Japanese Criteria Research Articles

PS-P08-5: METABOLIC SYNDROME RISK PREDICTION EQUATION AND A SIMPLE SCORE MODEL DERIVATION AND VALIDATION IN JAPANESE GENERAL POPULATION

Objective: Predicting metabolic syndrome (MetS) is important for identifying high risk cardiovascular disease individuals and providing preventive interventions. We aimed to develop and validate an equation and a simple MetS score according to the Japanese MetS criteria using Japanese health checkup data. Design and Methods: In total, 54,198 participants (age, 54.5 ± 10.1 years; men, 46.0%), with baseline and five year follow up data were randomly assigned to Derivation and Validation cohorts (ratio: 2:1). Multivariable logistic regression analysis was performed in derivation cohort and scores were assigned to factors corresponding to beta coefficients. We evaluated predictive ability of the scores using area under the curve (AUC), then applied them to validation cohort to assess reproducibility. For equation model, all variables were treated as continuous except for sex, current smoking, and alcohol consumption, which were treated as binary variables. Results: The primary model (including blood tests) ranged 0 to 27 points had an AUC of 0.81 (sensitivity: 0.81, specificity: 0.81, cut-off score: 14), and consisted of age, sex, blood pressure (BP), body mass index (BMI), serum lipids, glucose measurements, current smoking, and alcohol consumption. The simplified model (excluding blood tests) ranged 0 to 17 points with an AUC of 0.78 (sensitivity: 0.83, specificity: 0.77, cut off score: 15) and included seven variables: age, men, systolic BP, diastolic BP, BMI, alcohol consumption, and current smoking. We classified individuals with a score < 15 as low-risk MetS and ≧ 15 points as high risk MetS, respectively. The incidence of MetS increased constantly as the score increased. Furthermore, the equation model to predict MetS incidence from derivation cohort generated an AUC of 0.85 (sensitivity: 0.86, specificity: 0.55). Analysis of the validation and derivation cohorts yielded similar results. Conclusion: We developed a primary score, an equation model, and a simple score. The simple score is convenient, well validated with acceptable discrimination, and could be used for early detection of MetS in high risk individuals.

PS-BPP06-8: DIETARY SALT INTAKE PREDICTS FUTURE DEVELOPMENT OF METABOLIC SYNDROME IN THE GENERAL POPULATION

Objective: Dietary salt consumption is one of the most important modifiable factors in our lifestyle and restriction of dietary salt results in the reduction of blood pressure in previous studies. Excessive salt intake causes cardiovascular diseases independently of its effects on blood pressure. Since metabolic syndrome also increases a risk of cardiovascular disease, there may be some association between salt intake and metabolic syndrome. Therefore, we investigated a possible relationship between salt intake and future development of metabolic syndrome in the general population. Design and Methods: Consecutive 12,256 subjects without metabolic syndrome (male = 7,053, 52.1 ± 12.3 year-old) who visited our hospital for an annual physical check-up from April 2010 to March 2018 were enrolled. After baseline examination, subjects were followed up until March 2019 (median 1,582 days) with the endpoint being the development of metabolic syndrome. Metabolic syndrome was diagnosed according to the Japanese criteria (2005). Individual salt intake was estimated using a spot urine by a previously reported Tanaka method. Results: Salt intake was 8.7 ± 1.9 and 8.4 ± 1.8 g/day in male and female subjects, respectively, at baseline. During the follow-up period, 1,669 subjects developed metabolic syndrome (29.9 per 1,000 person-year) with the incidence being more frequent in male than female subjects (41.8 vs. 14.2 per 1,000 person-year). Non-adjusted hazard ratio (HR) (95% confidence interval [CI]) of salt intake for the development of metabolic syndrome was 1.192 (1.164–1.221). Kaplan-Meier analysis where subjects were divided into gender-specific quartiles according to the baseline salt intake revealed that the incidence of metabolic syndrome were increased across the quartiles (19.5, 24.2, 33.1, and 43.9 per 1,000 person-years; logrank p < 0.001). Multivariate Cox proportional hazard analysis adjusted for age, gender, body mass index, systolic blood pressure, heart rate, serum creatinine, uric acid, fasting plasma glucose, low-density lipoprotein cholesterol, triglyceride, hemoglobin and current smoking habit at baseline revealed that salt intake predicted the new onset of metabolic syndrome (HR:1.055, 95%CI:1.028–1.082). Conclusions: Excessive salt intake is significantly associated with the new development of metabolic syndrome in the general population. The results suggest that salt restriction prevents cardiovascular diseases through the prevention of not only hypertension but also metabolic syndrome.

PS-P13-5: ASSOCIATION BETWEEN G-GLUTAMYL TRANSPEPTIDASE WITH BLOOD PRESSURE IN APPARENTLY HEALTHY SUBJECTS

Objective: γ-glutamyl transpeptidase (γ-GTP) increases intracellular reduced glutathione (GSH) synthesis to scavenge increased intracellular ROSs. And oxidative stress is reported to be involved in the pathogenesis of hypertension recently. The aim of this study is to investigate whether oxidative stress is taking some part in the pathogenesis of hypertension using γ-GTP as a marker. Design and method: Apparently healthy 1259 cases who visited our department for the medical check-up examinations including BMI, TG, LDL-cholesterol, fasting plasma glucose (FPG), uric acid, blood pressure, tobacco habits, having metabolic syndrome according to Japanese criteria or not and γ-GTP were assessed. Subjects were not on medical treatment such as malignancy, hyperlipidemia, hypertension, diabetes, hyperuricemia, liver dysfunction or chronic viral infection. Simple correlations between blood pressure and these risk factors or γ-GTP were estimated by Pearson correlation coefficient (CC). Difference between blood pressure and gender, tobacco or metabolic groups were estimated by unpaired t-test. Then multiple regression analysis was estimated, adopting positively associated risk factors or γ-GTP as independent variables to explain the response variable of blood pressure. Results: Systolic blood pressure (SBP) correlated with gender (P < 0.001), age (CC; 0.341, P < 0.001), BMI (CC; 0.342, P < 0.001), metabolic syndrome (P < 0.001), uric acid (CC; 0.253, P < 0.001), TG (CC; 0.204, P < 0.001), LDL-cholesterol (CC; 0.194, P < 0.001), HDL-cholesterol (CC; -0.131, P < 0.001), FPG (CC; 0.311, P < 0.001), γ-GTP (CC; 0.164, P < 0.001). And multiple regression analysis revealed significant effect of gender (standardizedβ;; -0.062, P < 0.05), age (standardizedβ;; 0.302, P < 0.001), BMI (standardizedβ;; 0.243, P < 0.001), metabolic syndrome (standardizedβ;; -0.128, P < 0.001), LDL-cholesterol (standardizedβ;; 0.060, P < 0.05), HDL-cholesterol (standardizedβ;; 0.062, P < 0.05), FPG (standardizedβ;; 0.086, P < 0.005), and γ-GTP (standardizedβ;; 0.071, P < 0.01) on SBP. Similarly, Diastolic blood pressure (DBP) correlated with gender (P < 0.001), age (CC; 0.203, P < 0.001), BMI (CC; 0.333, P < 0.001), metabolic syndrome (P < 0.001), uric acid (CC; 0.315, P < 0.001), TG (CC; 0.253, P < 0.001), LDL-cholesterol (CC; 0.165, P < 0.001), HDL-cholesterol (CC; -0.162, P < 0.001), FPG (CC; 0.295, P < 0.001), γ-GTP (CC; 0.226, P < 0.001). Multiple regression analysis adopting diastolic blood pressure (DBP) as response variable revealed significant effect of gender (standardizedβ;; -0.161, P < 0.001), age (standardizedβ;; 0.159, P < 0.001), BMI (standardizedβ;; 0.193, P < 0.001), metabolic syndrome (standardizedβ;; -0.120, P < 0.001), uric acid (standardizedβ;; 0.067, P < 0.05), LDL-cholesterol (standardizedβ;; 0.058, P < 0.05), HDL-cholesterol (standardizedβ;; 0.078, P < 0.05), FPG (standardizedβ;; 0.082, P < 0.005), and γ-GTP (standardizedβ;; 0.099, P < 0.001) on DBP. Conclusion: Elevated blood γ-GTP level associated with blood pressure positively, significantly and independently of other risk factors of hypertension, indicating oxidative stress may take some part in pathophysiology of hypertension as cause or result.

The M-ANNHEIM-AiP-Activity-Score is useful for predicting relapse in patients with type 1 autoimmune pancreatitis

Background/ObjectivesProper assessment of disease activity and prediction of relapse are crucial for the management of autoimmune pancreatitis (AIP). The M-ANNHEIM-AiP-Activity-Score (MAAS) has been proposed to determine disease activity and predict relapse in German and Swedish patients with AIP. MAAS is calculated using six categories: pain report, pain control, exocrine insufficiency, endocrine insufficiency, imaging, and complications. This study aimed to clarify the usefulness of MAAS to predict relapse in Japanese patients with type 1 AIP. MethodsWe retrospectively analyzed 117 patients with type 1 AIP undergoing initial and maintenance steroid treatments at our institute between April 2006 and March 2021. AIP was diagnosed according to the Japanese Diagnostic Criteria for AIP 2018. We examined the association of MAAS with relapse during and after maintenance treatment. ResultsMAAS (median, 8 points) at the start of the initial treatment was reduced after treatment (median, 4 points; P < 0.001). A MAAS ≥11 points at the start of the initial treatment was associated with relapse. The initial treatment-induced reduction of MAAS<60% was more frequent in patients with relapse (75.0%) than in patients without relapse (37.6%; P = 0.007). MAAS at the start of maintenance treatment was higher for patients with relapse (median, 5 points) than that for patients without relapse (median, 4 points; P = 0.007). MAAS ≥4 points at the start of maintenance treatment was associated with subsequent relapse. ConclusionsMAAS is useful for predicting relapse in patients with type 1 AIP undergoing maintenance therapy.

Apply the Hirano or Japanese criteria when diagnosing MELAS.

Apply the Hirano or Japanese criteria when diagnosing MELAS.

Differences in Sensitivity Between the Japanese and Z Score Criteria for Detecting Coronary Artery Abnormalities Resulting from Kawasaki Disease.

No studies have assessed differences between the Japanese and Z score criteria in the echocardiographic detection sensitivity of coronary artery (CA) abnormalities using large-scale data containing samples from multiple facilities engaged in daily clinical practices of Kawasaki disease (KD). We analyzed data from the 25th Japanese nationwide KD survey, which identified 30,415 patients from 1357 hospitals throughout Japan during 2017-2018. Hospitals were classified according to their use of Z score criteria. We assessed differences in hospital and patient background factors and compared the prevalence of CA abnormalities among groups using the Z score criteria. Multivariable logistic regression analyses were performed to evaluate differences in the detection sensitivity for CA abnormalities. The Z score criteria were more likely to be utilized in larger hospitals with more pediatricians and cardiologists. Even after controlling for potential confounders, detection sensitivities by the Z score criteria were significantly higher than by the Japanese criteria in patients with CA dilatations (adjusted odds ratio (95% confidence interval) 1.77 (1.56-2.01)) and aneurysms (1.62 (1.17-2.24)). No significant difference was found in patients with giant CA aneurysms. Compared with the Japanese criteria, the Z score criteria were significantly more sensitive for detecting patients with CA dilatations regardless of age, and for those with CA aneurysms only in patients aged ≤ 1year. Our results indicate that differences in the detection sensitivity for CA abnormalities between the Z score and the Japanese criteria were dependent on the CA size and patient age.

Association between gestational weight gain and risk of overweight at 3 years old: The Japan Environment and Children's Study.

It is unclear if gestational weight gain (GWG) increases the risk of children with overweight. We examined the association between GWG and the risk of overweight in 3-year-old children in the Japanese nationwide birth cohort study. Among 64 336 singleton births, we calculated the risk ratios (RRs) and 95% confidence intervals (95% CIs) of the association between GWG categories and children with overweight, following an adjustment of the confounding variables. GWG was positively associated with the risk of overweight among 3-year-old children. The multivariable RR (95% CI) was 1.21 (1.17-1.25) per 5kg increase of the GWG. The multivariable RR (95% CI) for excessive GWG was 1.20 (1.12-1.28) and 1.27 (1.16-1.39) based on the modified Japanese and IOM criteria, respectively, compared to adequate GWG. The multivariable RR (95% CI) of overweight with children for inadequate versus adequate GWG was 0.83 (0.78-0.88) and 0.84 (0.79-0.89) based on the modified Japanese and IOM criteria, respectively. GWG was positively associated with a high risk of overweight at 3 years of age. The risk of offspring overweight was 20%-27% higher and 16%-17% lower with excessive GWG and inadequate GWG, respectively, compared to adequate GWG, based on the aforementioned criteria.

Association between equol production and metabolic syndrome in Japanese women in their 50s-60s.

Equol is an active metabolite of soy isoflavone. As a phytoestrogen, equol has the potential to prevent metabolic disorders such as hyperglycemia, hyperlipidemia, and obesity. This study aimed to determine the association between equol production and metabolic syndrome (METS) in postmenopausal women. This cross-sectional study included 1,345 women aged 50 to 69 years who underwent health checkups from February 2018 to November 2021 at four health centers in Fukushima, Japan. Equol producers were defined as those with a urinary equol concentration of 1.0 μM or more. METS was defined based on Japanese diagnostic criteria including abdominal obesity, atherogenic dyslipidemia, elevated blood pressure, and glucose intolerance. The association between equol production and METS was estimated by logistic regression analysis, with adjustments for age, exercise, physical activity, and fast walking. Of the 1,345 women, 378 (28.1%) were equol producers. The proportion of women who had METS (6.6% vs 10.9%) was significantly lower in the equol-producing group than in the nonproducing group. Multivariable logistic regression analysis revealed that equol production was significantly associated with METS (odds ratio, 0.60; 95% CI, 0.38-0.95). Equol production was associated with a lower prevalence of METS among women aged 50 to 69 years.

Accuracy of the Fracture Risk Assessment Tool for judging pharmacotherapy initiation for primary osteoporosis.

This study aimed to determine whether the Fracture Risk Assessment Tool (FRAX®) is useful in assessing the criteria for the initiation of pharmacotherapy for primary osteoporosis based on the current diagnostic criteria in Japan. We enrolled 614 patients aged ≥ 40years (average, 77.0years) who were eligible for primary osteoporosis evaluation. Bone mineral density measurements of the lumbar spine, total hip, and femoral neck using ALPHYS LF (FUJIFILM, Tokyo, Japan) and imaging studies involving the lumbar spine were obtained and the FRAX® scores of each patient were calculated with and without the T-score of the femoral neck. The receiver operating characteristic curve analysis method was used to calculate the cut-off FRAX® scores with reference to the criteria for initiating pharmacotherapy for osteoporosis; the accuracies of both FRAX® scores were compared. The FRAX® score calculated with the T-score was more accurate for hip fracture risk assessment [cut-off value 5.5%; the area under the curve (AUC) 0.946] than for major osteoporotic fracture risk assessment (cut-off value 17.0%; AUC 0.924) in judging the criteria (p = 0.001). Conversely, the FRAX® score calculated without the T-score was equally accurate for hip fracture risk assessment (AUC 0.796) and major osteoporotic fracture risk assessment (AUC 0.806) (p = 0.23). The FRAX® score can accurately assess the criteria for initiating pharmacotherapy for primary osteoporosis based on the current Japanese diagnostic criteria, especially when the T-score is used.

Association between visceral fat and influenza infection in Japanese adults: A population-based cross-sectional study.

BackgroundSeveral studies have reported that obesity is associated with influenza infection; however, the role of visceral fat remains unclear. The aim of this study was to investigate the association between visceral fat and influenza infection in community-dwelling Japanese adults.MethodsA cross-sectional study was performed using data from an annual community-based health check-up conducted from May to June in 2019. In total, 1,040 Japanese adults aged 20–89 years were enrolled in this study. Influenza infection status was determined by participants’ responses to a self-administered questionnaire. The visceral fat area (VFA) was measured using a bioimpedance-type visceral fat meter. Participants were classified into four groups using the following cut-off points: VFA < 100 cm2 was set as the reference category according to the Japanese criteria, 100 ≤ VFA < 150 cm2, 150 ≤ VFA < 200 cm2, and 200 cm2 ≤ VFA. Logistic regression models were used to assess the association between VFA and influenza infection.ResultsIn total, 119 participants had influenza infections in the past year. In the multivariate adjusted model, a higher VFA was significantly associated with increased influenza infection; the adjusted odds ratio for 200 cm2 ≤ VFA was 5.03 [95% confidence interval (CI): 1.07–23.6], that for 150 ≤ VFA < 200 cm2 was 1.97 (95% CI: 0.71–5.45), and that for 100 ≤ VFA < 150 cm2 was 1.62 (95% CI: 0.84–3.12), compared with that for VFA < 100 cm2 (p for trend = 0.049). These findings were confirmed in the same cohort the following year.ConclusionsOur results suggest that visceral fat accumulation is associated with influenza infection. Large-scale prospective studies using diagnostic information for influenza infection are required to confirm this association.

Clinical efficacy of blood purification using a polymethylmethacrylate hemofilter for the treatment of severe acute pancreatitis.

BackgroundSevere acute pancreatitis (SAP) is a systemic inflammatory disease, and it can often complicate into acute kidney injury (AKI) and acute lung injury/acute respiratory distress syndrome (ALI/ARDS). This study aimed to evaluate the clinical effectiveness of blood purification using a polymethylmethacrylate (PMMA) hemofilter.MethodsWe retrospectively examined 54 patients, who were diagnosed with SAP according to the Japanese criteria from January 2011 to December 2019.ResultsOf a total of 54 SAP patients, 26 patients progressively developed AKI and required continuous hemodialysis with a PMMA membrane hemofilter (PMMA-CHD). Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score were significantly higher in patients requiring PMMA-CHD than in patients not requiring hemodialysis. The lung injury scores were also significantly higher in patients requiring PMMA-CHD. Of the 26 patients, 16 patients developed ALI/ARDS and required mechanical ventilation. A total of seven patients developed severe ALI/ARDS and received additional intermittent hemodiafiltration using a PMMA hemofilter (PMMA-HDF). Although the length of intensive care unit stay was significantly longer in patients with severe ALI/ARDS, blood purification therapy was discontinued in all the patients. The survival rates at the time of discharge were 92.3% and 92.9% in patients with and without PMMA-CHD, respectively. These real mortality ratios were obviously lower than the estimated mortality ratios predicted by APACHE II scores.ConclusionsThese finding suggest that the blood purification using a PMMA hemofilter would be effective for the treatment of AKI and ALI/ARDS in SAP patients.

Utility of Updated Japanese Circulation Society Guidelines to Diagnose Isolated Cardiac Sarcoidosis.

BackgroundIn the population with cardiac sarcoidosis (CS), approximately one third lacks extracardiac involvement and is considered to have isolated CS. Recently, the Japanese Circulation Society updated the diagnostic criteria for CS, providing a methodology for diagnosing isolated CS. We aimed to assess the characteristics of isolated CS diagnosed using a multimodal imaging approach according to the updated Japanese Circulation Society guidelines.Methods and ResultsWe retrospectively identified 161 consecutive patients who underwent 18F‐fluorodeoxyglucose positron emission tomography for suspected CS between 2012 and 2019. According to the guidelines, patients were classified as having CS with extracardiac involvement, isolated CS, or no CS. We compared the characteristics of multimodality imaging and the prevalence of major adverse cardiovascular events. The Japanese Circulation Society criteria classified 28 patients (17%) as having CS with 4 (2%) with histological confirmation, 21 (13%) as isolated CS, and 112 (70%) as no CS. Compared with CS, isolated CS showed higher left ventricular volume and reduced left ventricular ejection fraction (P<0.01 for all). During the median follow‐up period of 522 days, 24 patients had major adverse cardiovascular events. Isolated CS (hazard ratio, 3.35; [95% CI, 1.08–10.39], P=0.036) was independently associated with major adverse cardiovascular events after adjusting for reduced left ventricular ejection fraction and steroid. In the subgroup of 41 patients with serial 18F‐fluorodeoxyglucose positron emission tomography evaluation, only updated CS criteria were associated with improvement in myocardial inflammation on 18F‐fluorodeoxyglucose positron emission tomography.ConclusionsIsolated CS detected using the updated Japanese Circulation Society guidelines was associated with poor event‐free survival and should be managed with caution.

Anti–Integrin αvβ6 Antibody as a Diagnostic Marker for Pediatric Patients With Ulcerative Colitis

Anti–Integrin αvβ6 Antibody as a Diagnostic Marker for Pediatric Patients With Ulcerative Colitis

Impact of patient body habitus on image quality and quantitative value in bone SPECT/CT.

The first edition of guidelines for standardization of bone single photon emission computed tomography (SPECT) imaging was published in 2017, and the optimization and standardization are widely promoted. To the purpose, clarification of the factors related to image quality and quantitative values and their influence are required. The present study aimed to clarify and optimize the influence of patient body habitus on image quality and quantitative values in bone SPECT/CT. National Electrical Manufacturers Association body phantom (S-size) and custom-made large body phantoms (M-size and L-size) that simulate the abdomens of Japanese patients weighing 60, 80, and 100kg, were used. Each phantom was filled with 99mTc-solutions of 108 and 18kBq/mL for the hot spheres and background, respectively. Dynamic SPECT acquisition was performed for 6000s (150s /rotation × 40 rotation). The data were divided into six projection data and reconstructed each acquisition time (150, 300, 450, 600, 750, 900s, and single projection 6000s). Image quality was evaluated for contrast (QH, 17mm), background noise (NB, 17mm), contrast-to-noise ratio (CNR), maximum standardized uptake value (SUVmax, 17mm), and visual assessment for a 17mm hot sphere. Image quality in the 300s acquisition showed that values of QH, 17mm, CNR, and SUVmax, 17mm decreased (-16.7%, -11.8%, and -11.3%) for M-size and (-28.2%, -30.1%, and -21.7%) for L-size compared with S-size, respectively. No significant difference was observed in NB, 17mm values. M-size and L-size required 1.2 and 2.3 times longer acquisition, to achieve same CNR as S-size. In visual assessment, 17mm hot sphere could not be detected only in the L-size. When the Japanese bone SPECT guidelines criteria were applied in 600s, the sphere could be detected between all phantoms. Patient body habitus significantly affects image quality and decreases the quantitative value in bone SPECT/CT. For the optimization, extend acquisition time according to the patient body habitus is effective for image quality. And for the standardization, it is important to achieve imaging conditions that meet the Japanese bone SPECT guidelines criteria to ensure adequate detectability.

Fracture risk associated with glucocorticoid-induced osteoporosis in Japan.

Glucocorticoid-induced osteoporosis (GIOP) is associated with elevated fracture risk. Practice guidelines have been published to reduce this risk but are insufficiently followed in everyday practice. The objectives of this study were to estimate fracture incidence in patients exposed to oral glucocorticoids and to analyse the impact of glucocorticoid use on fracture incidence. This retrospective cohort study was performed using the Medical Data Vision (MDV) claims database from Japan. All patients aged ≥ 18years initiating oral glucocorticoids and fulfilling Japanese guideline criteria for starting prophylactic osteoporosis treatment between 2009 and 2019 were identified. These were matched to a cohort of unexposed controls using propensity score matching. Fracture incidence in the two cohorts were compared using a Fine-Gray proportional sub-distribution hazard model. 13,090 glucocorticoid-exposed cases were compared to 13,090 unexposed controls. The 1-year fracture rate (all sites) was 9.3[95% CI 8.8-9.8] in cases and 5.8 [5.4-6.2] in controls. One-year vertebral fracture rates were 4.3[4.0-4.7] and 2.3[2.1-2.6] respectively. In the multivariate analysis, the use of glucocorticoids was associated with an increase in the incidence of osteoporotic fractures (hazard ratio: 1.63 [1.51-1.76]). The glucocorticoid-associated risk tended to be higher in subgroups of patients with rheumatoid arthritis, asthma, COPD and in those aged < 65years. Oral glucocorticoid use is associated with an increase in fracture incidence. It is necessary to raise awareness of GIOP and to take public health measures to change the perceptions and behaviour of doctors prescribing glucocorticoids.

Validation of Japanese Bleeding Risk Criteria in Patients After Percutaneous Coronary Intervention and Comparison With Contemporary Bleeding Risk Criteria.

Background: The utility of the Japanese version of high bleeding risk (J-HBR) criteria compared with contemporary bleeding risk criteria, including Academic Research Consortium for High Bleeding Risk criteria, has not been fully investigated.Methods and Results: This study included patients who underwent percutaneous coronary intervention between 2010 and 2019. The J-HBR score was calculated by assigning 1 point for each major criterion and 0.5 points for each minor criterion in the J-HBR criteria. Among 1,643 patients, 1,143 (69.6%) met the J-HBR criteria. Accumulated major bleeding event rates at 1 year were higher among those who met the J-HBR criteria (4.8% vs. 0.6%; P<0.001). J-HBR criteria had higher sensitivity (94.8%) and lower specificity (31.4%) than contemporary bleeding risk criteria in predicting major bleeding. Bleeding events increased with increasing J-HBR score. The C statistic for the J-HBR score for predicting major bleeding at 1 year was 0.75 (95% confidence interval 0.69–0.81), and is comparable to that of other risk scores. In multivariate analysis, of the factors included in J-HBR criteria, chronic kidney disease, heart failure, and active malignancy were associated with major bleeding.Conclusions: J-HBR criteria identified patients at high bleeding risk with high sensitivity and low specificity. Bleeding risk was closely related to J-HBR score and its individual components. The discriminative ability of the J-HBR score was comparable to that of contemporary bleeding risk scores.

MO949: Metabolic Syndrome and Longitudinal Risk of Renal and Cardiovascular Events in Renal Transplant Recipients: A Single Center Study in Japan

Abstract BACKGROUND AND AIMS Metabolic syndrome (MetS) is a condition that promotes arteriosclerosis due to various arteriosclerosis risk factors such as impaired glucose tolerance, impaired lipid metabolism and hypertension, caused by insulin resistance as a result of visceral fat obesity. There have been several epidemiological studies on MetS after renal transplantation conducted in the U.S. and Europe, indicating that MetS is an accumulation of non-immunological risks of renal transplantation, which affects the patient's prognosis as well as that of the kidney. However, the incidence of MetS in Japanese renal transplant recipients is 20 to 30% and lower compared with that of American and European recipients, and its effects on cardiovascular complications and kidney prognosis are not clear. We report on the results of our long-term longitudinal study on MetS in renal transplant recipients. METHOD A total of 104 renal transplant outpatients, over 6 months after their transplants and in stable condition, were diagnosed with MetS from January 2006 and June 2007 and followed up until December 2020. The effects of MetS on outcomes including renal and cardiovascular events were studied using four diagnostic criteria [NCEP-ATP III (Japanese, original, Asian) and IDF criteria]. We performed multivariate Cox proportional hazards regression analysis to examine the association between the presence or absence of MetS and combined vascular events in renal transplant recipients. This study protocol was conducted in accordance with the Principles of the Declaration of Helsinki and the Declaration of Istanbul, and was approved by the ethics committee of Osaka City University (No. 2020–197). All analyses were performed using R ver. 4.0.3 (https://www.r-project.org/foundation/) with the ‘rms’ and ‘RcmdrPlugin.EZR’ packages. RESULTS The incidence of MetS among our renal transplant recipients in our baseline investigation was 24.0% by the NCEP-ATP III (Japanese) criteria, and our longitudinal study showed that MetS was a significant risk factor even after adjustment of background factors using the propensity score (HR: 2.82; 95% CI: 1.26–6.34, P = 0.012). In addition, the effects of MetS diagnosed using the NCEP (original), NCEP (Asian) and IDF criteria on cardiac composite events were HR: 2.39; 95% CI: 1.07–5.38, P = 0.035, HR: 2.35; 95% CI: 1.00–5.55, P = 0.051, and HR: 1.90; 95% CI: 0.84–4.31, P = 0.12, respectively. CONCLUSION Although the incidence of MetS in Japanese renal transplant recipients was lower compared to that of American and European renal transplant recipients, our results indicated that MetS also affected cardiovascular complications and kidney prognosis in Japanese renal transplant recipients. Moreover, depending on the diagnostic criteria for MetS, the HR was shown to be around 2.0–3.0.

Association Between the Onset of Physical Frailty and Executive Function in Community-Dwelling Elderly People

Purpose: Physical frailty may increase the risk of dementia, but it is not known exactly how cognition decreases. In this study, the features of recognition dysfunction in physical frailty were assessed. Method: The subjects were 46 elderly people aged 75 years or older ( M age = 83.2 ± 5.1 years) who visited community day care facilities between July 2018 and January 2020. The subjects were divided into a physical frailty group and a nonfrailty group, and physical performance and cognitive function were evaluated. Physical performance was measured by the Timed Up and Go (TUG) test, handgrip strength, lower leg circumference on both sides, and one-leg standing time. The Mini-Mental State Examination, Raven's Colored Progressive Matrices, and the Trail Making Test (TMT) were used to assess cognitive function. Results: The subjects were diagnosed based on the Cardiovascular Health Study criteria, in particular, Cardiovascular Health Study diagnostic items based on the Japanese version criteria. The physical frailty group included 10 subjects with an average age of 82.9 ± 4.0 years, and the nonfrailty group included 18 subjects with an average age of 83.4 ± 3.9 years. The physical frailty group showed significantly lower TUG and TMT compared with the nonfrailty group. There was also a significant correlation between TUG and Part B of the TMT in the physical frailty group (r = 0.735, p &lt; .05). Conclusions: Executive function was lower in the physical frailty group, and the possibility of an effect on physical activity was suggested. Based on these results, evaluation of physical frailty can lead to more strategic prevention and treatment by combining physical performance evaluation with cognitive function tests including evaluation of executive function.

Clinical characteristics and treatment outcomes of carbapenem-resistant Enterobacterales infections in Japan

The dissemination of difficult-to-treat carbapenem-resistant Enterobacterales (CRE) is of great concern. We clarified the risk factors underlying CRE infection mortality in Japan. We conducted a retrospective, multicentre, observational cohort study of patients with CRE infections at 28 university hospitals from September 2014 to December 2016, using the Japanese National Surveillance criteria. Clinical information, including patient background, type of infection, antibiotic treatment, and treatment outcome, was collected. The carbapenemase genotype was determined using PCR sequencing.Multivariate analysis was performed to identify the risk factors for 28-day mortality. Among the 179 patients enrolled, 65 patients (36.3%) had bloodstream infections, with 37 (20.7%) infections occurring due to carbapenemase-producing Enterobacterales (CPE); all carbapenemases were of IMP-type (IMP-1: 32, IMP-6: 5). Two-thirds of CPE were identified as Enterobacter cloacae complex.Combination therapy was administered only in 46 patients (25.7%), and the 28-day mortality rate was 14.3%.Univariate analysis showed that solid metastatic cancer, Charlson Comorbidity Index ≥3, bloodstream infection, pneumonia, or empyema, central venous catheters, mechanical ventilation, and prior use of quinolones were significant risk factors for mortality. Multivariate analysis revealed that mechanical ventilation (OR: 6.71 [1.42-31.6], P=0.016), solid metastatic cancers (OR: 5.63 [1.38-23.0], P=0.016), and bloodstream infections (OR: 3.49 [1.02-12.0], P=0.046) were independent risk factors for 28-day mortality. The significant risk factors for 28-day mortality in patients with CRE infections in Japan are mechanical ventilation, solid metastatic cancers, and bloodstream infections.

Late-Onset Hypogonadism in a Male Patient with Long COVID Diagnosed by Exclusion of ME/CFS

After the acute phase of COVID-19, some patients have been reported to have persistent symptoms including general fatigue. We have established a COVID-19 aftercare clinic (CAC) to provide care for an increasing number of these patients. Here, we report the case of a 36-year-old man who developed post-COVID fatigue after acute infection with SARS-CoV-2. In the acute phase of COVID-19, the patient’s fever resolved within four days; however, general fatigue persisted for three months, and he visited our CAC 99 days after the initial infection. Examination revealed a high Aging Male’s Symptoms (AMS) score of 44 and low free testosterone (FT) level of 5.5 pg/mL, which meet the Japanese criteria of late-onset hypogonadism (LOH) syndrome. Imaging studies revealed an atrophic pituitary in addition to fatty liver and low bone mineral density. Anterior pituitary function tests showed a low follicle-stimulating hormonelevel and delayed reaction of luteinizing hormone (LH) after gonadotropin-releasing hormone (GnRH) stimulation, indicating the possibility of hypothalamic hypogonadism in addition to primary hypogonadism seen in patients with post-COVID-19 conditions. After the initiation of Japanese traditional medicine (Kampo medicine: hochuekkito followed by juzentaihoto), the patient’s symptoms as well as his AMS score and serum FT level were noticeably improved. Furthermore, follow-up tests of GnRH stimulation revealed improvements in LH responsiveness. Although many patients have been reported to meet the criteria of ME/CFS such as our case, we emphasize the possibility of other underlying pathologies including LOH syndrome. In conclusion, LOH syndrome should be considered a cause of general fatigue in patients with post-COVID-19 conditions and herbal treatment might be effective for long COVID symptoms due to LOH (264 words).