1
|
Klomberg RCW, Hellendoorn AE, Kemos P, Rizopoulos D, Ruemmele FM, Croft NM, de Ridder L. Rare and severe adverse events in children with inflammatory bowel disease: analysis of data from the PIBD-SETQuality Safety Registry. Lancet Child Adolesc Health 2024; 8:422-432. [PMID: 38697175 DOI: 10.1016/s2352-4642(24)00078-6] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND Rare and severe adverse events can occur in children with inflammatory bowel disease (IBD), and the relationship with disease or drug treatment is often uncertain. We aimed to establish a method of reporting adverse events of interest in children with IBD, allowing for estimates of incidence rates with comparison between different regions, and, if possible, to compare with published data on rates of adverse events in children overall. METHODS For this analysis, we used data from the Paediatric Inflammatory Bowel Disease Network for Safety, Efficacy and Treatment and Quality improvement of care (PIBD-SETQuality) Safety Registry, which collects data on multiple rare and severe adverse events in children younger than 19 years with IBD. Overall, the registry collected data on ten prespecified rare and severe adverse events in children with IBD, as established by a panel of paediatric IBD experts, via reports from paediatric gastroenterologists at participating hospitals between Nov 1, 2016, and March 31, 2023. Reporting physicians, who could only be paediatric gastroenterologists or IBD nurses reporting on behalf of paediatric gastroenterologists, were recruited through invitations sent to both national and international IBD networks and at conferences. Once per month, participating paediatric gastroenterologists received an email with an anonymous and unique link to an online survey asking them to report whether any of ten rare and severe adverse events had occurred in a patient in their paediatric-IBD population in the previous month. Prevalent or retrospective rare and severe adverse events were excluded, as were events occurring in children with an unconfirmed diagnosis of IBD or for whom inflammatory colitis was part of a monogenic immunodeficiency disorder. Duplicates and events that did not meet the definitions and criteria were excluded. Physicians could also report other, non-categorised adverse events if they considered them rare and severe. In case of no response, up to two reminders were sent for each per-month survey. Annual denominator data surveys were sent to obtain the total number of person-years for the estimation of incidence rates, which were calculated via Poisson regression models. FINDINGS Responses were gathered from 220 paediatric gastroenterologists from 167 centres. 121 centres were in Europe, 23 centres were in North America, 17 centres were in Asia, and six centres were in Oceania. Combined, the total population with paediatric IBD consisted of an estimated 30 193 children with 114 528 person-years of follow-up. 451 adverse events were initially reported. After excluding and reorganising adverse events, 402 were eligible; 261 (65%) were categorised and 141 (35%) were non-categorised. The most frequently reported adverse events were venous-thromboembolic events (n=66), renal failure (n=43), opportunistic infections (n=42), and cancer (n=33). Haemophagocytic lymphohistiocytosis (n=4) and liver failure (n=3) were the least frequently reported adverse events. Incidence rates per 10 000 person-years were 5·50 (95% CI 4·25-6·97) for venous-thromboembolic events, 3·75 (2·74-4·99) for renal failure, 3·67 (2·67-4·89) for opportunistic infection, and 2·88 (2·01-3·98) for cancer. Of 66 venous-thromboembolic events, 31 (47%) involved cerebral venous sinus thrombosis at an incidence rate of 2·71 (95% CI 1·86-3·77). INTERPRETATION The PIBD-SETQuality Safety Registry enabled us to identify incidence rates of rare and severe adverse events in children with IBD. Our findings can guide physicians and enhance awareness of the incidence of adverse events in children with IBD that are considered to be rare. FUNDING EU Horizon 2020 Research and Innovation Programme.
Collapse
Affiliation(s)
- Renz C W Klomberg
- Department of Pediatric Gastroenterology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, Netherlands
| | - Astrid E Hellendoorn
- Department of Pediatric Gastroenterology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, Netherlands
| | - Polychronis Kemos
- Paediatric Gastroenterology, Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Dimitris Rizopoulos
- Department of Epidemiology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, Netherlands
| | - Frank M Ruemmele
- Department of Pediatric Gastroenterology, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Hôpital Necker Enfants Malades, Paris, France
| | - Nicholas M Croft
- Paediatric Gastroenterology, Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Lissy de Ridder
- Department of Pediatric Gastroenterology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, Netherlands.
| |
Collapse
|
2
|
Vuijk SA, Jongsma MME, Hoeven BM, Cozijnsen MA, van Pieterson M, de Meij TGJ, Norbruis OF, Groeneweg M, Wolters VM, van Wering H, Hummel T, Stapelbroek J, van der Feen C, van Rheenen PF, van Wijk MP, Teklenburg S, Rizopoulos D, Poley MJ, Escher JC, de Ridder L. Randomised clinical trial: First-line infliximab biosimilar is cost-effective compared to conventional treatment in paediatric Crohn's disease. Aliment Pharmacol Ther 2024; 59:1510-1520. [PMID: 38644588 DOI: 10.1111/apt.18000] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/10/2023] [Accepted: 04/01/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Data on cost-effectiveness of first-line infliximab in paediatric patients with Crohn's disease are limited. Since biologics are increasingly prescribed and accompanied by high costs, this knowledge gap needs to be addressed. AIM To investigate the cost-effectiveness of first-line infliximab compared to conventional treatment in children with moderate-to-severe Crohn's disease. METHODS We included patients from the Top-down Infliximab Study in Kids with Crohn's disease randomised controlled trial. Children with newly diagnosed moderate-to-severe Crohn's disease were treated with azathioprine maintenance and either five induction infliximab (biosimilar) infusions or conventional induction treatment (exclusive enteral nutrition or corticosteroids). Direct healthcare consumption and costs were obtained per patient until week 104. This included data on outpatient hospital visits, hospital admissions, drug costs, endoscopies and surgeries. The primary health outcome was the odds ratio of being in clinical remission (weighted paediatric Crohn's disease activity index<12.5) during 104 weeks. RESULTS We included 89 patients (44 in the first-line infliximab group and 45 in the conventional treatment group). Mean direct healthcare costs per patient were €36,784 for first-line infliximab treatment and €36,874 for conventional treatment over 2 years (p = 0.981). The odds ratio of first-line infliximab versus conventional treatment to be in clinical remission over 104 weeks was 1.56 (95%CI 1.03-2.35, p = 0.036). CONCLUSIONS First-line infliximab treatment resulted in higher odds of being in clinical remission without being more expensive, making it the dominant strategy over conventional treatment in the first 2 years after diagnosis in children with moderate-to-severe Crohn's disease. TRIAL REGISTRATION NUMBER NCT02517684.
Collapse
Affiliation(s)
- Stephanie A Vuijk
- Department of Paediatric Gastroenterology, Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Maria M E Jongsma
- Department of Paediatric Gastroenterology, Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Britt M Hoeven
- Department of Paediatric Gastroenterology, Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Maarten A Cozijnsen
- Department of Paediatric Gastroenterology, Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Merel van Pieterson
- Department of Paediatric Gastroenterology, Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Tim G J de Meij
- Department of Paediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Obbe F Norbruis
- Department of Paediatric Gastroenterology, Isala Hospital, Zwolle, The Netherlands
| | - Michael Groeneweg
- Department of Paediatric Gastroenterology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Victorien M Wolters
- Department of Paediatric Gastroenterology, UMC Utrecht/Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Herbert van Wering
- Department of Paediatric Gastroenterology, Amphia Hospital, Breda, The Netherlands
| | - Thalia Hummel
- Department of Paediatric Gastroenterology, Medical Spectrum Twente, Enschede, The Netherlands
| | - Janneke Stapelbroek
- Department of Paediatric Gastroenterology, Catharina Hospital, Eindhoven, The Netherlands
| | - Cathelijne van der Feen
- Department of Paediatric Gastroenterology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Patrick F van Rheenen
- Department of Paediatric Gastroenterology, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Michiel P van Wijk
- Department of Paediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Sarah Teklenburg
- Department of Paediatric Gastroenterology, Isala Hospital, Zwolle, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Marten J Poley
- Institute for Medical Technology Assessment and Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Department of Pediatric Surgery and Intensive Care, Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Johanna C Escher
- Department of Paediatric Gastroenterology, Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Lissy de Ridder
- Department of Paediatric Gastroenterology, Erasmus Medical Center/Sophia Children's Hospital, Rotterdam, The Netherlands
| |
Collapse
|
3
|
Winter DA, de Bruyne P, van der Woude J, Rizopoulos D, de Ridder L, Samsom J, Escher JC. Biomarkers predicting the effect of anti-TNF treatment in paediatric and adult inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2024. [PMID: 38698646 DOI: 10.1002/jpn3.12221] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES Paediatric and adult inflammatory bowel disease (pIBD, aIBD) patients may lose response to anti-TNF treatment within the first year. Adult-extrapolated weight-based dosing is incorrect in children, due to age-related pharmacokinetic differences. We investigated biomarkers for initial and maintenance of response to infliximab (IFX) or adalimumab (ADA), comparing pIBD and aIBD patients. METHODS In this prospective, observational study, pIBD (n = 24) and aIBD (n = 21) patients were included when initiating anti-TNF. Escalation from standard dosing and continued anti-TNF at 12 and 18 months were assessed. Biomarkers included clinical laboratory parameters, faecal calprotectin (FCP) and IFX trough levels (TLs). Plasma proteomics was performed in pIBD. RESULTS During our study, treatment escalation (in clinical loss of response) occurred more common in pIBD versus aIBD (p = 0.02). We established that IFX therapy escalation in pIBD patients was not due to low infliximab levels. We identified 9 pro-inflammatory proteins that were elevated in patients losing response. CONCLUSION Anti-TNF exposure-response relationship may be different in pIBD versus aIBD. No biomarkers for maintained response were identified, but 9 inflammatory proteins were of interest as potential predictors for loss of response in pIBD.
Collapse
Affiliation(s)
- Dwight A Winter
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Pauline de Bruyne
- Department of Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium
| | | | | | - Lissy de Ridder
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Janneke Samsom
- Laboratory of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Johanna C Escher
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| |
Collapse
|
4
|
Rizopoulos D, Taylor JM, Papageorgiou G, Morgan TM. Using joint models for longitudinal and time-to-event data to investigate the causal effect of salvage therapy after prostatectomy. Stat Methods Med Res 2024; 33:894-908. [PMID: 38502034 DOI: 10.1177/09622802241239003] [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] [Indexed: 03/20/2024]
Abstract
Prostate cancer patients who undergo prostatectomy are closely monitored for recurrence and metastasis using routine prostate-specific antigen measurements. When prostate-specific antigen levels rise, salvage therapies are recommended in order to decrease the risk of metastasis. However, due to the side effects of these therapies and to avoid over-treatment, it is important to understand which patients and when to initiate these salvage therapies. In this work, we use the University of Michigan Prostatectomy Registry Data to tackle this question. Due to the observational nature of this data, we face the challenge that prostate-specific antigen is simultaneously a time-varying confounder and an intermediate variable for salvage therapy. We define different causal salvage therapy effects defined conditionally on different specifications of the longitudinal prostate-specific antigen history. We then illustrate how these effects can be estimated using the framework of joint models for longitudinal and time-to-event data. All proposed methodology is implemented in the freely-available R package JMbayes2.
Collapse
Affiliation(s)
- Dimitris Rizopoulos
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Center, the Netherlands
| | - Jeremy Mg Taylor
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Grigorios Papageorgiou
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Center, the Netherlands
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
5
|
Lika A, Andrinopoulou ER, van der Beek NAME, Rizopoulos D, van der Ploeg AT, Kruijshaar ME. Establishing how much improvement in lung function and distance walked is clinically important for adult patients with Pompe disease. Eur J Neurol 2024; 31:e16223. [PMID: 38375606 DOI: 10.1111/ene.16223] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/21/2023] [Accepted: 01/10/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND PURPOSE Pompe disease is a rare, inheritable, progressive metabolic myopathy. This study aimed to estimate the minimal clinically important difference (MCID) for an improvement in forced vital capacity in the upright seated position (FVCup) and the 6-min walk test (6MWT) after a year of treatment with enzyme replacement therapy. METHODS Data were obtained from two prospective follow-up studies. Between-group and within-group MCIDs were estimated using anchor-based methods. Additionally, a distribution-based method was used to generate supportive evidence. As anchors, self-reported change in health and in physical functioning, shortness of breath and a categorization of the Short-Form 36 Physical Component Summary score were used. Anchor appropriateness was assessed using Spearman correlations (absolute values ≥0.29) and a sufficient number of observations in each category. RESULTS In all, 102 patients had at least one FVCup or 6MWT measurement during enzyme replacement therapy. Based on the anchors assessed as appropriate, the between-group MCID for an improvement in FVCup ranged from 2.47% to 4.83% points. For the 6MWT, it ranged from 0.35% to 7.47% points which is equivalent to a distance of 2.18-46.61 m and 1.97-42.13 m for, respectively, a man and a woman of age 50, height 1.75 m and weight 80 kg. The results of the distribution-based method were within these ranges when applied to change in the outcome values. CONCLUSION The MCIDs for FVCup and 6MWT derived in this study can be used to interpret differences between and within groups of patients with Pompe disease in clinical trials and cohort studies.
Collapse
Affiliation(s)
- Aglina Lika
- Department of Pediatrics, Centre for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Eleni-Rosalina Andrinopoulou
- Department of Biostatistics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Nadine A M E van der Beek
- Department of Neurology, Centre for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Ans T van der Ploeg
- Department of Pediatrics, Centre for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Michelle E Kruijshaar
- Department of Pediatrics, Centre for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| |
Collapse
|
6
|
Abou Kamar S, Andrzejczyk K, Petersen TB, Chin JF, Aga YS, de Bakker M, Akkerhuis KM, Geleijnse M, Brugts JJ, Sorop O, de Boer RA, Rizopoulos D, Asselbergs FW, Boersma E, den Ruijter H, van Dalen BM, Kardys I. The plasma proteome is linked with left ventricular and left atrial function parameters in patients with chronic heart failure. Eur Heart J Cardiovasc Imaging 2024:jeae098. [PMID: 38597740 DOI: 10.1093/ehjci/jeae098] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/26/2024] [Accepted: 03/30/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Examining the systemic biological processes in the heterogeneous syndrome of heart failure with reduced ejection fraction (HFrEF), as reflected by circulating proteins, in relation to echocardiographic characteristics, may provide insights into HF pathophysiology. OBJECTIVE We investigated the link of 4210 repeatedly measured circulating proteins with repeatedly measured echocardiographic parameters, as well as with elevated left atrial pressure (LAP), in HFrEF patients, to provide insights into underlying mechanisms. METHODS In 173 HFrEF patients, we performed six-monthly echocardiography and trimonthly blood sampling during a median follow-up of 2.7(IQR:2.5-2.8) years. We investigated circulating proteins in relation to echocardiographic parameters of left ventricular (left ventricular ejection fraction[LVEF], global longitudinal strain[GLS]), and left atrial function (left atrial reservoir strain[LASr]) and elevated LAP(E/e' ratio >15), and used gene enrichment analyses to identify underlying pathophysiological processes. RESULTS We found 723, 249, 792 and 427 repeatedly measured proteins, with significant associations with LVEF, GLS, LASr and E/e' ratio, respectively. Proteins associated with LASr reflected pathophysiological mechanisms mostly related to the extracellular matrix (ECM). Proteins associated with GLS reflected cardiovascular biological processes and diseases, whereas those associated with LVEF reflected processes involved in the sympathetic nervous system. Moreover, 49 proteins were associated with elevated LAP; after correction for LVEF, three proteins remained: Cystatin-D, Fibulin-5 and HSP40. CONCLUSION Circulating proteins show varying associations with different echocardiographic parameters in HFrEF patients. These findings suggest that pathways involved in atrial and ventricular dysfunction, as reflected by the plasma proteome, are distinct.
Collapse
Affiliation(s)
- S Abou Kamar
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands
- The Netherlands Heart Institute, Utrecht, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - K Andrzejczyk
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands
| | - T B Petersen
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J F Chin
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Y S Aga
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - M de Bakker
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands
| | - K M Akkerhuis
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands
| | - M Geleijnse
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands
| | - J J Brugts
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands
| | - O Sorop
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands
| | - R A de Boer
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands
| | - D Rizopoulos
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - F W Asselbergs
- Department of Cardiology, Amsterdam Medical Center, The Netherlands
| | - E Boersma
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands
| | - H den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - B M van Dalen
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - I Kardys
- Erasmus MC, Cardiovascular Institute, Thorax Center, Department of Cardiology, Rotterdam, the Netherlands
| |
Collapse
|
7
|
van den Dorpel JJA, Mackenbach MJ, Dremmen MHG, van der Vlugt WMC, Rizopoulos D, van Doorn PA, van der Ploeg AT, Muetzel R, van der Beek NAME, van den Hout JMP. Long term survival in patients with classic infantile Pompe disease reveals a spectrum with progressive brain abnormalities and changes in cognitive functioning. J Inherit Metab Dis 2024. [PMID: 38584574 DOI: 10.1002/jimd.12736] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024]
Abstract
The aim of this longitudinal cohort study, is to provide more insight into the pattern of brain abnormalities, and possible consequences for cognitive functioning, in patients with classic infantile Pompe disease. We included 19 classic infantile Pompe patients (median age last assessment 8.9 years, range 1.5-22.5 years; 5/19 CRIM negative), treated with ERT. Using MR imaging of the brain (T1, T2, and FLAIR acquisitions), we classified progression of brain abnormalities on a 12-point rating scale at multiple time points throughout follow-up. Additionally we noted specific white matter patterns and examined atrophy. Cognitive development was studied using Wechsler IQ assessments obtained by certified neuropsychologists. The association between age and cognitive functioning, and MRI ratings and cognitive functioning was assessed by linear regression models. All but one patient developed brain abnormalities. The abnormalities progressed in a similar pattern throughout the brain, with early involvement of periventricular white matter, later followed by subcortical white matter, gray matter structures, and juxtacortical U-fibers. We found a significant decline (p < 0.01), with increasing age for full scale IQ, performance IQ and processing speed, but not for verbal IQ (p = 0.17). Each point increment in the 12-point MRI rating scale was associated with a significant decline (3.1-6.0 points) in all the IQ index scores (p < 0.05). The majority of long-term surviving patients in our cohort develop incremental brain MRI abnormalities and decline in cognitive functioning. This highlights the need for new therapies that can cross the blood-brain barrier in order to treat this CNS phenotype.
Collapse
Affiliation(s)
- J J A van den Dorpel
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Center for Lysosomal and Metabolic Diseases, The Netherlands
| | - M J Mackenbach
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Center for Lysosomal and Metabolic Diseases, The Netherlands
| | - M H G Dremmen
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - W M C van der Vlugt
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - D Rizopoulos
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - P A van Doorn
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Center for Lysosomal and Metabolic Diseases, The Netherlands
| | - A T van der Ploeg
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Center for Lysosomal and Metabolic Diseases, The Netherlands
| | - R Muetzel
- Department of Child and Adolescent Psychiatry/Psychology, Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - N A M E van der Beek
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Center for Lysosomal and Metabolic Diseases, The Netherlands
| | - J M P van den Hout
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Center for Lysosomal and Metabolic Diseases, The Netherlands
| |
Collapse
|
8
|
Rizopoulos D, Taylor JMG. Optimizing dynamic predictions from joint models using super learning. Stat Med 2024; 43:1315-1328. [PMID: 38270062 DOI: 10.1002/sim.10010] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/30/2023] [Accepted: 12/29/2023] [Indexed: 01/26/2024]
Abstract
Joint models for longitudinal and time-to-event data are often employed to calculate dynamic individualized predictions used in numerous applications of precision medicine. Two components of joint models that influence the accuracy of these predictions are the shape of the longitudinal trajectories and the functional form linking the longitudinal outcome history to the hazard of the event. Finding a single well-specified model that produces accurate predictions for all subjects and follow-up times can be challenging, especially when considering multiple longitudinal outcomes. In this work, we use the concept of super learning and avoid selecting a single model. In particular, we specify a weighted combination of the dynamic predictions calculated from a library of joint models with different specifications. The weights are selected to optimize a predictive accuracy metric using V-fold cross-validation. We use as predictive accuracy measures the expected quadratic prediction error and the expected predictive cross-entropy. In a simulation study, we found that the super learning approach produces results very similar to the Oracle model, which was the model with the best performance in the test datasets. All proposed methodology is implemented in the freely available R package JMbayes2.
Collapse
Affiliation(s)
- Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jeremy M G Taylor
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
9
|
García-Hernandez A, Pérez T, Del Carmen Pardo M, Rizopoulos D. An illness-death multistate model to implement delta adjustment and reference-based imputation with time-to-event endpoints. Pharm Stat 2024; 23:219-241. [PMID: 37940608 DOI: 10.1002/pst.2348] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/13/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023]
Abstract
With a treatment policy strategy, therapies are evaluated regardless of the disturbance caused by intercurrent events (ICEs). Implementing this estimand is challenging if subjects are not followed up after the ICE. This circumstance can be dealt with using delta adjustment (DA) or reference-based (RB) imputation. In the survival field, DA and RB imputation have been researched so far using multiple imputation (MI). Here, we present a fully analytical solution. We use the illness-death multistate model with the following transitions: (a) from the initial state to the event of interest, (b) from the initial state to the ICE, and (c) from the ICE to the event. We estimate the intensity function of transitions (a) and (b) using flexible parametric survival models. Transition (c) is assumed unobserved but identifiable using DA or RB imputation assumptions. Various rules have been considered: no ICE effect, DA under proportional hazards (PH) or additive hazards (AH), jump to reference (J2R), and (either PH or AH) copy increment from reference. We obtain the marginal survival curve of interest by calculating, via numerical integration, the probability of transitioning from the initial state to the event of interest regardless of having passed or not by the ICE state. We use the delta method to obtain standard errors (SEs). Finally, we quantify the performance of the proposed estimator through simulations and compare it against MI. Our analytical solution is more efficient than MI and avoids SE misestimation-a known phenomenon associated with Rubin's variance equation.
Collapse
Affiliation(s)
| | - Teresa Pérez
- Facultad de Estudios Estadísticos, Univ. Complutense, Madrid, Spain
| | | | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
10
|
Yang Z, Heijnsdijk EAM, Newcomb LF, Rizopoulos D, Erler NS. Exploring the relation of active surveillance schedules and prostate cancer mortality. Cancer Med 2024; 13:e6977. [PMID: 38491826 PMCID: PMC10943374 DOI: 10.1002/cam4.6977] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Active surveillance (AS), where treatment is deferred until cancer progression is detected by a biopsy, is acknowledged as a way to reduce overtreatment in prostate cancer. However, a consensus on the frequency of taking biopsies while in AS is lacking. In former studies to optimize biopsy schedules, the delay in progression detection was taken as an evaluation indicator and believed to be associated with the long-term outcome, prostate cancer mortality. Nevertheless, this relation was never investigated in empirical data. Here, we use simulated data from a microsimulation model to fill this knowledge gap. METHODS In this study, the established MIcrosimulation SCreening Analysis model was extended with functionality to simulate the AS procedures. The biopsy sensitivity in the model was calibrated on the Canary Prostate Cancer Active Surveillance Study (PASS) data, and four (tri-yearly, bi-yearly, PASS, and yearly) AS programs were simulated. The relation between detection delay and prostate cancer mortality was investigated by Cox models. RESULTS The biopsy sensitivity of progression detection was found to be 50%. The Cox models show a positive relation between a longer detection delay and a higher risk of prostate cancer death. A 2-year delay resulted in a prostate cancer death risk of 2.46%-2.69% 5 years after progression detection and a 10-year risk of 5.75%-5.91%. A 4-year delay led to an approximately 8% greater 5-year risk and an approximately 25% greater 10-year risk. CONCLUSION The detection delay is confirmed as a surrogate for prostate cancer mortality. A cut-off for a "safe" detection delay could not be identified.
Collapse
Affiliation(s)
- Zhenwei Yang
- Department of BiostatisticsErasmus University Medical CenterRotterdamthe Netherlands
- Department of EpidemiologyErasmus University Medical CenterRotterdamthe Netherlands
| | | | - Lisa F. Newcomb
- Cancer Prevention Program, Public Health Sciences, Fred Hutchinson Cancer CenterSeattleWashingtonUSA
| | - Dimitris Rizopoulos
- Department of BiostatisticsErasmus University Medical CenterRotterdamthe Netherlands
- Department of EpidemiologyErasmus University Medical CenterRotterdamthe Netherlands
| | - Nicole S. Erler
- Department of BiostatisticsErasmus University Medical CenterRotterdamthe Netherlands
- Department of EpidemiologyErasmus University Medical CenterRotterdamthe Netherlands
| |
Collapse
|
11
|
de Bakker M, Loncq de Jong M, Petersen T, de Lange I, Akkerhuis KM, Umans VA, Rizopoulos D, Boersma E, Brugts JJ, Kardys I. Sex-specific cardiovascular protein levels and their link with clinical outcome in heart failure. ESC Heart Fail 2024; 11:594-600. [PMID: 38009274 PMCID: PMC10804167 DOI: 10.1002/ehf2.14578] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/02/2023] [Accepted: 10/29/2023] [Indexed: 11/28/2023] Open
Abstract
AIMS This study aims to provide insight into sex-specific cardiovascular protein profiles and their associations with adverse outcomes, which may contribute to a better understanding of heart failure (HF) pathophysiology and the optimal use of circulating proteins for prognostication in women and men. METHODS AND RESULTS In 250 stable patients with HF with reduced ejection fraction (HFrEF), we performed trimonthly blood sampling (median follow-up: 26 [17-30] months). We selected all baseline samples and two samples closest to the primary endpoint (PEP; composite of cardiovascular death, heart transplantation, left ventricular assist device implantation, and HF hospitalization) or one sample closest to censoring and applied the Olink Cardiovascular III panel. We used linear regression to study sex-based differences in baseline levels and joint models to study differences in the prognostic value of serially measured proteins. In 66 women and 184 men (mean age of 66 and 67 years, respectively), 21% and 28% reached the PEP, respectively. Mean baseline levels of fatty acid-binding protein 4, secretoglobin family 3A member 2, paraoxonase 3, and trefoil factor 3 were higher in women (Pinteraction : 0.001, 0.007, 0.018, and 0.049, respectively), while matrix metalloproteinase-3, interleukin 1 receptor-like 1, and myoglobin were higher in men (Pinteraction : <0.001, 0.001, and 0.049, respectively), independent of clinical characteristics. No significant differences between sexes were observed in the longitudinal associations of proteins with the PEP. Only peptidoglycan recognition protein 1 showed a suggestive interaction with sex for the primary outcome (Pinteraction = 0.028), without multiple testing correction, and was more strongly associated with adverse outcome in women {hazard ratio [HR] 3.03 [95% confidence interval (CI), 1.42 to 6.68], P = 0.008} compared with men [HR 1.18 (95% CI, 0.84 to 1.66), P = 0.347]. CONCLUSIONS Although multiple cardiovascular-related proteins show sex differences at baseline, temporal associations with the adverse outcome do not differ between women and men with HFrEF.
Collapse
Affiliation(s)
- Marie de Bakker
- Department of CardiologyErasmus MC Cardiovascular Institute, University Medical Center RotterdamRoom Na‐316, P.O. Box 20403000 CARotterdamThe Netherlands
| | - Mylène Loncq de Jong
- Department of CardiologyErasmus MC Cardiovascular Institute, University Medical Center RotterdamRoom Na‐316, P.O. Box 20403000 CARotterdamThe Netherlands
| | - Teun Petersen
- Department of CardiologyErasmus MC Cardiovascular Institute, University Medical Center RotterdamRoom Na‐316, P.O. Box 20403000 CARotterdamThe Netherlands
- Department of BiostatisticsErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Iris de Lange
- Department of CardiologyErasmus MC Cardiovascular Institute, University Medical Center RotterdamRoom Na‐316, P.O. Box 20403000 CARotterdamThe Netherlands
| | - K. Martijn Akkerhuis
- Department of CardiologyErasmus MC Cardiovascular Institute, University Medical Center RotterdamRoom Na‐316, P.O. Box 20403000 CARotterdamThe Netherlands
| | - Victor A. Umans
- Department of CardiologyNorthwest ClinicsAlkmaarThe Netherlands
| | - Dimitris Rizopoulos
- Department of BiostatisticsErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
- Department of EpidemiologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Eric Boersma
- Department of CardiologyErasmus MC Cardiovascular Institute, University Medical Center RotterdamRoom Na‐316, P.O. Box 20403000 CARotterdamThe Netherlands
| | - Jasper J. Brugts
- Department of CardiologyErasmus MC Cardiovascular Institute, University Medical Center RotterdamRoom Na‐316, P.O. Box 20403000 CARotterdamThe Netherlands
| | - Isabella Kardys
- Department of CardiologyErasmus MC Cardiovascular Institute, University Medical Center RotterdamRoom Na‐316, P.O. Box 20403000 CARotterdamThe Netherlands
| |
Collapse
|
12
|
Dijk SW, Kroencke T, Wollny C, Barkhausen J, Jansen O, Halfmann MC, Rizopoulos D, Hunink MGM. Medical Imaging Decision And Support (MIDAS): Study protocol for a multi-centre cluster randomized trial evaluating the ESR iGuide. Contemp Clin Trials 2023; 135:107384. [PMID: 37949165 DOI: 10.1016/j.cct.2023.107384] [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: 07/03/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Medical imaging plays an essential role in healthcare. As a diagnostic test, imaging is prone to substantial overuse and potential overdiagnosis, with dire consequences to patient outcomes and health care costs. Clinical decision support systems (CDSSs) were developed to guide referring physicians in making appropriate imaging decisions. This study will evaluate the effect of implementing a CDSS (ESR iGuide) with versus without active decision support in a physician order entry on the appropriate use of imaging tests and ordering behaviour. METHODS A protocol for a multi-center cluster-randomized trial with departments acting as clusters, combined with a before-after-revert design. Four university hospitals with eight participating departments each for a total of thirty-two clusters will be included in the study. All departments start in control condition with structured data entry of the clinical indication and tracking of the imaging exams requested. Initially, the CDSS is implemented and all physicians remain blinded to appropriateness scores based on the ESR imaging referral guidelines. After randomization, half of the clusters switch to the active intervention of decision support. Physicians in the active condition are made aware of the categorization of their requests as appropriate, under certain conditions appropriate, or inappropriate, and appropriate exams are suggested. Physicians may change their requests in response to feedback. In the revert condition, active decision support is removed to study the educational effect. RESULTS/CONCLUSIONS The main outcome is the proportion of inappropriate diagnostic imaging exams requested per cluster. Secondary outcomes are the absolute number of imaging exams, radiation from diagnostic imaging, and medical costs. TRIAL REGISTRATION NUMBER Approval from the Medical Ethics Review Committee was obtained under protocol numbers 20-069 (Augsburg), B 238/21 (Kiel), 20-318 (Lübeck) and 2020-15,125 (Mainz). The trial is registered in the ClinicalTrials.gov register under registration number NCT05490290.
Collapse
Affiliation(s)
- Stijntje W Dijk
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Thomas Kroencke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Claudia Wollny
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Joerg Barkhausen
- Department of Radiology and Nuclear Medicine, University of Lübeck, Lübeck, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M G Myriam Hunink
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Centre for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, United States of America.
| |
Collapse
|
13
|
de Bakker M, Petersen TB, Rueten-Budde AJ, Akkerhuis KM, Umans VA, Brugts JJ, Germans T, Reinders MJT, Katsikis PD, van der Spek PJ, Ostroff R, She R, Lanfear D, Asselbergs FW, Boersma E, Rizopoulos D, Kardys I. Machine learning-based biomarker profile derived from 4210 serially measured proteins predicts clinical outcome of patients with heart failure. Eur Heart J Digit Health 2023; 4:444-454. [PMID: 38045440 PMCID: PMC10689916 DOI: 10.1093/ehjdh/ztad056] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/06/2023] [Accepted: 10/03/2023] [Indexed: 12/05/2023]
Abstract
Aims Risk assessment tools are needed for timely identification of patients with heart failure (HF) with reduced ejection fraction (HFrEF) who are at high risk of adverse events. In this study, we aim to derive a small set out of 4210 repeatedly measured proteins, which, along with clinical characteristics and established biomarkers, carry optimal prognostic capacity for adverse events, in patients with HFrEF. Methods and results In 382 patients, we performed repeated blood sampling (median follow-up: 2.1 years) and applied an aptamer-based multiplex proteomic approach. We used machine learning to select the optimal set of predictors for the primary endpoint (PEP: composite of cardiovascular death, heart transplantation, left ventricular assist device implantation, and HF hospitalization). The association between repeated measures of selected proteins and PEP was investigated by multivariable joint models. Internal validation (cross-validated c-index) and external validation (Henry Ford HF PharmacoGenomic Registry cohort) were performed. Nine proteins were selected in addition to the MAGGIC risk score, N-terminal pro-hormone B-type natriuretic peptide, and troponin T: suppression of tumourigenicity 2, tryptophanyl-tRNA synthetase cytoplasmic, histone H2A Type 3, angiotensinogen, deltex-1, thrombospondin-4, ADAMTS-like protein 2, anthrax toxin receptor 1, and cathepsin D. N-terminal pro-hormone B-type natriuretic peptide and angiotensinogen showed the strongest associations [hazard ratio (95% confidence interval): 1.96 (1.17-3.40) and 0.66 (0.49-0.88), respectively]. The multivariable model yielded a c-index of 0.85 upon internal validation and c-indices up to 0.80 upon external validation. The c-index was higher than that of a model containing established risk factors (P = 0.021). Conclusion Nine serially measured proteins captured the most essential prognostic information for the occurrence of adverse events in patients with HFrEF, and provided incremental value for HF prognostication beyond established risk factors. These proteins could be used for dynamic, individual risk assessment in a prospective setting. These findings also illustrate the potential value of relatively 'novel' biomarkers for prognostication. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT01851538?term=nCT01851538&draw=2&rank=1 24.
Collapse
Affiliation(s)
- Marie de Bakker
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Teun B Petersen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Anja J Rueten-Budde
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Victor A Umans
- Department of Cardiology, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Tjeerd Germans
- Department of Cardiology, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - Marcel J T Reinders
- Delft Bioinformatics Lab, Delft University of Technology, Van Mourik Broekmanweg 6, 2628 XE, Delft, The Netherlands
| | - Peter D Katsikis
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Peter J van der Spek
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Rachel Ostroff
- SomaLogic, Inc., 2945 Wilderness Pl., Boulder, CO 80301, USA
| | - Ruicong She
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Pl, Detroit, MI 48202, USA
| | - David Lanfear
- Center for Individualized and Genomic Medicine Research (CIGMA), Henry Ford Hospital, 2799 W. Grand Boulevard, Detroit MI, 48202, USA
- Heart and Vascular Institute, Henry Ford Hospital, 2799 W. Grand Boulevard, Detroit, MI 48202, USA
| | - Folkert W Asselbergs
- Amsterdam University Medical Centers, Department of Cardiology, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, Gower St, London, WC1E 6BT, UK
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
| |
Collapse
|
14
|
Veldscholte K, Hulst JM, Eveleens RD, de Jonge RC, de Koning BA, van den Berg SA, van der Wal R, Ruijter GJ, Rizopoulos D, Vanhorebeek I, Gunst J, Casaer M, Van den Berghe G, Joosten KF, Verbruggen SC. Gastrointestinal Biomarkers and Their Association with Feeding in the First Five Days of Pediatric Critical Illness. J Pediatr Gastroenterol Nutr 2023; 77:811-818. [PMID: 37728917 PMCID: PMC10642702 DOI: 10.1097/mpg.0000000000003950] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVES Predicting the patients' tolerance to enteral nutrition (EN) would help clinicians optimize individual nutritional intake. This study investigated the course of several gastrointestinal (GI) biomarkers and their association with EN advancement (ENA) longitudinally during pediatric intensive care unit (PICU) admission. METHODS This is a secondary analysis of the Early versus Late Parenteral Nutrition in the Pediatric Intensive Care Unit randomized controlled trial. EN was started early and increased gradually. The cholecystokinin (CCK), leptin, glucagon, intestinal fatty acid-binding protein 2 (I-FABP2), and citrulline plasma concentrations were measured upon PICU admission, day 3 and day 5. ENA was defined as kcal EN provided as % of predicted resting energy expenditure. The course of the biomarkers and ENA was examined in patients with samples on all time points using Friedman and Wilcoxon signed-rank tests. The association of ENA with the biomarkers was examined using a 2-part mixed-effects model with data of the complete population, adjusted for possible confounders. RESULTS For 172 patients, median age 8.6 years (first quartile; third quartile: 4.2; 13.4), samples were available, of which 55 had samples on all time points. The median ENA was 0 (0; 0) on admission, 14.5 (0.0; 43.8) on day 3, and 28.0 (7.6; 94.8) on day 5. During PICU stay, CCK and I-FABP2 concentrations decreased significantly, whereas glucagon concentrations increased significantly, and leptin and citrulline remained stable. None of the biomarkers was longitudinally associated with ENA. CONCLUSIONS Based on the current evidence, CCK, leptin, glucagon, I-FABP2, and citrulline appear to have no added value in predicting ENA in the first 5 days of pediatric critical illness.
Collapse
Affiliation(s)
- Karlien Veldscholte
- From the Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Jessie M. Hulst
- the Department of Pediatrics, University of Toronto, Toronto, Canada
- the Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- the Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
| | - Renate D. Eveleens
- the Department of Anesthesiology, Amsterdam University Medical Centers, AMC, Amsterdam, the Netherlands
| | - Rogier C.J. de Jonge
- From the Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Barbara A.E. de Koning
- Pediatric Gastroenterology, Erasmus MC Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Sjoerd A.A. van den Berg
- the Department of Clinical Chemistry, Erasmus MC, Rotterdam, The Netherlands
- the Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Ronald van der Wal
- the Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Dimitris Rizopoulos
- the Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands
- the Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Ilse Vanhorebeek
- the Department of Anesthesiology, Amsterdam University Medical Centers, AMC, Amsterdam, the Netherlands
| | - Jan Gunst
- the Department of Anesthesiology, Amsterdam University Medical Centers, AMC, Amsterdam, the Netherlands
| | - Michaël Casaer
- the Department of Anesthesiology, Amsterdam University Medical Centers, AMC, Amsterdam, the Netherlands
| | - Greet Van den Berghe
- the Department of Anesthesiology, Amsterdam University Medical Centers, AMC, Amsterdam, the Netherlands
| | - Koen F.M. Joosten
- From the Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Sascha C.A.T. Verbruggen
- From the Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands
| |
Collapse
|
15
|
Klomberg RCW, van der Wal HC, Aardoom MA, Kemos P, Rizopoulos D, Ruemmele FM, Charrout M, Escher JC, Croft NM, de Ridder L, Milovanovich ID, Ashton JJ, Henderson P, Ledder O, de Meij TGJ, Hansen R, Hummel TZ, Arai K, Rodrigues A, Cameron F, Koletzko S, Muhammed R, Nedelkopoulou N. Improved clinical outcomes with early anti-tumour necrosis factor alpha therapy in children with newly diagnosed Crohn's disease: real world data from the international prospective PIBD-SETQuality inception cohort study. J Crohns Colitis 2023:jjad197. [PMID: 38011797 DOI: 10.1093/ecco-jcc/jjad197] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND & AIMS Treatment guidelines for paediatric Crohn's disease (CD) suggest early use of anti-tumour necrosis factor alpha (anti-TNF) in high-risk individuals. The aim is to evaluate the effect of early anti-TNF in a real-world cohort. METHODS Children with newly-diagnosed CD were prospectively recruited at 28 participating sites of the international observational PIBD-SETQuality study. Outcomes were compared at 3 months, 1 and 2 years between patients receiving early anti-TNF (<90 days after diagnosis) and those not receiving early anti-TNF. Outcomes included sustained steroid-free remission (SSFR) without treatment intensification (specified as SSFR*) and sustained steroid-free mild/inactive disease without treatment intensification (specified as SSFMI*). Penalised logistic regression model-based standardisation was applied to estimate the relative risks (RR) of early therapy on outcomes. RRs were estimated for high-risk and low-risk patients based on presence of predictors of poor outcome (POPOs) and disease activity at diagnosis. RESULTS In total, 331 children (median age 13.9 years [IQR 12.2 - 15.3]) were enrolled, with 135 (41%) receiving early anti-TNF. At 1 year, patients on early anti-TNF had higher rates of SSFR* (30% vs. 14%, p<0.001) and SSFMI* (69% vs. 33%, p<0.001), with RRs of 2.95 (95%CI 1.63-5.36) and 4.67 (95%CI 2.46-8.87) respectively. At 1 year, the RRs for SSFMI* were higher, and statistically significant in high-risk patients, i.e. those with moderate/severe disease compared to mild/inactive disease at diagnosis (5.50 [95%CI 2.51-12.05]) vs. 2.91 [95%CI 0.92-9.11]), and those with any POPO compared to no POPO (5.05 [95%CI 2.45-10.43] vs. 3.41 [95%CI 0.54-21.7]). CONCLUSION In this cohort of children with newly-diagnosed CD, early anti-TNF demonstrated superior effectiveness in high-risk patients.
Collapse
Affiliation(s)
- Renz C W Klomberg
- Department of Pediatric Gastroenterology, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hella C van der Wal
- Department of Pediatric Gastroenterology, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Martine A Aardoom
- Department of Pediatric Gastroenterology, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Polychronis Kemos
- Pediatric Gastroenterology, Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Dimitris Rizopoulos
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Frank M Ruemmele
- Department of Pediatric Gastroenterology, Université Paris Descartes, Sorbonne Paris Cité, APHP, Hôpital Necker Enfants Malades, Paris, France
| | - Mohammed Charrout
- Delft Bioinformatics Lab, Delft University of Technology, Delft, the Netherlands
| | - J C Escher
- Department of Pediatric Gastroenterology, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nicholas M Croft
- Pediatric Gastroenterology, Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Lissy de Ridder
- Department of Pediatric Gastroenterology, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ivan D Milovanovich
- Department of Gastroenterology, Hepatology, and Endoscopy, University Children's Hospital, Belgrade, Serbia
| | - James J Ashton
- Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, United Kingdom, Human Genetics and Genomic Medicine, University of Southampton, Southampton, United Kingdom
| | - Paul Henderson
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children and Young People, Edinburgh, United Kingdom, Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Oren Ledder
- Juliet Keidan Institute of Paediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tim G J de Meij
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
| | - Richard Hansen
- Clinical Reader in Child Health, Department of Child Health, Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, Scotland, Department of Paediatric Gastroenterology, Royal Hospital for Children, Glasgow, Scotland
| | - Thalia Z Hummel
- Department of Paediatric Gastroenterology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Katsuhiro Arai
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Astor Rodrigues
- Department of Paediatric Gastroenterology, Oxford Children's Hospital, Oxford, United Kingdom
| | - Fiona Cameron
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Sibylle Koletzko
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany, Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland
| | - Rafeeq Muhammed
- Department of Paediatric Gastroenterology, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Natalia Nedelkopoulou
- Department of Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, United Kingdom
| |
Collapse
|
16
|
van Oudenhoven FM, Swinkels SHN, Soininen H, Kivipelto M, Hartmann T, Rizopoulos D. Correction: A competing risk joint model for dealing with different types of missing data in an intervention trial in prodromal Alzheimer's disease. Alzheimers Res Ther 2023; 15:188. [PMID: 37904252 PMCID: PMC10614307 DOI: 10.1186/s13195-023-01290-x] [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] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Affiliation(s)
- Floor M van Oudenhoven
- Department of Biostatistics, Erasmus Medical Center, PO Box 2040, 3000, Rotterdam, CA, the Netherlands.
- Danone Nutricia Research, Uppsalalaan 12, 3584 CT, Utrecht, The Netherlands.
| | | | - Hilkka Soininen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland
- Neurocenter, Department of Neurology, Kuopio University Hospital, PO Box 100, 70029, Kuopio, Finland
| | - Miia Kivipelto
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, 14157, Huddinge, Sweden
- Clinical Trials Unit, Theme Aging, Karolinska University Hospital, 14152, Huddinge, Sweden
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, St Dunstan's Road, London, UK
| | - Tobias Hartmann
- Deutsches Institut Für Demenz Prävention (DIDP), Medical Faculty, Saarland University, Kirrbergerstraße, 66421, Homburg, Germany
- Department of Experimental Neurology, Saarland University, Kirrbergerstraße, 66421, Homburg, Germany
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus Medical Center, PO Box 2040, 3000, Rotterdam, CA, the Netherlands
| |
Collapse
|
17
|
Wang K, Ahmadizar F, Geurts S, Arshi B, Kors JA, Rizopoulos D, Sijbrands EJG, Ikram MA, Kavousi M. Heart Rate Variability and Incident Type 2 Diabetes in General Population. J Clin Endocrinol Metab 2023; 108:2510-2516. [PMID: 37022971 PMCID: PMC10505535 DOI: 10.1210/clinem/dgad200] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/07/2023]
Abstract
CONTEXT Hyperglycemia and autonomic dysfunction are bidirectionally related. OBJECTIVE We investigated the association of longitudinal evolution of heart rate variability (HRV) with incident type 2 diabetes (T2D) among the general population. METHODS We included 7630 participants (mean age 63.7 years, 58% women) from the population-based Rotterdam Study who had no history of T2D and atrial fibrillation at baseline and had repeated HRV assessments at baseline and during follow-up. We used joint models to assess the association between longitudinal evolution of heart rate and different HRV metrics (including the heart rate-corrected SD of the normal-to-normal RR intervals [SDNNc], and root mean square of successive RR-interval differences [RMSSDc]) with incident T2D. Models were adjusted for cardiovascular risk factors. Bidirectional Mendelian randomization (MR) using summary-level data was also performed. RESULTS During a median follow-up of 8.6 years, 871 individuals developed incident T2D. One SD increase in heart rate (hazard ratio [HR] 1.20; 95% CI, 1.09-1.33), and log(RMSSDc) (HR 1.16; 95% CI, 1.01-1.33) were independently associated with incident T2D. The HRs were 1.54 (95% CI, 1.08-2.06) for participants younger than 62 years and 1.15 (95% CI, 1.01-1.31) for those older than 62 years for heart rate (P for interaction <.001). Results from bidirectional MR analyses suggested that HRV and T2D were not significantly related to each other. CONCLUSION Autonomic dysfunction precedes development of T2D, especially among younger individuals, while MR analysis suggests no causal relationship. More studies are needed to further validate our findings.
Collapse
Affiliation(s)
- Kan Wang
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Fariba Ahmadizar
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Julius Global Health, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Sven Geurts
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Banafsheh Arshi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Jan A Kors
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Eric J G Sijbrands
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| |
Collapse
|
18
|
van Gaalen MAC, van Gijn E, van Pieterson M, de Ridder L, Rizopoulos D, Escher JC. Validation and Reference Scores of the Transition Readiness Assessment Questionnaire in Adolescent and Young Adult IBD Patients. J Pediatr Gastroenterol Nutr 2023; 77:381-388. [PMID: 37347146 DOI: 10.1097/mpg.0000000000003868] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
OBJECTIVES Transition readiness can predict a successful transition from pediatric to adult care. This study aimed to validate and develop age-dependent reference scores for the (Dutch version of) Transition Readiness Assessment Questionnaire (TRAQ), in adolescents and young adults (AYAs) with inflammatory bowel disease (IBD). METHODS TRAQ has 20 items (score 1-5) distributed over 5 domains (total sum score 100) and is completed by AYAs. Following the COnsensus-based Standards for the selection of health Measurement INstruments methodology, we conducted the translation, back-to back translation, pretesting, and validation of the final Dutch version of TRAQ (TRAQ-NL) questionnaire. We used a Rasch model for structural validation, hypothesis testing for construct validity, and Cronbach alpha to demonstrate reliability. Reference scores were calculated using percentiles. RESULTS Two hundred fifty TRAQ questionnaires were evaluated in 136 AYAs with IBD [56% Crohn disease, 58% male, median age 17.5 years (range 15.7-20.4)]. The overall mean item score was 3.87 (range 1.45-5). With good reliability (Cronbach alpha 0.87), TRAQ-NL discriminated well between knowledge levels, especially in the lower levels. Transition readiness was defined as low, moderate, adequate, or excellent in patients with TRAQ percentile scores (PC) <25th (<3.375 mean item score), 25th-50th (3.375-3.9), 50th-90th (3.91-4.7), or >90th (>4.7). Younger patients, concomitant illness, fewer visits to the transition clinic, and parental dependence were associated with significantly lower TRAQ scores. CONCLUSION TRAQ(-NL) is reliable and valid, with age-dependent PC to identify (in)adequate transfer readiness. TRAQ can now be more easily used as a patient-reported outcome measure to monitor transition readiness longitudinally in routine care for AYAs IBD patients.
Collapse
Affiliation(s)
- Martha A C van Gaalen
- From the Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Emma van Gijn
- From the Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Merel van Pieterson
- From the Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Lissy de Ridder
- From the Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | - Johanna C Escher
- From the Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| |
Collapse
|
19
|
Veldscholte K, Cramer ABG, de Jonge RCJ, Rizopoulos D, Joosten KFM, Verbruggen SCAT. Intermittent feeding with an overnight fast versus 24-h feeding in critically ill neonates, infants, and children: An open-label, single-centre, randomised controlled trial. Clin Nutr 2023; 42:1569-1580. [PMID: 37478810 DOI: 10.1016/j.clnu.2023.07.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND & AIMS Critically ill children are fed day and night, assuming this improves enteral tolerance and the probability of achieving nutritional goals. It was previously shown that a fasting response, reflected by increased ketosis, at least partly explained the beneficial outcome of delayed initiation of supplemental parenteral nutrition. This study aims to investigate whether an overnight fast increases ketosis and is feasible and safe in critically ill children. METHODS The Continuousversus Intermittent Nutrition in Paediatric Intensive Care (ContInNuPIC) study is a randomised controlled trial in a tertiary referral Paediatric Intensive Care Unit (PICU) in the Netherlands. Critically ill children (term newborn-18 years) with an expected PICU stay ≥48 h, dependent on artificial nutrition, were eligible. Participants were randomly assigned (1:1, stratified for age group) to intermittent feeding, with interruption of feedings during an age-dependent overnight period of eight to 12 h, or to continuous feeding, with the administration of feedings day and night. In both groups, similar daily caloric targets were pursued. For children younger than one year, mandatory minor glucose infusions were provided during fasting. The primary outcome was the feasibility, defined as two conditions (1): a significant difference in the patients' highest daily ketone (3-β-hydroxybutyrate, BHB) levels during each overnight period, and (2): non-inferiority regarding daily caloric intake, examined using a two-part mixed-effects model with a predefined non-inferiority margin of 33%, in an intention-to-treat analysis. The study is registered in the Netherlands Trial Register (NL7877). RESULTS Between May 19, 2020, and July 13, 2022, 140 critically ill children, median (first quartile; third quartile) age 0.3 (0.1; 2.7) years, were randomised to intermittent (n = 67) or continuous feeding (n = 73). In the intermittent feeding group, BHB levels were significantly higher (median 0.4 (0.2; 1.0) vs. 0.3 (0.1; 0.7) mmol/L, p < 0.001). The ratio of total caloric intake in the intermittent feeding group to the intake in the continuous feeding group was not consistently significantly more than 0.67, thus not proving non-inferiority. No severe, resistant hypoglycaemic events, nor severe gastrointestinal complications related to the intervention occurred, and feeding intolerance did not occur more often in the intermittent than in the continuous feeding group. CONCLUSION Compared with day and night feeding, intermittent feeding with an overnight fast and mandatory glucose infusion for children younger than one year marginally increased ketosis and did not lead to more hypoglycaemic incidents in critically ill children. Because non-inferiority regarding daily caloric intake was not proven, the feasibility of an overnight fast could not be shown in the current study. However, as feeding intolerance did not increase during the condensed feeding periods, the nutritional intake was probably limited by the prescription of nutrition and interruptions. More research is needed to determine the optimal level and duration of clinically relevant ketosis and the best method to achieve this.
Collapse
Affiliation(s)
- Karlien Veldscholte
- Department of Neonatal and Paediatric Intensive Care, Division of Paediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Arnout B G Cramer
- Department of Neonatal and Paediatric Intensive Care, Division of Paediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Rogier C J de Jonge
- Department of Neonatal and Paediatric Intensive Care, Division of Paediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Koen F M Joosten
- Department of Neonatal and Paediatric Intensive Care, Division of Paediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Sascha C A T Verbruggen
- Department of Neonatal and Paediatric Intensive Care, Division of Paediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands.
| |
Collapse
|
20
|
Mackenbach MJ, Willemse EAJ, van den Dorpel JJA, van der Beek NAME, Díaz-Manera J, Rizopoulos D, Teunissen C, van der Ploeg AT, van den Hout JMP. Neurofilament Light and Its Association With CNS Involvement in Patients With Classic Infantile Pompe Disease. Neurology 2023; 101:e594-e601. [PMID: 37336766 PMCID: PMC10424841 DOI: 10.1212/wnl.0000000000207482] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/18/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Enzyme replacement therapy (ERT) has substantially improved the outcome of classic infantile Pompe disease, an inheritable muscle disease previously fatal at infancy. However, under treatment, patients develop white matter abnormalities and neurocognitive problems. Therefore, upcoming therapies also target the brain. Currently, biomarkers reflecting CNS involvement are lacking. We aimed to study the association of neurofilament light (NfL) and CNS involvement. METHODS To investigate the potential of NfL, we analyzed serum samples of patients with classic infantile Pompe disease who were treated with ERT. The samples were collected at ages of <1, 5, and 10 years, as well as around MRI scans. We compared the outcomes with levels in age- and sex-matched peers. Control samples were originally collected as part of routine blood work in children who underwent small surgeries and stored in the biobank of the Erasmus MC/Sophia Children's Hospital. RESULTS We analyzed 74 serum samples of 17 patients collected at ages ranging from 22 days to 21.2 years (1-8 samples per patient) and compared these with outcomes of 71 matched peers. In the first year of age, NfL levels in patients and controls were similar (10.3 vs 11.0 pg/mL), but mixed linear model analysis showed a yearly increase of NfL of 6.0% in patients, compared with a decrease of 8.8% in controls (p < 0.001). Higher NfL was associated with lower IQ scores (p = 0.009) and lower processing speed scores (p = 0.001). DISCUSSION We found significant differences in NfL levels between patients and controls and a good association between NfL and cognition. NfL deserves further exploration as a biomarker for CNS involvement in patients with classic infantile Pompe disease.
Collapse
Affiliation(s)
- Maarten J Mackenbach
- From the Center for Lysosomal and Metabolic Diseases (M.J.M., J.J.A.v.d.D., A.T.v.d.P., J.M.P.v.d.H.), Department of Paediatrics, Erasmus University Medical Center, Rotterdam; Neurochemistry laboratory (E.A.J.W., C.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Centres, VU University, the Netherlands; Departments of Biomedizin and Neurology (E.A.J.W.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital Basel and University of Basel, Switzerland; Center for Lysosomal and Metabolic Diseases (N.A.M.E.v.d.B.), Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands; John Walton Muscular Dystrophy Research Centre (J.D.-M.), Newcastle University, United Kingdom; Neuromuscular Disorders Laboratory (J.D.-M.), Institut de recerca de l'hospital de la Santa Creu I Sant Pau, Barcelona; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M.), Madrid, Spain; and Department of Biostatistics & Department of Epidemiology (D.R.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eline A J Willemse
- From the Center for Lysosomal and Metabolic Diseases (M.J.M., J.J.A.v.d.D., A.T.v.d.P., J.M.P.v.d.H.), Department of Paediatrics, Erasmus University Medical Center, Rotterdam; Neurochemistry laboratory (E.A.J.W., C.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Centres, VU University, the Netherlands; Departments of Biomedizin and Neurology (E.A.J.W.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital Basel and University of Basel, Switzerland; Center for Lysosomal and Metabolic Diseases (N.A.M.E.v.d.B.), Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands; John Walton Muscular Dystrophy Research Centre (J.D.-M.), Newcastle University, United Kingdom; Neuromuscular Disorders Laboratory (J.D.-M.), Institut de recerca de l'hospital de la Santa Creu I Sant Pau, Barcelona; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M.), Madrid, Spain; and Department of Biostatistics & Department of Epidemiology (D.R.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jan J A van den Dorpel
- From the Center for Lysosomal and Metabolic Diseases (M.J.M., J.J.A.v.d.D., A.T.v.d.P., J.M.P.v.d.H.), Department of Paediatrics, Erasmus University Medical Center, Rotterdam; Neurochemistry laboratory (E.A.J.W., C.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Centres, VU University, the Netherlands; Departments of Biomedizin and Neurology (E.A.J.W.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital Basel and University of Basel, Switzerland; Center for Lysosomal and Metabolic Diseases (N.A.M.E.v.d.B.), Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands; John Walton Muscular Dystrophy Research Centre (J.D.-M.), Newcastle University, United Kingdom; Neuromuscular Disorders Laboratory (J.D.-M.), Institut de recerca de l'hospital de la Santa Creu I Sant Pau, Barcelona; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M.), Madrid, Spain; and Department of Biostatistics & Department of Epidemiology (D.R.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nadine A M E van der Beek
- From the Center for Lysosomal and Metabolic Diseases (M.J.M., J.J.A.v.d.D., A.T.v.d.P., J.M.P.v.d.H.), Department of Paediatrics, Erasmus University Medical Center, Rotterdam; Neurochemistry laboratory (E.A.J.W., C.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Centres, VU University, the Netherlands; Departments of Biomedizin and Neurology (E.A.J.W.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital Basel and University of Basel, Switzerland; Center for Lysosomal and Metabolic Diseases (N.A.M.E.v.d.B.), Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands; John Walton Muscular Dystrophy Research Centre (J.D.-M.), Newcastle University, United Kingdom; Neuromuscular Disorders Laboratory (J.D.-M.), Institut de recerca de l'hospital de la Santa Creu I Sant Pau, Barcelona; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M.), Madrid, Spain; and Department of Biostatistics & Department of Epidemiology (D.R.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jordi Díaz-Manera
- From the Center for Lysosomal and Metabolic Diseases (M.J.M., J.J.A.v.d.D., A.T.v.d.P., J.M.P.v.d.H.), Department of Paediatrics, Erasmus University Medical Center, Rotterdam; Neurochemistry laboratory (E.A.J.W., C.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Centres, VU University, the Netherlands; Departments of Biomedizin and Neurology (E.A.J.W.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital Basel and University of Basel, Switzerland; Center for Lysosomal and Metabolic Diseases (N.A.M.E.v.d.B.), Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands; John Walton Muscular Dystrophy Research Centre (J.D.-M.), Newcastle University, United Kingdom; Neuromuscular Disorders Laboratory (J.D.-M.), Institut de recerca de l'hospital de la Santa Creu I Sant Pau, Barcelona; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M.), Madrid, Spain; and Department of Biostatistics & Department of Epidemiology (D.R.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Dimitris Rizopoulos
- From the Center for Lysosomal and Metabolic Diseases (M.J.M., J.J.A.v.d.D., A.T.v.d.P., J.M.P.v.d.H.), Department of Paediatrics, Erasmus University Medical Center, Rotterdam; Neurochemistry laboratory (E.A.J.W., C.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Centres, VU University, the Netherlands; Departments of Biomedizin and Neurology (E.A.J.W.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital Basel and University of Basel, Switzerland; Center for Lysosomal and Metabolic Diseases (N.A.M.E.v.d.B.), Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands; John Walton Muscular Dystrophy Research Centre (J.D.-M.), Newcastle University, United Kingdom; Neuromuscular Disorders Laboratory (J.D.-M.), Institut de recerca de l'hospital de la Santa Creu I Sant Pau, Barcelona; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M.), Madrid, Spain; and Department of Biostatistics & Department of Epidemiology (D.R.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Charlotte Teunissen
- From the Center for Lysosomal and Metabolic Diseases (M.J.M., J.J.A.v.d.D., A.T.v.d.P., J.M.P.v.d.H.), Department of Paediatrics, Erasmus University Medical Center, Rotterdam; Neurochemistry laboratory (E.A.J.W., C.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Centres, VU University, the Netherlands; Departments of Biomedizin and Neurology (E.A.J.W.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital Basel and University of Basel, Switzerland; Center for Lysosomal and Metabolic Diseases (N.A.M.E.v.d.B.), Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands; John Walton Muscular Dystrophy Research Centre (J.D.-M.), Newcastle University, United Kingdom; Neuromuscular Disorders Laboratory (J.D.-M.), Institut de recerca de l'hospital de la Santa Creu I Sant Pau, Barcelona; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M.), Madrid, Spain; and Department of Biostatistics & Department of Epidemiology (D.R.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ans T van der Ploeg
- From the Center for Lysosomal and Metabolic Diseases (M.J.M., J.J.A.v.d.D., A.T.v.d.P., J.M.P.v.d.H.), Department of Paediatrics, Erasmus University Medical Center, Rotterdam; Neurochemistry laboratory (E.A.J.W., C.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Centres, VU University, the Netherlands; Departments of Biomedizin and Neurology (E.A.J.W.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital Basel and University of Basel, Switzerland; Center for Lysosomal and Metabolic Diseases (N.A.M.E.v.d.B.), Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands; John Walton Muscular Dystrophy Research Centre (J.D.-M.), Newcastle University, United Kingdom; Neuromuscular Disorders Laboratory (J.D.-M.), Institut de recerca de l'hospital de la Santa Creu I Sant Pau, Barcelona; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M.), Madrid, Spain; and Department of Biostatistics & Department of Epidemiology (D.R.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Johanna M P van den Hout
- From the Center for Lysosomal and Metabolic Diseases (M.J.M., J.J.A.v.d.D., A.T.v.d.P., J.M.P.v.d.H.), Department of Paediatrics, Erasmus University Medical Center, Rotterdam; Neurochemistry laboratory (E.A.J.W., C.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam University Medical Centres, VU University, the Netherlands; Departments of Biomedizin and Neurology (E.A.J.W.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience (RC2NB), University Hospital Basel and University of Basel, Switzerland; Center for Lysosomal and Metabolic Diseases (N.A.M.E.v.d.B.), Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands; John Walton Muscular Dystrophy Research Centre (J.D.-M.), Newcastle University, United Kingdom; Neuromuscular Disorders Laboratory (J.D.-M.), Institut de recerca de l'hospital de la Santa Creu I Sant Pau, Barcelona; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M.), Madrid, Spain; and Department of Biostatistics & Department of Epidemiology (D.R.), Erasmus University Medical Center, Rotterdam, the Netherlands.
| |
Collapse
|
21
|
Alafandi A, van Garderen KA, Klein S, van der Voort SR, Rizopoulos D, Nabors L, Stupp R, Weller M, Gorlia T, Tonn JC, Smits M. Association of pre-radiotherapy tumour burden and overall survival in newly diagnosed glioblastoma adjusted for MGMT promoter methylation status. Eur J Cancer 2023; 188:122-130. [PMID: 37235895 DOI: 10.1016/j.ejca.2023.04.021] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/07/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
PURPOSE We retrospectively evaluated the association between postoperative pre-radiotherapy tumour burden and overall survival (OS) adjusted for the prognostic value of O6-methylguanine DNA methyltransferase (MGMT) promoter methylation in patients with newly diagnosed glioblastoma treated with radio-/chemotherapy with temozolomide. MATERIALS AND METHODS Patients were included from the CENTRIC (EORTC 26071-22072) and CORE trials if postoperative magnetic resonance imaging scans were available within a timeframe of up to 4weeks before radiotherapy, including both pre- and post-contrast T1w images and at least one T2w sequence (T2w or T2w-FLAIR). Postoperative (residual) pre-radiotherapy contrast-enhanced tumour (CET) volumes and non-enhanced T2w abnormalities (NT2A) tissue volumes were obtained by three-dimensional segmentation. Cox proportional hazard models and Kaplan Meier estimates were used to assess the association of pre-radiotherapy CET/NT2A volume with OS adjusted for known prognostic factors (age, performance status, MGMT status). RESULTS 408 tumour (of which 270 MGMT methylated) segmentations were included. Median OS in patients with MGMT methylated tumours was 117 weeks versus 61weeks in MGMT unmethylated tumours (p < 0.001). When stratified for MGMT methylation status, higher CET volume (HR 1.020; 95% confidence interval CI [1.013-1.027]; p < 0.001) and older age (HR 1.664; 95% CI [1.214-2.281]; p = 0.002) were significantly associated with shorter OS while NT2A volume and performance status were not. CONCLUSION Pre-radiotherapy CET volume was strongly associated with OS in patients receiving radio-/chemotherapy for newly diagnosed glioblastoma stratified by MGMT promoter methylation status.
Collapse
Affiliation(s)
- A Alafandi
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands; Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - K A van Garderen
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands; Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Medical Delta, Delft, the Netherlands
| | - S Klein
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - S R van der Voort
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - D Rizopoulos
- Department of Biostatistics and Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - L Nabors
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - R Stupp
- Malnati Brain Tumor Institute, Departments of Neurological Surgery and Neurology, Northwestern University, Chicago, IL, USA
| | - M Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - T Gorlia
- European Organisation for Research and Treatmeant of Cancer Headquarters, Brussels, Belgium
| | - J-C Tonn
- Department of Neurosurgery, LMU University Munich, Munich, Germany
| | - M Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands; Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Medical Delta, Delft, the Netherlands.
| |
Collapse
|
22
|
Petersen TB, de Bakker M, Asselbergs FW, Harakalova M, Akkerhuis KM, Brugts JJ, van Ramshorst J, Lumbers RT, Ostroff RM, Katsikis PD, van der Spek PJ, Umans VA, Boersma E, Rizopoulos D, Kardys I. HFrEF subphenotypes based on 4210 repeatedly measured circulating proteins are driven by different biological mechanisms. EBioMedicine 2023; 93:104655. [PMID: 37327673 DOI: 10.1016/j.ebiom.2023.104655] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/06/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND HFrEF is a heterogenous condition with high mortality. We used serial assessments of 4210 circulating proteins to identify distinct novel protein-based HFrEF subphenotypes and to investigate underlying dynamic biological mechanisms. Herewith we aimed to gain pathophysiological insights and fuel opportunities for personalised treatment. METHODS In 382 patients, we performed trimonthly blood sampling during a median follow-up of 2.1 [IQR:1.1-2.6] years. We selected all baseline samples and two samples closest to the primary endpoint (PEP; composite of cardiovascular mortality, HF hospitalization, LVAD implantation, and heart transplantation) or censoring, and applied an aptamer-based multiplex proteomic approach. Using unsupervised machine learning methods, we derived clusters from 4210 repeatedly measured proteomic biomarkers. Sets of proteins that drove cluster allocation were analysed via an enrichment analysis. Differences in clinical characteristics and PEP occurrence were evaluated. FINDINGS We identified four subphenotypes with different protein profiles, prognosis and clinical characteristics, including age (median [IQR] for subphenotypes 1-4, respectively:70 [64, 76], 68 [60, 79], 57 [47, 65], 59 [56, 66]years), EF (30 [26, 36], 26 [20, 38], 26 [22, 32], 33 [28, 37]%), and chronic renal failure (45%, 65%, 36%, 37%). Subphenotype allocation was driven by subsets of proteins associated with various biological functions, such as oxidative stress, inflammation and extracellular matrix organisation. Clinical characteristics of the subphenotypes were aligned with these associations. Subphenotypes 2 and 3 had the worst prognosis compared to subphenotype 1 (adjHR (95%CI):3.43 (1.76-6.69), and 2.88 (1.37-6.03), respectively). INTERPRETATION Four circulating-protein based subphenotypes are present in HFrEF, which are driven by varying combinations of protein subsets, and have different clinical characteristics and prognosis. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01851538https://clinicaltrials.gov/ct2/show/NCT01851538. FUNDING EU/EFPIA IMI2JU BigData@Heart grant n°116074, Jaap Schouten Foundation and Noordwest Academie.
Collapse
Affiliation(s)
- Teun B Petersen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, the Netherlands; Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, the Netherlands
| | - Marie de Bakker
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, the Netherlands
| | - Folkert W Asselbergs
- Amsterdam University Medical Centers, Department of Cardiology, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Health Data Research UK and Institute of Health Informatics, University College London, Gower St, London, United Kingdom
| | - Magdalena Harakalova
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, Utrecht, the Netherlands; Regenerative Medicine Center Utrecht, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, Utrecht, the Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, the Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, the Netherlands
| | - Jan van Ramshorst
- Department of Cardiology, Northwest Clinics, Wilhelminalaan 12, Alkmaar, the Netherlands
| | - R Thomas Lumbers
- British Heart Foundation Research Accelerator, University College London, Gower St, London, UK; Institute of Health Informatics, University College London, Gower St, London, UK; Health Data Research UK London, University College London, Gower St, London, UK
| | | | - Peter D Katsikis
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, the Netherlands
| | - Peter J van der Spek
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, the Netherlands
| | - Victor A Umans
- Department of Cardiology, Northwest Clinics, Wilhelminalaan 12, Alkmaar, the Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, the Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, the Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, the Netherlands.
| |
Collapse
|
23
|
de Bakker M, Petersen TB, Akkerhuis KM, Harakalova M, Umans VA, Germans T, Caliskan K, Katsikis PD, van der Spek PJ, Suthahar N, de Boer RA, Rizopoulos D, Asselbergs FW, Boersma E, Kardys I. Sex-based differences in cardiovascular proteomic profiles and their associations with adverse outcomes in patients with chronic heart failure. Biol Sex Differ 2023; 14:29. [PMID: 37198662 DOI: 10.1186/s13293-023-00516-9] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/05/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Studies focusing on sex differences in circulating proteins in patients with heart failure with reduced ejection fraction (HFrEF) are scarce. Insight into sex-specific cardiovascular protein profiles and their associations with the risk of adverse outcomes may contribute to a better understanding of the pathophysiological processes involved in HFrEF. Moreover, it could provide a basis for the use of circulating protein measurements for prognostication in women and men, wherein the most relevant protein measurements are applied in each of the sexes. METHODS In 382 patients with HFrEF, we performed tri-monthly blood sampling (median follow-up: 25 [13-31] months). We selected all baseline samples and two samples closest to the primary endpoint (PEP: composite of cardiovascular death, heart transplantation, left ventricular assist device implantation, and HF hospitalization) or censoring. We then applied an aptamer-based multiplex proteomic assay identifying 1105 proteins previously associated with cardiovascular disease. We used linear regression models and gene-enrichment analysis to study sex-based differences in baseline levels. We used time-dependent Cox models to study differences in the prognostic value of serially measured proteins. All models were adjusted for the MAGGIC HF mortality risk score and p-values for multiple testing. RESULTS In 104 women and 278 men (mean age 62 and 64 years, respectively) cumulative PEP incidence at 30 months was 25% and 35%, respectively. At baseline, 55 (5%) out of the 1105 proteins were significantly different between women and men. The female protein profile was most strongly associated with extracellular matrix organization, while the male profile was dominated by regulation of cell death. The association of endothelin-1 (Pinteraction < 0.001) and somatostatin (Pinteraction = 0.040) with the PEP was modified by sex, independent of clinical characteristics. Endothelin-1 was more strongly associated with the PEP in men (HR 2.62 [95%CI, 1.98, 3.46], p < 0.001) compared to women (1.14 [1.01, 1.29], p = 0.036). Somatostatin was positively associated with the PEP in men (1.23 [1.10, 1.38], p < 0.001), but inversely associated in women (0.33 [0.12, 0.93], p = 0.036). CONCLUSION Baseline cardiovascular protein levels differ between women and men. However, the predictive value of repeatedly measured circulating proteins does not seem to differ except for endothelin-1 and somatostatin.
Collapse
Affiliation(s)
- Marie de Bakker
- Department of Cardiology, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Teun B Petersen
- Department of Cardiology, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Magdalena Harakalova
- Department of Cardiology, Division Heart and Lungs, Circulatory Health Research Center, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Victor A Umans
- Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Tjeerd Germans
- Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Peter D Katsikis
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter J van der Spek
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Navin Suthahar
- Department of Cardiology, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Folkert W Asselbergs
- Amsterdam University Medical Centers, Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Eric Boersma
- Department of Cardiology, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, Room Na-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| |
Collapse
|
24
|
Lika A, Andrinopoulou ER, van der Beek NAME, Rizopoulos D, van der Ploeg AT, Kruijshaar ME. Association between changes in pulmonary function and in patient reported outcomes during enzyme therapy of adult patients with late-onset Pompe disease. J Inherit Metab Dis 2023. [PMID: 36966448 DOI: 10.1002/jimd.12606] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/28/2023] [Accepted: 03/23/2023] [Indexed: 03/27/2023]
Abstract
Pompe disease is a rare, progressive, and metabolic myopathy. Reduced pulmonary function is one of the main problems seen in adult patients with late-onset Pompe disease (LOPD). We aimed to explore the association between changes over time in pulmonary function and in patient-reported outcome measures (PROMs), in these patients treated with enzyme replacement therapy (ERT). This is a post hoc analysis of two cohort studies. Pulmonary function was assessed as forced vital capacity in the upright position (FVCup ). As PROMs, we assessed the physical component summary score (PCS) of the Medical Outcome Study 36-item Short-Form Health Survey (SF-36) and daily life activities (Rasch-Built Pompe-Specific Activity [R-PACT] scale). We fitted Bayesian multivariate mixed-effects models. In the models of PROMs, we assumed a linear association with FVCup , and adjusted for time (nonlinear), sex, and age and disease duration at the start of ERT. One hundred and one patients were eligible for analysis. PCS and R-PAct were positively associated with FVCup , while their relation with time was nonlinear (initial increase then decrease). A 1%-point increase in FVCup is expected to increase PCS by 0.14 points (95% Credible Interval: [0.09;0.19]) and R-PACT by 0.41 points [0.33;0.49] at the same time point. In the first year of ERT, we expect a change of PCS and R-PAct scores by +0.42 and +0.80 points, and in the 5th year of +0.16 and +0.45, respectively. We conclude that the physical domain of quality of life and daily life activities improve when FVCup increases during ERT.
Collapse
Affiliation(s)
- Aglina Lika
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Eleni-Rosalina Andrinopoulou
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nadine A M E van der Beek
- Department of Neurology, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ans T van der Ploeg
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Michelle E Kruijshaar
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
25
|
van Bodegom LS, Gerritsen SE, Dieleman GC, Overbeek MM, de Girolamo G, Scocco P, Hillegers MHJ, Wolke D, Rizopoulos D, Appleton R, Conti P, Franić T, Margari F, Madan J, McNicholas F, Nacinovich R, Pastore A, Paul M, Purper-Ouakil D, Saam MC, Santosh PJ, Sartor A, Schulze UME, Signorini G, Singh SP, Street C, Tah P, Tanase E, Tremmery S, Tuomainen H, Maras A. The importance of clinicians' and parents' awareness of suicidal behaviour in adolescents reaching the upper age limit of their mental health services in Europe. J Affect Disord 2023; 325:360-368. [PMID: 36621680 DOI: 10.1016/j.jad.2022.12.164] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND To study clinicians' and parents' awareness of suicidal behaviour in adolescents reaching the upper age limit of their Child and Adolescent Mental Health Service (CAMHS) and its association with mental health indicators, transition recommendations and mental health service (MHS) use. METHODS 763 CAMHS users from eight European countries were assessed using multi-informant and standardised assessment tools at baseline and nine months follow-up. Separate ANCOVA's and pairwise comparisons were conducted to assess whether clinicians' and parents' awareness of young people's suicidal behaviour were associated with mental health indicators, clinician's recommendations to continue treatment and MHS use at nine months follow-up. RESULTS 53.5 % of clinicians and 56.9 % of parents were unaware of young people's self-reported suicidal behaviour at baseline. Compared to those whose clinicians/parents were aware, unawareness was associated with a 72-80 % lower proportion of being recommended to continue treatment. Self-reported mental health problems at baseline were comparable for young people whose clinicians and parents were aware and unaware of suicidal behaviour. Clinicians' and parents' unawareness were not associated with MHS use at follow-up. LIMITATIONS Aspects of suicidal behaviour, such as suicide ideation, -plans and -attempts, could not be distinguished. Few young people transitioned to Adult Mental Health Services (AMHS), therefore power to study factors associated with AMHS use was limited. CONCLUSION Clinicians and parents are often unaware of suicidal behaviour, which decreases the likelihood of a recommendation to continue treatment, but does not seem to affect young people's MHS use or their mental health problems.
Collapse
Affiliation(s)
- Larissa S van Bodegom
- Yulius Mental Health Organization, Yulius Academy, Dordrecht 3300 BA, Netherlands; Erasmus Medical Center, Department of Child and Adolescent Psychiatry and Psychology, Rotterdam 3000 CB, Netherlands
| | - Suzanne E Gerritsen
- Erasmus Medical Center, Department of Child and Adolescent Psychiatry and Psychology, Rotterdam 3000 CB, Netherlands
| | - Gwendolyn C Dieleman
- Erasmus Medical Center, Department of Child and Adolescent Psychiatry and Psychology, Rotterdam 3000 CB, Netherlands.
| | - Mathilde M Overbeek
- Yulius Mental Health Organization, Yulius Academy, Dordrecht 3300 BA, Netherlands; Vrije Universiteit Amsterdam, Clinical Child and Family Studies, Amsterdam, 1081 BT, Netherlands
| | - Giovanni de Girolamo
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Psychiatric Epidemiology and Evaluation Unit, Brescia 25125, Italy
| | - Paolo Scocco
- ULSS 6 Euganea, Department of Mental health, Padova 35131, Italy
| | - Manon H J Hillegers
- Erasmus Medical Center, Department of Child and Adolescent Psychiatry and Psychology, Rotterdam 3000 CB, Netherlands
| | - Dieter Wolke
- University of Warwick, Department of Psychology, Coventry CV4 7AL, United Kingdom
| | - Dimitris Rizopoulos
- Erasmus Medical Center, Department of Biostatistics, Rotterdam 3000 CB, Netherlands; Erasmus Medical Center, Department of Epidemiology, Rotterdam 3000 CB, Netherlands
| | - Rebecca Appleton
- University College London, NIHR Mental Health Policy Research Unit, Division of Psychiatry, London W1T 7NF, United Kingdom
| | - Patrizia Conti
- ASST Lariana, Department of Child and Adolescent Psychiatry, Como 22100, Italy
| | - Tomislav Franić
- University Hospital Split, Department of Psychiatry, Split 21000, Croatia; University of Split, School of Medicine, Split 21000, Croatia
| | | | - Jason Madan
- University of Warwick, Warwick Medical School, Coventry CV4 7AL, United Kingdom
| | - Fiona McNicholas
- University College Dublin, School of Medicine & Medical Science, Dublin D04 V1W8, Republic of Ireland, United Kingdom; SJOG, Lucena CAMHS, Dublin, Republic of Ireland, United Kingdom
| | - Renata Nacinovich
- University of Milan Bicocca, Child and Adolescent Neuropsychiatry Unit S. Gerardo Hospital, Monza 20052, Italy
| | - Adriana Pastore
- University of Bari, Unit of Adolescent Psychiatric Emergency, Bari 70121, Italy
| | - Moli Paul
- University of Warwick, Warwick Medical School, Coventry CV4 7AL, United Kingdom
| | - Diane Purper-Ouakil
- Saint Eloi Hospital, Centre Hospitalier Universitaire de Montpellier, Montpellier 34090, France; INSERM, CESP U1018, PsyDev, University Paris Saclay, UVSQ, Versailles, France
| | - Melanie C Saam
- University of Ulm, Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm 89075, Germany
| | - Paramala J Santosh
- Kings College London, Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, London SE5 8AZ, United Kingdom; HealthTracker Ltd, Kent ME7 1AY, United Kingdom
| | - Anne Sartor
- Josefinum Augsburg, Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Augsburg 86154, Germany
| | - Ulrike M E Schulze
- University of Ulm, Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm 89075, Germany
| | - Giulia Signorini
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Psychiatric Epidemiology and Evaluation Unit, Brescia 25125, Italy
| | - Swaran P Singh
- University of Warwick, Warwick Medical School, Coventry CV4 7AL, United Kingdom
| | - Cathy Street
- University of Warwick, Warwick Medical School, Coventry CV4 7AL, United Kingdom
| | - Priya Tah
- University of Warwick, Warwick Medical School, Coventry CV4 7AL, United Kingdom; Rees Centre, Department of Education, University of Oxford, Oxford OX2 6PY, United Kingdom
| | - Elena Tanase
- University of Ulm, Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm 89075, Germany
| | - Sabine Tremmery
- KU Leuven, Department of Neurosciences, Leuven BE-3000, Belgium
| | - Helena Tuomainen
- University of Warwick, Warwick Medical School, Coventry CV4 7AL, United Kingdom
| | - Athanasios Maras
- Yulius Mental Health Organization, Yulius Academy, Dordrecht 3300 BA, Netherlands
| | | |
Collapse
|
26
|
Dorr MC, Sewnaik A, Andrinopoulou E, Berzenji D, Dronkers EAC, Bernard SE, Hoesseini A, Tans L, Rizopoulos D, Baatenburg de Jong RJ, Offerman MPJ. Longitudinal Patient-Reported Voice Quality in Early-Stage Glottic Cancer. Otolaryngol Head Neck Surg 2023; 168:1463-1471. [PMID: 36939474 DOI: 10.1002/ohn.263] [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: 09/19/2022] [Revised: 12/18/2022] [Accepted: 12/24/2022] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Patient-reported voice quality is an important outcome during counseling in early-stage glottic cancer. However, there is a paucity of adequate longitudinal studies concerning voice outcomes. This study aimed to investigate longitudinal trajectories for patient-reported voice quality and associated risk factors for treatment modalities such as transoral CO2 laser microsurgery, single vocal cord irradiation, and local radiotherapy. STUDY DESIGN A longitudinal observational cohort study. SETTING Tertiary cancer center. METHODS Patients treated for Tcis-T1b, N0M0 glottic cancer were included in this study (N = 294). The Voice Handicap Index was obtained at baseline and during follow-up (N = 1944). Mixed-effects models were used for investigating the different trajectories for patient-reported voice quality. RESULTS The mean follow-up duration was 43.4 (SD 21.5) months. Patients received transoral CO2 laser microsurgery (57.8%), single vocal cord irradiation (24.5%), or local radiotherapy (17.5%). A steeper improvement during the first year after treatment for single vocal cord irradiation (-15.7) and local radiotherapy (-12.4) was seen, compared with a more stable trajectory for laser surgery (-6.1). All treatment modalities showed equivalent outcomes during long-term follow-up. Associated risk factors for different longitudinal trajectories were age, tumor stage, and comorbidity. CONCLUSION Longitudinal patient-reported voice quality after treatment for early-stage glottic cancer is heterogeneous and nonlinear. Most improvement is seen during the first year of follow-up and differs between treatment modalities. No clinically significant differences in long-term trajectories were found. Insight into longitudinal trajectories can enhance individual patient counseling and provide the foundation for an individualized dynamic prediction model.
Collapse
Affiliation(s)
- Maarten C Dorr
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Elrozy Andrinopoulou
- Department of Biostatistics and Epidemiology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Diako Berzenji
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Emilie A C Dronkers
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Simone E Bernard
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Arta Hoesseini
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lisa Tans
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics and Epidemiology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marinella P J Offerman
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
27
|
Qi H, Rizopoulos D, van Rosmalen J. Sample size calculation for clinical trials analyzed with the meta-analytic-predictive approach. Res Synth Methods 2023; 14:396-413. [PMID: 36625478 DOI: 10.1002/jrsm.1618] [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: 05/19/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
The meta-analytic-predictive (MAP) approach is a Bayesian method to incorporate historical controls in new trials that aims to increase the statistical power and reduce the required sample size. Here we investigate how to calculate the sample size of the new trial when historical data is available, and the MAP approach is used in the analysis. In previous applications of the MAP approach, the prior effective sample size (ESS) acted as a metric to quantify the number of subjects the historical information is worth. However, the validity of using the prior ESS in sample size calculation (i.e., reducing the number of randomized controls by the derived prior ESS) is questionable, because different approaches may yield different values for prior ESS. In this work, we propose a straightforward Monte Carlo approach to calculate the sample size that achieves the desired power in the new trial given available historical controls. To make full use of the available historical information to simulate the new trial data, the control parameters are not taken as a point estimate but sampled from the MAP prior. These sampled control parameters and the MAP prior based on the historical data are then used to derive the statistical power for the treatment effect and the resulting required sample size. The proposed sample size calculation approach is illustrated with real-life data sets with different outcomes from three studies. The results show that this approach to calculating the required sample size for the MAP analysis is straightforward and generic.
Collapse
Affiliation(s)
- Hongchao Qi
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
28
|
van den Dorpel JJA, Dremmen MHG, van der Beek NAME, Rizopoulos D, van Doorn PA, van der Ploeg AT, Muetzel RL, van den Hout JMP. Diffusion tensor imaging of the brain in Pompe disease. J Neurol 2023; 270:1662-1671. [PMID: 36480052 PMCID: PMC9971081 DOI: 10.1007/s00415-022-11506-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/28/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Abstract
Enzyme replacement therapy has drastically changed prospects of patients with Pompe disease, a progressive metabolic myopathy. As classic infantile patients survive due to treatment, they exhibit progressive white matter abnormalities, while brain involvement in late-onset patients is not fully elucidated. To study the underlying microstructure of white matter, we acquired structural (T1, T2, FLAIR) and diffusion tensor imaging (DTI) of the brain in 12 classic infantile patients (age 5-20 years) and 18 late-onset Pompe patients (age 11-56 years). Structural images were scored according to a rating scale for classic infantile patients. Fractional anisotropy (FA) and mean diffusivity (MD) from classic infantile patients were compared to a reference population, using a Wilcoxon signed-rank, one sample test. Effect sizes (Hedges' G) were used to compare DTI metrics across different tracts. For late-onset patients, results were compared to (reported) tractography data on normal aging. In classic infantile patients, we found a significant lower FA and higher MD (p < 0.01) compared to the reference population. Large-association fibers were most severely affected. Classic infantile patients with advanced white matter abnormalities on structural MRI showed the largest deviations from the reference population. FA and MD were similar for younger and older late-onset patients in large WM-association fibers. We conclude that, while no deviations from typical neurodevelopment were found in late-onset patients, classic infantile Pompe patients showed quantifiable, substantially altered white matter microstructure, which corresponded with disease stage on structural MRI. DTI holds promise to monitor therapy response in future therapies targeting the brain.
Collapse
Affiliation(s)
- Jan J. A. van den Dorpel
- grid.5645.2000000040459992XCenter for Lysosomal and Metabolic Diseases, Department of Pediatrics, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Marjolein H. G. Dremmen
- grid.5645.2000000040459992XDepartment of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nadine A. M. E. van der Beek
- grid.5645.2000000040459992XCenter for Lysosomal and Metabolic Diseases, Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- grid.5645.2000000040459992XDepartment of Biostatistics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Pieter A. van Doorn
- grid.5645.2000000040459992XCenter for Lysosomal and Metabolic Diseases, Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ans T. van der Ploeg
- grid.5645.2000000040459992XCenter for Lysosomal and Metabolic Diseases, Department of Pediatrics, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Ryan L. Muetzel
- grid.5645.2000000040459992XDepartment of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johanna M. P. van den Hout
- grid.5645.2000000040459992XCenter for Lysosomal and Metabolic Diseases, Department of Pediatrics, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| |
Collapse
|
29
|
Roumans CAM, van der Bogt RD, Nieboer D, Steyerberg EW, Rizopoulos D, Lansdorp-Vogelaar I, Biermann K, Bruno MJ, Spaander MCW. Clinical consequences of nonadherence to Barrett's esophagus surveillance recommendations: a Multicenter prospective cohort study. Dis Esophagus 2022:6964556. [PMID: 36579763 DOI: 10.1093/dote/doac113] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 11/24/2022] [Accepted: 12/10/2022] [Indexed: 12/30/2022]
Abstract
Half of Barrett's esophagus (BE) surveillance endoscopies do not adhere to guideline recommendations. In this multicenter prospective cohort study, we assessed the clinical consequences of nonadherence to recommended surveillance intervals and biopsy protocol. Data from BE surveillance patients were collected from endoscopy and pathology reports; questionnaires were distributed among endoscopists. We estimated the association between (non)adherence and (i) endoscopic curability of esophageal adenocarcinoma (EAC), (ii) mortality, and (iii) misclassification of histological diagnosis according to a multistate hidden Markov model. Potential explanatory parameters (patient, facility, endoscopist variables) for nonadherence, related to clinical impact, were analyzed. In 726 BE patients, 3802 endoscopies were performed by 167 endoscopists. Adherence to surveillance interval was 16% for non-dysplastic (ND)BE, 55% for low-grade dysplasia (LGD), and 54% of endoscopies followed the Seattle protocol. There was no evidence to support the following statements: longer surveillance intervals or fewer biopsies than recommended affect endoscopic curability of EAC or cause-specific mortality (P > 0.20); insufficient biopsies affect the probability of NDBE (OR 1.0) or LGD (OR 2.3) being misclassified as high-grade dysplasia/EAC (P > 0.05). Better adherence was associated with older patients (OR 1.1), BE segments ≤ 2 cm (OR 8.3), visible abnormalities (OR 1.8, all P ≤ 0.05), endoscopists with a subspecialty (OR 3.2), and endoscopists who deemed histological diagnosis an adequate marker (OR 2.0). Clinical consequences of nonadherence to guidelines appeared to be limited with respect to endoscopic curability of EAC and mortality. This indicates that BE surveillance recommendations should be optimized to minimize the burden of endoscopies.
Collapse
Affiliation(s)
- Carlijn A M Roumans
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ruben D van der Bogt
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Katharina Biermann
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
30
|
García-Hernandez A, Pérez T, Pardo MDC, Rizopoulos D. A flexible analytical framework for reference-based imputation, delta adjustment and tipping-point stress-testing. Stat Biopharm Res 2022. [DOI: 10.1080/19466315.2022.2151506] [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] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Teresa Pérez
- Facultad de Estudios Estadísticos, Univ. Complutense, Madrid, Spain
| | | | | |
Collapse
|
31
|
Mchunu NN, Mwambi HG, Rizopoulos D, Reddy T, Yende-Zuma N. Using joint models to study the association between CD4 count and the risk of death in TB/HIV data. BMC Med Res Methodol 2022; 22:295. [PMID: 36401214 PMCID: PMC9675185 DOI: 10.1186/s12874-022-01775-7] [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: 01/13/2022] [Accepted: 10/26/2022] [Indexed: 11/20/2022] Open
Abstract
Background The association structure linking the longitudinal and survival sub-models is of fundamental importance in the joint modeling framework and the choice of this structure should be made based on the clinical background of the study. However, this information may not always be accessible and rationale for selecting this association structure has received relatively little attention in the literature. To this end, we aim to explore four alternative functional forms of the association structure between the CD4 count and the risk of death and provide rationale for selecting the optimal association structure for our data. We also aim to compare the results obtained from the joint model to those obtained from the time-varying Cox model. Methods We used data from the Centre for the AIDS Programme of Research in South Africa (CAPRISA) AIDS Treatment programme, the Starting Antiretroviral Therapy at Three Points in Tuberculosis (SAPiT) study, an open-label, three armed randomised, controlled trial between June 2005 and July 2010 (N=642). In our analysis, we combined the early and late integrated arms and compared results to the sequential arm. We utilized the Deviance Information Criterion (DIC) to select the final model with the best structure, with smaller values indicating better model adjustments to the data. Results Patient characteristics were similar across the study arms. Combined integrated therapy arms had a reduction of 55% in mortality (HR:0.45, 95% CI:0.28-0.72) compared to the sequential therapy arm. The joint model with a cumulative effects functional form was chosen as the best association structure. In particular, our joint model found that the area under the longitudinal profile of CD4 count was strongly associated with a 21% reduction in mortality (HR:0.79, 95% CI:0.72-0.86). Where as results from the time-varying Cox model showed a 19% reduction in mortality (HR:0.81, 95% CI:0.77-0.84). Conclusions In this paper we have shown that the “current value” association structure is not always the best structure that expresses the correct relationship between the outcomes in all settings, which is why it is crucial to explore alternative clinically meaningful association structures that links the longitudinal and survival processes.
Collapse
|
32
|
Qi H, Rizopoulos D, van Rosmalen J. Incorporating historical control information in ANCOVA models using the meta-analytic-predictive approach. Res Synth Methods 2022; 13:681-696. [PMID: 35439840 PMCID: PMC9790567 DOI: 10.1002/jrsm.1561] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/09/2022] [Accepted: 04/07/2022] [Indexed: 12/31/2022]
Abstract
The meta-analytic-predictive (MAP) approach is a Bayesian meta-analytic method to synthesize and incorporate information from historical controls in the analysis of a new trial. Classically, only a single parameter, typically the intercept or rate, is assumed to vary across studies, which may not be realistic in more complex models. Analysis of covariance (ANCOVA) is often used to analyze trials with a pretest-posttest design, where both the intercept and the baseline effect (coefficient of the outcome at baseline) affect the estimated treatment effect. We extended the MAP approach to ANCOVA, to allow for variation in the intercept and the baseline effect across studies, and possibly also correlation between these parameters. The method was illustrated using data from the Alzheimer's Disease Cooperative Study (ADCS) and assessed with a simulation study. In the ADCS data, the proposed multivariate MAP approach yielded a prior effective sample size of 79 and 58 for the intercept and the baseline effect respectively and reduced the posterior standard deviation of the treatment effect by 12.6%. The result was robust to the choice of prior for the between-study variation. In the simulations, the proposed approach yielded power gains with a good control of the type I error rate. Ignoring the between-study correlation of the parameters or assuming no variation in the baseline effect generally led to less power gain. In conclusion, the MAP approach can be extended to a multivariate version for ANCOVA, which may improve the estimation of the treatment effect.
Collapse
Affiliation(s)
- Hongchao Qi
- Department of BiostatisticsErasmus University Medical CenterRotterdamthe Netherlands,Department of EpidemiologyErasmus University Medical CenterRotterdamthe Netherlands
| | - Dimitris Rizopoulos
- Department of BiostatisticsErasmus University Medical CenterRotterdamthe Netherlands,Department of EpidemiologyErasmus University Medical CenterRotterdamthe Netherlands
| | - Joost van Rosmalen
- Department of BiostatisticsErasmus University Medical CenterRotterdamthe Netherlands,Department of EpidemiologyErasmus University Medical CenterRotterdamthe Netherlands
| |
Collapse
|
33
|
Dijk SW, Steijlen OFM, Kranenburg LW, Rouwet EV, Luik AI, Bierbooms AE, Kouwenhoven-Pasmooij TA, Rizopoulos D, Swanson SA, Hoogendijk WJG, Hunink MGM. DEcrease STress through RESilience training for Students (DESTRESS) Study: Protocol for a randomized controlled trial nested in a longitudinal observational cohort study. Contemp Clin Trials 2022; 122:106928. [PMID: 36116756 DOI: 10.1016/j.cct.2022.106928] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/30/2022] [Accepted: 09/12/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Chronic stress and burnout are highly prevalent among academically trained healthcare professionals, negatively affecting their well-being and capacity to engage in their work. Resilience to stress develops early in one's career path, hence offering resilience training to university students in these professions is one approach to fostering well-being and mental health. The aim of this study is to assess whether offering mindfulness-based resilience training to university students in healthcare professions reduces their perceived chronic stress. METHODS AND ANALYSIS The study has a hybrid design combining a longitudinal observational cohort with a nested randomized controlled trial (RCT) with sequential multiple assignment and multistage adaptive interventions while taking participants' preferences into account. All students in healthcare related programmes at the Erasmus University Rotterdam are invited to participate. Within the observational cohort, students with a score of 14 or higher on the Perceived Stress Scale (PSS) are invited to take part in the RCT (n = 706). Eligible participants are randomized to control or active intervention in a ratio of 1:6. Those randomized to the control group and non-randomized participants in the cohort receive passive web-based psychoeducation about chronic stress and burnout through referral to specific websites. Participants randomized to the intervention group receive one of 8 active mindfulness-based interventions. They select a rank order of 4 preferred interventions and are randomized across these with equal probability. Non-response to the intervention is followed by sequential randomized assignment to another intervention, for a total maximum of 3 sequential interventions. All participants receive questionnaires at baseline, before and after each 8-week intervention period, and at 1- and 2-year follow-up. The primary outcome is perceived chronic stress measured with the PSS. Secondary outcomes include mental well-being, burnout, quality of life, healthcare utilization, drug use, bodyweight, mental and physical stress-related symptoms, resilience, and study progress. ETHICS AND REGISTRATION Approval from the Medical Ethics Review Committee was obtained under protocol number MEC-2018-1645. The trial is registered in the Netherlands National Trial Register by registration number NL7623, 22/03/2019, https://www.trialregister.nl/.
Collapse
Affiliation(s)
- S W Dijk
- Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Netherlands Institute for Health Sciences (NIHES), Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, the Netherlands
| | - O F M Steijlen
- Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Netherlands Institute for Health Sciences (NIHES), Rotterdam, the Netherlands
| | - L W Kranenburg
- Department of Psychiatry, Erasmus MC University Medical Center, the Netherlands
| | - E V Rouwet
- Department of Public Health, Erasmus MC University Medical Center, the Netherlands
| | - A I Luik
- Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, the Netherlands
| | - A E Bierbooms
- Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - D Rizopoulos
- Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - S A Swanson
- Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, University of Pittsburgh, Pittsburgh, United States of America
| | - W J G Hoogendijk
- Department of Psychiatry, Erasmus MC University Medical Center, the Netherlands
| | - M G M Hunink
- Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Netherlands Institute for Health Sciences (NIHES), Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, the Netherlands; Centre for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, United States of America.
| |
Collapse
|
34
|
Mulder ST, Omidvari AH, Rueten-Budde AJ, Huang PH, Kim KH, Bais B, Rousian M, Hai R, Akgun C, van Lennep JR, Willemsen S, Rijnbeek PR, Tax DM, Reinders M, Boersma E, Rizopoulos D, Visch V, Steegers-Theunissen R. Dynamic Digital Twin: Diagnosis, Treatment, Prediction, and Prevention of Disease During the Life Course. J Med Internet Res 2022; 24:e35675. [PMID: 36103220 PMCID: PMC9520391 DOI: 10.2196/35675] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
A digital twin (DT), originally defined as a virtual representation of a physical asset, system, or process, is a new concept in health care. A DT in health care is not a single technology but a domain-adapted multimodal modeling approach incorporating the acquisition, management, analysis, prediction, and interpretation of data, aiming to improve medical decision-making. However, there are many challenges and barriers that must be overcome before a DT can be used in health care. In this viewpoint paper, we build on the current literature, address these challenges, and describe a dynamic DT in health care for optimizing individual patient health care journeys, specifically for women at risk for cardiovascular complications in the preconception and pregnancy periods and across the life course. We describe how we can commit multiple domains to developing this DT. With our cross-domain definition of the DT, we aim to define future goals, trade-offs, and methods that will guide the development of the dynamic DT and implementation strategies in health care.
Collapse
Affiliation(s)
- Skander Tahar Mulder
- Pattern Recognition Lab, Mathematics and Computer Science, Technical University Delft, Delft, Netherlands
| | - Amir-Houshang Omidvari
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Pei-Hua Huang
- Department of Medical Ethics and Philosophy, Erasmus Medical Center, Rotterdam, Netherlands
| | - Ki-Hun Kim
- Department of Industrial Engineering, Pusan National University, Busan, Republic of Korea
| | - Babette Bais
- Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Melek Rousian
- Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Rihan Hai
- Web Information Systems Group, Mathematics and Computer Science, Technical University of Delft, Delft, Netherlands
| | - Can Akgun
- Web Information Systems Group, Mathematics and Computer Science, Technical University of Delft, Delft, Netherlands
- Bioelectronics Section, Department of Microelectronics, Faculty of Electrical Engineering, Technical University Delft, Delft, Netherlands
| | | | - Sten Willemsen
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, Netherlands
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, Netherlands
| | - David Mj Tax
- Pattern Recognition Lab, Mathematics and Computer Science, Technical University Delft, Delft, Netherlands
| | - Marcel Reinders
- Pattern Recognition Lab, Mathematics and Computer Science, Technical University Delft, Delft, Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Valentijn Visch
- Industrial Design, Mathematics and Computer Science, Technical University Delft, Delft, Netherlands
| | | |
Collapse
|
35
|
Jaspal RK, Allen M, Cornette J, Rizopoulos D, Lees C. Correction: Validation of Non-invasive Measurement of Cardiac Output: Using Whole-Body Bio-impedance Versus Inert Gas Rebreathing in Healthy Women Undergoing In Vitro Fertilisation. Artery Res 2022. [DOI: 10.1007/s44200-022-00021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
36
|
Meziyerh S, Tomer A, Peters-Sengers H, van der Helm D, Coemans M, Pieters T, Venhuizen JH, Haitjema S, Jan Moes D, Michels W, de Fijter H, van der Boog P, Nguyen T, Florquin S, van Zuilen A, Bemelman F, Nurmohamed A, Steyerberg E, Rizopoulos D, Naesens M, de Vries A, Kers J. 401.5: Development of High-Performing and Multicenter-Validated Dynamic Prediction Models With Longitudinal Measurements of Serum Creatinine and Proteinuria for Death-Censored Kidney Graft Failure. Transplantation 2022. [DOI: 10.1097/01.tp.0000887464.25750.3c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
37
|
Lu Z, Geurts S, Arshi B, Tilly MJ, Aribas E, Roeters van Lennep J, de Groot N, Rizopoulos D, Ikram MA, Kavousi M. Longitudinal Anthropometric Measures and Risk of New-Onset Atrial Fibrillation Among Community-Dwelling Men and Women. Mayo Clin Proc 2022; 97:1501-1511. [PMID: 35691705 DOI: 10.1016/j.mayocp.2021.12.018] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the sex-specific evolution of various anthropometric measures and the association of their longitudinal trajectories with new-onset atrial fibrillation (AF). METHODS Among 5266 men and 7218 women free of AF at baseline from the prospective population-based Rotterdam Study, each anthropometric measure was measured 1 to 5 times from 1989 to 2014. Anthropometric measures were standardized to obtain hazard ratios per 1 SD increase to enable comparison. Joint models were used to assess the longitudinal association between anthropometric measures and incident AF. Use of the joint models is a preferred method for simultaneous analyses of repeated measurements and survival data for conferring less biased estimates. RESULTS Mean (SD) age was 63.9 (8.9) years for men and 64.9 (9.8) years for women. Median follow-up time was 10.5 years. Longitudinal evolution of weight, height, waist circumference, hip circumference, and body mass index was associated with an increased risk of new-onset AF in both men and women. In joint models, larger height in men (hazard ratio [95% credible interval] per 1 SD, 1.27 [1.17 to 1.38]) and weight in women (1.24 [1.16 to 1.34]) showed the largest associations with AF. In joint models, waist to hip ratio was significantly associated with incident AF only in women (1.10 [1.03 to 1.18]). CONCLUSION Considering the entire longitudinal trajectories in joint models, anthropometric measures were positively associated with an increased risk for new-onset AF among men and women in the general population. Increase in measure of central obesity showed a stronger association with increased risk of AF onset among women compared with men.
Collapse
Affiliation(s)
- Zuolin Lu
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Sven Geurts
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Banafsheh Arshi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Martijn J Tilly
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Elif Aribas
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | | | - Natasja de Groot
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| |
Collapse
|
38
|
Tong-Minh K, van der Does Y, van Rosmalen J, Ramakers C, Gommers D, van Gorp E, Rizopoulos D, Endeman H. Joint Modeling of Repeated Measurements of Different Biomarkers Predicts Mortality in COVID-19 Patients in the Intensive Care Unit. Biomark Insights 2022; 17:11772719221112370. [PMID: 35859926 PMCID: PMC9290097 DOI: 10.1177/11772719221112370] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/21/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction: Predicting disease severity is important for treatment decisions in patients with COVID-19 in the intensive care unit (ICU). Different biomarkers have been investigated in COVID-19 as predictor of mortality, including C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and soluble urokinase-type plasminogen activator receptor (suPAR). Using repeated measurements in a prediction model may result in a more accurate risk prediction than the use of single point measurements. The goal of this study is to investigate the predictive value of trends in repeated measurements of CRP, PCT, IL-6, and suPAR on mortality in patients admitted to the ICU with COVID-19. Methods: This was a retrospective single center cohort study. Patients were included if they tested positive for SARS-CoV-2 by PCR test and if IL-6, PCT, suPAR was measured during any of the ICU admission days. There were no exclusion criteria for this study. We used joint models to predict ICU-mortality. This analysis was done using the framework of joint models for longitudinal and survival data. The reported hazard ratios express the relative change in the risk of death resulting from a doubling or 20% increase of the biomarker’s value in a day compared to no change in the same period. Results: A total of 107 patients were included, of which 26 died during ICU admission. Adjusted for sex and age, a doubling in the next day in either levels of PCT, IL-6, and suPAR were significantly predictive of in-hospital mortality with HRs of 1.523 (1.012-6.540), 75.25 (1.116-6247), and 24.45 (1.696-1057) respectively. With a 20% increase in biomarker value in a subsequent day, the HR of PCT, IL-6, and suPAR were 1.117 (1.03-1.639), 3.116 (1.029-9.963), and 2.319 (1.149-6.243) respectively. Conclusion: Joint models for the analysis of repeated measurements of PCT, suPAR, and IL-6 are a useful method for predicting mortality in COVID-19 patients in the ICU. Patients with an increasing trend of biomarker levels in consecutive days are at increased risk for mortality.
Collapse
Affiliation(s)
- Kirby Tong-Minh
- Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yuri van der Does
- Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christian Ramakers
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Diederik Gommers
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eric van Gorp
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Henrik Endeman
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
39
|
Roumans CAM, Zellenrath PA, Steyerberg EW, Lansdorp-Vogelaar I, Doukas M, Biermann K, Alderliesten J, van Ingen G, Nagengast WB, Karrenbeld A, ter Borg F, Hage M, ter Borg PCJ, den Bakker MA, Alkhalaf A, Moll FCP, Brouwer-Hol L, van Baarlen J, Quispel R, van Tilburg A, Burger JPW, van Tilburg AJP, Ooms AHAG, Tang TJ, Romberg-Camps MJL, Goudkade D, Bruno MJ, Rizopoulos D, Spaander MCW. Sex Differences in Neoplastic Progression in Barrett’s Esophagus: A Multicenter Prospective Cohort Study. Cancers (Basel) 2022; 14:cancers14133240. [PMID: 35805012 PMCID: PMC9264818 DOI: 10.3390/cancers14133240] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/20/2022] [Accepted: 06/27/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Barrett’s esophagus (BE) is the only known precursor lesion of esophageal adenocarcinoma (EAC). Endoscopic surveillance plays an important role in the timely detection of neoplastic progression. However, the cost-effectiveness of current surveillance strategies is debatable. Previous studies have shown that male Barrett’s patients have lower neoplastic progression risk than females. However, these studies do not provide a more practical translation of these sex disparities into different surveillance intervals. The current multicenter prospective cohort study aimed to evaluate sex differences in 868 BE patients; not only with respect to neoplastic progression risk, but also concerning the difference in time to detection of high-grade dysplasia (HGD)/EAC: time to neoplastic progression was estimated to be almost twice as low in males than in females. In contrast, the stage of neoplasia appeared to be higher in females. Our results can guide future discussions for sex-specific guidelines, supporting the implementation of neoplastic risk stratification per individual patient in BE surveillance. Abstract Recommendations in Barrett’s esophagus (BE) guidelines are mainly based on male patients. We aimed to evaluate sex differences in BE patients in (1) probability of and (2) time to neoplastic progression, and (3) differences in the stage distribution of neoplasia. We conducted a multicenter prospective cohort study including 868 BE patients. Cox regression modeling and accelerated failure time modeling were used to estimate the sex differences. Neoplastic progression was defined as high-grade dysplasia (HGD) and/or esophageal adenocarcinoma (EAC). Among the 639 (74%) males and 229 females that were included (median follow-up 7.1 years), 61 (7.0%) developed HGD/EAC. Neoplastic progression risk was estimated to be twice as high among males (HR 2.26, 95% CI 1.11–4.62) than females. The risk of HGD was found to be higher in males (HR 3.76, 95% CI 1.33–10.6). Time to HGD/EAC (AR 0.52, 95% CI 0.29–0.95) and HGD (AR 0.40, 95% CI 0.19–0.86) was shorter in males. Females had proportionally more EAC than HGD and tended to have higher stages of neoplasia at diagnosis. In conclusion, both the risk of and time to neoplastic progression were higher in males. However, females were proportionally more often diagnosed with (advanced) EAC. We should strive for improved neoplastic risk stratification per individual BE patient, incorporating sex disparities into new prediction models.
Collapse
Affiliation(s)
- Carlijn A. M. Roumans
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.A.M.R.); (P.A.Z.); (M.J.B.)
- Department of Public Health, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (E.W.S.); (I.L.-V.)
| | - Pauline A. Zellenrath
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.A.M.R.); (P.A.Z.); (M.J.B.)
| | - Ewout W. Steyerberg
- Department of Public Health, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (E.W.S.); (I.L.-V.)
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (E.W.S.); (I.L.-V.)
| | - Michael Doukas
- Department of Pathology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (M.D.); (K.B.); (A.H.A.G.O.)
| | - Katharina Biermann
- Department of Pathology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (M.D.); (K.B.); (A.H.A.G.O.)
| | - Joyce Alderliesten
- Department of Gastroenterology & Hepatology, Albert Schweitzer Ziekenhuis, 3318 AT Dordrecht, The Netherlands;
| | - Gert van Ingen
- Laboratorium voor Pathologie, 3318 AL Dordrecht, The Netherlands;
| | - Wouter B. Nagengast
- Department of Gastroenterology & Hepatology, Groningen University Medical Center, 9713 GZ Groningen, The Netherlands;
| | - Arend Karrenbeld
- Department of Pathology, Groningen University Medical Center, 9713 GZ Groningen, The Netherlands;
| | - Frank ter Borg
- Department of Gastroenterology & Hepatology, Deventer Ziekenhuis, 7416 SE Deventer, The Netherlands;
| | - Mariska Hage
- Department of Pathology, Deventer Ziekenhuis, 7416 SE Deventer, The Netherlands;
| | - Pieter C. J. ter Borg
- Department of Gastroenterology & Hepatology, Ikazia Ziekenhuis, 3083 AN Rotterdam, The Netherlands;
| | - Michael A. den Bakker
- Department of Pathology, Ikazia Ziekenhuis, 3083 AN Rotterdam, The Netherlands;
- Department of Pathology, Maasstad Ziekenhuis, 3079 DZ Rotterdam, The Netherlands
| | - Alaa Alkhalaf
- Department of Gastroenterology & Hepatology, Isala Klinieken Zwolle, 8025 AB Zwolle, The Netherlands;
| | - Frank C. P. Moll
- Department of Pathology, Isala Klinieken Zwolle, 8025 AB Zwolle, The Netherlands;
| | - Lieke Brouwer-Hol
- Department of Gastroenterology & Hepatology, Maasstad Ziekenhuis, 3079 DZ Rotterdam, The Netherlands;
| | - Joop van Baarlen
- Department of Pathology, Medisch Spectrum Twente, 7512 KZ Enschede, The Netherlands;
- Laboratorium Pathologie Oost-Nederland, 7555 BB Hengelo, The Netherlands
| | - Rutger Quispel
- Department of Gastroenterology & Hepatology, Reinier de Graaf Gasthuis, 2625 AD Delft, The Netherlands;
| | - Arjan van Tilburg
- Department of Pathology, Reinier de Graaf Gasthuis, 2625 AD Delft, The Netherlands;
| | - Jordy P. W. Burger
- Department of Gastroenterology & Hepatology, Rijnstate Ziekenhuis, 6815 AD Arnhem, The Netherlands;
| | - Antonie J. P. van Tilburg
- Department of Gastroenterology & Hepatology, Franciscus Gasthuis & Vlietland, 3045 PM Rotterdam, The Netherlands;
| | - Ariadne H. A. G. Ooms
- Department of Pathology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (M.D.); (K.B.); (A.H.A.G.O.)
- Pathan, Pathologisch Laboratorium, 3045 PM Rotterdam, The Netherlands
| | - Thjon J. Tang
- Department of Gastroenterology & Hepatology, IJsselland Ziekenhuis, 2906 ZC Capelle a/d Ijssel, The Netherlands;
| | | | - Danny Goudkade
- Department of Pathology, Zuyderland Medisch Centrum, 6162 BG Sittard, The Netherlands;
| | - Marco J. Bruno
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.A.M.R.); (P.A.Z.); (M.J.B.)
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Manon C. W. Spaander
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands; (C.A.M.R.); (P.A.Z.); (M.J.B.)
- Correspondence: ; Tel.: +31-(0)-653437026
| |
Collapse
|
40
|
de Lange I, Petersen TB, de Bakker M, Akkerhuis KM, Brugts JJ, Caliskan K, Manintveld OC, Constantinescu AA, Germans T, van Ramshorst J, Umans VAWM, Boersma E, Rizopoulos D, Kardys I. Heart failure subphenotypes based on repeated biomarker measurements are associated with clinical characteristics and adverse events (Bio-SHiFT study). Int J Cardiol 2022; 364:77-84. [PMID: 35714717 DOI: 10.1016/j.ijcard.2022.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/11/2022] [Revised: 05/27/2022] [Accepted: 06/10/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study aimed to identify heart failure (HF) subphenotypes using 92 repeatedly measured circulating proteins in 250 patients with heart failure with reduced ejection fraction, and to investigate their clinical characteristics and prognosis. METHODS Clinical data and blood samples were collected tri-monthly until the primary endpoint (PEP) or censoring occurred, with a maximum of 11 visits. The Olink Cardiovascular III panel was measured in baseline samples and the last two samples before the PEP (in 66 PEP cases), or the last sample before censoring (in 184 PEP-free patients). The PEP comprised cardiovascular death, heart transplantation, Left Ventricular Assist Device implantation, and hospitalization for HF. Cluster analysis was performed on individual biomarker trajectories to identify subphenotypes. Then biomarker profiles and clinical characteristics were investigated, and survival analysis was conducted. RESULTS Clustering revealed three clinically diverse subphenotypes. Cluster 3 was older, with a longer duration of, and more advanced HF, and most comorbidities. Cluster 2 showed increasing levels over time of most biomarkers. In cluster 3, there were elevated baseline levels and increasing levels over time of 16 remaining biomarkers. Median follow-up was 2.2 (1.4-2.5) years. Cluster 3 had a significantly poorer prognosis compared to cluster 1 (adjusted event-free survival time ratio 0.25 (95%CI:0.12-0.50), p < 0.001). Repeated measurements clusters showed incremental prognostic value compared to clusters using single measurements, or clinical characteristics only. CONCLUSIONS Clustering based on repeated biomarker measurements revealed three clinically diverse subphenotypes, of which one has a significantly worse prognosis, therefore contributing to improved (individualized) prognostication.
Collapse
Affiliation(s)
- Iris de Lange
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Teun B Petersen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marie de Bakker
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Tjeerd Germans
- Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands
| | - Jan van Ramshorst
- Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands
| | | | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| |
Collapse
|
41
|
Minderhoud SCS, Fletcher AJ, MacNaught G, Cadet S, Korteland SA, Kardys I, Rizopoulos D, Slomka P, Newby DE, Roos-Hesselink JW, Walker NL, Semple S, Hirsch A, Dweck MR, Wentzel JJ. Vascular biomechanics and molecular disease activity in the thoracic aorta: a novel imaging method. Eur Heart J Cardiovasc Imaging 2022; 23:1698-1707. [PMID: 35666823 PMCID: PMC9671295 DOI: 10.1093/ehjci/jeac090] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/08/2022] [Accepted: 04/28/2022] [Indexed: 12/03/2022] Open
Abstract
AIMS The influence haemodynamics have on vessel wall pathobiology in aortic disease is incomplete. This aim of this study was to develop a repeatable method for assessing the relationship between aortic wall shear stress (WSS) and disease activity by fusing 4D flow cardiovascular magnetic resonance (CMR) with hybrid positron emission tomography (PET). METHODS AND RESULTS As part of an ongoing clinical trial, patients with bicuspid aortic valve (BAV) were prospectively imaged with both 18F-sodium fluoride (18F-NaF) PET, a marker of calcification activity, and 4D flow CMR. We developed novel software allowing accurate 3D co-registration and high-resolution comparison of aortic peak systolic WSS and 18F-NaF PET uptake (maximum tissue-to-background ratio). Intra-observer repeatability of both measurements was determined using Bland-Altman plots and intra-class correlation coefficients (ICCs). The relationship between localized WSS and 18F-NaF uptake was analysed using linear mixed-effect models. Twenty-three patients with BAV (median age 50 [44-55] years, 22% female) were included. Intra-observer repeatability for WSS (ICC = 0.92) and 18F-NaF (ICC = 0.91) measurements obtained within 1.4 ± 0.6 cm2 regions of interest was excellent. On multivariable analysis, 18F-NaF PET uptake was independently and negatively associated with WSS as well as diastolic blood pressure (both P < 0.05), adjusted for age. CONCLUSION Fused assessment of WSS and 18F-NaF PET uptake is feasible and repeatable, demonstrating a clear association between these two factors. This high spatial resolution approach has major potential to advance our understanding of the relationship between vascular haemodynamics and disease activity.
Collapse
Affiliation(s)
| | | | - Gillian MacNaught
- Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, EH16 4TJ Edinburgh, UK
| | - Sebastien Cadet
- Department of Imaging (Division of Nuclear Cardiology), Cedars-Sinai Medical Centre, CA 90048 Los Angeles, CA, USA
| | - Suze-Anne Korteland
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Piotr Slomka
- Department of Imaging (Division of Nuclear Cardiology), Cedars-Sinai Medical Centre, CA 90048 Los Angeles, CA, USA
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH16 4SB, UK
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Niki L Walker
- Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital, G81 4DY Clydebank, UK
| | - Scott Semple
- Edinburgh Imaging Facility, Queens Medical Research Institute, University of Edinburgh, EH16 4TJ Edinburgh, UK
| | - Alexander Hirsch
- Department of Cardiology, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | | | | |
Collapse
|
42
|
van Oudenhoven FM, Swinkels SHN, Hartmann T, Rizopoulos D. Modeling the underlying biological processes in Alzheimer's disease using a multivariate competing risk joint model. Stat Med 2022; 41:3421-3433. [PMID: 35582814 PMCID: PMC9545329 DOI: 10.1002/sim.9425] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/14/2021] [Revised: 02/15/2022] [Accepted: 04/03/2022] [Indexed: 11/17/2022]
Abstract
Many clinical trials repeatedly measure several longitudinal outcomes on patients. Patient follow‐up can discontinue due to an outcome‐dependent event, such as clinical diagnosis, death, or dropout. Joint modeling is a popular choice for the analysis of this type of data. Using example data from a prodromal Alzheimer's disease trial, we propose a new type of multivariate joint model in which longitudinal brain imaging outcomes and memory impairment ratings are allowed to be associated both with time to open‐label medication and dropout, and where the brain imaging outcomes may also directly affect the memory impairment ratings. Existing joint models for multivariate longitudinal outcomes account for the correlation between the longitudinal outcomes through the random effects, often by assuming a multivariate normal distribution. However, for these models, it is difficult to interpret how the longitudinal outcomes affect each other. We model the dependence between the longitudinal outcomes differently so that a first longitudinal outcome affects a second one. Specifically, for each longitudinal outcome, we use a linear mixed‐effects model to estimate its trajectory, where, for the second longitudinal outcome, we include the linear predictor of the first outcome as a time‐varying covariate. This facilitates an easy and direct interpretation of the association between the longitudinal outcomes and provides a framework for latent mediation analysis to understand the underlying biological processes. For the trial considered here, we found that part of the intervention effect is mediated through hippocampal brain atrophy. The proposed joint models are fitted using a Bayesian framework via MCMC simulation.
Collapse
Affiliation(s)
- Floor M van Oudenhoven
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,Danone Nutricia Research, Utrecht, The Netherlands
| | | | - Tobias Hartmann
- German Institute for Dementia Prevention (DIDP), Saarland University, Homburg, Germany.,Department of Experimental Neurology, Saarland University, Homburg, Germany
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| |
Collapse
|
43
|
Arshi B, Geurts S, Tilly MJ, van den Berg M, Kors JA, Rizopoulos D, Ikram MA, Kavousi M. Heart rate variability is associated with left ventricular systolic, diastolic function and incident heart failure in the general population. BMC Med 2022; 20:91. [PMID: 35189879 PMCID: PMC8862241 DOI: 10.1186/s12916-022-02273-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/24/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND HRV has mostly shown associations with systolic dysfunction and more recently, with diastolic dysfunction in Heart failure (HF) patients. But the role of sympathetic nervous system in changes of left ventricular (LV) systolic and diastolic function and new-onset HF has not been extensively studied. METHODS Among 3157 men and 4405 women free of HF and atrial fibrillation retrospectively included from the population-based Rotterdam Study, we used linear mixed models to examine associations of RR-interval differences and standard deviation of RR-intervals corrected for heart rate (RMSSDc and SDNNc) with longitudinal changes of LV ejection fraction (LVEF), E/A ratio, left atrial (LA) diameter, E/e' ratio. Afterwards, using cox regressions, we examined their association with new-onset HF. RESULTS Mean (SD) age was 65 (9.95) in men and 65.7 (10.2) in women. Every unit increase in log RMSSDc was accompanied by 0.75% (95%CI:-1.11%;-0.39%) and 0.31% (- 0.60%;-0.01%) lower LVEF among men and women each year, respectively. Higher log RMSSDc was linked to 0.03 (- 0.04;-0.01) and 0.02 (- 0.03;-0.003) lower E/A and also - 1.76 (- 2.77;- 0.75) and - 1.18 (- 1.99;-0.38) lower LVM index in both sexes and 0.72 mm (95% CI: - 1.20;-0.25) smaller LA diameters in women. The associations with LVEF in women diminished after excluding HF cases during the first 3 years of follow-up. During a median follow-up of 8.7 years, hazard ratios (95%CI) for incident HF were 1.34 (1.08;1.65) for log RMSSDc in men and 1.15 (0.93;1.42) in women. SDNNc showed similar associations. CONCLUSIONS Indices of HRV were associated with worse systolic function in men but mainly with improvement in LA size in women. Higher HRV was associated with higher risk of new-onset HF in men. Our findings highlight potential sex differences in autonomic function underlying cardiac dysfunction and heart failure in the general population.
Collapse
Affiliation(s)
- Banafsheh Arshi
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sven Geurts
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Martijn J Tilly
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marten van den Berg
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan A Kors
- Department of Medical Informatics, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
| |
Collapse
|
44
|
Klimczak-Tomaniak D, de Bakker M, Bouwens E, Akkerhuis KM, Baart S, Rizopoulos D, Mouthaan H, van Ramshorst J, Germans T, Constantinescu A, Manintveld O, Umans V, Boersma E, Kardys I. Dynamic personalized risk prediction in chronic heart failure patients: a longitudinal, clinical investigation of 92 biomarkers (Bio-SHiFT study). Sci Rep 2022; 12:2795. [PMID: 35181700 PMCID: PMC8857321 DOI: 10.1038/s41598-022-06698-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 06/04/2021] [Accepted: 02/02/2022] [Indexed: 11/28/2022] Open
Abstract
The aim of our observational study was to derive a small set out of 92 repeatedly measured biomarkers with optimal predictive capacity for adverse clinical events in heart failure, which could be used for dynamic, individual risk assessment in clinical practice. In 250 chronic HFrEF (CHF) patients, we collected trimonthly blood samples during a median of 2.2 years. We selected 537 samples for repeated measurement of 92 biomarkers with the Cardiovascular Panel III (Olink Proteomics AB). We applied Least Absolute Shrinkage and Selection Operator (LASSO) penalization to select the optimal set of predictors of the primary endpoint (PE). The association between repeatedly measured levels of selected biomarkers and the PE was evaluated by multivariable joint models (mvJM) with stratified fivefold cross validation of the area under the curve (cvAUC). The PE occurred in 66(27%) patients. The optimal set of biomarkers selected by LASSO included 9 proteins: NT-proBNP, ST2, vWF, FABP4, IGFBP-1, PAI-1, PON-3, transferrin receptor protein-1, and chitotriosidase-1, that yielded a cvAUC of 0.88, outperforming the discriminative ability of models consisting of standard biomarkers (NT-proBNP, hs-TnT, eGFR clinically adjusted) − 0.82 and performing equally well as an extended literature-based set of acknowledged biomarkers (NT-proBNP, hs-TnT, hs-CRP, GDF-15, ST2, PAI-1, Galectin 3) − 0.88. Nine out of 92 serially measured circulating proteins provided a multivariable model for adverse clinical events in CHF patients with high discriminative ability. These proteins reflect wall stress, remodelling, endothelial dysfunction, iron deficiency, haemostasis/fibrinolysis and innate immunity activation. A panel containing these proteins could contribute to dynamic, personalized risk assessment. Clinical Trial Registration: 10/05/2013 https://clinicaltrials.gov/ct2/show/NCT01851538?term=nCT01851538&draw=2&rank=1.
Collapse
Affiliation(s)
- Dominika Klimczak-Tomaniak
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Room NA-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Cardiology, Hypertension and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Marie de Bakker
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Room NA-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Elke Bouwens
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Room NA-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Room NA-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Sara Baart
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Jan van Ramshorst
- Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Tjeerd Germans
- Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Alina Constantinescu
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Room NA-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Olivier Manintveld
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Room NA-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Victor Umans
- Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Room NA-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Room NA-316, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| |
Collapse
|
45
|
van der Burgh AC, Stricker BH, Rizopoulos D, Ikram MA, Hoorn EJ, Chaker L. Kidney function and the risk of sudden cardiac death in the general population. Clin Kidney J 2022; 15:1524-1533. [PMID: 35892020 PMCID: PMC9308098 DOI: 10.1093/ckj/sfac049] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background Chronic kidney disease increases sudden cardiac death (SCD) risk, but the association between kidney function and SCD in a general population is largely unknown. Therefore, we investigated the association between kidney function and SCD in a general middle-aged and elderly population. Methods We included individuals aged ≥45 years from a prospective population-based cohort study. The association between kidney function assessments [estimated glomerular filtration rate based on serum creatinine (eGFRcreat), cystatin C (eGFRcys) or both (eGFRcreat-cys)] and SCD was investigated using Cox proportional-hazards and joint models. Absolute 10-year risks were computed using competing risk analyses. Mediation analyses were performed using a four-way decomposition method. Results We included 9687 participants (median follow-up 8.9 years; mean age 65.3 years; 56.7% women; 243 SCD cases). Lower eGFRcys and eGFRcreat-cys were associated with increased SCD risk [hazard ratio (HR) 1.23, 95% confidence interval (CI) 1.12–1.34 and HR 1.17, 95% CI 1.06–1.29, per 10 mL/min/1.73 m2 eGFR decrease]. A significant trend (P = 0.001) across eGFRcys categories was found, with an HR of 2.11 (95% CI 1.19–3.74) for eGFRcys <60 compared with eGFRcys >90 mL/min/1.73 m2. Comparing eGFRcys of 90 to 60 mL/min/1.73 m2, absolute 10-year risk increased from 1.0% to 2.5%. Identified subgroups at increased risk included older participants and participants with atrial fibrillation. The associations were not mediated by coronary heart disease, hypertension or diabetes. Conclusions Reduced kidney function is associated with increased SCD risk in the general population, especially with eGFRcys. eGFRcys could be added to prediction models and screening programmes for SCD prevention.
Collapse
Affiliation(s)
- Anna C van der Burgh
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ewout J Hoorn
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Layal Chaker
- Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
46
|
Tomer A, Nieboer D, Roobol MJ, Steyerberg EW, Rizopoulos D. Shared decision making of burdensome surveillance tests using personalized schedules and their burden and benefit. Stat Med 2022; 41:2115-2131. [PMID: 35146793 PMCID: PMC9305929 DOI: 10.1002/sim.9347] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 01/18/2022] [Accepted: 01/23/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Anirudh Tomer
- Department of Biostatistics Erasmus University Medical Center Rotterdam Zuid‐Holland The Netherlands
| | - Daan Nieboer
- Department of Public Health Erasmus University Medical Center Rotterdam Zuid‐Holland The Netherlands
- Department of Urology Erasmus University Medical Center Rotterdam Zuid‐Holland The Netherlands
| | - Monique J. Roobol
- Department of Urology Erasmus University Medical Center Rotterdam Zuid‐Holland The Netherlands
| | - Ewout W. Steyerberg
- Department of Public Health Erasmus University Medical Center Rotterdam Zuid‐Holland The Netherlands
- Department of Biomedical Data Sciences Leiden University Medical Center Leiden Zuid‐Holland The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics Erasmus University Medical Center Rotterdam Zuid‐Holland The Netherlands
| |
Collapse
|
47
|
Qi H, Rizopoulos D, Lesaffre E, van Rosmalen J. Incorporating historical controls in clinical trials with longitudinal outcomes using the modified power prior. Pharm Stat 2022; 21:818-834. [PMID: 35128780 PMCID: PMC9356117 DOI: 10.1002/pst.2195] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/12/2022] [Accepted: 01/22/2022] [Indexed: 11/16/2022]
Abstract
Several dynamic borrowing methods, such as the modified power prior (MPP), the commensurate prior, have been proposed to increase statistical power and reduce the required sample size in clinical trials where comparable historical controls are available. Most methods have focused on cross‐sectional endpoints, and appropriate methodology for longitudinal outcomes is lacking. In this study, we extend the MPP to the linear mixed model (LMM). An important question is whether the MPP should use the conditional version of the LMM (given the random effects) or the marginal version (averaged over the distribution of the random effects), which we refer to as the conditional MPP and the marginal MPP, respectively. We evaluated the MPP for one historical control arm via a simulation study and an analysis of the data of Alzheimer's Disease Cooperative Study (ADCS) with the commensurate prior as the comparator. The conditional MPP led to inflated type I error rate when there existed moderate or high between‐study heterogeneity. The marginal MPP and the commensurate prior yielded a power gain (3.6%–10.4% vs. 0.6%–4.6%) with the type I error rates close to 5% (5.2%–6.2% vs. 3.8%–6.2%) when the between‐study heterogeneity is not excessively high. For the ADCS data, all the borrowing methods improved the precision of estimates and provided the same clinical conclusions. The marginal MPP and the commensurate prior are useful for borrowing historical controls in longitudinal data analysis, while the conditional MPP is not recommended due to inflated type I error rates.
Collapse
Affiliation(s)
- Hongchao Qi
- Department of BiostatisticsErasmus University Medical CenterRotterdamThe Netherlands
- Department of EpidemiologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Dimitris Rizopoulos
- Department of BiostatisticsErasmus University Medical CenterRotterdamThe Netherlands
- Department of EpidemiologyErasmus University Medical CenterRotterdamThe Netherlands
| | | | - Joost van Rosmalen
- Department of BiostatisticsErasmus University Medical CenterRotterdamThe Netherlands
- Department of EpidemiologyErasmus University Medical CenterRotterdamThe Netherlands
| |
Collapse
|
48
|
Dommershuijsen LJ, Ruiter R, Erler NS, Rizopoulos D, Ikram MA, Ikram MK. Peripheral Immune Cell Numbers and C-Reactive Protein in Parkinson's Disease: Results from a Population-Based Study. J Parkinsons Dis 2022; 12:667-678. [PMID: 34897101 PMCID: PMC8925126 DOI: 10.3233/jpd-212914] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
BACKGROUND The immune system is known to be involved in Parkinson's disease (PD) pathogenesis, but the temporal relationship between peripheral immune responses and PD remains unknown. OBJECTIVE We determined the association between peripheral immune cell numbers, C-reactive protein (CRP), and prevalent as well as incident PD. METHODS This study was embedded in the population-based setting of the Rotterdam Study. We repeatedly measured peripheral immune cell numbers (differential leukocyte count and platelet count, granulocyte-to-lymphocyte ratio [GLR], platelet-to-lymphocyte ratio [PLR], and adapted systemic immune-inflammation index [adapted SII]) and CRP between 1990 and 2016. Participants were continuously followed-up for PD until 2018. We estimated the association of the markers with prevalent and incident PD using logistic regression models and joint models, respectively. Models were adjusted for age, sex, smoking, body mass index, and medication use. Odds ratios (OR) and hazard ratios (HR) are shown per doubling of the marker. RESULTS A total of 12,642 participants were included in this study. The mean age (standard deviation) was 65.1 (9.8) years and 57.5%were women. Participants with a higher lymphocyte count were less likely to have prevalent PD (adjusted OR: 0.34, 95%CI 0.17-0.68). Participants with a higher GLR, PLR, and adapted SII were more likely to have prevalent PD, but these effects were explained by the lymphocyte count. The peripheral immune cell numbers and CRP were not significantly associated with the risk of incident PD. CONCLUSION We found participants with a higher lymphocyte count to be less likely to have prevalent PD, but we did not find an association between peripheral immune cell numbers nor CRP and the risk of incident PD.
Collapse
Affiliation(s)
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Nicole S. Erler
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Dimitris Rizopoulos
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M. Kamran Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Correspondence to: M. Kamran Ikram, MD, PhD, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands. Tel.: +31 107043488; E-mail:
| |
Collapse
|
49
|
van de Beeten SDC, Ramdas WD, Yang S, Loudon SE, den Ottelander BK, Rizopoulos D, van Veelen MLC, Mathijssen IMJ. The use of OCT to detect signs of intracranial hypertension in patients with sagittal suture synostosis: Reference values and correlations. Childs Nerv Syst 2022; 38:1937-1947. [PMID: 35972534 PMCID: PMC9522733 DOI: 10.1007/s00381-022-05598-1] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/01/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To obtain pediatric normative reference values and determine whether optical coherence tomography (OCT) corresponds better with clinical signs of intracranial hypertension (ICH) compared to the traditional screening method fundoscopy in a large cohort of one type of single suture craniosynostosis. METHODS Control subjects without optic nerve diseases and isolated sagittal synostosis patients aged 3-10 years who underwent fundoscopy and OCT were included in this prospective cohort study. Normative reference values were obtained through bootstrap analysis. Main outcome was the association between peripapillary total retinal thickness (TRT) and total retinal volume (TRV) and appearance on fundoscopy. Signs and symptoms suggestive of ICH, including skull growth arrest, fingerprinting, and headache, were scored. RESULTS Sixty-four healthy controls and 93 isolated sagittal synostosis patients were included. Normative cut-off values for mean TRT are < 256 μm and > 504 μm and for mean TRV < 0.21 mm3 and > 0.39 mm3. TRT was increased in 16 (17%) and TRV in 15 (16%) of 93 patients, compared to only 4 patients with papilledema on fundoscopy (4%). Both parameters were associated with papilledema on fundoscopy (OR = 16.7, p = 0.02, and OR = 18.2, p = 0.01). Skull growth arrest was significantly associated with abnormal OCT parameters (OR = 13.65, p < 0.01). CONCLUSIONS The established cut-off points can be applied to screen for ICH in pediatrics. The present study detected abnormalities with OCT more frequent than with fundoscopy, which were associated with skull growth arrest. Therefore, a combination of OCT, fundoscopy, and skull growth arrest can improve clinical decision-making in craniosynostosis.
Collapse
Affiliation(s)
- Stephanie D C van de Beeten
- Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Room EE-1591, Postbus 2040, 3000 CA, Wytemaweg 80, 2015 CN, Rotterdam, The Netherlands.
| | - Wishal D Ramdas
- Department of Ophthalmology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Sumin Yang
- Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Room EE-1591, Postbus 2040, 3000 CA, Wytemaweg 80, 2015 CN, Rotterdam, The Netherlands
| | - Sjoukje E Loudon
- Department of Ophthalmology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Bianca K den Ottelander
- Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Room EE-1591, Postbus 2040, 3000 CA, Wytemaweg 80, 2015 CN, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Marie-Lise C van Veelen
- Department of Neurosurgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Room SK-1204, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Irene M J Mathijssen
- Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Room EE-1591, Postbus 2040, 3000 CA, Wytemaweg 80, 2015 CN, Rotterdam, The Netherlands
| |
Collapse
|
50
|
Gerritsen SE, van Bodegom LS, Dieleman GC, Overbeek MM, Verhulst FC, Wolke D, Rizopoulos D, Appleton R, van Amelsvoort TAMJ, Bodier Rethore C, Bonnet-Brilhault F, Charvin I, Da Fonseca D, Davidović N, Dodig-Ćurković K, Ferrari A, Fiori F, Franić T, Gatherer C, de Girolamo G, Heaney N, Hendrickx G, Jardri R, Kolozsvari A, Lida-Pulik H, Lievesley K, Madan J, Mastroianni M, Maurice V, McNicholas F, Nacinovich R, Parenti A, Paul M, Purper-Ouakil D, Rivolta L, de Roeck V, Russet F, Saam MC, Sagar-Ouriaghli I, Santosh PJ, Sartor A, Schulze UME, Scocco P, Signorini G, Singh SP, Singh J, Speranza M, Stagi P, Stagni P, Street C, Tah P, Tanase E, Tremmery S, Tuffrey A, Tuomainen H, Walker L, Wilson A, Maras A. Demographic, clinical, and service-use characteristics related to the clinician's recommendation to transition from child to adult mental health services. Soc Psychiatry Psychiatr Epidemiol 2022; 57:973-991. [PMID: 35146551 PMCID: PMC9042957 DOI: 10.1007/s00127-022-02238-6] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/22/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians' advice to continue treatment at AMHS. METHODS Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians' transition recommendations. RESULTS Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS. CONCLUSION Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate services.
Collapse
Affiliation(s)
- S E Gerritsen
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - L S van Bodegom
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
| | - G C Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.
| | - M M Overbeek
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
- Clinical Child and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - F C Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - D Wolke
- Department of Psychology, University of Warwick, Coventry, UK
| | - D Rizopoulos
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - T A M J van Amelsvoort
- Department of Psychiatry and Neuropsychology, University of Maastricht, Maastricht, The Netherlands
- Mondriaan Mental Health Care, Heerlen, The Netherlands
| | | | | | - I Charvin
- Centre Hospitalier Universitaire de Marseille, Marseille, France
| | - D Da Fonseca
- Centre Hospitalier Universitaire de Marseille, Marseille, France
| | - N Davidović
- University Hospital Split, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - K Dodig-Ćurković
- Faculty for Dental Care and Health, Osijek, Croatia
- University Health Center Osijek, Osijek, Croatia
- Unit for Child and Adolescent Psychiatry, Osijek, Croatia
| | - A Ferrari
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- DISM, ULSS 16, SOPROXI Onlus, Padua, Italy
| | - F Fiori
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
- HealthTracker Ltd, Kent, UK
| | - T Franić
- University Hospital Split, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - C Gatherer
- Warwick Medical School, University of Warwick, Coventry, UK
| | - G de Girolamo
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - N Heaney
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - G Hendrickx
- Department of Neurosciences, Centre for Clinical Psychiatry, KU Leuven, Leuven, Belgium
| | - R Jardri
- Lille Neurosciences and Cognitions, Plasticity and Subjectivity Team, CURE Platform, Université de Lille, INSERM (U-1172), Fontan Hospital, CHU Lille, Lille, France
| | | | | | - K Lievesley
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - J Madan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - M Mastroianni
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - V Maurice
- Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, Montpellier, France
| | - F McNicholas
- School of Medicine & Medical Science, University College Dublin, Dublin, Republic of Ireland
- Lucena CAMHS, SJOG, Dublin, Republic of Ireland
| | - R Nacinovich
- Child and Adolescent Neuropsychiatry Unit, ASST Monza, Monza, Italy
- Università Degli Studi Milano Bicocca, Milan, Italy
| | - A Parenti
- Centre Hospitalier Universitaire de Lille, Lille, France
| | - M Paul
- Warwick Medical School, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - D Purper-Ouakil
- Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, Montpellier, France
- INSERM, CESP U1018, PsyDev, University Paris Saclay, UVSQ, Versailles, France
| | - L Rivolta
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
- Department of Mental Health, Psychiatry Unit, San Gerardo Hospital, Monza, Monza Brianza, Italy
| | - V de Roeck
- Department of Neurosciences, KU Leuven, Leuven, Belgium
- Child and Youth Studies, Campus Social School, University Colleges Leuven Limburg, Heverlee, Belgium
| | - F Russet
- Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, Montpellier, France
| | - M C Saam
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - I Sagar-Ouriaghli
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - P J Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
- HealthTracker Ltd, Kent, UK
| | - A Sartor
- Josefinum Augsburg, Klinik für Kinder- und Jugenspsychiatrie und Psychotherapie, Augsburg, Germany
| | - U M E Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - P Scocco
- Department of Mental Health, ULSS 6 Euganea, Padua, Italy
- SOPROXI Onlus, Padua, Italy
| | - G Signorini
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - S P Singh
- Warwick Medical School, University of Warwick, Coventry, UK
| | - J Singh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - M Speranza
- INSERM, CESP U1018, PsyDev, University Paris Saclay, UVSQ, Versailles, France
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier de Versailles, Versailles, France
| | - P Stagi
- Child and Adolescent Neuropsychiatry Unit, AUSL Modena, Modena, Italy
| | - P Stagni
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- Child and Adolescent Neuropsychiatry, Department of Mental Health, Modena, Italy
| | - C Street
- Warwick Medical School, University of Warwick, Coventry, UK
| | - P Tah
- Warwick Medical School, University of Warwick, Coventry, UK
| | - E Tanase
- Abteilung für Psychiatrie und Psychotherapie des Kindes-und Jugendalters Weissenau, ZfP Südwürttemberg, Ravensburg, Germany
| | - S Tremmery
- Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - A Tuffrey
- Warwick Medical School, University of Warwick, Coventry, UK
| | - H Tuomainen
- Warwick Medical School, University of Warwick, Coventry, UK
| | - L Walker
- Warwick Medical School, University of Warwick, Coventry, UK
| | - A Wilson
- Warwick Medical School, University of Warwick, Coventry, UK
| | - A Maras
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
| |
Collapse
|