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Kriegbaum M, Lind BS, Grand MK, Andersen CL. The Copenhagen Primary Care Laboratory (CopLab) Database. Clin Epidemiol 2024; 16:155-163. [PMID: 38444401 PMCID: PMC10913898 DOI: 10.2147/clep.s437123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/22/2024] [Indexed: 03/07/2024] Open
Abstract
Background The Copenhagen General Practice Laboratory (CGPL) was founded in 1922 to provide paraclinical analyses to the primary health-care sector in Copenhagen. At the end of 2015, CGPL was closed and the CopLab database was established to make CGPL data available for research. Methods We isolated tests performed at the CGPL with clinically relevant test results. The database was linked to national registers containing health, social, and demographic information. Results are presented with descriptive statistics showing counts, percentages, medians, and interquartile ranges (IQR). Results The CopLab database includes 1,373,643 unique individuals from primary care with test results from laboratory analyses of blood/urine/semen as well as cardiac and lung function tests collected by CGPL from greater Copenhagen from 2000 to 2015. The CopLab database holds nearly all test results requested by general practitioners throughout years 2000 to 2015 for residents in the greater Copenhagen area. The median age of the individuals was 51 years and 59.7% were females. Each individual has a median of 4 requisitions. More than 1 million participants are currently alive and living in Denmark and may be followed in national registries such as the Danish National Patient Registry, Laboratory Database, National Prescription Database etc.
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Affiliation(s)
- Margit Kriegbaum
- The Copenhagen Primary Care Laboratory (CopLab) Database, Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bent Struer Lind
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Mia Klinten Grand
- The Copenhagen Primary Care Laboratory (CopLab) Database, Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christen Lykkegaard Andersen
- The Copenhagen Primary Care Laboratory (CopLab) Database, Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Haematology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Buhl Rasmussen AS, Andersen CL, Weimann A, Yang T, Tron C, Gandemer V, Dalhoff K, Rank CU, Schmiegelow K. Therapeutic drug monitoring of imatinib - how far are we in the leukemia setting? Expert Rev Clin Pharmacol 2024; 17:225-234. [PMID: 38345044 DOI: 10.1080/17512433.2024.2312256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/26/2024] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Tyrosine kinase inhibitors (TKIs) have revolutionized survival rates of chronic myeloid leukemia (CML) and Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia (ALL) and replaced hematopoietic stem cell transplantation (hSCT) as the key treatment option for these patients. More recently, the so-called Philadelphia chromosome-like (Ph-like) ALL has similarly benefitted from TKIs. However, many patients shift from the first generation TKI, imatinib, due to treatment-related toxicities or lack of treatment efficacy. A more personalized approach to TKI treatment could counteract these challenges and potentially be more cost-effective. Therapeutic drug monitoring (TDM) has led to higher response rates and less treatment-related toxicity in adult CML but is rarely used in ALL or in childhood CML. AREAS COVERED This review summarizes different antileukemic treatment indications for TKIs with focus on imatinib and its pharmacokinetic/-dynamic properties as well as opportunities and pitfalls of TDM for imatinib treatment in relation to pharmacogenetics and co-medication for pediatric and adult Ph+/Ph-like leukemias. EXPERT OPINION TDM of imatinib adds value to standard monitoring of ABL-class leukemia by uncovering non-adherence and potentially mitigating adverse effects. Clinically implementable pharmacokinetic/-dynamic models adjusted for relevant pharmacogenetics could improve individual dosing. Prospective trials of TDM-based treatments, including both children and adults, are needed.
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Affiliation(s)
- Anna Sofie Buhl Rasmussen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Allan Weimann
- Pediatric Oncology Research Laboratory, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tianwu Yang
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Camille Tron
- Department of Biological Pharmacology, Rennes University Hospital, Rennes, France
| | - Virginie Gandemer
- Department of Pediatric Hematology and Oncology, Rennes University Hospital, Rennes, France
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Cecilie Utke Rank
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
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Christensen ME, Grand MK, Kriegbaum M, Lind BS, Grønbæk K, Persson F, Johansen C, Andersen CL. Blood sampling patterns in primary care change several years before a cancer diagnosis. Acta Oncol 2024; 63:17-22. [PMID: 38349122 DOI: 10.2340/1651-226x.2024.28559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/26/2023] [Indexed: 02/15/2024]
Affiliation(s)
- Mathilde Egelund Christensen
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Denmark; Centre for General Practice, Institute for Public Health, University of Copenhagen, Denmark.
| | | | - Margit Kriegbaum
- Centre for General Practice, Institute for Public Health, University of Copenhagen, Denmark
| | - Bent Struer Lind
- Centre for General Practice, Institute for Public Health, University of Copenhagen, Denmark; Department of Clinical Biochemistry, Copenhagen University Hospital, Hvidovre, Denmark
| | - Kirsten Grønbæk
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Christoffer Johansen
- Department of Clinical Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Christen Lykkegaard Andersen
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Denmark; Centre for General Practice, Institute for Public Health, University of Copenhagen, Denmark
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Henriksen TV, Demuth C, Frydendahl A, Nors J, Nesic M, Rasmussen MH, Reinert T, Larsen OH, Jaensch C, Løve US, Andersen PV, Kolbro T, Thorlacius-Ussing O, Monti A, Gögenur M, Kildsig J, Bondeven P, Schlesinger NH, Iversen LH, Gotschalck KA, Andersen CL. Unraveling the potential clinical utility of circulating tumor DNA detection in colorectal cancer-evaluation in a nationwide Danish cohort. Ann Oncol 2024; 35:229-239. [PMID: 37992872 DOI: 10.1016/j.annonc.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/29/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Increasingly, circulating tumor DNA (ctDNA) is proposed as a tool for minimal residual disease (MRD) assessment. Digital PCR (dPCR) offers low analysis costs and turnaround times of less than a day, making it ripe for clinical implementation. Here, we used tumor-informed dPCR for ctDNA detection in a large colorectal cancer (CRC) cohort to evaluate the potential for post-operative risk assessment and serial monitoring, and how the metastatic site may impact ctDNA detection. Additionally, we assessed how altering the ctDNA-calling algorithm could customize performance for different clinical settings. PATIENTS AND METHODS Stage II-III CRC patients (N = 851) treated with a curative intent were recruited. Based on whole-exome sequencing on matched tumor and germline DNA, a mutational target was selected for dPCR analysis. Plasma samples (8 ml) were collected within 60 days after operation and-for a patient subset (n = 246)-every 3-4 months for up to 36 months. Single-target dPCR was used for ctDNA detection. RESULTS Both post-operative and serial ctDNA detection were prognostic of recurrence [hazard ratio (HR) = 11.3, 95% confidence interval (CI) 7.8-16.4, P < 0.001; HR = 30.7, 95% CI 20.2-46.7, P < 0.001], with a cumulative ctDNA detection rate of 87% at the end of sample collection in recurrence patients. The ctDNA growth rate was prognostic of survival (HR = 2.6, 95% CI 1.5-4.4, P = 0.001). In recurrence patients, post-operative ctDNA detection was challenging for lung metastases (4/21 detected) and peritoneal metastases (2/10 detected). By modifying the cut-off for calling a sample ctDNA positive, we were able to adjust the sensitivity and specificity of our test for different clinical contexts. CONCLUSIONS The presented results from 851 stage II-III CRC patients demonstrate that our personalized dPCR approach effectively detects MRD after operation and shows promise for serial ctDNA detection for recurrence surveillance. The ability to adjust sensitivity and specificity shows exciting potential to customize the ctDNA caller for specific clinical settings.
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Affiliation(s)
- T V Henriksen
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus
| | - C Demuth
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus
| | - A Frydendahl
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus
| | - J Nors
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus
| | - M Nesic
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus
| | - M H Rasmussen
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus
| | - T Reinert
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus
| | - O H Larsen
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus
| | - C Jaensch
- Department of Surgery, Regional Hospital Gødstrup, Herning
| | - U S Løve
- Department of Surgery, Regional Hospital Viborg, Viborg
| | - P V Andersen
- Department of Surgery, Odense University Hospital, Odense
| | - T Kolbro
- Department of Surgery, Odense University Hospital, Svendborg
| | | | - A Monti
- Department of Surgery, North Denmark Regional Hospital Hjørring, Hjørring
| | - M Gögenur
- Center for Surgical Sciences, Zealand University Hospital, Køge
| | - J Kildsig
- Department of Surgery, Copenhagen University Hospital, Herlev
| | - P Bondeven
- Department of Surgery, Regional Hospital Randers, Randers
| | - N H Schlesinger
- Department of Surgery, Copenhagen University Hospital, Bispebjerg
| | - L H Iversen
- Department of Surgery, Aarhus University Hospital, Aarhus
| | - K A Gotschalck
- Department of Surgery, Regional Hospital Horsens, Horsens, Denmark
| | - C L Andersen
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus.
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Høgnason Mohr G, Barcella CA, Grand MK, Kriegbaum M, Siersma V, Hahn MK, Agarwal SM, Bakkedal C, Baandrup L, Knop FK, Andersen CL, Ebdrup BH. Management of dyslipidaemia in individuals with severe mental illness: a population-based study in the Greater Copenhagen Area. Ther Adv Psychopharmacol 2023; 13:20451253231211574. [PMID: 38022836 PMCID: PMC10656803 DOI: 10.1177/20451253231211574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Severe mental illness (SMI) is associated with increased cardiovascular risk. Dyslipidaemia is a potentially modifiable risk factor, which may be inadequately managed in patients with SMI. Objectives To assess management of dyslipidaemia in patients with SMI versus healthy controls (HCs) in 2005 and 2015. Design and methods Using Danish registers, we identified adult patients with SMI in the Greater Copenhagen Area (schizophrenia spectrum disorders or bipolar disorder) with ⩾1 general practitioner contact in the year before 2005 and 2015, respectively, and HCs without SMI matched on age and gender (1:5). Outcomes were lipid-profile measurements, presence of dyslipidaemia and redemption of lipid-lowering pharmacotherapy. Differences in outcomes between patients with SMI and controls were measured with multivariable logistic regression. Results We identified 7217 patients with SMI in 2005 and 9939 in 2015. After 10 years, patients went from having lower odds of lipid measurements to having higher odds of lipid measurements compared with HCs [odds ratio (OR)2005 0.70 (99% confidence interval (CI) 0.63-0.78) versus OR2015 1.34 (99% CI 1.24-1.44); p2005versus2015 < 0.01]. Patients had higher odds of dyslipidaemia during both years [OR2005 1.43 (99% CI 1.10-1.85) and OR2015 1.23 (99% CI 1.08-1.41)]. Patients went from having lower odds of receiving lipid-lowering pharmacotherapy to having higher odds of receiving lipid-lowering pharmacotherapy [OR2005 0.77 (99% CI 0.66-0.89) versus OR2015 1.37 (99% CI 1.24-1.51); p2005versus2015 < 0.01]. However, among persons at high cardiovascular risk, patients had lower odds of receiving lipid-lowering pharmacotherapy during both years, including subsets with previous acute coronary syndrome [OR2005 0.30 (99% CI 0.15-0.59) and OR2015 0.44 (99% CI 0.24-0.83)] and ischaemic stroke or transient ischaemic attack (TIA) [OR2005 0.43 (99% CI 0.26-0.69) and OR 2015 0.61 (99% CI 0.41-0.89)]. Conclusion These results imply an increased general awareness of managing dyslipidaemia among patients with SMI in the primary prophylaxis of cardiovascular disease. However, secondary prevention with lipid-lowering drugs in patients with SMI at high cardiovascular risk may be lacking.
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Affiliation(s)
- Grimur Høgnason Mohr
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Nordstjernevej 41, 2600 Glostrup, Denmark
| | - Carlo Alberto Barcella
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, University of Copenhagen, Hellerup, Denmark
- Department of Internal Medicine, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | - Mia Klinten Grand
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Margit Kriegbaum
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Margaret K. Hahn
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sri Mahavir Agarwal
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Catrine Bakkedal
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lone Baandrup
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Mental Health Centre Copenhagen, Bispebjerg-Gentofte, Copenhagen NV, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Filip Krag Knop
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Christen Lykkegaard Andersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Hematology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Bjørn Hylsebeck Ebdrup
- Center for Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Svingel LS, Christensen SF, Kjærsgaard A, Stenling A, Paulsson B, Andersen CL, Christiansen CF, Stentoft J, Starklint J, Severinsen MT, Borg Clausen M, Hagemann Hilsøe M, Hasselbalch HC, Frederiksen H, Bak M, Mikkelsen EM. Labor market affiliation of patients with myeloproliferative neoplasms: a population-based matched cohort study. Acta Oncol 2023; 62:1286-1294. [PMID: 37656802 DOI: 10.1080/0284186x.2023.2251670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/19/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Patients with myeloproliferative neoplasms (MPNs) suffer from substantial symptoms and risk of debilitating complications, yet observational data on their labor market affiliation are scarce. MATERIAL AND METHODS We conducted a descriptive cohort study using data from Danish nationwide registries, including patients diagnosed with MPN in 2010-2016. Each patient was matched with up to ten comparators without MPN on age, sex, level of education, and region of residence. We assessed pre- and post-diagnosis labor market affiliation, defined as working, unemployed, or receiving sickness benefit, disability pension, retirement pension, or other health-related benefits. Labor market affiliation was assessed weekly from two years pre-diagnosis until death, emigration, or 31 December 2018. For patients and comparators, we reported percentage point (pp) changes in labor market affiliation cross-sectionally from week -104 pre-diagnosis to week 104 post-diagnosis. RESULTS The study included 3,342 patients with MPN and 32,737 comparators. From two years pre-diagnosis until two years post-diagnosis, a larger reduction in the proportion working was observed among patients than comparators (essential thrombocythemia: 10.2 [95% CI: 6.3-14.1] vs. 6.8 [95% CI: 5.5-8.0] pp; polycythemia vera: 9.6 [95% CI: 5.9-13.2] vs. 7.4 [95% CI: 6.2-8.7] pp; myelofibrosis: 8.1 [95% CI: 3.0-13.2] vs. 5.8 [95% CI: 4.2-7.5] pp; and unclassifiable MPN: 8.0 [95% CI: 3.0-13.0] vs. 7.4 [95% CI: 5.7-9.1] pp). Correspondingly, an increase in the proportion of patients receiving sickness benefits including other health-related benefits was evident around the time of diagnosis. CONCLUSION Overall, we found that Danish patients with essential thrombocythemia, polycythemia vera, myelofibrosis, and unclassifiable MPN had slightly impaired labor market affiliation compared with a population of the same age and sex. From two years pre-diagnosis to two years post-diagnosis, we observed a larger reduction in the proportion of patients with MPN working and a greater proportion receiving sickness benefits compared with matched individuals.
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Affiliation(s)
- Lise Skovgaard Svingel
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Denmark
| | | | - Anders Kjærsgaard
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Denmark
| | | | | | | | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Denmark
| | - Jesper Stentoft
- Department of Hematology, Aarhus University Hospital, Denmark
| | | | | | - Mette Borg Clausen
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | | | | | - Marie Bak
- Department of Hematology, Zealand University Hospital, Denmark
| | - Ellen Margrethe Mikkelsen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Denmark
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Rørth R, Kriegbaum M, Grand MK, Jacobsen PK, Lind BS, Andersen CL, Persson F. Risk of atrial fibrillation in individuals with dysglycemia and diabetes. J Diabetes Complications 2023; 37:108579. [PMID: 37573645 DOI: 10.1016/j.jdiacomp.2023.108579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 07/20/2023] [Accepted: 07/27/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE Diabetes is a risk factor for atrial fibrillation (AF), and increases the risk of thromboembolic events in persons with AF. However, the link between the two conditions is not fully elucidated. Few studies have investigated the association of dysglycemia and incident AF. We investigated the risk of incident AF and prognosis according to diabetes status. RESEARCH DESIGN AND METHODS The Copenhagen Primary Care Laboratory Database was merged with data on medical prescriptions, in- and outpatient contacts and vital status. The risk of AF according to diabetes status was investigated by use of Cox regression models. RESULTS Of 354.807 individuals with a hemoglobin A1c (HbA1c) measurement, 28.541 (8 %) had known diabetes, 13.038 (4 %) had new onset diabetes and 27.754 (8 %) had prediabetes (HbA1c 42-47 mmol/mol). Persons with dysglycemia (HbA1c > 42 mmol/mol) and diabetes were older, more were men, they had lower level of education and were more likely to be living alone. We observed a gradual increase in risk of developing AF from HbA1c levels of 40 to 60 mmol/mol. In adjusted analyses we found a stepwise increase in hazard of AF from normoglycemia over prediabetes to persons with diabetes (no diabetes: 1.00 [ref.]; prediabetes: 1.12 [1.08-1.16]; new-onset diabetes: 1.16 [1.10-1.22]; known diabetes: 1.15 [1.11-1.20]). Persons with known diabetes had a significant higher hazard of stroke, cardiovascular and all-cause mortality. CONCLUSION Increasing levels of HbA1c were associated with an increased hazard of developing AF. Persons with new onset of diabetes and those with known diabetes had similar hazard of developing AF, however persons with known diabetes had a significant higher hazard of stroke, cardiovascular- and all-cause mortality.
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Affiliation(s)
- Rasmus Rørth
- Steno Diabetes Center Copenhagen, Denmark; Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Margit Kriegbaum
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mia Klinten Grand
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Peter Karl Jacobsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bent Struer Lind
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Christen Lykkegaard Andersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Borg R, Kriegbaum M, Grand MK, Lind B, Andersen CL, Persson F. Chronic kidney disease in primary care: risk of cardiovascular events, end stage kidney disease and death. BMC Prim Care 2023; 24:128. [PMID: 37344787 DOI: 10.1186/s12875-023-02077-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND The prevalence of chronic kidney disease (CKD) is increasing globally. Early diagnosis in primary care may have a role in ensuring proper intervention. We aimed to determine the prevalence and outcome of CKD in primary care. METHODS We performed an observational cohort study in primary care in Copenhagen (2001-2015). Outcomes were stroke, myocardial infarction (MI), heart failure (HF), peripheral artery disease (PAD), all-cause- and cardiovascular mortality. We combined individuals with normal kidney function and CKD stage 2 as reference. We conducted cause-specific Cox proportional regressions to calculate the hazard ratios for outcomes according to CKD group. We explored the associations between kidney function and the outcomes examined using eGFR as a continuous variable modelled with penalised splines. All models were adjusted for age, gender, diabetes, hypertension, existing CVD, heart failure, LDL cholesterol and use of antihypertensive treatment. RESULTS We included 171,133 individuals with at least two eGFR measurements of which the majority (n = 157,002) had eGFR > 60 ml/min/1.73m2 at index date, and 0.05% were in CKD stage 5. Event rates were low in eGFR > 60 ml/min/1.73m2 but increased in those with higher stages of CKD. In adjusted analyses we observed an increase in hazard rates for every outcome with every increment in CKD stage. Compared to the reference group, individuals in CKD stage 4 had double the hazard rate of PAD, MI, cardiovascular and all-cause mortality. CONCLUSIONS Our data from a large primary care cohort demonstrate an early increase in the risk of adverse outcomes already at CKD stage 3. This underlines the importance of studying early intervention in primary care.
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Affiliation(s)
- Rikke Borg
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Margit Kriegbaum
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mia Klinten Grand
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bent Lind
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Christen Lykkegaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
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Bakkedal C, Persson F, Kriegbaum M, Andersen JS, Grant MK, Mohr GH, Lind BS, Andersen CL, Christensen MB, Siersma V, Rozing MP. Diabetes treatment for persons with severe mental illness: A registry-based cohort study to explore medication treatment differences for persons with type 2 diabetes with and without severe mental illness. PLoS One 2023; 18:e0287017. [PMID: 37310947 PMCID: PMC10263345 DOI: 10.1371/journal.pone.0287017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 05/29/2023] [Indexed: 06/15/2023] Open
Abstract
It has been argued that persons with severe mental illness (SMI) receive poorer treatment for somatic comorbidities. This study assesses the treatment rates of glucose-lowering and cardiovascular medications among persons with incident type 2 diabetes (T2D) and SMI compared to persons with T2D without SMI. We identified persons ≥30 years old with incident diabetes (HbA1c ≥ 48 mmol/mol and/or glucose ≥ 11.0 mmol/L) from 2001 through 2015 in the Copenhagen Primary Care Laboratory (CopLab) Database. The SMI group included persons with psychotic, affective, or personality disorders within five years preceding the T2D diagnosis. Using a Poisson regression model, we calculated the adjusted rate ratios (aRR) for the redemption of various glucose-lowering and cardiovascular medications up to ten years after T2D diagnosis. We identified 1,316 persons with T2D and SMI and 41,538 persons with T2D but no SMI. Despite similar glycemic control at diagnosis, persons with SMI redeemed a glucose-lowering medication more often than persons without SMI in the period 0.5-2 years after the T2D diagnosis; for example, the aRR was 1.05 (95% CI 1.00-1.11) in the period 1.5-2 years after the T2D diagnosis. This difference was mainly driven by metformin. In contrast, persons with SMI were less often treated with cardiovascular medications during the first 3 years after T2D diagnosis, e.g., in the period 1.5-2 years after T2D diagnosis, the aRR was 0.96 (95% CI 0.92-0.99). For people with SMI in addition to T2D, metformin is more likely to be used in the initial years after T2D diagnosis, while our results suggest potential room for improvement regarding the use of cardiovascular medications.
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Affiliation(s)
- Catrine Bakkedal
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Frederik Persson
- Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Margit Kriegbaum
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Sahl Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mia Klinten Grant
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Grimur Høgnason Mohr
- Centre for Neuropsychiatric Schizophrenia Research, CNSR Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Bent Struer Lind
- Department of Clinical Biochemistry, Copenhagen University Hospital, Hvidovre, Denmark
| | - Christen Lykkegaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Bring Christensen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maarten Pieter Rozing
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department O Rigshospitalet, Psychiatric Center of Copenhagen, Copenhagen, Denmark
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10
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Thomsen GN, Christoffersen MN, Lindegaard HM, Davidsen JR, Hartmeyer GN, Assing K, Mortz CG, Martin-Iguacel R, Møller MB, Kjeldsen AD, Havelund T, El Fassi D, Broesby-Olsen S, Maiborg M, Johansson SL, Andersen CL, Vestergaard H, Bjerrum OW. The multidisciplinary approach to eosinophilia. Front Oncol 2023; 13:1193730. [PMID: 37274287 PMCID: PMC10232806 DOI: 10.3389/fonc.2023.1193730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/25/2023] [Indexed: 06/06/2023] Open
Abstract
Eosinophilic granulocytes are normally present in low numbers in the bloodstream. Patients with an increased number of eosinophilic granulocytes in the differential count (eosinophilia) are common and can pose a clinical challenge because conditions with eosinophilia occur in all medical specialties. The diagnostic approach must be guided by a thorough medical history, supported by specific tests to guide individualized treatment. Neoplastic (primary) eosinophilia is identified by one of several unique acquired genetic causes. In contrast, reactive (secondary) eosinophilia is associated with a cytokine stimulus in a specific disease, while idiopathic eosinophilia is a diagnosis by exclusion. Rational treatment is disease-directed in secondary cases and has paved the way for targeted treatment against the driver in primary eosinophilia, whereas idiopathic cases are treated as needed by principles in eosinophilia originating from clonal drivers. The vast majority of patients are diagnosed with secondary eosinophilia and are managed by the relevant specialty-e.g., rheumatology, allergy, dermatology, gastroenterology, pulmonary medicine, hematology, or infectious disease. The overlap in symptoms and the risk of irreversible organ involvement in eosinophilia, irrespective of the cause, warrants that patients without a diagnostic clarification or who do not respond to adequate treatment should be referred to a multidisciplinary function anchored in a hematology department for evaluation. This review presents the pathophysiology, manifestations, differential diagnosis, diagnostic workup, and management of (adult) patients with eosinophilia. The purpose is to place eosinophilia in a clinical context, and therefore justify and inspire the establishment of a multidisciplinary team of experts from diagnostic and clinical specialties at the regional level to support the second opinion. The target patient population requires highly specialized laboratory analysis and therapy and occasionally has severe eosinophil-induced organ dysfunction. An added value of a centralized, clinical function is to serve as a platform for education and research to further improve the management of patients with eosinophilia. Primary and idiopathic eosinophilia are key topics in the review, which also address current research and discusses outstanding issues in the field.
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Affiliation(s)
| | | | - Hanne Merete Lindegaard
- Department of Rheumatology, Odense University Hospital, Denmark; Research Unit for Rheumatology, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Jesper Rømhild Davidsen
- Department of Respiratory Medicine, Odense University Hospital, Denmark; Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Kristian Assing
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, Denmark; University of Southern Denmark, Odense, Denmark
| | | | | | - Anette Drøhse Kjeldsen
- Department of ORL- Head and Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Troels Havelund
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Daniel El Fassi
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sigurd Broesby-Olsen
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, Denmark; University of Southern Denmark, Odense, Denmark
| | - Michael Maiborg
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Christen Lykkegaard Andersen
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Centre for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Vestergaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Ole Weis Bjerrum
- Department of Hematology, Odense University Hospital, Odense, Denmark
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11
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Christensen ME, Siersma V, Kriegbaum M, Lind BS, Samuelsson J, Østgård LSG, Grønbaek K, Andersen CL. Monocytosis in primary care and risk of haematological malignancies. Eur J Haematol 2023; 110:362-370. [PMID: 36479724 DOI: 10.1111/ejh.13911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
Abstract
Monocytosis (≥0.5 × 109 /L in peripheral blood) is the hallmark of chronic myelomonocytic leukaemia (CMML) but may be present in a spectrum of diseases including other haematological malignancies. In the primary care sector, monocytosis is a relatively common finding, but its predictive value for haematological malignancy is unknown. We included 663 184 adult primary care patients from the greater Copenhagen area with one or more differential cell counts registered between 2000 and 2016 and followed them in the extensive nationwide Danish health data registers for 3 years after blood sampling. We used logistic regression to model the risk of haematological malignancy and death following monocytosis. Monocytosis was associated with an increased risk of all types of haematological malignancy with the greatest relative risk increase observed in CMML with an OR of 105.22 (95% confidence interval: 38.27-289.30). Sustained monocytosis (at least two requisitions in 3 months) further increased CMML risk, although the diagnosis was still very rare, that is, observed in only 0.1% of these individuals. Outside the haematological setting, the absolute risk of haematological malignancy associated with monocytosis is low and haematological malignancy should mainly be suspected when monocytosis is sustained or the clinical presentation raises suspicion of malignancy.
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Affiliation(s)
- Mathilde Egelund Christensen
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Centre for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- Centre for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Margit Kriegbaum
- Centre for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bent Struer Lind
- Centre for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Biochemistry, Copenhagen University Hospital, Hvidovre, Denmark
| | - Jan Samuelsson
- Department of Haematology, University Hospital Linköping, Linköping, Sweden
| | - Lene Sofie Granfeldt Østgård
- Department of Haematology, Odense University Hospital, Odense, Denmark.,Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Kirsten Grønbaek
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Bio Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Christen Lykkegaard Andersen
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Centre for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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12
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Heinrich NS, Kriegbaum M, Grand MK, Lind BS, Andersen CL, Persson F. Biochemical profiling, pharmacological management and clinical outcomes in type 2 diabetes in Danish primary care from 2001 to 2015. Prim Care Diabetes 2022; 16:818-823. [PMID: 36272916 DOI: 10.1016/j.pcd.2022.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 03/14/2022] [Accepted: 10/14/2022] [Indexed: 11/17/2022]
Abstract
AIMS Primary care plays an integral role in the management of type 2 diabetes (T2D). We investigated in a large group of individuals in this setting the biochemical profiles, pharmacological management and clinical outcomes as well as their changes over time. METHODS This is a register-based study including relevant laboratory test results requested between 2000 and 2015 by general practitioners in the greater Copenhagen area. We identified 72,044 individuals with T2D on whom data concerning prescription medicine and clinical outcomes were obtained from national registries. RESULTS The number of individuals with T2D greatly increased from 2001 to 2015. Hemoglobin A1c, estimated glomerular filtration rate and urine albumin creatinine ratio did not change, but cholestrol levels improved. The proportion redeeming anti-diabetics remained around 80%, with an increase for metformin. The use of cardiovascular drugs increased. All-cause and especially cardiovascular mortality decreased over the period. Hospital admissions for non-fatal cardiovascular events dropped. CONCLUSION The number of individuals with T2D in primary care increased dramatically whereas pharmacological management, control of risk factors and clinical outcomes seem to have improved. Nevertheless, a conspicuous minority did not receive diabetes-related medication.
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Affiliation(s)
| | - Margit Kriegbaum
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mia Klinten Grand
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bent Struer Lind
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Christen Lykkegaard Andersen
- Department of Hematology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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13
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Christensen SF, Svingel LS, Kjærsgaard A, Stenling A, Darvalics B, Paulsson B, Andersen CL, Christiansen CF, Stentoft J, Starklint J, Severinsen MT, Clausen MB, Hilsøe MH, Hasselbalch HC, Frederiksen H, Mikkelsen EM, Bak M. Healthcare resource utilization in patients with myeloproliferative neoplasms: A Danish nationwide matched cohort study. Eur J Haematol 2022; 109:526-541. [PMID: 35900040 PMCID: PMC9804288 DOI: 10.1111/ejh.13841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 01/05/2023]
Abstract
Few studies have assessed healthcare resource utilization (HRU) in patients with Philadelphia-negative myeloproliferative neoplasms (MPN) using a matched cohort design. Further, no detailed assessment of HRU in the years preceding an MPN diagnosis exists. We conducted a registry-based nationwide Danish cohort study, including patients with essential thrombocythemia, polycythemia vera, myelofibrosis, and unclassifiable MPN diagnosed between January 2010 and December 2016. HRU data were summarized annually from 2 years before MPN diagnosis until emigration, death, or end of study (December 2017). We included 3342 MPN patients and 32 737 comparisons without an MPN diagnosis, matched on sex, age, region of residence, and level of education. During the study period, the difference in HRU (rate ratio) between patients and matched comparisons ranged from 1.0 to 1.5 for general practitioner contacts, 0.9 to 2.2 for hospitalizations, 0.9 to 3.8 for inpatient days, 1.0 to 4.0 for outpatient visits, 1.3 to 2.1 for emergency department visits, and 1.0 to 4.1 for treatments/examinations. In conclusion, MPN patients had overall higher HRU than the matched comparisons throughout the follow-up period (maximum 8 years). Further, MPN patients had substantially increased HRU in both the primary and secondary healthcare sector in the 2 years preceding the diagnosis.
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Affiliation(s)
| | - Lise Skovgaard Svingel
- Department of Clinical Epidemiology, Department of Clinical MedicineAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | - Anders Kjærsgaard
- Department of Clinical Epidemiology, Department of Clinical MedicineAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | | | - Bianka Darvalics
- Department of Clinical Epidemiology, Department of Clinical MedicineAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | | | - Christen Lykkegaard Andersen
- Department of HematologyCopenhagen University HospitalRigshospitaletDenmark,The Research Unit for General Practice and Section of General Practice, Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Department of Clinical MedicineAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | - Jesper Stentoft
- Department of HematologyAarhus University HospitalAarhusDenmark
| | - Jørn Starklint
- Department of HematologyHolstebro HospitalHolstebroDenmark
| | | | - Mette Borg Clausen
- Department of HematologyCopenhagen University HospitalRigshospitaletDenmark
| | | | | | | | - Ellen Margrethe Mikkelsen
- Department of Clinical Epidemiology, Department of Clinical MedicineAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | - Marie Bak
- Department of HematologyZealand University HospitalRoskildeDenmark,Department of HematologyCopenhagen University HospitalRigshospitaletDenmark
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14
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Sylow L, Grand MK, von Heymann A, Persson F, Siersma V, Kriegbaum M, Lykkegaard Andersen C, Johansen C. Incidence of New-Onset Type 2 Diabetes After Cancer: A Danish Cohort Study. Diabetes Care 2022; 45:e105-e106. [PMID: 35653597 DOI: 10.2337/dc22-0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/25/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Lykke Sylow
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Mia K Grand
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Annika von Heymann
- Cancer Survivorship and Treatment Late Effects (CASTLE), Department of Oncology, Center for Cancer and Organ Disease, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Margit Kriegbaum
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christen Lykkegaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects (CASTLE), Department of Oncology, Center for Cancer and Organ Disease, Copenhagen University Hospital, Copenhagen, Denmark
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15
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Andersen MA, Grand MK, Brieghel C, Siersma V, Andersen CL, Niemann CU. Pre-diagnostic trajectories of lymphocytosis predict time to treatment and death in patients with chronic lymphocytic leukemia. Commun Med 2022; 2:50. [PMID: 35603299 PMCID: PMC9098503 DOI: 10.1038/s43856-022-00117-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 04/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background The dynamics of pre-diagnostic lymphocytosis in patients with ensuing chronic lymphocytic leukemia (CLL) need to be explored as a better understanding of disease progression may improve treatment options and even lead to disease avoidance approaches. Our aim was to investigate the development of lymphocytosis prior to diagnosis in a population-based cohort of patients with CLL and to assess the prognostic information in these pre-diagnostic measurements. Methods All patients diagnosed with CLL in the Greater Copenhagen area between 2008 and 2016 were included in the study. Pre-diagnostic blood test results were obtained from the Copenhagen Primary Care Laboratory Database encompassing all blood tests requested by Copenhagen general practitioners. Using pre-diagnostic measurements, we developed a model to assess the prognosis following diagnosis. Our model accounts for known prognostic factors and corresponds to lymphocyte dynamics after diagnosis. Results We explore trajectories of lymphocytosis, associated with known recurrent mutations. We show that the pre-diagnostic trajectories are an independent predictor of time to treatment. The implementation of pre-diagnostic lymphocytosis slope groups improved the model predictions (compared to CLL-IPI alone) for treatment throughout the period. The model can manage the heterogeneous data that are to be expected from the real-world setting and adds further prognostic information. Conclusions Our findings further knowledge of the development of CLL and may eventually make prophylactic measures possible. While clinicians largely agree that patients with chronic lymphocytic leukemia (CLL) have increased levels of white blood cells in the years preceding their diagnosis, there is less certainty as to how and when this increase occurs. A better understanding of how white blood cell levels change during this period might help us to predict who will become ill and require treatment. In this work, we explore patterns of white blood cell growth and develop a tool to predict the time to treatment for CLL based on these growth rates. Using our tool in the clinic might help clinicians to decide who needs treatment for CLL and when, potentially leading to better outcomes for patients. Andersen et al. evaluate lymphocyte dynamics in chronic lymphocytic leukemia (CLL) patients prior to diagnosis. The authors develop a model to predict risk of requiring CLL treatment or death based on pre-diagnostic lymphocyte growth rates.
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16
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Borg R, Kriegbaum M, Klinten Grand M, Struer Lind B, Lykkegaard Andersen C, Persson F. MO518: Chronic Kidney Disease in Primary Care and the Risk of Cardiovascular Comorbidity and Mortality. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac071.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
The prevalence of chronic kidney disease (CKD) is increasing globally. Often, the condition develops silently over time, with no or only a few symptoms in earlier stages. Therefore, early recognition in primary care may have an important role in ensuring diagnosis and proper intervention. We aimed to determine the prevalence and outcome of CKD in a large primary care cohort in Denmark.
METHOD
We performed an observational cohort study using data from individuals above age 40 followed in primary care in the greater Copenhagen area between 2000 and 2015 and linked them to Danish health registries. A run-in period of 3 months was included to ensure stable conditions and rule out acute changes in eGFR at baseline. The date of the second measurement of eGFR during the study period was considered the subject's index date (baseline). Outcomes were relevant diagnoses such as stroke, myocardial infarction (MI), hospitalisations for heart failure (HHF) and peripheral artery disease (PAD) (last update 2018), all-cause mortality and cardiovascular mortality. Kidney function (eGFR) was estimated by the CKD-EPI formula based on serum creatinine and expressed in mL/min/1.73 m2. Conventional CKD groups are used with CKD 1 and 2 (normal—eGFR > 60 mL/min/1.73 m2) as reference groups for the hazard ratio estimates. Outcomes were presented as the number of events/100 person-years (PY). We conducted survival (all-cause mortality outcome) and competing risk (rest of the outcomes) analyses using the Cox proportional hazards model to calculate the (cause-specific) hazard ratios for the outcomes according to CKD group. We further explored the continuous associations between kidney function and the outcomes examined by using eGFR as a continuous variable with penalised splines. All models were adjusted for known risk factors (age, gender, diabetes, hypertension, existing CVD, heart failure, LDL cholesterol, use of antihypertensive treatment).
RESULTS
We included a population of 171 133 individuals. As expected, the majority (n = 157002) was in CKD 1 or 2 at the index date, and only a small proportion (0.05%) was in CKD stage 5. In general, event rates were low in CKD stages 1 and 2 and rose with higher stages of CKD. In the adjusted analyses, we observed a stepwise increase in hazard rates for every outcome with every increment in CKD stage (Fig. 1). This was confirmed by the continuous analysis. Compared with CKD stage 1 + 2, individuals in CKD stage 4 had approximately double the hazard rate of PAD, MI, cardiovascular and all-cause mortality.
CONCLUSION
Our data from a large primary care cohort demonstrate an early increase in risk for adverse outcomes already at CKD stage 3. This provides the basis and underlines the importance of studying early intervention in primary care.
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Affiliation(s)
- Rikke Borg
- Department of Nephrology, Zealand University Hospital, Roskilde, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Margit Kriegbaum
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mia Klinten Grand
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bent Struer Lind
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Christen Lykkegaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
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17
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Hougaard M, Thomsen GN, Kristensen TK, Lindegaard HM, Davidsen JR, Hartmeyer GN, Kjeldsen AD, Martin-Iguacel R, Maiborg M, Assing K, Andersen CL, Broesby-Olsen S, Møller MB, Vestergaard H, Bjerrum OW. A retrospective cohort study of patients with eosinophilia referred to a tertiary centre. Dan Med J 2022; 69:A07210558. [PMID: 35319447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Patients with eosinophilia (an increased number of eosinophilic granulocytes > 0.5 × 10⁸/l in the blood) are encountered in all medical specialties and frequently need thorough workup to identify the eliciting causes and decide whether treatment is indicated. In Denmark, highly specialised centres for eosinophilic diseases or conditions have been established to provide a foundation for the management of complicated cases. Here, we present experiences from such a multidisciplinary centre. METHODS This was a retrospective study of all patients seen in our tertiary centre for eosinophilia in the 2016-2019 period. RESULTS Referrals mainly derived from specialised secondary care and to a lesser degree from primary care physicians. Patients were either asymptomatic or exhibited symptoms from up to three organ systems and presented a median eosinophil count of 1.7 × 10⁸/l. Up to eight new clonality analyses or imaging studies per patient were performed after referral. One of these, T-cell receptor analysis, was performed frequently but provided limited information, whereas, e.g., flow cytometry proved more clinically applicable owing to its broader diagnostic range. In total, 51 patients were evaluated and classified as secondary (59%), myeloid neoplasm with PDGFRA rearrangement (2%), idiopathic hypereosinophilic syndrome (31%) and idiopathic hypereosinophilia (8%). CONCLUSION The value of a multidisciplinary and versatile approach in a highly specialised centre has a positive impact on diagnostic processes as well as on the evaluation of treatment need. FUNDING none. TRIAL REGISTRATION not relevant.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Kristian Assing
- Department of Clinical Immunology, Odense University Hospital
| | | | - Sigurd Broesby-Olsen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Denmark
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18
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Nørskov KH, Fridthjof K, Kampmann P, Dünweber A, Andersen CL, Renaberg T, Schöllkopf C, Ahmad SA, Schou K, Jensen CF, Møller P, Lundholm BW, Marcher C, Jepsen L, Ørntoft AK, Ommen HB, Andersen L, Behrentzs A, Hasselgren CF, Severinsen M, Grand MK, Jarden M, Møller T, Kjeldsen L. A national Danish proof of concept on feasibility and safety of home -based intensive chemotherapy in patients with acute myeloid leukemia. Leuk Res 2021; 112:106756. [PMID: 34839055 DOI: 10.1016/j.leukres.2021.106756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/09/2021] [Accepted: 11/21/2021] [Indexed: 11/12/2022]
Abstract
Technological advances have made it possible to offer home-based chemotherapy to patients without health care professionals being present. Prior studies on effects of home-based treatment lack inclusion of patients with hematologic malignancies. We present data from a multicenter single-arm feasibility and safety study of home-based intensive chemotherapy in patients with newly diagnosed acute myeloid leukemia and their quality of life and psychological wellbeing. This national study included patients from six sites in Denmark who received intensive chemotherapy on programmed CADD Solis infusion pumps through a central venous catheter and were also managed as outpatients during treatment-induced pancytopenia. Data are presented from 104 patients, receiving 272 treatments with 1.096 (mean 4.57, SD 3.0) home infusion days out of 1.644 treatment days (67 %). Sixty-two of 168 (36.9 %) reinduction and consolidation treatment cycles ensuing pancytopenia phases were solely handled in the outpatient clinic. Patients reported high satisfaction with home-based treatment, which had a positive influence on their ability to be involved in their treatment and be socially and physically active. No unexpected events occurred during the intervention. Overall, patients improved in all quality of life outcomes over time. Home-based intensive chemotherapy treatment was feasible and safe in this population. ClinicalTrials.gov identifier: NCT04904211.
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Affiliation(s)
- Kristina Holmegaard Nørskov
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | | | - Peter Kampmann
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Anne Dünweber
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Christen Lykkegaard Andersen
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Toni Renaberg
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Claudia Schöllkopf
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Syed Azhar Ahmad
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Katrine Schou
- Department of Haematology, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark.
| | - Cecilie Fremming Jensen
- Department of Haematology, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark.
| | - Peter Møller
- Department of Haematology, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark.
| | - Birgitte Wolf Lundholm
- Department of Hematology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.
| | - Claus Marcher
- Department of Hematology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.
| | - Lene Jepsen
- Department of Hematology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.
| | - Anne Katrine Ørntoft
- Department of Hematology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus C, Denmark.
| | - Hans Beier Ommen
- Department of Hematology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus C, Denmark.
| | - Lotte Andersen
- Department of Hematology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
| | - Anni Behrentzs
- Department of Hematology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
| | | | - Marianne Severinsen
- Department of Hematology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
| | - Mia Klinten Grand
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark.
| | - Mary Jarden
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Copenhagen, Denmark.
| | - Tom Møller
- University Hospital Center for Health Research, Ryesgade 27, 2200, Copenhagen N, Denmark.
| | - Lars Kjeldsen
- Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
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19
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la Cour JL, Medici BR, Grand MK, Nicolaisdottir DR, Lind B, Faber J, Andersen CL, Nygaard B. Risk of over- and under- treatment with levothyroxine in primary care in Copenhagen, Denmark. Eur J Endocrinol 2021; 185:673-679. [PMID: 34478406 DOI: 10.1530/eje-21-0485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/03/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A decrease over time in thyroid stimulating hormone (TSH) levels when initiating levothyroxine (L-T4) therapy for hypothyroidism has been reported, where treatment most often is initiated with TSH levels below 10 mIU/L. The primary objective of this study was to investigate whether this lower TSH threshold resulted in an increased number of overtreated patients. DESIGN AND METHOD Retrospective cohort study comprising inhabitants in Copenhagen had TSH measurements requested by general practitioners which led to a new prescription of L-T4 between 2001 and 2012. Over- and under- treatment were defined as TSH <0.1 mIU/L or above 10 mIU/mL, respectively, in three consecutive measurements. Data were analyzed by Aalen-Johansen estimators and Cox proportional hazards models. RESULTS In total, 14 533 initiations of L-T4 were included in the study. The cumulative risk of being over- or undertreated was 4.7 and 7.4% after 10 years. The hazard of overtreatment was higher among women, younger adults, and with lower initial TSH levels. The hazard of overtreatment decreased over the time period from 2001 to 2012. Among overtreated individuals, the chance of returning to a normal TSH was about 55% after 10 years. In 18% of the cases, L-T4 therapy was initiated on TSH levels less than 5 mIU/L. CONCLUSION Although a still decreasing threshold for initiating L-T4 therapy is known, the risk of overtreatment (and undertreatment) was low and lessened in the period 2001-2012 among Danish primary care patients. Nevertheless, as many as 18% were started on L-T4 with normal TSH levels.
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Affiliation(s)
- Jeppe Lerche la Cour
- Center for Endocrinology and Metabolism, Department of Internal Medicine, Herlev and Gentofte Hospitals, Herlev, Denmark
| | - Bjarke Røssner Medici
- Center for Endocrinology and Metabolism, Department of Internal Medicine, Herlev and Gentofte Hospitals, Herlev, Denmark
| | - Mia Klinten Grand
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dagny Ros Nicolaisdottir
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bent Lind
- Department of Clinical Biochemistry, Amager Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Jens Faber
- Center for Endocrinology and Metabolism, Department of Internal Medicine, Herlev and Gentofte Hospitals, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christen Lykkegaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Birte Nygaard
- Center for Endocrinology and Metabolism, Department of Internal Medicine, Herlev and Gentofte Hospitals, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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20
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Møllehave LT, Jacobsen RK, Linneberg A, Skaaby T, Knudsen N, Jørgensen T, Kårhus LL, Kriegbaum M, Grand MK, Siersma V, Lind B, Andersen CL, Nygaard B, Medici BB, Pedersen IB, Ravn-Haren G, Thuesen BH. Influence of educational level on test and treatment for incident hypothyroidism. Clin Endocrinol (Oxf) 2021; 94:1025-1034. [PMID: 33512012 DOI: 10.1111/cen.14429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/28/2020] [Accepted: 01/12/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The incidence of hypothyroidism is not expected to differ by socioeconomic factors. However, the decision to test and initiate treatment may differ. We aimed to examine whether educational level influences the probability of thyroid stimulation hormone (TSH)-measurement and initiation of levothyroxine treatment. DESIGN Citizens in the greater Copenhagen Area during 2001-2015 were included. Individual-level data on educational level, diagnoses, GP-contact, TSH-measurement and medication were derived from administrative and healthcare registers. The relative risks (RR) between educational levels of annual TSH-measurement and treatment initiation following a TSH-measurement were analysed in Poisson regression models with generalized estimation equations. RESULTS A TSH-measurement was performed in 19% of 9,390,052 person years. The probability of TSH-measurement was higher with short (RR 1.16 [95% CI 1.15-1.16]) and medium (RR 1.11 [95% CI 1.06-1.12]) compared with long education. Treatment was initiated after 0.8% of 2,049,888 TSH-measurements. For TSH < 5 mIU/L, RR for treatment initiation ranged between 0.47 (95%CI 0.39-0.57) and 0.78 (95%CI 0.67-0.91) for short and medium compared with long education. For TSH 5-10 mIU/L, there was no statistically significant difference. For TSH > 10 mIU/L, RR was 1.07 (95% CI 1.02-1.12) for short and 1.08 (95% CI 1.03-1.13) for medium compared with long education. CONCLUSION The probability of TSH-measurement was higher with shorter education, and the probability of treatment initiation with TSH > 10 mIU/L was marginally higher with short-medium education compared with long education. However, the probability of treatment initiation with TSH < 5 mIU/L, that is treatment incongruous with guidelines, was substantially higher in persons with long education.
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Affiliation(s)
- Line Tang Møllehave
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
| | - Rikke Kart Jacobsen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tea Skaaby
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
| | - Nils Knudsen
- Department of Endocrinology, Bispebjerg University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Line Lund Kårhus
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
| | - Margit Kriegbaum
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mia Klinten Grand
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bent Lind
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Christen Lykkegaard Andersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Birte Nygaard
- Department of Endocrinology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bjarke Borregaard Medici
- Department of Endocrinology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Inge Bülow Pedersen
- Department of Endocrinology and Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Gitte Ravn-Haren
- Division of Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Betina Heinsbaek Thuesen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region, Denmark
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21
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Tarpgaard LS, Andersen PV, Øgaard N, Demuth C, Andersen CL, Pfeiffer P. Complete pathological and serological response to immunotherapy in a patient with MMR-deficient early rectal cancer. Ann Oncol 2021; 32:805-806. [PMID: 33727198 DOI: 10.1016/j.annonc.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 01/19/2023] Open
Affiliation(s)
- L S Tarpgaard
- Department of Oncology, Odense University Hospital, Odense, Denmark.
| | - P V Andersen
- Department of Surgery, Odense University Hospital, Odense, Denmark
| | - N Øgaard
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - C Demuth
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - C L Andersen
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - P Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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22
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Egholm GJ, Andersen MA, Andersen CL, Frederiksen H, Bjerrum OW, Niemann CU. Abnormal eosinophil count at CLL diagnosis correlates with shorter treatment free survival. Br J Haematol 2020; 192:e81-e84. [PMID: 33316076 DOI: 10.1111/bjh.17264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/13/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | - Michael Asger Andersen
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Henrik Frederiksen
- Department of Haematology, Odense University Hospital, Odense, Denmark.,Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Ole Weis Bjerrum
- Department of Haematology, Odense University Hospital, Odense, Denmark.,Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Carsten Utoft Niemann
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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23
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Sørensen AL, Mikkelsen SU, Knudsen TA, Bjørn ME, Andersen CL, Bjerrum OW, Brochmann N, Patel DA, Gjerdrum LMR, El Fassi D, Kruse TA, Larsen TS, Mourits-Andersen HT, Nielsen CH, Ellervik C, Pallisgaard N, Thomassen M, Kjær L, Skov V, Hasselbalch HC. Ruxolitinib and interferon-α2 combination therapy for patients with polycythemia vera or myelofibrosis: a phase II study. Haematologica 2020; 105:2262-2272. [PMID: 33054051 PMCID: PMC7556624 DOI: 10.3324/haematol.2019.235648] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 12/20/2019] [Indexed: 11/20/2022] Open
Abstract
We report the final 2-year end-of-study results from the first clinical trial investigating combination treatment with ruxolitinib and low-dose pegylated interferon-α2 (PEG-IFNα2). The study included 32 patients with polycythemia vera and 18 with primary or secondary myelofibrosis; 46 patients were previously intolerant of or refractory to PEGIFNα2. The primary outcome was efficacy, based on hematologic parameters, quality of life measurements, and JAK2 V617F allele burden. We used the 2013 European LeukemiaNet and International Working Group- Myeloproliferative Neoplasms Research and Treatment response criteria, including response in symptoms, splenomegaly, peripheral blood counts, and bone marrow. Of 32 patients with polycythemia vera, ten (31%) achieved a remission which was a complete remission in three (9%) cases. Of 18 patients with myelofibrosis, eight (44%) achieved a remission; five (28%) were complete remissions. The cumulative incidence of peripheral blood count remission was 0.85 and 0.75 for patients with polycythemia vera and myelofibrosis, respectively. The Myeloproliferative Neoplasm Symptom Assessment Form total symptom score decreased from 22 [95% confidence interval (95% CI):, 16-29] at baseline to 15 (95% CI: 10-22) after 2 years. The median JAK2 V617F allele burden decreased from 47% (95% CI: 33-61%) to 12% (95% CI: 6-22%), and 41% of patients achieved a molecular response. The drop-out rate was 6% among patients with polycythemia vera and 32% among those with myelofibrosis. Of 36 patients previously intolerant of PEG-IFNα2, 31 (86%) completed the study, and 24 (67%) of these received PEG-IFNα2 throughout the study. In conclusion, combination treatment improved cell counts, reduced bone marrow cellularity and fibrosis, decreased JAK2 V617F burden, and reduced symptom burden with acceptable toxicity in several patients with polycythemia vera or myelofibrosis. #EudraCT2013-003295-12.
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Affiliation(s)
- Anders Lindholm Sørensen
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark; Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
| | - Stine Ulrik Mikkelsen
- Department of Hematology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Biotech Research and Innovation Center, University of Copenhagen, Copenhagen, Denmark
| | - Trine Alma Knudsen
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | | | - Christen Lykkegaard Andersen
- Department of Hematology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Weis Bjerrum
- Department of Hematology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Nana Brochmann
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Dustin Andersen Patel
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark; Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | | | - Torben A Kruse
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | | | | | - Claus Henrik Nielsen
- Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christina Ellervik
- Herlev University Hospital, Copenhagen, Denmark; Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Data and Development Support, Region Zealand, Sorø, Denmark
| | - Niels Pallisgaard
- Department of Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Mads Thomassen
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Lasse Kjær
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Vibe Skov
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
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24
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Christensen SF, Scherber RM, Brochmann N, Goros M, Gelfond J, Andersen CL, Flachs EM, Mesa R. Body Mass Index and Total Symptom Burden in Myeloproliferative Neoplasms Discovery of a U-shaped Association. Cancers (Basel) 2020; 12:E2202. [PMID: 32781663 PMCID: PMC7465643 DOI: 10.3390/cancers12082202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/30/2020] [Accepted: 08/02/2020] [Indexed: 12/18/2022] Open
Abstract
Elevated body mass index (BMI) is a global health problem, leading to enhanced mortality and the increased risk of several cancers including essential thrombocythemia (ET), a subtype of the Philadelphia-chromosome negative myeloproliferative neoplasms (MPN). Furthermore, evidence states that BMI is associated with the severity of symptom burden among cancer patients. MPN patients often suffer from severe symptom burden. The purpose of this study was to examine whether deviations from a normal BMI in an MPN population are associated with higher symptom burden and reduced quality of life (QoL). A combined analysis of two large cross-sectional surveys, the Danish Population-based Study, MPNhealthSurvey (n = 2044), and the international Fatigue Study (n = 1070), was performed. Symptoms and QoL were assessed using the validated Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF). Analysis of covariance was used to estimate the effects of different BMI categories on symptom scores while adjusting for age, sex, and MPN subtype. A U-shaped association between BMI and Total Symptom Burden was observed in both datasets with significantly higher mean scores for underweight and obese patients relative to normal weight (mean difference: underweight 5.51 (25.8%), p = 0.006; obese 5.70 (26.6%) p < 0.001). This is an important finding, as BMI is a potentially modifiable factor in the care of MPN patients.
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Affiliation(s)
| | - Robyn Marie Scherber
- Department of Hematology/Oncology, UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX 78229, USA;
- Hematologic Malignancies, Incyte Corporation, Wilmington, DE 19803, USA
| | - Nana Brochmann
- Department of Hematology, Zealand University Hospital, 4000 Roskilde, Denmark;
| | - Martin Goros
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX 78229, USA; (M.G.); (J.G.)
| | - Jonathan Gelfond
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, TX 78229, USA; (M.G.); (J.G.)
| | | | - Esben Meulengracht Flachs
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, 2400 Copenhagen, Denmark;
| | - Ruben Mesa
- Department of Hematology/Oncology, UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX 78229, USA;
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25
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Abstract
PURPOSE The Copenhagen Primary Care Laboratory Pregnancy (CopPreg) database was established based on data from The Danish Medical Birth Register and the Copenhagen Primary Care Laboratory (CopLab) database. The aim was to provide a biomedical and epidemiological data resource for research in early disease programming (eg, parental clinical biomarker levels and pregnancy/ birth outcomes or long-term health in the offspring). PARTICIPANTS The cohort consisted in total of 203 608 women (with 340 891 pregnancies) who gave birth to 348 248 children and with 200 590 related fathers. In this paper, we focused on women and fathers who had clinical test requisitions prior to and during pregnancy, and on all children. Thus, the cohort in focus consisted of 203 054 pregnancies with requisitions on 147 045 pregnant women, 39 815 fathers with requisitions during periconception and 65 315 children with requisitions. FINDINGS TO DATE In addition to information on pregnancy and birth health status and general socio-demographic data, over 2.2 million clinically relevant test results were available for pregnancies with requisitions, over 1.5 million for children and over 600 000 test results were available for the fathers with requisitions during periconception. These were ordered by general practitioners in the primary care setting only and included general blood tests, nutritional biomarkers (macronutrients and micronutrients) and hormone tests. Information on tests related to infections, allergies, heart and lung function and sperm analyses (fathers) were also available. FUTURE PLANS The CopPreg database provides ready to use and valid data from already collected, objectively measured and analysed clinical tests. With several research projects planned, we further invite national and international researchers to use this vast data resource. In a coming paper, we will explore and discuss the indication bias in our cohort.
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Affiliation(s)
- Janet Janbek
- Danish Dementia Research Centre, Department of Neurology, The Neuroscience Centre, Rigshospitalet, Copenhagen, Denmark
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Margit Kriegbaum
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mia Klinten Grand
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ina Olmer Specht
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Bent Struer Lind
- Department of Clinical Biochemistry, Copenhagen University Hospital, Hvidovre, Denmark
| | - Christen Lykkegaard Andersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Berit Lilienthal Heitmann
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
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26
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Palmblad J, Siersma V, Lind B, Bjerrum OW, Hasselbalch H, Andersen CL. Age-related prevalence and clinical significance of neutropenia - isolated or combined with other cytopenias: Real world data from 373 820 primary care individuals. Am J Hematol 2020; 95:521-528. [PMID: 32052479 DOI: 10.1002/ajh.25756] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/03/2020] [Accepted: 02/10/2020] [Indexed: 12/25/2022]
Abstract
Neutropenia (NP), that is, an absolute blood neutrophil count (ANC) <1.5 g/L, accompanies various diseases. However, the clinical significance of NP, detected in routine complete blood cell counts (CBC) in primary care, is poorly characterized. Here, from a primary care resource with ANCs from >370 000 individuals, we identified and followed neutropenic subjects for the next 4 years for novel ICD-10 based diagnoses of viral infections and hematological malignancies (ie, previously identified major outcomes in NP individuals) in Danish nationwide health registers. Risk estimates were assessed for children/adolescents (1-18 years) and adults (19-90 years) in relation to NP severity, and for isolated NP, bi- or pancytopenias. We found that NP was observed in 4.9% of children and in 1.9% of adults. The lower the ANC, the likelier was a diagnosis of viral infections or hematological malignancies established during the ensuing 4 years. Among neutropenic children, unspecified viral infections predominated, followed by mononucleosis (with other cytopenias in only 7% and 25% of the cases, respectively). All NP children with acute leukemia presented with bi- or pancytopenia from start of follow-up. In NP adults, hepatitis, followed by HIV, were the most common infections, and acute myelogenous leukemia (AML) and myelodysplastic syndromes (MDSs) the predominating hematological malignancies. Adult NP patients, subsequently diagnosed with hepatitis, HIV or AML, MDS, were bi- or pancytopenic in 42%, 47%, 90% and 91% of cases, respectively. Thus, presence of NP in even one CBC may be the first sign of a latent viral or hematological disorder requiring careful follow-up.
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Affiliation(s)
- Jan Palmblad
- Department of Hematology and MedicineThe Karolinska Institute at Karolinska University Hospital Huddinge Stockholm Sweden
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public HealthUniversity of Copenhagen Copenhagen Denmark
| | - Bent Lind
- Department of Clinical BiochemistryCopenhagen University Hospital Hvidovre Copenhagen Denmark
| | - Ole Weis Bjerrum
- Department of HematologyCopenhagen University Hospital Rigshospitalet Denmark
| | - Hans Hasselbalch
- Department of HematologyRoskilde University Hospital Herlev Denmark
| | - Christen Lykkegaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public HealthUniversity of Copenhagen Copenhagen Denmark
- Department of HematologyCopenhagen University Hospital Rigshospitalet Denmark
- Department of HematologyRoskilde University Hospital Herlev Denmark
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27
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Bjerrum OW, Siersma V, Hasselbalch HC, Lind B, Andersen CL. Association of the blood eosinophil count with end-organ symptoms. Ann Med Surg (Lond) 2019; 45:11-18. [PMID: 31360453 PMCID: PMC6637252 DOI: 10.1016/j.amsu.2019.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/19/2019] [Accepted: 06/23/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction Eosinophilia may cause organ dysfunction, but an exact relation between eosinophil blood counts and adverse outcomes has not been described. The aim of the study is to associate in one model both normal and increased blood eosinophil counts to the subsequent development of common conditions in internal medicine, in which eosinophil granulocytes may play a role for the symptoms. Methods From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 359,950 individuals with at least one differential cell count (DIFF) during 2000–2007. From these, one DIFF was randomly chosen. From the Danish National Patient Register we ascertained organ damage, within four years following the DIFF. Using multivariable logistic regression, odds ratios were calculated and adjusted for previous eosinophilia, sex, age, year, month, CRP and comorbid conditions. Results Risks for skin- and respiratory disease were increased from above the median eosinophil count of 0.16 × 109/l and reached a plateau around 1.0 × 109/l. Furthermore, risks of most outcomes also increased when the eosinophil count approached zero. Conclusions The observed U-shaped association with a plateau of risks around 1 × 109/l indicates that the risk for symptoms due to eosinophilia do not increase proportionate at higher counts. This study demonstrates for the first time that there is indeed an increased risk below median count of 0.16 × 109/l for an increased risk for the same manifestations. Clinically, it means that a normal or even low count of eosinophils do not rule out a risk for organ affection by eosinophils, and may contribute to explain, why patients may have normal eosinophil counts in e.g. asthma or allergy and still have symptoms from the lungs and skin, most likely explained by the extravasation of eosinophils. Blood eosinophilia may cause end-organ symptoms. An exact relation between eosinophil count and outcome has not been demonstrated. Eosinophil numbers correlate to organ damage even below the definition of eosinophilia. This association is U-shaped between organ manifestations and eosinophil count in blood. A plateau of risks is observed around 1 × 109/l.
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Affiliation(s)
- Ole Weis Bjerrum
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Denmark.,Department of Hematology, Odense University Hospital, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
| | | | - Bent Lind
- Department of Clinical Biochemistry, Hvidovre University Hospital, Denmark
| | - Christen Lykkegaard Andersen
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Denmark.,The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark.,Department of Hematology, Roskilde University Hospital, Denmark
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Medici BB, Nygaard B, la Cour JL, Grand MK, Siersma V, Nicolaisdottir DR, Lind B, Olivarius NDF, Andersen CL. Changes in Prescription Routines for Treating Hypothyroidism Between 2001 and 2015: An Observational Study of 929,684 Primary Care Patients in Copenhagen. Thyroid 2019; 29:910-919. [PMID: 31017048 DOI: 10.1089/thy.2018.0539] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Increased public attention toward health and quality-of-life issues has led to more intensified screening for various medical conditions, including hypothyroidism. A falling serum thyrotropin (s-TSH) at initiation of levothyroxine (LT4) treatment has been reported in the United Kingdom between 2001 and 2009, indicating a falling TSH threshold, which may lead to less benefit from therapy and possibly overtreatment. The aim of this study was to investigate changes in s-TSH threshold used by general practitioners to initiate LT4 therapy between 2001 and 2015 in Copenhagen. Methods: Retrospective analysis was conducted of all s-TSH measurements between 2001 and 2015 performed at the general practitioners' joint laboratory merged with The Danish Register of Medicinal Products Statistics and The Danish National Patient Registry. For each year, both the median s-TSH at therapy initiation and the estimated treatment threshold were calculated from all s-TSH measurements performed in that year, representing the s-TSH level where the estimated probability of starting LT4 therapy was 50%. Results: A total of 929,684 individuals with 2,975,277 s-TSH measurements were included in the calculations. The size and composition of the study population remained virtually unchanged. During the study period, the number of performed s-TSH measurements increased from 110,886 to 292,911 (164%), and the number of patients initiating LT4 therapy increased from 786 to 1825 (132%), though this was comparably unchanged from 2010 to 2015. The median s-TSH at therapy initiation decreased from 10 mIU/L (interquartile range 5.2-29.7 mIU/L) in 2001 to 6.8 mIU/L (interquartile range 5.1-11 mIU/L) in 2015, while the estimated treatment threshold decreased from 28.3 mIU/L [confidence interval 21.0-40.2 mIU/L] in 2001 to 14.2 mIU/L [confidence interval 12.0-18.0 mIU/L] in 2007. In 2015, 25% of patients started LT4 therapy with s-TSH ≤5 mIU/L, and during the entire period, 50% of patients started therapy with a single s-TSH measurement >5 mIU/L. Conclusions: This study performed on a sizeable primary care population demonstrates a considerable fall in the threshold for initiating LT4 therapy in hypothyroid patients. This increases the risk of futile treatment as well as overtreatment.
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Affiliation(s)
- Bjarke Borregaard Medici
- 1Center for Endocrinology and Metabolism, Department Internal Medicine, Herlev and Gentofte Hospitals, Herlev, Denmark
| | - Birte Nygaard
- 1Center for Endocrinology and Metabolism, Department Internal Medicine, Herlev and Gentofte Hospitals, Herlev, Denmark
| | - Jeppe Lerche la Cour
- 1Center for Endocrinology and Metabolism, Department Internal Medicine, Herlev and Gentofte Hospitals, Herlev, Denmark
| | - Mia Klinten Grand
- 2The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- 2The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dagny Ros Nicolaisdottir
- 2The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bent Lind
- 3Department of Clinical Biochemistry, Amager Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Niels de Fine Olivarius
- 2The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christen Lykkegaard Andersen
- 2The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- 4Department of Hematology, Roskilde University Hospital, Roskilde, Denmark
- 5Department of Hematology, Rigshospitalet, Copenhagen, Denmark
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Fugl A, Andersen CL. Epstein-Barr virus and its association with disease - a review of relevance to general practice. BMC Fam Pract 2019; 20:62. [PMID: 31088382 PMCID: PMC6518816 DOI: 10.1186/s12875-019-0954-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 04/29/2019] [Indexed: 12/15/2022]
Abstract
Background General practitioners encounter the vast majority of patients with Epstein-Barr virus-related disease, i.e. infectious mononucleosis in children and adolescents. With the expanding knowledge regarding the multifaceted role of Epstein-Barr virus in both benign and malignant disease we chose to focus this review on Epstein-Barr virus-related conditions with relevance to the general practitioners. A PubMed and Google Scholar literature search was performed using PubMed’s MeSH terms of relevance to Epstein-Barr virus/infectious mononucleosis in regard to complications and associated conditions. Main text In the present review, these included three early complications; hepatitis, splenic rupture and airway compromise, as well as possible late conditions; lymphoproliferative cancers, multiple sclerosis, rheumatoid arthritis, and chronic active Epstein-Barr virus infection. This review thus highlights recent advances in the understanding of Epstein-Barr virus pathogenesis, focusing on management, acute complications, referral indications and potentially associated conditions. Conclusions Hepatitis is a common and self-limiting early complication to infectious mononucleosis and should be monitored with liver tests in more symptomatic cases. Splenic rupture is rare. Most cases are seen within 3 weeks after diagnosis of infectious mononucleosis and may occur spontaneously. There is no consensus on the safe return to physical activities, and ultrasonic assessment of spleen size may provide the best estimate of risk. Airway compromise due to tonsil enlargement is encountered in a minority of patients and should be treated with systemic corticosteroids during hospitalization. Association between lymphoproliferative cancers, especially Hodgkin lymphoma and Burkitt lymphoma, and infectious mononucleosis are well-established. Epstein-Barr virus infection/infectious mononucleosis as a risk factor for multiple sclerosis has been documented and may be linked to genetic susceptibility. Chronic active Epstein-Barr virus infection is rare. However, a general practitioner should be aware of this as a differential diagnosis in patients with persisting symptoms of infectious mononucleosis for more than 3 months.
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Affiliation(s)
- Anders Fugl
- The Copenhagen Primary Care Laboratory (CopLab) Database, Section of General Practice and The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christen Lykkegaard Andersen
- The Copenhagen Primary Care Laboratory (CopLab) Database, Section of General Practice and The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. .,Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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30
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Bjørn ME, Brimnes MK, Gudbrandsdottir S, Andersen CL, Poulsen HE, Henriksen T, Hasselbalch HC, Nielsen CH. Ruxolitinib treatment reduces monocytic superoxide radical formation without affecting hydrogen peroxide formation or systemic oxidative nucleoside damage in myelofibrosis. Leuk Lymphoma 2019; 60:2549-2557. [PMID: 30785365 DOI: 10.1080/10428194.2019.1579323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The role of excess reactive oxygen species (ROS) with consequent DNA/RNA damage is now recognized as a hallmark of cancer. In JAK2V617F mutated myeloproliferative neoplasms, ROS have been suggested to be important factors in disease initiation and progression. Ruxolitinib is the most widely used drug for myelofibrosis, because it improves symptom-score. However, both the anti-clonal potential and improvement in overall survival are limited. We investigated the impact of ruxolitinib on formation of superoxide radical and hydrogen peroxide by monocytes in sequentially acquired blood samples from patients with myelofibrosis. We also investigated the impact on RNA and DNA damage by measuring urinary excretion of 8-oxo-Guo and 8-oxo-d-Guo. The formation of superoxide by monocytes was reduced significantly during ruxolitinib therapy, but no impact on the formation of hydrogen peroxide by monocytes or the systemic amount of oxidatively damaged RNA or DNA could be demonstrated. We conclude that ruxolitinib holds little anti-oxidative potential.
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Affiliation(s)
- Mads Emil Bjørn
- Department of Hematology, Region Zealand University, Roskilde Hospital , Roskilde , Denmark.,Institute for Inflammation Research (IIR), Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Marie Klinge Brimnes
- Institute for Inflammation Research (IIR), Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Sif Gudbrandsdottir
- Institute for Inflammation Research (IIR), Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark.,Department of Hematology, Herlev Hospital , Herlev , Denmark
| | | | - Henrik Enghusen Poulsen
- Laboratory of Clinical Pharmacology Q7642, University of Copenhagen, Rigshospitalet , Copenhagen , Denmark.,Department of Clinical Pharmacology, Bispebjerg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
| | - Trine Henriksen
- Laboratory of Clinical Pharmacology Q7642, University of Copenhagen, Rigshospitalet , Copenhagen , Denmark
| | - Hans Carl Hasselbalch
- Department of Hematology, Region Zealand University, Roskilde Hospital , Roskilde , Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
| | - Claus Henrik Nielsen
- Institute for Inflammation Research (IIR), Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
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31
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Brochmann N, Flachs EM, Christensen AI, Bak M, Andersen CL, Juel K, Hasselbalch HC, Zwisler AD, Rottmann N. Anxiety and depression in patients with Philadelphia-negative myeloproliferative neoplasms: a nationwide population-based survey in Denmark. Clin Epidemiol 2018; 11:23-33. [PMID: 30588121 PMCID: PMC6302798 DOI: 10.2147/clep.s162688] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective We sought to determine the prevalence and severity of anxiety and depression among patients with Philadelphia-negative myeloproliferative neoplasms (MPNs) and respective associations of anxiety and depression with demographic and lifestyle factors, comorbidity burden, duration of MPN disease, financial difficulties, and health-related quality of life (QoL). Methods This study used data from a nationwide, population-based, cross-sectional survey of health-related QoL in MPN patients in Denmark called the MPNhealthSurvey. Individuals with a diagnosis of MPN in the National Patient Register were invited. The Hospital Anxiety and Depression Scale was used to assess the prevalence and severity of anxiety and depression. The associations of anxiety and depression with age, sex, education, body mass index (BMI), smoking, alcohol intake, physical activity, comorbidity burden, duration of MPN disease, financial difficulties, symptom burden, sexual problems, fatigue, functioning, and global health/QoL were examined. Results In total, 2,029 patients completed the Hospital Anxiety and Depression Scale. The prevalence of anxiety, depression, and both was 21%, 12%, and 8%, respectively. Many participants who reported anxiety or depression exhibited mild symptoms. Middle-aged and elderly participants had lower odds of experiencing anxiety and depression when compared to younger participants, and females had higher odds of anxiety compared to males. Participants with higher education had lower odds of anxiety compared to those with lower education. Current smokers and ex-smokers had higher odds of anxiety and depression compared to those who had never smoked, and sedentary participants and participants with a lower level of physical activity had higher odds of anxiety and depression compared to participants who performed hard training several times a week. Higher comorbidity burden increased the odds of depression, and greater financial difficulties increased the odds of anxiety and depression. Higher total symptom burden and fatigue burden and higher level of sexual problems increased the odds of anxiety and depression. Finally, lower functional level and global health/quality of life increased the odds of anxiety and depression. BMI, alcohol intake, comorbidity burden, and duration of disease were not substantially associated with anxiety, whereas sex, educational level, and duration of MPN disease were not substantially associated with depression. Conclusion There may be an unmet need in handling psychological distress in MPN patients. Future research might explore the utility of screening for psychological distress and the effectiveness of lifestyle interventions, rehabilitation, and MPN-symptom reduction in preventing and treating psychological distress.
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Affiliation(s)
- Nana Brochmann
- Department of Hematology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark,
| | - Esben Meulengracht Flachs
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | | | - Marie Bak
- Department of Hematology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark,
| | | | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Hans Carl Hasselbalch
- Department of Hematology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark,
| | - Ann-Dorthe Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, University of Southern Denmark, Nyborg, Denmark
| | - Nina Rottmann
- Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, University of Southern Denmark, Nyborg, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark.,Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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32
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Borg R, Persson F, Siersma V, Lind B, de Fine Olivarius N, Andersen CL. Interpretation of HbA 1c in primary care and potential influence of anaemia and chronic kidney disease: an analysis from the Copenhagen Primary Care Laboratory (CopLab) Database. Diabet Med 2018; 35:1700-1706. [PMID: 29985535 DOI: 10.1111/dme.13776] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2018] [Indexed: 12/28/2022]
Abstract
AIMS To investigate, in a large population in primary care, the relationship between fasting plasma glucose and HbA1c measurements, as well as the clinical implications of anaemia or chronic kidney disease for the interpretation of HbA1c values. METHODS From a primary care resource, we examined HbA1c and fasting plasma glucose as well as haemoglobin and estimated GFR. We stratified observations by chronic kidney disease stage and anaemia level. The estimation of the mean fasting plasma glucose level from HbA1c alone, and from HbA1c , haemoglobin and estimated GFR, respectively, was evaluated. RESULTS In 198 346 individuals, the fasting plasma glucose-HbA1c relationship mimicked the regression described in the A1c-Derived Average Glucose (ADAG) study, which was based on average capillary and interstitial glucose. The fasting plasma glucose-HbA1c relationship was unaffected in mild to moderate chronic kidney disease and in mild to moderate anaemia. The correlation changed only in severe hyperglycaemia and concurrent severe anaemia or when estimated GFR was <45 ml/min/1.73m², so that glucose concentration was underestimated by HbA1c in anaemia and overestimated in chronic kidney disease. The prevalence of estimated GFR <30 ml/min/1.73m² was 0.82%, while the prevalence of haemoglobin <81 g/l (5.0 mmol/l) was 0.11%. CONCLUSIONS The relationship between fasting plasma glucose and HbA1c mimics that of the people with diabetes included in the ADAG study. Mild to moderate anaemia and CKD do not have a significant impact on the interpretation of HbA1c as a marker of retrograde glycaemia. Hence, it seems justified to use HbA1c without adjustment in primary care.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Anemia/blood
- Anemia/complications
- Anemia/epidemiology
- Blood Glucose/analysis
- Data Interpretation, Statistical
- Databases as Topic
- Denmark/epidemiology
- Diabetes Complications/blood
- Diabetes Complications/epidemiology
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/epidemiology
- Diagnostic Errors/statistics & numerical data
- Female
- General Practitioners/statistics & numerical data
- Glycated Hemoglobin/analysis
- Humans
- Laboratories/statistics & numerical data
- Male
- Middle Aged
- Practice Patterns, Physicians'/standards
- Practice Patterns, Physicians'/statistics & numerical data
- Primary Health Care/statistics & numerical data
- Renal Insufficiency, Chronic/blood
- Renal Insufficiency, Chronic/complications
- Renal Insufficiency, Chronic/epidemiology
- Young Adult
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Affiliation(s)
- R Borg
- Department of Nephrology, Zealand University Hospital, Roskilde, Denmark
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - F Persson
- Steno Diabetes Centre, Copenhagen, Denmark
| | - V Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - B Lind
- Department of Clinical Biochemistry, Hvidovre Hospital, Copenhagen, Denmark
| | - N de Fine Olivarius
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - C L Andersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Departments of Haematology, Zealand University Hospital, Roskilde, Denmark
- Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Nielsen LK, Klausen TW, Jarden M, Frederiksen H, Vangsted AJ, Do T, Kristensen IB, Frølund UC, Andersen CL, Abildgaard N, Gregersen H. Clarithromycin added to bortezomib-cyclophosphamide-dexamethasone impairs health-related quality of life in multiple myeloma patients. Eur J Haematol 2018; 102:70-78. [PMID: 30230047 DOI: 10.1111/ejh.13175] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The Danish Myeloma Study Group initiated a randomized, placebo-controlled, double-blinded phase II study to investigate the efficacy of adding clarithromycin to cyclophosphamide-bortezomib-dexamethasone (VCD) induction therapy in transplant eligible, newly diagnosed multiple myeloma patients. The study was prematurely terminated due to severe complications, and no effect of adding clarithromycin was found. The aim of this study was to compare health-related quality of life (HRQoL) between the two groups and to explore the coherence hereof with adverse event (AE) registration by clinicians. METHODS Patients completed three validated HRQoL questionnaires at inclusion, before cyclophosphamide priming, and two months after high-dose therapy (HDT). The mean score difference was interpreted by clinically relevant differences between groups. Spearman's correlation analysis was used to compare patient-reported toxicities with AEs. RESULTS Of 58 included patients, 55 participated in the HRQoL reporting. Before cyclophosphamide priming, patients in the clarithromycin group reported clinically relevant reduced HRQoL for eleven domains with persistent reduction in four domains two months after HDT. Poor correlation between patient-reported toxicities and clinician-reported AEs was observed. CONCLUSIONS Despite the premature study termination, our data demonstrate impaired HRQoL when clarithromycin was added to the VCD regimen. We found clear underreporting of toxicities by clinicians. ClinicalTrials.gov number NCT02573935.
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Affiliation(s)
- Lene Kongsgaard Nielsen
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark
| | | | - Mary Jarden
- Department of Haematology, University Hospital of Copenhagen at Rigshospitalet, Copenhagen, Denmark
| | - Henrik Frederiksen
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark.,Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Annette Juul Vangsted
- Department of Haematology, University Hospital of Copenhagen at Rigshospitalet, Copenhagen, Denmark
| | - Trung Do
- Department of Haematology, University Hospital of Copenhagen at Herlev, Copenhagen, Denmark
| | | | | | | | - Niels Abildgaard
- Quality of Life Research Center, Department of Haematology, Odense University Hospital, Odense, Denmark.,Department of Haematology, Odense University Hospital, Odense, Denmark
| | - Henrik Gregersen
- Department of Haematology, Aalborg University Hospital, Aalborg, Denmark
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Pouplier S, Olsen MÅ, Willadsen TG, Sandholdt H, Siersma V, Andersen CL, Olivarius NDF. The development of multimorbidity during 16 years after diagnosis of type 2 diabetes. J Comorb 2018; 8:2235042X18801658. [PMID: 30363325 PMCID: PMC6169975 DOI: 10.1177/2235042x18801658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 08/14/2018] [Indexed: 12/21/2022]
Abstract
Objective: The aims of this study were to (1) quantify the development and composition
of multimorbidity (MM) during 16 years following the diagnosis of type 2
diabetes and (2) evaluate whether the effectiveness of structured personal
diabetes care differed between patients with and without MM. Research design and methods: One thousand three hundred eighty-one patients with newly diagnosed type 2
diabetes were randomized to receive either structured personal diabetes care
or routine diabetes care. Patients were followed up for 19 years in Danish
nationwide registries for the occurrence of outcomes. We analyzed the
prevalence and degree of MM based on 10 well-defined disease groups. The
effect of structured personal care in diabetes patients with and without MM
was analyzed with Cox regression models. Results: The proportion of patients with MM increased from 31.6% at diabetes diagnosis
to 80.4% after 16 years. The proportion of cardiovascular and
gastrointestinal diseases in surviving patients decreased, while, for
example, musculoskeletal, eye, and neurological diseases increased. The
effect of the intervention was not different between type 2 diabetes
patients with or without coexisting chronic disease. Conclusions: In general, the proportion of patients with MM increased after diabetes
diagnosis, but the composition of chronic disease changed during the 16
years. We found cardiovascular and musculoskeletal disease to be the most
prevalent disease groups during all 16 years of follow-up. The post hoc
analysis of the intervention showed that its effectiveness was not different
among patients who developed MM compared to those who continued to have
diabetes alone.
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Affiliation(s)
- Sandra Pouplier
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maria Åhlander Olsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tora Grauers Willadsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Håkon Sandholdt
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christen Lykkegaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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35
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Bjerrum OW, Fassi DE, Madsen G, Stentoft J, Vestergaard H, Rønnov-Jessen D, Pedersen PT, Pulczynski S, Overgaard UM, Andersen CL. [Eosinophilia]. Ugeskr Laeger 2018; 180:V01180032. [PMID: 30259829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
When the number of eosinophil granulocytes in blood increases, the cause is not always easy to disentangle. This review highlights the symptoms of rare clonal and common reactive diagnoses, how to approach the patient clinically, and how to implement the armamentarium of available tests in order to identify the correct diagnosis and offer the proper treatment. Two referral centres for eosinophilia have been established in Denmark to support this activity by a collaboration between all departments of haematology and the relevant specialities, meeting the manifestations of eosinophilia.
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36
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Gregersen H, Do T, Kristensen IB, Frølund UC, Andersen NF, Nielsen LK, Andersen CL, Klausen TW, Vangsted AJ, Abildgaard N. A randomized placebo-controlled phase II study of clarithromycin or placebo combined with VCD induction therapy prior to high-dose melphalan with stem cell support in patients with newly diagnosed multiple myeloma. Exp Hematol Oncol 2018; 7:18. [PMID: 30123673 PMCID: PMC6090810 DOI: 10.1186/s40164-018-0110-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 08/06/2018] [Indexed: 01/22/2023] Open
Abstract
Background The objective of this randomized placebo-controlled study was to investigate the efficacy and safety of clarithromycin in combination with bortezomib-cyclophosphamide-dexamethasone (VCD) in patients with newly diagnosed multiple myeloma eligible for high-dose therapy. Methods Patients were randomized to receive tablet clarithromycin 500 mg or matching placebo tablet twice daily during the first 3 cycles of VCD induction therapy. Primary endpoint was to compare the rate of very good partial response (VGPR) or better response after three cycles of VCD combined with clarithromycin or placebo. Results The study was prematurely stopped for safety reasons after the inclusion of 58 patients (36% of the planned study population). The patients were randomly assigned to clarithromycin (n = 27) or placebo (n = 31). VGPR or better response after the VCD induction therapy was obtained in 12 patients (44.4%, 95% CI 25.5-64.7) and in 16 patients (51.6%, 33.1-69.8) (p = 0.59) in the clarithromycin group and the placebo group, respectively. Seven patients (25.9%) in the clarithromycin group developed severe gastrointestinal complications (≥ grade 3) comprising pain, neutropenic enterocolitis, paralytic ileus or peptic ulcer. These complications occurred in only one patient in the placebo group. Septicemia with Gram negative bacteria was observed in 5 patients in the clarithromycin group in contrast to one case of pneumococcal septicemia in the placebo group. Patient-reported QoL were negatively affected in the clarithromycin group compared to the placebo group. Conclusion The study was prematurely stopped due to serious adverse events, in particular serious gastrointestinal complications and septicemia. The response data do not suggest any effect of clarithromycin when added to the VCD regimen. The combination of clarithromycin and bortezomib containing regimens is toxic and do not seem to offer extra anti-myeloma efficacy.Trial registration EudraCT (no. 2014-002187-32, registered 7 October 2014, https://www.clinicaltrialsregister.eu/ctr-search/trial/2014-002187-32/DK) and ClinicalTrials.gov (no NCT02573935, retrospectively registered 12 October 2015, https://www.clinicaltrials.gov/ct2/show/NCT02573935?term=Gregersen&cntry=DK&rank=9).
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Affiliation(s)
- Henrik Gregersen
- 1Department of Hematology, Aalborg University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark
| | - Trung Do
- 2Department of Hematology, Herlev Hospital, 2730 Herlev, Denmark
| | | | | | | | | | | | | | | | - Niels Abildgaard
- 8Department of Hematology, Odense University Hospital, 5000 Odense C, Denmark
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Bjerrum OW, Samuelsson J, Ghanima W, Kauppila M, Andersen CL. Thromboembolism prophylaxis in patients with Philadelphia-negative myeloproliferative neoplasms-Clinical practice among Nordic specialists. Eur J Haematol 2018; 100:475-478. [PMID: 29427461 DOI: 10.1111/ejh.13043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) have higher risks of developing thromboembolisms compared to the general population. International guidelines on the management of MPNs therefore include recommendations concerning thromboembolism prophylaxis. In clinical practice, strict adherence to guidelines may be challenging and dependent on factors such as physician experience, outpatient clinic setting, and access to therapy; however, no data exist on physician adherence or patient compliance to thromboembolism prophylaxis in MPNs. OBJECTIVES The Nordic Myeloproliferative Neoplasm Study Group (NMPN) performed a survey among Nordic hematology specialists with the aim of documenting the implementation of international recommendations in a region of Northern Europe with similar healthcare systems. RESULTS The study showed that Nordic specialists managed their patients in accordance with international guidelines concerning medical intervention, but to a lesser degree regarding the management of additional cardiovascular risk factors. The survey also drew attention to the common clinical dilemma of combining antiaggregatory agents with vitamin K antagonists (VKA), or novel oral anticoagulants (NOAC), as well as phlebotomy limits in female polycythemia vera patients. CONCLUSIONS The results of this study highlight the importance of considering all risk factors for thrombosis and an optimal collaboration with the primary healthcare sector.
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Affiliation(s)
| | - Jan Samuelsson
- Department of Hematology, Linkoping University Hospital, Linkoping, Sweden
| | - Waleed Ghanima
- Department of Internal Medicine, Østfold hospital and Department of Haematology, Institute of Clinical Medicine, University of Oslo, Norway
| | - Marjut Kauppila
- Department of Hematology, Turku University Hospital, Turku, Finland
| | - Christen Lykkegaard Andersen
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark.,Department of Hematology, Roskilde Hospital, Roskilde, Denmark
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Nielsen HM, Andersen CL, Westman M, Kristensen LS, Asmar F, Kruse TA, Thomassen M, Larsen TS, Skov V, Hansen LL, Bjerrum OW, Hasselbalch HC, Punj V, Grønbæk K. Epigenetic changes in myelofibrosis: Distinct methylation changes in the myeloid compartments and in cases with ASXL1 mutations. Sci Rep 2017; 7:6774. [PMID: 28754985 PMCID: PMC5533802 DOI: 10.1038/s41598-017-07057-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 06/26/2017] [Indexed: 02/07/2023] Open
Abstract
This is the first study to compare genome-wide DNA methylation profiles of sorted blood cells from myelofibrosis (MF) patients and healthy controls. We found that differentially methylated CpG sites located to genes involved in 'cancer' and 'embryonic development' in MF CD34+ cells, in 'inflammatory disease' in MF mononuclear cells, and in 'immunological diseases' in MF granulocytes. Only few differentially methylated CpG sites were common among the three cell populations. Mutations in the epigenetic regulators ASXL1 (47%) and TET2 (20%) were not associated with a specific DNA methylation pattern using an unsupervised approach. However, in a supervised analysis of ASXL1 mutated versus wild-type cases, differentially methylated CpG sites were enriched in regions marked by histone H3K4me1, histone H3K27me3, and the bivalent histone mark H3K27me3 + H3K4me3 in human CD34+ cells. Hypermethylation of selected CpG sites was confirmed in a separate validation cohort of 30 MF patients by pyrosequencing. Altogether, we show that individual MF cell populations have distinct differentially methylated genes relative to their normal counterparts, which likely contribute to the phenotypic characteristics of MF. Furthermore, differentially methylated CpG sites in ASXL1 mutated MF cases are found in regulatory regions that could be associated with aberrant gene expression of ASXL1 target genes.
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Affiliation(s)
- Helene Myrtue Nielsen
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Danish Stem Cell Centre (DanStem) Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christen Lykkegaard Andersen
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Hematology, Roskilde Hospital, Roskilde, Denmark
| | - Maj Westman
- Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
| | - Lasse Sommer Kristensen
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Fazila Asmar
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Torben Arvid Kruse
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Mads Thomassen
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | | | - Vibe Skov
- Department of Hematology, Roskilde Hospital, Roskilde, Denmark
| | | | - Ole Weis Bjerrum
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Vasu Punj
- Division of Hematology, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Kirsten Grønbæk
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. .,Danish Stem Cell Centre (DanStem) Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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Hansen JW, Sandholdt H, Siersma V, Ørskov AD, Holmberg S, Bjerrum OW, Hasselbalch HC, Olivarius NDF, Grønbaek K, Andersen CL. Anemia is present years before myelodysplastic syndrome diagnosis: Results from the pre-diagnostic period. Am J Hematol 2017; 92:E130-E132. [PMID: 28383148 DOI: 10.1002/ajh.24757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Jakob Werner Hansen
- Department of Hematology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Håkon Sandholdt
- The Research Unit for General Practice and Section of General Practice, Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Andreas Due Ørskov
- Department of Hematology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Staffan Holmberg
- Department of Hematology; Herlev Hospital, University of Copenhagen; Copenhagen Denmark
| | - Ole Weis Bjerrum
- Department of Hematology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Hans Carl Hasselbalch
- Department of Hematology; Roskilde Hospital, University of Copenhagen; Copenhagen Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Kirsten Grønbaek
- Department of Hematology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Christen Lykkegaard Andersen
- Department of Hematology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health; University of Copenhagen; Copenhagen Denmark
- Department of Hematology; Roskilde Hospital, University of Copenhagen; Copenhagen Denmark
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Nielsen LK, Jarden M, Andersen CL, Frederiksen H, Abildgaard N. A systematic review of health-related quality of life in longitudinal studies of myeloma patients. Eur J Haematol 2017; 99:3-17. [PMID: 28322018 DOI: 10.1111/ejh.12882] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Multiple myeloma (MM) patients report high symptom burden and reduced health-related quality of life (HRQoL) compared to patients with other haematological malignancies. The aim of this review was to analyse published longitudinal studies including MM patients according to a change in HRQoL scores, which is perceived as beneficial to the patient according to two published guidelines. METHODS A literature search was performed May 2016. Publications with longitudinal follow-up using the EORTC QLQ-C30 instrument for HRQoL measurement of physical functioning, global quality of life, fatigue and/or pain were included. An analysis of mean change from baseline was carried out according to minimal important difference (MID). RESULTS Large and medium HRQoL improvements were reported during first-line treatments. No clinically beneficial change or deteriorations in scores of global QoL or fatigue were reported during relapse treatment. HRQoL data during maintenance therapy are sparse and inconclusive. CONCLUSIONS Guidelines for interpreting changes in HRQoL including definitions of MID have been developed; however, consensus is missing. Improvements in HRQoL are far more likely to occur during first-line compared to relapsed treatment regimens. The background of these findings should be in focus in future studies, and HRQoL measurements should be integrated in maintenance studies.
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Affiliation(s)
- Lene Kongsgaard Nielsen
- Quality of Life Research Centre, Department of Haematology, Odense University Hospital, Odense, Denmark.,The Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Mary Jarden
- University Hospitals Centre for Health Research, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Henrik Frederiksen
- Quality of Life Research Centre, Department of Haematology, Odense University Hospital, Odense, Denmark.,The Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Niels Abildgaard
- Quality of Life Research Centre, Department of Haematology, Odense University Hospital, Odense, Denmark.,The Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
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Brochmann N, Flachs EM, Christensen AI, Andersen CL, Juel K, Hasselbalch HC, Zwisler AD. A nationwide population-based cross-sectional survey of health-related quality of life in patients with myeloproliferative neoplasms in Denmark (MPNhealthSurvey): survey design and characteristics of respondents and nonrespondents. Clin Epidemiol 2017; 9:141-150. [PMID: 28280390 PMCID: PMC5338855 DOI: 10.2147/clep.s117587] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The Department of Hematology, Zealand University Hospital, Denmark, and the National Institute of Public Health, University of Southern Denmark, created the first nationwide, population-based, and the most comprehensive cross-sectional health-related quality of life (HRQoL) survey of patients with myeloproliferative neoplasms (MPNs). In Denmark, all MPN patients are treated in public hospitals and treatments received are free of charge for these patients. Therefore, MPN patients receive the best available treatment to the extent of its suitability for them and if they wish to receive the treatment. The aims of this article are to describe the survey design and the characteristics of respondents and nonrespondents. MATERIAL AND METHODS Individuals with MPN diagnoses registered in the Danish National Patient Register (NPR) were invited to participate. The registers of the Danish Civil Registration System and Statistics Denmark provided information regarding demographics. The survey contained 120 questions: validated patient-reported outcome (PRO) questionnaires and additional questions addressing lifestyle. RESULTS A total of 4,704 individuals were registered with MPN diagnoses in the NPR of whom 4,236 were eligible for participation and 2,613 (62%) responded. Overall, the respondents covered the broad spectrum of MPN patients, but patients 70-79 years old, living with someone, of a Danish/Western ethnicity, and with a higher level of education exhibited the highest response rate. CONCLUSION A nationwide, population-based, and comprehensive HRQoL survey of MPN patients in Denmark was undertaken (MPNhealthSurvey). We believe that the respondents broadly represent the MPN population in Denmark. However, the differences between respondents and nonrespondents have to be taken into consideration when examining PROs from the respondents. The results of the investigation of the respondents' HRQoL in this survey will follow in future articles.
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Affiliation(s)
- Nana Brochmann
- Department of Hematology, Zealand University Hospital, University of Copenhagen, Roskilde
| | | | | | | | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen
| | - Hans Carl Hasselbalch
- Department of Hematology, Zealand University Hospital, University of Copenhagen, Roskilde
| | - Ann-Dorthe Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Odense, Denmark
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Bak M, Ibfelt EH, Stauffer Larsen T, Rønnov-Jessen D, Pallisgaard N, Madelung A, Udby L, Hasselbalch HC, Bjerrum OW, Andersen CL. The Danish National Chronic Myeloid Neoplasia Registry. Clin Epidemiol 2016; 8:567-572. [PMID: 27822101 PMCID: PMC5094615 DOI: 10.2147/clep.s99462] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim The Danish National Chronic Myeloid Neoplasia Registry (DCMR) is a population-based clinical quality database, introduced to evaluate diagnosis and treatment of patients with chronic myeloid malignancies. The aim is to monitor the clinical quality at the national, regional, and hospital departmental levels and serve as a platform for research. Study population The DCMR has nationwide coverage and contains information on patients diagnosed at hematology departments from January 2010 onward, including patients with essential thrombocythemia, polycythemia vera, myelofibrosis, unclassifiable myeloproliferative neoplasms, chronic myelomonocytic leukemia, and chronic myeloid leukemia. Main variables Data are collected using standardized registration forms (so far up to four forms per patient), which are consecutively filled out online at time of diagnosis, after 2-year and 5-year follow-ups, and at end of follow-up. The forms include variables that describe clinical/paraclinical assessments, treatment, disease progression, and survival – disease-specific variables – as well as variables that are identical for all chronic myeloid malignancies. Descriptive data By the end of 2014, the DCMR contained data on 2,690 patients with an inclusion rate of ∼500 patients each year. Since the registry was established, annual reports have shown consistently high national coverage and data completeness, ≥90% and ≥88%, respectively. Conclusion The DCMR is a national database used for monitoring the quality of patient care in patients with chronic myeloid malignancies, but until validation has been conducted, the data must be used with caution. However, the DCMR is a valuable data source accessible to clinicians and researchers.
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Affiliation(s)
- Marie Bak
- Department of Hematology, Zealand University Hospital, University of Copenhagen, Roskilde
| | - Else Helene Ibfelt
- Research Centre for Prevention and Health, Rigshospitalet Glostrup, University of Copenhagen, Glostrup
| | | | | | - Niels Pallisgaard
- Department of Surgical Pathology, Zealand University Hospital, University of Copenhagen, Roskilde
| | - Ann Madelung
- Department of Surgical Pathology, Zealand University Hospital, University of Copenhagen, Næstved
| | - Lene Udby
- Department of Hematology, Zealand University Hospital, University of Copenhagen, Roskilde
| | - Hans Carl Hasselbalch
- Department of Hematology, Zealand University Hospital, University of Copenhagen, Roskilde
| | - Ole Weis Bjerrum
- Department of Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christen Lykkegaard Andersen
- Department of Hematology, Zealand University Hospital, University of Copenhagen, Roskilde; Department of Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Andersen CL, Nielsen HM, Kristensen LS, Søgaard A, Vikeså J, Jønson L, Nielsen FC, Hasselbalch H, Bjerrum OW, Punj V, Grønbæk K. Whole-exome sequencing and genome-wide methylation analyses identify novel disease associated mutations and methylation patterns in idiopathic hypereosinophilic syndrome. Oncotarget 2016; 6:40588-97. [PMID: 26497854 PMCID: PMC4747354 DOI: 10.18632/oncotarget.5845] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 09/22/2015] [Indexed: 02/07/2023] Open
Abstract
A thorough understanding of the idiopathic hypereosinophilic syndrome (IHES) and further optimization of diagnostic work-up procedures are warranted. We analyzed purified eosinophils from patients with IHES by next-generation whole-exome sequencing and compared DNA methylation profiles from reactive eosinophilic conditions to known clonal and suspected clonal eosinophilia. Somatic missense mutations in cancer-related genes were detected in three IHES patients. These included the spliceosome gene PUF60 and the cadherin gene CDH17. Furthermore, reactive eosinophilia samples could be differentiated from known- and suspected clonal eosinophilia samples based on 285 differentially methylated CpG sites corresponding to 128 differentially methylated genes. Using Ingenuity pathway analysis, we found that differentially methylated genes were highly enriched in functional pathways such as cancer, cell death and survival, and hematological disease. Our data show that a subset of IHES may be of clonal origin not related to the classical molecular aberrations of FGFR, PDGFRA/B, or T-cells, and that the initiating hits could be point mutations in a variety of genes, including spliceosome mutations or hypermethylated tumor suppressor genes. In addition, we identified a DNA methylation signature that is relevant for distinguishing clonal and suspected clonal eosinophilia from reactive eosinophilia per se, which may be useful in daily clinical work.
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Affiliation(s)
- Christen Lykkegaard Andersen
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Hematology, Roskilde University Hospital, Roskilde, Denmark
| | - Helene Myrtue Nielsen
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lasse Sommer Kristensen
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alexandra Søgaard
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jonas Vikeså
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Jønson
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Finn Cilius Nielsen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hans Hasselbalch
- Department of Hematology, Roskilde University Hospital, Roskilde, Denmark
| | - Ole Weis Bjerrum
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vasu Punj
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kirsten Grønbæk
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Andersen CL, Tesfa D, Siersma VD, Sandholdt H, Hasselbalch H, Bjerrum OW, Felding P, Lind B, Olivarius NDF, Palmblad J. Prevalence and clinical significance of neutropenia discovered in routine complete blood cell counts: a longitudinal study. J Intern Med 2016; 279:566-75. [PMID: 26791682 DOI: 10.1111/joim.12467] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Neutropenia, defined as an absolute blood neutrophil count (ANC) <1.5 G L(-1) , may accompany a variety of diseases. However, the clinical significance of neutropenia detected in a routine complete blood cell count is poorly understood. METHODS Using a primary care resource, comprising more than 370 000 individuals, we assessed the association with a number of previously recognized conditions as well as all-cause mortality in the 4 years following the identification of neutropenia. By matching laboratory data with Danish nationwide health registers, risk estimates were assessed. RESULTS Neutropenia was observed in approximately 1% of all individuals and was associated dose dependently with viral infections, haematological malignancies (but not autoimmune disorders or solid cancers) and mortality. Neutropenia was particularly associated with HIV, acute leukaemias and myelodysplastic syndromes. Odds ratios [95% confidence interval (CI)] for viral infections were 2.32 (1.84-2.91), 2.80 (2.20-3.57) and 4.77 (3.22-7.07) for subnormal (≥1.5-1.8 G L(-1) ), mild (≥1.0-1.5 G L(-1) ) and moderate-severe (≥0.0-1.0 G L(-1) ) neutropenic individuals, respectively (all P < 0.001). Likewise, odds ratios (95% CI) for haematological malignancies were 3.23 (2.35-4.45), 8.69 (6.58-11.47) and 46.03 (33.98-62.35 ), for the same neutropenia levels, respectively (all P < 0.001). Thus, the lower the ANC, the greater the likelihood of these diseases. The relative risk estimates observed for severe neutropenia corresponded to absolute risks of haematological malignancies and mortality from any cause of 40% and >50%, respectively. CONCLUSIONS Neutropenia is an ominous sign necessitating careful follow-up. The risk estimates presented here support focusing attention to viral diseases and haematological malignancies when neutropenia is observed.
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Affiliation(s)
- C L Andersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Hematology, Roskilde University Hospital, Roskilde, Denmark
| | - D Tesfa
- Departments of Hematology and Medicine, The Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - V D Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - H Sandholdt
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - H Hasselbalch
- Department of Hematology, Roskilde University Hospital, Roskilde, Denmark
| | - O W Bjerrum
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - P Felding
- The Elective Laboratory of the Capital Region, Copenhagen, Denmark
| | - B Lind
- The Elective Laboratory of the Capital Region, Copenhagen, Denmark
| | - Niels de F Olivarius
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - J Palmblad
- Departments of Hematology and Medicine, The Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
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Brochmann N, Zwisler AD, Kjerholt M, Flachs EM, Hasselbalch HC, Andersen CL. A new internet-based tool for reporting and analysing patient-reported outcomes and the feasibility of repeated data collection from patients with myeloproliferative neoplasms. Qual Life Res 2015; 25:835-46. [PMID: 26358064 DOI: 10.1007/s11136-015-1125-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE An Internet-based tool for reporting and analysing patient-reported outcomes (PROs) has been developed. The tool enables merging PROs with blood test results and allows for computation of treatment responses. Data may be visualized by graphical analysis and may be exported for downstream statistical processing. The aim of this study was to investigate, whether patients with myeloproliferative neoplasms (MPNs) were willing and able to use the tool and fill out questionnaires regularly. METHODS Participants were recruited from the outpatient clinic at the Department of Haematology, Roskilde University Hospital, Denmark. Validated questionnaires that were used were European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, Myeloproliferative Neoplasm Symptom Assessment Form, Brief Fatigue Inventory and Short Form 36 Health Survey. Questionnaires were filled out ≥ 6 months online or on paper according to participant preference. Regularity of questionnaire submission was investigated, and participant acceptance was evaluated by focus-group interviews. RESULTS Of 135 invited patients, 118 (87 %) accepted participation. One hundred and seven participants (91 %) preferred to use the Internet-based tool. Of the 118 enrolled participants, 104 (88 %) submitted PROs regularly ≥ 6 months. The focus-group interviews revealed that the Internet-based tool was well accepted. CONCLUSION The Internet-based approach and regular collection of PROs are well accepted with a high participation rate, persistency and adherence in a population of MPN patients. The plasticity of the platform allows for adaptation to patients with other medical conditions.
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Affiliation(s)
- Nana Brochmann
- Department of Haematology, Roskilde University Hospital, Koegevej 7-13, 4000, Roskilde, Denmark.
| | - Ann-Dorthe Zwisler
- National Centre for Rehabilitation and Palliation, University of Southern Denmark, and Odense University Hospital, Oester Farimagsgade 5A, 1353, Copenhagen, Denmark
| | - Mette Kjerholt
- Department of Haematology, Roskilde University Hospital, Koegevej 7-13, 4000, Roskilde, Denmark
| | - Esben Meulengracht Flachs
- National Institute of Public Health, University of Southern Denmark, Oester Farimagsgade 5A, 1353, Copenhagen, Denmark
| | - Hans Carl Hasselbalch
- Department of Haematology, Roskilde University Hospital, Koegevej 7-13, 4000, Roskilde, Denmark
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Ocias LF, Holmström MO, Riley CH, Andersen CL, Rønnov-Jessen D, Starklint J, Frederiksen M, Steffensen MS, Bjerrum OW, Farmer S, Mourits-Andersen T, Hasselbalch HC, Larsen TS. [Status and perspectives on chronic myeloproliferative neoplasm treatment]. Ugeskr Laeger 2015; 177:V12140652. [PMID: 25967090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Polycythaemia vera, essential thrombocytosis and primary myelofibrosis are closely related, clonal myeloproliferative neoplasms. Our knowledge of the underlying molecular mechanisms driving these diseases has increased dramatically during the latest ten years. Traditionally, treatment of these malignancies has focused on lowering their inherent thromboembolic risk but with the discovery of the JAK2-V617F mutation and most recently the calreticulin mutations new therapeutic options such as interferon-alpha, JAK2-inhibitors and statins are being contemplated. This article reviews these new treatment options.
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Andersen CL, Siersma VD, Hasselbalch HC, Lindegaard H, Vestergaard H, Felding P, de Fine Olivarius N, Bjerrum OW. Eosinophilia in routine blood samples as a biomarker for solid tumor development - A study based on the Copenhagen Primary Care Differential Count (CopDiff) Database. Acta Oncol 2014; 53:1245-50. [PMID: 24913152 DOI: 10.3109/0284186x.2014.887857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Eosinophilia may represent an early paraclinical sign of malignant disease and a host anti-tumor effect. The association between eosinophilia and the development of solid tumors has never before been examined in an epidemiological setting. The aim of the present study was to investigate eosinophilia in routine blood samples as a potential biomarker of solid tumor development in a prospective design. MATERIAL AND METHODS From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356 196 individuals with at least one differential cell count (DIFF) encompassing the eosinophil count during 2000-2007. From these, one DIFF was randomly chosen and categorized according to no (< 0.5 × 10(9)/l), mild (≥ 0.5-1.0 × 10(9)/l) or severe (≥ 1.0 × 10(9)/l) eosinophilia. From the Danish Civil Registration System and the Danish Cancer Registry we ascertained all-cause death and solid tumors within the first three years following the DIFF. Using multivariable logistic regression, odds ratios (OR) were calculated and adjusted for previous eosinophilia, sex, age, year, month, C-reactive protein, previous cancer and Charlson's Comorbidity Index. RESULTS The risk of bladder cancer was increased with mild eosinophilia [OR 1.93 (CI 1.29-2.89), p = 0.0013]. No associations with eosinophilia were observed for the remaining solid cancers. CONCLUSION We demonstrate that eosinophilia in routine blood samples associates with an increased risk of bladder cancer. Our data emphasize that additional preclinical studies are needed in order to shed further light on the role of eosinophils in carcinogenesis, where it is still unknown whether the cells contribute to tumor immune surveillance or neoplastic evolution.
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Tuupanen S, Hänninen UA, Kondelin J, von Nandelstadh P, Cajuso T, Gylfe AE, Katainen R, Tanskanen T, Ristolainen H, Böhm J, Mecklin JP, Järvinen H, Renkonen-Sinisalo L, Andersen CL, Taipale M, Taipale J, Vahteristo P, Lehti K, Pitkänen E, Aaltonen LA. Identification of 33 candidate oncogenes by screening for base-specific mutations. Br J Cancer 2014; 111:1657-62. [PMID: 25117815 PMCID: PMC4200084 DOI: 10.1038/bjc.2014.429] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/23/2014] [Accepted: 07/08/2014] [Indexed: 01/07/2023] Open
Abstract
Background: Genes with recurrent codon-specific somatic mutations are likely drivers of tumorigenesis and potential therapeutic targets. Hypermutable cancers may represent a sensitive system for generation and selection of oncogenic mutations. Methods: We utilised exome-sequencing data on 25 sporadic microsatellite-instable (MSI) colorectal cancers (CRCs) and searched for base-specific somatic mutation hotspots. Results: We identified novel mutation hotspots in 33 genes. Fourteen genes displayed mutations in the validation set of 254 MSI CRCs: ANTXR1, MORC2, CEP135, CRYBB1, GALNT9, KRT82, PI15, SLC36A1, CNTF, GLDC, MBTPS1, OR9Q2, R3HDM1 and TTPAL. A database search found examples of the hotspot mutations in multiple cancer types. Conclusions: This work reveals a variety of new recurrent candidate oncogene mutations to be further scrutinised as potential therapeutic targets.
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Affiliation(s)
- S Tuupanen
- 1] Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki 00014, Finland [2] Research Programs Unit, Genome-Scale Biology Research Program, University of Helsinki, Biomedicum, PO Box 63 (Haartmaninkatu 8), Helsinki FIN-00014, Finland
| | - U A Hänninen
- 1] Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki 00014, Finland [2] Research Programs Unit, Genome-Scale Biology Research Program, University of Helsinki, Biomedicum, PO Box 63 (Haartmaninkatu 8), Helsinki FIN-00014, Finland
| | - J Kondelin
- 1] Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki 00014, Finland [2] Research Programs Unit, Genome-Scale Biology Research Program, University of Helsinki, Biomedicum, PO Box 63 (Haartmaninkatu 8), Helsinki FIN-00014, Finland
| | - P von Nandelstadh
- Research Programs Unit, Genome-Scale Biology Research Program, University of Helsinki, Biomedicum, PO Box 63 (Haartmaninkatu 8), Helsinki FIN-00014, Finland
| | - T Cajuso
- 1] Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki 00014, Finland [2] Research Programs Unit, Genome-Scale Biology Research Program, University of Helsinki, Biomedicum, PO Box 63 (Haartmaninkatu 8), Helsinki FIN-00014, Finland
| | - A E Gylfe
- 1] Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki 00014, Finland [2] Research Programs Unit, Genome-Scale Biology Research Program, University of Helsinki, Biomedicum, PO Box 63 (Haartmaninkatu 8), Helsinki FIN-00014, Finland
| | - R Katainen
- 1] Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki 00014, Finland [2] Research Programs Unit, Genome-Scale Biology Research Program, University of Helsinki, Biomedicum, PO Box 63 (Haartmaninkatu 8), Helsinki FIN-00014, Finland
| | - T Tanskanen
- 1] Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki 00014, Finland [2] Research Programs Unit, Genome-Scale Biology Research Program, University of Helsinki, Biomedicum, PO Box 63 (Haartmaninkatu 8), Helsinki FIN-00014, Finland
| | - H Ristolainen
- 1] Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki 00014, Finland [2] Research Programs Unit, Genome-Scale Biology Research Program, University of Helsinki, Biomedicum, PO Box 63 (Haartmaninkatu 8), Helsinki FIN-00014, Finland
| | - J Böhm
- Department of Pathology, Jyväskylä Central Hospital, University of Eastern Finland, Keskussairaalantie 19, Jyväskylä 40620, Finland
| | - J-P Mecklin
- Department of Surgery, Jyväskylä Central Hospital, University of Eastern Finland, Keskussairaalantie 19, Jyväskylä 40620, Finland
| | - H Järvinen
- Department of Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, Helsinki 00290, Finland
| | - L Renkonen-Sinisalo
- Department of Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, Helsinki 00290, Finland
| | - C L Andersen
- Department for Molecular Medicine (MOMA), Aarhus University Hospital, Brendstrupgårdsvej 21, Aarhus N DK-8200, Denmark
| | - M Taipale
- 1] Research Programs Unit, Genome-Scale Biology Research Program, University of Helsinki, Biomedicum, PO Box 63 (Haartmaninkatu 8), Helsinki FIN-00014, Finland [2] Department of Biosciences and Nutrition, Karolinska Institutet, Hälsovägen 7, Huddinge SE-141 83, Sweden
| | - J Taipale
- 1] Research Programs Unit, Genome-Scale Biology Research Program, University of Helsinki, Biomedicum, PO Box 63 (Haartmaninkatu 8), Helsinki FIN-00014, Finland [2] Department of Biosciences and Nutrition, Karolinska Institutet, Hälsovägen 7, Huddinge SE-141 83, Sweden
| | - P Vahteristo
- 1] Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki 00014, Finland [2] Research Programs Unit, Genome-Scale Biology Research Program, University of Helsinki, Biomedicum, PO Box 63 (Haartmaninkatu 8), Helsinki FIN-00014, Finland
| | - K Lehti
- Research Programs Unit, Genome-Scale Biology Research Program, University of Helsinki, Biomedicum, PO Box 63 (Haartmaninkatu 8), Helsinki FIN-00014, Finland
| | - E Pitkänen
- 1] Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki 00014, Finland [2] Research Programs Unit, Genome-Scale Biology Research Program, University of Helsinki, Biomedicum, PO Box 63 (Haartmaninkatu 8), Helsinki FIN-00014, Finland
| | - L A Aaltonen
- 1] Department of Medical Genetics, Haartman Institute, University of Helsinki, Helsinki 00014, Finland [2] Research Programs Unit, Genome-Scale Biology Research Program, University of Helsinki, Biomedicum, PO Box 63 (Haartmaninkatu 8), Helsinki FIN-00014, Finland
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Andersen CL, Bjørn ME, McMullin MF, Harrison C, Samuelsson J, Ejerblad E, Zweegman S, Fernandes S, Bareford D, Knapper S, Löfvenberg E, Linder O, Andreasson B, Ahlstrand E, Jensen MK, Bjerrum OW, Vestergaard H, Larsen H, Klausen TW, Mourits-Andersen T, Skov V, Thomassen M, Kruse T, Grønbæk K, Hasselbalch HC. Circulating YKL-40 in patients with essential thrombocythemia and polycythemia vera treated with the novel histone deacetylase inhibitor vorinostat. Leuk Res 2014; 38:816-21. [DOI: 10.1016/j.leukres.2014.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/02/2014] [Accepted: 04/04/2014] [Indexed: 11/26/2022]
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Andersen CL, Siersma VD, Karlslund W, Hasselbalch HC, Felding P, Bjerrum OW, de Fine Olivarius N. The Copenhagen Primary Care Differential Count (CopDiff) database. Clin Epidemiol 2014; 6:199-211. [PMID: 24966694 PMCID: PMC4062550 DOI: 10.2147/clep.s60991] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The differential blood cell count provides valuable information about a person’s state of health. Together with a variety of biochemical variables, these analyses describe important physiological and pathophysiological relations. There is a need for research databases to explore associations between these parameters, concurrent comorbidities, and future disease outcomes. Methods and results The Copenhagen General Practitioners’ Laboratory is the only laboratory serving general practitioners in the Copenhagen area, covering approximately 1.2 million inhabitants. The Copenhagen General Practitioners’ Laboratory has registered all analytical results since July 1, 2000. The Copenhagen Primary Care Differential Count database contains all differential blood cell count results (n=1,308,022) from July 1, 2000 to January 25, 2010 requested by general practitioners, along with results from analysis of various other blood components. This data set is merged with detailed data at a person level from The Danish Cancer Registry, The Danish National Patient Register, The Danish Civil Registration System, and The Danish Register of Causes of Death. Conclusion This paper reviews methodological issues behind the construction of the Copenhagen Primary Care Differential Count database as well as the distribution of characteristics of the population it covers and the variables that are recorded. Finally, it gives examples of its use as an inspiration to peers for collaboration.
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Affiliation(s)
- Christen Lykkegaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark ; Department of Hematology, Roskilde University Hospital, Copenhagen, Denmark
| | - Volkert Dirk Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Willy Karlslund
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Peter Felding
- The Elective Laboratory of the Capital Region, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole Weis Bjerrum
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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