Risk Of Mortality In Individuals Research Articles

Sex-specific associations between haemoglobin glycation index and the risk of cardiovascular and all-cause mortality in individuals with pre-diabetes and diabetes: A large prospective cohort study.

The aim of this study was to investigate the relationship between the haemoglobin glycation index (HGI), and cardiovascular disease (CVD) and all-cause mortality in adults with pre-diabetes and diabetes. This study included 10 267 adults with pre-diabetes and diabetes from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Sex-differentiated relationships between HGI and mortality were elucidated using multivariate Cox proportional hazards models, restricted cubic splines and a two-piecewise Cox proportional hazards model. During the median follow-up time of 103.5 months, a total of 535 CVD deaths and 1918 all-cause deaths were recorded. After multivariate adjustment, in males with pre-diabetes and diabetes, there was a U-shaped relationship between HGI and CVD mortality and all-cause mortality, with threshold points of -0.68 and -0.63, respectively. Before the threshold point, HGI was negatively associated with CVD mortality [hazard ratio (HR) 0.60; 95% confidence interval (CI) 0.41, 0.89] and all-cause mortality (HR 0.56; 95% CI 0.43, 0.74), and after the threshold point, HGI was positively associated with CVD mortality (HR 1.46; 95% CI 1.23, 1.73) and all-cause mortality (HR 1.40; 95% CI 1.23, 1.59). In contrast, HGI had an L-shaped relationship with all-cause mortality and no significant association with CVD mortality in females. To the left of the threshold points, the risk of all-cause mortality decreased (HR 0.50; 95% CI 0.35, 0.71) progressively with increasing HGI. In the cohort study, HGI in pre-diabetic and diabetic populations was found to have a U-shaped association with CVD mortality and all-cause mortality in males and an L-shaped association with all-cause mortality only in females. Further prospective and mechanistic studies are warranted.

Serum klotho as a novel biomarker for metabolic syndrome: findings from a large national cohort.

Metabolic syndrome is a cluster of metabolic abnormalities that significantly increase the risk of cardiovascular disease and mortality. The identification of novel biomarkers associated with mortality in patients with metabolic syndrome could facilitate early risk stratification and targeted interventions. We conducted a large prospective cohort study using data from five cycles (2009-2016) of the National Health and Nutrition Examination Survey (NHANES) database, including a total of 40,439 participants. Logistic regression analysis was used to assess the association between serum klotho protein levels and metabolic syndrome, while Cox regression analysis was employed to examine the correlation between serum klotho levels and all-cause mortality. Mortality data were updated until December 31, 2019. After adjusting for demographic and socioeconomic confounders, the logistic regression model demonstrated that higher serum klotho levels were significantly associated with a decreased prevalence of metabolic syndrome (OR [95% CI] Highest vs. lowest quartile: 0.84 [0.70-0.99], P=0.038). In the Cox regression model, elevated klotho levels were found to significantly reduce the risk of all-cause mortality among individuals with metabolic syndrome (HR [95% CI] Highest vs. lowest quartile: 0.68 [0.51-0.90], P=0.006). Serum klotho levels were found to be inversely associated with the prevalence of metabolic syndrome, independent of potential confounding factors such as demographics, socioeconomic status, and lifestyle factors. Furthermore, higher klotho levels strongly indicated a lower risk of all-cause mortality in individuals with metabolic syndrome.

Metabolic dysfunction-associated steatotic liver disease and the risk of mortality in individuals with type 2 diabetes: a systematic review and meta-analysis.

The systematic review aimed to assess the risks of metabolic dysfunction-associated steatotic liver disease (MASLD) on all-cause and cause-specific mortality in patients with type 2 diabetes (T2DM). EMBASE and MEDLINE were searched from inception to June 2022 for observational studies examining the relationship between MASLD and the risk of mortality among T2DM patients. Meta-analysis was conducted using random-effects models with hazard ratios (HRs) to quantify the risk of mortality. A total of 5877 articles were screened, and ultimately, 12 eligible studies encompassing 368 528 T2DM patients, with a median follow-up of 8.9 years (interquartile range, 4.7-14.5), were included. Our analysis revealed a significant association between MASLD and an increased risk of all-cause mortality in T2DM patients [HR 1.28; 95% confidence interval (CI), 1.05-1.58; I 2 = 90%]. Meta-regression analyses did not show significant effects of mean age, mean BMI, and percentage of smokers, hypertension, and hyperlipidemia on the association between MASLD and the risk of all-cause mortality. However, we found that MASLD was not significantly associated with mortality related to cardiovascular diseases (HR 1.05; 95% CI, 0.82-1.35; I2 = 0%) or cancer (HR 1.21; 95% CI, 0.41-3.51; I 2 = 79%) among patients with T2DM. No publication bias was observed. This comprehensive meta-analysis provides substantial evidence supporting a significant association between MASLD and an increased risk of all-cause mortality among the T2DM population. These findings underscore the potential benefits of screening for MASLD in T2DM patients, aiding in the early identification of high-risk individuals and enabling risk modification strategies to improve survival.

Proton Pump Inhibitor Use and the Risk of Cardiovascular Complications and Death in Older Adults with Diabetes: A Population-Based Cohort Study.

The unfavorable effect of proton pump inhibitors (PPIs) on cardiovascular (CV) outcomes and mortality was reported in the general population. We investigated the impact of PPIs on CV outcomes and total mortality in older people with diabetes mellitus (DM) for whom evidence is missing. Using administrative health databases of the Lombardy Region, we analyzed the risk of myocardial infarction (MI), ischemic stroke and total mortality in individuals with DM (≥65 years of age) exposed to PPIs in 2015 and followed up to 2021. The outcomes were analyzed using a multivariable-adjusted Cox proportional hazards model to compute hazard ratios (HRs) with 95% confidence intervals (CIs). HRs between PPI users and non-users were also estimated in selected subgroups. A sensitivity analysis was also performed in a 1:1 propensity score matching population. A total of 284,068 patients were included in the analysis (49.4% PPI users, 50.6% non-PPI users). A higher prevalence of comorbidities and medications was reported in PPI users as compared with non-users. During a median follow-up of 6.7 years, the use of PPIs was associated with a higher risk for ischemic stroke (HR 1.14, 95% CI 95% 1.08-1.20), MI (HR 1.36, 95% CI 1.31-1.41) and total mortality (HR 1.24, 95% CI 1.22-1.26). These risks were higher in PPI users regardless of the PPI type. Among sexes, previous CV diseases, and insulin subgroups, the use of PPIs was correlated with a statistically significant increased risk of ischemic stroke in men, in individuals without a history of CV disease, and in those who were not treated with insulin. A significantly higher risk of MI was associated with PPIs for all subgroups, as well as for total mortality, with the exception of patients with a previous history of CV diseases. The sensitivity analysis confirmed the results of the unmatched cohort. Our findings confirmed an increased risk of CV events and all-cause mortality in a large population of older adults with DM exposed to PPIs. This could have an important impact on public health and costs for National Health Service, therefore a regular assessment of PPI appropriateness is recommended, particularly in this population.

Prevalence of prediabetes and risk of CVD mortality in individuals with prediabetes alone or plus hypertension in Northeast China: insight from a population based cohort study

BackgroundTo evaluate the current prevalence of prediabetes in northeast China, and further determine the association between prediabetes alone or coexistent with hypertension and cardiovascular disease (CVD) mortality.MethodsIn the prospective study, 15,557 participants without diabetes among aged ≥40 years in northeast China, were followed for a median of 5.5 years. Following the American Diabetes Association, prediabetes was defined as fasting plasma glucose (FPG) range of 5.6-6.9 mmol/L or glycated hemoglobin (HbA1c) range of 5.7-6.4% in people without diabetes.ResultsThe prevalence of prediabetes was 44.3% among population aged ≥40 years in northeast China. Prediabetes alone did not promote risk of CVD mortality. However, when the subgroups were stratified by hypertension, the CVD mortality risk in prediabetes plus hypertension subjects increased significantly compared with population without prediabetes and hypertension. Multivariate-adjusted hazard ratios for CVD mortality in prediabetes subgroups plus hypertension were 2.28 (95% CI: 1.50, 3.47) for those diagnosed by FPG < 5.6 mmol/L & HbA1c 5.7-6.4%, 2.18 (95% CI: 1.53, 3.10) for those diagnosed by FPG 5.6-6.0 mmol/L & HbA1c < 6.5% and 2.35 (95% CI: 1.65, 3.35) for those diagnosed by FPG 6.1-6.9 & HbA1c < 6.5% compared with the reference group. Moreover, the percentage of hypertension in prediabetes subjects was high (60.4%), but the awareness, treatment and control rates were far from satisfactory (45.3, 35.1 and 4.8%, respectively).ConclusionsThe prevalence of prediabetes remains high in northeast China, and the CVD mortality was elevated significantly in prediabetes coexistent with hypertension. Considering the high percentage and low control rate of hypertension in prediabetes, strategies focused on HbA1c screening, FPG lowering and blood pressure management should be emphasized in northeast China.

Inter-relationships between cardiovascular, renal and metabolic diseases: Underlying evidence and implications for integrated interdisciplinary care and management.

Cardiovascular, renal and metabolic (CaReMe) diseases are individually among the leading global causes of death, and each is associated with substantial morbidity and mortality. However, as these conditions commonly coexist in the same patient, the individual risk of mortality and morbidity is further compounded, leading to a considerable healthcare burden. A number of pathophysiological pathways are common to diseases of the CaReMe spectrum, including neurohormonal dysfunction, visceral adiposity and insulin resistance, oxidative stress and systemic inflammation. Because of the shared pathology and common co-occurrence of the CaReMe diseases, the value of managing these conditions holistically is increasingly being realized. A number of pharmacological and non-pharmacological approaches have been shown to offer simultaneous metabolic, cardioprotective and renoprotective benefits, leading to improved patient outcomes across the CaReMe spectrum. In addition, increasing value is being placed on interdisciplinary team-based and coordinated care models built on greater integration between specialties to increase the rate of early diagnosis and adherence to practice guidelines, and improve clinical outcomes. This interdisciplinary approach also facilitates integration between primary and specialty care, improving the patient experience, optimizing resources, and leading to efficiencies and cost savings. As the burden of CaReMe diseases continues to increase, implementation of innovative and integrated care delivery models will be essential to achieve effective and efficient chronic disease management and to ensure that patients benefit from the best care available across all three disciplines.

A novel score to predict in-hospital mortality for patients with acute coronary syndrome and out-of-hospital cardiac arrest: the FACTOR study.

Acute coronary syndromes (ACS) represent a substantial global healthcare challenge. In its most severe form, it can lead to out-of-hospital cardiac arrest (OHCA). Despite medical advancements, survival rates in OHCA patients remain low. Further, the prediction of outcomes in these patients poses a challenge to all health care providers involved. This study aims at developing a score with variables available on admission to assess in-hospital mortality of patients with OHCA undergoing coronary angiography. All patients with OHCA due to ACS admitted to a tertiary care center were included. A multivariate logistic regression analysis was conducted to explore the association between clinical variables and in-hospital all-cause mortality. A scoring system incorporating variables available upon admission to assess individual patients' risk of in-hospital mortality was developed (FACTOR score). The score was then validated. A total of 291 patients were included in the study, with a median age of 65 [56-73] years, including 47 women (16.2%). The in-hospital mortality rate was 41.2%. A prognostic model was developed in the derivation cohort (n = 138) and included the following variables: age, downtime, first detected rhythm, and administration of epinephrine. The area under the curve for the FACTOR score was 0.823 (95% CI 0.737-0.894) in the derivation cohort and 0.828 (0.760-0.891) in the validation cohort (n = 153). The FACTOR score demonstrated a reliable prognostic tool for health care providers in assessing in-hospital mortality of OHCA patients. Early acknowledgement of a poor prognosis may help in patient management and allocation of resources.

Association of serum 25-hydroxyvitamin D concentrations with all-cause and cardiovascular mortality among US adults with prehypertension: a prospective cohort study

BackgroundPrehypertension affects 25–50% of adults worldwide and no prior study has examined the relationship between serum 25-hydroxyvitamin D [25(OH)D] concentrations and mortality risk in individuals with prehypertension. This study aims to investigate the association of serum 25(OH)D concentrations with all-cause and CVD mortality among prehypertensive adults by utilizing data from the US National Health and Nutrition Examination Survey (NHANES) 2007–2014 and linked 2019 mortality file.MethodsWe included 4345 prehypertensive adults who participated in the NHANES between 2007 and 2014 and were followed up until 31 December 2019. Weighted Cox proportional hazards models were used with adjustments for multiple covariates to calculate the hazard ratio (HR) and 95% confidence interval (CI) for the risks of dying from any cause and CVD.ResultsDuring a median follow-up of 8.8 years, 335 deaths from any causes were documented, of which 88 participants died from CVD. Compared with participants with sufficient 25(OH)D (≥ 75 nmol/L), the multivariate-adjusted HRs and 95% CIs for participants with severe deficiency (< 25 nmol/L), moderate deficiency (25–49.9 nmol/L), and insufficient concentrations (50–74.9 nmol/L) of serum 25(OH)D for all-cause death were 2.83 (1.46–5.52), 1.17 (0.74–1.86), and 1.36 (0.93–1.98), respectively. Similarly, the multivariable-adjusted HRs and 95%CIs for CVD death were 4.14 (1.10–15.51), 1.23 (0.46–3.28), and 1.73 (0.96–3.14), respectively. We found that there was a 9% reduction in the risk of death from all causes and a 14% reduction in the risk of death from CVD for every 10 nmol/L increase in serum 25(OH)D concentrations.ConclusionSevere serum 25(OH)D deficiency among prehypertensive adults was associated with increased risk of mortality from all causes as well as from CVD. Our work suggests that supplementing with vitamin D may prevent premature death in severely deficient individuals with prehypertension.

Diabetes mellitus: association of cystatin C- versus creatinine-based estimated glomerular filtration rate with mortality and cardiovascular events.

To explore the association between the differences between cystatin C- and creatinine-based estimated glomerular filtration rate (eGFRdiff), and the risk of mortality and cardiovascular (CV) events in individuals with diabetes. Three prospective cohorts analyzed data from adults with diabetes from the Incident, Development, and Prognosis of Diabetic Kidney Disease (INDEED) study (2016-17 to 2020) in China, the National Health Nutrition Examination Survey (NHANES, 1999-2004 to 2019) in the USA and UK Biobank (UKB, 2006-10 to 2022) in the UK. Baseline eGFRdiff was calculated using both absolute difference between cystatin C- and creatinine-based calculations (eGFRabdiff), and the ratio between them (eGFRrediff). Cox proportional hazards regression models were used to investigate the association between eGFRdiff and outcomes including all-cause mortality and incident CV events. A total of 8129 individuals from INDEED (aged 60.7±10.0years), 1634 from NHANES (aged 62.5±14.4years) and 29358 from UKB (aged 59.4±7.3 years) were included. At baseline, 43.6%, 32.4% and 42.1% of participants in INDEED, NHANES and UKB, respectively, had an eGFRabdiff value ≥15mL/min/1.73 m2. During a median follow-up of 3.8years for INDEED, 15.2years for NHANES and 13.5years for UKB, a total of 430, 936 and 6143 deaths and a total of 481, 183 and 5583 CV events occurred, respectively. Each 1-standard deviation higher baseline eGFRabdiff was independently associated with a lower risk of all-cause mortality and CV events, with hazard ratios of 0.77 and 0.82 in INDEED, 0.70 and 0.68 in NHANES, and 0.66 and 0.78 in UKB. Similar results were observed for eGFRrediff. eGFRdiff represents a marker of adverse events for diabetes among general population. Monitoring both eGFRcys and eGFRcr yields additional prognostic information and has clinical utility in identifying high-risk individuals for mortality and CV events.

Comparison of NAFLD, MAFLD and MASLD characteristics and mortality outcomes in United States adults.

Following the classification of metabolic dysfunction-associated fatty liver disease (MAFLD), non-alcoholic fatty liver disease (NAFLD) has recently been redefined again as metabolic dysfunction-associated steatotic liver disease (MASLD). However, the distinctions in characteristics and mortality outcomes between NAFLD, MAFLD and MASLD remain unclear. We analysed data from 7519 participants in the third National Health and Nutrition Examination Surveys of United States (US) and their linked mortality until 2019. Survey weight-adjusted multivariable Cox proportional model was used to study the mortality over three terms. The prevalence of NAFLD, MAFLD and MASLD was 18.5%, 19.3% and 20.8%, respectively. Most individuals with NAFLD (94.5%) or MAFLD (100%) can be classified as MASLD, while a relatively low percentage of those with MASLD were also diagnosed with either NAFLD (84.1%) or MAFLD (92.7%). During a median follow-up of 26.9 years, both MAFLD and MASLD were associated with increased risk of all-cause mortality (adjusted hazard ratio [aHR] 1.18, 95% CI 1.04-1.33 and 1.19, 1.06-1.34, respectively), this association was mainly observed in NAFLD-/MASLD+ subgroups. NAFLD was not associated with all-cause mortality. However, all three terms were associated with an increased risk of all-cause mortality in individuals with advanced fibrosis (aHR: 1.71-1.81). Subgroup analyses showed that higher risk of all-cause mortality for both MAFLD and MASLD were observed among older adults (≥65 year), non-Hispanic whites and those without diabetes. Both MASLD and MALFD were linked to higher all-cause mortality risk, but MASLD identified a greater number of individuals compared to MAFLD.

The impact of obesity on different glucose tolerance status with incident cardiovascular disease and mortality events over 15 years of follow-up: a pooled cohort analysis

BackgroundThe effect of obesity in different glucose tolerance statuses i.e. normoglycemia (NGT), pre-diabetes, and type 2 diabetes (T2DM) on cardiovascular disease (CVD) and mortality has been an area of ongoing debate and uncertainty. In the present study, we aimed to examine the impact of being obese, whether general or central separately, in comparison with non-obese in different glucose tolerance statuses on the above outcomes.MethodsThe study population included 18,184 participants aged 30–60 years (9927 women) from three longitudinal studies, including Atherosclerosis Risk in Communities, Multi-Ethnic Study of Atherosclerosis, and Tehran Lipid and Glucose Study. Glucose tolerance status was defined as NGT (fasting plasma glucose < 5.55 mmol/L), pre-diabetes (5.55–7.00 mmol/L), and T2DM (≥ 7 mmol/L or taking any medication for diabetes). Moreover, general and central obesity were defined based on body mass index and waist circumference (WC), respectively. Multivariable stratified Cox regression analysis was used to estimate hazard ratios (HRs (95% CI)) for CVD and mortality events.ResultsDuring a 16-year follow-up, 2733 CVD events, 1101 CV mortality, and 3678 all-cause mortality events were recorded. We observed that being generally obese in comparison with non-obese increased the risk of CV and all-cause mortality in all glucose tolerance statuses; while considering CVD events, only among individuals with T2DM, the presence of general obesity was associated with marginally significant higher risk [1.19 (0.98–1.43); p-value = 0.07]. Regarding central adiposity, multivariate analysis revealed that elevated WC in NGT participants is associated with incident CVD [1.27(1.12–1.46)] and all-cause mortality [1.13(1.00–1.28)]. Moreover, central adiposity increased the risk of CV mortality in pre-diabetes individuals [1.47 (1.11–1.95)].ConclusionFindings from this pooled prospective cohort studies provide evidence that general obesity shows an unfavorable association with CV and all-cause mortality among the general population irrespective of their glucose tolerance statusThe findings imply that it's important to take into account the requirement and magnitude of weight reduction in people who are obese when offering guidance.

Differences in the impact of newly diagnosed type 2 diabetes on cardiovascular mortality between normotensive and hypertensive individuals.

We investigated the interrelationship between hyperglycemia and hypertension on cardiovascular mortality in the middle-aged and elderly people. In this retrospective cohort study that used data from the Hiroshima Study on Glucose Metabolism and Cardiovascular Diseases, we included 16,564 participants without cardiovascular disease (mean age: 65.8 years; 6179 normoglycemic people, 3017 people with newly diagnosed type 2 diabetes, and 7368 people with prediabetes per the 75-g oral glucose tolerance test). Hypertension was defined as the use of antihypertensive medications and/or having a systolic/diastolic blood pressure of at least 140/90 mm Hg. During a median follow-up period of 12.4 years, a total of 1513 cardiovascular death occurred. Cardiovascular death rates per 1000 participant-years were 4.01, 4.98, 8.33, 8.22, 8.81, and 11.1 among normotensive participants with normal glycemia, prediabetes, and diabetes and hypertensive participants with normal glycemia, prediabetes, and diabetes, respectively. Prediabetes was significantly associated with a high risk of cardiovascular mortality in normotensive individuals [hazard ratio: 1.24, 95% confidence interval (95% CI): 1.02-1.50] but not in hypertensive individuals. Type 2 diabetes was associated with a high risk of cardiovascular mortality in both normotensive (hazard ratio: 1.94, 95% CI: 1.55-2.43) and hypertensive individuals (hazard ratio: 1.35, 95% CI: 1.13-1.62). Stratified analyses revealed no significant impact of type 2 diabetes on cardiovascular mortality in hypertensive individuals aged at least 65 years. The effect of hyperglycemia on cardiovascular death differed with age and the presence or absence of hypertension, demonstrating the clinical importance of case-specific risk assessments.

Effect of water salinity on immature performance and lifespan of adult Asian tiger mosquito

BackgroundAedes albopictus (Skuse, 1894) is a vector for pathogens like dengue, chikungunya, and Zika viruses. Its adaptive capacity enables reproduction in temperate climates and development mainly in artificial containers with fresh water in urbanized areas. Nevertheless, breeding in coastal areas may also occur along with its aggressive invasiveness. Global warming and the consequent rise in sea levels will increase saline (> 30 ppt) or brackish (0.5–30 ppt salt) water in coastal regions. To address whether Ae. albopictus can breed in brackish water, we initiated the current study that analyses the survival of immature stages at different salinity concentrations and explores whether carryover effects occur in the resulting adults. This possible adaptation is important when considering the potential for development in new habitats and expansion of one of the world’s most invasive species.MethodsWe investigated the influence of salinity on the survival of Ae. albopictus larvae and adults under laboratory-controlled conditions. First instar larvae were exposed to different salinity concentrations (0 to 30 ppt) and their development time, pupation, adult emergence, and overall survival were monitored daily. We used Kaplan-Meier and Cox regression models to analyze the survival rates at different salinity levels. Furthermore, life tables were constructed under each salinity concentration.ResultsIncreasing salt concentrations significantly increased the mortality risk during immature development, while no significant effect was observed on adult mortality risk. A comparison between distilled and bottled water revealed a notable increase in overall mortality risk for individuals developing in distilled water. However, no significant effects were found when analyzing survival from the first larval stage to adult emergence and adult lifespan. The life expectancy of immature stages decreased with increasing salt concentrations, although salinity concentration did not significantly impact adult life expectancy.ConclusionsOur findings suggest that Ae. albopictus, previously considered freshwater species, can successfully develop and survive in brackish waters, even in the absence of characteristic structures found in euryhaline species. These adaptations may enable Ae. albopictus to establish new breeding sites and colonize unexplored territories. Knowledge of these physiological adaptations of Ae. albopictus to salinity should be pursued to increase the range of control of the species, and to make more accurate predictions of its dispersal and vectoring ability.Graphical

Nomogram to predict risk of early mortality following definitive or adjuvant radiation and systemic therapy for head and neck cancer

Purpose/ObjectivesWe sought to create nomograms to predict individual risk of early mortality, which can identify patients who require interventions to prevent early death. MethodsWe included patients in the National Cancer Database with non-metastatic squamous cell carcinoma of the head and neck who received radiation and systemic therapy between 2004 and 2017 in the definitive or adjuvant setting. Early mortality was defined as any death less than 90 days after starting radiation. Multivariable logistic regression was used to assess the relationship between covariates and early mortality. Nomograms to predict the risk of early death were created for both the definitive and adjuvant settings. ResultsAmong 84,563 patients in the definitive group and 18,514 patients in the adjuvant group, rates of early mortality were 3.5 % (95 % CI 3.4–3.7 %) and 2.2 %, (95 % CI 1.9–2.4 %), respectively. Patients above the age of 70 had an early mortality rate of 7.8 % (95 % CI 7.3–8.2 %) in the definitive group and 4.4 % (95 % CI 3.6–5.4 %) in the adjuvant group. In the multivariable analysis, age, comorbidity, T and N category, and tumor site were associated with early mortality in both cohorts (p < 0.05 for all). Nomograms including age, comorbidity, T and N category and tumor site performed better than age alone at predicting early mortality (AUC for definitive group: 0.70 vs 0.66; AUC for adjuvant group: 0.71 vs 0.61). ConclusionNomograms including age, comorbidity, T and N category and tumor site were developed to predict the risk of early death following definitive or adjuvant chemoradiation.

Diabetic retinopathy related homeostatic dysregulation and its association with mortality among diabetes patients: A cohort study from NHANES

AimsTo develop a metric termed the diabetic retinopathy-related homeostatic dysregulation (DRHD) value, and estimate its association with future risk of mortality in individuals with type 2 diabetes. MethodsWith the data of the NHANES, the biomarkers associated with DR were identified from 40 clinical parameters using LASSO regression. Subsequently, the DRHD value was constructed utilizing the Mahalanobis distance approach. In the retrospective cohortof 6420 type 2 diabetes patients, we estimated the associations between DRHD values and mortality related to all-cause, cardiovascular disease (CVD) and diabetes-specific causes using Cox proportional hazards regression models. ResultsA set of 14 biomarkers associated with DR was identified for the construction of DRHD value. During an average of 8 years of follow-up, the multivariable-adjusted HRs and corresponding 95 % CIs for the highest quartiles of DRHD values were 2.04 (1.76, 2.37), 2.32 (1.78, 3.01), and 2.29 (1.72, 3.04) for all-cause, CVD and diabetes-specific mortality, respectively. Furthermore, we developed a web-based calculator for the DRHD value to enhance its accessibility and usability (https://dzwxl-drhd.streamlit.app/). ConclusionsOur study constructed the DRHD value as a measure to assess homeostatic dysregulation among individuals with type 2 diabetes. The DRHD values exhibited potential as a prognostic indicator for retinopathy and for mortality in patients affected by type 2 diabetes.

Prevalence of Sarcopenia in Liver Cirrhosis Patients and Determinants of Survival in Cirrhotic Population: A Prospective Cohort Study

Introduction: Chronic liver diseases are the leading cause of mortality and are associated with a significant reduction in health-related quality of life, as well as being a major complication in cirrhosis. There is a high risk of reduced muscle mass, muscle strength, or function, known as sarcopenia, in patients with liver cirrhosis. Sarcopenia is a major determinant of survival in cirrhosis patients, along with the Child-Turcotte Pugh (CTP) score and the Model for End-stage Liver Disease (MELD) scores. Aim: To study the prevalence of sarcopenia in patients with liver cirrhosis by assessing skeletal muscle mass using the third lumbar level Skeletal Muscle Index (SMI) through Computed Tomography (CT) and to determine the survival analysis of the cohort using a Cox regression model. Materials and Methods: The present study was a prospective cohort study conducted in the Department of Gastroenterology and Hepatology at Sree Gokulam Medical College and Research Foundation in Thiruvananthapuram, Kerala, India South India, from October 2018 to October 2022. A total of 209 patients with cirrhosis were evaluated. Liver biochemical parameters, CTP score, and the MELD score were studied. Age, gender, and aetiology were noted. All subjects were assessed for sarcopenia using CT at the third lumbar vertebrae level SMI, and all subjects were followed up every six months for survival. Survival curves and survival probability were evaluated for all the subjects recruited in the present study. Cumulative survival rates were estimated by the Kaplan-Meier method for sarcopenia, CTP score, and the MELD scores after categorisation into the aetiology of cirrhosis, and the groups were compared using the Log-rank test. Independent factors associated with mortality were identified using Cox proportional hazards models. A p-value &lt;0.05 was considered statistically significant. Results: The mean age±Standard Deviation of the subjects was 58.24±9.9 years. Among the subjects, males accounted for 161 (77%), while 48 (23%) were females. In subjects with sarcopenia (n=77), the survival rate was 53 (68.8%), and in subjects without sarcopenia (n=132), the survival rate was significantly higher at 110 (83.3%) with a p-value &lt;0.05 (p=0.027). Univariate Cox regression analysis indicated that sarcopenia was a statistically significant predictor of survival. The mortality risk was higher in individuals with sarcopenia, with a Hazard Ratio (HR) of 1.9 and a 95% Confidence Interval (CI) ranging from 1.1-1.4. In the Cox regression model, CTP class B/C had a 2.4 times higher risk for mortality than CTP class A (p&lt;0.05). Individuals with sarcopenia had a 1.76 times higher risk of mortality compared to those without (HR=1.765, 95% CI: 0.983-3.17) in the multivariate Cox regression analysis. Aetiology and CTP class scores were independently associated with mortality (p&lt;0.05) after adjusting for multiple prognostic factors in the multivariate Cox regression analysis. Conclusion: Univariate Cox regression analysis indicated that sarcopenia was a statistically significant predictor of survival, with a higher mortality risk in individuals with sarcopenia. The multivariate Cox regression model for survival concluded that CTP class B/C posed a higher risk for mortality compared to CTP class A.

Assessment of tropospheric nitrogen dioxide (NO2) levels on the COVID-19 pandemic in Morocco

After being discovered in Wuhan, China towards the end of December, the novel infectious disease with human-to-human transmission (COVID-19) spread around the world and became a pandemic. Globally, there have been over 4 million 600,000 COVID-19 cases reported, and over 300,000 patients have passed away. Many of the pre-existing diseases that are impacted by long-term exposure to air pollution are also those that raise the risk of infection and mortality in individuals with COVID-19. Under the locking conditions, the current study investigates this correlation at the national Moroccan level. TROPOMI data from the Sentinel-5P satellite is utilized to map the distribution of NO2 in the troposphere. According to the findings, three administrative regions with the highest tropospheric NO2 concentrations harbored 60% of the COVID-19 infected cases. When viewed within the global context, these findings suggest that prolonged exposure to this contaminant may play a role in the infection, death, and dissemination of the COVID-19 virus.

Understanding COVID-19 vaccination decisions during pregnancy and while breastfeeding in a Canadian province

ABSTRACTBackgroundVaccination in pregnancy is important for preventing illness for mothers and babies; however, vaccine uptake in pregnant individuals is lower than non-pregnant females of fertile age. Given the devastating effects of COVID-19 and the increased morbidity and mortality risk for pregnant individuals, it is important to understand the determinants of vaccine hesitancy in pregnancy. The focus of our study was to explore COVID-19 vaccination among pregnant and breastfeeding individuals and its association with their reasons (psychological factors) for vaccination using the 5C scale and other factors.MethodsAn online survey investigating prior vaccinations, level of trust in healthcare providers, demographic information, and the 5C scale was used for, pregnant and breastfeeding individuals in a Canadian province.ResultsPrior vaccinations, higher levels of trust in medical professionals, education, confidence, and collective responsibility predicted increased vaccine uptake pregnant and breastfeeding individuals.ConclusionsThere are specific psychological and socio-demographic determinants that affect COVID-19 vaccine uptake in pregnant populations. Implications of these findings include targeting these determinants when informing and developing intervention and educational programs for both pregnant and breastfeeding individuals, as well as healthcare professionals who are making vaccine recommendations to patients. Study limitations include a small sample and lack of ethnic and socioeconomic diversity.

Фактори несприятливого прогнозу в жінок із високим ризиком гострої тромбоемболії легеневої артерії

The aim – to determine the risk factors of an unfavorable prognosis in patients with pulmonary embolism (PE) depending on gender.Materials and methods. A retrospective analysis of the data of 635 patients with a verified diagnosis of PE according to multispiral computed tomographic angiography (MSCT-angiography) of pulmonary vessels and/or according to autopsy results, who were consecutively hospitalized at Kharkiv City Clinical Hospital No. 8 for the period from January 1, 2017 to January 1, 2023. Patients were divided into two groups: IA group included patients with high-risk acute PE who were discharged from the hospital, IВ group – patients with high-risk acute PE who died during the hospital period. Clinical and anamnestic, laboratory and instrumental indicators were analyzed, statistical processing of data depending on gender was carried out.Results and discussion. When analyzing the obtained data, it was established that in the group of deceased patients with a high risk there was probably a higher proportion of women (72 % at p=0.014). Deceased males had more severe clinical manifestations than deceased females, as evidenced by significantly lower SpO2 values (p=0.022) and larger right ventricular dimensions on echocardiography (p=0.036). In turn, such a risk factor of PE as obesity was more common in women than in men (61.1 % vs. 28.6 % at p=0.039). In order to determine independent factors associated with in-hospital mortality in high-risk PE patients in women, we conducted uni- and multifactorial logistic regression analysis of the influence of the studied factors. Since the small number of deceased men in the sample (n=14) does not allow us to draw reasonable conclusions, the analysis of factors affecting mortality is given only for the group of women. Factors associated with in-hospital death were the presence of arterial hypertension in the anamnesis (p=0.043), a decrease in systolic blood pressure (p=0.0003) in the acute period, and the localization of a thrombus at the bifurcation of the pulmonary arteries (p=0.012). After performing the regression analysis, we derived a formula for individual prediction of the risk of in-hospital death for gender with high-risk PE. Using the ROC analysis, it was established that the sensitivity of the obtained prognostic formula is 75.0 %; specificity – 83.9 (area under the ROC curve 0.867; 95 % confidence interval 0.762–0.938, p&lt;0.0001). The formula developed by us includes available general clinical indicators and allows specifying the individual risk of in-hospital mortality for female patients with high-risk PE.Conclusions. The results of a comparative analysis of two subgroups of patients with high-risk PE who died, depending on gender, showed that men were more likely to have lower SpO2 values and larger right ventricular sizes according to echocardiography. In turn, such risk factors as obesity were more common in women than in men. According to multivariate logistic regression analysis, additional independent factors that are associated with the development of death during the hospital period in women with high-risk PE are the presence of arterial hypertension in the anamnesis, a decrease in systolic blood pressure in the acute period, and the localization of a thrombus at the bifurcation of the pulmonary arteriesof. Proposed formula, according to which Y&gt;0.5 establishes an additional high risk of in-hospital death in women with high-risk PE.

Adherence to Plant-Based Diets and Risk of CKD Progression and All-Cause Mortality: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study

Studies have shown that generally healthy individuals who consume diets rich in plant foods have a lower risk of incident chronic kidney disease (CKD) and cardiovascular disease. This study investigated the prospective associations of plant-based diets with the risk of CKD progression and all-cause mortality in individuals with CKD. Prospective cohort study. 2,539 participants with CKD recruited between 2003-2008 into the Chronic Renal Insufficiency Cohort (CRIC) Study. Responses on the Diet History Questionnaire were used to calculate scores for the overall plant-based diet index, healthy plant-based diet index, and unhealthy plant-based diet index. (1) CKD progression defined as≥50% estimated glomerular filtration rate decline from baseline or kidney replacement therapy (dialysis, transplant) and (2) all-cause mortality. Cox proportional hazards models to compute hazard ratios and 95% confidence intervals adjusting for lifestyle, socioeconomic, and clinical covariates. There were 977 CKD progression events and 836 deaths during a median follow-up period of 7 and 12 years, respectively. Participants with the highest versus lowest adherence to overall plant-based diets and healthy plant-based diets had 26% (HR, 0.74 [95% CI, 0.62-0.88], P trend<0.001) and 21% (HR, 0.79 [95% CI, 0.66-0.95], P trend=0.03) lower risks of all-cause mortality, respectively. Each 10-point higher score of unhealthy plant-based diets was modestly associated with a higher risk of CKD progression (HR, 1.14 [95% CI, 1.03-1.25) and all-cause mortality (HR, 1.11 [95% CI, 1.00-1.23). Self-reported diet may be subject to measurement error. Adherence to an overall plant-based diet and a healthy plant-based diet is associated with a reduced risk of all-cause mortality among individuals with CKD. An unhealthy plant-based was associated with an elevated risk of CKD progression and all-cause mortality. Plant-based diets are healthful dietary patterns that have been linked to a lower risk of chronic diseases. However, the impact of plant-based diets on clinical outcomes in patients with chronic kidney disease (CKD) is not well established. In 2,539 individuals with CKD, we examined the associations of adherence to 3 different types of plant-based diets with the risks of CKD progression and all-cause mortality. We found that following an overall plant-based diet and a healthy plant-based diet was associated with a lower risk of all-cause mortality. By contrast, following an unhealthy plant-based diet was associated with a higher risk of CKD progression and all-cause mortality. These results suggest that the quality of plant-based diets may be important for CKD management.