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Hao Q, Gong Z, Song Y, Wang Y, Meng W, Wu W, Li Y, Zhang Y. Amyloid and Tau as cerebrospinal fluid biomarkers in anti-N-Methyl-D-aspartate receptor encephalitis. Neurol Sci 2024; 45:3399-3410. [PMID: 38280087 DOI: 10.1007/s10072-024-07341-x] [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: 11/11/2023] [Accepted: 01/19/2024] [Indexed: 01/29/2024]
Abstract
INTRODUCTION Neuroinfection is associated with the deposition of amyloid-beta (Aβ) peptides, and subsequent decrease in cerebrospinal fluid (CSF) amyloid levels. However, whether autoimmune encephalitis involves extracellular deposition of Aβ peptides in the brain is unreported. METHODS We examined CSF amyloid and tau values in adults with anti-N-methyl-D-aspartate receptor encephalitis (NMDAR-E). Forty-two patients with NMDAR-E, 35 patients with viral and bacterial neuroinfections, and 16 controls were included. We measured CSF Aβ1-42 (cAβ1-42), Aβ1-40 (cAβ1-40), t-Tau (ct-Tau), and p-Tau181 (cp-Tau181) levels and assessed their efficacies regarding differential diagnosis and predicting prognosis. RESULTS NMDAR-E patients had lower cAβ1-42 levels; however, they were higher than those of patients with bacterial meningitis. ct-Tau levels in NMDAR-E patients were lower than those in patients with neuroinfections. No changes were observed in controls. cAβ1-42 and ct-Tau were combined as an excellent marker to distinguish NMDAR-E from neuroinfections. cAβ1-42 levels in NMDAR-E patients were positively correlated with Montreal Cognitive Assessment scores. We observed an inverse relationship between cAβ1-42 levels and modified Rankin Scale scores. Patients with poor outcomes exhibited low cAβ1-42 levels and high levels of several blood parameters. cAβ1-42 was the highest quality biomarker for assessing NMDAR-E prognosis. Correlations were found between cAβ1-42 and some inflammatory indicators. CONCLUSION cAβ1-42 was decreased in NMDAR-E patients. cAβ1-42 levels indicated NMDAR-E severity and acted as a biomarker for its prognosis. Combining cAβ1-42 and ct-Tau levels could serve as a novel differential diagnostic marker for NMDAR-E.
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Affiliation(s)
- Qianmeng Hao
- Department of Blood Transfusion, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450053, Henan, China
| | - Zhe Gong
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yajun Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yali Wang
- Department of Blood Transfusion, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450053, Henan, China
| | - Weiwei Meng
- Department of Blood Transfusion, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450053, Henan, China
| | - Wei Wu
- Department of Blood Transfusion, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450053, Henan, China
| | - Yanfei Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yulin Zhang
- Department of Blood Transfusion, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450053, Henan, China.
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Gil-Serrano J, Labrador-Horrillo M, Galvan-Blasco P, Sala-Cunill A, Bigas P, Pereira-González J, Luengo O, Cardona V, Guilarte M. Systemic inflammation biomarkers during angioedema attacks in hereditary angioedema. Front Immunol 2024; 15:1400526. [PMID: 38953032 PMCID: PMC11215006 DOI: 10.3389/fimmu.2024.1400526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/27/2024] [Indexed: 07/03/2024] Open
Abstract
Background Hereditary angioedema (HAE) is a rare disease characterized by localized and self-limited angioedema (AE) attacks. A local increase of bradykinin (BK) mediates AE attacks in HAE, however the role of inflammation in HAE has been poorly explored We aim to analyze the role of inflammatory mediators in HAE patients during AE attacks. Methods Patients with a confirmed HAE diagnosis due to C1 inhibitor deficiency (HAE-C1INH) or patients F12 gene mutations (HAE-FXII) attending to our outpatient clinic between November-2019 and May-2022 were included. Demographic and clinical characteristics were analyzed. Blood samples were collected both during symptom-free periods (baseline) and during HAE attacks, and acute phase reactants (APR), such as serum amyloid A (SAA), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), D-Dimer and white blood cells were measured. Results Seventy-eight patients were enrolled in the study, with a predominant representation of women (76%, n=59), and a mean age of 47.8 years (range 6-88). Among them, 67% (n=52) of patients had HAE-C1INH (46 classified as type 1 and 6 as type 2) while 33% (n=26) had HAE-FXII. During attack-free periods, the majority of patients exhibited normal levels of SAA, ESR, D-dimer, ACE and WCC. However, in a subset of patients (16% for SAA, 18% for ESR, and 14.5% for D-dimer), elevations were noted at baseline. Importantly, during HAE attacks, significant increases were observed in SAA in 88% of patients (p< 0.0001 vs. baseline), in ESR in 65% (p= 0.003 vs. baseline) and D-dimer in 71% (p=0.001 vs. baseline) of the patients. A comparison between baseline and acute attack levels in 17 patients revealed significant differences in SAA AA (p<0. 0001), ESR (p<0.0001) and D-dimer (p= 0.004). No significant differences were observed in CRP (p=0.7), ACE (p=0.67) and WCC (p=0.54). These findings remained consistent regardless of HAE type, disease activity or location of angioedema. Conclusion The systemic increase in APR observed during HAE attacks suggests that inflammation extends beyond the localized edematous area. This finding underscores the potential involvement of inflammatory pathways in HAE and highlights the need for further investigation into their role in the pathophysiology of HAE.
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Affiliation(s)
- Johana Gil-Serrano
- Department of Allergy, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Allergy Research Unit, Institut de Recerca Vall d’Hebron (VHIR), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Moisés Labrador-Horrillo
- Department of Allergy, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Allergy Research Unit, Institut de Recerca Vall d’Hebron (VHIR), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paula Galvan-Blasco
- Department of Allergy, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Allergy Research Unit, Institut de Recerca Vall d’Hebron (VHIR), Barcelona, Spain
| | - Anna Sala-Cunill
- Department of Allergy, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Allergy Research Unit, Institut de Recerca Vall d’Hebron (VHIR), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Bigas
- Department of Allergy, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Allergy Research Unit, Institut de Recerca Vall d’Hebron (VHIR), Barcelona, Spain
| | - Javier Pereira-González
- Department of Allergy, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Allergy Research Unit, Institut de Recerca Vall d’Hebron (VHIR), Barcelona, Spain
| | - Olga Luengo
- Department of Allergy, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Allergy Research Unit, Institut de Recerca Vall d’Hebron (VHIR), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victoria Cardona
- Department of Allergy, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Allergy Research Unit, Institut de Recerca Vall d’Hebron (VHIR), Barcelona, Spain
| | - Mar Guilarte
- Department of Allergy, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Allergy Research Unit, Institut de Recerca Vall d’Hebron (VHIR), Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Ma W, Liang P, Wu B, Yu Y, Shi Q, Zhong R. Social participation, subjective well-being, and cognitive function as serial mediators between tooth loss and functional limitations in older Chinese adults. BMC Public Health 2024; 24:803. [PMID: 38486217 PMCID: PMC10938731 DOI: 10.1186/s12889-024-18255-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/01/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Although tooth loss appears to be related to functional limitations, the mechanisms that underpin this relationship are unknown. We sought to address this knowledge gap by examining a multiple mediation hypothesis whereby tooth loss is predicted to indirectly affect functional limitations through social participation, subjective well-being, and cognitive function. METHODS This study included 7,629 Chinese adults from the 2017/2018 Chinese Longitudinal Healthy Longevity Survey wave. The serial mediation effects were examined using Model 6 in the Hayes' PROCESS macro for SPSS. RESULTS Tooth loss was significantly related to functional limitations. There was a direct (β = - 0.0308; 95% CI, - 0.0131 to - 0.0036) and indirect (β = - 0.0068; 95% CI, - 0.0096 to - 0.0041) association between tooth loss and instrumental activities of daily living (IADL) limitations, but only an indirect correlation with activities of daily living (ADL) limitations (β = - 0.0188; 95% CI, - 0.0259 to - 0.0121). Social participation, subjective well-being, and cognitive function serially mediated the relationship between tooth loss and ADL/IADL limitations. CONCLUSION The association between tooth loss and functional limitations is serially mediated by social participation, subjective well-being, and cognitive function. Our findings underscore the necessity of considering psychological and social factors as integrated healthcare approaches for the functional health of older adults.
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Affiliation(s)
- Weibo Ma
- School of Public Administration, Faculty of Economics and Management, East China Normal University, 3663 Zhongshan Road, Putuo District, 200062, Shanghai, China
| | - Pengchen Liang
- School of Microelectronics, Shanghai University, Shanghai, China
| | - Bei Wu
- NYU Aging Incubator and Hartford Institute for Geriatric Nursing, New York, USA
| | - Ying Yu
- Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Qiusi Shi
- School of Public Administration, Faculty of Economics and Management, East China Normal University, 3663 Zhongshan Road, Putuo District, 200062, Shanghai, China
| | - Renyao Zhong
- School of Public Administration, Faculty of Economics and Management, East China Normal University, 3663 Zhongshan Road, Putuo District, 200062, Shanghai, China.
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Ye X, Hu M. Allostatic load and oral health later in life among middle-aged and older adults: An analysis of population-based panel data in China. J Oral Rehabil 2024; 51:313-320. [PMID: 37654157 DOI: 10.1111/joor.13586] [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: 11/01/2022] [Revised: 04/06/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Oral health is a major global public health problem, but its risk factors have not been fully identified. The limited evidence suggests that AL may affect oral health conditions, but most of these studies focus only on middle-aged western populations. OBJECTIVES To examine whether allostatic load is associated with oral health conditions later in life among middle-aged and older adults in China and there there is a correlation in both middle-aged and older people. MATERIALS AND METHODS Data were collected from the China Health and Retirement Longitudinal Study 2011-2018 (N = 10 890) and were analysed using logistic regressions for the overall sample and subsamples by age. RESULTS Results showed that higher inflammation load significantly increased the odds of edentulism (OR = 1.358, 95% CI = 1.020-1.809, p < .05). Higher metabolic load significantly increased the odds of denture use (OR = 1.375, 95% CI = 1.154-1.640, p < 0.001) and difficulty in chewing solid foods (OR = 1.100, 95% CI = 1.035-1.169, p < .01). These associations were manifested in older adults over 60 years of age, while in the middle-aged subsample, the associations were not significant. CONCLUSION The findings suggested that higher allostatic load was associated with poorer oral health conditions later in life. It is critical to lower allostatic load and improve oral health conditions, especially for older adults over 60 years of age. Prospective studies and intervention trials help to better understand whether allostatic load is causally linked to oral health.
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Affiliation(s)
- Xin Ye
- Institute for Global Public Policy, Fudan University, Shanghai, China
- LSE-Fudan Research Centre for Global Public Policy, Fudan University, Shanghai, China
| | - Mingzheng Hu
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
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Hafez W, Nasa P, Khairy A, Jose M, Abdelshakour M, Ahmed S, Abdulaal F, Nair N, Ahmad M, Rashid VJ, Ayman Y, John S, Fdl Alla O, Abu Shady R, Mohamed AA, Soliman R, Nader S. Interleukin-6 and the determinants of severe COVID-19: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e36037. [PMID: 37960722 PMCID: PMC10637408 DOI: 10.1097/md.0000000000036037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
Cytokines, notably interleukin-6 (IL-6), increase considerably in patients with severe corona virus disease 2019 (COVID-19). This vigorous immune response may cause end-organ failure or death; hence, measuring IL-6 in the context of patient characteristics may help predict outcomes and encourage early comprehensive therapy. This study investigated the association between serum IL-6 levels, COVID-19 severity, and demographic, clinical, and biochemical characteristics. COVID-19 inpatients in NMC hospitals were investigated between November 2020 and November 2021. Several patient variables related to serum IL-6 and COVID-19 severity have been examined. The study included 374 COVID-19 inpatients, 235 of whom had severe disease with a median age of 51. The elderly had an increased risk of severe COVID-19 (73.8%) compared with young adults (71%), with higher white blood cells, D-dimer, Lactate dehydrogenase, creatinine, ferritin, prothrombin time, Procalcitonin, and fibrinogen levels (P < .001). C-reactive protein, troponin, intensive care unit admission, disease severity score, and mortality were significantly associated with higher serum IL-6 levels (P = .05) in the univariate analysis, but this significance disappeared in the multivariate analysis. IL-6, along with other demographic and clinical variables affected COVID-19 severity. These characteristics may predict patients at risk of severe disease and assist in establishing early comprehensive disease outcome strategies. Large-scale clinical research is needed to emphasize IL-6 and COVID-19.
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Affiliation(s)
- Wael Hafez
- Internal Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
- Internal Medicine Department, The Medical Research Division, The National Research Center, Cairo, Egypt
| | - Prashant Nasa
- NMC Specialty Hospital, Al Nahda, Dubai, United Arab Emirates
| | - Ahmed Khairy
- Internal Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Mohan Jose
- Internal Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Mahmoud Abdelshakour
- Internal Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Sabah Ahmed
- Internal Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Fatema Abdulaal
- Internal Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Nivedita Nair
- Internal Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Mohammad Ahmad
- Internal Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Vanya Jalal Rashid
- Internal Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Youmna Ayman
- Internal Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Steffi John
- Internal Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Osman Fdl Alla
- Internal Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Reham Abu Shady
- Internal Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
| | - Ahmed Ali Mohamed
- Intensive Care Unit, Theodor Bilharz Research Institute, El Warraq, Giza Governorate, Egypt
| | - Rami Soliman
- National Institute of chest and Allergy, Cairo, Egypt
| | - Simon Nader
- Internal Medicine, NMC Royal Hospital, Khalifa City, Abu Dhabi, United Arab Emirates
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Moin ASM, Sathyapalan T, Atkin SL, Butler AE. The severity and duration of Hypoglycemia affect platelet-derived protein responses in Caucasians. Cardiovasc Diabetol 2022; 21:202. [PMID: 36203210 PMCID: PMC9541052 DOI: 10.1186/s12933-022-01639-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Severe hypoglycemia is associated with increased cardiovascular death risk, and platelet responses to hypoglycemia (hypo) have been described. However, the impact of deep transient hypo (deep-hypo) versus prolonged milder hypo (mild-hypo) on platelet response is unclear. Research Design and methods Two hypo studies were compared; firstly, mild-hypo in 18-subjects (10 type-2-diabetes (T2D), 8 controls), blood glucose to 2.8mmoL/L (50 mg/dL) for 1-hour; secondly deep-hypo in 46-subjects (23 T2D, 23 controls), blood glucose to < 2.2mmoL/L (< 40 mg/dL) transiently. Platelet-related protein (PRP) responses from baseline to after 1-hour of hypo (mild-hypo) or at deep-hypo were compared, and at 24-hours post-hypo. Slow Off-rate Modified Aptamer (SOMA)-scan plasma protein measurement was used to determine PRP changes for 13 PRPs. Results In controls, from baseline to hypo, differences were seen for four PRPs, three showing increased %change in deep-hypo (Plasminogen activator inhibitor-1(PAI-1), CD40 ligand (CD40LG) and Protein-S), one showing increased %change in mild-hypo (von Willebrand factor (vWF)); at 24-hours in controls, %change for Protein-S remained increased in deep-hypo, whilst % change for vWF and plasminogen were increased in mild-hypo. In T2D, from baseline to hypo, differences were seen for 4 PRPs, three showing increased %change in deep-hypo (PAI-1, platelet glycoprotein VI and Tissue factor), one showing increased %change in mild-hypo (CD40LG); at 24-hours in T2D, %change for CD40LG remained increased, together with vWF, in deep-hypo. Conclusion Both mild-hypo and deep-hypo showed marked PRP changes that continued up to 24-hours, showing that both the severity and duration of hypoglycemia are likely important and that any degree of hypoglycemia may be detrimental for increased cardiovascular risk events through PRP changes. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01639-w.
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Affiliation(s)
- Abu Saleh Md Moin
- Research Department, Royal College of Surgeons in Ireland, PO Box 15503, Adliya, Bahrain
| | | | - Stephen L Atkin
- Research Department, Royal College of Surgeons in Ireland, PO Box 15503, Adliya, Bahrain
| | - Alexandra E Butler
- Research Department, Royal College of Surgeons in Ireland, PO Box 15503, Adliya, Bahrain.
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Kotronia E, Brown H, Papacosta O, Lennon LT, Weyant RJ, Whincup PH, Wannamethee SG, Ramsay SE. Oral health problems and risk of incident disability in two studies of older adults in the United Kingdom and the United States. J Am Geriatr Soc 2022; 70:2080-2092. [PMID: 35437751 PMCID: PMC9283258 DOI: 10.1111/jgs.17792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 02/08/2022] [Accepted: 03/11/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Preventing oral health problems can be crucial for maintaining physical independence in older adults. We aimed to examine the associations of a range of oral health problems with incidence of disability in older adults. METHODS We used prospective data from the British Regional Health Study (BRHS) (N = 2147, 71-92 years), and the Health, Aging and Body Composition (HABC) study (USA) (N = 3075, 71-80 years). Oral health measures included tooth loss, periodontal disease, self-rated oral health, and self-reported dry mouth. Participants were followed for onset of disability over a follow-up period of 3 years. Onset of disability was assessed through new cases of mobility limitations, activities of daily living (ADL), and instrumental activities of daily living (IADL). Logistic regression was performed to calculate the odds of incident disability. RESULTS In the BRHS, tooth loss was associated with greater odds of mobility limitations and ADL difficulties. Periodontal disease was associated with greater incidence of mobility limitations. Self-report of ≥3 dry mouth symptoms was associated with increased odds of incident mobility limitations and ADL difficulties (OR = 2.08, 95% CI 1.27-3.42; OR = 1.73, 95% CI 1.03-2.90). Fair/poor self-rated oral health was associated with greater incidence of IADL difficulties. In the HABC study, complete tooth loss was associated with greater incidence of mobility limitations (OR = 1.86, 95% CI 1.13-3.06), and fair/poor self-rated oral health was associated with increased odds of incident ADL difficulties (OR = 1.42, 95% CI 1.04-1.94). CONCLUSIONS Oral health problems in older adults, particularly tooth loss, self-reported dry mouth and self-rated oral health were associated with greater incidence of disability. Poor oral health plays a potentially important role in the development of disability in older populations, which in turn is an essential part of quality of life and healthy aging.
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Affiliation(s)
- Eftychia Kotronia
- Population Health Sciences InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Heather Brown
- Population Health Sciences InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Olia Papacosta
- Department of Primary Care & Population HealthInstitute of Epidemiology and Health Care, University College LondonLondonUK
| | - Lucy T. Lennon
- Department of Primary Care & Population HealthInstitute of Epidemiology and Health Care, University College LondonLondonUK
| | - Robert J. Weyant
- Department of Dental Public Health, School of Dental MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Peter H. Whincup
- Population Health Research InstituteSt George's University of LondonLondonUK
| | - Sasiwarang Goya Wannamethee
- Department of Primary Care & Population HealthInstitute of Epidemiology and Health Care, University College LondonLondonUK
| | - Sheena E. Ramsay
- Population Health Sciences InstituteNewcastle UniversityNewcastle Upon TyneUK
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Maamar M, Artime A, Pariente E, Fierro P, Ruiz Y, Gutiérrez S, Tobalina M, Díaz-Salazar S, Ramos C, Olmos JM, Hernández JL. Post-COVID-19 syndrome, low-grade inflammation and inflammatory markers: a cross-sectional study. Curr Med Res Opin 2022; 38:901-909. [PMID: 35166141 PMCID: PMC8935459 DOI: 10.1080/03007995.2022.2042991] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Post-COVID syndrome (PCS) is a poorly known entity. An underlying chronic, low-grade inflammation (LGI) has been theorized as a pathophysiological mechanism. Available data on biomarkers in PCS show conflicting results. Our aim was to know whether subjects with PCS present higher levels of inflammatory markers, after a mild COVID-19. METHODS Analytical cross-sectional study. Cases of mild COVID-19 in a community setting were included. We collected epidemiological data (age, sex, BMI, smoking, comorbidities), variables of the acute COVID-19 (duration, symptoms), and data at 3 months after the acute phase (symptoms and laboratory test). Serum C-reactive protein (CRP), neutrophil and lymphocyte counts, neutrophil/lymphocyte ratio (NLR), lactate dehydrogenase, ferritin, fibrinogen, and D-dimer levels were analysed. LGI was defined as CRP >0.3 and <1.0 mg/dL. A subject was classified as PCS + if presented signs and symptoms >12 weeks after an infection consistent with COVID-19. Five composite indices (C1-C5) were developed, combining the upper ranges of biomarkers distributions. Multivariate analyses were performed. RESULTS We analysed 121 mild COVID-19 cases (mean age = 45.7 years, 56.2% women). Among the acute symptoms, women presented a higher frequency of fatigue (54.4% vs 30.2%; p = .008). PCS affected 35.8% of women and 20.8% of men (p = .07), and the most reported symptoms were fatigue (42.8%), anosmia (40%), ageusia (22.8%), dyspnea (17.1%) and myalgia (11.4%). Neutrophil count, NLR, CRP and fibrinogen showed the best correlations with PCS and were selected to develop the indices. In women PCS+, C1, C3 and C4 indices were more frequently met, while in men PCS+, C2, C5 and CRP were in the range of LGI. Anosmia, ageusia and fatigue were related to higher neutrophil counts, with sex differences. Fibrinogen levels were higher in persistent myalgia (510 ± 82 mg/dL vs 394 ± 87; p = .013). In multivariable analysis, a woman with a neutrophil count above the median, or with fibrinogen level or NLR in the highest tertile, had a 4-5-fold increased risk of prevalent PCS. A man with CRP in the range of LGI, or fibrinogen level or a neutrophil count in the highest tertile, had a 10-17-fold increased risk of prevalent PCS. CONCLUSIONS The data obtained in the present cross-sectional study seems to demonstrate a consistent association between PCS and upper ranges of the neutrophil count, NLR, fibrinogen, and CRP in the LGI range. Furthermore, composite indices appear useful in detecting relationships between slight elevations of biomarkers and PCS, and our study identifies relevant sex differences in symptoms and markers regarding the PCS.
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Affiliation(s)
- Meryam Maamar
- Emergency Service. Osakidetza, Servicio Vasco de Salud, Bilbao, País Vasco, Spain
| | - Arancha Artime
- El Llano - Primary Health Care Center, SESPA - Servicio Asturiano de Salud, Gijón Asturias, Spain
| | - Emilio Pariente
- Camargo Interior - Primary Health Care Center, Servicio Cántabro de Salud, Muriedas, Cantabria, Spain
- Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, Spain
- CONTACT Emilio Pariente “Camargo Interior” Primary Care Center, Associate Professor, University of Cantabria, Avda Bilbao, s/n. 39600-Muriedas, Cantabria, Spain
| | - Patricia Fierro
- Camargo Interior - Primary Health Care Center, Servicio Cántabro de Salud, Muriedas, Cantabria, Spain
| | - Yolanda Ruiz
- Camargo Interior - Primary Health Care Center, Servicio Cántabro de Salud, Muriedas, Cantabria, Spain
| | - Silvia Gutiérrez
- Camargo Interior - Primary Health Care Center, Servicio Cántabro de Salud, Muriedas, Cantabria, Spain
| | - Marian Tobalina
- Camargo Interior - Primary Health Care Center, Servicio Cántabro de Salud, Muriedas, Cantabria, Spain
| | - Sara Díaz-Salazar
- Camargo Interior - Primary Health Care Center, Servicio Cántabro de Salud, Muriedas, Cantabria, Spain
| | - Carmen Ramos
- Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, Spain
- Camargo Costa - Primary Health Care Center, Servicio Cántabro de Salud, Maliaño, Cantabria, Spain
| | - José M. Olmos
- Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, Spain
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
| | - José L. Hernández
- Depto. de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, Spain
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria, Spain
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9
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Qin Y, Wang Y, Meng F, Feng M, Zhao X, Gao C, Luo J. Identification of biomarkers by machine learning classifiers to assist diagnose rheumatoid arthritis-associated interstitial lung disease. Arthritis Res Ther 2022; 24:115. [PMID: 35590341 PMCID: PMC9118651 DOI: 10.1186/s13075-022-02800-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/06/2022] [Indexed: 12/14/2022] Open
Abstract
Background This study aimed to search for blood biomarkers among the profiles of patients with RA-ILD by using machine learning classifiers and probe correlations between the markers and the characteristics of RA-ILD. Methods A total of 153 RA patients were enrolled, including 75 RA-ILD and 78 RA-non-ILD. Routine laboratory data, the levels of tumor markers and autoantibodies, and clinical manifestations were recorded. Univariate analysis, least absolute shrinkage and selection operator (LASSO), random forest (RF), and partial least square (PLS) were performed, and the receiver operating characteristic (ROC) curves were plotted. Results Univariate analysis showed that, compared to RA-non-ILD, patients with RA-ILD were older (p < 0.001), had higher white blood cell (p = 0.003) and neutrophil counts (p = 0.017), had higher erythrocyte sedimentation rate (p = 0.003) and C-reactive protein (p = 0.003), had higher levels of KL-6 (p < 0.001), D-dimer (p < 0.001), fibrinogen (p < 0.001), fibrinogen degradation products (p < 0.001), lactate dehydrogenase (p < 0.001), hydroxybutyrate dehydrogenase (p < 0.001), carbohydrate antigen (CA) 19–9 (p < 0.001), carcinoembryonic antigen (p = 0.001), and CA242 (p < 0.001), but a significantly lower albumin level (p = 0.003). The areas under the curves (AUCs) of the LASSO, RF, and PLS models attained 0.95 in terms of differentiating patients with RA-ILD from those without. When data from the univariate analysis and the top 10 indicators of the three machine learning models were combined, the most discriminatory markers were age and the KL-6, D-dimer, and CA19-9, with AUCs of 0.814 [95% confidence interval (CI) 0.731–0.880], 0.749 (95% CI 0.660–0.824), 0.749 (95% CI 0.660–0.824), and 0.727 (95% CI 0.637–0.805), respectively. When all four markers were combined, the AUC reached 0.928 (95% CI 0.865–0.968). Notably, neither the KL-6 nor the CA19-9 level correlated with disease activity in RA-ILD group. Conclusions The levels of KL-6, D-dimer, and tumor markers greatly aided RA-ILD identification. Machine learning algorithms combined with traditional biostatistical analysis can diagnose patients with RA-ILD and identify biomarkers potentially associated with the disease. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02800-2.
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Affiliation(s)
- Yan Qin
- Department of Rheumatology, Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Yanlin Wang
- Department of Rheumatology, Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Fanxing Meng
- The Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Min Feng
- Department of Rheumatology, Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Xiangcong Zhao
- Department of Rheumatology, Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Chong Gao
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jing Luo
- Department of Rheumatology, Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China.
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10
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Short-term or long-term outcomes for stroke patients with cancer according to biological markers. J Neurol Sci 2022; 436:120246. [DOI: 10.1016/j.jns.2022.120246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/12/2022] [Accepted: 03/28/2022] [Indexed: 11/21/2022]
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11
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Dai J, Li, J, He, X, Huang, H, Li Y. A relationship among the blood serum levels of interleukin-6, albumin, and 25-hydroxyvitamin D and frailty in elderly patients with chronic coronary syndrome. Aging Med (Milton) 2022; 5:17-29. [PMID: 35309153 PMCID: PMC8917258 DOI: 10.1002/agm2.12201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 01/09/2023] Open
Abstract
Background With the aggravation of the aging of the world population, frailty has become one of the common complications in elderly people. Its diagnosis is not objective, the pathogenesis is not clear, and interventions are not sound, thus intensifying the problem. Furthermore, frailty is closely associated with the occurrence and poor prognosis of coronary atherosclerotic heart disease. Moreover, few studies report on the prevalence of frailty in elderly patients with the chronic coronary syndrome (CCS). Objective We aimed to investigate the prevalence of frailty in elderly patients with CCS. We analyzed the correlation between the blood serum levels of interleukin-6 (IL-6), albumin (Alb), and 25-hydroxyvitamin D (25(OH)D) with frailty in elderly patients with CCS. We have also provided recommendations for helping the objective diagnosis as well as proposed new intervention methods in the future. Methods Two hundred eight-eight inpatients (≥60 years) with the chronic coronary syndrome were recruited at the Department of Geriatrics, the First People's Hospital of Yunnan Province, China. General information and laboratory examination data were collected. The comprehensive geriatric assessment was conducted via an internet-based platform of the Comprehensive Geriatric Assessment (inpatient version) developed by us, among which frailty was assessed by the Chinese version of Fried Frailty Phenotype, a component of the assessment scale. Results Among the total number of old patients with CCS, 87 (30.2%) had no frailty, 93 (32.3%) had early frailty, and 108 (37.5%) had frailty. According to the multivariate logistic regression analysis, after adjusting for confounding factors, IL-6 (OR = 1.066, 95% CI 1.012-1.127), Alb (OR = 0.740, 95% CI 0.560-0.978), and 25(OH)D (OR = 0.798, 95% CI 0.670-0.949) were independently associated with frailty in the three groups of models. Conclusion IL-6 proved to be a risk factor for frailty in elderly patients with CCS, while Alb and 25(OH)D were protective factors, which make the potential targets for predicting and intervening frailty in elderly patients with CCS.
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Affiliation(s)
- Jing‐rong Dai
- School of MedicineKunming University of Science and TechnologyKunmingChina
- Department of GeriatricsThe First People's Hospital of Yunnan ProvinceKunmingChina
| | - Jie Li,
- School of MedicineKunming University of Science and TechnologyKunmingChina
- Department of GeriatricsThe First People's Hospital of Yunnan ProvinceKunmingChina
| | - Xu He,
- School of MedicineKunming University of Science and TechnologyKunmingChina
- Department of GeriatricsThe First People's Hospital of Yunnan ProvinceKunmingChina
| | - Hong Huang,
- School of MedicineKunming University of Science and TechnologyKunmingChina
- Department of GeriatricsThe First People's Hospital of Yunnan ProvinceKunmingChina
| | - Yan Li
- School of MedicineKunming University of Science and TechnologyKunmingChina
- Department of GeriatricsThe First People's Hospital of Yunnan ProvinceKunmingChina
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12
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Physical exercise is associated with a reduction in plasma levels of fractalkine, TGF-β1, eotaxin-1 and IL-6 in younger adults with mobility disability. PLoS One 2022; 17:e0263173. [PMID: 35113938 PMCID: PMC8812905 DOI: 10.1371/journal.pone.0263173] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 01/13/2022] [Indexed: 11/24/2022] Open
Abstract
Mobility disability (MD) refers to substantial limitations in life activities that arise because of movement impairments. Although MD is most prevalent in older individuals, it can also affect younger adults. Increasing evidence suggests that inflammation can drive the development of MD and may need to be targeted for MD prevention. Physical exercise has anti-inflammatory properties and has been associated with MD prevention. However, no studies to date have examined whether exercise interventions affect the peripheral inflammatory status in younger adults with MD. To this end, we used blood samples from young and middle-aged adults with MD (N = 38; median age = 34 years) who participated in a 12-week intervention that included aerobic and resistance exercise training. A pre-post assessment of inflammatory biomarkers was conducted in plasma from two timepoints, i.e., before the exercise trial and at follow-up (3–7 days after the last exercise session). We successfully measured 15 inflammatory biomarkers and found that exercise was associated with a significant reduction in levels of soluble fractalkine, transforming growth factor beta 1 (TGF-β1), eotaxin-1 and interleukin (IL) 6 (corrected α = 0.004). We also found significant male-specific effects of exercise on (i) increasing IL-16 and (ii) decreasing vascular endothelial growth factor-A (VEGF-A). In line with our results, previous studies have also found that exercise can reduce levels of TGF-β1, eotaxin-1 and IL-6. However, our finding that exercise reduces plasma levels of fractalkine in younger adults with MD, as well as the sex-dependent findings, have not been previously reported and warrant replication in larger cohorts. Given the suggested role of inflammation in promoting MD development, our study provides additional support for the use of physical exercise as a treatment modality for MD.
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13
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Wang H, Lv B, Li W, Wang S. The Impact of D-Dimer on Postoperative Deep Vein Thrombosis in Patients with Thoracolumbar Fracture Caused by High-Energy Injuries. Clin Appl Thromb Hemost 2022; 28:10760296211070009. [PMID: 34981993 PMCID: PMC8733349 DOI: 10.1177/10760296211070009] [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] [Indexed: 12/05/2022] Open
Abstract
Objective To investigate the dynamic variation of D-dimer and to evaluate the efficacy and accuracy of D-dimer level in patients with thoracolumbar fractures caused by high-energy injuries. Methods A total of 121 patients with thoracolumbar fractures caused by high-energy injuries were retrospectively identified and included in this study. There were 83 males and 38 females, with an average age of 48.6 ± 11.2 years. All patients were treated with either screw fixation surgery or decompression fixation surgery. The D-dimer levels were measured 1 day before surgery and on the first, third, and fifth days after surgery. The dynamic variation of D-dimer and the effects of risk factors on D-dimer levels were analysed. A receiver operating characteristic (ROC) curve analysis was performed and the appropriate D-dimer cut-off level was determined for deep vein thrombosis (DVT) screening. Results Due to a trough on the third day, D-dimer levels grew in an unsustainable manner following surgery (P < 0.001). Patients with the operation time >120 min (P = 0.009) and those with an American Spinal Injury Association (ASIA) score A-C (P < 0.001) had higher D-dimer levels. The area under the curve of D-dimer was the greatest on the third day. Applying stratified cut-off values did not change the sensitivity, specificity and negative predictive value in the group with an operation time >120 min, and ASIA score A-C group. Conclusions D-dimer levels elevated with fluctuation in patients with thoracolumbar fractures caused by high-energy injuries after surgery. Both operation time and ASIA score had an impact on D-dimer levels. Regarding DVT diagnoses, the diagnostic value of D-dimer was highest on the third day postoperatively, and stratified cut-off values by these two factors did not show better diagnostic efficacy compared with a collective one.
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Affiliation(s)
- Haiying Wang
- 592469Baoding No 1 Central Hospital, Baoding, 071000, P.R. China
| | - Bing Lv
- 592469Baoding No 1 Central Hospital, Baoding, 071000, P.R. China
| | - Weifeng Li
- 592469Baoding No 1 Central Hospital, Baoding, 071000, P.R. China
| | - Shunyi Wang
- 592469Baoding No 1 Central Hospital, Baoding, 071000, P.R. China
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McKechnie DGJ, Papacosta AO, Lennon LT, Ramsay SE, Whincup PH, Wannamethee SG. Associations between inflammation, cardiovascular biomarkers and incident frailty: the British Regional Heart Study. Age Ageing 2021; 50:1979-1987. [PMID: 34254997 PMCID: PMC8675445 DOI: 10.1093/ageing/afab143] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction cardiovascular disease (CVD) and chronic inflammation are implicated in the development of
frailty. Longitudinal analyses of inflammatory markers, biomarkers of cardiac dysfunction and
incidence of frailty are limited. Methods in the British Regional Heart Study, 1,225 robust or pre-frail men aged 71–92 years
underwent a baseline examination, with questionnaire-based frailty assessment after 3 years.
Frailty definitions were based on the Fried phenotype. Associations between incident frailty
and biomarkers of cardiac dysfunction (high-sensitivity cardiac troponin T (hs-cTnT),
N-terminal pro B-type natriuretic peptide (NT-proBNP)) and inflammation (C-reactive protein
(CRP) and interleukin-6 (IL-6)) were examined, by tertile, with the lowest as reference. Results follow-up data were available for 981 men. Ninety one became frail. Adjusted for age,
pre-frailty, prevalent and incident CVD, comorbidity, polypharmacy and socioeconomic status,
IL-6 (third tertile OR 2.36, 95% CI 1.07–5.17) and hs-cTnT (third tertile OR 2.24, 95% CI
1.03–4.90) were associated with increased odds of frailty. CRP (third tertile OR 1.83, 95% CI
0.97–4.08) and NT-proBNP (second tertile OR 0.48, 95% CI 0.23–1.01) showed no significant
association with incident frailty. The top tertiles of CRP, IL-6, hscTnT and NT-proBNP were
strongly associated with mortality prior to follow-up. Conclusion IL-6 is associated with incident frailty, supporting the prevailing argument that
inflammation is involved in the pathogenesis of frailty. Cardiomyocyte injury may be
associated with frailty risk. Associations between elevated CRP and frailty cannot be fully
discounted; NT-proBNP may have a non-linear relationship with incident frailty. CRP, IL-6,
hs-cTnT and NT-proBNP are vulnerable to survivorship bias.
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Affiliation(s)
- Douglas G J McKechnie
- Department of Primary Care and Population Health, University College London, London, UK
| | - A Olia Papacosta
- Department of Primary Care and Population Health, University College London, London, UK
| | - Lucy T Lennon
- Department of Primary Care and Population Health, University College London, London, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter H Whincup
- Population Health Research Institute, St George’s University of London, London, UK
| | - S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, London, UK
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15
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Kim JS, Anderson MR, Bernstein EJ, Oelsner EC, Raghu G, Noth I, Tsai MY, Salvatore M, Austin JHM, Hoffman EA, Barr RG, Podolanczuk AJ. Associations of D-Dimer with Computed Tomographic Lung Abnormalities, Serum Biomarkers of Lung Injury, and Forced Vital Capacity: MESA Lung Study. Ann Am Thorac Soc 2021; 18:1839-1848. [PMID: 33861685 PMCID: PMC8641831 DOI: 10.1513/annalsats.202012-1557oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/08/2021] [Indexed: 12/30/2022] Open
Abstract
Rationale: The coagulation cascade may play a role in the pathogenesis of interstitial lung disease through increased production of thrombin and fibrin deposition. Whether circulating coagulation cascade factors are linked to lung inflammation and scarring among community-dwelling adults is unknown. Objectives: To test the hypothesis that higher baseline D-dimer concentrations are associated with markers of early lung injury and scarring. Methods: Using the MESA (Multi-Ethnic Study of Atherosclerosis) cohort (n = 6,814), we examined associations of baseline D-dimer concentrations with high attenuation areas from examination 1 (2000-2002; n = 6,184) and interstitial lung abnormalities from examination 5 computed tomographic (CT) scans (2010-2012; n = 2,227), and serum MMP-7 (matrix metalloproteinase-7) and SP-A (surfactant protein-A) from examination 1 (n = 1,098). We examined longitudinal change in forced vital capacity (FVC) from examinations 3-6 (2004-2018, n = 3,562). We used linear logistic regression and linear mixed models to examine associations and adjust for potential confounders. Results: The mean (standard deviation) age of the cohort was 62 (10) years, and the D-dimer concentration was 0.35 (0.69) ug/ml. For every 10% increase in D-dimer concentration, there was an increase in high attenuation area percentage of 0.27 (95% confidence interval (CI), 0.08-0.47) after adjustment for covariates. Associations were stronger among those older than 65 years (P values for interaction < 0.001). A 10% increase in D-dimer concentration was associated with an odds ratio of 1.05 for interstitial lung abnormalities (95% CI, 0.99-1.11). Higher D-dimer concentrations were associated with higher serum MMP-7 and a faster decline in FVC. D-dimer was not associated with SP-A. Conclusions: Higher D-dimer concentrations were associated with a greater burden of lung parenchymal abnormalities detected on CT scan, MMP-7, and FVC decline among community-dwelling adults.
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Affiliation(s)
- John S. Kim
- Department of Medicine, University of Virginia, Charlottesville, Virginia
- Department of Medicine
| | | | | | | | - Ganesh Raghu
- Department of Medicine, University of Washington, Seattle, Washington
| | - Imre Noth
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Michael Y. Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | | | | | - Eric A. Hoffman
- Departments of Radiology, Medicine, and Biomedical Engineering, University of Iowa Carver College of Medicine, Iowa City, Iowa; and
| | - R. Graham Barr
- Department of Medicine
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Anna J. Podolanczuk
- Department of Medicine
- Department of Medicine, Weill Cornell Medical Center, New York, New York
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16
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Francistiová L, Klepe A, Curley G, Gulya K, Dinnyés A, Filkor K. Cellular and Molecular Effects of SARS-CoV-2 Linking Lung Infection to the Brain. Front Immunol 2021; 12:730088. [PMID: 34484241 PMCID: PMC8414801 DOI: 10.3389/fimmu.2021.730088] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/27/2021] [Indexed: 12/13/2022] Open
Abstract
In December 2019, a new viral disease emerged and quickly spread all around the world. In March 2020, the COVID-19 outbreak was classified as a global pandemic and by June 2021, the number of infected people grew to over 170 million. Along with the patients' mild-to-severe respiratory symptoms, reports on probable central nervous system (CNS) effects appeared shortly, raising concerns about the possible long-term detrimental effects on human cognition. It remains unresolved whether the neurological symptoms are caused directly by the SARS-CoV-2 infiltration in the brain, indirectly by secondary immune effects of a cytokine storm and antibody overproduction, or as a consequence of systemic hypoxia-mediated microglia activation. In severe COVID-19 cases with impaired lung capacity, hypoxia is an anticipated subsidiary event that can cause progressive and irreversible damage to neurons. To resolve this problem, intensive research is currently ongoing, which seeks to evaluate the SARS-CoV-2 virus' neuroinvasive potential and the examination of the antibody and autoantibody generation upon infection, as well as the effects of prolonged systemic hypoxia on the CNS. In this review, we summarize the current research on the possible interplay of the SARS-CoV-2 effects on the lung, especially on alveolar macrophages and direct and indirect effects on the brain, with special emphasis on microglia, as a possible culprit of neurological manifestation during COVID-19.
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Affiliation(s)
- Linda Francistiová
- BioTalentum Ltd, Gödöllő, Hungary
- Department of Physiology and Animal Health, Institute of Physiology and Animal Health, Hungarian University of Agriculture and Life Sciences, Gödöllő, Hungary
| | - Adrián Klepe
- BioTalentum Ltd, Gödöllő, Hungary
- Department of Cell Biology and Molecular Medicine, University of Szeged, Szeged, Hungary
- Hungarian Centre of Excellence for Molecular Medicine - University of Szeged (HCEMM-USZ) StemCell Research Group, University of Szeged, Szeged, Hungary
| | - Géza Curley
- BioTalentum Ltd, Gödöllő, Hungary
- Department of Cell Biology and Molecular Medicine, University of Szeged, Szeged, Hungary
- Hungarian Centre of Excellence for Molecular Medicine - University of Szeged (HCEMM-USZ) StemCell Research Group, University of Szeged, Szeged, Hungary
| | - Károly Gulya
- Department of Cell Biology and Molecular Medicine, University of Szeged, Szeged, Hungary
| | - András Dinnyés
- BioTalentum Ltd, Gödöllő, Hungary
- Department of Cell Biology and Molecular Medicine, University of Szeged, Szeged, Hungary
- Hungarian Centre of Excellence for Molecular Medicine - University of Szeged (HCEMM-USZ) StemCell Research Group, University of Szeged, Szeged, Hungary
| | - Kata Filkor
- BioTalentum Ltd, Gödöllő, Hungary
- Department of Cell Biology and Molecular Medicine, University of Szeged, Szeged, Hungary
- Hungarian Centre of Excellence for Molecular Medicine - University of Szeged (HCEMM-USZ) StemCell Research Group, University of Szeged, Szeged, Hungary
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Zhang Q, Li J, Zhang Y, Gao J, Wang P, Ai M, Ding W, Tan X. Differences in clinical characteristics and liver injury between suspected and confirmed COVID-19 patients in Jingzhou, Hubei Province of China. Medicine (Baltimore) 2021; 100:e25913. [PMID: 34106656 PMCID: PMC8133163 DOI: 10.1097/md.0000000000025913] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 01/08/2023] Open
Abstract
ABSTRACT To evaluate the clinical characteristics and liver injury in coronavirus disease 2019 (COVID-19) patients, and analyze the differences between suspected and confirmed COVID-19 patients, this retrospective study was performed on 157 COVID-19 patients and 93 suspected patients who were ultimately excluded from COVID-19 (control patients). Differences in clinical characteristics and liver injury between suspected and confirmed COVID-19 patients were analyzed. Age, male sex, fever, chest tightness and dyspnea were related to the severity of COVID-19. C-reactive protein (CRP) and D-dimer may be predictors of the severity of COVID-19. Computed tomography (CT) played an important role in the screening of COVID-19 and the evaluation of disease severity. Multiple factors may cause liver injury in COVID-19 patients. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be more likely to cause liver injury than common respiratory infectious diseases. Age, temperature (T), white blood cell (WBC), lymphocytes (LY), hematocrit (HCT), CRP, and finger pulse oxygen saturation (SpO2) may correlate with liver function impairment and may predict the occurrence and severity of liver function impairment. Some therapeutic drugs (like glucocorticoid) may be involved in the liver function impairment of COVID-19 patients. Most liver function indices improved significantly after active treatment. Although COVID-19 and other common respiratory infectious diseases share some clinical characteristics, COVID-19 has its own characteristics.
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Affiliation(s)
- Qing Zhang
- Department of Gastroenterology, First Hospital of Yangtze University
- Clinical Medical College, Yangtze University, Jingzhou, Hubei Province
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jie Li
- Department of Gastroenterology, First Hospital of Yangtze University
| | - Yan Zhang
- Department of Gastroenterology, First Hospital of Yangtze University
| | - Jie Gao
- Department of Gastroenterology, First Hospital of Yangtze University
| | - Peixue Wang
- Department of Gastroenterology, First Hospital of Yangtze University
| | - Minghua Ai
- Department of Gastroenterology, First Hospital of Yangtze University
| | - Wen Ding
- Department of Gastroenterology, First Hospital of Yangtze University
| | - Xiaoping Tan
- Department of Gastroenterology, First Hospital of Yangtze University
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Xu G, Chen F, Zhao W, Zheng Y, Zhuang W, Yu F. Establishment and assessment of a nomogram model for predicting the risk of fulminant myocarditis: A STROBE compliant cross-sectional study. Medicine (Baltimore) 2021; 100:e25317. [PMID: 33907091 PMCID: PMC8084052 DOI: 10.1097/md.0000000000025317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/19/2021] [Accepted: 03/02/2021] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT We aimed to identify potential clinical predictors associated with the risk of fulminant myocarditis, and further to establish and assess a nomogram model based on significant attributes for clinical practicability.This is a retrospective, cross-sectional study, involving 28 patients with fulminant myocarditis and 35 age-, and sex-matched patients with non-fulminant myocarditis. Effect-size estimates are expressed as odds ratio (OR) and 95% confidence interval (CI).Fifteen factors were primarily identified to be associated with the significant risk of fulminant myocarditis after adjusting for confounders. Due to strong correlation, 6 factors were retained, including mean arterial pressure (OR, 95% CI, P: .82, .72-.94, .005), creatinine (2.15, 1.13-4.10, 0.020), blood urea nitrogen (1.45, 1.04-2.02, 0.028), aspartate aminotransferase (2.62, 1.16-5.91, 0.021), troponin I (1.43, 1.07-1.90, 0.015), and ventricular wall motion abnormality (25.81, 2.52-264.69, 0.006). The contribution of the 6 significant factors to predicting fulminant myocarditis risk was significant from multi-angle analyses, and regressing these factors in a nomogram model exhibited good predictive accuracy, as reflected by both C-index (>90%, P < .001).We have identified 6 clinical factors in significant association with fulminant myocarditis, and their prediction capability was more obvious in a nomogram model. Further investigations with larger sample sizes and longer follow-up intervals are warranted.
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Affiliation(s)
- Guifen Xu
- Department of Cardiology, The First Affiliated Hospital, Fujian Medical University
- Fujian Hypertension Research Institute, The First Affiliated Hospital, Fujian Medical University
| | - Feizhen Chen
- Department of Ultrasound, The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Wenxiang Zhao
- Department of Cardiology, The First Affiliated Hospital, Fujian Medical University
| | - Yong Zheng
- Department of Cardiology, The First Affiliated Hospital, Fujian Medical University
| | - Wei Zhuang
- Department of Cardiology, The First Affiliated Hospital, Fujian Medical University
| | - Fuling Yu
- Department of Cardiology, The First Affiliated Hospital, Fujian Medical University
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Kotronia E, Wannamethee SG, Papacosta AO, Whincup PH, Lennon LT, Visser M, Kapila YL, Weyant RJ, Ramsay SE. Poor Oral Health and Inflammatory, Hemostatic, and Cardiac Biomarkers in Older Age: Results From Two Studies in the UK and USA. J Gerontol A Biol Sci Med Sci 2021; 76:346-351. [PMID: 32306041 PMCID: PMC7812424 DOI: 10.1093/gerona/glaa096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND We examined the association of objective and subjective oral health markers with inflammatory, hemostatic, and cardiac biomarkers in older age. METHODS Cross-sectional analyses were based on the British Regional Heart Study (BRHS) comprising British men aged 71-92 years (n = 2,147), and the Health, Aging and Body Composition (HABC) Study comprising American men and women aged 71-80 years (n = 3,075). Oral health markers included periodontal disease, tooth count, dry mouth. Inflammatory biomarkers included C-reactive protein (CRP), interleukin-6 (IL-6) in both studies, and tissue plasminogen activator (t-PA), von Willebrand Factor (vWF), fibrin D-dimer, high-sensitivity Troponin T (hsTnT), and N-terminal pro-brain natriuretic peptide (NTproBNP) only in the BRHS. RESULTS In both studies, tooth loss, was associated with the top tertile of CRP-odds ratios (ORs) (95% confidence interval [CI]) are 1.31 (1.02-1.68) in BRHS; and 1.40 (1.13-1.75) in the HABC Study, after adjusting for confounders. In the HABC Study, cumulative (≥3) oral health problems were associated with higher levels of CRP (OR [95% CI] =1.42 [1.01-1.99]). In the BRHS, complete and partial tooth loss was associated with hemostatic factors, in particular with the top tertile of fibrin D-dimer (OR [95% CI] = 1.64 [1.16-2.30] and 1.37 [1.05-1.77], respectively). Tooth loss and periodontal disease were associated with increased levels of hsTnT. CONCLUSIONS Poor oral health in older age, particularly tooth loss, was consistently associated with some inflammatory, hemostatic, and cardiac biomarkers. Prospective studies and intervention trials could help understand better if poor oral health is causally linked to inflammatory, hemostatic, and cardiac biomarkers.
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Affiliation(s)
- Eftychia Kotronia
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - S Goya Wannamethee
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, UK
| | - A Olia Papacosta
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, UK
| | - Peter H Whincup
- Faculty of Medical Sciences, Population Health Research Institute, St George’s University of London, UK
| | - Lucy T Lennon
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, UK
| | - Marjolein Visser
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit, the Netherlands
| | - Yvonne L Kapila
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco
| | - Robert J Weyant
- Department of Dental Public Health, School of Dental Medicine, University of Pittsburgh, Pennsylvania
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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Cho ES, McClelland PH, Cheng O, Kim Y, Hu J, Zenilman ME, D'Ayala M. Utility of d-dimer for diagnosis of deep vein thrombosis in coronavirus disease-19 infection. J Vasc Surg Venous Lymphat Disord 2020; 9:47-53. [PMID: 32738407 PMCID: PMC7390766 DOI: 10.1016/j.jvsv.2020.07.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/23/2020] [Indexed: 12/31/2022]
Abstract
Objective The objective of this study was to investigate the clinical usefulness of d-dimer in excluding a diagnosis of deep vein thrombosis (DVT) in patients with coronavirus disease (COVID-19) infection, potentially limiting the need for venous duplex ultrasound examination. Methods We retrospectively reviewed consecutive patients admitted to our institution with confirmed COVID-19 status by polymerase chain reaction between March 1, 2020, and May 13, 2020, and selected those who underwent both d-dimer and venous duplex ultrasound examination. This cohort was divided into two groups, those with and without DVT based on duplex ultrasound examination. These groups were then compared to determine the value of d-dimer in establishing this diagnosis. Results A total of 1170 patients were admitted with COVID-19, of which 158 were selected for this study. Of the 158, there were 52 patients with DVT and 106 without DVT. There were no differences in sex, age, race, or ethnicity between groups. Diabetes and routine hemodialysis were less commonly seen in the group with DVT. More than 90% of patients in both groups received prophylactic anticoagulation, but the use of low-molecular-weight heparin or subcutaneous heparin prophylaxis was not predictive of DVT. All patients had elevated acute-phase d-dimer levels using conventional criteria, and 154 of the 158 (97.5%) had elevated levels with age-adjusted criteria (mean d-dimer 16,163 ± 5395 ng/mL). Those with DVT had higher acute-phase d-dimer levels than those without DVT (median, 13,602 [interquartile range, 6616-36,543 ng/mL] vs 2880 [interquartile range, 1030-9126 ng/mL], P < .001). An optimal d-dimer cutoff of 6494 ng/mL was determined to differentiate those with and without DVT (sensitivity 80.8%, specificity 68.9%, negative predictive value 88.0%). Wells DVT criteria was not found to be a significant predictor of DVT. Elevated d-dimer as defined by our optimal metric was a statistically significant predictor of DVT in both univariate and multivariable analyses when adjusting for other factors (odds ratio, 6.12; 95% confidence interval, 2.79-13.39; P < .001). Conclusions d-dimer levels are uniformly elevated in patients with COVID-19. Although standard predictive criteria failed to predict DVT, our analysis showed a d-dimer of less than 6494 ng/mL may exclude DVT, potentially limiting the need for venous duplex ultrasound examination.
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Affiliation(s)
- Edward S Cho
- Department of Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Paul H McClelland
- Department of Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Olivia Cheng
- Department of Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Yuri Kim
- Department of Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - James Hu
- Department of Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Michael E Zenilman
- Department of Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Marcus D'Ayala
- Department of Surgery, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY.
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21
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Tian M, Huang W, Ren F, Luo L, Zhou J, Huang D, Tang L. Comparative analysis of connective tissue disease-associated interstitial lung disease and interstitial pneumonia with autoimmune features. Clin Rheumatol 2019; 39:575-583. [PMID: 31758424 DOI: 10.1007/s10067-019-04836-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/29/2019] [Accepted: 10/31/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE This retrospective clinical study aimed to examine the similarities and differences between connective tissue disease-associated interstitial lung disease (CTD-ILD) and interstitial pneumonia with autoimmune features (IPAF) and to identify the influencing factors of CTD-ILD, with a goal of early detection and active treatment of the disease. METHODS We conducted a retrospective study of 480 patients: 412 with CTD-ILD and 68 with IPAF. Demographic features, clinical characteristics, laboratory indicators, and chest high-resolution computed tomography (HRCT) imaging data were analyzed. RESULTS Compared with the IPAF group, the CTD-ILD group contained more women, and the incidences of joint pain, dry mouth/dry eyes, and Raynaud's phenomenon were higher; erythrocyte sedimentation rate (ESR) and D-dimer levels were higher; red blood cell (RBC) and hemoglobin (Hb) levels were lower; a high rheumatoid factor (RF) titer (> 2 times the normal upper limit) was observed, and anti-cyclic citrullinated peptide antibody (anti-CCP), anti-keratin antibody (AKA), antinuclear antibody (ANA), and anti-melanoma differentiation-associated gene 5 antibody (anti-MDA5) levels were higher. Compared with CTD-ILD patients, IPAF patients were more likely to present initially with respiratory symptoms, with higher rates of fever, cough and expectoration, dyspnea, and Velcro crackles; anti-Ro52 titers were higher; incidences of honeycombing opacity, reticulate opacity, patchy opacity, and pleural thickening were greater. Female sex, a high RF titer (> 2 times the normal upper limit), anti-CCP positivity, ANA positivity, and anti-MDA5 positivity were risk factors for CTD-ILD when the odds ratios were adjusted. CONCLUSION CTD-ILD and IPAF patients differed in demographic features, clinical characteristics, laboratory indicators, and chest HRCT imaging data. Female sex, a high RF titer (> 2 times the normal upper limit), anti-CCP positivity, ANA positivity, and anti-MDA5 positivity were risk factors for CTD-ILD.Key Points• This retrospective clinical study comprehensively compared the demographic features, clinical characteristics, laboratory indicators, and chest HRCT imaging data of CTD-ILD and IPAF patients.• The evidence suggested that female sex, a high RF titer, anti-CCP positivity, ANA positivity, and anti-MDA5 positivity were risk factors for CTD-ILD.
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Affiliation(s)
- Mengxue Tian
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China
| | - Wenhan Huang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China
| | - Feifeng Ren
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China
| | - Lei Luo
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China
| | - Jun Zhou
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China
| | - Dongmei Huang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China
| | - Lin Tang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Chongqing, 400010, China.
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McBride WT, Kurth MJ, McLean G, Domanska A, Lamont JV, Maguire D, Watt J, Fitzgerald P, Young I, Joseph J, Ruddock MW. Stratifying risk of acute kidney injury in pre and post cardiac surgery patients using a novel biomarker-based algorithm and clinical risk score. Sci Rep 2019; 9:16963. [PMID: 31740699 PMCID: PMC6861253 DOI: 10.1038/s41598-019-53349-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/31/2019] [Indexed: 12/22/2022] Open
Abstract
Acute kidney injury (AKI) following cardiac surgery significantly increases morbidity and mortality risks. Improving existing clinical methods of identifying patients at risk of perioperative AKI may advance management and treatment options. This study investigated whether a combination of biomarkers and clinical factors pre and post cardiac surgery could stratify patients at risk of developing AKI. Patients (n = 401) consecutively scheduled for elective cardiac surgery were prospectively studied. Clinical data was recorded and blood samples were tested for 31 biomarkers. Areas under receiver operating characteristic (AUROCs) were generated for biomarkers pre and postoperatively to stratify patients at risk of AKI. Preoperatively sTNFR1 had the highest predictive ability to identify risk of developing AKI postoperatively (AUROC 0.748). Postoperatively a combination of H-FABP, midkine and sTNFR2 had the highest predictive ability to identify AKI risk (AUROC 0.836). Preoperative clinical risk factors included patient age, body mass index and diabetes. Perioperative factors included cardio pulmonary bypass, cross-clamp and operation times, intra-aortic balloon pump, blood products and resternotomy. Combining biomarker risk score (BRS) with clinical risk score (CRS) enabled pre and postoperative assignment of patients to AKI risk categories. Combining BRS with CRS will allow better management of cardiac patients at risk of developing AKI.
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Affiliation(s)
- William T McBride
- Department of Cardiac Anaesthesia, Belfast Health & Social Care Trust, 274 Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
| | - Mary Jo Kurth
- Randox Laboratories Ltd, Clinical Studies Group, 55 Diamond Road, Crumlin, County Antrim, BT29 4QY, Northern Ireland, UK
| | - Gavin McLean
- Department of Cardiac Anaesthesia, Belfast Health & Social Care Trust, 274 Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
| | - Anna Domanska
- Randox Laboratories Ltd, Clinical Studies Group, 55 Diamond Road, Crumlin, County Antrim, BT29 4QY, Northern Ireland, UK
| | - John V Lamont
- Randox Laboratories Ltd, Clinical Studies Group, 55 Diamond Road, Crumlin, County Antrim, BT29 4QY, Northern Ireland, UK
| | - Daniel Maguire
- Randox Laboratories Ltd, Clinical Studies Group, 55 Diamond Road, Crumlin, County Antrim, BT29 4QY, Northern Ireland, UK
| | - Joanne Watt
- Randox Laboratories Ltd, Clinical Studies Group, 55 Diamond Road, Crumlin, County Antrim, BT29 4QY, Northern Ireland, UK
| | - Peter Fitzgerald
- Randox Laboratories Ltd, Clinical Studies Group, 55 Diamond Road, Crumlin, County Antrim, BT29 4QY, Northern Ireland, UK
| | - Ian Young
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University of Belfast, 97 Lisburn Road, Health Sciences Building, Belfast, BT9 7BL, Northern Ireland, UK
| | - Jijin Joseph
- Department of Cardiac Anaesthesia, Belfast Health & Social Care Trust, 274 Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
| | - Mark W Ruddock
- Randox Laboratories Ltd, Clinical Studies Group, 55 Diamond Road, Crumlin, County Antrim, BT29 4QY, Northern Ireland, UK.
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Dhamoon MS, Cheung YK, Moon YP, Wright CB, Sacco RL, Elkind MSV. Interleukin-6 and lipoprotein-associated phospholipase A2 are associated with functional trajectories. PLoS One 2019; 14:e0214784. [PMID: 30934019 PMCID: PMC6443177 DOI: 10.1371/journal.pone.0214784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/20/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/OBJECTIVES Inflammatory biomarkers have been associated with stroke and mortality, but inflammation may also have detrimental effects beyond acute events. We hypothesized that serum concentrations of interleukin-6 (IL6) and lipoprotein-associated phospholipase A2 (LpPLA2) were inversely associated with long-term functional decline independently of vascular risk factors, stroke and myocardial infarction (MI) occurring during follow-up. DESIGN Prospective population based cohort study. SETTING The Northern Manhattan Study. PARTICIPANTS (INCLUDING THE SAMPLE SIZE) Race/ethnically diverse stroke-free individuals in northern Manhattan aged ≥40 years (n = 3298). INTERVENTION None. MEASUREMENTS Annual functional assessments with the Barthel index (BI), for a median of 13 years. BI was analyzed as a continuous variable (range 0-100). Baseline demographics, risk factors, and laboratory studies were collected, including IL6 (n = 1679), LpPLA2 mass (n = 1912) and activity (n = 1937). Separate mixed models estimated standardized associations between each biomarker and baseline functional status and change over time, adjusting for demographics, vascular risk factors, social variables, cognition, and depression measured at baseline, and stroke and MI occurring during follow-up. RESULTS Mean age was 69 (SD 10) years, 35% were male, 53% Hispanic, 74% hypertensive, and 16-24% diabetic. LogIL6 was associated with decline in BI over time (-0.13 points per year, 95% CI -0.24, -0.02) and marginally with baseline BI (-0.20, 95% CI -0.40, 0.01). LpPLA2 activity levels were associated with baseline BI (-0.36, 95% CI -0.68, -0.04) but not change over time, and LpPLA2 mass levels were not associated with either. CONCLUSION In this large population-based study, higher serum inflammatory biomarker levels were associated with disability, even when adjusting for baseline covariates and stroke and MI occurring during follow-up.
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Affiliation(s)
- Mandip S. Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Ying-Kuen Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Yeseon P. Moon
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Clinton B. Wright
- National Institutes of Health, Bethesda, MD, United States of America
| | - Ralph L. Sacco
- McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, United States of America
- Departments of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States of America
- Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, United States of America
- Human Genetics, Miller School of Medicine, University of Miami, Miami, FL, United States of America
| | - Mitchell S. V. Elkind
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
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Friedman EM, Mroczek DK, Christ SL. Multimorbidity, inflammation, and disability: a longitudinal mediational analysis. Ther Adv Chronic Dis 2018; 10:2040622318806848. [PMID: 31452864 PMCID: PMC6700847 DOI: 10.1177/2040622318806848] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/14/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Using longitudinal data from the Survey of Mid-Life Development in the United States, this study examined the role of systemic inflammation in mediating the link between multimorbidity and increases in and onset of functional limitations over a 17-19 year follow-up period. METHODS Participants completed questionnaire assessments of chronic conditions and functional limitations. Interleukin-6, C-reactive protein, and fibrinogen were assayed in serum. Structural equation models were used to predict increases in and onset of functional limitations associated with baseline multimorbidity status; mediation by inflammation was also determined. RESULTS Multimorbidity (versus 0-1 conditions) predicted more functional limitations and greater odds of onset of limitations over time. Significant indirect effects showed that inflammation partially mediated the link between multimorbidity and changes in, but not onset of, limitations. DISCUSSION These results show that inflammation, a nonspecific marker of multiple disease conditions, explains in part the degree to which multimorbidity is disabling.
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Affiliation(s)
- Elliot M. Friedman
- Department of Human Development and Family
Studies, Purdue University, 1202 West State Street, West Lafayette, IN
47907, USA
| | - Daniel K. Mroczek
- Department of Psychology and Feinberg School of
Medicine, Northwestern University, Evanston, IL, USA
| | - Sharon L. Christ
- Department of Human Development and Family
Studies, Purdue University, West Lafayette, IN, USA
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25
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Lu Y, Monaco G, Camous X, Andiappan AK, Rotzschke O, Ng TP, Larbi A. Biomarker Signatures Predicting 10-Year All-Cause and Disease-Specific Mortality. J Gerontol A Biol Sci Med Sci 2018; 74:469-479. [DOI: 10.1093/gerona/gly138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Indexed: 01/21/2023] Open
Affiliation(s)
- Yanxia Lu
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A*STAR), Biopolis, Singapore
| | - Gianni Monaco
- Institute of Ageing and Chronic Disease, University of Liverpool, UK
| | - Xavier Camous
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A*STAR), Biopolis, Singapore
| | - Anand Kumar Andiappan
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A*STAR), Biopolis, Singapore
| | - Olaf Rotzschke
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A*STAR), Biopolis, Singapore
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Anis Larbi
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (A*STAR), Biopolis, Singapore
- Department of Biology, Faculty of Science, University Tunis El Manar, Tunis, Tunisia
- Geriatrics Division, Department of Medicine, Research Center on Ageing, University of Sherbrooke, Quebec, Canada
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26
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Impact of D-dimer levels for short-term or long-term outcomes in cryptogenic stroke patients. J Neurol 2018; 265:628-636. [DOI: 10.1007/s00415-018-8742-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/05/2018] [Accepted: 01/06/2018] [Indexed: 01/08/2023]
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Sartini C, Whincup PH, Wannamethee SG, Jefferis BJ, Lennon L, Lowe GDO, Welsh P, Sattar N, Morris RW. Associations of time of day with cardiovascular disease risk factors measured in older men: results from the British Regional Heart Study. BMJ Open 2017; 7:e018264. [PMID: 29133328 PMCID: PMC5695475 DOI: 10.1136/bmjopen-2017-018264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE We estimated associations of time of day with cardiovascular disease (CVD) risk factors measured in older men. METHODS CVD risk factors (markers of inflammation and haemostasis, and cardiac markers) were measured on one occasion between 08:00 and 19:00 hours in 4252 men aged 60-79 years from the British Regional Heart Study. Linear models were used to estimate associations between time of day and risk factors. When an association was found, we examined whether the relationship between risk factors and cardiovascular mortality was affected by the adjustment for time of day using survival analyses. RESULTS N-terminal pro-brain natriuretic peptide (NT-proBNP) levels increased by 3.3% per hour (95% CI 1.9% to 4.8%), interleukin-6 (IL-6) increased by 2.6% per hour (95% CI 1.8% to 3.4%), while tissue plasminogen activator (t-PA) decreased by 3.3% per hour (95% CI 3.7% to 2.9%); these associations were unaffected by adjustment for possible confounding factors. The percentages of variation in these risk factors attributable to time of day were less than 2%. In survival analyses, the association of IL-6, NT-proBNP and t-PA with cardiovascular mortality was not affected by the adjustment for time of day. C reactive protein, fibrinogen, D-dimer, von Willebrand factor and cardiac troponin T showed no associations with time of day. CONCLUSIONS In older men, markers of inflammation (IL-6), haemostasis (t-PA) and a cardiac marker (NT-proBNP) varied by time of day. The contribution of time of day to variations in these markers was small and did not appear to be relevant for the CVD risk prediction.
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Affiliation(s)
- Claudio Sartini
- Department of Primary Care & Population Health, University College London, London, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - S Goya Wannamethee
- Department of Primary Care & Population Health, University College London, London, UK
| | - Barbara J Jefferis
- Department of Primary Care & Population Health, University College London, London, UK
| | - Lucy Lennon
- Department of Primary Care & Population Health, University College London, London, UK
| | - Gordon DO Lowe
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Paul Welsh
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Naveed Sattar
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Richard W Morris
- Centre for Academic Primary Care, Schoolof Social and Community Medicine, University of Bristol, Bristol, UK
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Circulating interleukin-6 levels and cardiovascular and all-cause mortality in the elderly population: A meta-analysis. Arch Gerontol Geriatr 2017; 73:257-262. [DOI: 10.1016/j.archger.2017.08.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 08/10/2017] [Accepted: 08/12/2017] [Indexed: 12/21/2022]
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29
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Inflammation and post-operative recovery in patients undergoing total knee arthroplasty-secondary analysis of a randomized controlled trial. Osteoarthritis Cartilage 2017; 25:1265-1273. [PMID: 28323139 DOI: 10.1016/j.joca.2017.03.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 03/01/2017] [Accepted: 03/08/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Reduced function persists for many patients after total knee arthroplasty (TKA). Inflammation is part of osteoarthritis' pathophysiology, and surgery induces a marked inflammatory response. We therefore wanted to explore the role of inflammation in long-term recovery after TKA, and thus conducted this secondary analysis of our randomized controlled trial (RCT) of physical rehabilitation ± progressive strength training (PST). We aimed to investigate whether (1) inflammation is associated with functional performance, knee-extension strength, and knee pain before TKA; (2) PST affects inflammation, and the inflammatory state over time; (3) baseline or surgery-induced inflammation modifies the effect of rehabilitation ± PST on change in 6-min walk test (Δ6MWT); and (4) baseline or surgery-induced inflammation is associated with Δ6MWT following TKA. DESIGN In the primary trial report's per-protocol analysis, 72/82 patients were included. Sixty had ≥1 blood sample before and after TKA, and were included in this secondary analysis. Inflammation was measured by interferon γ-inducible protein (IP)-10, soluble urokinase plasminogen activator receptor (suPAR), interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α at baseline; day 1, week 4, 8, and 26 after TKA. RESULTS At baseline, suPAR (P = 006) was negatively associated with 6MWT. Neither baseline nor surgery-induced inflammation modified the response to rehabilitation ± PST. Only surgery-induced IL-10 was associated with Δ6MWT26 weeks-baseline (P = 0.001), also adjusted for 6MWTbaseline, age, sex and body mass index (BMI). CONCLUSION In this secondary analysis, only increased surgery-induced IL-10 response was associated with decreased long-term functional performance after TKA. The importance of controlling the surgery-induced immune response remains to be investigated further. TRIAL IDENTIFICATION NCT01351831.
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30
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Wannamethee SG, Whincup PH, Papacosta O, Lennon L, Lowe GD. Associations between blood coagulation markers, NT-proBNP and risk of incident heart failure in older men: The British Regional Heart Study. Int J Cardiol 2016; 230:567-571. [PMID: 28043678 PMCID: PMC5267630 DOI: 10.1016/j.ijcard.2016.12.056] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 12/09/2016] [Accepted: 12/16/2016] [Indexed: 12/28/2022]
Abstract
AIMS Chronic heart failure (HF) is associated with activation of blood coagulation but there is a lack of prospective studies on the association between coagulation markers and incident HF in general populations. We have examined the association between the coagulation markers fibrinogen, von Willebrand Factor (VWF), Factors VII, VIII and IX, D-dimer, activated protein C (APC) and activated partial thromboplastin time (aPPT) with NT-proBNP and incident HF. METHODS AND RESULTS Prospective study of 3366 men aged 60-79years with no prevalent HF, myocardial infarction or venous thrombosis and who were not on warfarin, followed up for a mean period of 13years, in whom there were 203 incident HF cases. D-dimer and vWF were significantly and positively associated with NT-proBNP (a marker of neurohormonal activation and left ventricular wall stress) even after adjustment for age, lifestyle characteristics, renal dysfunction, atrial fibrillation (AF) and inflammation (C-reactive protein). By contrast Factor VII related inversely to AF and NT-proBNP even after adjustment. No association was seen however between the coagulation markers VWF, Factor VII, Factor VIII, Factor IX, D-dimer, APC resistance or aPPT with incident HF in age-adjusted analyses. Fibrinogen was associated with incident HF but this was abolished after adjustment for HF risk factors. CONCLUSION Coagulation activity is not associated with the development of HF. However D-dimer and vWF were significantly associated with NT-proBNP, suggesting that increased coagulation activity is related to cardiac stress; and the increased coagulation seen in HF patients may in part be a consequence of neurohormonal activation.
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Affiliation(s)
- S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, UK.
| | - Peter H Whincup
- Population Health Research Centre, Division of Population Health Sciences and Education, St George's, University of London, UK
| | - Olia Papacosta
- Department of Primary Care and Population Health, University College London, UK
| | - Lucy Lennon
- Department of Primary Care and Population Health, University College London, UK
| | - Gordon D Lowe
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, UK
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Cauley JA, Barbour KE, Harrison SL, Cloonan YK, Danielson ME, Ensrud KE, Fink HA, Orwoll ES, Boudreau R. Inflammatory Markers and the Risk of Hip and Vertebral Fractures in Men: the Osteoporotic Fractures in Men (MrOS). J Bone Miner Res 2016; 31:2129-2138. [PMID: 27371811 PMCID: PMC5240475 DOI: 10.1002/jbmr.2905] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/14/2016] [Accepted: 06/23/2016] [Indexed: 01/04/2023]
Abstract
Cytokines play major roles in regulating bone remodeling, but their relationship to incident fractures in older men is uncertain. We tested the hypothesis that men with higher concentrations of pro-inflammatory markers have a higher risk of fracture. We used a case-cohort design and measured inflammatory markers in a random sample of 961 men and in men with incident fractures including 120 clinical vertebral, 117 hip, and 577 non-spine fractures; average follow-up 6.13 years (7.88 years for vertebral fractures). We measured interleukin (IL)-6, C-reactive protein (CRP), tumor necrosis factor alpha (TNFα), soluble receptors (SR) of IL-6 (IL-6SR) and TNF (TNFαSR1 and TNFαSR2), and IL-10. The risk of non-spine, hip, and clinical vertebral fracture was compared across quartiles (Q) of inflammatory markers using Cox proportional hazard models with tests for linear trend. In multivariable-adjusted models, men with the highest (Q4) TNFa cytokine concentrations and their receptors had a 2.0-4.2-fold higher risk of hip and clinical vertebral fracture than men with the lowest (Q1). Results were similar for all non-spine fractures, but associations were smaller. There was no association between CRP and IL-6SR and fracture. Men in the highest Q of IL-10 had a 49% lower risk of vertebral fracture compared with men in Q1. Among men with ≥3 inflammatory markers in the highest Q, the hazard ratio (HR) for hip fractures was 2.03 (95% confidence interval [CI] 1.11-3.71) and for vertebral fracture 3.06 (1.66-5.63). The HRs for hip fracture were attenuated by 27%, 27%, and 15%, respectively, after adjusting for appendicular lean mass (ALM), disability, and bone density, suggesting mediating roles. ALM also attenuated the HR for vertebral fractures by 10%. There was no association between inflammation and rate of hip BMD loss. We conclude that inflammation may play an important role in the etiology of fractures in older men. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kamil E Barbour
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Yona K Cloonan
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Kristine E Ensrud
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.,Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN, USA
| | - Howard A Fink
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.,Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN, USA.,Geriatric Education and Clinical Center, VA Health Care System, Minneapolis, MN, USA
| | - Eric S Orwoll
- Bone and Mineral Unit, Oregon Health and Science University, Portland, OR, USA
| | - Robert Boudreau
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
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32
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Liljas AEM, Wannamethee SG, Whincup PH, Papacosta O, Walters K, Iliffe S, Lennon LT, Carvalho LA, Ramsay SE. Hearing impairment and incident disability and all-cause mortality in older British community-dwelling men. Age Ageing 2016; 45:662-7. [PMID: 27146303 PMCID: PMC5027638 DOI: 10.1093/ageing/afw080] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/23/2016] [Indexed: 11/25/2022] Open
Abstract
Background and objective: hearing impairment is common in older adults and has been implicated in the risk of disability and mortality. We examined the association between hearing impairment and risk of incident disability and all-cause mortality. Design and setting: prospective cohort of community-dwelling older men aged 63–85 followed up for disability over 2 years and for all-cause mortality for 10 years in the British Regional Heart Study. Methods: data were collected on self-reported hearing impairment including hearing aid use, and disability assessed as mobility limitations (problems walking/taking stairs), difficulties with activities of daily living (ADL) and instrumental ADL (IADL). Mortality data were obtained from the National Health Service register. Results: among 3,981 men, 1,074 (27%) reported hearing impairment. Compared with men with no hearing impairment, men who could hear and used a hearing aid, and men who could not hear despite a hearing aid had increased risks of IADL difficulties (age-adjusted OR 1.86, 95% CI 1.29–2.70; OR 2.74, 95% CI 1.53–4.93, respectively). The associations remained after further adjustment for covariates including social class, lifestyle factors, co-morbidities and social engagement. Associations of hearing impairment with incident mobility limitations, incident ADL difficulties and all-cause mortality were attenuated on adjustment for covariates. Conclusion: this study suggests that hearing problems in later life could increase the risk of having difficulties performing IADLs, which include more complex everyday tasks such as shopping and light housework. However, further studies are needed to determine the associations observed including the underlying pathways.
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Affiliation(s)
- Ann E M Liljas
- Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - S Goya Wannamethee
- Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Peter H Whincup
- Population Health Research Centre, Division of Population Health Sciences and Education, St George's, University of London, London, UK
| | - Olia Papacosta
- Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Lucy T Lennon
- Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Livia A Carvalho
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Sheena E Ramsay
- Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
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Liu X, Huang R, Wu H, Wu J, Wang J, Yu X, Yang X. Patient characteristics and risk factors of early and late death in incident peritoneal dialysis patients. Sci Rep 2016; 6:32359. [PMID: 27576771 PMCID: PMC5006021 DOI: 10.1038/srep32359] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/04/2016] [Indexed: 12/12/2022] Open
Abstract
This study was conducted to identify key patient characteristics and risk factors for peritoneal dialysis (PD) mortality in terms of different time-point of death occurrence. The incident PD patients from January 1, 2006 to December 31, 2013 in our PD center were recruited and followed up until December 31, 2015. Patients who died in the early period (the first 3 months) were older, had higher neutrophil to lymphocyte ratio (N/L), serum phosphorus, and uric acid level, and had lower diastolic pressure, hemoglobin, serum albumin, and calcium levels. After adjustment of gender, age, and PD inception, higher N/L level [hazard ratio (HR) 1.115, P = 0.006], higher phosphorus lever (HR 1.391, P < 0.001), lower hemoglobin level (HR 0.596, P < 0.001), and lower serum albumin level (HR 0.382, P = 0.017) were risk factors for early mortality. While, presence of diabetes (HR 1.627, P = 0.001), presence of cardiovascular disease (HR 1.847, P < 0.001) and lower serum albumin level (HR 0.720, P = 0.023) were risk factors for late mortality (over 24 months). In conclusion, patient characteristics and risk factors associated with early and late mortality in incident PD patients were different, which indicated specific management according to patient characteristics at the initiation of PD should be established to improve PD patient survival.
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Affiliation(s)
- Xinhui Liu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, Guangdong 510080, China
| | - Rong Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, Guangdong 510080, China
| | - Haishan Wu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, Guangdong 510080, China
| | - Juan Wu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, Guangdong 510080, China
| | - Juan Wang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, Guangdong 510080, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, Guangdong 510080, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, Guangdong 510080, China
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Feng YX, Yang LJ, Li T, Dong HW, Yao HC, Liu FZ. Association between elevated D-dimer levels and adverse outcome in patients with acute heart failure. Int J Cardiol 2016; 214:415-6. [DOI: 10.1016/j.ijcard.2016.03.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 03/29/2016] [Indexed: 10/22/2022]
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35
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Predictors for mortality from respiratory failure in a general population. Sci Rep 2016; 6:26053. [PMID: 27180927 PMCID: PMC4867438 DOI: 10.1038/srep26053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/27/2016] [Indexed: 02/07/2023] Open
Abstract
Risk factors for death from respiratory failure in the general population are not established. The aim of this study was to determine the characteristics of individuals who die of respiratory failure in a Japanese general population. In total, 3253 adults aged 40 years or older participated in annual health check in Takahata, Yamagata, Japan from 2004 to 2006. Subject deaths through the end of 2010 were reviewed; 27 subjects died of respiratory failure (pneumonia, n = 22; COPD, n = 1; pulmonary fibrosis, n = 3; and bronchial asthma, n = 1). Cox proportional hazard analysis revealed that male sex; higher age, high levels of D-dimer and fibrinogen; lower body mass index (BMI) and total cholesterol; and history of stroke and gastric ulcer were independent risk factors for respiratory death. On analysis with C-statistics, net reclassification improvement, and integrated discrimination improvement, addition of the disease history and laboratory data significantly improved the model prediction for respiratory death using age and BMI. In conclusion, we identified risk factors for mortality from respiratory failure in a prospective cohort of a Japanese general population. Men who were older, underweight, hypocholesterolemic, hypercoagulo-fibrinolytic, and had a history of stroke or gastric ulcer had a higher risk of mortality due to respiratory failure.
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Kulu R, Akyildiz H, Akcan A, Oztürk A, Sozuer E. Plasma citrulline measurement in the diagnosis of acute mesenteric ischaemia. ANZ J Surg 2016; 87:E57-E60. [PMID: 27061614 DOI: 10.1111/ans.13524] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 12/16/2015] [Accepted: 01/19/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND The differential diagnosis in acute mesenteric ischaemia (AMI) is essential and sometimes life-saving. A marker for early diagnosis is lacking. Citrulline is an amino acid mainly synthesized by small bowel enterocytes from glutamine. In this study, we aimed to evaluate the diagnostic and prognostic values of citrulline with those of the D-dimer in patients with AMI. METHODS The patients were divided into two groups; group 1: patients with acute abdominal findings which were attributed preoperatively to AMI, and group 2: patients with acute abdominal findings which were attributed preoperatively to causes other than AMI. All patients underwent surgical exploration. Blood samples were taken before surgery. The demographic features, laboratory examinations, citrulline concentration, D-dimer level and surgical findings were evaluated. RESULTS Overall, 48 patients were enrolled in the study. AMI was diagnosed in 23 of the 48 patients. There was no significant difference between the groups with regard to gender, leucocyte count and creatinine levels but group 1 was significantly older than group 2. Citrulline, D-dimer and lactate levels were also significantly higher in group 1. Age, lactate, D-dimer and citrulline levels were statistically significant for mortality. The most significant factor was increased lactate level at admission. CONCLUSION Plasma citrulline level may be helpful in the diagnosis of patients with AMI.
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Affiliation(s)
- Rıdvan Kulu
- Department of General Surgery, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Hizir Akyildiz
- Department of General Surgery, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Alper Akcan
- Department of General Surgery, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Ahmet Oztürk
- Department of Biostatistics, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Erdogan Sozuer
- Department of General Surgery, School of Medicine, Erciyes University, Kayseri, Turkey
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Okano T, Inui K, Tada M, Sugioka Y, Mamoto K, Wakitani S, Koike T, Nakamura H. Levels of interleukin-1 beta can predict response to tocilizumab therapy in rheumatoid arthritis: the PETITE (predictors of effectiveness of tocilizumab therapy) study. Rheumatol Int 2015; 36:349-57. [DOI: 10.1007/s00296-015-3379-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/28/2015] [Indexed: 01/05/2023]
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