Comorbidity Factors Research Articles

Evaluation of body mass index, ponderal index, visceral cross-sectional area, subcutaneous fat cross-sectional area, and liver volume as predictive factors for obesity-related comorbidities: a retrospective cohort study

BackgroundThe body mass index is an imperfect clinical measure of obesity that should be used in conjunction with other valid measures of weight-related risk. We studied whether there is a superior measure of obesity-related comorbidities. MethodsRecords of bariatric clinic patients who had an abdominal computed tomography (CT) within one year of visit were reviewed. The presence of obesity-related comorbidities was determined at the time of the scan. Body mass index (BMI) and ponderal index (PI) were calculated, and CT scans were reviewed to determine the visceral cross-sectional area (VCSA), subcutaneous fat cross-sectional area (SFCSA), and liver volume (LV). Data was analyzed using the Kruskal-Wallis test and Mann-Whitney U test. ResultsA higher number of comorbidities were found to be associated with a larger BMI (p=0.011), VCSA (p=0.014), SFCSA (p=0.007), and LV (p=0.014), but not a larger PI (p=0.11). Of the 16 comorbidities assessed, VCSA and LV were associated with more than BMI and SFCSA. However, each measure could be associated with different comorbidities. A higher BMI was associated with increased insulin use (p=0.034), HTN (p=0.007), and history of OSA (p=0.015), none of which were associated with PI. BMI and PI were the only measures associated with a history of DVT/PE (both p<0.01). Only SFCSA was found to be associated with GERD (p=0.029). VCSA (p=0.038) and LV (p=0.001) were associated with NAFLD. ConclusionNo measure could account for all obesity-related comorbidities, implying the need for targeted measurements. However, the ponderal index was the least effective measure.

Distinct biological signature and modifiable risk factors underlie the comorbidity between major depressive disorder and cardiovascular disease

Major depressive disorder (MDD) and cardiovascular disease (CVD) are often comorbid, resulting in excess morbidity and mortality. Here we show that CVDs share most of their genetic risk factors with MDD. Multivariate genome-wide association analysis of shared genetic liability between MDD and atherosclerotic CVD revealed seven loci and distinct patterns of tissue and brain cell-type enrichments, suggesting the involvement of the thalamus. Part of the genetic overlap was explained by shared inflammatory, metabolic and psychosocial or lifestyle risk factors. Our data indicated causal effects of genetic liability to MDD on CVD risk, but not from most CVDs to MDD, and showed that the causal effects were partly explained by metabolic and psychosocial or lifestyle factors. The distinct signature of MDD–atherosclerotic CVD comorbidity suggests an immunometabolic subtype of MDD that is more strongly associated with CVD than overall MDD. In summary, we identified biological mechanisms underlying MDD–CVD comorbidity and modifiable risk factors for prevention of CVD in individuals with MDD.

Risk prediction model for acute care use among patients with advanced cancer on clinical trials.

11074 Background: Reducing acute care use is an important strategy for improving value. Patients with advanced cancer are at high risk for unplanned Emergency Room visits (ER_visit) and hospital stays (HS). Identifying patients at highest risk could inform personalized risk-based intervention strategies and resource allocation. Methods: The data were from the SWOG Cancer Research Network. We linked data from trials in advanced cancer to Medicare claims data. The primary endpoint was the occurrence of any HS or ER_visit within 1 year after enrollment. Patients were required to have had continuous Medicare parts A and B claims from registration to 12 months after registration or death to detect all utilization outcomes. We examined sociodemographic (age, sex, race, ethnicity, insurance status), geographic (rural or urban, area-level deprivation), clinical (prognostic risk, performance status), treatment characteristics (line of therapy, therapy type), and individual comorbidity factors to establish a predictive risk model. Twenty-six factors were evaluated. A training/test approach was used. First, a 60% random sample training set of patients was generated. Best subset selection was used to identify candidate variables that minimized mean squared error using 5-fold cross validation repeated 10 times. Candidate variables were examined in multivariable logistic regression, with factors with p&lt;.05 retained. A risk model was built by summing adverse factors and creating high vs low- risk groups by splitting at the median and into quartiles. The derived model is reported. Results: Among N=1397 total patients from 6 trials (lung, 3; prostate, 2; pancreas, 1), 839 (60%) comprised the training set. In these, 32.9% were 75+ years, 21.3% were female, and 7.7% were Black. The overall proportion of patients with &gt;1 hospitalization/ER visit was 67.5%. In the training set, adverse risk factors were first line treatment (vs. subsequent), high (vs. low) prognostic risk, coronary artery disease (yes vs. no), hypertension (yes vs. no), and liver disease (yes vs. no). Patients with &gt;2 factors (high risk; n=487, 58.0%) vs. 0/1 risk factor (low risk; n=352, 42.0%), were more likely to experience hospitalization/ER visit (80.3% vs. 49.7%, p&lt;.001), corresponding to a &gt;4-fold increase in risk (OR=4.12, 95% CI, 3.03-5.59, p&lt;.001). Quartile-level proportions were 38.8%, 55.4%, 76.8%, and 84.0%, respectively, with an eightfold increased risk for those in the highest vs. lowest quartiles (Q4 vs. Q1, OR=8.25, 95% CI, 4.98-13.65, p&lt;.001). Validation of the derived risk model in an independent set of 558 patients (40%) is planned. Conclusions: A limited set of 5 comorbid conditions, clinical and treatment variables predicted a 4-fold increased risk of HS and ER_visits in cancer patients with advanced disease. Personalized targeted interventions aimed at preventing acute care use could decrease the cost and improve the quality of cancer care.

Risk factors associated with liver cancer in all US participants.

e16276 Background: Liver cancer incidence rates have risen in recent years, more than tripled since 1980, and the liver cancer-caused death rates have more than doubled during the same time. The objective of this research was to identify significant risk factors (both genetic and environmental) that may contribute to the liver cancer development. Methods: The study cohort was obtained from the All of Us (AoU) population with the latest data (data cutoff date 07/01/22) of 413,457 participants. The baseline survey data, genomics data, and electronic medical data have been queried for studying the risk factors to the liver cancer. Baseline demographics, comorbidities, AUDIT-C score (positive score, defined as &gt; = 5 for men and &gt; = 4 for women, was considered as with high risk of alcoholic hepatitis), social determinants of health (SDoH), and genetic variants were evaluated using the logistic regression models respecting the prevalence of liver cancer. Results: The study cohort included total 254,356 participants with their EMR data, genomics data, and AUDIT-C answers (median age 55 years, 61% women, 45% from minority groups, 19% Hispanics). Among them, 1,048 patients were diagnosed liver cancer. Using the logistic regression models, SDoHs showed association with the development of liver cancer. Retired groups demonstrated higher risk (adjusted odds ratio or aOR: 1.34, 95%CI:1.09-1.67) as well as the unemployed groups (aOR: 1.19, 95%CI: 0.98-1.46). C &gt; G variants at 22:43928847 (aOR: 1.18, 95%CI: 1-1.39), G &gt; G variants at 22:43937814 (aOR: 1.35, 95%CI: 0.97-1.82), and G &gt; A variants at 22:43932850 (aOR: 1.18, 95%CI: 0.99-1.39) of gene PNPLA3 were associated with higher risks. C &gt; T variants at 19:19268740 of gene TM6SF2 demonstrated higher risks (aOR: 1.23, 95%CI: 0.97-1.54) as well. The following demographic and comorbidities factors significantly contributed to the development of liver cancer: 45 to 65 age group (aOR: 6.89, 95%CI: 4.05-13), greater than 65 (aOR: 9.99, 95%CI: 5.84-18.91), hepatitis c virus infection (aOR: 12.46, 95%CI: 10.51-14.75), diabetes with chronic complications (aOR: 1.49, 95%CI: 1.25-1.78 ), diabetes without chronic complications (aOR: 1.81, 95%CI: 1.53-1.2.14). Conclusions: This study reveals that multiple risk factors are significantly associated with the liver cancer ranging from common genetic variants, socioeconomic conditions, age, viral infection, and diabetes. Thus, it is very important to take a comprehensive approach for the liver cancer prevention.

SARS-CoV-2 Catastrophe and aftermath in 3800 Indian patients with comorbidities: A retrospective study

Introduction: The severity of SARS-CoV-2 infections on the basis of hospitalization, ventilation support, oxygen therapy, and morbidity has been a major challenge witnessed by the medical fraternity during 2020 due to the global pandemic. The correlation and effects of the severity caused by the disease outcome due to SARS-CoV-2 infections along with co-morbid factors and lifestyle habits in the diverse Indian population are of greater interest to evaluate. Objective: In this study, we aimed to investigate the association between various co-morbid factors, addiction habits, and their contribution towards disease severity, and the need for hospitalisation in a retrospective manner in a cohort of SARS-CoV-2 positive patients from the eastern part of India. Methodology: Swab samples from a total of 75000 individuals were screened by RT-PCR technology between the months of July-November, 2020 at the inDNA Life Sciences laboratory as per ICMR guidelines. Out of 75000 individuals, 3800 SARS-CoV-2 positive individuals were included in this study. Retrospectively, the positive cases were considered for follow-up investigations. Clinical correlation between the severity of the disease and co-morbid factors along with addiction habits were performed. Results: We observed that the young age group of 20-30 had the highest incidence of SARS-CoV-2 and the majority of infected individuals were males (66%). Disease transmission was high with the majority of asymptomatic patients presenting with low-grade fever. It was also observed that disease severity, mortality, and average recovery time (&gt;14 days) were higher in patients with co-morbid conditions as compared to patients without co-morbidity. In addition, patients with a history of addiction exhibited higher severity of the disease and longer hospitalization with comparatively high mortality. Conclusion: In this retrospective study we found, that co-morbid conditions such as diabetes, hypertension, COPD, asthma, liver disorder, and kidney disorder contributed to the severity or had detrimental outcomes of SARS-CoV-2 infections. Addiction to alcohol and smoking/chewing tobacco also results in poor clinical outcomes of the disease. Therefore, understanding the relationship between these risk factors and their association with disease outcomes can further assist the medical fraternity in managing the current patients in the clinic/ hospitals with a prior history of SARS-CoV-2 infection. Years after the outbreak, COVID-19 still remains a gray area with probably a lot of answers to be given to mankind.

Effect of type 2 diabetes mellitus (T2DM) as a comorbid factor on the morbidity rate and length of hospital stay (LoS) in patients undergoing cholecystectomy

effect of type 2 diabetes mellitus (T2DM) as a comorbid factor on the morbidity rate and length of hospital stay (LoS) in patients undergoing cholecystectomy

Clinical and Epidemiological Characteristics of Severe and Very Severe Pneumonia in Infants

Background: Childhood pneumonia is a leading cause of mortality and morbidity in developing countries. World Health Organization (WHO) stated that pneumonia is the cause of mortality of around 1.2 million children under 5 years per year. The high incidence of very severe pneumonia cases with preventable risk factors become the background of this study.Purpose: The aim of our study was to describe clinical and epidemiological characteristics of severe and very severe pneumonia in infants and children.Methods: This is a descriptive cross-sectional study. The study were conducted from January 2017 to December 2018. We obtained clinical and demographic data of each patient based on medical records.The diagnosis of pneumonia was made clinically based on the Indonesian Ministry of Health criteria. Prematurity was defined as babies born with gestational age less than 37 weeks, low birth weight was defined as babies with birth weight less than 2500 grams. The nutritional status of children is clinically and anthropometrically evaluated using 2006 WHO curve of weight-by-age. Results: A total of 465 patients were diagnosed with pneumonia during 48 months study. 212 patients were excluded and 253 pneumonia patients met the inclusion criteria, 140 patients with very severe pneumonia and 113 patients with severe pneumonia. Among 253 patients, 141 were boys. 125 patients were 2-5 months of age. 71 patients were born with low birth weight and 62 patients had history of preterm birth. There were 86 patients receiving exclusive breastfeeding and 138 patients with complete immunization status. There were 131 patients with moderate and severe malnutrition, and 127 patients with comorbidity factors. 94 patients developed pneumonia with suspected bacterial causative agents.Conclusion: Lower age, prematurity, low birth weight, poor nutritional status, exclusive breastfeeding, comorbidities, and suspected bacterial causative agents are common characteristics of severe and very severe pneumonia in infants and children in Dr. Soetomo Surabaya.

Association between operative duration and adverse outcomes after hip fracture surgery: A NSQIP matched cohort study

BackgroundProlonged operative duration is an independent risk factor for surgical complications in numerous subspecialties. However, associations between adverse events and operative duration of hip fracture fixation in older adults have not been well-quantified. This study aims to determine if prolonged operative duration of hip fracture surgery is related to adverse outcomes. We hypothesized that patients with high operative durations experience greater rates of 30-day complications. MethodsThe American College of Surgeons National Surgical Quality Improvement Program database was retrospectively reviewed to identify older adults (55 years and above) who underwent hip fracture fixation between 2015–2019. Prolonged operative duration was defined as >75th percentile, and cases were matched using propensity scores based on demographic, surgical, and comorbidity factors. Univariate differences in adverse events (including readmission, reoperation, mortality, and organ-system complications) were analyzed. Multivariable mixed-effects logistic regression analyses were completed for statistically significant events. ResultsA total of 8827 case-control pairs were identified for comparison. Rates of superficial surgical site infection (SSI) (p= 0.022), any SSI (p= 0.032), and any complication (p < 0.001) were elevated in those with prolonged surgical duration in univariate analyses. In multivariable models, prolonged operative time was associated with superficial SSI (OR 1.50, p= 0.019), any SSI (OR 1.35; p= 0.029) and any complication (OR 1.58; p < 0.001). In subgroup analyses, all findings persisted for IMN with operative time associated with superficial SSI (OR 1.98, p= 0.012), any SSI (OR 1.71; p= 0.019), and any complication (OR 1.84; p < 0.001). Operative time was associated only with any complication for hemiarthroplasty/internal fixation and sliding hip screw (OR 1.27 and 1.89, respectively; p < 0.001). ConclusionOur study demonstrates that duration of surgery is an independent risk factor for superficial SSI, any SSI, and any complication. Notably, our findings suggest that high operative durations may be most concerning for SSIs in IMN fixation, which is currently the most common choice for hip fracture fixation in the US. However, the rate of any complication is significantly elevated when surgical duration is prolonged, regardless of surgery type.

Racial disparities in access to, and outcomes of, acute ischaemic stroke treatments in the USA

BackgroundRacism contributes to higher comorbid risk factors and barriers to preventive measures for black Americans. Advancements in systems of care, tissue plasminogen activator (tPA) availability and endovascular thrombectomy (ET) have...

Underlying reasons for sex difference in survival following out-of-hospital cardiac arrest: a mediation analysis.

Previous studies have indicated a poorer survival among women following out-of-hospital cardiac arrest (OHCA), but the mechanisms explaining this difference remain largely uncertain.This study aimed to assess the survival after OHCA among women and men and explore the role of potential mediators, such as resuscitation characteristics, prior comorbidity, and socioeconomic factors. This was a population-based cohort study including emergency medical service-treated OHCA reported to the Swedish Registry for Cardiopulmonary Resuscitation in 2010-2020, linked to nationwide Swedish healthcare registries. The relative risks (RR) of 30-day survival were compared among women and men, and a mediation analysis was performed to investigate the importance of potential mediators. Total of 43 226 OHCAs were included, of which 14 249 (33.0%) were women. Women were older and had a lower proportion of shockable initial rhythm. The crude 30-day survival among women was 6.2% compared to 10.7% for men [RR 0.58, 95% confidence interval (CI) = 0.54-0.62]. Stepwise adjustment for shockable initial rhythm attenuated the association to RR 0.85 (95% CI = 0.79-0.91). Further adjustments for age and resuscitation factors attenuated the survival difference to null (RR 0.98; 95% CI = 0.92-1.05). Mediation analysis showed that shockable initial rhythm explained ∼50% of the negative association of female sex on survival. Older age and lower disposable income were the second and third most important variables, respectively. Women have a lower crude 30-day survival following OHCA compared to men. The poor prognosis is largely explained by a lower proportion of shockable initial rhythm, older age at presentation, and lower income.

Postoperative pain score does not correlate with injury severity in isolated tibial plateau fractures.

Appropriate management of acute postoperative pain is critical for patient care and practice management. The purpose of this study was to determine whether postoperative pain score correlates with injury severity in tibial plateau fractures. A retrospective review of prospectively collected data was completed at a single academic level one trauma center. All adult patients treated operatively for tibial plateau fractures who did not have concomitant injuries, previous injury to the ipsilateral tibia or knee joint, compartment syndrome, inadequate follow-up, or perioperative regional anesthesia were included (n = 88). The patients were split into groups based on the AO/OTA fracture classification (B-type vs C-type), energy mechanism, number of surgical approaches, need for temporizing external fixation, and operative time as a proxy for injury severity. The primary outcome measure was the visual analog scale (VAS) pain score (average in the first 24h, highest in the first 24h, two- and six-week postoperative appointments). Psychosocial and comorbid factors that may affect pain were studied and controlled for (history of diabetes, neuropathy, anxiety, depression, PTSD, and previous opioid prescription). Additionally, opioid use in the postoperative period was studied and controlled for (morphine milligram equivalents (MME) administered in the first 24h, discharge MME/day, total discharge MME, and opioid refills). VAS scores were similar between groups at each time point except the two-week postoperative time point. At the two-week postoperative time point, the absolute difference between the groups was 1.3. The groups were significantly different in several injury and surgical variables as expected, but were similar in all demographic, comorbid, and postoperative opioid factors. There was no clinical difference in postoperative pain between AO/OTA 41B and 41C tibial plateau fractures. This supports the idea of providers uncoupling nociception and pain in postoperative patients. Providers should consider minimizing extended opioid use, even in more severe injuries.

Sex and Psychosocial Differences in Acute Stress Symptoms Prior to Open-Heart Surgery.

Acute stress symptoms can occur while cardiac patients await open-heart surgery (OHS). The distress leads to poor outcomes. This study aimed to investigate the association of sex and psychosocial factors (quality-of-life and character strengths). Our study cohort included 481 pre-OHS patients (female 42%; mean age 62 years).Medical indices/factors were obtained from the Society of Thoracic Surgeon's nationaldatabase. Multiple regression analyses were performed following pre-planned stepsand adjusting medical factors. Our findings revealed that sex differences in trauma-related symptoms wereassociated with poor mental well-being, alongside comorbidities. Both mental well-beingand comorbidity factors were directly related to acute stress symptoms, whiledispositional optimism had an inverse association with this outcome. To improve OHS outcomes, our findings suggest healthcare providers be attentive topre-OHS acute stress symptoms, pay greater attention to the emotional well-being oftheir female patients, and develop supportive interventions to enhance personalitystrengths.

Glucagonlike peptide-1 receptor agonists versus dipeptidyl peptidase-4 inhibitors in ischemic strokes with diabetes 2.

Cardiovascular outcome trials demonstrate that glucagonlike peptide-1 receptor agonists (GLP-1RAs) reduce the risk of major adverse cardiovascular events in patients with type 2 diabetes (T2D), whereas dipeptidyl peptidase-4 inhibitors (DPP-4is) have not shown cardiovascular benefits. We compared acute ischemic stroke (AIS) with T2D treated with either a GLP-1RA or DPP-4i prior to the index stroke. This national cohort study included AIS patients with T2D from 2017 to 2020 in Denmark who were users of a GLP-1RA or DPP-4i. To be categorized as a user, we required at least 12 months of exposure and no concurrent treatment with another newer glucose-lowering medication during the last 3 months prior to the index stroke. GLP-1RA users were compared to users of DPP-4i while adjusting for the calendar year of index stroke, age, sex, comorbidity, and socioeconomic factors. The study included 1567 AIS events with T2D; 593 were users of GLP-1RA and 974 of DPP-4i. The absolute risk of a very severe stroke was 2.4% (95% confidence interval [CI] = 1.2-3.7) in GLP-1RA users and 6.1% (95% CI = 4.6-7.7) in DPP-4i users. The corresponding adjusted risk ratio (aRR) of GLP-1RA versus DPP-4i was 0.49 (95% CI = 0.24-1.00). The aRRs of 30-day and 365-day mortality were 0.55 (95% CI = 0.32-0.94) and 0.72 (95% CI = 0.53-0.98), respectively. The risk of a very severe stroke as well as the 30-day and 365-day poststroke mortality rates were lower among the AIS patients with comorbid T2D receiving GLP-1RA prior to the index stroke compared to those receiving DPP-4i. Hence, GLP-1RA may improve stroke outcomes in comparison with DPP-4i.

An effective complex approach to the management of patients with chronic musculoskeletal low back pain and pains in other body sites

Low back pain (LBP) is a major public health problem globally. As life expectancy increases, the number of people with LBP will further increase in the coming decades. LBP is the leading cause of work productivity and activity impairment worldwide, therefore training of neurologists, primary care physicians, and general practitioners for timely and accurate diagnosis of LBP, as well as effective treatment of patients with LBP is an economically and socially significant challenge for medical practice. The clinical case describes the successful management of a female patient with LBP. It provides a modern, clear and effective approach to the diagnosis and treatment of musculoskeletal LBP. The typical comorbid disorders and factors that contribute to the pain syndrome chronicity are presented. The female patient was treated using a complex approach that included disease awareness conversations, kinesiotherapy, and pharmacotherapy in the form of a 10-day nonsteroidal anti-inflammatory drug (NSAID) course. Nimesil (nimesulide) with proven efficacy and safety in the treatment of musculoskeletal pain has become a drug of choice. It should be noted that nimesulide was prescribed to the patient from the first days of treatment concurrently with the beginning of a training course in kinesiology. The patient experienced a rapid pain relief while taking pharmacotherapy, which played an important role in supporting adherence to recommendations for increasing physical activity and taking training courses in kinesiology. The patient reported a significant decrease in pain on Day 10. After 1.5-month treatment, the pain regressed and she returned to her normal daily activities. The presented approach to therapy allows to provide LBP patients with a relatively fast pain relief, and the 6-month follow up period demonstrated sustainability of the therapeutic effect achieved.

Structure of comorbidity and main risk factors for myocardial infarction in young patients

Structure of comorbidity and main risk factors for myocardial infarction in young patients

Comorbid Word Reading and Mathematics Computation Difficulty at Start of First Grade.

The purpose of this analysis was to describe cognitive processes associated with comorbid difficulty between word reading (WR) and mathematics computation (MC) at the start of first grade among children selected for WR and MC delays. A sample of 234 children (mean age 6.50 years, SD = 0.31) was assessed on WR, MC, core cognitive processes (phonological processing, rapid automatized naming, verbal counting [VC]), and domain-general cognitive processes (working memory, oral language, nonverbal reasoning, attentive behavior). Structural equation modeling was used to predict a latent Comorbidity factor, which modeled shared variance between WR and MC, and to identify processes associated with that Comorbidity factor. Results identified each of the core cognitive processes, especially VC, and each of the domain-general cognitive processes, especially working memory, as explaining shared variance between WR and MC. Implications for understanding comorbid difficulty at the start of first grade and designing coordinated first-grade interventions are discussed.

Medial and Lateral Burns With Concomitant Infection After Genicular Nerve Radiofrequency Ablation: A Case Report

BACKGROUND: Knee osteoarthritis management might include medication, intraarticular injections, physical therapy, and surgical intervention. Genicular nerve radiofrequency ablation (RFA) is an effective therapy for patients who do not receive benefit from conservative medical management and are not surgical candidates (secondary to medical comorbidity, patient preference, and other factors). Genicular nerve RFA is generally safe and has a low complication rate. However, there have been case reports of minor and major complications after RFA. We report a case of burns after genicular nerve RFA. CASE REPORT: A 49-year-old man (92 kg; body mass index [kg/m2] 28.3), with a history of coronary artery disease and chronic tobacco use, presented with 20 years of chronic knee pain. He previously had short-term relief with an intraarticular steroid knee injection. He was found to be a suitable candidate for genicular nerve RFA and underwent the procedure successfully without any immediate complications. His pain decreased from 9/10 before the procedure to 5/10 after his RFA. On postprocedure day 33, a 1 cm circular lesion with drainage was noted on the medial aspect of his knee. A lateral lesion was discovered at a subsequent follow-up appointment. He was treated with antibiotics, chlorhexidine cleansing, and dressing changes which resolved the lesions without any long-term sequelae. CONCLUSION: Our case represents an instance of full thickness skin burns with concomitant infection post genicular RFA, uniquely in both the medial and lateral sites. Our patient’s risk factors of low body mass index, smoking, and vascular disease may have led to a delayed healing response. In addition, needle depth may also have contributed to his injury. Ensuring adequate needle depth and patient selection can minimize these complications. KEY WORDS: Radiofrequency ablation, knee pain, osteoarthritis, chronic pain, genicular nerve, RFA, adverse event, complication

Distribution of Normative Percentiles of Liver Stiffness Measurement Using Ultrasound Shear Wave Elastography in an Adult Asian Indian Population

Abstract Objective The aim of this study was to determine the normative percentiles for liver stiffness measurement (LSM) using shear wave elastography in an adult Asian Indian population as part of the preventive radiology initiative of the Indian Radiological and Imaging Association (IRIA). Methods LSMs were ascertained by two-dimensional (2D) shear wave elastography using the Mindray Resona series of ultrasound machines. The image quality was assessed using the motion stability index (M-STB) and reliability (RLB) map. Ten acquisitions were documented, and an interquartile range-to-median (IQR/M) ratio ≤30% kilopascal (kPa) units was considered a good-quality measurement. A subgroup of the study population without comorbidities was chosen to derive the normative percentile distribution of LSM using a generalized least squares multivariable fractional polynomial regression model that adjusted for sex and body mass index (BMI). The effectiveness of the estimated percentiles was assessed on the entire study population using the greater than 90th percentile value of the LSM as the cutoff for abnormality. Results The study included 852 people who underwent shear wave elastography from June 2022 to July 2023. The magnitude of compensated advanced chronic liver disease (cACLD) and clinically significant portal hypertension (CSPH) was 6.81% (95% confidence interval [CI]: 5.30–8.7) and 4.91% (95% CI: 3.67–6.60), respectively. The normative percentiles were estimated from 282 persons without associated comorbidity and risk factors. The mean age (standard deviation [SD]) of the normal individuals was 40.90 ± 12.92 years, and 210 (71.47%) were males. The mean age (SD) of the 570 persons excluded from the normative percentiles analysis was 47.94 (12.49) years and 72.11% were males. The sex- and BMI-adjusted age-specific 90th percentiles of LSM were 8.76, 8.78, 8.96, 8.97, 9.25, and 9.45 kPa for 18 to 20, 21 to 30, 31 to 40, 41 to 50, 51 to 60, and 61 to 70 years, respectively. Conclusion The sex- and BMI-adjusted age-specific 90th percentiles for LSM using shear wave elastography in Asian Indian adults are almost similar to the greater than 9 kPa cutoff proposed by the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement guidelines to discriminate cACLD and CSPH from normal individuals.

Type 2 diabetes mellitus in patients with ischemic stroke - A nationwide study.

Type 2 diabetes (T2D) is a risk factor for ischemic stroke (IS) and associated with an adverse prognosis. Both stroke and diabetes care has evolved substantially during the last decade. This study aimed to determine the prevalence of T2D among IS patients along with time trends in the risk profile, use of glucose-lowering medications, quality-of-care and clinical outcomes, including stroke severity; length-of-stay; mortality, readmission and recurrent stroke in a large national cohort. Registry-based cohort study including all IS events in Denmark from 2004 to 2020. IS with co-morbid T2D were compared to IS without diabetes while adjusting for age, sex, stroke severity, co-morbidity and socio-economic factors. The study included 169,262 IS events; 24,479 with co-morbid T2D. The prevalence of T2D in IS increased from 12.0% (2004-2006) to 17.0% (2019-2020). The adjusted absolute 30-day mortality risk in IS with T2D decreased from 9.9% (2004-2006) to 7.8% (2019-2020). The corresponding adjusted risk ratios (aRR) were 1.22 95% confidence interval (1.09-1.37) and 1.29 (1.11-1.50), respectively. The aRR of 365-day mortality was in 2004-2006: 1.20 (1.12-1.29) and in 2019-2020: 1.34 (1.22-1.47). The 30- and 365-day readmissions rates were also consistently higher in IS with T2D. The prevalence of T2D in IS increased over time. The 30- and 365-day mortality rates decreased over the time-period but were consistently higher in IS with co-morbid T2D. Readmissions were also higher in IS with T2D. This highlights an urgent need for strategies to further improve the prognosis in IS patients with co-morbid T2D.

A systematic review of prediction models on arteriovenous fistula: Risk scores and machine learning approaches.

Failure-to-mature and early stenosis remains the Achille's heel of hemodialysis arteriovenous fistula (AVF) creation. The maturation and patency of an AVF can be influenced by a variety of demographic, comorbidity, and anatomical factors. This study aims to review the prediction models of AVF maturation and patency with various risk scores and machine learning models. Literature search was performed on PubMed, Scopus, and Embase to identify eligible articles. The quality of the studies was assessed using the Prediction model Risk Of Bias ASsessment (PROBAST) Tool. The performance (discrimination and calibration) of the included studies were extracted. Fourteen studies (seven studies used risk score approaches; seven studies used machine learning approaches) were included in the review. Among them, 12 studies were rated as high or unclear "risk of bias." Six studies were rated as high concern or unclear for "applicability." C-statistics (Model discrimination metric) was reported in five studies using risk score approach (0.70-0.886) and three utilized machine learning methods (0.80-0.85). Model calibration was reported in three studies. Failure-to-mature risk score developed by one of the studies has been externally validated in three different patient populations, however the model discrimination degraded significantly (C-statistics: 0.519-0.53). The performance of existing predictive models for AVF maturation/patency is underreported. They showed satisfactory performance in their own study population. However, there was high risk of bias in methodology used to build some of the models. The reviewed models also lack external validation or had reduced performance in external cohort.