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Jia S, Wang Y, Ross MH, Zuckerman JB, Murray S, Han MK, Cahalan SE, Lenhan BE, Best RN, Taylor-Cousar JL, Simon RH, Fitzgerald LJ, Troost JP, Sood SL, Gifford AH. Association between CFTR modulators and changes in iron deficiency markers in cystic fibrosis. J Cyst Fibros 2024:S1569-1993(24)00030-4. [PMID: 38490920 DOI: 10.1016/j.jcf.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/22/2024] [Accepted: 03/01/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Iron deficiency (ID) is a common extrapulmonary manifestation in cystic fibrosis (CF). CF transmembrane conductance regulator (CFTR) modulator therapies, particularly highly-effective modulator therapy (HEMT), have drastically improved health status in a majority of people with CF. We hypothesize that CFTR modulator use is associated with improved markers of ID. METHODS In a multicenter retrospective cohort study across 4 United States CF centers 2012-2022, the association between modulator therapies and ID laboratory outcomes was estimated using multivariable linear mixed effects models overall and by key subgroups. Summary statistics describe the prevalence and trends of ID, defined a priori as transferrin saturation (TSAT) <20 % or serum iron <60 μg/dL (<10.7 μmol/L). RESULTS A total of 568 patients with 2571 person-years of follow-up were included in analyses. Compared to off modulator therapy, HEMT was associated with +8.4 % TSAT (95 % confidence interval [CI], +6.3-10.6 %; p < 0.0001) and +34.4 μg/dL serum iron (95 % CI, +26.7-42.1 μg/dL; p < 0.0001) overall; +5.4 % TSAT (95 % CI, +2.8-8.0 %; p = 0.0001) and +22.1 μg/dL serum iron (95 % CI, +13.5-30.8 μg/dL; p < 0.0001) in females; and +11.4 % TSAT (95 % CI, +7.9-14.8 %; p < 0.0001) and +46.0 μg/dL serum iron (95 % CI, +33.3-58.8 μg/dL; p < 0.0001) in males. Ferritin was not different in those taking modulator therapy relative to off modulator therapy. Hemoglobin was overall higher with use of modulator therapy. The prevalence of ID was high throughout the study period (32.8 % in those treated with HEMT). CONCLUSIONS ID remains a prevalent comorbidity in CF, despite availability of HEMT. Modulator use, particularly of HEMT, is associated with improved markers for ID (TSAT, serum iron) and anemia (hemoglobin).
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Affiliation(s)
- Shijing Jia
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Yizhuo Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Melissa H Ross
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan B Zuckerman
- Department of Internal Medicine, Maine Medical Center, Tufts University, Portland, ME, USA
| | - Susan Murray
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - MeiLan K Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Shannon E Cahalan
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Blair E Lenhan
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Ryan N Best
- Department of Internal Medicine, Maine Medical Center, Tufts University, Portland, ME, USA
| | - Jennifer L Taylor-Cousar
- Departments of Internal Medicine and Pediatrics, National Jewish Health, Denver, CO, USA; Departments of Internal Medicine and Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard H Simon
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Linda J Fitzgerald
- Department of Pharmacy Services, University of Michigan, Ann Arbor, MI, USA; Sanofi Medical Affairs, Bridgewater, NJ, USA
| | - Jonathan P Troost
- Michigan Institute for Clinical Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Suman L Sood
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Alex H Gifford
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA
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Orfanos G, Nantha Kumar N, Redfern D, Burston B, Banerjee R, Thomas G. The incidence and risk factors for abnormal postoperative blood tests following primary total joint replacement. Bone Jt Open 2023; 4:899-905. [PMID: 37995746 PMCID: PMC10667041 DOI: 10.1302/2633-1462.411.bjo-2023-0137.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
Aims We aim to evaluate the usefulness of postoperative blood tests by investigating the incidence of abnormal results following total joint replacement (TJR), as well as identifying preoperative risk factors for abnormal blood test results postoperatively, especially pertaining to anaemia and acute kidney injury (AKI). Methods This is a retrospective cohort study of patients who had elective TJR between January and December 2019 at a tertiary centre. Data gathered included age at time of surgery, sex, BMI, American Society of Anesthesiologists (ASA) grade, preoperative and postoperative laboratory test results, haemoglobin (Hgb), white blood count (WBC), haematocrit (Hct), platelets (Plts), sodium (Na+), potassium (K+), creatinine (Cr), estimated glomerular filtration rate (eGFR), and Ferritin (ug/l). Abnormal blood tests, AKI, electrolyte imbalance, anaemia, transfusion, reoperation, and readmission within one year were reported. Results The study included 2,721 patients with a mean age of 69 years, of whom 1,266 (46.6%) were male. Abnormal postoperative bloods were identified in 444 (16.3%) patients. We identified age (≥ 65 years), female sex, and ASA grade ≥ III as risk factors for developing abnormal postoperative blood tests. Preoperative haemoglobin (≤ 127 g/dl) and packed cell volume (≤ 0.395 l/l) were noted to be significant risk factors for postoperative anaemia, and potassium (≤ 3.7 mmol/l) was noted to be a significant risk factor for AKI. Conclusion The costs outweigh the benefits of ordering routine postoperative blood tests in TJR patients. Clinicians should risk-stratify their patients and have a lower threshold for ordering blood tests in patients with abnormal preoperative haemoglobin (≤ 127 g/l), blood loss > 300 ml, chronic kidney disease, ASA grade ≥ III, and clinical concern.
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Affiliation(s)
- Georgios Orfanos
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Nakulan Nantha Kumar
- Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
- Keele University, Newcastle, UK
| | - Daniel Redfern
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Ben Burston
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Robin Banerjee
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Geraint Thomas
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
- Keele University, Newcastle, UK
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Meier JM, Tschoellitsch T. Artificial Intelligence and Machine Learning in Patient Blood Management: A Scoping Review. Anesth Analg 2022; 135:524-531. [PMID: 35977362 DOI: 10.1213/ane.0000000000006047] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Machine learning (ML) and artificial intelligence (AI) are widely used in many different fields of modern medicine. This narrative review gives, in the first part, a brief overview of the methods of ML and AI used in patient blood management (PBM) and, in the second part, aims at describing which fields have been analyzed using these methods so far. A total of 442 articles were identified by a literature search, and 47 of them were judged as qualified articles that applied ML and AI techniques in PBM. We assembled the eligible articles to provide insights into the areas of application, quality measures of these studies, and treatment outcomes that can pave the way for further adoption of this promising technology and its possible use in routine clinical decision making. The topics that have been investigated most often were the prediction of transfusion (30%), bleeding (28%), and laboratory studies (15%). Although in the last 3 years a constantly increasing number of questions of ML in PBM have been investigated, there is a vast scientific potential for further application of ML and AI in other fields of PBM.
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Affiliation(s)
- Jens M Meier
- From the Department of Anesthesiology and Critical Care Medicine, Kepler University, Hospital GmbH and Johannes Kepler University, Linz, Austria
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