Insulin Therapy For Diabetes Research Articles

EVALUATION DE LA PRATIQUE DE L’INSULINOTHERAPIE PAR LES SUJETS DIABETIQUES AU CENTRE DU DIABETE MARC SANKALE

Introduction: Insulin therapy is a substitute and referencetherapy for type 1 diabetes (T1D), unbalanced gestationaldiabetes and certain circumstances of type 2 diabetes(T2D). Its practice requires good therapeutic education,which guarantees a reduction in complications. Theobjective was to evaluate the practice of insulin therapy indiabetics followed at the Marc Sankalé Antidiabetic Centerin Dakar.Methods: This was an observational, descriptive andanalytical study conducted from April 1 to September 31,2021 and involving 202 diabetic patients on insulin therapy.Results: The mean age of the patients was 39.04 ± 14 yearsand the sex ratio 0.28. The socioeconomic standard of livingwas considered low in 67% and 41% had no schooling.These were 39% T2D, 36% T1D and 25% gestationaldiabetes. The diabetes had a duration < 5 years in 65%and 94% of the patients had benefited from at least 02education sessions. Mean blood sugar was 1.93 ± 0.9 g/land HbA1c was >7.5% in 66% of cases. In our series, 47.5%had previously presented a hyperglycemia complication,29.2% hypoglycemia. Decreased visual acuity andneuropathy were observed respectively in 37.6% and 36.6%of cases. The duration of insulin therapy was <12 monthsin 60% and 54% of patients used the vial against 44% forthe pre-filled pen. In practice, 69% kept the insulin cool,only 8% purged the syringe or pen, 98% reused the needleor syringe and 91% of patients shook the insulin beforeuse. A skin fold was performed before injection by 17% ofpatients, 76% regularly changed injection site. Only 7% ofpatients were assisted by a third party for the injection. Onglycemic self-monitoring, 24% checked their glycemiabefore the administration of insulin and only 23% had ablood glucose meter. Hypoglycaemia was found in 30% ofcases.Conclusion: despite a precarious environment, the practiceof insulin therapy by diabetics at the Marc Sankalé Centerseems satisfactory. The challenges lie in providing patientswith tools that make it easier for them to comply with hygienerules and blood glucose monitoring.Keywords : Diabetes, Insulinothérapie, Center MarcSankalé, Dakar1

Diabetes Mellitus - An Ayurvedic Perspective

Diabetes mellitus is one of the most common non-communicable diseases in the world. Diabetes management in India confronts various obstacles, including increased incidence in urban and rural regions, a lack of disease awareness among the general public, inadequate health care facilities, high treatment costs, inefficient glycemic control, and an increase in the prevalence of diabetic complications. Diabetes insulin therapy is often administered via subcutaneous injections up to four times per day. Long-term insulin therapy, along with the intrusive aspect of its administration, has resulted in issues with patient compliance, impacting patient outcomes. Diabetes is a chronic condition that arises when the pancreas does not create enough insulin or when the body cannot adequately use the insulin that is produced. Insulin is a hormone that regulates blood glucose levels. Ayurvedic preventive practises can help to keep the disease at bay. Sedentary lifestyle and eating habits are thought to be the primary causes. It is characterised in Ayurveda as Vataja pramehas, which can be managed conservatively with exercise, nutrition, and internal treatment.

PSUN257 Acute Onset Diabetes and GAD Antibody Positivity After COVID-19

Abstract Background Viral infections can trigger the development of auto-antibodies including against the pancreas (1). The Sars-CoV2 virus can infect the pancreas (2). Limited data exist linking COVID-19 infection and the development of islet related auto-antibodies and diabetes in adults. Case A 46-year-old healthy man (BMI 24.7kg/m2) developed upper respiratory symptoms in mid-July 2021. He did not have a family or personal history of autoimmune diseases. His mother has mild type 2 diabetes mellitus. He underwent Sars-CoV-2 testing in July which was positive. In August, upper respiratory symptoms resolved, however, he developed acute onset polyuria, polydipsia, fatigue, and weight loss. He lost 12.7kg within one month. On his own, he noticed that he felt worse after eating carbohydrates and modified his eating (limiting to 20g of carbohydrates per meal), which reduced his polyuria, polydipsia, and weight loss. In September, he presented to his primary care physician who diagnosed him with hyperglycemia and diabetes. Fasting blood glucose was 331mg/dL (18.4mmol/L) and hemoglobin A1C was 11.3%. He presented to endocrinology clinic in October for evaluation and was started on insulin therapy for diabetes. Laboratory studies included: glucose 194mg/dL (10.8mmol/L), repeat hemoglobin A1C 10.1%. Autoantibody testing was positive for GAD65 (glutamic acid decarboxylase 65 antibody 34.4nmol/L, reference <0.02nmol/L). Other type 1 diabetes related autoantibodies were negative. Blood glucose normalized on insulin therapy (average 115mg/dL (6.4mmol/L) on continuous glucose monitor). Op de Beeck, Anne and Decio L. Eizirik, Nature Reviews, May 2016.Muller, J, et al. Nature Metabolism, Feb 2021. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Preoperative Transthoracic Echocardiography Predicts Cardiac Complications in Elderly Patients with Coronary Artery Disease Undergoing Noncardiac Surgery.

PurposeGuidelines have not recommended routine transthoracic echocardiography (TTE) for elderly patients prior to noncardiac surgery. We aimed to evaluate the significance of preoperative TTE to predict perioperative cardiac complications (PCCs) for elderly patients with coronary artery disease (CAD) undergoing noncardiac surgery.Patients and methodsWe retrospectively reviewed 2204 patients over 65 years of age with CAD who underwent TTE before intermediate- or high-risk noncardiac surgery in a teaching hospital in China between September 2013 and August 2019. The revised cardiac risk index (RCRI) was assessed. PCCs comprised acute coronary syndrome, heart failure, new-onset severe arrhythmia, nonfatal cardiac arrest, and cardiac death. Logistic regression was used to build the prediction model for PCCs. Discrimination was evaluated using receiver operating characteristic curves, and a nomogram of the predictive model was constructed.ResultsPCCs occurred in 189 (8.6%) patients. Multivariable analysis showed that eight clinical risk factors (age, history of myocardial infarction, insulin therapy for diabetes, New York Heart Association classification, preoperative serum creatinine, preoperative electrocardiogram ST-T abnormality and pathological Q wave, and American Society of Anesthesiologists classification) and five TTE parameters (left atrial anteroposterior dimension, left ventricular ejection fraction, left ventricular diastolic dysfunction, pulmonary hypertension, and regional ventricular wall motion abnormality) were associated with PCCs. The receiver operating characteristic curve for the clinical plus TTE model provided better discrimination for PCCs compared with the RCRI model (area under the curve: 0.731 vs 0.564; P < 0.001) and the clinical model (area under the curve: 0.731 vs 0.697, P = 0.001), respectively. The clinical plus TTE model was presented as a prognostic nomogram.ConclusionPreoperative TTE may help predict PCCs in elderly patients with CAD undergoing noncardiac surgery, and the prognostic nomogram from this study appeared to be useful for the assessment of perioperative cardiac risk.

Yoga and Diabetes : The Impact of Yoga Practice on Diabetic Symptoms

“Diabetes mellitus”, is one of the most common non-communicable diseases worldwide. India faces several challenges in diabetes management, including a rising prevalence in urban and rural areas, lack of disease awareness among the public, limited health care facilities, high cost of treatment, suboptimal glycaemic control and rising prevalence of diabetic complications. Insulin therapy for diabetes is most commonly delivered via subcutaneous injections, up to four times a day. Long-term insulin therapy, compounded by the invasive nature of its administration, has caused problems with patient compliance, ultimately influencing patient outcomes. There is an increase in the prevalence of type 1diabetes also, but main cause of diabetic epidemic is type2 diabetes mellitus, which accounts for more than 90 percent of all diabetes cases. Type2 diabetes is a serious and common chronic disease resulting from a complex inheritance- environment interaction along with other risk factors such as obesity and sedentary lifestyle.

Evidence for Indoxyl Sulfate as an Inducer of Oxidative Stress in Patients With Diabetes.

Indoxyl sulfate is a metabolite of tryptophan and its urinary level reflects the status of bacterial flora in the intestine. Indoxyl sulfate possesses prooxidant properties and is implicated in various diseases including chronic kidney disease and cardiovascular diseases. However, the relation of urinary indoxyl sulfate to oxidative stress is not known. The association of urinary indoxyl sulfate levels with urinary levels of oxidative stress markers, 15-isoprostane F2t and pteridine derivatives, was investigated in 255 patients with type 2 diabetes. Indoxyl sulfate and pteridine derivatives were measured by using spectrofluorometry. Urinary levels of indoxyl sulfate, pteridines, and 15-isoprostane F2t showed a normal distribution after logarithmic transformation but not before it, and they were thus used for parametric analysis after logarithmic transformation. Urinary indoxyl sulfate levels were significantly correlated (p<0.01) with urinary 15-isoprostane F2t and pteridine levels [Pearson's correlation coefficients: 0.503 (15-isoprostane F2t) and 0.562 (pteridines)]. These associations were also found in multivariable analysis after adjusting for age, sex, insulin therapy for diabetes, body mass index, mean arterial pressure, hemoglobin A1c, estimated glomerular filtration rate, urinary albumin, and histories of smoking and alcohol drinking. Urinary indoxyl sulfate levels showed associations with urinary levels of oxidative stress markers, and the associations were independent of age, sex, insulin therapy for diabetes, body mass index, blood pressure, glycemic status, renal function, smoking, and alcohol drinking. Indoxyl sulfate appears to be an important determinant of redox balance in patients with diabetes.

Insulin therapy in childhood type 1 diabetes: Knowledge and practice in Senegal

IntroductionChildhood type 1 diabetes (T1D) is a chronic condition with serious repercussions on both the quality of life of the child and the family. Insulin therapy is the cornerstone of optimal blood sugar control. The main objective of our study was to assess the level of knowledge of physicians about insulin therapy in diabetes. MethodsThis was a multicenter survey over a period of 5 months (from March 5 to August 2, 2018). It took place in five reference university hospital centers in the Dakar region. ResultThe number of doctors interviewed in our study was 82, 47.6% of whom were confirmed pediatricians or pediatricians in the process of specialization. The number of years of experience in the field of diabetes was on average 3 years. Fast-acting regular insulins were recommended by 75.6% of doctors and mixtures of insulin (intermediate and rapid-acting) by 50% of doctors. Overall, 91% of doctors recommend a variation in insulin injection sites. The “basal bolus” treatment regimen with insulin analogs was recommended by 50% of doctors, while 31.7% recommended it with human insulin. Regarding adapting insulin doses for leisure and sports activities, more than half (54.9%) of the doctors had to reduce the doses. ConclusionThis study enabled us to assess the level of knowledge of insulin therapy among doctors caring for children with diabetes in Senegal, which proved to be limited. We recommend the reinforcement and follow-up of training on the management of T1D for providers at the different facilities.

A Retrospective Observational Study of Insulin Glargine in Type 2 Diabetic Patients with Advanced Chronic Kidney Disease.

BackgroundThe majority of type 2 diabetes mellitus (T2DM) subjects are on multiple oral antidiabetic drugs (OADs) but as kidney dysfunction progresses, many of them become inappropriate. Basal insulin, such as glargine, is generally recommended as first-line insulin therapy by most guidelines. However, there is limited data on the safety and efficacy of the use of glargine in diabetic kidney disease (DKD).ObjectivesTo evaluate the efficacy and safety of insulin glargine in T2 DM patients with Stage 3 or 4 chronic kidney disease (CKD).Material and methodsThis single-centered, retrospective, observational study evaluates the efficacy and safety of insulin glargine in DKD with estimated glomerular filtration rate (eGFR) 60 and below. Non-pregnant T2DM patients with DKD receiving insulin glargine for 24 weeks and beyond were included for analysis. Data relating to anthropometric measurements, blood pressure, renal parameters, and glycemic control were analyzed. Sixty patients were in CKD Stage 3 (group A) and 35 patients were in CKD Stage 4 (group B). Glargine was started at an initial dose of 10 units daily as per the standard of care followed by the institute and up-titrated or down-titrated using a prespecified algorithm to maintain fasting plasma glucose between 90 mg/dl and 130 mg/dl.ResultsThe study achieves (1.2%) (13.2 mmol/mol) of glycosylated hemoglobin (HbA1C) reduction in both groups (Group A and Group B) and a significant reduction in fasting and postprandial glucose values without a significant weight change over the study period. Out of 95 patients, 32 (33.68%) had documented hypoglycemia; out of them, 9 (28.2%) had severe hypoglycemia, and 8 (25%) had nocturnal hypoglycemia (either mild or severe). No change in weight, blood pressure, or eGFR was observed during the study period.ConclusionsTreatment with glargine-based basal insulin therapy in diabetes with Stage 3 or Stage 4 CKD was efficacious in reducing glycemic parameters and was safe without significant changes in weight and hypoglycemia.

Processes to assist family members of elderly patients with diabetes insulin therapy

Processes to assist family members of elderly patients with diabetes insulin therapy

Improving the Clinical Value and Utility of CGM Systems: Issues and Recommendations: A Joint Statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group.

The first systems for continuous glucose monitoring (CGM) became available over 15 years ago. Many then believed CGM would revolutionize the use of intensive insulin therapy in diabetes; however, progress toward that vision has been gradual. Although increasing, the proportion of individuals using CGM rather than conventional systems for self-monitoring of blood glucose on a daily basis is still low in most parts of the world. Barriers to uptake include cost, measurement reliability (particularly with earlier-generation systems), human factors issues, lack of a standardized format for displaying results, and uncertainty on how best to use CGM data to make therapeutic decisions. This Scientific Statement makes recommendations for systemic improvements in clinical use and regulatory (pre- and postmarketing) handling of CGM devices. The aim is to improve safety and efficacy in order to support the advancement of the technology in achieving its potential to improve quality of life and health outcomes for more people with diabetes.

Improving the clinical value and utility of CGM systems: issues and recommendations : A joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group.

The first systems for continuous glucose monitoring (CGM) became available over 15years ago. Many then believed CGM would revolutionise the use of intensive insulin therapy in diabetes; however, progress towards that vision has been gradual. Although increasing, the proportion of individuals using CGM rather than conventional systems for self-monitoring of blood glucose on a daily basis is still low in most parts of the world. Barriers to uptake include cost, measurement reliability (particularly with earlier-generation systems), human factors issues, lack of a standardised format for displaying results and uncertainty on how best to use CGM data to make therapeutic decisions. This scientific statement makes recommendations for systemic improvements in clinical use and regulatory (pre- and postmarketing) handling of CGM devices. The aim is to improve safety and efficacy in order to support the advancement of the technology in achieving its potential to improve quality of life and health outcomes for more people with diabetes.

Novel inflammatory markers for incident pre-diabetes and type 2 diabetes: the Rotterdam Study

The immune response involved in each phase of type 2 diabetes (T2D) development might be different. We aimed to identify novel inflammatory markers that predict progression from normoglycemia to pre-diabetes, incident T2D and insulin therapy. We used plasma levels of 26 inflammatory markers in 971 subjects from the Rotterdam Study. Among them 17 are novel and 9 previously studied. Cox regression models were built to perform survival analysis. Main Outcome Measures: During a follow-up of up to 14.7 years (between April 1, 1997, and Jan 1, 2012) 139 cases of pre-diabetes, 110 cases of T2D and 26 cases of insulin initiation were identified. In age and sex adjusted Cox models, IL13 (HR = 0.78), EN-RAGE (1.30), CFH (1.24), IL18 (1.22) and CRP (1.32) were associated with incident pre-diabetes. IL13 (0.62), IL17 (0.75), EN-RAGE (1.25), complement 3 (1.44), IL18 (1.35), TNFRII (1.27), IL1ra (1.24) and CRP (1.64) were associated with incident T2D. In multivariate models, IL13 (0.77), EN-RAGE (1.23) and CRP (1.26) remained associated with pre-diabetes. IL13 (0.67), IL17 (0.76) and CRP (1.32) remained associated with T2D. IL13 (0.55) was the only marker associated with initiation of insulin therapy in diabetics. Various inflammatory markers are associated with progression from normoglycemia to pre-diabetes (IL13, EN-RAGE, CRP), T2D (IL13, IL17, CRP) or insulin therapy start (IL13). Among them, EN-RAGE is a novel inflammatory marker for pre-diabetes, IL17 for incident T2D and IL13 for pre-diabetes, incident T2D and insulin therapy start.

Cystic fibrosis in Austria.

Registry data for patients with cystic fibrosis (CF) are increasingly used to evaluate the natural history, for benchmarking of therapy and in order to identify eligible patients for clinical studies. So far, no data on frequency and clinical status of CF patients have been available for Austria on a national level. We collected data of CF patients treated 2014 in Austrian CF outpatient clinics by means of a European CF registry and on an individual search basis. A total of 773 CF patients with a median age of 18.9years (SD 11.8years) were seen in 13centers (18-151 patients/center). Homozygous F508del mutation being the most common genotype was observed in 48.8% of patients. Mean age at diagnosis was 27days. In 59% of all patients FEV1% predicted (Forced Exspiratory Volume in 1 second) was <80% and in 20% <50%. An average FEV1 predicted decline per year of 1.9% was observed between 6-18years of age. Colonisation with Pseudomonas aeruginosa ranged between 12% and 69% in adult patients and in 0-16% in children with CF. Burkholderia cepacia complex species were present in a total of 29samples (3.8%). Insulin therapy for diabetes was given in 14.5%. Liver involvement was reported in 36.3%. A wide variation of prescribed CF therapy was observed between centers. Data on CF patients living in Austria are now available and form a basis for clinical benchmarking as well as analyses from a public health perspective.

Assessment of insulin injection techniques among diabetes patients in a tertiary care centre

AimsThe efficacy of insulin therapy in diabetes depends on proper storage and injection technique. The purpose of this study was to assess the practice of insulin administration among diabetes patients in a tertiary care center. Materials and methodsThis observational study was done in Endocrinology department of a tertiary care center during April–June 2015. The consecutive patients using insulin for at least three months by either syringe or pen were recruited. All of them underwent a survey by the questionnaire which focused on key insulin injection parameters. ResultsOne hundred and sixty eight (74.67%) patients were storing insulin vials properly. The thigh was the most common site of insulin injection and 209(92.89%) study participants were rotating at the injection sites. Only 48.57% (34/70) subjects were mixing insulin properly before injection. The practice of hand washing and the cleaning of the injection site was practiced by 158(70%) & 171(76.44%) subjects respectively. One hundred and fifty six (69%) patients were injecting with the proper skin fold and 123(55%) subjects were injecting insulin at 90° angle. The majority of patients (91%) were throwing the needle and syringes directly into the garbage and public drainage system. ConclusionsThere was a significant gap between the insulin administration guidelines and current insulin injection practice. The diabetic education and counseling about proper insulin injection techniques should be provided to all diabetic subjects.

Effectiveness of a serious game for medical education on insulin therapy for diabetes: randomized controlled trial

Effectiveness of a serious game for medical education on insulin therapy for diabetes: randomized controlled trial

Too Much or Too Little? The Double Jeopardy of Subcutaneous Insulin Therapy in Diabetes.

A quote variously attributed to either Woodrow Wilson or Winston Churchill describes golf as “an ineffectual attempt to put an elusive ball into an obscure hole with implements ill-adapted to the purpose.” There are many analogies with the challenges faced with insulin therapy in diabetes. In health, nondiabetic β-cells detect changes in ambient glucose, facilitated by signals from circulating hormones such as glucagon-like peptide 1 and perhaps neural signals (1), allowing insulin secretion to be altered appropriately. Critically, insulin is then released in an oscillatory fashion into the portal circulation so that the levels in the portal vein are approximately fourfold higher than those seen in systemic circulation (2). With exogenous insulin therapy in diabetes, this situation is fundamentally different. In addition to the significant clinical challenges of determining regimen and appropriate insulin doses and timing while allowing for factors such as pharmacokinetics and variability in absorption, exogenous insulin is delivered subcutaneously so that the usual ratio of portal-to-systemic insulin is lost. This means that the direct actions of insulin to suppress net hepatic glycemic output might be lessened and/or the peripheral actions of insulin to promote glucose disposal, particularly in skeletal muscle, might be increased. What are the implications of this for insulin therapy in diabetes, i.e., does this matter for patients and clinicians? In this issue of Diabetes , Gregory et al. (3) compared the differential effects …

User Assessment of "InsuOnLine," a Game to Fight Clinical Inertia in Diabetes: A Pilot Study.

We performed a pilot study to assess usability and playability of "InsuOnLine," a serious game for education of primary care physicians on insulin therapy for diabetes mellitus. A multidisciplinary team has designed and developed "InsuOnLine," using Andragogy and Problem-Based Learning principles, with game elements to improve players' motivation. The prototype was tested by four medical doctors and two medical students, using the System Usability Scale (SUS) and a questionnaire to assess playability. These results were used to guide corrections, after which the beta version was retested by 14 medical students and 6 residents. Out of a maximum score of 100 on the SUS, the "InsuOnLine" prototype was rated 88, and some areas for improvement were identified (game instructions, controls). After corrections, the beta version was rated 92.5 on the SUS. Users have found the beta version to be fun, engaging, challenging, relevant, and realistic. Users said that the game has increased their knowledge on diabetes and insulin, that it has made them feel more confident for prescribing insulin, and that it would have impact on how they treated patients with diabetes. Most users said they have learned more from the game than they would have from a lecture. Lessons learned were the need of early piloting, preferably by users with very little or very much gaming experience, on their own computers and free patterns of use. "InsuOnLine" was rated by users as easy to play, fun, and useful for learning. Further studies will assess its educational effectiveness. "InsuOnLine" is a promising tool for large-scale continuing medical education on insulin, helping to fight clinical inertia in diabetes.

Cystic fibrosis-related diabetes: A distinct condition

Cystic fibrosis is the most common fatal inherited autosomal recessive disease in Caucasians, affecting approximately one out of every 2,000 births. Survival of patients with cystic fibrosis has significantly improved due to advances in respiratory and nutritional care, and their current average life expectancy is 30-40 years. Development of cystic fibrosis-related diabetes is a comorbidity that increases with age and may reach a prevalence up to 50% in adults. Its development is associated to impaired lung function and nutritional status, and early diagnosis and treatment are therefore essential to improve quality of life and performance status. Insulin therapy for diabetes and other early carbohydrate metabolism disorders may improve lung function and nutritional status of patients with cystic fibrosis.

Diabetes en la fibrosis quística: una entidad diferente

Cystic fibrosis is the most common fatal inherited autosomal recessive disease in Caucasians, affecting approximately one out of every 2,000 births. Survival of patients with cystic fibrosis has significantly improved due to advances in respiratory and nutritional care, and their current average life expectancy is 30-40 years. Development of cystic fibrosis-related diabetes is a comorbidity that increases with age and may reach a prevalence up to 50% in adults. Its development is associated to impaired lung function and nutritional status, and early diagnosis and treatment are therefore essential to improve quality of life and performance status. Insulin therapy for diabetes and other early carbohydrate metabolism disorders may improve lung function and nutritional status of patients with cystic fibrosis.

Combined Use of High-sensitivity C-Reactive Protein and N-Terminal Pro-B-type Natriuretic Peptide for Risk Stratification of Vascular Surgery Patients

We sought to assess whether high-sensitivity C-reactive protein (hs-CRP) and pro-B-type natriuretic peptide (NT-proBNP) improve risk prediction when added to an established predictive tool and develop a point-based risk score. Four hundred eleven vascular surgery patients were enrolled. The primary outcome was a composite of death, acute coronary syndromes, pulmonary edema within 30 days of surgery, and postoperative troponin-I elevation. The risk score was developed from a logistic regression model by using an integer-based scoring system. The rate of the primary outcome was 18%. Adding both hs-CRP and NT-proBNP to the Revised Cardiac Risk Index led to an increase in C statistic from 0.670 to 0.774. The net reclassification improvement was 0.210 (P = 0.004) and the integrated discrimination improvement was 0.112 (P = 0.0001). In the multivariable regression analysis used to develop the risk score, insulin therapy for diabetes (odds ratio [OR]: 2.8; P = 0.003), open surgery (OR: 1.95; P = 0.027), fibrinogen >377 mg/dL (OR: 2.83; P = 0.001), hs-CRP >3.2 mg/L (OR: 3.85; P < 0.0001), and NT-proBNP >221 ng/L (OR: 4.05; P < 0.0001) were associated with the primary outcome. There was no statistical evidence of overfit. The C index was 0.82 and the Hosmer-Lemeshow statistic was 1.61 (P = 0.0447). The observed and predicted rates of the primary outcome across quartiles of risk score were highly correlated. Hs-CRP and NT-proBNP substantially improve risk prediction when added to an established predictive tool. The biochemical marker-based risk score may be useful for accurately risk-stratifying vascular surgery patients; nonetheless, further validation studies on external datasets are needed before it can be used in clinical practice.