Hgb Levels Research Articles

JAK2 unmutated erythrocytosis: 2023 Update on diagnosis and management.

JAK2 unmutated or non-polycythemia vera (PV) erythrocytosis encompasses a heterogenous spectrum of hereditary and acquired entities. Foremost in the evaluation of erythrocytosis is the exclusion of PV through JAK2 (inclusive of exons 12-15) mutation screening. Initial assessment should also include gathering of previous records on hematocrit (Hct) and hemoglobin (Hgb) levels, in order to streamline the diagnostic process by first distinguishing longstanding from acquired erythrocytosis; subsequent subcategorization is facilitated by serum erythropoietin (Epo) measurement, germline mutation screening, and review of historical data, including comorbid conditions and medication list. Hereditary erythrocytosis constitutes the main culprit in the context of longstanding erythrocytosis, especially when associated with a positive family history. In this regard, a subnormal serum Epo level suggests EPO receptor mutation. Otherwise, considerations include those associated with decreased (high oxygen affinity Hgb variants, 2,3-bisphosphoglycerate deficiency, PIEZO1 mutations, methemoglobinemia) or normal oxygen tension at 50% Hgb saturation (P50). The latter include germline oxygen sensing pathway (HIF2A-PHD2-VHL) and other rare mutations. Acquired erythrocytosis commonly results from central (e.g., cardiopulmonary disease, high-altitude habitat) or peripheral (e.g., renal artery stenosis) hypoxia. Other noteworthy conditions associated with acquired erythrocytosis include Epo-producing tumors (e.g., renal cell carcinoma, cerebral hemangioblastoma) and drugs (e.g., testosterone, erythropoiesis stimulating agents, sodium-glucose cotransporter-2 inhibitors). Idiopathic erythrocytosis is an ill-defined terminology that presumes the existence of an increased Hgb/Hct level without an identifiable etiology. Such classification often lacks accounting for normal outliers and is marred by truncated diagnostic evaluation. Current consensus treatment guidelines are not supported by hard evidence and their value is further undermined by limited phenotypic characterization and unfounded concerns for thrombosis. We are of the opinion that cytoreductive therapy and indiscriminate use of phlebotomy should be avoided in the treatment of non-clonal erythrocytosis. However, it is reasonable to consider therapeutic phlebotomy if one were to demonstrate value in symptom control, with frequency determined by symptoms rather than Hct level. In addition, cardiovascular risk optimization and low dose aspirin is often advised. Advances in molecular hematology might result in better characterization of "idiopathic erythrocytosis" and expansion of the repertoire for germline mutations in hereditary erythrocytosis. Prospective controlled studies are needed to clarify potential pathology from JAK2 unmutated erythrocytosis, as well as to document the therapeutic value of phlebotomy.

5610357 REDUCTION IN BLOOD TRANSFUSION BURDEN FOLLOWING INITIATION OF VOXELOTOR OR CRIZANLIZUMAB: A CASE SERIES

Background: Patients with sickle cell disease (SCD) often require blood transfusions. While transfusions may improve disease complications, resultant iron overload can lead to end-organ damage. Other transfusion complications include forming of alloantibodies and transmission of infection. Crizanlizumab and voxelotor have been shown respectively to reduce the frequency of vasoocclusive crises (VOCs) and improve anemia. This case series describes 5 patients with SCD who had a clinically significant decrease in transfusion burden following initiation of these therapies. Cases: Patient A is a 63-year-old woman with HbSBeta+thal and avascular necrosis (AVN) who was on intermittent erythrocytapheresis (apheresis) for symptomatic anemia and developed iron overload. Her serum ferritin was elevated despite chelation therapy. Upon initiation of voxelotor, the frequency of apheresis was reduced. She had a sustained improvement in her baseline hemoglobin (hgb) level as well as symptoms of anemia. Her ferritin decreased from 1253 to 714 ng/mL within 5 months and iron chelation therapy was discontinued. She had no change in acute care visits for VOCs (Table 1). Patient B is a 52-year-old woman with Hb SS, AVN and chronic pain who received intermittent simple transfusions for symptomatic anemia requiring 5 units of blood in the 12-months preceding initiation of voxelotor. She did not require any transfusions in the 12-month period following start of voxelotor. Hydroxyurea was discontinued once voxelotor was initiated due to antecedent myelosuppression at doses greater than 200mg. She had a sustained improvement in hgb as well as symptoms of anemia. She had a slight increase in acute care visits for VOCs (Table 1). Patient C is a 48-year-old man with Hb SS and retinopathy who was on monthly apheresis for many years to prevent VOCs. He had iron overload but declined iron chelation. To offset the transfusion associated iron overload, he opted to discontinue apheresis in favor of initiation of voxelotor and reinitiate hydroxyurea which had previously been discontinued. Following cessation of transfusions, he had a sustained improvement in hgb and no change in acute care visits for VOCs (Table 1). His port, placed solely for apheresis, was removed. His serum ferritin decreased from 2913 to 161 ng/mL in 18 months. Patient D is a 30-year-old man with Hb SS, AVN, chronic pain, and priapism who was on monthly apheresis for many years to prevent VOCs. He developed iron overload, however had poor compliance with chelation. After initiation of crizanlizumab for VOC prevention, the number of units utilized for apheresis was gradually tapered. Despite this, his hgb remained stable, he had no change in acute care visits for VOCs (Table 1) and reported an improvement in priapism frequency. Patient E is a 42-year-old woman with Hb SC, retinopathy, AVN, and chronic pain who received monthly apheresis for prevention of VOCs. Crizanlizumab was added for VOC prevention. She had sporadic childcare available, thus she missed some of her apheresis sessions. Despite this inadvertent decrease in transfusions, her hgb remained stable, and she had a decrease in acute care visits for VOCs (Table 1). Conclusion: In SCD patients who receive frequent simple or exchange blood transfusions for indications other than stroke prevention, tapering the amount of blood administered is possible, and should be considered when these patients are treated with crizanlizumab or voxelotor.

Multimodal Imaging Characteristics and Risk Factors Analysis of Waldenström Macroglobulinemia Retinopathy

To summarize the multimodal imaging features and analyze the risk factors of Waldenström macroglobulinemia retinopathy (WMR). Retrospective, cross-sectional study. Patients diagnosed with Waldenström macroglobulinemia and underwent ophthalmic examination in Peking Union Medical College Hospital in the last decade were included. Multimodal imaging characteristics of WMR were summarized. Univariate and multivariate logistic regression analysis of WMR and potential systemic and ocular factors was performed. A total of 50 WM patients were included in this study, and 28 patients had WMR in at least one eye. WMR was found to have worse LogMAR visual acuity (VA) (0.52±0.54 vs. 0.21±0.18, p=0.009), and was characterized by tortuous retinal vessels, extensive retinal hemorrhage, and distinctive shape of macular edema, etc. In univariate analysis, the presence of WMR was significantly associated with the mean VA (LogMAR), serum RBC counts, serum PLT counts, HGB level, serum M protein, serum IgM level, and LDH (with p<0.05). In multivariate analysis, WMR was significantly correlated with M protein (adjusted OR=1.127, 95% CI 1.052-1.209, p= 0.001) and serum IgM (adjusted OR=1.059, 95% CI 1.023-1.095, p= 0.001) with the predicted AUC of 0.820 and 0.859, respectively. The optimal cut-off values were 26.2g/L for M protein, and 51.0g/L for IgM, which accounts for a sensitivity of 95.4% and 95.4%, and specificity of 64.3% and 60.7%. Retinopathy of WM has specific characteristics in ophthalmic examinations. Serum IgM levels and M protein are good predictors of WMR, which could attach important value of fundus examinations for WM patients.

Phase angle and extracellular water-to-total body water ratio estimated by bioelectrical impedance analysis are associated with levels of hemoglobin and hematocrit in patients with diabetes

BackgroundAnemia is one of the common complications of diabetes and is associated with mortality. Phase angle (PhA), ratio of extracellular water to total body water (ECW/TBW) and skeletal muscle mass index (SMI) estimated by bioelectrical impedance analysis (BIA) have been used as prognostic indicators for various chronic diseases and frailty. We aimed to clarify the clinical significance of PhA, ECW/TBW and SMI for anemia in patients with diabetes. Materials and methodsThe values of PhA, ECW/TBW and SMI were estimated by a portable BIA device and blood samples were collected in 371 Japanese patients with diabetes. The relationships of PhA, ECW/TBW and SMI with hemoglobin (Hgb) and hematocrit (Hct) were statistically evaluated. ResultsIn simple linear regression analysis, PhA and SMI were positively correlated with Hgb and Hct levels in total subjects, male subjects and female subjects. In contrast, ECW/TBW was negatively correlated with Hgb and Hct levels regardless of sex. Multivariate regression analysis showed that both PhA and ECW/TBW but not SMI independently contributed to Hgb and Hct levels after adjustment of clinical confounding factors in both males and females. ConclusionsPhA and ECW/TBW but not SMI were associated with levels of Hgb and Hct in patients with diabetes. Therefore, aberrant values of PhA and ECW/TBW suggest a risk of anemia in diabetic patients.

Prevalence of Anemia and Associated Factors among Female Students in a Health Science College

Anemia is a condition defined with less hemoglobin (Hgb) level than the normal range in the body, which decreases the oxygen-carrying capacity of red blood cells to tissues. A cross-sectional study was conducted to, estimates the prevalence of anemia and associated risk factors among female students in the College of Health and Medical Sciences. Of a total of 422 surveyed 13.5% were anemic in which 61.3% and 26.1% were mild and moderate respectively. Univariate analysis of the potential risk factors has depicted that the history of malaria and folic supplementation showed a statistically significant association with the proportion of anemic (p&lt; 0.05). With multivariable analysis, only folic supplementation showed a statistically significant association with anemia (p&lt; 0.05). As a result, students on the iron supplement (OR=7.39, 1.45-37.57) were at higher risk of anemic than non-iron supplements. The present study has also demonstrated the existence of a high prevalence of anemia and deep-rooted the importance of iron supplements as possible causes of anemia. It is, therefore, recommended to prevent anemia in women by considering potential risk factors.

Blood biomarkers as potential malnutrition screening alternatives among adult patients with cancer on treatment in oncology unit of jimma tertiary hospital: A cross-sectional analysis

BackgroundCancer is becoming the most common global public health concern. Early malnutrition detection and treatment in patients with cancer is an important aspect of cancer management. Although Subjective global assessment (SGA) is a gold standard nutritional assessment tool, it is not routinely utilized due to it is tedious and needs patient literacy. Thus, early detection of malnutrition necessitates alternative parameters comparable with SGA. Therefore this study aims to evaluate serum albumin, Total Protein (TP), and Hemoglobin (Hgb) and their correlation with malnutrition in patients with cancer at Jimma Medical Center (JMC).MethodsFacility based cross-sectional study was conducted from October 15 to December 15, 2021 G.C at JMC among a total of 176 adult patients with cancer selected via a systematic sampling technique. Nutritional status and behavioural data were collected using the SGA tool and a structured questionnaire. Five ml of venous blood was collected and the level of serum albumin, TP and Hgb were measured using Cobas®6000 chemistry analyzer and hematology analyzer UniCel DxH 800. Descriptive statistics, independent t-test, Pearson’s correlation coefficient (r), and logistic regression analysis were implemented for analysis.ResultFrom the total of 176 study participants, 69.3% were females and the mean age was 50.1 ± 13.7 years. Based on SGA, 61.4% of the patients were malnourished. There was a significant decrease in the mean level of serum albumin, TP and Hgb in malnourished as compared to well-nourished patients. Serum albumin(r=-0.491), TP(r=-0.270), and Hgb (r=-0.451) had a significant correlation with SGA tool. Stage IV cancer AOR = 4.98 (1.23–20.07), Gastrointestinal (GI) cancer AOR = 3.39(1.29–8.88) and malnutrition AOR = 3.9(1.81–8.4) were significantly associated with hypoalbuminemia. Similarly, age of > 64 years AOR = 6.44(1.55–26.67), GI cancer AOR = 2.92(1.01–6.29) and malnutrition AOR = 3.14(1.43–6.94) were significantly associated with hypoproteinemia; and stage-IV cancer AOR = 3.94(1.11–13.35) and malnutrition AOR = 3.8(1.82–8.2) were significantly associated with low Hgb level.Conclusion and recommendationAltered level of serum albumin, TP and Hgb was correlated with the SGA tool of malnutrition. Therefore, it is suggested to be used as an alternative or additional screening tool for prompt detection of malnutrition in adult patients with cancer.

Post-Embolization Hemoglobin Changes: When to Consider Re-intervention.

Decline in hemoglobin (Hgb) levels is common post-embolization, but there is no consensus on the classification of patients based on risk for re-bleeding or re-intervention. The current study evaluated post-embolization Hgb level trends with the goal of understanding the factors predictive of re-bleeding and re-intervention. All patients who underwent embolization for gastrointestinal (GI), genitourinary, peripheral, or thoracic arterial hemorrhage from 01/2017 to 01/2022 were reviewed. Data included demographics, periprocedural pRBC transfusion (TF) or pressor requirements, and outcome. Lab data consisted of Hgb values pre-embolization, immediately post-embolization, and daily values on days 1-10 after embolization. Hgb trends were compared between patients across TF and re-bleeding outcomes. Regression model was used to examine factors predictive of re-bleeding and magnitude of Hgb reduction post-embolization. A total of 199 patients were embolized for active arterial hemorrhage. Perioperative Hgb level trends were similar for all sites and between TF + and TF- patients, showing a decline reaching a nadir within 6days post-embolization followed by an upward trend. Maximum Hgb drift was predicted by GI embolization (p = 0.018), TF before embolization (p = 0.001), and use of vasopressor (p = 0.000). Patients with Hgb drop > 15% within the first two days post-embolization had a higher chance of having a re-bleeding episode (p = 0.04). Perioperative Hgb trends showed a consistent downward drift followed by an upward shift, irrespective of TF requirement status or site of embolization. Using a cut-off value of 15% Hgb reduction within the first two days post-embolization may be helpful to assess re-bleeding risk.

Prognostic analysis of inflammatory response-related genes and biomarkers in patients with urothelial carcinoma of ureter.

Ureteral urothelial carcinoma is a common urinary system tumor, accounting for 40% to 60% of all ureteral diseases. This study attempted to analyze the prognosis of patients with urothelial carcinoma, judging ureteral urothelial carcinoma by genes and biomarkers of inflammatory response. In this paper, co-expression network analysis and gene-based image fusion evaluation methods were proposed to obtain the prognosis results of patients with ureteral urothelial carcinoma. The experimental results showed that the levels of PLR and NLR increased, and the levels of HGB and HCT decreased; high PLR and high NLR levels, low HGB and low HCT levels were all risk factors affecting bladder urothelial carcinoma, and their ratios (OR) were 1.023, 1.611, 0.961, 0.859, 1.015, 1.072, 0.979, and 0.951, respectively. However, high PLR and high NLR levels were independent risk factors for bladder urothelial carcinoma, and their OR values were 1.497 and 1.071, respectively. Through biomarker diagnosis, the area under the curve, sensitivity, specificity and Youden index of hsa-mir-17, hsa-mir-93, hsa-mir-429 and hsa-mir-20a all exceeded 0.9, indicating that this is a potential diagnostic indicators. All in all, during the treatment of ureteral cancer, in order to reduce tumor recurrence, systemic therapy should be combined with ureteral cancer. In addition, this study also analyzed the prognosis of chemotherapy patients, and the results showed that immunotherapy may increase the risk of tumor cell reperfusion during chemotherapy.

A scoring system to predict molecular responses in patients with chronic myeloid leukemia in the chronic phase receiving initial imatinib therapy

Objective: To develop a scoring system to predict molecular responses in patients with chronic myeloid leukemia in the chronic phase (CML-CP) receiving initial imatinib therapy. Methods: Data from consecutive adults with newly diagnosed CML-CP treated by initial imatinib was interrogated and subjects were distributed randomly into training and validation cohort, in a ratio of 2∶1. Fine-gray models were applied in the training cohort to identify co-variates of predictive value for major molecular response (MMR) and MR4. A predictive system was built using significant co-variates. The predictive system was then tested in the validation cohort and the area under the receiver-operator characteristic curve (AUROC) was used to estimate accuracy of the predictive system. Results: 1 364 CML-CP subjects receiving initial imatinib were included in this study. Subjects were distributed randomly into training cohort (n=909) and validation cohort (n=455) . In the training cohort, the male gender, European Treatment and Outcome Study for CML (EUTOS) Long-Term Survival (ELTS) intermediate-risk, ELTS high-risk, high WBC (≥130×10(9)/L or 120×10(9)/L, MMR or MR4) and low HGB (<110 g/L) at diagnosis were significantly related with poor molecular responses and were given points based on their regression coefficients. For MMR, male gender, ELTS intermediate-risk and low HGB (<110 g/L) were given 1 point; ELTS high-risk and high WBC (≥130×10(9)/L) , 2 points. For MR4, male gender was given 1 point; ELTS intermediate-risk and low HGB (<110 g/L) were given 2 points; high WBC (≥120×10(9)/L) , 3 points; ELTS high-risk, 4 points. We divided all subjects into 3 risk subgroups according to the predictive system above. Cumulative incidence of achieving MMR and MR4 in 3 risk subgroups was significantly different in both training and validation cohort (all P values <0.001) . In the training and validation cohorts, the time-dependent AUROC ranges of MMR and MR4 predictive systems were 0.70-0.84 and 0.64-0.81, respectively. Conclusions: A scoring system combining gender, WBC, HGB level and ELTS risk was built to predict MMR and MR4 in CML-CP patients receiving initial imatinib therapy. This system had good discrimination and accuracy, which could help phsicians optimize the selsction of initial TKI-therapy.

Prevalence of anemia and its predictors among patients with chronic kidney disease admitted to a teaching hospital in Ethiopia: A hospital-based cross-sectional study.

Anemia is a common complication of chronic kidney disease (CKD) and is associated with adverse patient outcomes. However, data on the prevalence of anemia in CKD patients is sparse, particularly in resource-limited settings. Therefore, this study aimed to assess the prevalence of anemia and its predictors among patients with CKD admitted to the Jimma medical center, southwest Ethiopia. A hospital-based prospective cross-sectional study was conducted from September 1 to November 30, 2020. All adult patients with CKD aged ≥18 years who fulfilled the inclusion criteria were consecutively recruited into the study. Data were entered into the Epi data manager version 4.4.1 and then exported to SPSS version 22 (IBM Corp., Armonk, NY) for analysis. The predictors of anemia were determined using multivariable logistic regression analysis. Statistical significance was set at P < .05. A total of 150 patients were included in this study. Of these, 64.67% were male, 56.67% had stage 5 CKD, 78% had a CKD duration of less than 1 year, and 74% had proteinuria. Hypertension (40.7%) and diabetes (14.7%) were the common causes of CKD. The prevalence of anemia was 85.33%. Of the patients, 28.67%, 40.67%, and 16% had mild, moderate, and severe anemia, respectively. On multivariate logistic regression, stage 4 CKD (adjusted odds ratio [AOR] 3.2, confidence interval [CI]: 1.78-12.91, P = .025), stage 5 CKD (AOR 4.03, CI: 1.17-13.73, P = .016), and CKD duration of less than 1 year (AOR 3, CI: 1.19-9.11, P = .007) were significantly associated with anemia. The prevalence of anemia among stage 3 to 5 CKD patients was very high. Anemia was significantly associated with the severity and duration of CKD. Therefore, serial follow-up of patients with a long duration and advanced stages of CKD may help prevent anemia and its adverse consequences.

Strategic Management of Bleeding Small Bowel Gastrointestinal Angiodysplasias (GIADs): A 12 Year Retrospective Review in a Veteran Population and Cost Comparison.

Gastrointestinal angiodysplasias (GIADs), also known as gastrointestinal angioectasias, are dilated, abnormally thin-walled blood vessels that occur in the mucosa and submucosa throughout the gastrointestinal tract. As a common cause of small bowel bleeding, GIADs have a significant impact on patient's morbidity and healthcare costs. Presently, somatostatin has been used widely to treat GIADs, but it is unclear if other therapies are as beneficial and cost-effective as somatostatin in managing GIADs. (2) Methods: A retrospective chart review was performed, which included subjects treated with Lanreotide, a somatostatin analog, and other therapies at the VA Loma Linda Healthcare System (VALLHCC) from January 2006 to December 2018. Patients who had symptomatic GIADs were detected by video capsule endoscopy (VCE), a device-assisted enteroscopy (DAE) or, in our case, push enteroscopy (PE) with an Endocuff. (3) Results: Three hundred twelve patients were diagnosed with GIADs. In this group of patients, 72 underwent ablation (endoscopic BICAP) with the addition of Lanreotide (SST), 63 underwent ablation therapy, eight were treated with SST only, 128 received iron replacement only, 25 received iron plus SST therapy, and 61 were observed with no therapy. Each group was followed via their hemoglobin (Hgb) level immediately thereafter, and Hgb levels were then obtained every 3 months for a 12-month period. After ablation therapy, 63 patients maintained stable Hgb levels over the course of the study, suggesting a significant therapeutic effect by controlling active bleeding. The 27 patients receiving ablation +SST therapy did not show improvements when compared to ablation only and the 128 patients who received iron therapy alone. (4) Conclusions: Importantly, 12 years of managing these patients has given us a cost- and time-sensitive strategy to maintain the patients' Hgb levels and avoid hospital admissions for acute bleeding. Iron treatment alone is effective compared to SST treatment in recovering from GIADs. Eliminating SST treatment from therapeutic intervention would save $89,100-445,550 per patient, depending on the number of doses for private care patients and $14,286-28,772 for VA patients, respectively. A suggested therapy would be to perform DAE on actively bleeding patients, ablate the lesions using a coagulation method, and place the patient on iron. If that fails, gastroenterologists should repeat VCE and perform either PE with Endocuff or balloon enteroscopy (all DAEs).

OP34 Enteral Nutrition Compared with Steroids in Children with Crohn’s Disease – In Israel: a nationwide study from the epi-IIRN

Abstract Background Studies have shown that exclusive enteral nutrition (EEN) treatment is as effective to corticosteroids (CS) for induction of remission in pediatric Crohn's disease (CD) with fewer side effects, but long-term outcome data are scarce. In this nationwide study we aimed to compare the risk of complicated disease course (CDC) after 2 years of follow-up in children with CD receiving EEN or CS as induction therapy. Methods Data of children diagnosed with CD in the epi-IIRN cohort between 2005-2020 were retrieved from the 4 Israeli Health-Maintenance-Organizations covering 98% of the population. The primary outcome was CDC defined as CD-related surgery, steroid-dependency, or need for more than one biologic class during 2 years post-diagnosis. Secondary outcomes included hospitalizations, and the use of biologics (any). Additionally, anthropometrics, labs reflecting nutrition (i.e., Alb and HGB), and growth were assessed at repeated visits until 2 years thereafter. To account for confounding by indication bias, we compared children with similar baseline characteristics based on Propensity Score (PS) individual matching. Time to CDC outcome was evaluated using Kaplan-Meier survival curves and compared by the log-rank test. A Cox proportional hazard model was sought to assess the relationship between the type of induction and time to CDC outcome. Results A total of 785 children with CD were induced after diagnosis with either EEN (n=410) or CS (n=375); mean age 13.3±3.5 years, 59% males. PS successfully matched 116 pairs of whom 85 (36%) had CDC. The survival probability of CDC at 6, 12,18, and 24 months was higher in the CS group compared to the EEN group at all time points (5%vs4%, 12% vs 10%, 22% vs 3%, and 27% vs.16%, respectively p=0.045; fig. 1). In a Cox multivariable model adjusted by year of diagnosis, CS induction treatment was similarly associated with higher hazard of CDC by 2 years (HR 1.8 [95%CI 1.01-3.25]). The survival probability of hospitalization was also higher in the CS group at 6,12,8, and 24 months (16% vs 9%, 20% vs 12%, 25% vs 14%, and 27% vs. 15%, respectively, p=0.024; fig.2). There was no difference in time to biologics (p=0.96, n=59 (51%) in EEN, n=57 (49%) in CS) and anthropometric data (Table 1). Significant improvements were observed in HGB and Alb levels for the EEN group during the first 3 months from diagnosis compared with the CS (p=0.046 and p=0.035 respectively) (table 1). Conclusion EEN as induction therapy in pediatric CD is associated with a lower long-term risk of complicated disease course and larger improvement in HGB and Alb but not in growth parameters compared with CS, even when adjusting to baseline disease severity and patients characteristics.

EFFICACY OF UPADACITINIB IN PATIENTS PREVIOUSLY TREATED WITH TOFACITINIB FOR THE MANAGEMENT OF ULCERATIVE COLITIS

Abstract BACKGROUND Tofactinib is a JAK inhibitor that targets mainly JAK 1 and JAK3 approved to treat Ulcerative Colitis (UC) in 2018. The JAK inhibitor Upadacitinib (upa) was recently approved to treat UC in March 2022 and has increased selectivity for JAK1. The relative efficacy and safety of these two JAK inhibitors is not presently clear. An important clinical question is whether patients who have not responded or lost response to tofacitinib will have a reasonable likelihood of response with upadacitinib. AIM To determine whether patients previously exposed to tofacitinib would benefit from treatment with upa. METHODS We identified adult patients at our center with active UC who had previously been treated with tofacitinib who were started on upa in the spring of 2022. Pre- and post- upa characteristics were recorded including demographic information, prior treatments, hemoglobin (hgb), albumin (alb), C-reactive protein (CRP), and partial Mayo score (pMS). Primary end points evaluated were clinical response (decrease in pMS &amp;gt;2), and clinical remission (pMS &amp;lt; 2). Secondary endpoints included serious adverse events, steroid use at time of follow up, and normalization of CRP, hgb and alb. IRB approval was obtained for the study. RESULTS A total of 3 patients were identified. All patients were given upa 45 mg daily for 8 weeks followed by 30 mg daily for maintenance. Median follow up time was 10 weeks (range 10-11 weeks). All three patients achieved the primary endpoints of clinical response and remission with pMS values of 0 at time of follow up. Patients 1 and 2 were concurrently started on a prednisone taper when initiating upa and were no longer on prednisone at time of follow up. Patients 1 and 2 had normalization of their CRP values, patient 3 only had a pre-upa CRP value available and that was 0. See table 1 for data on hgb and alb levels. Patient 1 had a pre-upa endoscopic mayo score of 3, while patients 2 and 3 had pre-upa endoscopic mayo scores of 2. No patient had post-upa endoscopic evaluation at time of follow up. No patient had any serious adverse events. CONCLUSIONS In this small case-series, use of upadacitinib in patients previously treated with tofacitinib was safe and effective in achieving clinical remission.

Transfusion Thresholds Can Be Safely Lowered in the Hip Fracture Patient: A Consecutive Series of 1,496 Patients.

The purpose of this study is to identify optimal threshold hemoglobin (Hgb) and hematocrit (Hct) laboratory values to transfuse hip fracture patients. A consecutive series of hip fracture patients were reviewed for demographic, clinical, and cost data. Patients receiving an allogeneic transfusion of packed red blood cells (pRBCs) were grouped based on last Hct or Hgb (H&H) value before first transfusion. Multivariate logistic regressions of H&H quantile were performed to predict "good outcomes," a composite binary variable defined as admissions satisfying (1) no major complications, (2) length of stay below top tertile, (3) cost below median, (4) no mortality within 30 days, and (5) no readmission within 30 days. Odds ratios (OR) for "good outcomes" were calculated for each H&H quantile. One thousand four hundred ninety-six hip fracture patients were identified, of which 598 (40.0%) were transfused with pRBCs. Patients first transfused at Hgb values from 7.55 to 7.85 g/dL ( P = 0.043, OR = 2.70) or Hct values from 22.7 to 23.8% ( P = 0.048, OR = 2.63) were most likely to achieve "good outcomes." The decision to transfuse patients should be motivated by Hgb and Hct laboratory test results, given that transfusion timing relative to surgery has been shown to not affect outcomes among patients matched by trauma risk score. Surgeons should aim to transfuse hip fracture patients at Hgb levels between 7.55 g/dL and 7.85 g/dL or Hct levels between 22.7% and 23.8%. These transfusion thresholds have the potential to lower healthcare costs without compromising quality, ultimately resulting in less costly, efficacious care for the patient. Level III.

Rate, risk factors and estimations of time to develop severe acute malnutrition after children receiving antiretroviral therapy at selected health facilities in northwest Ethiopia.

Severe acute malnutrition (SAM) affects up to 50 % of children with HIV, especially those who reside in resource-constrained healthcare setting like Ethiopia. During subsequent follow-up of children factors related to incidence of SAM after antiretroviral therapy (ART) is set on, however, there is no prior evidence. An institution-based retrospective cohort study was employed among 721 HIV-positive children from 1 January to 30 December 2021. Data were entered using Epi-Data version 3.1 and exported to STATA version 14 for analysis. Bi-variable and multivariable Cox-proportional hazard models were employed at 95 % confidence intervals to identify significant predictors for SAM. According to this result, the overall mean (±sd) age of the participants was found to be 9⋅83 (±3⋅3) years. At the end of the follow-up period, 103 (14⋅29 %) children developed SAM with a median time of 30⋅3 (13⋅4) months after ART initiation. The overall incidence density of SAM was found to be 5⋅64 per 100 child (95 % CI 4⋅68, 6⋅94). Children with CD4 counts below the threshold [AHR 2⋅6 (95 % CI 1⋅2, 2⋅9, P = 0⋅01)], disclosed HIV status [AHR 1⋅9 (95 % CI 1⋅4, 3⋅39, P = 0⋅03)] and Hgb level ≤10 mg/dl [AHR 1⋅8 (95 % CI 1⋅2, 2⋅9, P = 0⋅03)] were significant predictors for SAM. Significant predictors of acute malnutrition were having a CD4 count below the threshold, children who had previously reported their HIV status, and having haemoglobin <10 mg/dl. To ensure better health outcomes, healthcare practitioners should improve earlier nutritional screening and consistent counselling at each session of care.

PS-BPC08-4: IMPACT OF TESTOSTERONE REPLACEMENT THERAPY ON 24-HOUR AMBULATORY BLOOD PRESSUR E MEASUREMENTS IN MALES WITH OPIOID-INDUCED ANDROGEN DEFICIENCY. A PLACEBO-CONTROLLED RCT

Objective: The primary aim was to investigate the effects of testosterone replacement therapy (TRT) on 24-hour ambulatory blood pressure (24hABPM) in opioid-treated men with relative hypogonadism. The secondary aim was to evaluate potential effect modification of baseline body composition and red blood cell measurements on the impact of TRT on 24hABPM. Design and methods: This was a double blinded and placebo controlled study. Men aged &gt; 18 years, treated with an opioid dosage &gt; 50 mg opioid/day were eligible for inclusion if total testosterone (TT) was &lt; 12 nmol/L. Participants were randomized to TRT (1,000 mg testosterone undecanoate) or placebo at 0, 6 and 18 weeks. Participants were examined before and during 24 weeks of TRT/placebo. Results: The two groups (TRT, n = 15 and placebo, n = 20) were comparable at baseline. TRT was associated with numerical increase in 24hABPM. The difference in changes from baseline of daytime systolic blood pressure (SBP) was 5.2 mmHg (P = 0.134) between the TRT group and the placebo group. In subgroup analysis, baseline values of body mass index (BMI), hematocrit (Hct) and hemoglobin (Hgb) levels displayed significant positive interaction on the effect of TRT on change in SBP compared to placebo. In participants with BMI above the study median (30.7 m2/kg), daytime SBP change from baseline was 17.6 mmHg [10.6, 24.6] (P = 0.002) in the TRT group and 0.4 mmHg [-5.5, 4.7] (P = 0.864) in the placebo group. In participants with Hct levels above the study median (0.43%), daytime SBP increased 8.4 mmHg [-1.9, 18.8] (P = 0.09) in the TRT group and decreased -2.3 mmHg [-11.3, 6.8] (P = 0.564) in the placebo group. Similarly, in participants with Hgb&gt; 8.7 mmol/L daytime, SBP change was 11.2mmHg [0.6–21.7] (P = 0.041) in the TRT group and -2.9 mmHg [-4.1, 9.9] (P = 0.367) in the placebo group. Baseline cIMT also increased the strength of association between TRT and change in SBP. After adjusting for delta-BMI, delta-Hct remained significantly associated with increase in daytime SBP. An increase in 1 mmHg SBP was associated with an increase in Hct of 0.11% [0.10–0.22] (P = 0.032). Conclusions: Baseline levels of BMI, Hct, Hgb and cIMT, influence the effect of TRT on BP. The magnitude of BP increase is associated with increase in Hct levels.

Preclinical toxicity assessment of a peptide-based antiPCSK9 vaccine in healthy mice

BackgroundProprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition is a novel cholesterol-lowering treatment for decreasing the risk of atherosclerosis. We have previously shown that active immunization using the antiPCSK9 vaccine could decrease hypercholesterolemia and impede the development of atherosclerotic lesions in the experimental model of atherosclerosis. Here, we evaluated the toxicity of the vaccine in healthy mice. MethodsForty male and female albino mice were divided into 4 experimental groups, including vaccine female (10 mice) and male (10 mice) groups receiving the antiPCSK9 vaccine as well as the corresponding control female (10 mice) and male (10 mice) groups receiving the phosphate buffer. Vaccination was planned based on 4 subcutaneous injections of the vaccine formulation (10 µg/mouse) in bi-weekly intervals. The toxicity study was performed by the subacute protocol, 28 days after the last vaccine injection. To this end, the plasma levels of lipid indexes, urea, creatinine, AST, ALT, ALP, and fasting plasma glucose (FPG), as well as the CBC test were measured. To evaluate histopathological alterations, various tissues including the heart, liver, kidney, spleen, and brain were studied using hematoxylin & eosin (H&E) staining by an expert pathologist. The severity of damage to the tissue was considered based on the standard classification; grade 1 as light damage, grade 2 as moderate damage, grade 3 as near intense damage, and grade 4 as intense damage. ResultsThe results showed non-significant changes of total cholesterol, LDL-C, triglyceride, HDL-C, FBS, creatinine, urea, AST, ALP, ALT, and PAB in the vaccinated mice when compared with control mice. The CBS test indicated that there were no significant changes in the levels of WBC, RBC, HGB, HCT, MCH, MCHC, PLT, LYM, NEUT, MCV, RDW-S, PDW, and MPV in the vaccinated mice when compared with control mice. Evaluating histopathological alterations in various tissues indicated no significant adverse effects in vaccinated mice when compared to control mice. ConclusionThe findings of the present study indicate that antiPCSK9 is safe and exerts no adverse effects on the function of different organs and blood levels of cellular and biochemical biomarkers in healthy mice.

Investigation of the relationship between inflammatory markers and grade of disease in patients with acute ischemic stroke with partial anterior circulation infarct

Objectives: The aim of this study was to investigate the relationship between National Institutes of Health Stroke Scale scores and Glasgow coma scores of patients with partial anterior ischemic stroke and laboratory results, particularly serum CRP, albumin, platelet and other complete blood count data, and prognosis. Methods: In this retrospective study 226 of patients with partial anterior circulation infarction who were admitted to the Bolu Abant İzzet Baysal University Neurology Clinic between January 2021 and 2022 with the diagnosis of acute ischemic stroke and hospitalized within the first 24 hours were investigated. The demographic data, stroke etiology and risk factors, National Institutes of Health Stroke Scale, Glasgow coma scores, complete blood count, certain inflammatory markers and biochemical parameters, length of hospital stay and mortality rates were examined. And the relationship between inflammatory markers and grade of disease was evaluated statistically. Results: The patients with moderate Glasgow coma score had a lower lymphocyte level, severe patients had higher PCT level and moderate patients had higher CRP level among others. Patients with moderate GCS had higher CRP/ALB val­ues than those with mild. Patients with moderate and moderate-severe National Institutes of Health Stroke Scale had higher RBC and HGB levels than the patients with mild. Moderate-severe patients had lower albumin lev­els. Conclusion: CRP-albumin ratio, serum platelet and serum albumin levels may have prognostic value in acute partial anterior ischemic stroke patients.

The initial attempt at home hemodialysis in mainland China

BackgroundObservational studies have shown home hemodialysis (HHD) to be associated with better survival than facility hemodialysis (HD) and peritoneal dialysis (PD). Patients on HHD have reported higher quality of life and independence. HHD is considered to be an economical way to manage end-stage kidney disease (ESKD). The coronavirus disease 2019 pandemic has had a significant impact on patients with ESKD. Patients on HHD may have an advantage over in-center HD patients because of a lower risk of exposure to infection.Participants and methodsWe enrolled HD patients from our dialysis center. We first established the HHD training center. The training center was approved by the Chinese government. Doctors, nurses and engineers train and assess patients separately. There are three forms of patient monitoring: home visits, internet remote monitoring, and outpatient services. Demographic and medical data included age, sex, blood pressure, and dialysis-related data. Laboratory tests were conducted in our central testing laboratory, including hemoglobin (Hgb), serum creatinine (Cr), urea nitrogen (BUN), uric acid (UA), albumin (Alb), calcium (Ca), phosphorus (P), parathyroid hormone (PTH), and brain natriuretic peptide (BNP) levels.ResultsSix patients who underwent regular dialysis in the HD center of our hospital were selected for HHD training. We enrolled 6 patients, including 4 males and 2 females. The mean age of the patients was 47.5 (34.7-55.7) years, and the mean dialysis age was 33.5 (11.2-41.5) months. After an average of 16.0 (11.2-25.5) months of training, Alb, P and BNP levels were improved compared with the baseline values. After training, three patients returned home to begin independent HD. During the follow-up, there were no serious adverse events leading to hospitalization or death, but there were several adverse events. They were solved quickly by extra home visits of the technicians or online by remote monitoring. During the follow-up time, the laboratory indicators of all the patients, including Hgb, Alb, Ca, P, PTH, BNP, and β2-MG levels, remained stable before and after HHD treatment.ConclusionHHD is feasible and safe for ESKD in China, but larger-scale and longer-term studies are needed for further confirmation.

Hemoglobin Levels Among Male Agricultural Workers: Analyses From the Demographic and Health Surveys to Investigate a Marker for Chronic Kidney Disease of Uncertain Etiology.

Estimate agricultural work's effect on hemoglobin (Hgb) level in men. A negative effect may indicate presence of chronic kidney disease of uncertain etiology. We use Demographic and Health Surveys data from seven African and Asian countries and use matching to control for seven confounders. On average, Hgb levels were 0.09 g/dL lower among agricultural workers compared with matched controls. Significant effects were observed in Ethiopia, India, Lesotho, and Senegal, with effects from 0.07 to 0.30 g/dL lower Hgb level among agricultural workers. The findings were robust to multiple control groups and a modest amount of unmeasured confounding. Men engaged in agricultural work in four of the seven countries studied have modestly lower Hgb levels. Our data support integrating kidney function assessments within Demographic and Health Surveys and other population-based surveys.