Predictor Of Decrease Research Articles

Factors predicting a decrease in suicidality among young people (0-28 years old)

Abstract Background Suicide, self-harm and suicidal thoughts (i.e., suicidality) are important public health concerns. Most youth that experience suicidality find a way to overcome these affronts. Preventative public health measures require an understanding of factors that can help youth overcome their suicidality. Methods Data come from a Dutch prospective birth-cohort study that surveyed youth from age 11 to 28 (measurements 2-3 years apart). We determined the proportion of youth that experienced suicidality across seven waves and focused on changes in suicidality, and factors associated with changes in suicidality using linear discriminant analysis. We examined a mix of individual, family, peer and socio-cultural factors in line with an ecological framework, e.g. the Interpersonal Theory of Suicide. Results Between 4-8% of youth experienced suicidal thoughts and between 2-5% experienced self-harm across time points. Most youth (89%-94% across time points) did not experience changes in suicidality, while between 3-6% experienced a decline of suicidal thoughts and between 2-4% a decline in self-harm across time points. Discriminant analyses could correctly identify ≈90% of subgroup per case (decline, increase, stable suicidality). But, the model was not very accurate in predicting which youth belonged to the declining suicidality subgroup. Functions with best predictive ability indicated the importance of interpersonal factors; belonging to peers, parents, classmates, teachers and religion. Also, overall happiness and positive changes in romantic relationships and family had predictive value. Conclusions It remains difficult to distinguish youth who experience a decrease in suicidality. Interpersonal factors may play a role in changes in suicidality, but we need to identify new factors related to declines in suicidality. Future prospective birth-cohort study should consider including factors that may be better predictors of decreases in suicidality and mental health in general. Key messages • Factors that contribute to decreases in suicidality will enrich suicide prevention strategies, which have until thusfar mostly been informed by a risk perspective. • Interpersonal factors might play an important role in changes in suicidality among youth, which indicates we need an ecological perspective on suicidality rather than an individual perspective.

Real-world predictors of changes in fear of COVID-19 in the Japanese general population: a large-scale internet-based cohort study with 20,712 participants

BackgroundCoronavirus disease 2019 (COVID-19) is a respiratory infection that considerably impacts both physical and mental health. In particular, the prolonged nature of psychological issues associated with COVID-19 has become a concern. However, evidence based on longitudinal studies investigating the changes in fear of COVID-19 has been limited, posing a public health challenge.MethodsWe investigated the predictors of changes in the Fear of COVID-19 Scale (FCV-19S) scores in the general Japanese population using data from a large-scale internet-based cohort study.ResultsWe included 20,712 study participants (mean age = 51.1 years, percentage of males = 49.9%). The baseline FCV-19S score for the research participants was 17.0, and one year later, the FCV-19S score decreased to 15.8. The predictors of increase in FCV-19S scores were older age, male sex, COVID-19 requiring oxygen therapy, higher baseline FCV-19S total score, severe psychological distress, never married, worsening subjective health status, a greater number of COVID-19 vaccinations, a history of alcohol dependency, and living with family members. Conversely, the predictors of decrease in FCV-19S scores included habitual alcohol intake, COVID-19 not requiring oxygen therapy and a higher household income. Our study was an internet-based survey focused on residents of Japan, which raises the possibility of selection bias and makes it unclear whether the findings can be extrapolated to other countries and cultures.ConclusionDuring the observation period, the FCV-19S scores significantly decreased. Severe COVID-19 requiring oxygen therapy within one year of baseline was the most impactful predictor of an increase in FCV-19S score. On the other hand, mild COVID-19 not requiring oxygen therapy was a predictor of a decrease in FCV-19S scores. Therefore, we believe that it is necessary to adopt individualized approaches stratified by the severity of the infection when addressing the fear of COVID-19.

486. Predictors of Decreases in Suicidal Ideation in Patients With Treatment-Resistant Depression Receiving Repetitive Transcranial Magnetic Stimulation Treatment: A Retrospective Clinical Cohort Analysis

486. Predictors of Decreases in Suicidal Ideation in Patients With Treatment-Resistant Depression Receiving Repetitive Transcranial Magnetic Stimulation Treatment: A Retrospective Clinical Cohort Analysis

Effectiveness of a Scalable mHealth Intervention for Children With Overweight and Obesity.

Background: Multicomponent interventions are the first line of treatment for pediatric obesity, but are challenging to access. Mobile health (mHealth) interventions hold promise as they address commonly cited barriers for attending in person programs and have potential for wide scale dissemination. Methods: This retrospective cohort study examined data from youth who enrolled in the Kurbo program, which includes personal health coaching and a mobile app. Hierarchical linear regression was used to examine the impact of baseline percentage of the 95th% percentile for body mass index (%BMIp95), number of coaching sessions, and length of time enrolled in the program on change in %BMIp95, controlling for baseline age and sex. Results: A total of 3500 youth (mean age of 12.79 years, 71.3% female) were included. Youth experienced a 0.70 U decrease in BMI [standard deviation (SD) = 2.19] and a 4.45% decrease (SD = 8.5) in %BMIp95 over a mean of 31.5 weeks. The overall regression model was significant, R2 = 0.066, F(3,3494) = 77.18, and p < 0.001. Predictors of decrease in weight status included being female (b = -1.11, p < 0.001), higher baseline %BMIp95, (b = -0.58, p < 0.001), and greater number of coaching sessions (b = -0.12, p < 0.001), while greater time enrolled in the program (b = 0.02, p < 0.001) was associated with less change. Conclusion: Findings suggest a scalable coaching program with integrated digital tools for monitoring diet and activity can lead to significant reductions in weight status. Findings need to be replicated with more rigorous study designs, including a comparison condition and verified assessment of height and weight.

Factors Associated with Self-Reported Changes in Alcohol Use among Young Adults during the COVID-19 Pandemic: A Comparative Analysis between Canada and France.

While the COVID-19 pandemic impacted young adults' alcohol use patterns, little is known about how changes in alcohol use may differ across different settings. Our objective was to identify and compare factors associated with changes in alcohol use among young adults in Canada and France during the first year of the COVID-19 pandemic. We conducted an online cross-sectional survey in October-December 2020 with young adults aged 18-29 (n = 5185) in Canada and France. In each country, weighted multinomial logistic regressions were performed to identify factors associated with self-reported decrease and increase in alcohol use separately (reference: no change). Respectively, 33.4% and 21.4% reported an increase in alcohol use in Canada and France, while 22.9% and 33.5% reported a decrease. Being 25-29 was a predictor of decrease in Canada, while living away from family was associated with an increase in France. In both countries, participants were more likely to report an increase if they reported depressive symptoms, smoking tobacco, or cannabis use. Conversely, those who had been tested for COVID-19 and those who were highly compliant with COVID-19 preventive measures were more likely to report a decrease. Efforts are needed to develop alcohol use interventions for young adults, including in ways that prioritize those with mental health challenges.

1019-P: Predictors of Response to Metformin in Youth with Type 1 Diabetes (T1D) and Increased BMI

Metformin used as adjuvant therapy in youth with T1D and elevated BMI decreased total daily insulin dose (TDID) and insulin resistance, although hemoglobin A1c (A1c) did not change. Yet, the factors that are associated with greater benefit from metformin are not well known. Here, we tested whether baseline measures predict response to metformin in youth with T1D and increased BMI-z score. We analyzed publicly available data from the metformin treatment arm of the T1D Exchange Metformin Study (NCT01881828) , with 61 adolescents (median age 15.3 yrs, range 12-18.9; 36% males; 72% non-Hispanic Whites, 98% overweight or obese; median diabetes duration 7.4 yrs, range 1.7-15) . We assessed baseline age, sex, diabetes duration, race/ethnicity, BMI z-score, waist circumference, body fat percentage (BF%) measured by Dual-energy X-ray Absorptiometry (DXA) scan and serum adipokines. Outcome measures included changes in A1c, TDID and BF% at 13 and 26 weeks (wks) . After adjusting for baseline values, multiple linear regression models were used to identify predictors for the outcomes. Decreases in TDID at 13 and 26 wks showed a significant negative association with baseline leptin (p=0.0008, p=0.004, respectively) . Decreases in BF% at 26 wks were positively associated with baseline BMI z-score (p=0.03) and negatively associated with baseline BF% (p=0.0002) . Increase in A1c at 26 wks trended towards a positive association with baseline BF% (p=0.07) and a negative association with baseline adiponectin (p=0.06) . Compared to females, males showed a significant reduction in BF% at 26 wks (p&amp;lt;0.0001) and a trend towards a reduction in TDID at 13 wks (p=0.06) .In sum, in adolescents with T1D and elevated BMI treated with metformin as adjuvant to insulin, baseline leptin was the strongest predictor of decrease in TDID at 13 and 26 wks. Decrease in BF% was predicted by higher BMI z-score and lower BF% at baseline. These findings may aid a precision medicine approach in this population. Disclosure J.Wang: None. S.Barua: None. M.Tosur: Advisory Panel; Provention Bio, Inc. M.J.Redondo: Advisory Panel; Provention Bio, Inc. H.M.Ismail: n/a.

Prevalence of Macular Microcystoid Lacunae in Autosomal Dominant Optic Atrophy Assessed With Adaptive Optics.

To assess the prevalence of macular microcystoid lacunae in patients with autosomal dominant optic atrophy (ADOA) and its association with visual function and inner retinal morphology. The study included 140 participants with ADOA, with a mean age of 44 (SD ±19, range 7-82) years. Study participants with a genetically verified sequence variant in the OPA1 gene were examined with best-corrected visual acuity, contrast sensitivity, optical coherence tomography (Spectralis, Heidelberg) and adaptive optics fundus photography (rtx1, Imagine Eyes). Optically empty microcystoid spaces in the ganglion cell layer and inner plexiform layer were mapped by inspection of the 2 sets of images. Data were analyzed with a mixed model adjusted for age and sex with family and individual as random effect. Microcystoid lacunae were present in 32 of 140 participants (23%) including 18 males and 14 females. Microcystoid lacunae were associated with younger age ( P = 0.0503) and a smaller nerve fiber layer volume ( P = 0.035). No association was found between presence of microcystoid lacunae and visual acuity ( P = 0.2), contrast sensitivity ( P = 0.8), axial length ( P = 0.7), or ganglion cell layer volume ( P = 0.2). The analysis showed moderately reduced visual acuity in patients with microcystoid lacunae. Normal and severely impaired visual function were seen only in participants without microcystoid lacunae. In ADOA, macular microcystoid lacunae were found in 23% of the study participants and tended to be present in younger participants with moderate visual acuity reduction and a smaller nerve fiber layer volume. Further studies are needed to investigate whether cavities left by dead ganglion cells are predictors of decrease in visual function.

Autonomic nervous system abnormalities predict cardiovascular changes after initiation of siponimod in secondary progressive multiple sclerosis

ObjectiveThe aim of this study was to identify whether autonomic nervous system (ANS) dysfunction identified prior to treatment initiation can predict siponimod related decrease in heart rate (HR) after treatment initiation. MethodsIn 26 people with secondary progressive multiple sclerosis (SPMS) the following ANS testing protocol was applied: 10-min supine resting position, Valsalva maneuver, deep breathing test, 10 min tilt-up table test, 5-min supine resting period, ingestion of siponimod, followed by 180-min supine resting period recordings. Heart rate variability (HRV) parameters were investigated as possible predictors of decrease in HR (ΔHR) after treatment initiation. ResultsAfter treatment initiation, there was a statistically significant drop in HR (71.1 ± 9.2 to 66.3 ± 8.1, p < 0.001) and elevation of systolic blood pressure (sBP) (113.2 ± 12.4 to 117.1 ± 10.8, p = 0.04). Values of the diastolic BP (dBP) followed similar trend as did sBP, however not reaching statistical significance (72.8 ± 9.6 to 74.9 ± 8.3, p = 0.13). In a multivariable regression model, disease duration and standard deviation of NN intervals (SDNN) were identified as independent predictors for ΔHR, where increase in SDNN and longer disease duration predict smaller ΔHR. ConclusionANS abnormalities may predict cardiovascular abnormalities associated with treatment initiation with siponimod. SignificanceResults of this study may help mitigate risks associated with siponimod treatment.

Retrospective analysis of prognostic value of neutrophils to lymphocyte ratio and platelet count in patients with colorectal carcinoma

Background: Colorectal cancer (CRC) is the third most common cancer in men and second in women with 1.8 million new cases (1,026,000 men and 823, 3 women) and almost 881.000 deaths. Rates are substantially higher in males than in females Worldwide in 2018.Aim of the work: In this retrospective study we aimed to evaluate the prognostic impact of baseline NLR and platelet count on the clinicopathological factors and outcome in patients of all stages Colorectal cancer treated from 1st of January 2014 to the end of December 2016 in Department of Clinical Oncology and Nuclear Medicine, Ain Shams University hospitals, Cairo, Egypt.Patients and methods: Out of 409 patient’s medical records in the GI oncology unit, Ain Shams Clinical Oncology Department were reviewed from the period between 1st of January 2014 to 30 December 2016. Total neutrophils, lymphocytic, and platelets’ counts were available for only 169 patients. Study ended in 1st of August 2018 with median period of follow up of 27.5 month, ranging between 1/1/2014 to 1/8/2018. All patients (169) were pathologically proven colorectal adenocarcinoma, with age ranging from 18-75 years old (median age: 55.5 yrs.)Results: Out of 169 patients enrolled in this study, 124 patients were resectable and underwent curative surgeries, 44 patients tumour was right located and 80 patient’s tumour located in the left sided colon. 45 patients were metastatic from the start. Postoperative Platelets ≥ 310 in our study was statistically significant regarding OS, PFS and DFS (P values &lt;.001, &lt;.001 and 0.007) respectively. Pre-treatment platelet revealed more frequent thrombocytosis in metastatic group than locally advanced group, yet statistically was not significant (P Value = .066). Postoperative NLR ≥ 2 was significant regarding OS, PFS and DFS among 169 enrolled patients (P values &lt;.001, .002 and &lt;.001) respectively. In the multivariate analysis, elevated postoperative NLR was proven as both independent prognostic and predictor factor for DFS, PFS and OAS. (sig. =.03, .03, ≤ 0.001 respectively). And platelet count is both independent prognostic factor and predictor for both PFS, OS with significance =.04, =.03 respectively).Conclusion: Abnormal NLR ratio (≥ 2) acting as a prognostic and predictor of decrease in DFS, PFS and OS in all patients groups. It also showed that abnormal platelet count (≥ 310) is prognostic and predictor of significant decrease in PFS and OS. Multidisciplinary management is needed to aware surgeons about importance of adequate lymph node dissection, our study showed a statistically significant decrease in OAS in patients underwent inadequate LNs dissection.

The relationship between mindfulness meditation and well-being during 8 weeks of ecological momentary assessment

ObjectivesThe main effects of 8-week mindfulness-based programs (MBP) on anxiety and depression are now supported by reasonably robust evidence. However, few to no studies have looked at whether and how these main effects come to be over the course of the MBP. The goal of the present study was to look at how meditation practice predicted changes in well-being, and vice versa, at a weekly level, within an 8-week online MBP.MethodsThe participants were 457 Finnish upper secondary education students who underwent an 8-week online MBP. App-based ecological momentary assessment data were collected on how many minutes the participants meditated (daily) and their anxiety, happiness, and sleep problems (weekly). These data were analyzed using a longitudinal (nine time point) path model.ResultsParticipants’ weekly minutes of mindfulness meditation were a consistent, albeit weak, predictor of decreases in anxiety and increases in happiness. During the course of the study, answer rates declined from 75.7% (Time 0) to 27.4% (Time 8) for anxiety, happiness, and sleep and from 80.5% to 37.0% for meditation minutes.ConclusionsResults suggest well-being improvement from mindfulness meditation is an ongoing process and that ecological momentary assessment is a promising methodology for studying it.

The Role of Personality in Becoming Aware of Age-Related Changes.

Awareness of age-related change (AARC) refers to an individual's conscious knowledge about the gains and losses resulting from growing older. Personality traits reflect dispositional patterns of behavior, perception, and evaluation and should therefore influence the experience of AARC. The 4.5-year longitudinal study examines this association between personality traits and AARC in a sample of 423 individuals aged 40 to 98 years (M = 62.9 years) using latent change analyses. After controlling for sex, health, and education, a different pattern of associations for cross-sectional vs. longitudinal relations. Cross-sectionally, neuroticism was positively related to AARC losses, whereas openness, conscientiousness, and neuroticism were positively related to AARC gains. Longitudinally, the impact of personality traits on change in AARC was rather limited with only higher conscientiousness acting as a predictor of decreases in AARC losses over time. Overall, the findings add to the existing literature on associations between personality traits and subjective aging. Specifically, the results indicate that personality traits are differentially related to awareness of age-related gains in comparison to awareness of age-related losses.

Динамика маркеров печеночного фиброза на терапии лираглутидом у больных сахарным диабетом 2 типа в сочетании с метаболическим синдромом

Therapy of glucagon-like peptide 1 receptors agonists (aGLP1) liraglutide within 24 weeks led to considerable weight reduction, a circle of a waist, HbA1c, TG, AST and increase in HDLP at patients with type 2 diabetes mellitus (2TDM) and multiple manifestations of metabolic syndrome (obesity, dyslipidemia, hypertension) in real clinical practice. Effects of therapy liraglutide on the markers of fibrosis and a scale estimating risk of its progression were ambiguous and depended on various predictors. Decrease in the index of fibrosis on therapy aGLP1 depended on a floor and extent of increase in HDLP. Dynamics galectin-3 depended on weight reduction and its significant decrease is noted only at patients with loss weight ≥ 5%. Initial levels of incretin (GIP and GLP1) acted as predictors of decrease in PIIINP. Further researches on big cohorts of patients with obesity, a metabolic syndrome and 2TDM are necessary for definition of groups of the patients capable it is essential to reduce risk of a progression of fibrosis on therapy aGLP1

Does assimilation of problematic experiences predict a decrease in symptom intensity?

The assimilation model describes therapeutic change as an integration of experiences that had previously been problematic, distressing, avoided, or warded off. This study assessed whether assimilation was associated with treatment outcome in a sample of psychotherapeutic treatments for depression. Further, it assessed the direction of the association—whether increasing assimilation predicted decreases in symptom intensity or decreasing symptom intensity predicted increases in assimilation.MethodParticipants were 22 clients with mild to moderate depression drawn from a clinical trial comparing cognitive behavioral therapy with emotion‐focused therapy. The direction of prediction between assimilation progress and changes in self‐reported symptom intensity was assessed.ResultsThe assimilation progress was shown to be a better predictor of decreases in symptom intensity than the reverse.ConclusionThe results supported the assimilation model's suggestion that assimilation progress promotes decreases in symptom intensity in the treatment of clients with major depressive disorder.

Abstract P3-06-35: Association of estrogen receptor (ER) levels and prediction of antiproliferative effect of hormone therapy (HT) in lower ER-expressing tumors

Abstract Intro Accurate measurement of ER in early stage invasive breast cancer (EBC) is important to identify patients likely to benefit from HT. While immunohistochemistry (IHC) is the most common method to quantify ER, other methods can also accurately measure ER, such as RT-PCR. ER is one of the genes included in the RT-PCR based 21-gene Recurrence Score assay (Oncotype DX®, Genomic Health, Redwood City, CA) and is also reported separately as a single gene expression. Additionally, the association between ER expression by RT-PCR (ER-PCR) and tamoxifen benefit has been reported by Kim, et al (2011). A recent study reported that patients with ER levels &amp;lt;10% by IHC were largely negative by RT-PCR (Singh, et al; 2014) and that this has potential implications for which patients may be expected to benefit from HT. Robust measures of ER and the proliferative response may be useful in identifying patients likely to respond to HT. Aim The study aims are: (1) To correlate quantification of ER in EBC as assessed by Allred Score (AS) and ER as measured by RT-PCR in the 21-gene assay; (2) To describe changes in ER, Recurrence Score, and measures of proliferation after 2wks of an aromatase inhibitor (AI); (3) To perform exploratory analyses of factors associated with changes in proliferation. Methods 55 postmenopausal EBC patients with lower ER (AS 2-7) were treated with 2wks of an AI followed by wide excision. All patients had a 21-gene assay on a pre-and post-treatment (Tx) sample. Proliferation was measured by both Ki67 by IHC (in 45 patients) and by the proliferation gene group score (PGS) in the RT-PCR based 21-gene assay (in all patients). Proliferation response was defined by a 20% relative decrease in Ki67 or a decrease in PGS. Changes in proliferation were correlated with AS, ER-PCR and Recurrence Score result. Results The Table shows the correlation of AS with ER-PCR measured in the pre-Tx (r=0.83) samples. 94% of AS (2-3) patients and 56% of AS (4-5) were ER(-) by RT-PCR There was a significant change (pre to post) in the average Ki67 level (18% to 11%; p&amp;lt;0.001) and PGS but not Recurrence Score result. 37/45 patients showed a 20% decrease in Ki67 while only 32/55 had a decrease in PGS. Changes in Ki67 levels were greatest in AS 6/7 patients with a 76% relative decrease vs 21% in AS 2/3 patients. The range of PGS change was 1% increase in AS 2/3, 1% decrease in AS 4/5 and 14% decrease in AS 6/7 patients. Univariate predictors of decrease in Ki67 were AS of 5/6/7 (vs 2/3/4), Recurrence Score result, ER-PCR (continuous or binary), and PR-PCR. The same variables were predictors of PGS change. Pre-Tx ASER-PCR Status (Pre-Tx)NegativePositiveTotalAS 2-317 (94%)1(6%)18AS 4-59(56%)7(44%)6AS 6-70 (0%)21(100%)21Total262955 Conclusions • Results confirm earlier reports showing substantial disagreement in ER measured by IHC vs RT-PCR in patients with lower ER-expressing tumors • The clinical implications are that a substantial number of patients with low ER by IHC may have little to no benefit from HT • The 21-gene assay may be useful in selecting patients likely to benefit from HT • Further studies in larger cohorts are required to confirm these findings. Citation Format: J Michael Dixon, Arran Turnbull, Lorna Renshaw, Megan P Rothney, Cynthia A Loman, Laura Arthur, Jeremy S Thomas, Oliver Young, Juliette Murray, Linda Williams, Amy P Sing, David Cameron. Association of estrogen receptor (ER) levels and prediction of antiproliferative effect of hormone therapy (HT) in lower ER-expressing tumors [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-06-35.

Waist/Height Ratio as a Predictor of Decrease in Expiratory Reserve Volume

Waist/Height Ratio as a Predictor of Decrease in Expiratory Reserve Volume

Hematologic safety of Ra-223 dichloride (Ra-223) in castration-resistant prostate cancer (CRPC) patients with bone metastases from the phase III ALSYMPCA trial.

5060 Background: In the updated analysis of the ALSYMPCA study, Ra-223 significantly improved median survival by 3.6 mo vs placebo (Pbo) in 921 CRPC patients (pts) with bone mets (HR = 0.695; 95% CI, 0.581-0.832; p = 0.00007) and had a highly favorable safety profile (Parker et al. ASCO 2012). The hematologic safety profile and results from a post hoc analysis assessing prognostic factors for changes in hematologic parameters in ALSYMPCA pts are presented. Methods: Pts were randomized 2:1 to 6 injections (inj) of Ra-223 (50 kBq/kg IV) q4wk or matching Pbo and stratified by prior docetaxel (D) use, total alkaline phosphatase (tALP), and current bisphosphonate use.Multivariate regression analysis was performed to explore the relationship of 6 baseline factors (Table) with maximum % change of hematologic parameters from baseline up to 24 wk on treatment (tx). Results: The updated analysis included 901 pts (safety population; Ra-223, n = 600; Pbo, n = 301). Overall grade 3/4 AEs were similar between Ra-223 and Pbo groups, with neutropenia in 2% and 1%, thrombocytopenia in 6% and 2%, and anemia in 13% and 13% of Ra-223 and Pbo groups, respectively. Tx with Ra-223, prior D use, extent of disease (EOD) &gt; 6 bone mets, and tALP ≥ 220 U/L, but not current bisphosphonate use, were associated with decreases from baseline in hemoglobin (Hb), neutrophils, or platelets; prior EBRT to bone for pain was associated with an increase. The significance of the relationship between baseline factors and changes in hematologic parameters is summarized in the Table. Conclusions: Overall, there was a low risk for hematologic AEs with Ra-223 tx in CRPC pts with bone mets. The strongest prognostic factors for decreases in neutrophils and platelets were Ra-223 tx and prior D use. Baseline tALP ≥ 220 U/L was a strong predictor of decrease in Hb. Clinical trial information: NCT00699751. [Table: see text]

Bisphosphonate treatment and renal function in 201 myeloma patients undergoing stem cell transplantation

Administration of bisphosphonates (BPs) is an essential supportive treatment for reducing bone-related complications in cancer. Deterioration of renal function is one possible side effect of BPs as well as a clinical feature in multiple myeloma. It has been suggested that the nephrotoxicity of different BPs may differ. We performed a retrospective evaluation of renal function in 201 myeloma patients undergoing myeloablative chemotherapy and treatment with ibandronate (I), pamidronate (P), or zoledronate (Z) for up to 36months. There was no significant deterioration in mean creatinine clearance (CreaCl) in the entire cohort. The percentage of patients experiencing a decrease in CreaCl≥25% from baseline was 33.0% in the I group, 44.4% in the P group and 21.4% in the Z group, respectively. CreaCl at baseline (P<0.0001), relapse/progression (P=0.0019), proteinuria at baseline (P=0.039), age (P=0.0031) were identified as significant independent predictors of decrease in renal function. In both descriptive multivariant analyses, we found no evidence of an advantage of any particular BP with respect to effects on renal function. In line with these data, in a subgroup of 90 patients with a baseline CreaCl <90ml/min, no significant difference was evident between the cohorts of patients treated with different BPs. Regular treatment with the BPs I, P and Z in myeloma patients undergoing intensive chemotherapy appear to be equally safe for up to 3years in terms of nephrotoxicity.

Predictors of decrease in ankle-brachial index among patients with diabetes mellitus

Screening for peripheral arterial disease, a complication among patients with diabetes, is performed by periodic assessment of ankle-brachial index. We aimed to study the degree of ankle-brachial index change over time and factors associated with significant change. We assessed difference between two ankle-brachial index measurements over time in a consecutive series of 82 patients with Type 2 diabetes. All patients had ankle-brachial index > 0.9 but ≤ 1.3 for the first measurement, and significant ankle-brachial index decrease was defined as a decrease of > 0.1 in the follow-up measurement compared with the baseline. The mean follow-up duration was 27.6 (median 30.0) months. Significant ankle-brachial index decrease was seen in 20.7% of patients, including 5% with follow-up ankle-brachial index of ≤ 0.9, consistent with the diagnosis of peripheral arterial disease. After adjusting for age and gender, higher baseline HbA(1c) and serum creatinine levels, increase in follow-up serum LDL cholesterol levels compared with baseline and history of retinopathy were predictors of significant ankle-brachial index decrease. Our study suggests that, within two years, one in five patients with diabetes and a normal ankle-brachial index may have significant progression of peripheral arterial disease. Annual ankle-brachial index assessment and better control of hyperlipidaemia may thus be required for at-risk patients with poor glycaemic control, renal impairment and retinopathy.

Abstract P299: BMI and BP Predict Brachial Distensibility in Healthy Adolescents and Young Adults

Introduction: CV risk-factor (CVRF) related increase in arterial stiffness is associated with adverse CV events in adults. Cross-sectional studies in youth show a relationship between CVRF and arterial stiffness. Longitudinal data are lacking. Hypothesis: CVRFs will predict decreased brachial artery distensibility (BrachD). Methods: Demographics, anthropometrics, BP, fasting glucose, insulin, lipids and BrachD were measured in 425 healthy youth in a school-based longitudinal cohort (age 17.4 +2.1 yrs, 41% male, 61% Caucasian). Anthropometrics, BP and BrachD were repeated 2.1 + 0.3 years later. Mean values for baseline and follow-up variables were evaluated by paired t-test. Characteristics of subjects with decrease in BrachD (N=167) were compared by t-test with subjects without BrachD decrease. The multivariable model to determine predictors of follow-up BrachD contained baseline and change of age, sex, BMI, MAP, HR, baseline lipids, glucose and insulin. Results: Over 2 years, the cohort increased in HT, WT, BMI, SBP and BrachD (all p&lt;0.02). Predictors of decrease in BrachD were greater baseline and change in BMI, MAP and HR (R 2 = 0.36, model p &lt;0.0001, parameter p&lt; 0.02, BrachD at follow-up = 2.7 + 0.04*Age at baseline + 0.4*Sex (male=1, female=2) − 0.02 Age at baseline*Sex − 0.33*BMI at baseline − 0.02*BMI change - 0.005*MAP at baseline - 0.004*MAP change - 0.002*HR at baseline - 0.003*HR change). BMI at baseline and change in BMI contributed the majority of the variance in BrachD at follow-up (16 and 4%). Subjects with decrease in BrachD were more likely to have gained more BMI (1.3 vs 0.6 kg/m 2 ) or increased more in MAP (0.8 vs −1.3 mmHg) and HR (1.1 vs −2.0 beats/min, all p&lt;0.002). Conclusions: Development of obesity with subsequent changes in BP and HR may lead to development of arterial dysfunction. Prevention of obesity may be the most important approach to improve the CV health of adolescents and young adults.

Predictors of Changes in Hemoglobin Levels in Patients with Chronic Hepatitis C Treated with Ribavirin Plus Pegylated Interferon-α

Background: Combination therapy with pegylated interferon (pegIFN)-α and ribavirin (RBV) for chronic hepatitis C virus (HCV) infection is associated with reduction in hemoglobin (Hb) concentrations and anemia. The aim of this study was to evaluate the magnitude and frequency of change in Hb and determine the predictive risk factors for Hb decrease during this therapy. Methods: We enrolled 308 patients with chronic HCV infection who were receiving weekly subcutaneous pegIFN injection in combination with body weight-based oral RBV for 24 weeks. Clinical and virological characteristics were used for studying the predictors of decrease in Hb. Results: The majority (95%) of patients showed reduction in Hb concentration of at least 1 g/dL during pegIFN and RBV combination therapy. The mean and median maximal decrease in Hb level of the study patients was 3.9 g/dL (range −0.3 to 8.2 g/dL; interquartile range 2.8–5.0 g/dL). Of all patients, 49.4% showed a reduction in Hb level of more than 4 g/dL; a higher number of male patients than female patients showed an Hb decrease of >4 g/dL. Multivariate analysis of our data showed that older age, high baseline Hb concentration, high HCV RNA viral load, low estimated glomerular filtration rate (eGFR), and low platelet count were independent predictors of significant decline in Hb levels. Conclusions: Patients with low eGFR before antiviral therapy may have an increased risk of RBV-related anemia and should be closely monitored. Clinician should consider the potential risk of significant reduction in Hb level according to eGFR while deciding the RBV dose.