Multivariate-adjusted Logistic Regression Analysis Research Articles

Primary Care Quality Improvement Through Patient-Centered Medical Homes and the Impact on Emergency Department Utilization for Children With Autism and Mental Health Disorders.

To address health care spending growth, coordinated care, and patient-centered primary care, most states in the United States have adopted value-based care coordination programs such as patient-centered medical homes (PCMHs). The objective of this study was to understand the relationship between having access to PCMHs and emergency department (ED) utilization for high cost/need children with autism and children with mental health disorders (MHDs). This cross-sectional study included 87 723 children between ages 3 and 17 years in the 2016-2018 National Survey for Children's Health. Multivariate-adjusted logistic regression analyses were used to assess the association between ED and PCMH utilization for children with autism, with MHDs without autism, and others without autism or MHDs. Marginal predictions were used to examine whether PCMH utilization was moderated by health conditions. The results showed that children with a PCMH had a 16% reduction in the odds to visit the ED (adjusted odds ratio [aOR] = 0.84; confidence interval [CI], 0.77-0.92; P < .001). When compared with the reference group of children without autism and without MHDs, children with MHDs but without autism had 93% higher odds to visit the ED (aOR = 1.93; CI, 1.75-2.13; P < .001) and children with autism had 35% higher odds to visit the ED (aOR = 1.35; CI, 1.04-1.75; P = .023). Marginal effects results suggested that PCMHs reduced the odds of ED visits the most for children with MHDs without autism and reduced the predicted ED visits from 30.1% to 23.7% (P < .001). Primary care quality improvement through access to a PCMH reduced ED visits for children, but the effect varied by autism and MHD conditions. Future PCMH efforts should continue to support children with autism and address unmet needs for children with MHDs with a focus on needed care coordination, family-centered care, and referrals.

The Inflammation-Fibrosis Combined Index: A Novel Marker for Predicting Left Ventricular Reverse Remodeling and Prognosis in Patients with HFrEF.

Inflammation and cardiac fibrosis are important pathogenic drivers of heart failure. The fibrosis-4 index (FIB-4) is associated with a higher degree of fibrosis. The systemic immune inflammation index (SII) is associated with a higher degree of systemic inflammation status. Previous studies have shown that they are associated with a poor prognosis for cardiovascular disease. We sought to investigate the value of FIB-4 combined with the SII as a novel inflammation-fibrosis combined index (IFCI) in predicting left ventricular reverse remodeling (LVRR) and prognosis among reduced ejection fraction heart failure (HFrEF) patients. A total of 895 patients with HFrEF were continuously recruited. Receiver operating characteristic curves were drawn to assess the abilities of inflammation-fibrosis indicators to predict LVRR. Multivariable Cox regression analysis was used to examine independent predictors of composite cardiac events and all-cause death. After six months of follow-up, 344 (38.4%) patients experienced LVRR. The IFCI had the largest area under the curve (0.835, P < 0.001). In multivariate-adjusted logistic regression analyses, FIB-4, SII, and IFCI were predictive of LVRR (P value < 0.05). The IFCI was associated with a 3.686-fold higher risk of non-LVRR (odds ratio [OR] = 3.686, P < 0.001). Moreover, an increased IFCI predicted a poor prognosis in HFrEF patients. The highest risk of composite cardiac events (hazard ratio [HR] = 2.716, P < 0.001) was observed in the top IFCI-tertile group, and similar results were found regarding independent risk indicators of all-cause death. In summary, this study indicated that increased IFCI at admission offers good predictability regarding non-LVRR and predicts the risk of all-cause mortality or composite cardiovascular events due to HFrEF patients and could be used as a novel marker.

Association of pulse pressure and mean blood pressure to frailty, sarcopenia, and cognitive dysfunction in elderly outpatients with history of hypertension.

This study aimed to evaluate the relationship between pulse pressure (PP) and sarcopenia, frailty, and cognitive function in elderly patients with hypertension. We evaluated 435 elderly patients with a history of hypertension who visited the frail outpatient clinic between July 2015 and October 2021. Data at the 1-, 2-, and 3-year follow-ups were available for 222, 177, and 164 patients, respectively. Sarcopenia, frailty, and cognitive function, including Mini-Mental State Examination (MMSE) scores, were evaluated. The patients' mean age was 79.2 ± 6.3 years (male, 34.9%). PP and mean blood pressure (BP) were 60.1 ± 13.6 mmHg and 94.1 ± 13.0 mmHg, respectively. At baseline, lower PP was associated with probable dementia (MMSE score ≤23 points) (OR = 0.960 per 1 mmHg increase; 95% CI, 0.933-0.989; P = 0.006) in the model adjusted for conventional confounding factors and comorbidities, whereas higher PP was associated with low handgrip strength (OR = 1.018 per 1 mmHg increase; 95% CI, 1.001-1.036; P = 0.041). In multivariate-adjusted logistic regression analysis of patients with preserved handgrip strength at baseline, reductions in PP (OR = 0.844; 95% CI, 0.731-0.974; P = 0.020) and mean BP (OR = 0.861; 95% CI, 0.758-0.979; P = 0.022) were significantly associated with the incidence of low handgrip strength at 3 years. In conclusion, a higher PP induced by increased arterial stiffness was associated with lower handgrip strength, whereas a lower PP was associated with probable dementia. Reduced PP was associated with decreased handgrip strength after three years.

Increased levels of circulating endostatin are linked to orthostatic hypotension

Abstract Background Orthostatic hypotension (OH) occurs when blood pressure regulation fails. The underlying molecular mechanism of OH remain largely unexplored. Endostatin is a biologically active molecule cleaved by matrix metalloproteinases, elastases and cathepsins from collagen XVIII in the extracellular matrix and inhibits angiogenesis. Circulating levels of endostatin have been proposed to be involved in blood pressure (BP) regulation, by inducing nitric oxide release. To date, the relationship between endostatin and OH have not been examined. Purpose We aimed to investigate circulating levels of endostatin in patients with verified OH by tilt test at a tertiary syncope unit compared with healthy age- and sex-matched controls from the same geographical region. Methods We performed an age- and sex-matched case-control study in 150 patients with OH verified by positive head-up tilt-testing and other cardiovascular autonomic tests at a tertiary syncope unit, and 150 healthy controls with negative active standing tests and no history of syncope, orthostatic intolerance, and endocrine disease. High-sensitivity chemiluminescence sandwich immunoassay was used to measure circulating levels of endostatin in a blinded fashion. Receiver operating characteristic curves were constructed to analyze the discriminative ability of endostatin in OH compared with healthy controls. Multivariate logistic regression was used to assess the association between endostatin, OH and hemodynamic variables adjusting for age and sex. Results Study characteristics are displayed in the Table. Patients with OH had significantly higher absolute levels of circulating endostatin compared with healthy controls (59,024 ± 2513 vs. 44,090 ± 1978 pg/mL, p&amp;lt;0.001). Multivariate-adjusted logistic regression analysis controlling for age, sex, minimum systolic and minimum diastolic BP during tilt, identified endostatin as an independent determinant for OH (beta-coefficient 0.80, p=0.025). The obtained area under the curve was 0.70, P&amp;lt;0.001, Figure). Conclusions Our findings indicate that patients with orthostatic hypotension have increased circulating levels of endostatin, independent of age, sex, and hemodynamic variables. Our results highlight the relevance of investigating the molecular pathways related to orthostatic hypotension. Further studies are warranted to assess the prognostic and therapeutic role of endostatin assessment in individuals with orthostatic hypotension.Tablestudy characteristicsFigureROC Curve

Poorer outcomes following COVID-19 infection for patients with depression: A cohort analysis in South Korea.

It remains unknown whether patients with pre-existing depressive conditions are at high risk of severe COVID-19. Therefore, this study aims to investigate the association between patients with pre-existing depressive conditions and severe COVID-19. This study is part of the Korea Disease Control and Prevention Agency-COVID19-National Health Insurance Service cohort study of an ongoing large-scale health screening survey of adults 18 years and older residing in South Korea. Pre-existing depression status was measured from 552,860 patients who participated in a biennial health screening from 2019 to 2020. Finally, 29,106 confirmed COVID-19 patients were enrolled and followed up to track any severe clinical events within 1 month of their diagnosis date. Adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated using multivariate-adjusted logistic regression analysis. We identified 2868 COVID-19 patients with severe clinical events and 26,238 COVID-19 patients without severe clinical events. The moderate-to-severe depressive symptoms group showed an elevated odds of severe outcomes of COVID-19 (aOR, 1.46; 95% CI, 1.25-1.72), including those without vaccination (aOR, 1.32; 95% CI, 1.08-1.61) and those with complete vaccination (aOR, 1.76; 95% CI, 1.18-2.63). In addition, those who were diagnosed with depression along with depressive symptoms at the health screening revealed an increased risk of severe outcomes of COVID-19 (aOR, 2.22; 95% CI, 1.22-4.05). Moderate-to-severe depressive symptoms were associated with higher odds of severe COVID-19 events in both no and complete vaccination groups. Participants with depressive symptoms may be at higher risk of severe outcomes of COVID-19.

Differences in self-reported psychotic symptoms between patients with autism spectrum disorder and those with schizophrenia.

Patients with autism spectrum disorder (ASD) are prone to develop overt psychosis and share symptom presentations with those with schizophrenia (SZ). This study aimed to explore differences in the distributions of psychotic symptoms among first-visit patients with ASD, SZ, or a nonpsychiatric diagnosis (N-PD). Data from first-visit patients were retrospectively collected from medical records from the Department of Psychiatry, Dokkyo Medical University Hospital between June 2019 and May 2021. A total of 254 patients with data on the PRIME Screen-Revised (PS-R) assessments were included in our analysis. In the hospital, all psychiatric diagnoses were based on the DSM-5 diagnostic criteria. In the ASD, SZ, and N-PD groups, endorsements of perplexity and delusional mood were 15.6% (7/45), 41.5% (44/106), and 1.1% (1/88), and those of perceptual abnormalities were 11.1% (5/45), 40.6% (43/106), and 2.3% (2/88), respectively. Trend analysis clarified that the endorsement of these psychotic symptoms increased from N-PD to ASD and SZ. In the multivariate-adjusted multinomial logistic regression analysis, the ASD and N-PD groups were compared with the SZ group. Higher age and the presence of perceptual abnormalities were associated with lack of an ASD diagnosis, whereas male sex, lack of perplexity and delusional mood, and lack of perceptual abnormalities were associated with N-PD. Our results are preliminary; however, a detailed assessment of positive symptoms might facilitate differentiation between ASD and SZ.

975-P: Clinical and Lifestyle Determinants of Continuous Glucose Monitoring Metrics in Insulin-Treated Patients with Type 2 Diabetes

Objective: There was limited evidence to evaluate the association between lifestyle habits and continuous glucose monitoring (CGM) metrics. Thus, we aimed to depict the behavioral and metabolic determinants of CGM metrics in insulin-treated patients with type 2 diabetes (T2DM). Methods: This is a prospective observational study. We analyzed data from 122 insulin-treated patients with T2DM. Participants wore Dexcom G6 and Fitbit, and diet information was identified for 10 days. Multivariate-adjusted logistic regression analysis was performed for the simultaneous achievement of CGM-based targets, defined by the percentage of time in terms of hyper, hypoglycemia and glycemic variability (GV). Intake of macronutrients and fiber, step counts, sleep, postprandial C-peptide to glucose ratio (PCGR), information about glucose-lowering medications and metabolic factors were added to the analyses. Additionally, we evaluated the impact of the distribution of energy and macronutrient during a day, and snack consumption on CGM metrics. Results: Logistic regression analysis revealed that female, participants with high PCGR, low HbA1c and daytime step count had a higher probability of achieving all targets based on CGM (odds ratios [95% confidence intervals] which were 0.24 [0.09–0.65], 0.95 [0.9–0.99], 1.34 [1.03–1.25], and 1.15 [1.03–1.29], respectively). And participants who ate snacks showed a shorter period of hyperglycemia and less GV compared to those without. Conclusions: We confirmed that residual insulin secretion, daytime step count, HbA1c, and women were the most relevant determinants of adequate glycemic control in insulin-treated patients with T2DM. In addition, individuals with snack consumption were exposed to lower times of hyperglycemia and GV. Disclosure D.Lee: None. N.Kim: None. I.Jung: None. S.Park: None. J.Yu: None. J.Seo: None. S.Park: None. N.Kim: None. Funding National Research Foundation of Korea (2019M3E5D3073102, 2019R1H1A2039682, 2020R1I1A1A01071665); National IT Industry Promotion Agency (S0252-21-1001)

Lifestyle factors and the risk of gallstones: results from the national health and nutrition examination survey 2018–2020 and mendelian randomization analysis

Objectives This study aimed to investigate the relationship between lifestyle and gallstones. Materials and Methods We performed an observational study using the 2018–2020 National Health and Nutrition Examination Survey (NHANES). Univariate and multivariate-adjusted logistic regression analyses were performed to assess the correlations between lifestyle factors and gallstone risk. Second, Mendelian randomization (MR) was applied to decrease the causal relationship between lifestyle factors and gallstones. Results This observational study enrolled 11,970 individuals. The risk of gallstones was found to increase with increased sitting time (odds ratio (OR) 1.03, 95% CI 1.00–1.05, p = 0.02). In contrast, the risk of gallstones was found to decrease with recreational activity (OR 0.50, 95% CI 0.29–0.87, p = 0.02). The results of the MR also showed that time spent watching television (OR 1.646; 95% CI 1.161–2.333, p = 0.005) and physical activity (OR 0.953, 95% CI 0.924–0.988, p = 0.003) remained independently causally associated with gallstones. Conclusions Prolonged sitting increases the risk of gallstones, whereas recreational activity reduces the risk. These findings need to be verified in further prospective cohort studies with larger sample sizes and longer follow-up periods.

U-shaped association between serum IGF2BP3 and T2DM: A cross-sectional study in Chinese population.

To clarify the expression of N6-methyladenosine (m6 A) modulators involved in the pathogenesis of type 2 diabetes mellitus (T2DM). We further explored the association of serum insulin-like growth factor 2 mRNA-binding proteins 3 (IGF2BP3) levels and odds of T2DM in a high-risk population. The gene expression data set GSE25724 was obtained from the Gene Expression Omnibus, and a cluster heatmap was generated by using the R package ComplexHeatmap. Differential expression analysis for 13 m6 A RNA methylation regulators between nondiabetic controls and T2DM subjects was performed using an unpaired t test. A cross-sectional design, including 393 subjects (131 patients with newly diagnosed T2DM, 131 age- and sex-matched subjects with prediabetes, and 131 healthy controls), was carried out. The associations between serum IGF2BP3 concentrations and T2DM were modeled by restricted cubic spline and logistic regression models. Two upregulated (IGF2BP2 and IGF2BP3) and 5 downregulated (methyltransferase-like 3 [METTL3], alkylation repair homolog protein 1 [ALKBH1], YTH domain family 2 [YTHDF2], YTHDF3, and heterogeneous nuclear ribonucleoprotein [HNRNPC]) m6 A-related genes were found in islet samples of T2DM patients. A U-shaped association existed between serum IGF2BP3 levels and odds of T2DM according to cubic natural spline analysis models, after adjustment for body mass index, waist circumference, diastolic blood pressure, total cholesterol, and triglyeride. Multivariate logistic regression showed that progressively higher odds of T2DM were observed when serum IGF2BP3 levels were below 0.62 ng/mL (odds ratio 3.03 [95% confidence interval 1.23-7.47]) in model 4. Seven significantly altered m6 A RNA methylation genes were identified in T2DM. There was a U-shaped association between serum IGF2BP3 levels and odds of T2DM in the general Chinese adult population. This study provides important evidence for further examination of the role of m6 A RNA methylation, especially serum IGF2BP3 in T2DM risk assessment.

PS-P01-9: RELATIONSHIP BETWEEN BLOOD PRESSURE AND FRAILTY IN ELDERLY PATIENTS WITH ANY CARDIOMETABOLIC RISK FACTORS

Background: High blood pressure in mid-life was associated with frailty in elderly patients; however, frail patients have reduced quality of life (QOL) causing blood pressure decline. We thought to evaluated relationship between the blood pressure and frailty. Methods: We registered 691 elderly patients who had any cardiometabolic risk factors (hypertension, diabetes, dyslipidemia, atrial fibrillation, and heart failure) between Sep. 2015 and April 2022, and follow up for 1 year (N = 363). Clinic blood pressure (CBP) was taken twice in a seated position, using semi-automatic upper arm device, without doctors or nurses present. Frailty was evaluated using modified Japanese Cardiovascular Health Study score (J-CHS) that included appendicular skeletal muscle index, hand grip strength, and walk speed, and Kihon check list (KCL) that included QOL associated with frailty. Results: Mean age was 79.2 ± 6.3 years (male 35.6%). There were 30.4 % of patients with frailty by J-CHS criteria and 38.0 % by KCL criteria. In the multivariate-adjusted logistic regression analysis, frailty by J-CHS criteria was significantly associated with lower clinic DBP (OR = 0.901 per 5 mmHg increase, 95%CI, 0.829–0.978, P = 0.013); frailty by KCL criteria was with lower clinic SBP (OR = 0.843 per 10 mmHg increase, 95%CI 0.761–0.933, P = 0.001). In patients with antihypertensive medication, frailty with KCL was associated with clinic SBP (OR = 0.815 per 10 mmHg increase, 95%CI 0.703–0.944, P = 0.006). In frail patients by J-CHS criteria at baseline, low clinic DBP at baseline (OR = 0.937 per 1 mmHg increase, 95%CI 0.883–0.994, P = 0.031) and change in clinic DBP (OR = 0.921 per 1 mmHg change, 95%CI 0.861–0.986, P = 0.018) were associated with sustained frailty at 1 year later. In patients with preserved walk speed (&gt; 1.0m/sec) at baseline, change in clinic DBP was associated with development of reduced walk speed (&lt; 1.0m/s) at 1 year later (OR = 0.945, 95%CI 0.893–0.999, P = 0.046). Conclusion: Frailty was associated with lower clinic systolic or diastolic blood pressure, and change in clinic DBP in elderly patients with cardiometabolic risk factors.

Higher Neutrophil to Lymphocyte Ratio at Admission is Association with Post-PCI Depressive Symptoms in Patients with ACS.

Depression and elevated blood biomarkers of inflammation are common in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Neutrophil to lymphocyte ratio (NLR) is an indicator of peripheral inflammation and has been proved to be associated with both ACS and depression. Our aim was to evaluate the possible association between NLR at admission and post-PCI depressive symptoms at 1 month. A total of 224 patients with ACS who underwent PCI for the first time were recruited and completed 1-month follow-up. The 24-item Hamilton Depression Scale (HAMD-24) was used to measure depressive symptoms at 1 month after PCI. Logistic regression was used to analyze the relationship between different NLR levels and post-PCI depressive symptoms. A receiveroperatingcharacteristic(ROC)curveanalysiswasperformedtoassessthevalue of NLR for predicting post-PCI depressive symptoms and to determine its critical value. Of the 224 enrolled patients, 52 (23.2%) patients were diagnosed with depressive symptoms at 1 month after PCI. Patients with depressive symptoms showed significantly higher level of NLR at admission than patients without depressive symptoms (4.33 (3.26, 7.01) vs 2.57 (1.72, 3.91), P < 0.001). The proportion of depressive symptoms in post-PCI patients increases progressively along with NLR quartile. In the results of multivariate-adjusted logistic regression analysis, the odds ratio (OR) of post-PCI depressive symptoms was 12.028 (95% CI, 2.642-54.752) for the lowest quartile of NLR compared with the highest quartile. According to the receiver operating characteristic curve (ROC), the area under the curve (AUC) for predicting post-PCI depressive symptoms was 0.716 (95% CI, 0.641-0.791; P < 0.001), and the optimal cutoff of NLR levels was 3.235 (sensitivity: 76.9%, specificity: 66.9%). Higher NLR levels at admission were associated with post-PCI depressive symptoms at 1 month, suggesting that NLR might be useful inflammatory markers to predict post-PCI depressive symptoms at 1 month.

Effect of vitamin D deficiency on metabolic syndrome among Korean shift workers.

This study aimed to investigate the effect of vitamin D deficiency on metabolic syndrome among shift workers. This study included 207 756 workers who underwent a comprehensive health examination at a large South Korean university hospital between 2012 and 2018. We performed multivariate-adjusted logistic regression analysis and analyzed mediation and exposure-mediator interaction. Overall, 5.5% of the participants had metabolic syndrome. Compared to day work, the odds ratios (OR) of metabolic syndrome and vitamin D deficiency (<12 ng/mL) for shift work were 1.14 [95% confidence interval (CI) 1.06-1.22] and 1.63 (95% CI 1.57-1.70), respectively. Among shift workers, the OR of metabolic syndrome for vitamin D levels of 12-20 and <12 ng/mL, compared with a level of ≥20 ng/mL, were 1.36 (95% CI 1.15-1.61) and 1.51 (95% CI 1.26-1.81), respectively. Shift work and vitamin D deficiency showed an additive interaction; the relative excess risks due to interaction, attributable proportion, and synergy index were 0.26 (95% CI 0.08-0.44), 0.17 (95% CI 0.07-0.28), and 2.09 (95% CI 1.23-3.55), respectively. When vitamin D deficiency was treated as a mediator, the direct and total effects of shift work on metabolic syndrome were 1.12 (95% CI 1.04-1.22) and 1.15 (95% CI 1.07-1.25), respectively. The indirect effect was 1.03 (95% CI 1.02-1.04) and accounted for 18% of the total effect. Vitamin D is a potential mediator of the impact of shift work on metabolic risk factors.

ODP612 Inverse Association Between Healthy Diet Status and Non-Alcoholic Fatty Liver Disease Among Patients With Diabetes Mellitus

Abstract Objective Aimed to investigate the associations between healthy diet status and non-alcoholic fatty liver disease (NAFLD) among patients with diabetes mellitus. Methods This study enrolled 2,404 participants (1,504 males and 900 females; mean age 50.18 ± 12. 06). Healthy diet status was defined based on the number of healthy diet scores and classified into three categories. Multivariate-adjusted logistic regression analyses were performed to explore the association between healthy diet status and NAFLD, presented by odds ratio (OR) with 95% confidence intervals (CI). Results Participants with the most healthy diet had a lower odds of NAFLD than those with the least healthy diet (OR: 0.66, 95% CI: 0.50,0.88, P = 0. 004), no significant interactions were showed between healthy diet status and strata (gender, age, diabetes duration, metabolic status). Linear regression analyses showed the most healthy diet was negatively associated with FLI (β: -4.70, 95% CI: -7.61, -1.79, P = 0. 002). Conclusions The most healthy diet was independently and inversely associated with NAFLD prevalence and FLI among Chinese patients with diabetes mellitus. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Low muscle mass is linked with presence of non-alcoholic fatty liver disease irrespective to central obesity: highlights from a prospective epidemiological study in Greece

Abstract Background/Introduction The association between sarcopenia and nonalcoholic fatty liver (NAFL) is highlighted in recent epidemiological studies, although results remain inconsistent. Purpose This study aimed to examine the association of low skeletal muscle mass with NAFL as well as the potential mediating effect of waist circumference on the examined association. Methods At baseline, 3,042 participants from the Attica region of Greece were recruited. NAFL was assessed through hepatic steatosis index (HSI). Skeletal muscle mass index (SMI) was indirectly calculated using a standard validated procedure. Results Ranking from 1st to 3rd SMI tertiles NAFL rate was 45%, 33% and 22%, respectively (p&amp;lt;0.001). Multi-adjusted logistic regression analysis revealed that participants assigned in the 2nd (Odds Ratio (OR): 0.50, 95% Confidence Interval (95% CI): 0.41–0.61)) and 3rd SMI tertile had 50% and 76% (OR: 0.24, 95% CI: 0.19–0.29) lower likelihood to have NAFL compared with their 1st tertile counterparts. This association remained robust after multiple adjustments; however, significance was marginally lost, when waist circumference was added to the model. Subsequently, a multi-adjusted dose-response analysis between SMI and NAFL was performed in the total sample, as well as in the subcategories of normal and abnormal waist circumference. In the total sample, a significant inverse association between SMI and NAFL was observed [OR (per 2 points increase in SMI) = 0.94 (95% CI: 0.92–0.95); p=0.001]. When categorized by waist circumference, participants with moderate/high SMI and normal waist circumference had the lowest NAFL rates (24.3%). Those with low SMI and normal waist circumference and those with moderate/high SMI and abnormal waist circumference had similar rates of NAFL (47.4% and 50.3%, respectively; p=0.25). Participants with both low SMI and abnormal waist circumference presented the highest NAFL rate (60.5%), which was significantly higher compared with the rest subgroups (p&amp;lt;0.001). These findings were confirmed in multi-adjusted analysis to assess NAFL odds per case: participants with adnormal waist, [OR (per 2 points increase in SMI) = 0.97 (95% CI: 0.94–1.00)] vs. participants with normal waist [OR (per 2 points increase in SMI) = 0.89 (95% CI: 0.84–0.95)]. Conclusions Increasing SMI was associated with lower rates of NAFL independently to abdominal obesity, whereas the two interact as key determinants of NAFL. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Hellenic Society of Cardiology

Reduced serum vitamin D levels are associated with poor sleep quality in early stroke patients.

BackgroundPoor sleep quality and vitamin D deficiency are common in stroke patients. Our aim was to evaluate the possible association between vitamin D and sleep quality in acute ischemic stroke (AIS) patients.MethodsA total of 301 AIS patients were screened and completed 1-month follow-up. Serum 25-hydroxyvitamin D [25(OH)D] was used to assess the vitamin D status by a competitive protein-binding assay at baseline. All patients were divided into equal quartile according to the distribution of 25(OH)D. One month after stroke, sleep quality was evaluated by using Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) questionnaire; depression status was confirmed by 17-item Hamilton Depression Scale (HAMD).ResultsThere were 89 (29.6%) AIS patients with poor sleep quality 1-month post-event. Within 24 h after admission, serum 25(OH)D levels were significantly lower in patients with poor sleep quality after stroke (P < 0.001). In the results of multivariate-adjusted logistic regression analysis, the odds ratio (OR) of poor sleep quality was 6.199 (95% CI, 2.066–18.600) for the lowest quartile of 25(OH)D compared with the highest quartile. In patients without depression, reduced 25(OH)D were still significantly associated with poor sleep quality (OR = 8.174, 95% CI = 2.432–27.473). Furthermore, 25(OH)D and HAMD score were combined to enhance the diagnostic accuracy of poor sleep quality, with the area under the receiver operating characteristic curve of 0.775.ConclusionReduced serum levels of vitamin D at admission were independently and significantly associated with poor sleep quality at 1 month after stroke. Our findings suggested the combination of vitamin D and depression status could provide important predictive information for post-stroke sleep quality.

MP14-05 URETEROSCOPY UNDER CONSCIOUS SEDATION FOR UPPER TRACT PATHOLOGY

You have accessJournal of UrologyCME1 May 2022MP14-05 URETEROSCOPY UNDER CONSCIOUS SEDATION FOR UPPER TRACT PATHOLOGY Kunal Jain, Esha Jain, Ruben Blachman-Braun, Amanda Eng, Brian Peters, and Premal Patel Kunal JainKunal Jain More articles by this author , Esha JainEsha Jain More articles by this author , Ruben Blachman-BraunRuben Blachman-Braun More articles by this author , Amanda EngAmanda Eng More articles by this author , Brian PetersBrian Peters More articles by this author , and Premal PatelPremal Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002543.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteroscopies are commonly performed under general anesthesia to maximize patient tolerability and minimize surgical complications. However, given the improvements in endoscopic technology and risks associated with general anesthesia, alternate forms of anesthesia have been postulated. We aimed to evaluate the outcomes of ureteroscopy for the entire upper urinary tract under conscious sedation. METHODS: We completed a retrospective cohort study from November 2019 to June 2020 at a tertiary-level hospital. All ureteroscopies that were performed with physician-directed, nursing-administered intravenous sedation were included. Our primary outcome was success rate. Secondary outcomes included: stone-free rate, intra-operative complication rate, hospital admission rate, and sedation requirement. Univariate- and multivariate-adjusted logistic regression analyses were employed. RESULTS: In total, 99 ureteroscopies were included: 73 (73.7%) for urolithiasis, 24 (24.2%) for urothelial carcinoma, and 2 (2.0%) for ureteric obstruction. The overall success rate was 83.8% (83/99). The stone-free rate was 80.8% (59/73). No intra-operative complications, nor hospital admissions, were reported. The mean amount of sedation required was 3 [interquartile range: 2–4] mg of midazolam and 100 [100–150] μg of fentanyl. On multivariate analysis, midazolam was significantly associated with increased success [odds ratio: 2.496, 95% confidence interval: 1.057–5.892; p=0.037]. CONCLUSIONS: For the first time in literature, we have shown that ureteroscopy under conscious sedation is safe and effective when evaluating upper tract pathology. We were limited by our small sample size, selection bias to chose healthy patients, and lack of patient tolerability data. Patient selection is paramount when identifying appropriate candidates for this approach. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e233 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kunal Jain More articles by this author Esha Jain More articles by this author Ruben Blachman-Braun More articles by this author Amanda Eng More articles by this author Brian Peters More articles by this author Premal Patel More articles by this author Expand All Advertisement PDF DownloadLoading ...

Ureteroscopy under conscious sedation: A proof-of-concept study.

Ureteroscopy (URS) is commonly performed under general anesthesia (GA) to maximize patient tolerability and minimize surgical complications; however, given the improvements in endoscopic technology and risks associated with GA, alternate forms of anesthesia have been postulated. We aimed to evaluate the outcomes of URS under conscious sedation. We completed a retrospective cohort study from November 2019 to June 2020 at a tertiary-level hospital. All URSs that were performed under urologist-directed conscious sedation were included. Our primary outcome was the ability to complete URS, defined as success rate. Secondary outcomes included: stone-free rate, intraoperative complication rate, hospital admission rate, and sedation requirement. Univariate- and multivariate-adjusted logistic regression analyses were employed. Ninety-nine URSs were included. Most (73/99, 73.7%) were performed for urolithiasis. The overall success rate was 83.8% (83/99), with 81.0% (34/42) intra-renal and 70.0% (16/23) proximal ureter success rates. The stone-free rate was 80.8% (59/73). No intraoperative complications nor hospital admissions were reported. The mean amount of sedation required was 3 mg (interquartile range [IQR] 2-4] of midazolam and 100 μg (100-150) of fentanyl. On multivariate analysis, midazolam was significantly associated with increased success (odds ratio 2.496, 95% confidence interval 1.057-5.892, p=0.037). We have shown that proximal and intrarenal URS under conscious sedation is safe and effective. We were limited by our lack of followup, small sample size, selection bias to chose healthy patients, and lack of patient tolerability data. Patients and healthcare systems may benefit from implementing this innovation more broadly.

Implications of Malnutrition on Contrast-Associated Acute Kidney Injury in Young and Old Patients Undergoing Percutaneous Coronary Intervention: A Multicenter Prospective Cohort.

BackgroundThe relationship between malnutrition and the risk of contrast-associated acute kidney injury (CA-AKI) and the resulting prognosis in patients undergoing percutaneous coronary intervention (PCI) is still not well known.MethodsPatients undergoing PCI were consecutively enrolled in a multicenter study in China (NCT01402232), categorized by nutritional status (non-malnutrition, malnutrition) based on two different cut-off values (i.e., traditional threshold and the best cut-off value based on the receiver operating characteristic (ROC) curve) for the controlling nutritional status (CONUT) score. The primary endpoint was CA-AKI, diagnosed as a rise in serum creatinine >0.3 mg/dl or >50% than the baseline level occurring within 48 h after the intervention. The secondary endpoint was all-cause mortality. The relationships of malnutrition, CA-AKI, and all-cause mortality were examined using multivariate-adjusted logistic and Cox regression analyses, respectively.ResultsAmong 2,083 patients undergoing PCI (age: 62.8 ± 11.1 years; 79.0% men), 1,258 (60.4%) were malnourished. During hospitalization, 80 (3.8%) patients developed CA-AKI events. The incidence of CA-AKI in patients who did not have malnutrition (the non-malnutrition group) and those who did have malnutrition (the malnutrition group) was 1.7% and 5.25%, respectively. Patients with malnutrition had a 2-fold increased adjusted risk of CA-AKI compared to those with no malnutrition [adjusted odds ratio (aOR) (95% confidence interval CI): 2.41 (1.22 to 5.22)]. Malnutrition was associated with a 3-fold increased adjusted risk of CA-AKI in patients aged ≤ 75 years [N = 1,791, aOR (95% CI): 3.39 (1.46–9.25)]. Malnourished patients with CA-AKI had a higher risk of all-cause mortality than the others. Similar results were observed in the grouping of Supplemental Analyses based on the optimal cut-off value of the CONUT score identified by the ROC curve.ConclusionsMalnutrition is strongly associated with an increased risk of CA-AKI in both young and old patients undergoing PCI. Malnourished patients with CA-AKI had a significantly higher risk of all-cause mortality. Further studies are needed to prospectively assess the efficacy of nutritional interventions on outcomes in patients undergoing PCI.

National Trends of Mental Health Care Among US Adults Who Attempted Suicide in the Past 12 Months

Although suicide attempts remain the strongest risk factor for future suicide, little is known about recent trends in the prevalence of and risk factors for suicide attempts and past-year use of services among adults who attempted suicide. To estimate annual rates of suicide attempts and use of mental health services among US adults from 2008 to 2019. This US nationally representative cross-sectional study used the National Survey of Drug Use and Health (NSDUH) from 2008 through 2019. Participants included noninstitutionalized US civilians 18 years or older (n = 484 732). The overall annual rates of suicide attempts per 100 000 adults in the general population and national trends from 2008 to 2019 were estimated, with suicide attempts defined as self-reported efforts to kill one's self in the past 12 months. Subgroup analyses were also performed by demographic characteristics and clinical conditions. The trends in past-year use of mental health services among those who reported past-year suicide attempts were then examined. Data were analyzed from October to December 2021. Rate of suicide attempts from 2008 to 2019. Multivariate-adjusted logistic regression analyses were used to determine whether adjusting for sociodemographic and clinical factors associated with past-year suicide attempts could account for the change within the study period. Of 484 732 survey participants, most were 35 years or younger (69.8%), women (51.8%), and non-Hispanic White individuals (65.7%). From 2008 to 2019, the weighted unadjusted suicide attempt rate per 100 000 population increased from 481.2 to 563.9 (odds ratio [OR], 1.17 [95% CI, 1.01-1.36]; P = .04) and remained significant after controlling for sociodemographic characteristics (adjusted OR [aOR], 1.23 [95% CI, 1.05-1.44]; P = .01). Rates of suicide attempt increased particularly among young adults aged 18 to 25 years (aOR, 1.81 [95% CI, 1.52-2.16]; P < .001), women (aOR, 1.33 [95% CI, 1.09-1.62]; P = .005), those who were unemployed (aOR, 2.22 [95% CI, 1.58-3.12]; P < .001) or never married (aOR, 1.60 [95% CI, 1.31-1.96]; P < .001), and individuals who used substances (aOR, 1.44 [95% CI, 1.19-1.75]; P < .001). In multivariate analyses, the temporal trend of increasing suicide attempts remained significant even after controlling for other significant sociodemographic and clinical factors (aOR, 1.36 [95% CI, 1.16-1.60]; P < .001). Several sociodemographic and clinical subgroups remained independently associated with suicide attempts, especially those with serious psychological distress (aOR, 7.51 [95% CI, 6.49-8.68]; P < .001), major depressive episodes (aOR, 2.90 [95% CI, 2.57-3.27]; P < .001), and alcohol use disorder (aOR, 1.81 [95%CI, 1.61-2.04]; P< .001) as well as individuals who reported being divorced or separated (aOR, 1.65 [95% CI, 1.35-2.02]; P < .001) or being unemployed (aOR, 1.47 [95% CI, 1.27-1.70]; P< .001) and those who identified as Black (aOR, 1.41 [95% CI, 1.24-1.60]; P < .001) or American Indian or Alaska Native, Asian, or Native Hawaiian or Other Pacific Islander (aOR, 1.56 [95% CI, 1.26-1.93]; P < .001). Among adults with a suicide attempt, there was no significant change in the likelihood of receiving past-year mental health or substance-related services. During the study period, 34.8% to 45.5% reported needing services but did not receive them, with no significant change from 2008 to 2019. Although suicide attempts appear to be increasing, use of services among those who attempted suicide has not increased, suggesting a need to expand service accessibility and/or acceptability, as well as population-wide prevention efforts.

Association of Visceral Obesity-Related Indices With Coronary Collateralization in Patients With Chronic Total Occlusion.

Background: Obesity is an independent risk factor for cardiovascular disease. We investigated whether and to what extent visceral obesity-related indices were associated with coronary collateralization (CC) in chronic total occlusion (CTO) patients.Methods: This retrospective cohort study involved 1,008 consecutive patients with CTO who underwent CTO-percutaneous coronary artery intervention (PCI). CC was graded according to the Rentrop scoring system. Data on demographic and clinical characteristics were collected by cardiovascular doctors. Logistic regression, receiver operating characteristic (ROC) curve and Kaplan-Meier analyses were performed to assess the predictive value of visceral obesity-related indices for CC.Results: Overall, 1,008 inpatients were assigned to the poor CC group (n = 592) and good CC group (n = 416). In multivariate-adjusted logistic regression analyses, all visceral obesity-related indices (P-value < 0.001) were significantly associated with CC. After ROC analysis and the Delong test, the Chinese visceral adiposity index (CVAI) had the largest area under the curve (AUC) of 0.741 (0.711–0.771). Further analysis revealed that CVAI quartile remained a risk factor for poor CC in all groups, CVAI was associated with a 1.018-fold higher risk of poor CC (OR = 1.018, 95% CI: 1.014–1.021, P < 0.001). Individuals in the top CVAI quartile group had the highest risk of poor CC (OR = 10.657, 95% CI: 6.492–17.493, P < 0.001). Subgroup analyses showed similar results, and CVAI quartile remained a risk factor for poor CC. Moreover, increased CVAI predicted poor prognosis in CTO patients.Conclusion: In summary, this study indicated that all the increased visceral obesity-related indices were significantly associated with increased poor CC risk. After adjusting for potential risks, CVAI had the best performance for estimating CC and predicting prognosis in CTO patients.