Age-adjusted Research Articles

Critical care therapy use after radical cystectomy in patients with non-metastatic bladder cancer

PurposeTo assess critical care therapy use in patients with non-metastatic bladder cancer undergoing radical cystectomy. MethodsUsing the National Inpatient Sample (2000-2019), we identified non-metastatic bladder cancer patients undergoing radical cystectomy. Study endpoints consisted of critical care therapy use, defined as total parenteral nutrition, invasive mechanical ventilation, dialysis, percutaneous endoscopic gastrostomy tube insertion, tracheostomy, and in-hospital mortality. Estimated annual percentage changes (EAPC) and multivariable logistic regression models were used. ResultsOf 25,535 patients, 3,091 (12.1%) received critical care therapy. Critical care therapy use decreased from 13.1 in 2000 to 5.9% in 2019 (EAPC -2.4; p=0.005), and in-hospital mortality also decreased from 3.4 to 0.7% (EAPC -4.2%; p<0.001). Older (≥80 years: odds ratio [OR] 1.91; p<0.001, and 60-79 years OR 1.41; p<0.001) and sicker patients (Charlson comorbidity index [CCI] ≥3: OR 3.16; p<0.001; CCI 1-2 OR 1.89; p<0.001) were more likely to receive critical care therapy. Conversely, minimally-invasive surgical approach (OR 0.66; p=0.01) and teaching hospital status (OR 0.70; p=0.008) independently predicted lower critical care therapy use. The same risk factors were identified for in-hospital mortality. ConclusionsCritical care therapy use in radical cystectomy patients decreased from 13.1 in 2000 to 5.9% in 2019 and so did in-hospital mortality (3.4 to 0.7%). Of all critical care therapy determinants, CCI ≥3 (OR 3.2) represented the strongest followed by octogenarian age (OR 1.9). Even after adjustment for patient age and comorbidities, minimally-invasive surgical approach and teaching hospital status were associated with lower critical care therapy use, and lower in-hospital mortality.

Treatment outcomes and survival of patients with breast cancer aged 75 and older: A comparative study using propensity score-adjusted analysis.

e13763 Background: With an aging society, the incidence of breast cancer among elderly patients is expected to rise. We aimed to explore treatment outcomes in breast cancer patients aged 75 and older at our institution. The lack of consensus on whether adjuvant therapy for elderly breast cancer patients should mimic that for younger patients prompted our investigation. Methods: We conducted a comparative study using data from 1553 breast cancer surgery cases (stage 0-3) treated between April 2007 and August 2021. Patients were divided into two groups: those aged 75 and older (n=184) and those aged 74 and younger (n=1369). Variables investigated included mean age, tumor size, stage, and subtype; surgical procedures and adjuvant therapies; overall survival (OS); and OS in the 75 and older group, considering the presence or absence of hormone therapy, and propensity score-adjusted OS. Results: Comparing the group aged 74 and younger with the group aged 75 and older revealed: Mean age: (55.5 years vs. 79.6 years), tumor size: (2.4 cm vs. 2.3 cm), stage (0/1/2/3) (%): (7.3/43.1/44.1/4/6 vs. 7.6/43.4/43.4/5.7), subtype (Luminal A/Luminal B/TN/HER2) (%): (60.0/16.7/11.3/7.9 vs. 63.5/10.7/15.7/5.7). Except for age, no significant differences were observed. Mastectomy (%): 45.9 vs. 50.8, axillary lymph node dissection (%): 33 vs. 22.3, adjuvant therapy (%): 93.2 vs. 65.7, adjuvant hormone therapy (%): 90 vs. 68, adjuvant chemotherapy (%): 68 vs. 14. The group aged 75 and older received significantly less adjuvant hormone therapy and chemotherapy. Kaplan-Meier 10-year OS rates: 90.3% vs. 77.5%, showing a trend toward lower survival in the group aged 75 and older, albeit not statistically significant. No significant differences were found in overall survival rates by subtype. In the group aged 75 and older, hormone therapy was omitted in 44.6% and administered in 55.4%, resulting in a significant difference in 10-year OS rates (63.5% vs. 84.7%). Following propensity score adjustment for age, stage, and subtype, the hormone therapy-free group exhibited a higher 10-year OS rate of 100%, in contrast to 84.7% in the hormone therapy group. Conclusions: Breast cancer cases in patients aged 75 and older show similar biological characteristics to those aged 74 and younger. The absence of adjuvant therapy does not impact OS, even though elderly patients aged 75 and older are less likely to receive adjuvant hormone therapy and chemotherapy.

The relationship between serum 25-hydroxy vitamin D status and hypertension in Syrian population: retrospective cohort study

Introduction: Vitamin D is a liposoluble steroid hormone that plays a crucial role in the maintenance of bone metabolism and calcium homoeostasis. Many studies on the effects of vitamin D on general health have been significantly increased, driven by new findings concerning the systemic and extraskeletal effects of this hormone. This study was performed to determine whether low levels of vitamin D were associated with hypertension in Syrian people. Materials and methods: This retrospective cohort study consisted of 207 subjects, including 83 (40.1%) patients suffering from essential hypertension and 124 (59.9%) patients with normal blood pressure. Aged older than 18 years, who was referred to the endocrinology clinic from September 2022 to September 2023. The data were analysed by using SPSS (version 25). Logistic regression analyses were performed with adjustments for age, sex, and waist circumference. Results: Hypertension rates were 73%, 20%, and 5% in 25-hydroxyvitamin D groups less than 12 ng/ml, 12–20 ng/mL, and greater than or equal to 20 ng/ml, respectively. Odds ratios (95% CIs) for hypertension adjusting for age, sex, and waist circumference were 178.6 (30.5_1045.6), 5.13 (0.9_26.5) for 25-hydroxyvitamin D levels less than 12 ng/ml, and 12–20 ng/ml, respectively, compared with the greater than or equal to 20 ng/ml group. Conclusions: This study has shown a high prevalence of low vitamin D levels (25OHVD/20 ng/ml) among a sample of Syrian people (78.3%). The lowest 25OHVD group was associated with a higher prevalence of hypertension, which refers to an adverse association between vitamin D level and essential hypertension. Further research is needed to confirm this relationship.

Mother's own milk and bronchopulmonary dysplasia in appropriate for gestational age preterm infants.

To evaluate the association between mother's own milk (MOM) and bronchopulmonary dysplasia (BPD) in appropriate for gestational age (AGA) preterm infants <32 weeks. Clinical data of AGA preterm infants (24+0/7-31+6/7 weeks) were reviewed. Infants with ≥66% of cumulative prescribed enteral volumes as MOM from birth to 36 weeks were allocated to the high provision of MOM group (H-MOM), whereas those with <66% were assigned to the low provision of MOM group (L-MOM). Multiple regressions were used to assess the association of H-MOM with BPD and oxygen saturation to fraction inspired oxygen ratio (SFR) at 36 weeks. A total of 1041 infants met the inclusion criteria, with a median provision of cumulative enteral nutrition volumes of 5721 (IQR 2616) mL/kg. Among them, 517 (49.7%) were H-MOM and 524 (50.3%) L-MOM infants. H-MOM showed a reduction in the incidence of BPD to 31.6% compared to L-MOM infants. H-MOM had a lower risk of BPD than L-MOM infants after the adjustment for gestational age, sex, cesarean section, mean SFR at the first hours of life, surfactant administration, patent ductus arteriosus, sepsis, prolonged ventilatory supports/oxygen exposure, and cumulative energy intakes from birth to 36 weeks [aOR: 0.613, p = 0.047]. H-MOM was also associated with a lower risk of SFR in the first quartile at 36 weeks [aOR: 0.616, p = 0.028] than L-MOM. A high provision (≥66%) of enteral volume as MOM from birth to 36 weeks is associated with a reduced risk of both BPD and low SFR at 36 weeks in AGA preterm infants <32 weeks.

Circulating levels of amyloid-beta (1-40) peptide associate with cardiometabolic traits and risk for metabolic dysfunction-associated steatotic liver disease

Abstract Funding Acknowledgements None. Background and Aims The ageing-associated amyloid-beta 1-40 peptide (Αbeta40) has recently emerged as a blood-based biomarker of cardiovascular disease (CVD). Its levels predict future cardiovascular death and major adverse cardiovascular events in patients with established CVD. The value of Abeta40 in patients with metabolic syndrome who do not concomitantly have clinically overt CVD or other end-organ damage remains poorly understood. At the present study we investigated the value of plasma Αbeta40 in patients with pre- or established metabolic syndrome who are at risk for metabolic dysfunction-associated steatotic liver disease (MASLD). Methods Αbeta40 was measured in plasma by enzyme-linked immunosorbent assay and cardiometabolic traits were determined in a mixed population (n=888) of patients with established (n=243) and pre- or without metabolic syndrome (n=645) who did not have clinical signs of established cardiometabolic disease. The endpoint of the study was the association of Abeta40 with cardiometabolic indices and risk (BARD score) for MASLD. Odds ratio (OR) was calculated by ordinal regression analysis for the increasing incidence of metabolic syndrome components per increasing Abeta40 (1-SD) after adjustment for age, sex, smoking status and hyperlipidemia. Results Abeta40 levels are associated with the presence of metabolic syndrome and with higher odds for increasing incidence of metabolic syndrome components (prediabetes, low HDL-C levels, high triglyceride levels, increased waist circumference and high-risk for MASLD) after adjustment for sex, age, smoking status, hypertension and dyslipidemia. Increased Abeta40 plasma levels were associated with decreased HDL-C levels and increased triglyceride levels after adjustment for traditional cardiovascular risk factors (age, sex, smoking status, hypertension and hyperlipidemia). Among the total population (n=888), we identified n=473 subjects with increased MASLD risk if any of the following was present: hepatic steatosis index≥36 or fatty liver index≥60 or Fib-4 index≥2.67 or NAFLD score≥0.675. Among patients with high-risk for MASLD, patients with increased BARD score had significantly higher Abeta40 levels (median Abeta40 concentration in patients with BARD score≥2 vs. patients with BARD score&amp;lt;2: 54.9 pg/ml (IQR=38.25) vs. 41.9 pg/m (IQR=30.35), P=0.012). Increased Abeta40 levels were associated with increased odds for AST/ALT≥0.8 ratio (OR:1.017, 95% CI: 1.006-1.028, P=0.003) and increased odds for BARD score≥2 after adjustment for age, sex, smoking status, hypertension and hyperlipidemia. Conclusion Our findings suggest that Abeta40 peptide is associated with cardiometabolic traits and risk for MASLD. Whether Abeta40 may emerge as an early cardiometabolic prognostic biomarker, future longitudinal studies are warranted to determine the prognostic value of Abeta40 for the development of cardiometabolic diseases in patients with metabolic syndrome.

Serum Magnesium Levels Are Negatively Associated with Obesity and Abdominal Obesity in Type 2 Diabetes Mellitus: A Real-World Study.

There remains controversy over the relationship between serum magnesium levels and obesity in type 2 diabetes mellitus (T2DM). Therefore, the aim of this study was to assess whether there is any association of serum magnesium levels with obesity and abdominal obesity in T2DM. This cross-sectional, real-world study was conducted in 8,010 patients with T2DM, which were stratified into quintiles according to serum magnesium levels. The clinical characteristics and the prevalence of obesity and abdominal obesity were compared across serum magnesium quintiles in T2DM. Regression analyses were used to evaluate the relationship of serum magnesium with obesity and abdominal obesity in T2DM (clinical trial registration number: ChiCTR1800015893). After adjustment for age, sex, and duration of diabetes, the prevalence of obesity and abdominal obesity was significantly declined across magnesium quintiles (obesity: 51.3%, 50.8%, 48.9%, 45.3%, and 43.8%, respectively, P<0.001 for trend; abdominal obesity: 71.5%, 70.5%, 68.2%, 66.4%, and 64.5%, respectively, P=0.001 for trend). After controlling for confounders, there were clearly negative associations of serum magnesium levels and quintiles with obesity and abdominal obesity in T2DM. Moreover, C-reactive protein partly mediates the effect of serum magnesium on obesity and abdominal obesity (P=0.016 and P=0.004, respectively). The significantly negative relationship between serum magnesium and the risk of obesity and abdominal obesity was observed in T2DM. Furthermore, the independently negative association of serum magnesium with obesity may be explained by its anti-inflammatory functions. Serum magnesium levels may be applied to assess the risk of obesity and abdominal obesity in T2DM.

Endovascular treatment of stroke in the late time window with large vessel occlusion using the ASPECTS as an imaging screening criterion

To assess the Alberta Stroke Program Early CT Score (ASPECTS) screening tool for effectiveness in endovascular treatment of late time window stroke with large vessel occlusion. A retrospective analysis was performed of individuals administered endovascular treatment in our neurology department between 2016 and 2020 for ischemic stroke induced by acute large vessel occlusion in the anterior circulation and ASPECTS ≥ 6. Detailed baseline and endovascular treatment data were collected. Patients were assigned to 2 groups based on stroke onset time, including the 0–6 h (treated within 6 h of stroke onset) and 6–24 h (earlier/unknown time of onset, up to 24 h from the last time of appearing normal) groups. Both groups were compared for baseline information, revascularization rates, symptomatic intracranial hemorrhage, and 90-day functional independence. Totally 221 individuals were enrolled. The 0–6 h and 6–24 h groups had 129 and 92 patients, respectively, whose median ages were 64 and 63 years, respectively. Both groups were similar in previous medical history, NIHSS score at onset, lesion location and surgical complications. The 6–24 h group had elevated intracranial atherosclerotic stenosis (48.9 vs. 33.3%, P = 0.020) and revascularization (96.7 vs. 86.8%, P = 0.011) rates versus the 6–24 h group. Upon adjustment for age, sex, National Institutes of Health Stroke Scale, ASPECTS, Intracranial atherosclerosis, intraoperative tirofiban, stent detachment, successful recanalization, and symptomatic intracranial hemorrhage, the 0-6 h group had a higher rate of individuals achieving functional independence (mRS score of 0–2; 52.7 vs. 47.8%, OR = 0.242 [0.070–0.833], P = 0.024). However, the rates of individuals with a favorable outcome (mRS scores of 0–3) were similar in both groups (66.7 vs. 69.6%; OR = 0.564 [0.140–2.266], P = 0.419) as well as 90-d mortality (OR = 0.889 [0.170–4.660], P = 0.889). The ASPECTS is effective for screening individuals for endovascular treatment of stroke in the late time window with large vessel occlusion. The ASPECTS should be considered a simple and practical patient screening strategy for stroke centers without multimodal imaging evaluation.

Link between parental myopia and early-onset high myopia: Insights from a clinical retrospective analysis.

Genetic aetiology is suspected in the development of early-onset high myopia (spherical equivalent refractive error [SER] ≤-6.00 D at ≤6 years of age), considering that the role of environmental factors in inducing high myopia is improbable at an early age. Therefore, we aimed to understand if early-onset high myopia is associated with parental myopia in a clinical setting. A retrospective study was conducted in which information about demographics, age of apparent onset of myopia, refractive error, axial length, number of myopic parents, time spent outdoors and time spent on near-work was obtained from electronic medical records (EMR). It included 195 myopic individuals categorised into (1) Early-onset high myopes (EOHM): SER ≤ -6.00 D with age of presentation ≤6 years, (2) Early-onset low myopes (EOLM): SER > -6.00 D with age of apparent onset ≤6 years, (3) Late-onset high myopes (LOHM): SER ≤ -6.00 D with age of presentation and age of apparent onset >6 years and (4) Late-onset low myopes (LOLM): SER > -6.00 D with age of apparent onset >6 years. Overall, 63% of individuals were found to have parental myopia. The proportion of individuals with EOHM, EOLM, LOHM and LOLM with parental myopia was 57%, 74%, 53% and 64%, respectively. After adjustment for age, gender and environmental factors, the odds of development of EOHM (Odds ratio: 0.78, 95% confidence interval: 0.25-2.48), EOLM (1.54, 0.65-3.67) or LOHM (0.70, 0.30-1.65) were similar in the presence of myopic parents, when compared with LOLM. The SER and axial length did not differ based on the number of myopic parents in any of these categories. This retrospective analysis reveals that the presence of parental myopia, which was self-reported, did not induce additional risk for early-onset high myopia.

Long-term patient outcome is affected by deep venous thrombosis after Achilles tendon rupture repair.

The aim of the study was to examine the impact of a deep venous thrombosis (DVT) on patient outcomes 3 years after Achilles tendon rupture (ATR) repair and if there were continued improvements between 1 and 3 years after surgery. A secondary aim was to determine risk factors associated with impaired patient outcomes in the long term. This cohort study consisted of 181 ATR-repaired patients, from two large randomized clinical trials, who attended a 3-year follow-up evaluation. Patients were postoperatively randomized to two different weight-bearing interventions compared with immobilization in a below-knee plaster cast for 2 weeks. During immobilization, screening for DVT was performed with Doppler ultrasound. At 1 and 3 years postoperatively, functional- and patient-reported outcomes were evaluated by the validated heel-rise test and self-reported questionnaire, Achilles tendon Total Rupture Score (ATRS). In total, 76 out of 181 (42%) patients exhibited a DVT at the 2- or 6-week screening after ATR surgery. Suffering from a DVT during immobilization resulted at 3 years in a worse limb symmetry index (LSI) of heel-rise total work compared to patients without DVT, adjusted for age (DVT mean LSI 68% vs. no DVT 78%, p = 0.027). At 3 years, patients with a DVT during immobilization displayed lower ATRS (DVT median 88 vs. no DVT 93, p = 0.046), which was not significant after adjustment for age. However, patients with DVT exhibited an improvement in ATRS, LSI total work, and LSI maximum height between 1 and 3 years, which was not seen among patients without DVT. Independent risk factors for reduced patient functional outcomes at 3 years were older age, greater calf muscle hypotrophy, and suffering a DVT. DVT during immobilization affects patients' long-term functional outcomes 3 years after ATR repair. Clinicians should adequately address risk factors contributing to impaired patient outcomes in the long term, including calf muscle hypotrophy, DVT, and older age. Level Ⅲ.

Associations of sedentary behavior and screen time with biomarkers of inflammation and insulin resistance.

Sedentary behavior (SB) has been linked to risk factors of cardiometabolic disease, with inconsistent findings reported in the literature. We aimed to assess the associations of SB with multiple biomarkers of inflammation and insulin resistance in adults. Domain-specific SB, sitting time and moderate-to-vigorous physical activity (MVPA) were measured in 78 adults (mean ± SD 52.0 ± 10.8 y). Body fat percentage (BF%) was assessed using multi-frequency bioelectrical impedance. A blood draw assessed glucose, insulin, C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), leptin, and adiponectin. Adiponectin-leptin ratio (ALR), homeostasis model assessment of insulin resistance (HOMA-IR) and beta-cell function (HOMA-β) were calculated. Multivariable linear regression analyses, controlling for age, sex, MVPA, and BF%, were used to assess associations. After adjustment for age, sex and MVPA, total SB (7.5 ± 2.5h/day) was positively associated with leptin, insulin, HOMA-IR, HOMA-β (Standardized Beta (β) range 0.21-0.32) and negatively associated with ALR (β = -0.24, p < 0.05 for all). Similarly, total sitting time (7.2 ± 2.9h/day) was associated with TNF-α (β = 0.22) and ALR (β = -0.26). These associations were attenuated to non-significance after adjustment for BF%. Leisure screen time was detrimentally associated with IL-6 (β = 0.24), leptin (β = 0.21), insulin (β = 0.37), HOMA-IR (β = 0.37), and HOMA-β (β = 0.34), independent of age, sex and MVPA (p < 0.05 for all). Only the associations with insulin (β = 0.26), HOMA-IR (β = 0.26), and HOMA-β (β = 0.23) remained significant after further controlling BF% (p < 0.05). Self-reported SB is associated with biomarkers of inflammation and insulin resistance, independent of MVPA, and in some cases BF%.

Relationship between the perioperative prognostic nutritional index and postoperative gait function in elderly hip fractures

ObjectivesWe investigated the relationship between the perioperative nutritional status and postoperative walking ability in patients with hip fractures. MethodsWe included 246 surgically treated elderly patients with hip fractures who were ambulatory before the injury. Patients were divided into two groups: group A, who were able to walk at discharge, and group B, who were unable to walk at discharge. We pair-matched these two groups according to age, preoperative subdivided walking ability, and fracture site to form groups A′ and B'. The prognostic nutritional index (PNI; PNI = 10 × serum albumin (g/dL) + 0.005 × blood total lymphocyte count (/mm³)) before surgery and 1 day, 1 week, and 2 weeks after surgery and energy intake 1 and 2 weeks after surgery were compared. ResultsAfter adjustments for age, preoperative subdivided walking ability, and fracture site, there were 51 patients in group A' (mean age 84.6 years) and 51 patients in group B' (mean age 84.7 years). In group A'/group B′, PNI was 43.38/42.60 (P = 0.19) before surgery, 33.87/33.31 (P = 0.44) 1 day after surgery, 34.99/32.35 (P = 0.01) 1 week after surgery, and 37.33/35.69 (P = 0.15) 2 weeks after surgery. Energy intake was 1380.8/1203.1 kcal (P = 0.01) 1 week after surgery and 1382.0/1335.6 kcal (P = 0.60) 2 weeks after surgery. ConclusionsPNI and energy intake at 1 week postoperatively were associated with early postoperative nutrition and the recovery of walking ability.

Postoperative atrial fibrillation is associated with late mortality independently of patient comorbidities: a systematic review and reconstructed individual patient data meta-analysis

Abstract Background Early postoperative atrial fibrillation (POAF) is the most common complication within the first days after cardiac surgery. It is hypothesized to result from perioperative stressors such as inflammation, oxidative stress, and increased adrenergic tone, along with an advanced arrhythmogenic substrate resulting from advanced age and cardiovascular comorbidities including hypertension, heart failure, or chronic obstructive pulmonary disease (COPD).[1, 2] Although prior studies have demonstrated an association between in-hospital POAF and late mortality or stroke, it is questionable whether these long-term adverse events result from the occurrence of early-POAF or, rather, from the advanced cardiovascular risk profile that partly underlies the development of early-POAF.[3] Purpose To investigate the association of early-POAF with late mortality (primary outcome) and stroke (secondary outcome) in patients undergoing cardiac surgery after adjustment for age and the cardiovascular risk profile. Methods A systematic search, covering PubMed, EMBASE, and the Cochrane Library, was conducted to identify studies reporting on late mortality after cardiac surgery in patients with and without new-onset POAF during hospitalization. Articles meeting the criteria, which included Kaplan-Meier (KM) curves along with risk tables, were included for a pooled analysis of late mortality and stroke. Individual time-to-event data were reconstructed from the KM curves and incorporated into a multivariable frailty Cox model. The model included adjustments for age, sex, preoperative cardiovascular comorbidity profile (hypertension, diabetes mellitus [DM], peripheral artery disease [PAD], history of stroke, heart failure, and COPD), type of surgery, and a frailty term (study variable). Results In total, 28 studies were included in the analysis for late mortality (N=112931), and 9 studies in the analysis for late stroke (N=35004). Overall, 31039 patients had early-POAF with a pooled incidence of 29.7% (95% CI: 25.7-34.1%). Patients developing POAF were older (68.5 vs. 64.1 years old, p&amp;lt;0.001), had a more frequent history of PAD (9.5% vs. 7.8%, p=0.026), a history of stroke (9.3% vs. 7.6%, p&amp;lt;0.001), heart failure (17.2% vs. 15.1%, p&amp;lt;0.001), and COPD (12.5% vs. 9.7%, p&amp;lt;0.001). Unadjusted analysis showed that POAF was strongly associated with increased late mortality (Hazard Ratio [HR]=1.64, 95% CI: 1.59 to 1.69, p&amp;lt;0.001) and late stroke (HR=1.46, 95% CI: 1.36 to 1.58, p&amp;lt;0.001) (Figure 1). POAF was an independent predictor for late mortality (HR=1.46, 95% CI: 1.36 to 1.58, p&amp;lt;0.001) but not for late stroke (HR=1.10, 95% CI: 0.85 to 1.43, p=0.48) after adjustment for age, cardiovascular comorbidity profile, type of surgery, and frailty (study term). Conclusion Early-POAF after cardiac surgery is an independent predictor of mortality in the years following discharge after cardiac surgery, regardless of age, cardiovascular comorbidity profile, and type of surgery.Figure 1

Biomarkers to predict improvement of left ventricular ejection fraction after atrial fibrillation ablation

Abstract Background Atrial fibrillation (AF) and heart failure (HF) frequently coexist. Catheter ablation (CA) of AF is increasingly used in patients with AF and HF. However, prediction of improvement of HF after CA is challenging. Aim We aimed to evaluate the value of biomarkers, alone and in conjunction with a clinical tool (Antwerp score) to predict left ventricular ejection fraction (LVEF) recovery after CA in patients with AF and HF. Methods Patients undergoing CA for AF with depressed LVEF (&amp;lt;50%) were included. Plasma levels of 13 biomarkers were measured immediately prior to CA. Patients were categorized into "responders" (LVEF normalisation after CA in case of HFmrEF and at least 10% LVEF improvement and LVEF &amp;gt; 40% at follow-up in case of HFrEF) and "non-responders" (no LVEF recovery after CA). Models were constructed by comparing the plasma levels of the various biomarkers in responders and non-responders and by adjusting for age, sex, and Antwerp score and subsequent biomarkers were then combined according based on likelihood-ratios. The predictive power of the biomarkers alone and combined in outcome prediction, as well as improvement of the Antwerp score was then evaluated. Results Out of 1665 patients undergoing CA of AF, we included 208 patients with depressed LVEF (median age 63 years, 19% female, median LAVI 42 ml/m2, median LVEF 43%). The median follow-up time was 30 months [IQR 20-34] and the median time to LVEF recovery was 8 months [IQR 3-22]. Of these, 161 (77%) were responders and 47 (23%) were non-responders. Out of 13 biomarkers, four biomarkers (ANG2, GDF15, FGF23 and MyBPC3) were significantly different between responders and non-responders (p ≤0.001). A biomarker panel using these four biomarkers could predict LVEF recovery after CA for AF with an AUC of 0.72 (95%CI 0.64-0.81) overall, 0.69 (95%CI 0.59-0.78) in HFmrEF and 0.88 (95%CI 0.77-0.98) in HFrEF (Figure, A). Only ANG2 and GDF15 remained significantly associated with LVEF recovery after adjustment for age, sex, and the Antwerp score. The AUC of the Antwerp score for prediction of LVEF recovery improved from 0.75 (95% CI 0.67-0.83, Figure, B) to 0.78 (95% CI 0.70-0.86, Figure, C) in the overall population, from 0.71 (95% CI 0.61-0.81) to 0.74 (95% CI 0.64-0.84) in case of HFmrEF and from 0.87 (95% CI 0.78-0.97) to 0.92 (95% CI 0.85-0.99) in case of HFrEF when ANG2 and GDF15 were included in the model. Conclusion A biomarker panel using ANG2, GDF15, FGF23 and MyBPC3 performs similarly for prediction of LVEF recovery after CA in AF compared to the Antwerp score. The biomarkers ANG2 and GDF15 slightly improve the predictive value of the Antwerp score.Figure

Mortality, Hepatic Decompensation, and Cardiovascular- and Renal-Related Outcomes in Lean Versus Non-lean Patients Hospitalized With Metabolic Dysfunction-Associated Steatohepatitis (MASH).

Metabolic dysfunction-associated steatohepatitis (MASH) is an important cause of cirrhosis and end-stage liver disease. In addition, there have been reports of worse extrahepatic outcomes, especially cardiovascular events, in patients with lean patients' fatty liver disease compared to the non-lean group.There is limited data on hepatic, cardiac, and renal outcomes in lean compared to non-lean patients with MASH. This study aims to evaluate the cardiovascular, renal, and hepatic outcomes in hospitalized US adults with MASH, focusing on a comprehensive comparison between lean and non-lean patients. The National Inpatient Sample (NIS) database was queried from 2016 to 2020 to identify hospitalizations with MASH. Hospitalizations with a history of overweight and obesity (lean body mass index (BMI) <25 vs. lean BMI >25) were also identified. The primary outcome was in-hospital mortality. Secondary outcomes were major adverse cardiovascular outcomes (MACE: a composite of acute myocardial infarction, cardiac arrest, stroke, heart failure, and atrial fibrillation); major adverse kidney outcome (MAKE: a composite outcome of acute kidney injury (AKI), renal replacement therapy, and renal cancer), and hepatic decompensation (esophageal varices with bleeding, ascites, spontaneous bacterial peritonitis (SBP), hepatic encephalopathy, and hepatorenal syndrome) Multivariate logistic regression analysis was used to derive risk ratios for clinical outcomes. We included 539,275 MASH patients in our sample; 324,330 (60%) were lean. The included patients were mostly female (61%), the mean age was 64 years, and 76% were White. At baseline, non-lean patients had a higher prevalence of heart failure, hypertension, and hyperlipidemia. There was no difference in the prevalence of smoking among both groups.In a multivariate analysis, with adjustment for age, sex, race, sarcopenia, cardiometabolic risk factors, hospital characteristics, admission type, socioeconomic factors, and all comorbidities (including 31 Elixhauser comorbidities), lean status was associated with a 40% increased risk of mortality(adjusted odds ratio (aOR) 1.40, confidence interval (CI) 1.29-1.53), 19% increased risk of MACE (aOR 1.19; 95% CI 1.14-1.24), 20% increased risk of renal decompensation (aOR 1.25; 95% CI 1.20-1.30), and 33% increased risk of hepatic decompensation (aOR 1.33 CI 1.28-1.38). Lean patients with MASH are at higher risk of cardiovascular and renal outcomes and may benefit from enhanced screening for early identification and treatment to improve outcomes.

Long-term outcomes in hybrid versus standalone thoracoscopic ablation in patients with atrial fibrillation: a systematic review and reconstructed individual patient data meta-analysis

Abstract Background Both hybrid and standalone thoracoscopic atrial fibrillation (AF) ablation techniques have demonstrated favorable outcomes in the management of (long-standing) persistent AF patients, as compared to catheter ablation. However, it is currently unknown whether there is a difference in long-term freedom from AF when comparing these two procedures. Purpose To compare long-term freedom from atrial tachyarrhythmias (ATA) in patients undergoing hybrid and standalone thoracoscopic AF ablation. Methods A systematic search encompassing PubMed, EMBASE, and the Cochrane Library databases from January 1, 2012, to September 6, 2023, was performed using the following search terms: 'thoracoscopic ablation,' 'hybrid ablation,' 'atrial fibrillation,' and various alternative spellings. Articles were included for pooled analysis of freedom from ATA after meeting the criteria of reporting on consecutive patients and presenting Kaplan-Meier (KM) curves. Individual time-to-event data were reconstructed from the KM curves and included in a multivariable Cox and frailty Cox model with adjustments for age, sex, type of AF, AF duration, and study (frailty term in the frailty Cox model). Results In total, 18 studies were included in the meta-analysis for long-term freedom from ATA, comprising 2215 patients. Patients undergoing hybrid thoracoscopic ablation were older (62.0 vs. 58.8 years old, p=0.046), had less frequently paroxysmal AF-history (9.6% vs. 32.1%, p&amp;lt;0.01), and had a longer duration of AF-history (7.0 vs. 5.3 years, p=0.04), as compared to patients undergoing standalone thoracoscopic ablation. There were no significant differences between the two ablation procedures regarding short-term outcomes including early mortality (0.6% vs. 1.0%, p=0.07) and early stroke (1.9% vs 0.9%, p=0.11). Adjusted analysis revealed that hybrid thoracoscopic ablation was significantly associated with greater freedom from ATA (Hazard Ratio [HR]=0.59, 95%CI: 0.43-0.83, p&amp;lt;0.001) compared to standalone thoracoscopic ablation (see Figure 1A). Additionally, older age (HR=1.07, 95%CI: 1.03-1.12, p=0.002) and a higher percentage of male patients (HR=1.02, 95% CI: 1.01-1.03, p&amp;lt;0.001) were significantly associated with ATA recurrence. Adjusted freedom from ATA at 1 year, 3 years, and 5 years was 71.6%, 55.1%, and 46.8% for thoracoscopic ablation, and 82.0%, 69.9%, and 63.6% for hybrid ablation (see Figure 1B). Conclusion Hybrid thoracoscopic AF-ablation is associated with a higher level of freedom from ATA when compared to standalone thoracoscopic ablation.Figure 1

Red cell distribution width to total serum calcium ratio and in-hospital mortality risk in patients with acute ischemic stroke: A MIMIC-IV retrospective analysis.

We investigated the relationship among red cell distribution width (RDW), to total serum calcium (TSC) ratio (RCR), and in-hospital mortality in patients with acute ischemic stroke (AIS). This study was a retrospective analysis. The data of 2700 AIS patients was retrospectively analyzed from the Medical Information Mart for Intensive Care database (version IV). The main outcome of interest was in-hospital mortality. A Cox proportional hazards regression model was used to determine whether RCR was independently associated with in-hospital mortality. The Kaplan-Meier method was used to plot the survival curves for RCR. Subgroup analyses were performed to measure the mortality across various subgroups. The area under curve (AUC) of receiver operating characteristic curve (ROC) was calculated to ascertain the quality of RCR as a predictor of in-hospital mortality in patients with AIS. In the multivariate analysis, statistically significant differences were identified in age, ethnicity, length of ICU stay, mechanical ventilation, sequential organ failure assessment (SOFA) score, RDW, hemoglobin, RCR, whether taking anticoagulants, hyperlipidemia, and atrial fibrillation (P < .05). A threshold inflection point value of 1.83 was obtained through a two-piecewise regression model. There was a non-linear relationship between RCR and hospital mortality in patients with AIS. The hazard ratio (HR) and the 95% confidence intervals (CI) on the right and left of the inflection point were 0.93 (0.57-1.51; P = .7660) and 2.96 (1.37-6.42; P = .0060), respectively. The Kaplan-Meier curve indicated that survival rates were higher when RCR was ≤ 1.83 and lower when RDW was > 1.83 after adjustment for age, gender, BMI, ethnicity. The area under curve (AUC) of RCR was 0.715. A higher RCR was associated with an increased risk of in-hospital mortality in patients with AIS.

#2470 Isolated diastolic hypertension in hemodialysis patients

Abstract Background and Aims Isolated diastolic hypertension (IDH) is relatively rare in the general population (prevalence about 6.5%, Front Cardiovasc Med. 2021;8:810105) and of uncertain etiologic implications. The prevalence of this alteration in the hemodialysis (HD) population and the etiologic implications of IDH have not been studied. Method We investigated the prevalence and the risk for all-cause death and cardiovascular events of isolated diastolic hypertension in a population of 534 HD patients enrolled in 7 centres in 3 European countries (the EURECA-m working group). BP was measured by a golden standard method in this population (48 h ABPM) using well-validated instruments (AAMI/ESH/ISO). Along with recommendations by the European Society of Hypertension guidelines, recordings were made at 15-minute intervals during the day and 30 minutes at night. According to a consensus document by the EURECAm working group (Nephrol Dial Transplant. 2019;34:1542-1548), isolated diastolic hypertension was defined as 48 h diastolic BP &amp;gt; 80 mmHg with a systolic BP &amp;lt;130. Results Among 534 HD patients, thirty-one (5.8%) had isolated diastolic HTN, which is very close to the prevalence estimated in the general population (6.5%). During a mean follow-up of 2.6 years, 138 patients died, 188 had at least one CV event, and 249 experienced the combined event. In univariate analyses, diastolic hypertension was associated with death (HR 0.21; 95% CI: 0.05-0.86, P = 0.03) and the combined outcome of death and CV events (HR 0.42, 95% CI: 0.20-0.88, P = 0.02). However, these associations were no longer significant after adjustment for age and sex (all P &amp;gt; 0.45). Additional sensitivity analyses substantially confirmed these findings. No effect modification by age or gender was observed in these associations. Conclusion In a large cohort of HD patients studied by state-of-the-art 48-hour BP monitoring, the prevalence of isolated diastolic hypertension in HD patients (5.8%) is close to that registered in the general population (6.5%). This alteration predicts the risk for clinical outcomes in unadjusted analyses but not after adjustment for age and sex. Isolated diastolic hypertension is as rare as it is in the general population and unlikely to contribute to the high risk of adverse clinical outcomes in the dialysis population.

#740 Very early BK polyomavirus viremia is associated with graft dysfunction in kidney transplant recipients

Abstract Background and Aims BK polyomavirus-associated nephropathy (BKN) is a leading cause of graft dysfunction and loss, mostly related to the lack of effective treatments. Increasing BK polyomavirus viremia (BKV) precedes BKN, and its monitoring is therefore the focus of preventive strategies; whether BKV itself and its timing of occurrence post-transplant are associated with graft dysfunction is not clearly understood. Method We designed a single-center retrospective study enrolling all patients who received a kidney transplant at our center from January 1st 2018 to June 30th 2022. The study received approval from local Ethical Committee (252/2023/OSS*/AOUMO SIRER ID 651-BKNEPHMO). We collected clinical and demographical data at baseline; donor and transplant characteristics, significant clinical parameter during follow-up. Patients were regularly screened for BK viremia (roughly, once every two weeks in the first 3 months, then monthly until 1 year, then at least every 3 months or on clinical indication). We defined sustained viremia as the presence of BK viremia confirmed in 3 different measurements; probable BKN as the presence of BKV with a viral load &amp;gt;3log10 copies/ml; presumptive BKN as BKV with a viral load &amp;gt;4log10 copies/ml. Results After exclusion of patients with less than 6 months of follow-up, we considered 138 subjects. We stratified patients in 3 groups: no viremia (group A), any BKV (after more than one month from transplant, group B) and very early BKV (within one month from transplant, group C). Clinical, demographic, transplant characteristics are reported in Fig. 1. Of note, group C had a significantly higher proportion of patients with diabetes mellitus (DM) and positive anti-HBc serology, and a lower proportion of Caucasians; there were no differences in transplant characteristics. During follow-up, patients in group C had a significantly stronger reduction in immunosuppressive treatment (especially with regards to MMF), had higher chance of receiving a graft biopsy and were more likely to develop donor-specific antibodies. While patients in group C had a higher probability of sustained BKV compared to those in group B, there were no differences in the proportion of probable, presumptive and histological BKN. With univariate logistic regression, pre-transplant DM and positive anti-HBc were significantly associated with development of very early BKV, while Caucasian ethnicity was a protective factor; only DM maintained statistical significance at multivariate analysis after adjustment for age and sex (OR 7959 with 95% CI 1593-39 771, p = 0.012). Time to eGFR &amp;lt;50% from baseline and time to graft failure were significantly shorter in group C (see Fig. 2). With univariate logistic regression, higher cold-ischemia time and positive BKV within one month from transplant were significantly associated with eGFR loss &amp;gt;50% at 12 months in our cohort; only BKV within one month maintained statistical significance at multivariate analysis after adjustment for age, sex and baseline eGFR (OR 22.17 with 95% CI 1.81-271.47, p = 0.015). Conclusion Patients who develop BKV very early after kidney transplantation are at increased risk of premature severe graft dysfunction (irrespective of the development of BKN); these patients should be offered close and intense surveillance with strategies aiming at identifying treatable causes of progressive kidney damage, and careful management of immunosuppressive treatment. Considering study design and low number of enrolled patients, further data are needed to confirm our findings, to elucidate risk factors for very early BKV and precise causes of rapid deterioration of graft function in these patients.

#1701 IgA nephropathy in numbers: the experience of a single center

Abstract Background and Aims IgA nephropathy is probably the most common glomerular disease worldwide and kidney histology is recognized to significantly impact the risk of progressive kidney failure. Method This is a retrospective cohort study of adult patients diagnosed with biopsy-proven IgA nephropathy during the last decade in the nephrology department of a tertiary hospital. Results In total, 75 patients with biopsy-proven IgA nephropathy were identified and data from 53 of them were analyzed [mean age 48 ± 16 [SD] years, 81% males, 60% hypertensives, 19% diabetics, baseline serum creatinine 2.03 ± 1.80 mg/dl, baseline estimated glomerular filtration rate (eGFR) 60.9 ± 31.4 ml/min/1.73 m2, baseline proteinuria 2.76 ± 2.44 gr/24 h]. Eventually, 6 patients were submitted to chronic dialysis. 50% of the patients received RAAS blockers and 14% received SGLT2-inhibitors. The most frequently used immunosuppression regimens were glucocorticoids alone (33%), glucocorticoids plus cyclophosphamide and azathioprine (13%), budesonide (9%). Relapse was identified in 9% of the patients and it was treated with glucocorticoids alone or budesonide. 25% of the patients had elevated serum IgA levels. Crescents were identified in 36% of the patients and interstitial and mesangial inflammation were observed in 83% and 64% of the patients respectively. Approximately all of the patients had arterial vessels with hyalinosis or fibroelastosis. Concerning immunofluorescence, the dominant findings were IgA, IgM, c3, λ light chain, while all other components were merely found. The median duration of follow-up was 2 years and the follow-up minus baseline serum creatinine, eGFR, and proteinuria differences were 0.35 ± 1.77 mg/dl, −4.0 ± 22.2 ml/min/1.73 m2, and −1.46 ± 2.39 gr/24 h, respectively. Median follow-up minus baseline eGFR was higher for diabetics (1.5 vs 0 ml/min/1.73 m2, p = 0.04). Participants receiving treatment with glucocorticoids were found to present a reduction of serum creatinine during follow-up (follow-up minus baseline median serum creatinine −0.1 vs 0.2 mg/dl for participants receiving vs not receiving glucocorticoids, p = 0.02) and a non-reduction of eGFR (follow-up minus baseline median eGFR 0 vs −3 ml/min/1.73 m2 for participants receiving vs not receiving glucocorticoids, p = 0.01). Participants receiving treatment with SGLT2 inhibitors were also found to have stable median eGFR during follow-up (follow-up minus baseline median eGFR 0 vs −11 ml/min/1.73 m2 for participants receiving vs not receiving SGLT2 inhibitors, p = 0.01). In multivariable linear regression analysis, follow-up minus baseline serum creatinine was independently associated with baseline proteinuria (β = 0.38, p &amp;lt; 0.01), administration of glucocorticoids (β= −1.23, p = 0.01), and the S component of MEST-c score (β = 1.27, p = 0.04), after adjustment for age, sex, baseline serum creatinine, diabetes, hypertension, MEST-c score, and percentage of interstitial fibrosis. In multivariable linear regression analysis, follow-up minus baseline eGFR was independently associated with baseline eGFR (β= −0.43, p &amp;lt; 0.01), baseline proteinuria (β= −2.54, p &amp;lt; 0.05), and hypertension status (β= −18.93, p = 0.02), after adjustment for age, sex, diabetes, treatment with glucocorticoids, MEST-c score, and percentage of interstitial fibrosis. Conclusion These preliminary data indicate that patients with IgA nephropathy who were treated with glucocorticoids or SGLT2 inhibitors present better course concerning the renal function, and the S component of MEST-c score was the only element of the kidney biopsy associated with the kidney outcome.

#1680 Cardiovascular disease in kidney transplant recipients with post-transplant diabetes mellitus—retrospective analysis from a randomized trial

Abstract Background and Aims Kidney transplant recipients are at risk for glucometabolic deterioration. While many individuals recover their glycemic profiles, some develop posttransplant diabetes mellitus (PTDM). Previous reports have shown that PTDM is associated with increased risk for cardiovascular disease (CVD) and mortality. Here we aimed at assessing the association of PTDM with the development of CVD in kidney transplant recipients from a randomized trial. Method CVD with functioning graft (WFG), all-cause death WFG and death-censored graft loss were retrospectively investigated in N = 263 participants from the Insulin Therapy for the Prevention of New Onset Diabetes after Transplantation multicenter randomized-controlled trial (ITP-NODAT, ClinicalTrials.gov NCT03507829). The clinical trial was conducted from November 2012 through May 2018; kidney transplant recipients without previous diabetes diagnosis had received basal insulin therapy or control for afternoon hyperglycemia. For the current analysis, CVD was defined as a composite of cerebrovascular disease (stroke, transient ischemic attack), coronary artery disease (myocardial infarction, revascularization, stenting), hospitalization for heart failure and vascular/peripheral arterial disease interventions. Participants were to perform three OGTTs at 6, 12 and 24 months posttransplant, which we handled as landmarks in our present analysis. Besides PTDM versus NON-PTDM, we stratified according to basal insulin intervention and control. Cox proportional hazard models were presented unadjusted and adjusted for age, sex and pre-transplant CVD. All patients gave informed consent to participate in the trial and we obtained institutional review board approval for the present analysis. Results Cumulative incidence curves for CVD WFG are presented in Fig. 1. The associated risk of PTDM at 6, 12 and 24 months for CVD WFG tended to be higher in PTDM versus NON-PTDM. At the respective timepoints, the control versus basal insulin groups were similar (Fig. 1). Cause-specific hazard ratios for CVD WFG, all-cause death WFG and death-censored graft loss are presented in Table 1. PTDM was associated with CVD WFG in the univariable models. Corresponding Hazard Ratios (with 95% Confidence Intervals) at 6, 12 and 24 months were 2.53 (1.23, 5.18), 3.19 (1.51, 6.78) and 4.28 (1.94, 9.48), respectively. After adjustment for age, sex and pre-transplant history of CVD, corresponding HRs (95% CIs) were 1.37 (0.64, 2.91), 1.37 (0.61, 3.06) and 3.01 (1.26, 7.22), respectively. PTDM was not associated with all-cause death WFG in the univariable models. Corresponding HRs (95% CIs) at 6, 12 and 24 months were 1.97 (0.82, 4.75), 2.44 (0.95, 6.25) and 2.32 (0.89, 6.05), respectively. PTDM was also not associated with death-censored graft loss in the univariable models. Corresponding HRs (95% CIs) at 6, 12 and 24 months were 1.44 (0.62, 3.36), 2.10 (0.89, 4.94) and 1.15 (0.39, 3.37), respectively. PTDM was neither associated with all-cause death WFG or death-censored graft loss in the adjusted models. Conclusion PTDM diagnosed by OGTT at month 24 was significantly associated with cardiovascular disease independent of age, sex or pre-transplant CVD. The association, however, was not significant when PTDM was diagnosed before month 24. It is possible that transient PTDM diagnosis, early CVD events and study discontinuations before month 24 may have contributed to the differing results over time. Timely PTDM diagnosis may open a window of opportunity for interventions, such as in the form of novel glucose-lowering agents, that may reduce cardiovascular risk in kidney transplant recipients.