University, 215 Heping West Rd, Xinhua, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Ruiqin Xie
- Division of Cardiology, The Second Hospital of Hebei Medical University, 215 Heping West Rd, Xinhua, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Haijuan Hu
- Division of Cardiology, The Second Hospital of Hebei Medical University, 215 Heping West Rd, Xinhua, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Guoqiang Gu
- Division of Cardiology, The Second Hospital of Hebei Medical University, 215 Heping West Rd, Xinhua, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Hongmei Zheng
- Division of Cardiology, The Second Hospital of Hebei Medical University, 215 Heping West Rd, Xinhua, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Jidong Zhang
- Division of Cardiology, The Second Hospital of Hebei Medical University, 215 Heping West Rd, Xinhua, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Xiaohong Yang
- Division of Cardiology, The Second Hospital of Hebei Medical University, 215 Heping West Rd, Xinhua, Shijiazhuang, Hebei, 050000, People's Republic of China
| | - Ximiao He
- Laboratory of Metabolism, National Cancer Institute, National Institutes of Health, 37 Convent Drive, Bethesda, MD, 20892, USA.
| | - Wei Cui
- Division of Cardiology, The Second Hospital of Hebei Medical University, 215 Heping West Rd, Xinhua, Shijiazhuang, Hebei, 050000, People's Republic of China.
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Roumelioti ME, Nolin T, Unruh ML, Argyropoulos C. Revisiting the Middle Molecule Hypothesis of Uremic Toxicity: A Systematic Review of Beta 2 Microglobulin Population Kinetics and Large Scale Modeling of Hemodialysis Trials In Silico. PLoS One 2016; 11:e0153157. [PMID: 27055286 PMCID: PMC4824495 DOI: 10.1371/journal.pone.0153157] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 03/24/2016] [Indexed: 01/01/2023] Open
Abstract
Background Beta-2 Microglobulin (β2M) is a prototypical “middle molecule” uremic toxin that has been associated with a higher risk of death in hemodialysis patients. A quantitative description of the relative importance of factors determining β2M concentrations among patients with impaired kidney function is currently lacking. Methods Herein we undertook a systematic review of existing studies reporting patient level data concerning generation, elimination and distribution of β2M in order to develop a population model of β2M kinetics. We used this model and previously determined relationships between predialysis β2M concentration and survival, to simulate the population distribution of predialysis β2M and the associated relative risk (RR) of death in patients receiving conventional thrice-weekly hemodialysis with low flux (LF) and high flux (HF) dialyzers, short (SD) and long daily (LD) HF hemodialysis sessions and on-line hemodiafiltration at different levels of residual renal function (RRF). Results We identified 9 studies of 106 individuals and 156 evaluations of or more compartmental kinetic parameters of β2M. These studies used a variety of experimental methods to determine β2M kinetics ranging from isotopic dilution to profiling of intra/inter dialytic concentration changes. Most of the patients (74/106) were on dialysis with minimal RRF, thus facilitating the estimation of non-renal elimination kinetics of β2M. In large scale (N = 10000) simulations of individuals drawn from the population of β2M kinetic parameters, we found that, higher dialytic removal materially affects β2M exposures only when RRF (renal clearance of β2M) was below 2 ml/min. In patients initiating conventional HF hemodialysis, total loss of RRF was predicted to be associated with a RR of death of more than 20%. Hemodiafiltration and daily dialysis may decrease the high risk of death of anuric patients by 10% relative to conventional, thrice weekly HF dialysis. Only daily long sessions of hemodialysis consistently reduced mortality risk between 7–19% across the range of β2M generation rate. Conclusions Preservation of RRF should be considered one of the therapeutic goals of hemodialysis practice. Randomized controlled trials of novel dialysis modalities may require large sample sizes to detect an effect on clinical outcomes even if they enroll anuric patients. The developed population model for β2M may allow personalization of hemodialysis prescription and/or facilitate the design of such studies by identifying patients with higher β2M generation rate.
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Affiliation(s)
- Maria Eleni Roumelioti
- Division of Nephrology, Department of Internal Medicine, University of New Mexico Health Sciences Center, School of Medicine, Albuquerque, NM, United States of America
| | - Thomas Nolin
- Department of Pharmacy and Therapeutics, and Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh Schools of Pharmacy and Medicine, Pittsburgh, PA, United States of America
| | - Mark L. Unruh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico Health Sciences Center, School of Medicine, Albuquerque, NM, United States of America
| | - Christos Argyropoulos
- Division of Nephrology, Department of Internal Medicine, University of New Mexico Health Sciences Center, School of Medicine, Albuquerque, NM, United States of America
- * E-mail:
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Nassirpour R, Raj D, Townsend R, Argyropoulos C. MicroRNA biomarkers in clinical renal disease: from diabetic nephropathy renal transplantation and beyond. Food Chem Toxicol 2016; 98:73-88. [PMID: 26925770 DOI: 10.1016/j.fct.2016.02.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 02/24/2016] [Indexed: 12/13/2022]
Abstract
Chronic Kidney Disease (CKD) is a common health problem affecting 1 in 12 Americans. It is associated with elevated risks of mortality, cardiovascular disease, and high costs for the treatment of renal failure with dialysis or transplantation. Advances in CKD care are impeded by the lack of biomarkers for early diagnosis, assessment of the extent of tissue injury, estimation of disease progression, and evaluation of response to therapy. Such biomarkers should improve the performance of existing measures of renal functional impairment (estimated glomerular filtration rate, eGFR) or kidney damage (proteinuria). MicroRNAs (miRNAs) a class of small, non-coding RNAs that act as post-transcriptional repressors are gaining momentum as biomarkers in a number of disease areas. In this review, we examine the potential utility of miRNAs as promising biomarkers for renal disease. We explore the performance of miRNAs as biomarkers in two clinically important forms of CKD, diabetes and the nephropathy developing in kidney transplant recipients. Finally, we highlight the pitfalls and opportunities of miRNAs and provide a broad perspective for the future clinical development of miRNAs as biomarkers in CKD beyond the current gold standards of eGFR and albuminuria.
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Affiliation(s)
- Rounak Nassirpour
- Drug Safety, Pfizer Worldwide Research and Development, Andover, MA, USA
| | - Dominic Raj
- Department of Internal Medicine, Division of Renal Disease and Hypertension, The George Washington University School of Medicine, Washington, DC, USA
| | - Raymond Townsend
- Department of Internal Medicine, Nephrology and Hypertension, University of Pennsylvania Medical Center, Philadelphia, PA, USA
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Ma Q, Zhou Y, Zhai G, Gao F, Zhang L, Wang J, Yang Q, Cheng W. Meta-Analysis Comparing Rosuvastatin and Atorvastatin in Reducing Concentration of C-Reactive Protein in Patients With Hyperlipidemia. Angiology 2015; 67:526-35. [PMID: 26271127 DOI: 10.1177/0003319715599863] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We conducted a meta-analysis of 13 randomized trials comparing the efficacy of rosuvastatin versus atorvastatin in reducing concentrations of C-reactive protein (CRP). We searched PubMed, Ovid, and Elsevier databases until June 2014. Search terms included C-reactive protein or CRP, rosuvastatin, atorvastatin, randomized, randomly, and randomization; 13 trials (3798 patients) were included. Funnel plots for CRP were inspected to assess publication bias. The pooled analysis demonstrated the benefit of rosuvastatin over atorvastatin therapy for all 13 trials (mean difference [MD] = −0.11, which is standardized mean with no unit although the raw data before pooling is mg/L, 95% confidence interval −0.15 to −0.07, P < .0001) with no evidence of significant publication bias (I2 = 6.9%, P = .377). Subgroup analysis indicated a significant benefit of rosuvastatin over atorvastatin regarding the 1/1 dose ratio (MD = −0.14, 95% CI −0.21 to −0.06) and 1/2 dose ratio (MD= −0.11, 95% CI −0.16 to −0.05). Cumulative and influence analyses showed accuracy and stability for the estimation mentioned earlier. Our meta-analysis shows that rosuvastatin produces better reduction in CRP concentrations than atorvastatin at a dose ratio of 1/1 and 1/2 (rosuvastatin/atorvastatin), respectively.
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Affiliation(s)
- Qian Ma
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Anzhenli Avenue, Chao Yang District, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Anzhenli Avenue, Chao Yang District, Beijing, China
| | - Guangyao Zhai
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Anzhenli Avenue, Chao Yang District, Beijing, China
| | - Fei Gao
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Anzhenli Avenue, Chao Yang District, Beijing, China
| | - Linlin Zhang
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Anzhenli Avenue, Chao Yang District, Beijing, China
| | - Jianlong Wang
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Anzhenli Avenue, Chao Yang District, Beijing, China
| | - Qing Yang
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Anzhenli Avenue, Chao Yang District, Beijing, China
| | - Wanjun Cheng
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Anzhenli Avenue, Chao Yang District, Beijing, China
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Proton Pump Inhibitor Usage and the Risk of Myocardial Infarction in the General Population. PLoS One 2015; 10:e0124653. [PMID: 26061035 PMCID: PMC4462578 DOI: 10.1371/journal.pone.0124653] [Citation(s) in RCA: 214] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/17/2015] [Indexed: 12/12/2022] Open
Abstract
Background and Aims Proton pump inhibitors (PPIs) have been associated with adverse clinical outcomes amongst clopidogrel users after an acute coronary syndrome. Recent pre-clinical results suggest that this risk might extend to subjects without any prior history of cardiovascular disease. We explore this potential risk in the general population via data-mining approaches. Methods Using a novel approach for mining clinical data for pharmacovigilance, we queried over 16 million clinical documents on 2.9 million individuals to examine whether PPI usage was associated with cardiovascular risk in the general population. Results In multiple data sources, we found gastroesophageal reflux disease (GERD) patients exposed to PPIs to have a 1.16 fold increased association (95% CI 1.09–1.24) with myocardial infarction (MI). Survival analysis in a prospective cohort found a two-fold (HR = 2.00; 95% CI 1.07–3.78; P = 0.031) increase in association with cardiovascular mortality. We found that this association exists regardless of clopidogrel use. We also found that H2 blockers, an alternate treatment for GERD, were not associated with increased cardiovascular risk; had they been in place, such pharmacovigilance algorithms could have flagged this risk as early as the year 2000. Conclusions Consistent with our pre-clinical findings that PPIs may adversely impact vascular function, our data-mining study supports the association of PPI exposure with risk for MI in the general population. These data provide an example of how a combination of experimental studies and data-mining approaches can be applied to prioritize drug safety signals for further investigation.
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13
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Zumrutdal A. Role of β 2-microglobulin in uremic patients may be greater than originally suspected. World J Nephrol 2015; 4:98-104. [PMID: 25664251 PMCID: PMC4317633 DOI: 10.5527/wjn.v4.i1.98] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/03/2014] [Accepted: 10/10/2014] [Indexed: 02/06/2023] Open
Abstract
The role of beta2-microglobulin (β2M) in dialysis-related amyloidosis as a specific amyloid precursor was defined in the 1980s. Studies in those years were largely related to β2M amyloidosis. In 2005, for what was probably the first time in the available literature, we provided data about the association between β2M and early-onset atherosclerosis in hemodialysis patients without co-morbidities. In recent years, the role of uremic toxins in uremic atherosclerosis and the interest in β2M as a marker of cardiovascular (CV) and/or mortality risk have grown. In the current literature, clinical studies suggest that β2M is an independent, significant predictor of mortality, not only in dialysis patients, but also in predialysis patients and in the high-risk portion of the general population, and it seems to be a factor strongly linked to the presence and severity of CV disease. It is still unknown whether β2M is only a uremic toxin marker or if it also has an active role in vascular damage, but data support that it may reflect an increased burden of systemic atherosclerosis in a setting of underlying chronic kidney disease. Thus, although there have been some inconsistencies among the various analyses relating to β2M, it promises to be a novel risk marker of kidney function in the awareness and detection of high-risk patients. However, more research is required to establish the pathophysiological relationships between retained uremic toxins and further biochemical modifications in the uremic milieu to get answers to the questions of why and how. In this review, the recent literature about the changing role of β2M in uremic patients will be examined.
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Chang P, Nead KT, Olin JW, Cooke JP, Leeper NJ. Clinical and socioeconomic factors associated with unrecognized peripheral artery disease. Vasc Med 2014; 19:289-296. [PMID: 24872403 DOI: 10.1177/1358863x14535475] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Peripheral artery disease (PAD) is a highly prevalent condition that frequently goes undetected and untreated. Socioeconomic factors associated with unrecognized PAD are not known. The ankle-brachial index (ABI) was calculated in 1656 study participants undergoing non-emergent coronary angiography with PAD defined as an ABI <0.9. Subjects were followed for mortality and cardiovascular outcomes. Compared to those without PAD, those with unrecognized PAD at enrollment were older, had higher rates of cardiovascular comorbidities, and had higher major adverse cardiovascular events (MACE) (p<0.03 for all). Among those enrolling without a reported history of PAD, there was a higher prevalence of PAD with decreasing income (p=0.004), education level (p<0.001), social isolation (p=0.027) and depression (p=0.034); 50% of these individuals reported symptoms suggestive of claudication. In conclusion, the prevalence of unrecognized PAD is high amongst a cohort of high-risk individuals referred for coronary angiography. A profile of lower socioeconomic status is associated with unrecognized PAD. These subjects will report symptoms suggestive of claudication and impaired walking ability when directly queried.
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Affiliation(s)
- Peter Chang
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Kevin T Nead
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeffrey W Olin
- Zena and Michael A Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY, USA
| | - John P Cooke
- Methodist Hospital Research Institute, Houston, TX, USA
| | - Nicholas J Leeper
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA Stanford Cardiovascular Institute, Stanford, CA, USA
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15
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Witt K, Hawton K, Fazel S. The relationship between suicide and violence in schizophrenia: analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) dataset. Schizophr Res 2014; 154:61-7. [PMID: 24581550 PMCID: PMC3988953 DOI: 10.1016/j.schres.2014.02.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/20/2014] [Accepted: 02/02/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Suicide and violence often co-occur in the general population as well as in mentally ill individuals. Few studies, however, have assessed whether these suicidal behaviors are predictive of violence risk in mental illness. AIMS The aim of this study is to investigate whether suicidal behaviors, including suicidal ideation, threats, and attempts, are significantly associated with increased violence risk in individuals with schizophrenia. METHOD Data for these analyses were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial, a randomized controlled trial of antipsychotic medication in 1460 adults with schizophrenia. Univariate Cox regression analyses were used to calculate hazard ratios (HRs) for suicidal ideation, threats, and attempts. Multivariate analyses were conducted to adjust for common confounding factors, including: age, alcohol or drug misuse, major depression, antisocial personality disorder, depression, hostility, positive symptom, and poor impulse control scores. Tests of discrimination, calibration, and reclassification assessed the incremental predictive validity of suicidal behaviors for the prediction of violence risk. RESULTS Suicidal threats and attempts were significantly associated with violence in both males and females with schizophrenia with little change following adjustment for common confounders. Only suicidal threats, however, were associated with a significant increase in incremental validity beyond age, diagnosis with a comorbid substance use disorder, and recent violent behavior. CONCLUSIONS Suicidal threats are independently associated with violence risk in both males and females with schizophrenia, and may improve violence risk prediction.
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Affiliation(s)
- Katrina Witt
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK
| | - Seena Fazel
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK.
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16
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Priest JR, Nead KT, Wehner MR, Cooke JP, Leeper NJ. Self-reported history of childhood smoking is associated with an increased risk for peripheral arterial disease independent of lifetime smoking burden. PLoS One 2014; 9:e88972. [PMID: 24558458 PMCID: PMC3928325 DOI: 10.1371/journal.pone.0088972] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/06/2014] [Indexed: 11/19/2022] Open
Abstract
Atherosclerotic disorders are well known to be associated with obesity, lipid profile, smoking, hypertension and other medical comorbidities, and large cohort studies have explored the childhood correlates to these adult risk factors. However, there has been little investigation into the childhood risk factors for peripheral arterial disease (PAD). We endeavored to better understand the role of smoking in childhood in the risk for PAD in a well described cohort of 1,537 adults at high risk for cardiovascular disease. In a multivariate regression model, we observed an increased risk of PAD among those who reported a history of smoking during childhood (OR = 2.86; 95% CI, 1.99-4.11; P<0.001), which remained statistically significant after controlling for lifetime smoking burden (OR = 1.55; 95% CI, 1.00-2.41; P = 0.049). Our novel observation of disproportionate risk of PAD conferred by a history of childhood smoking may reflect an unrecognized biological mechanism such as a unique susceptibility to vascular injury or an unaccounted for covariate such as secondhand smoke exposure in childhood. This observation suggests further investigation is required into the pathophysiology of smoking in the developing vasculature and the need for detailed clinical data about patterns of childhood smoking and smoke exposure.
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Affiliation(s)
- James R. Priest
- Division of Pediatric Cardiology, Stanford University School of Medicine, Stanford, California, United States of America
- Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - Kevin T. Nead
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Mackenzie R. Wehner
- Stanford University School of Medicine, Stanford, California, United States of America
| | - John P. Cooke
- Center for Cardiovascular Regeneration, Methodist DeBakey Heart and Vascular Center, Houston, Texas, United States of America
- Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, United States of America
| | - Nicholas J. Leeper
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California, United States of America
- Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
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Downing KP, Nead KT, Kojima Y, Assimes T, Maegdefessel L, Quertermous T, Cooke JP, Leeper NJ. The combination of 9p21.3 genotype and biomarker profile improves a peripheral artery disease risk prediction model. Vasc Med 2013; 19:3-8. [PMID: 24323119 DOI: 10.1177/1358863x13514791] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Peripheral artery disease (PAD) is a highly morbid condition affecting more than 8 million Americans. Frequently, PAD patients are unrecognized and therefore do not receive appropriate therapies. Therefore, new methods to identify PAD have been pursued, but have thus far had only modest success. Here we describe a new approach combining genomic and metabolic information to enhance the diagnosis of PAD. We measured the genotype of the chromosome 9p21 cardiovascular-risk polymorphism rs10757269 as well as the biomarkers C-reactive protein, cystatin C, β2-microglobulin, and plasma glucose in a study population of 393 patients undergoing coronary angiography. The rs10757269 allele was associated with PAD status (ankle-brachial index < 0.9) independent of biomarkers and traditional cardiovascular risk factors (odds ratio = 1.92; 95% confidence interval, 1.29-2.85). Importantly, compared to a previously validated risk factor-based PAD prediction model, the addition of biomarkers and rs10757269 significantly and incrementally improved PAD risk prediction as assessed by the net reclassification index (NRI = 33.5%; p = 0.001) and integrated discrimination improvement (IDI = 0.016; p = 0.017). In conclusion, a model including a panel of biomarkers, which includes both genomic information (which is reflective of heritable risk) and metabolic information (which integrates environmental exposures), predicts the presence or absence of PAD better than established risk models, suggesting clinical utility for the diagnosis of PAD.
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Affiliation(s)
- Kelly P Downing
- Division of Vascular Surgery, Stanford University, Stanford, CA, USA
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18
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Nead KT, Cooke JP, Olin JW, Leeper NJ. Alternative ankle-brachial index method identifies additional at-risk individuals. J Am Coll Cardiol 2013; 62:553-9. [PMID: 23707317 PMCID: PMC3732795 DOI: 10.1016/j.jacc.2013.04.061] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 04/07/2013] [Accepted: 04/22/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The aim of this study was to determine whether use of an alternative ankle-brachial index (ABI) calculation method improves mortality risk prediction compared with traditional methods. BACKGROUND The ABI is used to diagnose peripheral arterial disease (PAD) and to identify those at risk for cardiovascular events. Traditionally, the ABI is calculated with the higher of the dorsalis pedis and posterior tibial ankle arteries. Studies directly comparing calculation methods are limited. METHODS The ABI was calculated at baseline in 1,413 study participants undergoing non-emergent coronary angiography subsequently followed for all-cause and cardiovascular mortality. There were 224 individuals assigned to the traditional-PAD group (ABI <0.90) with the traditional ABI method. Of those remaining, an alternative ABI method using the lower of the 2 ankle pressures assigned 282 patients to the alternative-PAD group. The 862 individuals not assigned to PAD by either method were the no-PAD group. RESULTS There were 163 mortalities during a median follow-up of 5.0 years. Adjusted Cox regression models showed that the alternative-PAD group had an increased risk for all-cause (hazard ratio [HR]: 1.49; 95% confidence interval: 1.01 to 2.19) and cardiovascular mortality (HR: 3.21; 95% confidence interval: 1.53 to 6.37) versus the no-PAD group. Additionally, in the no-PAD group, there was an 11% (HR: 1.11; 95% confidence interval: 1.05 to 1.17) increased risk of all-cause mortality/1-mm Hg increased difference between the left and right brachial systolic pressures. CONCLUSIONS The implementation of an alternative ABI method and use of the brachial difference identifies individuals at an increased risk for mortality who are currently missed with traditional ABI methods. Current ABI protocols might need to be evaluated.
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Affiliation(s)
- Kevin T. Nead
- Division of Cardiovascular Medicine, Stanford University School of Medicine
| | - John P. Cooke
- Division of Cardiovascular Medicine, Stanford University School of Medicine
| | - Jeffrey W. Olin
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine
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Nead KT, Zhou M, Diaz Caceres R, Olin JW, Cooke JP, Leeper NJ. Walking impairment questionnaire improves mortality risk prediction models in a high-risk cohort independent of peripheral arterial disease status. Circ Cardiovasc Qual Outcomes 2013; 6:255-61. [PMID: 23633217 DOI: 10.1161/circoutcomes.111.000070] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Walking Impairment Questionnaire (WIQ) is a subjective measure of patient-reported walking performance developed for peripheral arterial disease. The purpose of this study is to examine whether this simple tool can improve the predictive capacity of established risk models and whether the WIQ can be used in patients without peripheral arterial disease. METHODS AND RESULTS At baseline we assessed the walking distance, stair-climbing, and walking speed WIQ category scores among individuals who were undergoing coronary angiography. During a median follow-up of 5.0 years, there were 172 mortalities among 1417 study participants. Adjusted Cox proportional hazards models showed that all 3 WIQ categories independently predicted future all-cause and cardiovascular mortality, including among individuals without peripheral arterial disease (P<0.001). Compared with the cardiovascular risk factors model, we observed significantly increased risk discrimination with a C-index of 0.741 (change in C-index, 0.040; 95% confidence interval, 0.011-0.068) and 0.832 (change in C-index, 0.080; 95% confidence interval, 0.034-0.126) for all-cause and cardiovascular mortality, respectively. Examination of risk reclassification using the net reclassification improvement index showed a 48.4% (P<0.001) improvement for all-cause mortality and a 77.4% (P<0.001) improvement for cardiovascular mortality compared with the cardiovascular risk factors model. CONCLUSIONS All 3 WIQ categories independently predicted future all-cause and cardiovascular mortality. Importantly, we found that this subjective measure of walking ability could be extended to patients without peripheral arterial disease. The addition of the WIQ scores to established cardiovascular risk models significantly improved risk discrimination and reclassification, suggesting broad clinical use for this simple, inexpensive test.
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Affiliation(s)
- Kevin T Nead
- Division of Cardiovascular Medicine and Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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