Haukeland University Hospital Research Articles

Stroke Mimics on the Stroke Unit - Temporal trends 2008-2017 at a large Norwegian university hospital.

The objective was to quantify temporal trends in stroke mimics (SM) admissions relative to cerebrovascular accidents (CVA), incidence of hospitalized SMs and characterize the SM case-mix at a general hospital's stroke unit (SU). All SU admissions (n=11240) of patients aged 15 or older to Haukeland University Hospital between 2008-2017 were prospectively included and categorized as CVA or SM. Logistic regression was used to estimate time trends in the proportion of SMs among the admissions. Poisson regression was used to estimate time trends in age- and sex-dependent SM incidence. SMs were on average younger thaan CVA patients (68.3 vs. 71.4years) and had a higher proportion of females (53.6% vs. 44.5%). The total proportion of SM admissions was 51.0%. There was an increasing time trend in the proportion of SM admissions, odds ratio 1.150 per year (p<0.001), but this trend appears flattening, represented by a significant quadratic time-term, odds ratio 1.009 (p<0.001). A higher SM proportion was also associated with the time period of a Mass Media Intervention (FAST campaign) in 2014. There was also an increasing trend in SM incidence, that remains after adjusting for age, sex, and population; also, for incidence the trend appears to be flattening. SMs account for approximately half of the SU admissions, and the proportion has been increasing. A FAST campaign appears to have temporarily increased the SM proportion. The age- and sex-dependent incidence of SM has been increasing but appears to flatten out.

Risk factors for surgical site infection following cesarean delivery: A hospital-based case-control study.

Cesarean section is the single most important risk factor for postpartum infection. Where the rest of the world shows increasing trends, the cesarean section rates are low in Norway and risk factors for infection after cesarean section may differ in high and low cesarean section settings. The goal of this study was to examine independent risk factors for surgical site infection after cesarean delivery in a setting of low cesarean section rates. We conducted a hospital-based case-control study at Haukeland University Hospital. We included women who presented to our hospital with surgical site infection after cesarean section during the years 2014-2016 (n=75). Controls were selected at a ratio of 2:1 (n=148). Cases and controls were compared with respect to maternal and pregnancy characteristics using uni- and multivariable logistic regression models. Main outcome measures were anticipated risk factors for surgical site infection. The occurrence of surgical site infection was 0.4% and 5.4% after elective and emergency cesarean section, respectively. Compared to women without surgical site infection, women with surgical site infection were almost thrice more obese before pregnancy (OR 2.8, 95% CI 1.2-7.0), four times more likely to have preexisting psychiatric conditions (OR 4.4, 95% CI 1.1-17.6), and five times more likely to receive blood transfusion (OR 5.1, 95% CI 1.4-18.8). Signs of infection during labor was a marginally significant risk factor for surgical site infection (OR 2.0, 95% CI 1.0-5.4). Emergency cesarean section was a significant risk factor for surgical site infection. Pregestational obesity, preexisting psychiatric conditions, and blood transfusion during or following delivery, were independent risk factors for surgical site infection. Signs of infection during labor was a marginally significant risk factor. Women with either of these risk factors should be carefully monitored and evaluated for signs of infection in the postpartum period.

Mortality and non-use of antipsychotic drugs after acute admission in schizophrenia: A prospective total-cohort study

BackgroundIn society at large, it is debated whether use of antipsychotic drugs is associated with increased or decreased mortality among patients with schizophrenia. Large register studies have demonstrated an increased mortality risk associated with non-use of antipsychotic drugs, but prospective studies are missing. AimsTo investigate the association between mortality and non-use of antipsychotics in patients with schizophrenia. MethodAn open cohort study included and followed all patients with a discharge-diagnosis of schizophrenia consecutively admitted to a psychiatric acute unit at Haukeland University Hospital, Bergen, Norway during a 10 year period (n = 696). Cox multiple regression analyses were conducted with use of antipsychotic drugs as a time dependent variable, and periods of use and non-use were compared within individual patients. Adjustments were made for gender, age at index admission, number of acute psychiatric hospital admissions, excessive use of alcohol and illicit substances and use of benzodiazepines and antidepressants. ResultsA total of 68 (9.8%) deaths were registered during follow-up. Of these, 40 (59%) had natural causes, whereas 26 (38%) had unnatural causes. Non-use of antipsychotics was associated with 2.15 (p = .01, CI: 1.24–3.72) times higher mortality risk compared to use of antipsychotics. The difference in mortality risk between use and non-use of antipsychotic drugs was age dependent, with the largest risk difference in young patients. ConclusionsNon-use of antipsychotic drugs was associated with twofold increased mortality risk in patients with schizophrenia.

Self-Reported Health in Adolescents With Exercise-Induced Laryngeal Obstruction; A Cross-Sectional Study.

Background: Exercise-induced laryngeal obstruction (EILO) is common in young people with exertional breathing difficulties. Psychological characteristics have been proposed as underlying contributors; however, the evidence for this is limited.Objectives: Describe self-reported health, self-efficacy, and anxiety symptoms in adolescents with EILO, and address possible associations with EILO subtypes and severity.Methods: Cross-sectional study of 71/180 (39%) adolescents tested for EILO at Haukeland University Hospital during 2014–2016, age range 14–18 years. Validated questionnaires were used to assess general self-rated health, subjective health complaints (Health Behavior in School-aged Children-Symptom Check List; HBSC-SCL), general self-efficacy (GSE), and anxiety symptoms (SCARED). The outcomes were compared with normative data from comparable unselected populations.Results: The HBSC-SCL items for somatic complaints revealed weekly or more often occurrence of headache in 42%, abdominal pain in 30%, backache in 31%, and dizziness in 32%. For psychological complaints, corresponding figures were 26% for feeling low, 43% for irritability or bad mood, 33% for feeling nervous, and 38% for sleep problems. Mean (range) GSE score was 3.13 (2.2–4.0), and reports suggesting anxiety symptoms were rare. The outcomes were in line with normative data from comparable unselected populations. Self-rated health, and scores obtained for HBSC-SCL, GSE, and SCARED were similarly distributed across EILO subtypes and severity.Conclusion: Self-reported health, self-efficacy, and level of anxiety symptoms in adolescents with laryngoscopically confirmed EILO were similar to data obtained in comparable unselected populations, irrespective of EILO subtype and severity. The findings challenge the notion that pediatric EILO is causally related to psychological problems.

A whole blood based resuscitation strategy in civilian medical services: Experience from a Norwegian hospital in the period 2017-2020.

Civilian and military guidelines recommend early balanced transfusion to patients with life-threatening bleeding. Low titer group O whole blood was introduced as the primary blood product for resuscitation of massive hemorrhage at Haukeland University Hospital, Bergen, Norway, in December 2017. In this report, we describe the whole blood program and present results from the first years of routine use. Patients who received whole blood from December 2017 to April 2020 were included in our quality registry for massive transfusions. Post-transfusion blood samples were collected to analyze isohemagglutinin (anti-A/-B) and hemolysis markers. Administration of other blood products, transfusion reactions, and patient survival (days 1 and 30) were recorded. User experiences were surveyed for both clinical and laboratory staff. Two hundred and five patients (64% male and 36% female) received 836 units in 226 transfusion episodes. Patients received a mean of 3.7units (range 1-35) in each transfusion episode. The main indications for transfusion were trauma (26%), gastrointestinal (22%), cardiothoracic/vascular (18%), surgical (18%), obstetric (11%), and medical (5%) bleeding. There was no difference in survival between patients with blood type O when compared with non-group O. Haptoglobin level was lower in the transfusion episodes for non-O group patients, however no clinical hemolysis was reported. No patients had conclusive transfusion-associated adverse events. Both clinical and laboratory staff preferred whole blood to component therapy for massive transfusion. The experience from Haukeland University Hospital indicates that whole blood is feasible, safe, and effective for in-hospital treatment of bleeding.

Abstract 2520: Detection of transcriptional active HPV 16/18 in patients with oropharyngeal squamous cell carcinoma by dual immunohistochemistry p16INK4 and in situ hybridization E6/E7 mRNA in archival material older than 25 years

Abstract Introduction: Determination of Human Papillomavirus (HPV) status in oropharyngeal squamous cell carcinomas (OPSCC) is important because it influences the therapeutic decision. A dual protocol combining immunohistochemistry (IHC) for detection of p16INK4 overexpression with in situ hybridization (ISH) for mRNA E6/E7 detection may improve the accuracy of determining the HPV status in OPSCC patients. The aim of this study was to optimize a multiplex method for simultaneous detection of p16 and mRNA E6/E7 on the same formalin-fixed paraffin-embedded (FFPE) tissue samples. Methods: IHC for the detection of p16INK4 and chromogenic ISH for mRNA E6/E7 were combined in different sequences and with different intermediate steps for fixation on OPSCC tissue samples from primary tumors and lymph node metastases. Archival tissue samples stored at Department of Pathology at Haukeland University Hospital since 1990 has been used for tests. Results: A combined method for simultaneous detection of p16INK4 and mRNA E6/E7 transcripts on the same tissue slides were successfully developed. Active HPV status was detected in OPSCC tissue samples from both primary and metastatic lymph nodes for all cases tested, including tissue samples stored for 30 years. The result was correlated to DNA HPV status. Conclusion: This study confirms that a more precise detection of active HPV infection is possible on FFPE tissue slides. This method could be easily implemented in clinical settings for more specific stratification of OPSCC patients. At the same time, the method is also robust and sensitive on retrospective archival material, and this could be used for answering important research questions on HPV-related OPSCC. Citation Format: Stian Tornaas, Siren Fromreid, Hans Jørgen Aarstad, Olav Karsten Vintermyr, Daniela Elena Costea, Harsh Nitin Dongre. Detection of transcriptional active HPV 16/18 in patients with oropharyngeal squamous cell carcinoma by dual immunohistochemistry p16INK4 and in situ hybridization E6/E7 mRNA in archival material older than 25 years [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2520.

Prevalence of patients “at risk of malnutrition” and nutritional routines among surgical and non-surgical patients at a large university hospital during the years 2008–2018

Being "at risk of malnutrition", which includes both malnutrition and the risk to be so, is associated with increased morbidity and mortality in both surgical and non-surgical patients. Several strategies and guidelines have been introduced to prevent and treat this, but the effects are scarcely investigated. This study aims to evaluate the long-term effects of these efforts by examining trends concerning: 1) the prevalence of patients«at risk of malnutrition» and 2) the use of nutritional support and diagnostic coding related to malnutrition over an 11-year period in a large university hospital. Moreover, we wanted to investigate if there was a difference in trends between surgical and non-surgical patients. From 2008 to 2018, Haukeland University Hospital, Norway, conducted 34 point-prevalence surveys to investigate the prevalence of patients«at risk of malnutrition», as defined by Nutritional Risk Screening 2002, and the use of nutritional support at the hospital. Diagnostic coding included ICD-10 codes related to malnutrition (E43, E44 and E46) at hospital discharge, which were extracted from the electronic patient journal. Trend analysis by calendar year was investigated using logistic regression models with and without adjustment for age (continuous), gender (male/female) and Charlson Comorbidity Index (none, mild, moderate or severe). The number of patients included in the study was 18933, where 52.1% were male and the median (25th, 75th percentile) age was 65 (51, 76) years. Of these, 5121 (27%) patients were identified to be «at risk of malnutrition». Fewer surgical patients (21.2%) were «at risk of malnutrition», as compared to non-surgical patients (30.9%) (p<0.001). Adjusted trend analysis did not identify any change in the prevalence of patients«at risk of malnutrition» from 2008 to 2018. The percentage of patients«at risk of malnutrition»who received nutritional support increased from 61.6% in 2008 to 71.9% in 2018 (p<0.001), with a range from 55.6 to 74.8%. This trend was seen for both surgical and non-surgical patients (p<0.001 for both). Similarly, dietitians were more involved in the patients' treatment (range: 3.8-16.7%), and there was increased use of ICD-10 codes related to malnutrition during the study period (range: 13.0-41.8%) (p<0.001). These trends were seen for both surgical patients and non-surgical patients (p<0.001), despite use being less common for surgical patients, as compared to non-surgical patients (p<0.001). This large hospital study shows no apparent change in the prevalence of patients«at risk of malnutrition» from 2008 to 2018. However, more patients«at risk of malnutrition», both surgical and non-surgical, received nutritional support, treatment from a dietitian and a related ICD-10 code over the study period, indicating improved nutritional routines as a result of the implementation of nutritional guidelines and strategies.

Interdisciplinary Approaches Suggested for Children With Multiple Hospital Referrals Presenting With Non-specific Conditions.

Aims: To describe the care patterns of patients with repeated referrals to both mental and somatic specialist healthcare, and to study their diagnostic processes.Methods: In a previous register study patients aged 6–12 years referred to Haukeland University Hospital from 2013 to 2015, we found 922 children with at least three referrals including both somatic and mental health services. Of these, more than one in four (250) were randomly selected and observed from their first hospital episode ever and further after inclusion followed during their next three referrals or until July 2017. Data on referral patterns and diagnostics were collected from patient hospital records.Results: Mean number of referrals was 6.5 prior to inclusion and 4.2 in the follow-up period. At the end of the study period 15% of patients still had a non-specific diagnosis. During the follow-up period, more than half of the children were again referred across the border between somatic and mental healthcare.Conclusion: Very complex care patterns were found for these patients, who were repeatedly being referred and “crossing over” between mental and somatic healthcare. This indicates a need for more interdisciplinary-based approaches both within specialist care and between different care levels to broaden the perspective and achieve shorter time lag before reaching a diagnostic conclusion.Trial Registration: Data was obtained from Haukeland university hospital the patient registry system No. 2017/12470. Start of registration was April 1th 2017 and patients included was from 2013 to 15.

Real-world discontinuation rate of teriflunomide and dimethyl fumarate in multiple sclerosis.

BackgroundFor patients with MS, medication switches increase the risk of disease reactivation.ObjectiveCompare discontinuation rates due to treatment failure or side effects between teriflunomide and dimethyl fumarate, and investigate clinical variables affecting discontinuation rates.MethodsAll patients who received teriflunomide or dimethyl fumarate at Haukeland University Hospital from 2013 until 2018 were identified. Clinical and demographic variables were extracted from the Norwegian MS Registry. Cause-specific Cox regression models estimated the rate of discontinuation due to treatment failure or side effects.ResultsWe included 354 patients treated with either dimethyl fumarate (n = 185) or teriflunomide (n = 169). We found 38% lower risk of discontinuation because of treatment failure for patients using dimethyl fumarate compared to teriflunomide (p < 0.05). In a treatment-naive subgroup (n = 183), we found a 38% reduced risk of discontinuation for any reason among patients using dimethyl fumarate (p < 0.05). There was no significant difference between treatment groups in discontinuation rate due to side effects, although more patients reported side effects when treated with dimethyl fumarate.ConclusionOur findings suggests that dimethyl fumarate has a lower risk of discontinuation because of treatment failure among both treatment-experienced and treatment-naive patients.

Comparing the impact of upfront radiosurgery versus expectation in vestibular schwannoma (the V-REX study): protocol for a randomised, observer-blinded, 4-year, parallel-group, single-centre, superiority study

IntroductionThe optimal management of small-sized to medium-sized vestibular schwannoma (VS) is a matter of controversy. Clinical results of the prevailing treatment modalities (microsurgery, stereotactic radiosurgery (SRS), and conservative management (CM))...

Preoperative predictors of pathological tumour stage and prognosis may be used when selecting candidates for intensified treatment in upper tract urothelial carcinoma

Purpose Intensified treatment such as extended lymph node dissection (LND) and/or perioperative chemotherapy in addition to radical nephroureterectomy (RNU) has been suggested for high-risk cases of upper tract urothelial carcinoma (UTUC). We aimed to identify preoperative predictors of tumour stage and prognosis in the diagnostic work-up before RNU. Further to evaluate if our findings could be used in selecting patients for intensified treatment. Patients and methods A total of 179 patients treated with RNU for UTUC at Haukeland University Hospital (HUS) and Vestfold Hospital Trust (VHT) during 2005–2017 were included in this retrospective study. All relevant preoperative variables regarding the patient, the CT and the ureteroscopy (URS) were registered and analysed regarding their ability to predict non-organ confined disease (NOCD, pT3+ and/or N+) at final pathology after RNU. The prognosis was assessed calculating survival for the cohort and stratified by preoperative variables. Results Local invasion and pathological lymph nodes at CT predicted NOCD in uni and multivariate regression analyses (OR 3.36, p=.004 and OR 6.21, p=.03, respectively). Reactive oedema surrounding the tumour (OR 2.55, p=.02), tumour size (4.8 vs. 3.9 cm, p=.006) and high-grade tumour at URS biopsy (OR 3.59, p=.04) predicted NOCD at univariate regression analyses. The 5-year CSS and OS for the entire cohort was 79% and 60%. ECOG, local invasion, pathological lymph nodes and reactive oedema surrounding the tumour at CT predicted CSS. Conclusions Several variables at the CT predicted both stage and survival. Local invasion at CT seems the most promising feature for selecting patients for intensified treatment.

What Do We Mean by "Stone Free," and How Accurate Are Urologists in Predicting Stone-Free Status Following Ureteroscopy?

Background and Purpose: No consensus exists on how stone-free rates (SFRs) should be reported after stone treatment. The aim of this study was to assess how accurate urologists predict their patients being stone free after completing ureteroscopy (URS) and to see how various treatment strategies influenced the precision of these predictions. We also wanted to study how different definitions of stone-free status (SFS) affected the results and propose a standard definition of "stone free" to be used in future studies. Materials and Methods: A retrospective evaluation of 1019 URS done for stone treatment at Haukeland University Hospital between 2013 and 2018 was performed. Data on pretreatment status, the surgical procedure, and follow-up were recorded. SFS was defined as either no fragments detected on computed tomography (CT) after 3 months or as practical stone-free status, which also included those with small residual fragments not needing further treatment. Exact chi-squared and independent-samples t-tests were used comparing data between different treatment modalities. Results: The overall SFR, irrespective of treatment strategy and location of stone, using the no residual fragments and practical stone-free definitions were 54.2% and 74.7%, respectively. Urologists predicted intraoperatively that 91.0% of their patients treated with fragmentation and extraction would be stone free compared to 76.8% of patients treated with dusting, p < 0.0001. At follow-up, the actual SFRs with no residual fragments for the two treatment strategies were 68.0% and 35.5%, respectively, p < 0.0001. The practical SFRs for fragmentation and retrieval were 83.1% and 64.8% for dusting, p < 0.0001. Conclusion: The different definitions of SFS have great impact on SFRs. Urologists are far too optimistic predicting their patient being stone free after URS. SFS should be defined as no fragments detected on CT 3 months after the URS procedure when presented in studies.

Impact of transcatheter aortic valve implantation on left ventricular function recovery, mass regression and outcome in patients with aortic stenosis: protocol of the TAVI-NOR prospective study

IntroductionTranscatheter aortic valve implantation (TAVI) is a widely used treatment option as an alternative to surgical aortic valve replacement in patients with severe aortic stenosis (AS) at high or intermediate...

Safety and efficacy of rituximab as first- and second line treatment in multiple sclerosis - A cohort study.

BackgroundRituximab is increasingly used as off-label therapy in multiple sclerosis (MS). More data are needed on safety and efficacy of rituximab, particularly in cohorts of de novo patients and patients in early therapy escalation.ObjectiveTo investigate the safety and efficacy of off-label treatment with rituximab in an MS-cohort of predominantly de novo patients or as therapy escalation.MethodsWe retrieved safety and efficacy data from the Norwegian MS-registry and biobank for all MS-patients treated with rituximab at Haukeland University Hospital, Bergen, Norway, during a four year period.ResultsIn the 365 MS-patients (320 relapsing-remitting MS (RRMS), 23 secondary progressive MS (SPMS), and 22 primary progressive MS (PPMS)), the overall annualized relapse rate (ARR) was 0.03 and annualized drug discontinuation rate (ADDR) was 0.05. NEDA-3 was achived in 79% of patients with available data (n=351). Sixty-one patients experienced infusion-related adverse events of which two were serious (CTCAE grade 3–4). Eighteen patients experienced serious non-infusion related adverse events, of which 16 were infections. Infections (n = 34; 9.3%, CTCAE grade 2-5), hypogammaglobulinemia (n = 19, 5.2%) and neutropenia (n = 16; 4.4%) were the most common non-infusion-related adverse events.ConclusionRituximab was a safe and highly efficient disease modifying therapy in this cohort of MS-patients; however, infections and neutropenia need to be monitored.

Nevrosarkoidose – en pasientserie

Neurosarcoidosis is a rare form of sarcoidosis that affects the nervous system. The aim of the study was to survey clinical manifestations, findings from assessments and treatment strategies for patients with neurosarcoidosis. The study performed a retrospective assessment of 17patients with definitive, probable and possible neurosarcoidosis diagnosed in the period 2008-2019 at the Department of Neurology, Haukeland University Hospital. The average prevalence of definitive, probable or possible neurosarcoidosis in Norway's Vestland county was 2.7per 100 000 inhabitants in the period in question. Onset took the form of central nervous affection (8 of 17), hydrocephalus (5 of 17) and cranial neuropathy (5 of 17). Sarcoidosis-like findings were made in 14 of 17patients by means of contrast-enhanced magnetic resonance tomography (MRT) of the central nervous system, in 7 of 8patients by positron emission tomography (PET), and in 12 of 16patients by computed tomography (CT) of the thorax. There were cerebrospinal fluid abnormalities in 15 of 15patients, with biopsy verification for 13 of 15. The symptoms of 16 of 17patients improved or stabilised with prednisolone and/or other immunotherapy. Neurosarcoidosis affects both the central and the peripheral nervous system. Cerebrospinal fluid analysis and contrast-enhanced MRT are important means of detecting inflammation. A biopsy is necessary for making a definitive diagnosis, but is not always feasible. PET can be used as a supplement to other examinations to assess various organ manifestations and to pinpoint biopsy sites. Corticosteroid therapy, and in some cases other immunotherapy, elicits a good response.

Maintained survival outcome after reducing lymphadenectomy rates and optimizing adjuvant treatment in endometrial cancer

ObjectiveMain controversies in endometrial cancer treatment include the role of lymphadenectomy and optimal adjuvant treatment. We assessed clinical outcome in a population-based endometrial cancer cohort in relation to changes in treatment management over two decades. MethodsAll consenting endometrial cancer patients receiving primary treatment at Haukeland University Hospital from 2001 to 2019 were included (n = 1308). Clinicopathological variables were evaluated for year-to-year changes. Clinical outcome before and after discontinuing adjuvant radiotherapy and individualizing extent of lymphadenectomy was analyzed. ResultsThe rate of lymphadenectomy was reduced from 78% in 2001–2012 to 53% in 2013–2019. The rate of patients with verified lymph node metastases was maintained (9% vs 8%, p = 0.58) and FIGO stage I patients who did not undergo lymphadenectomy had stable 3-year recurrence-free survival (88% vs 90%, p = 0.67). Adjuvant chemotherapy for completely resected FIGO stage III patients increased from 27% to 97% from 2001 to 2009 to 2010–2019, while adjuvant radiotherapy declined from 57% to 0% (p < 0.001). These patients had improved 5-year overall- and recurrence-free survival; 0.49 [95% CI: 0.37–0.65] in 2001–2009 compared to 0.61 [0.45–0.83] in 2010–2019, p = 0.04 and 0.51 [0.39–0.68] to 0.71 [0.60–0.85], p = 0.03, respectively. For stage I, II and IV, survival rates were unchanged. ConclusionsOur study demonstrates that preoperative stratification by imaging and histological assessments permits a reduction in lymphadenectomy to around 50%, and is achievable without an increase in recurrences at 3 years. In addition, our findings support that adjuvant chemotherapy alone performs equally to adjuvant radiotherapy with regard to survival, and is likely superior in advanced stage patients.

The Polar Code and Telemedicine

One result of a warmer global climate is increased maritime activity in the Arctic. Areas that used to be covered by ice and snow are now accessible for the scientific community and commercial users. The Norwegian government has chosen tourism as a pillar of the economy of Svalbard and facilitates the development of the tourism industry. Aase and Jabour have shown that tourist vessels sail as far north as 82° N, beyond the range of geostationary satellites. The Polar Code states that appropriate communication equipment to enable telemedical assistance in polar areas shall be provided. This paper describes a series of functional telemedicine tests carried out on board the Norwegian Coast Guard vessel NoCGV Svalbard during her transit between Svalbard and the Norwegian mainland in September 2019. Communication was established between the vessel and Haukeland University Hospital in Bergen, Norway, using the new Iridium NEXT constellation of communication satellites. Our tests show that medical services that require low bandwidths work.

Perfluoroalkyl substances (PFASs) and mercury in never-pregnant women of fertile age: association with fish consumption and unfavorable lipid profile

ObjectivesTo examine concentrations of perfluoroalkyl substances (PFASs) and lifestyle factors that may contribute to higher levels of pollutants in never-pregnant women of fertile age.DesignObservational cross-sectional study.SettingParticipants were recruited among employees...

HDL, apo a1 and long-term cardio-metabolic prognosis in statin-treated patients with suspected stable angina pectoris: a prospective cohort study

Abstract Background Reduced serum levels of high density lipoprotein cholesterol (HDL-C) is a hallmark of the metabolic syndrome. Epidemiologic studies have reported an inverse correlation between HDL- C and cardiovascular disease (CVD) risk. However, recent works suggest that the association is strongest in healthy individuals. Changes in particle number and functional properties of HDL may more closely reflect CVD prognosis in patients with pre-existent disease. The majority of such patients receive statin treatment, which affects both HDL-C levels, and particle composition. Hence, serum apoA1 and the HDL-C:apoA1 ratio have been proposed as more sensitive indicators of cardio-metabolic prognosis. Purpose We studied the associations of serum HDL-C, apoA1 and the HDL-C: apoA1 ratio to long term risk of CVD mortality and incident type 2 diabetes (T2D) patients with suspected stable angina pectoris (SAP). Methods A total of 41064 patients underwent elective coronary angiography in 2000–2004 and were followed-up for CVD mortality throughout 2016. In a subgroup of 2519 participants without verified or possible diabetes at baseline, the associations to incident type 2 diabetes (T2D) were evaluated throughout 2014. Information on clinical endpoints was obtained through national health registries. Risk estimates are reported per 1 SD increment of (log transformed) biomarkers and were calculated by cox or logistic regression. We explored risk classification by calculating the continuous net reclassification improvement (NRI). Results At inclusion, median (25th-75th percentiles) age was 62 (55–70) years, 28% were women 76% had obstructive coronary artery disease and 80% received statins. During median (25th-75th percentiles) 13.9 (12.0–15.3) years of follow-up, 14.1% of the participants died from CVD. After multivariate adjustment (age, gender, body mass index, HbA1c, triglycerides, statin treatment, fasting status) HDL and apoA1, but not the HDL: apoA1 ratio, significantly predicted CVD mortality. The hazard ratio (HR) and 95% confidence interval (CI) was: 0.86 (0.78–0.94), 0.88 (0.80–0.98) and 0.96 (0.86–1.03) for HDL-C, apoA1 and the HDL-C:apoA1 ratio, respectively. HDL-C was the only of the evaluated biomarkers providing a significant NRI (95% CI) of 0.14 (0.04–0.19). In the subset evaluated for incdent T2D, HDL-C provided multivariate adjusted odds ratios (OR; 95% CI) and NRI (95% CI) of 0.69 (0.58–0.82) and 0.34 (0.21–0.47) for new onset TSD. The corresponding OR (95% CI) and NRI (95% CI) for apoA1 were: 0.85 (0.73–0.99) and 0.20 (0.06–0.33), respectively. The HDL:apo A1 ratio provided an OR (95% CI) of 0.66 (0.55–0.80) and NRI (95% CI) of 0.24 (0.11–0.37) for T2D. No significant effect modifications according to statin treatment were found (P≥0.22). Conclusion Among patients with suspected SAP, of which the majority received statins, HDL-C was non-inferior to apoA1 and the HDL:apoA1 ratio in predicting long term risk of CVD mortality and T2D. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Department of Heart Disease, Haukeland University Hospital; Department of Clinical Science, University of Bergen

Time from ECG Diagnosis to sheath insertion is a strong predictor for mortality in patients with ST elevation myocardial infarction admitted for primary percutaneous coronary intervention

Abstract Introduction If reperfusion can be performed within 120 minutes, pPCI is the ESC guideline recommended treatment in patients with ST-elevation myocardial infarction (STEMI). Aims Historically, prognosis is dependent on time from diagnosis to reperfusion in patients with STEMI. We sought to investigate this in a contemporary patient population by assessing mortality as function of time from ECG diagnosis to sheath insertion in the Norwegian registry for invasive cardiology (NORIC). Methods NORIC, which is a part of the Norwegian Cardiovascular Disease Registry, is a national, mandatory and non-consensual person-identifiable health registry. Data from NORIC were linked with the National Population Register. Data were registered from 1st of January 2013 to 31st of June 2019. Results During this period complete data were available for n=5754 patients with 526 events. ECG diagnosis to sheath insertion was a predictor of mortality with the 4th (&amp;gt;106 min) vs 1st quartile (&amp;lt;54 min) with a HR of 1.74 (95% CI 1.36–2.22), p-value &amp;lt;0.00001. The HR increased by 1.20 (95% CI 1.11–1.30) per quartile (p-value for trend &amp;lt;0.00001). Nationally 62% percent of the patients received pPCI within the ESC recommended 90 minutes from ECG-diagnosis with large geographical variation (range 38–89%). Nationally 80% received pPCI within 115 minutes (range 75–202 minutes). Conclusion In a contemporary STEMI population, time from ECG diagnosis to sheath insertion is a strong predictor for mortality in patients admitted for pPCI for STEMI. However, the data also demonstrate large variations between different geographical health regions in Norway that should be addressed. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Haukeland University Hospital