Higher Prevalence Of Comorbidities Research Articles

Investigation of the Exometabolomic Profiles of Rat Islets of Langerhans Cultured in Microfluidic Biochip.

Diabetes mellitus (DM) is a complex disease with high prevalence of comorbidity and mortality. DM is predicted to reach more than 700 million people by 2045. In recent years, several advanced in vitro models and analytical tools were developed to investigate the pancreatic tissue response to pathological situations and identify therapeutic solutions. Of all the in vitro promising models, cell culture in microfluidic biochip allows the reproduction of in-vivo-like micro-environments. Here, we cultured rat islets of Langerhans using dynamic cultures in microfluidic biochips. The dynamic cultures were compared to static islets cultures in Petri. The islets' exometabolomic signatures, with and without GLP1 and isradipine treatments, were characterized by GC-MS. Compared to Petri, biochip culture contributes to maintaining high secretions of insulin, C-peptide and glucagon. The exometabolomic profiling revealed 22 and 18 metabolites differentially expressed between Petri and biochip on Day 3 and 5. These metabolites illustrated the increase in lipid metabolism, the perturbation of the pentose phosphate pathway and the TCA cycle in biochip. After drug stimulations, the exometabolome of biochip culture appeared more perturbed than the Petri exometabolome. The GLP1 contributed to the increase in the levels of glycolysis, pentose phosphate and glutathione pathways intermediates, whereas isradipine led to reduced levels of lipids and carbohydrates.

Preoperative Evaluation and Cardiac Risk Assessment in Vascular Surgery.

We summarize epidemiologic trends, outcomes, and preoperative guidelines for vascular surgery patients from 2010 to 2022. Vascular surgery continues to evolve in technology and engineering to treat a surgical population that suffers from a high prevalence of comorbidities. Preoperative optimization seeks to characterize the burden of disease and to achieve medical control in the timeline available before surgery. Risk assessment, evaluation, optimization, and prediction of major adverse cardiac events is an evolving science where the Vascular Surgery Quality Initiative has made an impact. Ongoing investigation may demonstrate value for preoperative echocardiography, functional capacity, frailty, and mobility assessments.

Impact of Immunosuppression on the Severity of SARS-CoV-2 Infection in Renal Transplant Recipients

Abstract: Kidney transplant patients have a high case fatality rate following severe acute respiratory syndrome 2 (SARS-CoV-2) infection. In addition, the vaccine immune response is lower and less durable, which makes them more susceptible to severe forms, even when vaccinated. Evidence suggests that in addition to advanced age and the high prevalence of comorbidities often associated with worse prognosis, such as diabetes, obesity, and cardiovascular disease, prolonged immunosuppression exerts an independent effect on outcomes. In fact, the cellular and humoral adaptive immune response, which is inhibited by immunosuppression, is a key step in resolving SARS-CoV-2 infection. On the other hand, lymphocyte inhibition could modulate the aberrant production of proinflammatory cytokines that result in severe lung impairment, mitigating the severity of the condition. In addition, some immunosuppressive drugs have antiviral properties, potentially applicable to coronavirus. This narrative review aimed to discuss the available evidence on the impact of immunosuppressive drugs on COVID-19 outcomes in kidney transplant recipients

Différences sexuelles dans la mortalité par accident vasculaire cérébral en Thaïlande : une étude de cohorte nationale

BackgroundOver half of the growing global stroke-mortality burden is accounted for by the East-Asian-subcontinent alone. Sex differences in stroke-mortality in the Asian population is yet to be assessed in the literature. We aimed to assess the sex-differences in mortality following stroke in a large cohort of Thai-patients. MethodAll stroke admissions between 2004–2015 were included from the Thailand public-health-insurance-database. The association between sex and mortality was assessed in-hospital, at 1 month, 1 year and 5 years, using multivariable Cox-regressions, separately for ischaemic-stroke (IS), haemorrhagic-stroke (HS) and stroke-of-undetermined-type(SUT), adjusting for confounders. Results608,890 patients were included: 370,527 patients with IS(60.9%), 173,236 with HS(28.5%) and 65,127 with SUT(10.6%). Women were older than men in all three groups and had higher prevalence of comorbidities. Adjusted hazard-ratios(HRs) of mortality showed women had higher mortality post-IS compared to men (in-hospital: HR: 1.20; 95% CI: 1.17–1.23; 1 month: HR: 1.17; 95% CI: 1.15–1.20; 1 year: HR: 1.10; 95% CI: 1.09–1.12 and 5 years: HR: 1.02; 95% CI: 1.01–1.03). Women also had higher mortality after HS (in-hospital: HR: 1.02; 95% CI: 1.00–1.04; 1 month: HR: 1.08; 95% CI: 1.06–1.10; 1 year: HR: 1.04; 95% CI: 1.03–1.06 and 5 years: HR: 1.09; 95% CI: 1.08–1.11), and SUT (in-hospital: HR: 1.04; 95% CI: 1.03–1.06; 1 month: HR: 1.20; 95% CI: 1.14–1.27; 1 year: HR: 1.14; 95% CI: 1.09–1.18 and 5 years: HR: 1.06; 95% CI: 1.03–1.10). ConclusionsCompared to men, women were older at time of stroke-diagnosis and had higher burden of stroke risk-factors. Women also had higher mortality after stroke regardless of stroke-type or duration since stroke-onset. Post-IS, excess stroke-mortality in women was greatest during the in-hospital period, whereas excess stroke-mortality increased with time in women who had HS. No clear relationship was found between duration since stroke-onset and mortality in patients who had SUT.

Prognostic implications of atrial fibrillation in adults with Ebstein anomaly

ObjectiveSupraventricular arrhythmias are common in adults with Ebstein anomaly (EA). However, there are limited data about prognostic implications of atrial fibrillation (AF) in this population. Accordingly, our aim was to...

Abstract 11910: Contemporary In-Hospital Outcomes of Bifurcation Percutaneous Coronary Interventions: Update From the Prospective Global Registry for the Study of Bifurcation Lesion Interventions (PROGRESS-BIFURCATION)

Introduction: Bifurcation percutaneous coronary intervention (PCI) techniques are rapidly evolving and can be challenging to perform. Methods: We examined the angiographic, procedural characteristics, and outcomes of 472 bifurcation PCIs in Prospective Global Registry for the Study of Bifurcation Lesion Interventions (PROGRESS-BIFURCATION, NCT05100992). Results: A total of 472 bifurcation PCIs were included. Mean age was 67±12 years, 74% were men with a high prevalence of comorbidities: hypertension (81%), diabetes mellitus (36%), dyslipidemia (90%). Overall technical success was 95%. The incidence of in-hospital major adverse cardiovascular events (MACE) was 5.1%. The most common stenting strategy was provisional (71%), double-kissing (DK) crush (12%), mini-crush wish 2 stents (3%), culotte (3%), T-and protrusion (4%), and T-stenting (1.5%). Patients treated with the DK-crush had more severe stenosis of the left main (35%±38 vs. 19%±30, p<0.001), proximal left anterior descending (68%±29, vs. 52%±35, p=0.001), and side branch lesion (82%±15, 51%±36, p<0.001). Medina classification was more often 1,1,1 (79% vs. 39%, p<0.001), with higher use of intravascular ultrasound/optical coherence tomography (57% vs. 31%, p<0.001) compared to non-DK crush. The DK-crush required use of more contrast and took longer to perform (Table). Conclusions: Despite high patient comorbidity, bifurcation PCI can be performed with high technical success and low in-hospital MACE rates. DK-crush technique was more commonly preferred in bifurcation lesions with more severe/proximal vessel involvement.

Abstract 13436: Sex-Specific Predictors of Postoperative Atrial Fibrillation and the Role of Cardiometabolic Diseases

Introduction: Cardiometabolic diseases increase the risk of postoperative atrial fibrillation (POAF), which in turn is associated with higher long-term risk of major cardiovascular events (MACE). Little is known regarding the sex-specific impact of cardiometabolic diseases on POAF risk. We evaluated the sex-specific predictors of POAF after coronary artery bypass grafting (CABG), with a focus on preoperative cardiometabolic profile. Methods: In a prospective registry of patients undergoing isolated CABG (2006-2019), we compared predictors of POAF between sexes. We excluded patients with previous AF history, redo/urgent/off-pump CABG, perioperative mortality, and permanent pacemakers/defibrillators. Abdominal obesity was defined as a waist circumference (WC) >102 cm (men [M]) or >88 cm (women [W]). Results: We included 7,851 patients (19% women). Baseline characteristics are presented in Table 1. POAF occurred in 27% of women and 31% of men (p<0.01). Women were older and had a higher prevalence of comorbidities, abdominal obesity and a worse lipid profile. In a logistic regression model adjusting for the variables in Table 1, men had a higher risk of POAF (OR M = 1.4 [1.2-1.6], p<0.01). When stratifying by sex, significant predictors (p<0.05) of POAF for both sexes were age, WC (OR M = 1.04 [1.00-1.08]; OR W = 1.01 [1.00-1.03]), and triglycerides (TG) (OR M = 0.98 [0.97-0.99]; OR W = 0.97 [0.95-0.99]). Sex-specific predictors were creatinine for women and beta-blockers, extracorporeal circulation time, intensive care stay and hemoglobin for men. Conclusions: Women had less POAF but worse preoperative cardiometabolic profile compared to men. WC was a strong predictor of POAF for both sexes, while higher TG levels were protective. Since POAF is linked to future risk of MACE, the preoperative clinical assessment of WC should be encouraged and targeted for preventive strategies, especially in women. More studies are needed to investigate the role of TG in POAF.

Abstract 15093: Elevated Risk of Recurrent Ablation in Black Compared to White Patients With Atrial Fibrillation: Another Paradox of Atrial Fibrillation in Blacks

Introduction: Lower prevalence of atrial fibrillation (AF) despite a higher prevalence of risk factors in blacks compared to whites (AF paradox) has been reported. However, less information is available about recurrent ablation events in blacks compared to whites. Methods: Demographic characteristics and one-year recurrent ablation events were analyzed in AF patients admitted to a community hospital from 2018 to 2021. Results: Recurrent AF ablation occurred in 3.7% (16/435) of the study population and was significantly higher in black compared to white patients [9/86 (10.5%) vs. 7/349 (2.0%), respectively, p=0.0001]. Black race and history of atrial flutter were predictors of recurrent AF ablation (p<0.05) within one year of initial ablation. Black patients were younger (p=0.03) with a significantly higher prevalence of hypertension, diabetes, cardiomyopathy/heart failure, thyroid disease, renal disease, sleep apnea, COVID-19, pacemaker/AICD placement, and history of Ventricular tachycardia (Table). Concomitant medications were similar between races besides higher use of antihypertensive medications in black patients (Table). Conclusions: In our community hospital setup, black patients with AF had a higher prevalence of comorbidities and significantly higher incidence of one-year recurrent ablation events despite similar therapy compared to white patients. These observations should be explored in a larger prospective study to understand the differential association of comorbidities in black AF patients and associated higher risk for recurrent events.

RF17 | PSAT126 Early Life Adversity and a Sex-Specific Polygenic Risk Score for Altered Fasting Insulin are Associated with Executive Functioning.

Abstract Insulin is an important homeostatic hormone with implications for childhood growth, development and adult psychopathology. Considering the high prevalence of co-morbidity between altered metabolism and executive function problems (e.g. obesity and ADHD), we hypothesized that 1) the genetic background associated with altered fasting insulin (FI) and ADHD could be shared; 2) if (1) is rejected, it suggests that interactive models between the genetic background associated with altered FI and childhood environment would better predict executive functions. Using conjunctional false discovery rate (FDR), we found no SNPs shared between the FI GWAS and ADHD GWAS. (2) We calculated polygenic risk scores (PRS) from the sex-specific FI GWAS and identified the threshold that best predicted insulin levels in male and female children in the ALSPAC cohort [Nmales = 245, Nfemales = 222; pt-intial-males = 0.35 (41,108 SNPs), pt-intial-females = 0.01 (2751 SNPs)], further refining it to only include SNPs significantly associated with insulin levels [pt-refined-males = 0.05 (32,520 SNPs), pt-refined-females = 0.05 (230 SNPs)]. We calculated the refined PRS (rPRS) at different ages in multiple cohorts and investigated its interaction effect with early adversity on attention deficit assessments, through CBCL Attention Problems Scale and DSM ADHD Scale, in males and females. In MAVAN, there was a significant interaction [N = 74, p = 0.039] in females at the age of 60 months where simple slope analysis informed us that within the low rPRS group, there is a significant [p = 0.005] positive association between postnatal adversity and attention problems. In GUSTO, there was a significant interaction [N = 208, p = 0.026] in males at the age of 4 years where simple slope analysis informed us that within the high rPRS group, there is a significant [p = 0.003] positive association between postnatal adversity and attention problems. In ABCD, there was a significant interaction in males [N = 4012, p = 0.05] at the age of 10 years and in females [N = 1689, p = 0.013] at the age of 11 years where simple slope analysis informed us that within the low and high rPRS groups, there is a significant [plow_PRS_male < 0.01, phigh_PRS_male< 0.01, plow_PRS_female < 0.01, phigh_PRS_female= 0.03] positive association between postnatal adversity and attention problems. The sex differences at different ages observed in these analyses agree with the differences in males’ and females’ growth trajectories, which are influenced by insulin during development. We conclude that since conjunctional FDR was not feasible and there were no main effects of fasting insulin PRS, the genetic background associated with FI levels is linked with executive function psychopathology, but this effect is sex and environment dependent. The findings reported have implications for age-dependent identification and treatment of psychopathology. Presentation: Sunday, June 12, 2022 12:54 p.m. - 12:59 p.m.

Racial and ethnic disparities in 3-year outcomes following infrainguinal bypass for chronic limb-threatening ischemia.

Black and Hispanic patients have had higher rates of chronic limb-threatening ischemia (CLTI) and experienced worse perioperative outcomes after lower extremity bypass compared with White patients. The underlying reasons for these disparities have remained unclear, and data on 3-year outcomes are limited. Therefore, we examined the differences in 3-year outcomes after open infrainguinal bypass for CLTI stratified by race/ethnicity and explored the potential factors contributing to these differences. We identified all CLTI patients who had undergone primary open infrainguinal bypass in the Vascular Quality Initiative registry from 2003 to 2017 with linkage to Medicare claims through 2018 for the 3-year outcomes. Our primary outcomes were the 3-year rates of major amputation, reintervention, and mortality. We also recorded the 30-day major adverse limb events (MALE) defined as major amputation or reintervention. We used Kaplan-Meier estimation methods and multivariable Cox regression analyses to evaluate the outcomes stratified by race/ethnicity and identify contributing factors. Of the 7108 patients with CLTI, 5599 (79%) were non-Hispanic White, 1053 (15%) were Black, 48 (1%) were Asian, and 408 (6%) were Hispanic patients. Compared with White patients, Black patients had higher rates of 3-year major amputation (Black vs White, 32% vs 19%; hazard ratio [HR], 1.9; 95% confidence interval [CI], 1.7-2.2), reintervention (Black vs White, 61% vs 57%; HR, 1.2; 95% CI, 1.1-1.3), and 30-day MALE (Black vs White, 8.1% vs 4.9%; HR, 1.3; 95% CI, 1.2-1.4) but lower mortality (Black vs White, 38% vs 42%; HR, 0.9; 95% CI, 0.8-0.99). Hispanic patients also experienced higher rates of amputation (Hispanic vs White, 27% vs 19%; HR, 1.6; 95% CI, 1.3-2.0), reintervention (Hispanic vs White, 70% vs 57%; HR, 1.4; 95% CI, 1.2-1.6), and MALE (Hispanic vs White, 8.7% vs 4.9%; HR, 1.5; 95% CI, 1.3-1.7. However, mortality was similar between the two groups (Hispanic vs White, 38% vs 42%; HR, 0.88; 95% CI, 0.76-1.0). The low number of Asian patients prevented a meaningful assessment of amputation (Asian vs White, 20% vs 19%; HR, 0.93; 95% CI, 0.44-2.0), reintervention (Asian vs White, 55% vs 57%; HR, 0.79; 95% CI, 0.51-1.2), MALE (Asian vs White, 8.5% vs 4.9%; HR, 0.71; 95% CI, 0.46-1.1), or mortality (Asian vs White, 36% vs 42%; HR, 0.83; 95% CI, 0.52-1.3). In the adjusted analyses, the association of Black race and Hispanic ethnicity with amputation and reintervention was explained by differences in the demographic characteristics (ie, age, sex) and baseline comorbidities (ie, tobacco use, diabetes, renal disease). Compared with White patients, Black and Hispanic patients had higher 3-year major amputation and reintervention rates. However, mortality was lower for Black patients than for the White patients and similar between Hispanic and White patients. Disparities in amputation and reintervention were partly attributable to differences in demographic characteristics and the higher prevalence of comorbidities in Black and Hispanic patients with CLTI. Future work is necessary to determine whether interventions to improve access to care and reduce the burden of comorbidities in these populations will confer limb salvage benefits.

Morbidity and Mortality After Rib Fracture in Elderly Patients (>65 Years Old) Compared to a Younger Cohort (≤65 Years of Age) at Doctor Hospital Renaissance Health.

Traumatic rib fracture is a major cause of morbidity and mortality. Recent studies highlight the inadequacy of age and the number of rib fractures (NRFs) to assess patients' care needs, which may unnecessarily increase the burden of intensive care unit (ICU) admissions. Therefore, we sought to clarify the clinical outcomes of patients admitted to a level I trauma center with multiple blunt-trauma rib fractures by age and fracture location. We performed a retrospective cohort study of patients aged 18-95 admitted to Doctors Hospital at Renaissance Health with multiple rib fractures during 2017-2020. Patients with major vascular/cerebral injuries or emergency surgery from other injuries were excluded. The study population comprised 71 patients aged ≤65 and 53 patients aged >65 years. The primary study outcomes included mortality and non-home discharge. ICU length of stay (ICU-LOS), total hospital length of stay (HLOS), and days on the ventilator were the secondary outcomes. Study outcomes were also analyzed by stratifying patients by fracture location. Patients aged >65 years with multiple blunt-trauma rib fractures had lower mortality rates despite a higher prevalence of comorbidities but with higher rates of non-home discharges compared to younger patients. However, the mortality and non-home discharge odds ratios were not statistically significant. Also, median ICU-LOS and HLOS were numerically higher in geriatric patients but were not statistically significant. Nonetheless, younger patients required significantly more days of respiratory support than older patients. Similar differences were observed in the clinical outcome of patients ≤65 or >65 years when stratified by fracture locations. Young patients with blunt trauma rib fractures may have similar, if not worse, clinical outcomes than geriatric patients. These findings underscore the need for individual assessment of the patient's trauma severity independent of age, the number of rib fractures, or fracture location to reduce ICU burden.

Surgical Management of Peripheral Vein Thrombophlebitis in the Upper Extremity

Peripheral vein thrombophlebitis has a reported overall incidence ranging from 20% to 80%. Thrombophlebitis can progress despite antibiotic therapy to become a challenging clinical problem requiring surgical intervention. There is currently no consensus on its optimal management. We reviewed our experience of surgical intervention with analyses of the indications for intervention, descriptions of the surgical procedures, and outcomes. We aimed to provide guidance on the management of this potentially serious complication. This is a retrospective review of 51 patients with thrombophlebitis refractory to conservative management between January 2017 and August2020. Analyses revealed a high prevalence of comorbidities, including diabetes mellitus, malignancy, and chronic kidney disease. A total of 60% of patients had concurrent bacteremia, and the decision to operate had a low threshold in the presence of these factors. On exploration, 80% of patients had intraluminal thrombus, 47% had intraluminal pus, and 29% had pus beyond the veins or extending proximally. The surgical approach employed in 98% of patients involved an extensile incision in those with several morbidity factors (diabetes mellitus, chronic kidney disease, or bacteremia). One patient presented with severe clinical signs of local infection, and on exploration, there was intraluminal pus and thrombus up to 10 cm. A novel technique of a minimally invasive approach of intermittent stab incisions was employed in a young and healthy patient without comorbidities. We developed an algorithm to guide the indications for intervention and surgical approach to thrombophlebitis. The threshold for intervening surgically should be lowered by the presence of comorbidities. The failure of antibiotics to resolve the clinical signs of infection or the suspicion of abscess formation should mandate intervention. Thrombosed sections of the vein should be ligated proximally and distally and excised and surrounding collections of pus drained. Delayed secondary wound closure is usual. Stab incisions may limit surgical dissection and subsequent scarring in less severe cases. Prognostic IV.

Aetiology of influenza-like illnesses in the pre-COVID-19 season 2019-2020: role of coronaviruses

Abstract Background Only a proportion of seasonal influenza-like illnesses (ILIs) can de facto be attributed to influenza viruses. This study investigated the aetiology of ILIs to estimate the prevalence of human coronaviruses (CoVs) and to analyse their clinical-epidemiological traits. Methods A sample of 613 outpatients (253 adults, 360 children) with ILI in Veneto Region, Italy, was included. ILI was defined according with the EU Decision 2018/945. Sigma-Virocult nasopharyngeal swab were used. Nucleic acids were extracted with the QiaAmp Viral RNA Mini Kit (Qiagen). Molecular detection of respiratory viruses was performed with commercial One-step RT qPCR reagents (Allplex® Respiratory Panels, Seegene). Information on age, sex, symptoms, co-infections and comorbidities was collected. Results CoVs were the 3rd most frequent pathogen in adults (7.5%, after influenza and rhinovirus) and the 4th in children (4.7%, after influenza, rhino- and adenovirus). Subtype distribution was similar, with OC43 the most frequent. Probability of CoV involvement was twice in males (AOR=2.16; 95%CI: 1.05-4.39), whereas no association with age was noted. Co-infection with other viruses was frequent in children (65% of cases). CoV symptoms were not peculiar, although respiratory tract involvement was less likely than influenza (AOR=0.13; 95%CI: 0.04-0.41). Among CoV outpatients, 36% had one or more chronic diseases, compared with 5.6% among influenza (p = 0.001). Conclusions Even before the COVID-19 pandemic, CoVs had a substantial role in ILI aetiology: 1 case of CoV every 3 influenza infections in adults. The higher prevalence of comorbidities among CoV positives compared to influenza indirectly shows the benefits of flu vaccines in individuals at higher risk. Careful surveillance of the viruses responsible for ILI continues to be desirable, including, but not limited to, detecting a possible change in the aetiology of ILI after the administration of SARS-CoV-2 vaccines in the population. Key messages • Pre-pandemic virological surveillance of influenza-like illnesses (ILIs) reveals how seasonal coronaviruses were the third most frequent respiratory pathogen in adults. • Prevalence of comorbidities was significantly higher in patients with a coronavirus-related ILI compared to influenza, supporting the benefits of flu vaccination for high risk groups.

ТНЕ ANALYSIS OF THE COMORBIDITY PREVALENCE IN MILITARY PERSONNEL WITH CORONARY ARTERY DISEASE AFTER ACUTE MYOCARDIAL INFARCTION

Objective: to determine the prevalence of comorbidity in military personnel with coronary artery disease after acute myocardial infarction.Research materials. An analysis of medical records of the 83 military personnel who were hospitalized to the National Military Medical Clinical Center "Main Military Clinical Hospital" in 2016-2020 with acute myocardial infarction was carried out using the method of random sampling. All patients were male, aged from 22 to 60 years (mean age 48,5±4,35 years). To study the age characteristics of the comorbidity prevalence, all patients were divided into two groups: the 1st group with individuals of 50 years old and younger (41 patients, average age 42,9±6,15 years) and the 2nd group who is 50+ years old (42 patients, average age 54,0±2,54 years).Methods. of investigation are bibliographic, statistical, systematic approach and analysis. Statistical processing was carried out using the Microsoft Excel 2007 program and the standard statistical package STATISTICA 6.0.Results. We found a high prevalence of comorbidity in military personnel with coronary artery disease after acute myocardial infarction. Arterial hypertension has been diagnosed in 60,2±5,4% of military personnel (58,5±7,7% of patients in the 1st group and 64,3±7,4% in the 2nd group, p>0.05). Another comorbid cardiovascular disease has been identified: carotid artery stenosis in 60,2±5,4% of patients (56,1±7,8% and 54,8±7,7% in 1st and 2nd groups, at p>0.05); dyscirculatory encephalopathy of the I-II stages in 37,3±5,3% (4,4±6,7% and 50,0±7,7% in 1st and 2nd groups, respectively, at p<0,05); peripheral artery disease in 4,8±2,3% of military personnel (in 0 and 9,5±4,5%, respectively, at p<0,05). The most common comorbid diseases of the digestive system in patients were: non-alcoholic fatty liver disease in 16,9±4,1% (22,0±6.5% in 1st group and 11,9±4,9% in 2th group, at p>0.05), chronic gastroduodenitis in 21,7±4,5% (26,8±6,9% and 16,7±5,8%, respectively, at p>0,05), peptic ulcer disease in 20,5±4,4% (7,1±5,8% and 23,8±6,6%, respectively, at p>0.05), chronic pancreatitis in 19,3±4,3% (19,5±6,2% and 19,0±6,1%, respectively, at p>0.05), chronic cholecystitis – 18,1±4,2% (14,6±5,5% and 21,4±6,3%, respectively, at p>0.05). Obesity was determined in 36,1±5,3% of patients (48,8±7,8% of patients in the 1st group and 23,8±6,6% in the 2nd group, at p<0,05); type II diabetes – in 13,3±3,7% (7,3±4,1% and 19,0±6,1%, respectively, at p>0,05), thyroid diseases – 13,3±3,7% (12,2±5,1% and 11,9±4,9%, respectively, at p>0,05). Chronic kidney disease was determined in 6,0±2,6% of patients: 4,8±3,3% and 7,2±4,0%, respectively, at p>0,05. Osteochondrosis of the spine was detected in 30,1±5,0% of military personnel (24,9±6,8% and 35,7±7,4%, respectively, at p>0,05).Conclusions. Our study demonstrated a significant prevalence of comorbidity in military personnel with coronary artery disease after acute myocardial infarction: the most prevalent comorbidities were arterial hypertension, carotid artery stenosis, obesity, osteochondrosis of the spine, gastrointestinal disease, type II diabetes, which must be taken into account when developing individual treatment programs to increase the effectiveness of treatment and prevent complications.No statistically significant difference has been determined regarding the frequency of detection of most comorbid diseases in the age group younger than and older than 50 years; only cerebrovascular diseases with discirculatory encephalopathy and peripheral artery disease were more often (statistical significant) in military personnel older than 50 years.

Muscle mass and physical function in patients with bladder cancer-Data from a prematurely terminated prospective cohort study.

BackgroundPatients with bladder cancer (BC) have a high prevalence of comorbidity and low adherence to systemic anticancer treatment but it is unknown whether this is associated with sarcopenia.ObjectiveWe aimed to investigate if the sarcopenia-defining parameters (muscle strength, muscle mass and physical performance) were associated with reduced adherence to systemic anticancer treatment in patients with BC, and if these muscle domains changed during treatment.MethodsPatients >18 years of age with BC referred for chemotherapy or immunotherapy at Department of Oncology, Rigshospitalet, Denmark were eligible for study inclusion. Measurements were performed before treatment initiation and within one week after treatment termination, and consisted of assessments of muscle strength, muscle mass, and physical performance. Data was compared with thresholds outlined by the European Working Group on Sarcopenia in Older Patient's (EWGSOP2) guidelines and a healthy, age-matched Danish cohort.ResultsOver a period of 29 months, we included 14 patients of whom two completed follow-up measurements. The recruitment rate was <50% of planned due to logistics and Covid-19 related limitations. Consequently, a decision to prematurely terminate the study was made. No patients fulfilled EWGSOP2 criteria for sarcopenia, but the majority had reduction in one or more muscle domains compared to healthy, age-matched individuals. The majority of patients had poor treatment tolerance, leading to dose reductions and postponed treatments.ConclusionsIn this prematurely terminated study, no patients fulfilled EWGSOP2 criteria for sarcopenia, yet, most patients were affected in one or more muscle domains and the majority had compromised treatment adherence.

Prognostic relevance of left ventricular global longitudinal strain in patients with heart failure and reduced ejection fraction

Abstract Background Patients with heart failure (HF) and reduced ejection fraction (HFrEF) are complex patients who often have a high prevalence of comorbidities and cardiovascular risk factors. However, risk stratification and treatment decision in these patients mainly depend on simple measurements of left ventricular (LV) ejection fraction (EF). In the present study, we investigated the prognostic significance of LV global longitudinal strain (GLS) along with important clinical and echocardiographic risk factors in patients with HFrEF. Methods Patients who had a first echocardiographic diagnosis of LV systolic dysfunction, defined as LVEF ≤45%, were identified. LV GLS was measured with speckle-tracking echocardiography and represented by a positive value. To divide the study population into 2 groups, spline curve analysis was used to derive the optimal threshold value of LV GLS (i.e. where the predicted hazard ratio for the endpoint was ≥1) (Figure 1). Patients were followed up for worsening HF, as well as the composite endpoint of worsening HF and all-cause mortality. Results A total of 2394 patients (mean age 63±12 years, 75% men) were analyzed. During a median follow-up of 60 months (interquartile range [IQR] 31–60 months), 306 patients (13%) experienced worsening HF and the composite endpoint of worsening HF and all-cause mortality occurred in 673 patients (28%). The 5-year event-free survival rates for the primary and secondary endpoint were significantly lower in the patients who had LV GLS ≤10% compared to the patients who had LV GLS &amp;gt;10% (Figure 2A for worsening HF and Figure 2B for the composite endpoint of worsening HF and all-cause mortality). After adjustment for important clinical and echocardiographic risk factors, including HF treatments and baseline LVEF, baseline LV GLS remained independently associated with a higher risk of worsening HF (HR=0.95, 95% CI 0.90–0.99, p=0.029) and the composite of worsening HF and all-cause mortality (HR=0.94, 95% CI 0.90–0.97, p=0.001). Conclusions Baseline LV GLS is associated with long-term prognosis in patients with HFrEF, independently from various clinical and echocardiographic risk factors. Funding Acknowledgement Type of funding sources: None.

CLINICAL AND ECONOMIC IMPACT OF DELIRIUM ON HOSPITALIZATION OUTCOMES OF ACUTE RESPIRATORY FAILURE: A RETROSPECTIVE NATIONAL COHORT

CLINICAL AND ECONOMIC IMPACT OF DELIRIUM ON HOSPITALIZATION OUTCOMES OF ACUTE RESPIRATORY FAILURE: A RETROSPECTIVE NATIONAL COHORT

INTERSECTION OF SEPSIS, ATRIAL FIBRILLATION, AND SEVERE OBESITY: A POPULATION-BASED ANALYSIS IN THE UNITED STATES

INTERSECTION OF SEPSIS, ATRIAL FIBRILLATION, AND SEVERE OBESITY: A POPULATION-BASED ANALYSIS IN THE UNITED STATES

Prevalence and risk factors associated with different comorbidities in obese children and adolescents

IntroductionDifferent obesity-related comorbidities already present in childhood, such as: vitamin D deficiency, impaired carbohydrate metabolism, dyslipidaemia, arterial hypertension and non-alcoholic steatohepatitis. In this study, we aim to analyse the prevalence of comorbidities and to determine the predictive factors that affect these comorbidities. Material and methodsAnthropometric, demographic and biochemical variables were collected from obese patients between six and 18 years of age. Subsequently, a statistical analysis was performed to describe the characteristics of the patients and the prevalence of comorbidities, as well as their predictive factors. ResultsA total of 158 obese children (76 boys and 82 girls) with a mean age at diagnosis of 12.48 years and a BMI Z-score of +3.24 SDS were included. The most prevalent comorbidities were vitamin D deficiency (64.2%), insulin resistance (45.1%), dyslipidaemia (32.2%), hyperuricaemia (18.5%) and arterial hypertension (15%). Age, BMI Z-score, percentage of fat mass and male sex have been found to be predictors of these comorbidities. ConclusionObese children and adolescents have a high prevalence of comorbidities. Once the diagnosis of obesity has been established, it would be very useful to identify early those patients with a higher risk of comorbidities, knowing their relationship with sex, age, BMI Z-score, percentage of fat mass and pubertal stage.

S53 Disparities in the Readmission Rates After Hospitalization for Acute Pancreatitis

Introduction: Acute pancreatitis (AP) is one of the leading causes of hospitalization in the United States. Patients with AP frequently get readmitted and that proves to be a great burden on our healthcare system. Age, male sex, tobacco use, alcohol use, and necrotizing pancreatitis have been linked to a higher readmission rate in AP patients. However, studies on the impact of socioeconomic status are lacking. Our study attempts to find the impact of income on the readmission rates in patients admitted for AP. Methods: We queried the National Readmission Database (NRD) from 2017 to 2018 to identify patients with a primary diagnosis of AP. Those who died during the index hospitalization were excluded when examining readmission rates. Multivariable Cox proportional-hazards regression was used to study the impact of income on 90-day readmission adjusted for age, sex, comorbidities, hospital characteristics, and primary payer. Results: A total of 313,565 AP patients were identified, 99,023 of whom belonged to median income quartile 1, 89,582 to quartile 2, 74,027 to quartile 3, and 50,933 to quartile 4 with quartile 4 having the highest income. Slightly more than half of each quartile group were men (53.1%, 52.8%, 53.0%, 53.5%, respectively). Patients with lower income had higher prevalence of comorbidities. Among those who survived the index hospitalization, 21,694 (21.9%), 18,880 (21.1%), 15,264 (20.6%), and 9,854 (19.3%) patients in quartiles 1, 2, 3, and 4 were readmitted within 90 days, respectively. When compared with the highest income quartile (quartile 4), patients in quartiles 1, 2, and 3 were associated with an increasingly higher hazard of readmission (quartile 1, aHR 1.09, p< 0.001; quartile 2, aHR 1.07, p< 0.001; quartile 3, aHR 1.06, p< 0.001). (Figure) Conclusion: Our study finds a positive correlation between poverty and the 90-day readmission rate in AP patients. Alcohol use is one of the top causes of pancreatitis in the US. It would be interesting to investigate if there is a difference in the prevalence of substance use in patients of various economic strata that could be impacting the readmission. Furthermore, it is imperative that we bring reforms in our financial and health policy to make it more equiTable in order to alleviate some of the disparities we see.Figure 1.: Kaplan-Meier curves of readmissions after acute pancreatitis stratified to median income quartile