Complications In Subgroup Research Articles

Acromegaly: Incidence, patient characteristics and treatment patterns in a 10-year nationwide retrospective hospital cohort study

IntroductionAcromegaly is a multisystemic disease associated with numerous comorbidities, notably cardiovascular disease and cancer. The objective of our study was to estimate the contemporary prevalence and incidence of acromegaly and its complications in a nationwide French retrospective cohort. MethodsFirst, the positive predictive value of the ICD-10 acromegaly code E22.0 was checked by individually reviewing 132 medical records from one teaching hospital. Second, to estimate the prevalence of acromegaly, data of patients hospitalized between 2012 and 2021 were extracted from the PMSI French hospital database, using the dedicated ICD-10 code. Third, in a 2015–2020 subset cohort, we estimated the incidence of acromegaly, prevalence of complications and risk ratios of associated comorbidities or complications in subgroups of interest. ResultsA total of 7943 adult patients were identified, with a positive predictive value of 87%, resulting in a prevalence of 10.4/100,000 in France. Annual incidence was 0.76/100,000. The most frequent complications were hypertension (43%), sleep apnea (34.3%) and diabetes (31.3%), mostly with onset before diagnosis. Patients with diabetes were at higher risk for most comorbidities: myocardial infarction (odds ratio (OR) 3.14 [1.92–5.13]), ischemic stroke (1.64 [1.18–2.28]) and cancer of any type (1.53 [1.27–1.84]). These risks were partially attenuated after adjustment for other cardiovascular risk factors, becoming respectively 1.52 [0.89–2.59], 0.92 [0.64–1.33] and 1.09 [0.88–1.34]. Treatment involved pituitary surgery in 43% and radiotherapy in 4.6% of patients. ConclusionThis study was the first, in a large population, to estimate the contemporary incidence and prevalence of acromegaly in non-selected patients at nationwide level in France. We found higher prevalences of complications than previously reported in tertiary specialized expert centers, probably reflecting suboptimal management in non-selected hospitals, whether specialized or not.

Characteristics of glucolipid metabolism and complications in novel cluster-based diabetes subgroups: a retrospective study

BackgroundGlucolipid metabolism plays an important role in the occurrence and development of diabetes mellitus. However, there is limited research on the characteristics of glucolipid metabolism and complications in different subgroups of newly diagnosed diabetes. This study aimed to investigate the characteristics of glucolipid metabolism and complications in novel cluster-based diabetes subgroups and explore the contributions of different glucolipid metabolism indicators to the occurrence of complications and pancreatic function.MethodsThis retrospective study included 547 newly diagnosed type 2 diabetes patients. Age, body mass index (BMI), glycated hemoglobin (HbA1C), homeostasis model assessment-2 beta-cell function (HOMA2-β), and homeostasis model assessment-2 insulin resistance (HOMA2-IR) were used as clustering variables. The participants were divided into 4 groups by k-means cluster analysis. The characteristics of glucolipid indicators and complications in each subgroup were analyzed. Regression analyses were used to evaluate the impact of glucolipid metabolism indicators on complications and pancreatic function.ResultsTotal cholesterol (TC), triglycerides (TG), triglyceride glucose index (TyG), HbA1C, fasting plasma glucose (FPG), and 2-h postprandial plasma glucose (2hPG) were higher in the severe insulin-resistant diabetes (SIRD) and severe insulin-deficient diabetes (SIDD) groups. Fasting insulin (FINS), fasting C-peptide (FCP), 2-h postprandial insulin (2hINS), 2-h postprandial C-peptide (2hCP), and the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) were higher in mild obesity-related diabetes (MOD) and SIRD. 2hCP, FCP, and FINS were positively correlated with HOMA2-β, while FPG, TyG, HbA1C, and TG were negatively correlated with HOMA2-β. FINS, FPG, FCP, and HbA1C were positively correlated with HOMA2-IR, while high-density lipoprotein (HDL) was negatively correlated with HOMA2-IR. FINS (odds ratio (OR),1.043;95% confidence interval (CI) 1.006 ~ 1.081), FCP (OR,2.881;95%CI 2.041 ~ 4.066), and TyG (OR,1.649;95%CI 1.292 ~ 2.104) contributed to increase the risk of nonalcoholic fatty liver disease (NAFLD); 2hINS (OR,1.015;95%CI 1.008 ~ 1.022) contributed to increase the risk of atherosclerotic cardiovascular disease (ASCVD); FCP (OR,1.297;95%CI 1.027 ~ 1.637) significantly increased the risk of chronic kidney disease (CKD).ConclusionsThere were differences in the characteristics of glucolipid metabolism as well as complications among different subgroups of newly diagnosed type 2 diabetes. 2hCP, FCP, FINS, FPG, TyG, HbA1C, HDL and TG influenced the function of insulin. FINS, TyG, 2hINS, and FCP were associated with ASCVD, NAFLD, and CKD in newly diagnosed T2DM patients.

Progression of Diabetic Complications in Subgroups of People with Long Term Diabetes Type 1 According to Clinical Course.

Prevention and prediction of microvascular complications are important aims of medical care in people with type 1 diabetes. Since the course of the disease is heterogenous, we tried to identify subgroups with specific risk profiles for microvascular complications. Retrospective analysis of a cohort of 285 people (22637 consultations) with >10 years of type 1 diabetes. Persons were grouped into slow (<15 years), fast (>15 years) and non progressors according to the average onset of microvascular complications. Generalized estimating equations for binary outcomes were applied and pseudo coefficients of determination were calculated. Progression to microvascular disease was associated with age (OR: 1.034 [1.001-1.068]; p=0.04), diabetes duration (OR: 1.057 [1.021-1.094]; p=0.002), HbA1c (OR: 1.035 [1.011-1.060]; p=0.005), BMI (OR: 0.928 [0.866-0.994]; p=0.034) and the social strata index (OR: 0.910 [0.830-0.998]; p=0.046). Generalized estimating equations predicted 31.02% and exclusion of HbA1c marginally reduced the value to 28.88%. The proportion of patients with LADA was higher in fast than slow progressors [13 (26.5%) vs. 14 (11.9%); p=0.019]. A generalized estimating equation comparing slow to fast progressors revealed no significant markers. In our analysis, we were able to confirm known risk factors for microvascular disease in people with type 1 diabetes. Overall, prediction of individual risk was difficult, the effect of individual markers minor and we could not find differences regarding slow or fast progression. We therefore emphasis the need for additional markers to predict individual risk for microvascular disease.

Evaluation of surgical complications incidence after radical cystectomy

Objective : to study the frequency of surgical complications and postoperative mortality after radical cystectomy (RCE). Material and methods . In study included 107 patients who underwent RCE by one surgeon. Starting in 2015, the protocol for accelerated recovery of patients after surgery, ERAS was applied in all patients undergoing RCE. The frequency of complications and mortality was studied depending on the age of the patients and the ERAS protocol. There were 84 male (78.5 %) and 23female (21.5 %) in this study. All patients were divided into 2 groups: 1st group — 89 (83.0 %) people younger 75 years and 2nd group — 18 (17.0 %) people from 75 years and older. Depending on the application of the ERAS protocol, patients in each group were divided into 2 subgroups. Group 1st consists of subgroups: 1(A) — 40 (45.0 %) patients with ERAS protocol, 1(B) — 49 (55.0 %) patients without ERAS protocol. Group 2nd also consists of subgroups: 2(A) — 8 (44.4 %) patients with ERAS protocol, 2(B) — 10 (55.6 %) patients without ERAS protocol. The average age of the patients was 65.5 (32—85) years. Results . Totally, over the 90-day period after the operation, 55 cases (51.4 %) of complications were recorded: Clavien—Dindo I—II in 1st group — 27 (30.3 %), in 2nd group — 8 (44.4 %). Complications of Clavien—Dindo III—IV in the 1st group — 15 (16.8 %), in the 2nd group — 5 (27.7 %). The overall 90-day mortality was 10 cases (9.3 %): in 1st group — 8 (9.0 %) patients, in 2ndgroup — 2 (11.1 %) patients. According to the comparative study of the use of the ERAS protocol in subgroup 1(A), the incidence of complications of the Clavien—Dindo I—II category was noted in 11 (27.5 %) patients, and in subgroup 1(B) in 16 (32.6 %) patients. Complications of Clavien—Dindo Ш —IV in subgroup 1(A) were observed in 5 (12.5 %) patients and in subgroup 1(B) — in 10 (20.4 %) patients; in subgroup 2(A), the incidence of Clavien—Dindo I—II complications was noted in 3 (37.5 %) patients, and in subgroup 2(B) — in 5 (50.0 %) patients. Complications of Clavien— Dindo III—IV in subgroup 2(A) were observed in 2 (25.0 %) patients and in subgroup 2(B) — in 3 (30.0 %) patients. Thus, the ERAS protocol decreased the number of complications in the subgroup 1(A) compared to the subgroup 1(B) (z = 1.44; p = 0.08) and between the subgroup 2(A) and 2(B) (z = 1.39; p = 0.09). Also there was an increase in the number of complications in older subgroups: in subgroup 2(B) compared with subgroup 1(B) (z = 1.86; p = 0.068). The 90-day mortality in subgroup 1(A) was in 3 (7.5 %) cases, 1(B) — 5 (10.2 %) cases. The 90-day mortality in subgroups 2(A) was in 1 (12.5 %) case, in subgroup 2(B) was 1 (10.0 %) cases. Repeated hospitalization for the first 90 days was 14 (13.0 %) cases, with differences in the frequency of rehospitalization depending on age and application of the ERAS protocol. Conclusion . RCE is an acceptable method of treatment in patients of the older age group and should be performed in hospitals with experience of regular treatment of this nosology. Application of the ERAS protocol (accelerated recovery after surgery) in patients undergoing RCE allows, regardless of age, to reduce the incidence of early postoperative surgical complications and mortality.

Acute haemorrhagic tamponade in cancer patients receiving direct oral anticoagulant: case series.

The use of direct oral anticoagulants (DOACs) is on the rise in the general population. However, data related to the safety of DOACs in patients with malignancy are limited. In this brief report, we present a series of three cases of haemorrhagic pericardial effusions and tamponade in patients receiving DOACs while undergoing cancer therapy. These three cases were all observed within a period of 6 weeks at a single institution and occurred shortly after the initiation of anticoagulation with one of the DOACs. Two of these patients had evidence of neoplastic pericardial process and were being treated with immunotherapy. The third patient was receiving targeted cancer therapy with a drug known to be associated with increased bleeding risks. Haemorrhagic pericarditis may represent a unique type of DOACs-related complications in subgroups of cancer patients with neoplastic pericardial disease and/or complex pharmacodynamics drug–drug interaction. The purpose of this report is to raise awareness of the lack of conclusive safety data of DOACs in certain cancer patients and to remind clinical providers of the National Comprehensive Cancer Network guidelines recommending against their use in patients with malignancy on the basis of limited safety data in patients undergoing cancer therapies.

Independent Predictors of Bleeding Complications in Patients Undergoing PCI With Concomitant Treatment With Bivalirudin in Clinical Practice Results From the Improver Registry

Bleeding complications are associated with an adverse outcome after a percutaneous coronary intervention (PCI) is performed. Traditional risk factors for bleeding complications are age, gender, underweight, hypertension, and renal impairment. The aim of our study was to identify the independent predictors of bleeding complications in patients undergoing a PCI with concomitant treatment with bivalirudin. Between January 2005 and June 2006, a total of 3799 patients, undergoing a planned or urgent PCI with concomitant bivalirudin treatment, were prospectively enrolled in the ImproveR registry. One hundred two centers out of 12 European countries participated in the ImproveR registry. In this analysis, we report the incidence of bleeding complications in subgroups to be at a high risk for developing bleeding complications. A multivariate logistic regression model was performed to identify the independent predictors of bleeding complications. Major bleeding complications occurred in 1.7% of the patients. The highest incidence of major bleeding complications was observed in the subgroup with a sheath size ≥7F (4.3%), heparin use after the PCI (3.5%), and additional use of GP IIb/IIIa inhibitors (3.3%). The multivariate regression analysis revealed female gender [odds ratio (OR), 2.3; 95% confidence interval (CI), 1.4-3.8], heparin after the PCI (OR, 3.1; 95% CI, 1.9-5.1), and sheath size ≥7F (OR, 3.1; 95% CI, 1.8-5.4) as the independent predictors of bleeding. The rate of occurrence of bleeding complications in patients undergoing a PCI with concomitant use of bivalirudin is low in clinical practice. Female gender and procedural factors, such as sheath size and heparin after PCI, were associated with an increase in bleeding complications, whereas other traditional risk factors associated with bleeding, such as age, diabetes mellitus, and renal impairment, had no impact.