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Nagata A, Otsuka Y, Konuma R, Adachi H, Wada A, Kishida Y, Konishi T, Yamada Y, Nagata R, Noguchi Y, Marumo A, Mukae J, Toya T, Igarashi A, Najima Y, Kobayashi T, Sakamaki H, Ohashi K, Doki N. Weight-adjusted urinary creatinine excretion predicts transplant outcomes in adult patients with acute myeloid leukemia in complete remission. Leuk Lymphoma 2022; 63:3117-3127. [PMID: 36067521 DOI: 10.1080/10428194.2022.2109334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Sarcopenia is a prognostic factor for cancer. Because creatinine is formed from creatine phosphate in muscle tissue, urinary creatinine excretion (UCE) serves as an index of muscle volume. However, as of yet, there are no studies assessing the clinical impact of UCE or weight- adjusted urinary creatinine excretion (WA-UCE) on allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. We analyzed the association between pre-transplant WA-UCE and transplant outcomes among 164 adult patients with acute myeloid leukemia in complete remission who underwent their first allo-HSCT at our center. The patients were classified into a high (n = 106) and a low WA-UCE group (n = 58) for predicting overall survival (OS) based on the receiver operating characteristics curve. On multivariate analysis, low WA-UCE was associated with poor OS, progression-free survival and a high incidence of non-relapse mortality. WA-UCE has the potential to be an objective biomarker for predicting transplant outcomes, especially the incidence of infection-related death.
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Affiliation(s)
- Akihito Nagata
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yuki Otsuka
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Ryosuke Konuma
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Hiroto Adachi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Atsushi Wada
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yuya Kishida
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Tatsuya Konishi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yuta Yamada
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Ryohei Nagata
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yuma Noguchi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Atsushi Marumo
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Junichi Mukae
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Takashi Toya
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Aiko Igarashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yuho Najima
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Takeshi Kobayashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Hisashi Sakamaki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Kazuteru Ohashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
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Should we pay more attention to low creatinine levels? ENDOCRINOLOGIA, DIABETES Y NUTRICION 2020; 67:486-492. [PMID: 32331974 DOI: 10.1016/j.endinu.2019.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/18/2019] [Accepted: 12/27/2019] [Indexed: 12/25/2022]
Abstract
A review is made of the basic aspects of creatine/creatinine metabolism and the close relationship between creatinine and muscle mass, which makes the former a biochemical marker of the latter. Emphasis is placed on the current prognostic value of both the low urinary excretion of creatinine and low serum creatinine levels in different clinical settings in which sarcopenia probably plays a significant role in morbidity and mortality.
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Lucke-Wold B, Vaziri S, Scott K, Busl K. Urinary dysfunction in acute brain injury: A narrative review. Clin Neurol Neurosurg 2020; 189:105614. [PMID: 31786429 DOI: 10.1016/j.clineuro.2019.105614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/11/2019] [Accepted: 11/15/2019] [Indexed: 02/05/2023]
Abstract
The frontal lobe urinary control center is an important regulator of urinary function. Neurologic injury often causes damage or temporary dysfunction of this center and other related urinary control pathways. Little has been reported about this topic in the literature although a majority of neurologic injury patients suffer from some type of urinary dysfunction. In this review, we highlight what is known about urinary dysfunction based on injury type (traumatic brain injury, hemorrhagic stroke, ischemic stroke, subarachnoid hemorrhage, subdural hematoma, and epilepsy). We discuss both clinical and pre-clinical data and pinpoint areas warranting further investigation. In the final section, we provide proposed practice suggestions for managing these patients clinically with the intended goal for refinement in these approaches following further clinical trials.
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Affiliation(s)
- Brandon Lucke-Wold
- University of Florida, Department of Neurosurgery, Gainesville, FL, United States.
| | - Sasha Vaziri
- University of Florida, Department of Neurosurgery, Gainesville, FL, United States.
| | - Kyle Scott
- University of Florida, Department of Neurosurgery, Gainesville, FL, United States.
| | - Katharina Busl
- University of Florida, Department of Neurosurgery, Gainesville, FL, United States; University of Florida, Department of Neurology, Gainesville, FL, United States.
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Chen CM, Lee M, Yang YH, Huang SS, Lin CH. Association between Clinical and Laboratory Markers and 5-year Mortality among Patients with Stroke. Sci Rep 2019; 9:11521. [PMID: 31395912 PMCID: PMC6687732 DOI: 10.1038/s41598-019-47975-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/16/2019] [Indexed: 12/16/2022] Open
Abstract
Factors influencing long-term stroke mortality have not been comprehensively investigated. This study aimed to identify the baseline clinical, laboratory, demographic/socioeconomic, and hospital factors influencing 5-year mortality in patients with first stroke. Total 3,956 patients with first-stroke hospitalization from 2004 to 2008 were connected to the longitudinal National Health Insurance Research Database. Post-admission baseline data that significantly increased 5-year mortality were red cell distribution width (RDW) >0.145 (adjusted hazard ratio [aHR] = 1.71), hemoglobin <120 g/L (aHR = 1.25), blood sugar <3.89 mmol/L (70 mg/dL)(aHR = 2.57), serum creatinine >112.27 μmol/L (aHR = 1.76), serum sodium <134 mmol/L (aHR = 1.73), body mass index (BMI) < 18.5 kg/m2 (aHR = 1.33), Glasgow Coma Scale <15 (aHR = 1.43), Stroke Severity Index ≥20 (aHR = 3.92), Charlson–Deyo Comorbidity Index ≥3 (aHR = 4.21), no rehabilitation (aHR = 1.86), and age ≥65 years (aHR = 2.25). Hemoglobin, RDW, blood sugar, serum creatinine and sodium, BMI, consciousness, stroke severity, comorbidity, rehabilitation, and age were associated with 5-year mortality in patients with first stroke.
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Affiliation(s)
- Chien-Min Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan. .,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Meng Lee
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Shih-Shin Huang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chu-Hsu Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Creatinine synthesis rate and muscle strength and self-reported physical health in dialysis patients. Clin Nutr 2019; 39:1600-1607. [PMID: 31378513 DOI: 10.1016/j.clnu.2019.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/06/2019] [Accepted: 07/02/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Urinary creatinine excretion reflecting endogenous creatinine synthesis rate (CSR) is an established measure of muscle mass in the general populations and in patients with chronic kidney disease. There is increasing data to suggest that CSR not only reflects muscle mass, but also muscle function. In dialysis patients, CSR has rarely been studied since it requires dialysate collection. We aimed to study whether CSR is associated with muscle strength, and self-reported physical health in dialysis patients. METHODS Total daily CSR (dialytic removal plus, if applicable, urinary excretion), handgrip strength, and self-reported physical health according subscales of the Checklist Individual Strength and the Short Form-36 were assessed in 50 dialysis patients. Associations of CSR, indexed to body surface area, with handgrip strength and self-reported physical health were studied using multivariable linear regression models. RESULTS Median age was 69 [interquartile range 60-78] years. Mean CSR was higher in men than in women (9.5 ± 3.3 mmol/24 h versus 6.8 ± 1.9 mmol/24 h respectively, P = 0.007). Age, BMI, and plasma albumin were positively associated with CSR. CSR was positively associated with handgrip strength (adjusted (a-) β: 0.44 [95% CI: 0.18 to 0.71), physical functioning (a-β: 0.54 [95% CI: 0.19 to 0.88]), social functioning (a-β: 0.43 [95%CI 0.08 to 0.76]), and inversely with physical inactivity (adjusted β: -0.69 [95% CI: -1.00 to -0.38), fatigue (adjusted β: -0.61 [95% CI: -0.93 to -0.27]), and role limitation due to physical health (a-β: 0.39 [95% CI: 0.04 to 0.74]). CONCLUSIONS In dialysis patients, a greater CSR is associated with higher muscle strength, better physical and social functioning, and physical activity, and with less fatigue, and role limitation due to physical health. Thus, CSR reflects muscle function, self-reported physical health and social functioning in dialysis patients.
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Molle Da Costa RD, Luvizutto GJ, Martins LG, Thomaz De Souza J, Regina Da Silva T, Alvarez Sartor LC, Winckler FC, Modolo GP, Molle ERDSD, Dos Anjos SM, Bazan SGZ, Cuadrado LM, Bazan R. Clinical factors associated with the development of nonuse learned after stroke: a prospective study. Top Stroke Rehabil 2019; 26:511-517. [PMID: 31230583 DOI: 10.1080/10749357.2019.1631605] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Upper extremity impairment is present in most of people with stroke. The use of the affected upper extremity can be impacted not only by physical impairment but also by abehavioral phenomenon called learned nonuse. Objective: The aim of this study was to evaluate which clinical factors in the acute phase are associated with the development of learned nonuse in the upper extremity after stroke. Methods: This cohort study included 38 patients with ischemic stroke. Hospital discharge data were collected for clinical aspects, scales of severity, incapacity and autonomy, as well as for neuromuscular and sensory evaluations. At 90 days after hospital discharge, the score on the Motor Activity Log scale for detecting learned nonuse was obtained, and life quality was evaluated by the EuroQol. The individuals with and without learned nonuse were compared by attest for univariate analysis, and ageneralized linear model was employed to find possible predictors, which were considered significant p <0.05. Results: In the statistical model, age (p= .006), severity at discharge (p= .036), handgrip strength (p= .000), altered sensitivity (p= .011), incapacity at discharge (p= .009) and autonomy at discharge (p= .011) were found to be associated with learned nonuse. In relation to quality of life, mobility, personal care, usual activities, anxiety, depression and perception had lower mean values in the learned nonuse group. Conclusion: Age, severity of stroke, incapacity and neuromuscular and sensory compromises are associated with upper extremity learned nonuse in stroke patients.
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Affiliation(s)
| | - Gustavo José Luvizutto
- Department of Applied Physical Therapy, Federal University of Triângulo Mineiro , Uberaba , Brazil
| | | | | | - Taís Regina Da Silva
- Department of rehabilitation Center, Botucatu Medical School , Botucatu , Brazil
| | | | | | - Gabriel Pinheiro Modolo
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School , Botucatu , Brazil
| | | | - Sarah M Dos Anjos
- Department of Medicine, University of Alabama , Birmingham , AL , USA
| | | | | | - Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School , Botucatu , Brazil
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Hessels L, Koopmans N, Gomes Neto AW, Volbeda M, Koeze J, Lansink-Hartgring AO, Bakker SJ, Oudemans-van Straaten HM, Nijsten MW. Urinary creatinine excretion is related to short-term and long-term mortality in critically ill patients. Intensive Care Med 2018; 44:1699-1708. [PMID: 30194465 PMCID: PMC6182361 DOI: 10.1007/s00134-018-5359-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/28/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE Patients with reduced muscle mass have a worse outcome, but muscle mass is difficult to quantify in the ICU. Urinary creatinine excretion (UCE) reflects muscle mass, but has not been studied in critically ill patients. We evaluated the relation of baseline UCE with short-term and long-term mortality in patients admitted to our ICU. METHODS Patients who stayed ≥ 24 h in the ICU with UCE measured within 3 days of admission were included. We excluded patients who developed acute kidney injury stage 3 during the first week of ICU stay. As muscle mass is considerably higher in men than women, we used sex-stratified UCE quintiles. We assessed the relation of UCE with both in-hospital mortality and long-term mortality. RESULTS From 37,283 patients, 6151 patients with 11,198 UCE measurements were included. Mean UCE was 54% higher in males compared to females. In-hospital mortality was 17%, while at 5-year follow-up, 1299 (25%) patients had died. After adjustment for age, sex, estimated glomerular filtration rate, body mass index, reason for admission and disease severity, patients in the lowest UCE quintile had an increased in-hospital mortality compared to the patients in the highest UCE quintile (OR 2.56, 95% CI 1.96-3.34). For long-term mortality, the highest risk was also observed for patients in the lowest UCE quintile (HR 2.32, 95% CI 1.89-2.85), independent of confounders. CONCLUSIONS In ICU patients without severe renal dysfunction, low urinary creatinine excretion is associated with short-term and long-term mortality, independent of age, sex, renal function and disease characteristics, underscoring the role of muscle mass as risk factor for mortality and UCE as relevant biomarker.
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Affiliation(s)
- Lara Hessels
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Niels Koopmans
- Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Antonio W Gomes Neto
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Meint Volbeda
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Jacqueline Koeze
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Annemieke Oude Lansink-Hartgring
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Stephan J Bakker
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Maarten W Nijsten
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
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