Rate Of Cardiovascular Complications Research Articles

Incidence of acute kidney injury after noncardiac surgery in patients receiving intraoperative dexmedetomidine: a retrospective study

BackgroundPostoperative acute kidney injury (AKI) is a common complication and is associated with increased hospital length of stay and 30 day all-cause mortality. Unfortunately, we have neither a defined strategy to prevent AKI nor an effective treatment. In vitro, animal, and human studies have suggested that dexmedetomidine may have a renoprotective effect. We conducted a retrospective cohort study to evaluate if intraoperative dexmedetomidine was associated with a reduced incidence of AKI. MethodsWe collected data from 6625 patients who underwent major non-cardiothoracic cancer surgery. Before and after propensity score matching, we compared the incidence of postoperative AKI in patients who received intraoperative dexmedetomidine and those who did not. AKI was defined according to the Kidney Disease Improving Global Outcomes (creatinine alone values) criteria and calculated for postoperative Days 1, 2, and 3. ResultsTwenty per cent (n=1301) of the patients received dexmedetomidine. The mean [standard deviation] administered dose was 78 [49.4] mcg. Patients treated with dexmedetomidine were matched to those who did not receive the drug. Patients receiving dexmedetomidine had a longer anaesthesia duration than the non-dexmedetomidine group. The incidence of AKI was not significantly different between the groups (dexmedetomidine 8% vs no dexmedetomidine 7%; P=0.333). The 30 day rates of infection, cardiovascular complications, or reoperation attributable to bleeding were higher in patients treated with dexmedetomidine. The 30 day mortality rate was not statistically different between the groups. ConclusionsThe administration of dexmedetomidine during major non-cardiothoracic cancer surgery is not associated with a reduction in AKI within 72 h after surgery.

Longitudinal Trends in Cardiovascular Risk Factor Profiles and Complications Among Patients Hospitalized for COVID-19 Infection: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry.

The COVID-19 pandemic has evolved through multiple phases characterized by new viral variants, vaccine development, and changes in therapies. It is unknown whether rates of cardiovascular disease (CVD) risk factor profiles and complications have changed over time. We analyzed the American Heart Association COVID-19 CVD registry, a national multicenter registry of hospitalized adults with active COVID-19 infection. The time period from April 2020 to December 2021 was divided into 3-month epochs, with March 2020 analyzed separately as a potential outlier. Participating centers varied over the study period. Trends in all-cause in-hospital mortality, CVD risk factors, and in-hospital CVD outcomes, including a composite primary outcome of cardiovascular death, cardiogenic shock, new heart failure, stroke, and myocardial infarction, were evaluated across time epochs. Risk-adjusted analyses were performed using generalized linear mixed-effects models. A total of 46 007 patient admissions from 134 hospitals were included (mean patient age 61.8 years, 53% male, 22% Black race). Patients admitted later in the pandemic were younger, more likely obese, and less likely to have existing CVD (Ptrend ≤0.001 for each). The incidence of the primary outcome increased from 7.0% in March 2020 to 9.8% in October to December 2021 (risk-adjusted Ptrend=0.006). This was driven by an increase in the diagnosis of myocardial infarction and stroke (Ptrend<0.0001 for each). The overall rate of in-hospital mortality was 14.2%, which declined over time (20.8% in March 2020 versus 10.8% in the last epoch; adjusted Ptrend<0.0001). When the analysis was restricted to July 2020 to December 2021, no temporal change in all-cause mortality was seen (adjusted Ptrend=0.63). Despite a shifting risk factor profile toward a younger population with lower rates of established CVD, the incidence of diagnosed cardiovascular complications of COVID increased from the onset of the pandemic through December 2021. All-cause mortality decreased during the initial months of the pandemic and thereafter remained consistently high through December 2021.

Characterising the burden of chronic kidney disease among people with type 2 diabetes in England: a cohort study using the Clinical Practice Research Datalink

ObjectivesTo describe prevalence of chronic kidney disease (CKD), demographic and clinical characteristics, treatment patterns and rates of cardiovascular and renal complications for patients with type 2 diabetes (T2D) treated in...

A DESCRIPTIVE CROSS-SECTIONAL OBSERVATIONAL STUDY ON ASSESSMENT OF PATIENTS KNOWLEDGE, ATTITUDE AND PRACTICE ON HYPERTENSION AT A TERTIARY CARE HOSPITAL

Introduction: Hypertension is a strong independent risk factor for coronary and cerebrovascular diseases, as well as for heart failure, atrialfibrillation and chronic renal failure, thus substantially contributing to the global burden of disease. Moreover, it is well known that reducing blood pressure (BP) in hypertensive patientsis associated with a significant reduction in the rate of cardiovascular complications and adecline in renal function. Aim: To assess the patients knowledge, attitude and practice (KAP) and to create awareness about hypertension among hypertensive patients. Objectives: To evaluate the current situation and differences in knowledge, attitude and practices regarding hypertension and to create awareness of hypertension by giving verbal counseling to hypertensivepatients. Conclusion: Our study signifies that patients require support and guidance for practicing better disease management. Hence we conclude that aclinical pharmacist can play major role in improving patients knowledge and adherence bypatient education, developing maintenance of diet and exercise improved the patients practice activities. Clinical activities such as patient counseling, Home Medication Review, Pharmaceutical care program help to increase the patients practice in disease management.

Functional analysis of plasma membrane Ca2+ATPase 3 and its primary aldosteronism-associated mutations.

Primary aldosteronism (PA) is the most common form of secondary hypertension and can lead to higher rates of cardiovascular complications and death than essential hypertension. Aldosterone-producing adenomas (APAs) are the most frequent cause of PA. Most APAs have mutations in plasma membrane ion-transport proteins with 0.6%-9% carrying a mutation in the Plasma Membrane Ca2+ ATPase 3 (PMCA3). We have developed a Xenopus oocyte expression system to measure the function of PMCA3 wildtype (PMCA3WT) and an APA associated deletion mutant (PMCA3L425_V426del.) with minimal endogenous contamination. We measured ATPase activity at 37 °C in plasma membrane preparations from oocytes expressing PMCA3. Ca2+-dependent ATPase was observed in preparations from oocytes expressing PMCA3WT, with a [Ca2+] dependence well described with a rectangular hyperbola (K0.5 = 25.6 ± 5.1 μM) (triplicates from three independent membrane preparations). In contrast, membrane preparations from PMCA3L425_V426del. expressing oocytes lacked Ca2+-dependent ATPase activity, indicating loss of enzymatic activity in the mutant. We used two-electrode voltage clamp electrophysiology to evaluate the presence of PMCA3-variant mediated currents. At resting intracellular [Ca2+], PMCA3WT-injected oocytes had currents indistinguishable from those in uninjected oocytes, at all voltages. When bathed by extracellular 125 mM Na+, PMCA3L425_V426del.-injected oocytes presented inward currents at negative membrane potentials and outward currents at positive ones, consistent with induction of an aberrant channel-like current. The currents were outwardly directed upon substitution of external Na+ with N-methyl D-glucamine+ and were insensitive to changes in extracellular [Ca2+]. These results indicate that PMCA3L425_V426del. causes hyperaldosteronism due to the concomitant loss of active Ca2+ transport and induction of a depolarizing Na+-mediated current. Current experiments are evaluating the ATPase and physiological characteristics of other PA-associated PMCA3 mutations. Funded by NSF-MCB 2003251.

PS-C03-5: REAL-WORLD DATA OF BLOOD PRESSURE IN DIALYSIS PATIENTS WITH AND WITHOUT DIABETES IN JAPAN USING THE WEB-BASED DATABASE

Objective: Diabetic nephropathy was the most common primary disease among patients undergoing dialysis, and the number is growing each year. Despite advancements in dialysis technique, cardiovascular complications and mortality in dialysis patients with diabetes remain higher than in those without diabetes. Furthermore, hypertension is commonly known to contribute to the development of cardiovascular complications in dialysis patients, and we aimed to compare the systolic blood pressure (SBP) in dialysis patients with and without diabetes using the Web-based Analysis of Dialysis Data Archives (WADDA) system database. Design and Methods: From 2014 to 2020, we enrolled dialysis patients who had their predialysis SBP measured using the WADDA system 2.1. We classified SBP and evaluated its trends over time by gender, age, and presence of diabetes using the Japanese Society of Hypertension guidelines 2019 (JSH2019). Furthermore, we looked at the relationship between SBP and cardiovascular death in patients with and without diabetes. Results: Dialysis patients with diabetes (n = 168,227) had a mean age of 69.2 (11.7) years versus 69.4 (13.3) years, a mean predialysis history of 5.5 (5.3) years versus 9.4 (9.3 years), and a mean dialysis SBP of 156.6 (25.0) mmHg versus 147.9 (23.6) mmHg, respectively. Dialysis patients with diabetes had higher rates of cardiovascular complications than those without diabetes. From 2014 to 2020, the percentage and absolute values of hypertension were higher in dialysis patients with diabetes than across all age groups and in both men and women. Patients with cerebrovascular death had a higher rate of hypertension, but there was no difference in the rate of grade I and II hypertension between the two groups. Conclusion: We summarized the recent trends in SBP of Japanese dialysis patients with and without diabetes using the WADDA system. Dialysis patients with diabetes had higher SBP than those without diabetes in all age groups and in both men and women. As a result, optimal blood pressure management for dialysis patients with and without diabetes is important for the prevention of cerebrovascular death.

Maternal and fetal outcomes of bicuspid aortic valve with early-onset complications.

Bicuspid aortic valve is the most common congenital heart malformation and predisposes patients to thoracic aortic aneurysms and aortic dissections. Current peripartum guidelines are extrapolated from other heritable causes of thoracic aortic disease and do not account for unique characteristics of bicuspid aortic valve patients. We therefore evaluated the prevalence of maternal and fetal complications of women with early-onset complications of bicuspid aortic valve disease in the UTHealth Bicuspid Aortic Valve Research Registry. We found that the rate of cardiovascular complications was high and that relatively few women received guideline-recommended care.

Adverse outcomes of artificial pneumothorax under right bronchial occlusion for patients with thoracoscopic-assisted oesophagectomy in the prone position versus the semiprone position.

BackgroundThere are few studies on the impact of body position on variations in circulation and breathing, and it has not been confirmed whether body position changes can reduce the pulmonary complications of thoracoscopic-assisted oesophagectomy.MethodsA single-center retrospective study included patients undergoing thoracoscopic-assisted oesophagectomy in the prone position or semiprone position between 1 July 2020, and 30 June 2021, at the Shanghai Chest Hospital. There were 103 patients with thoracoscopic-assisted oesophagectomy in the final analysis, including 43 patients undergoing thoracoscopic-assisted oesophagectomy in the prone position. Postoperative pulmonary complication (PPC) incidence was the primary endpoint. The incidence of cardiovascular and other complications was the secondary endpoint. Chest tube duration, patient-controlled anaesthesia (PCA) pressing frequency within 24 h, ICU stay, and the postoperative hospital length of stay (LOS) were also collected.ResultsCompared with the semiprone position, the prone position decreased the incidence of atelectasis (12% vs. 30%, P = 0.032). Nevertheless, there were no considerable differences in the rates of cardiovascular and other complications, ICU stay, or LOS (P >0.05). Multivariable logistic regression analysis showed that the prone position (OR = 0.196, P = 0.011), no smoking (OR = 0.103, P <0.001), preoperative DLCO% ≥90% (OR = 0.230, P = 0.003), and an operative time <180 min (OR = 0.268, P = 0.006) were associated with less atelectasis.ConclusionsOur study shows that artificial pneumothorax under right bronchial occlusion one-lung ventilation for patients with thoracoscopic-assisted oesophagectomy in the prone position can decrease postoperative atelectasis compared with the semiprone position.

Vascular Endothelial Dysfunction in Myeloproliferative Neoplasms and Gene Mutations.

Essential thrombocythemia (ET) and polycythemia vera (PV), are common Philadelphia-negative myeloproliferative neoplasms (MPN). Patients with MPN have a high rate of cardiovascular complications and often have acquired JAK2V617F and CALR genetic mutations. In this study, we aimed to analyze vascular endothelial function in patients with MPN.We evaluated 27 outpatients, including 10 patients diagnosed with MPN, flow-mediated dilatation (FMD), and nitroglycerin-mediated dilation (NMD), between September 2014 and August 2016. We measured serum adiponectin, which protects vascular endothelial function, and serum asymmetric dimethyl arginine (ADMA), which inhibits the production of adiponectin. The presence or absence of JAK2V617F and CALR mutations was evaluated in patients with MPN.Venous thrombosis was observed more frequently in patients with MPN than in those without. Seven MPN patients were diagnosed with PV, and 3 MPN patients were diagnosed with ET. JAK2V617F and CALR mutations were found in 5 and 3 MPN patients, respectively. FMD was significantly lower in JAK2V617F-positive MPN patients than in JAK2V617F-negative MPN patients, although NMD, adiponectin, and ADMA were similar in both groups. Adiponectin levels were higher and ADMA levels were lower in CALR-positive MPN patients than in CALR-negative MPN patients. There was no difference in FMD and NMD prevalence between the 2 groups. Furthermore, we had 3 representative MPN patients who were complicated with coronary spasm, possibly caused by MPN-related endothelial dysfunction.We found that patients with MPN presented with endothelial dysfunction, which was related to the presence of genetic mutations and was sometimes associated with cardiovascular disease.

Well-Being and Health in Kidney Failure: A Scoping Review.

Kidney failure (KF) is associated with impaired physical function, reduced health-related quality of life, increased health care costs, and high rates of cardiovascular complications and mortality. Among individuals with KF, well-being and related constructs, such as positive affect, optimism, self-efficacy, and resilience, may have both mental and physical health benefits, independent of the effects of negative emotions and affective syndromes. However, there has been minimal review of these characteristics in people with KF. We conducted a scoping review, using a semi-systematic approach, to summarize the relationships between well-being characteristics and renal health, the potential mechanisms mediating these relationships, and the effects of interventions that promote positive constructs on adherence and health outcomes. We conducted database searches using PubMed and PsycINFO until November 2020. Articles were included if they examined (1) relationships between a well-being construct and health outcome in patients with KF, (2) potential biologic or behavioral mediators, or (3) interventions that target positive psychologic constructs as outcomes or mediators in KF and (4) were written in English or Spanish. Among patients with KF, well-being constructs are associated with increased health-related quality of life, reduced morbidity and complications, and increased survival. Potential mechanisms mediating these associations include reduced inflammation, improved autonomic and endothelial function, and improved health behavior adherence. Psychologic and psychosocial interventions promoting well-being have primarily focused on improving self-efficacy to promote behavior change, with limited study of interventions to promote positive psychologic constructs in this population. Further research is needed to better understand the relationship between well-being constructs and health, specific to KF populations. This could inform the development of needed interventions that harness the promotion of other positive characteristics to improve well-being and health.

Does chronic kidney disease affect the complications and prognosis of patients after primary colorectal cancer surgery?

BACKGROUNDThe effect of chronic kidney disease (CKD) on the outcomes of colorectal cancer (CRC) patients after primary CRC surgery is controversial.AIMTo analyze whether CKD had specific effect on the outcomes after CRC surgery.METHODSWe searched the PubMed, Embase, Cochrane Library databases and CNKI, from inception to March 14, 2022. Newcastle-Ottawa Scale was used for the quality assessment in this meta-analysis, and we used RevMan 5.3 was used for data analysis.RESULTSA total of nine studies including 47771 patients were eligible for this meta-analysis. No significant difference was found in terms of overall postoperative complications [odds ratio (OR) = 1.78, 95%CI: 0.64-4.94, P = 0.27]. We analyzed the specific complications and found that the CKD group had higher rates of pulmonary infection (OR = 2.70, 95%CI: 1.82-4.00, P < 0.01), cardiovascular complications (OR = 3.39, 95%CI: 2.34-4.91, P < 0.01) and short-term death (OR = 3.01, 95%CI: 2.20-4.11, P < 0.01). After pooling the hazard ratio (HR), the CKD group had worse overall survival (OS) (HR = 1.51, 95%CI: 1.04-2.20, P = 0.03). We performed subgroup analyses of the dialysis and non-dialysis groups, and no significant difference was found in the non-dialysis group (HR = 1.20, 95%CI: 0.98-1.47, P = 0.08). The dialysis group had worse OS (HR = 3.36, 95%CI: 1.92-5.50, P < 0.01) than the non-dialysis group. The CKD group had worse disease-free survival (DFS) (HR = 1.41, 95%CI: 1.12-1.78, P < 0.01), and in the subgroup analysis of the dialysis and non-dialysis groups, no significant difference was found in the non-dialysis group (HR = 1.27, 95%CI: 0.97-1.66, P = 0.08). The dialysis group had worse OS (HR = 1.95, 95%CI: 1.23-3.10, P < 0.01) than the non-dialysis group.CONCLUSIONPreexisting CKD was associated with higher rates of pulmonary infection, higher rates of short-term death, and worse OS and poorer DFS following CRC surgery.

PATIENTS WITH PSORIASIS PRESENT IMPAIRED MICROVASCULAR REACTIVITY INDEPENDENTLY OF TRADITIONAL CARDIOVASCULAR RISK FACTORS

Objective: Psoriasis is associated with increased rates of cardiovascular complications. Altered microvascular responses in divergent vascular beds are considered as an early precursor of cardiovascular disease and have been well-described in patients with cardiovascular risk factors and chronic inflammatory diseases. Laser Speckle Contrast Imaging (LSCI) has emerged as a novel, non-invasive and highly reproducible technique for the in vivo, real-time evaluation of microvascular perfusion. Design and method: We aimed to assess real-time skin microvascular function in patients with psoriasis free from established cardiovascular disease, in comparison with controls matched for cardiovascular risk factors. Microvascular function was evaluated dynamically using LSCI coupled with a post-occlusive reactive hyperaemia (PORH) protocol. Well-established markers of arterial stiffness, i.e. pulse wave velocity (PWV) and augmentation index (AIx), were assessed as surrogate markers of cardiovascular disease through a whole 24 h period using the Mobil-O-Graph device. Results: We studied 90 patients with psoriasis and 45 control individuals. Traditional cardiovascular risk factors and surrogate markers of cardiovascular disease did not differ between groups. By contrast, several indices of microvascular responses assessed with LSCI were found impaired in patients with psoriasis compared to controls, specifically baseline flux [45.7 (11.7) vs 36.2 (7.5) LSPUs, p &lt; 0.001], occlusion flux [11.6 (7.1) vs 7.4 (4.6) LSPUs, p &lt; 0.001], peak-to-baseline magnitude [128.9 (46.4) vs 179.0 (62.0) %, p &lt; 0.001], and baseline cutaneous vascular conductance (0.50 ± 0.13 vs 0.39 ± 0.10 LSPUs/mmHg, p &lt; 0.001). 24 h PWV significantly correlated with nearly all LSCI parameters, including time-to-peak flux, baseline perfusion, occlusion flux, peak flux, peak-to-baseline magnitude, and baseline cutaneous vascular conductance (p &lt; 0.05 for all). 24 h AIx significantly correlated only with occlusion flux (r = 0.223, p = 0.011). The latter was significantly associated with psoriasis duration (r = 0.300, p = 0.015). Conclusions: Our study shows for the first-time impaired microcirculation dynamics in patients with psoriasis using LSCI, in the absence of established cardiovascular disease and regardless of cardiovascular risk factors. A cross-talk between micro-macrovascular dysfunction apparently exists even at these early stages, before the establishment of clinically evident cardiovascular manifestations.

Cardiovascular outcomes in patients with chronic kidney disease and COVID-19: a multi-regional data-linkage study.

BackgroundData describing cardiovascular outcomes in patients with COVID-19 and chronic kidney disease (CKD) are lacking. We compared cardiovascular outcomes of patients with and without COVID-19, stratified by CKD status.MethodsThis retrospective, multi-regional data-linkage study utilised individual patient-level data from two Scottish cohorts. All patients tested for SARS-CoV-2 in Cohort 1 between 01/02/2020 and 31/03/2021, and in Cohort 2 between 28/02/2020 and 08/02/2021, were included.ResultsOverall, 86 964 patients were tested for SARS-CoV-2. There were 36 904 patients (61±21 years, 58.1% women, 15.9% CKD, 10.1% COVID-19 positive) in Cohort 1 and 50 060 patients (63±20 years, 62.0% women, 16.4% CKD, 9.1% COVID-19 positive) in Cohort 2. In CKD patients, COVID-19 increased the risk of cardiovascular death by more than two-fold within 30 days (cause-specific hazard ratio [csHR] meta-estimate 2.34, 95% confidence interval [CI] 1.83–2.99), and by 57% at the end of follow-up (csHR meta-estimate 1.57, 95% CI 1.31–1.89). Similarly, the risk of all-cause death in COVID-19 positive versus negative CKD patients was greatest within 30 days (HR 4.53, 95% CI 3.97–5.16). Compared to patients without CKD, those with CKD had a higher risk of testing positive (11.5% versus 9.3%). Following a positive test, CKD patients had higher rates of cardiovascular death (11.1% versus 2.7%), cardiovascular complications, and cardiovascular hospitalisations (7.1% versus 3.3%) than those without CKD.ConclusionsCOVID-19 increases the risk of cardiovascular and all-cause death in CKD patients, especially in the short-term. CKD patients with COVID-19 are also at a disproportionate risk of cardiovascular complications than those without CKD.

Anthracycline Associated Disturbances of Cardiovascular Homeostasis.

Despite the dynamic progress of modern medicine, oncological and cardiovascular diseases (CVD) remain a severe economic burden worldwide. Therefore, the study of chemotherapeutic cardiotoxicity appears to be comprehensively demanded. Nowadays, pharmacological therapy in oncology has undoubtedly unprecedented development, but at the same time, the rates of cardiovascular complications of chemotherapy still remain unchanged. The well-established and highly effective, but at the same time, cardiotoxic anthracyclines have not lost their relevance. Furthermore, they remain indispensable components of an immense amount of chemotherapy regimens, such as AC, FAC, etc. Moreover, the anthracycline-containing chemotherapy regimens have become a standard of care in several cancer types. In the context of the above mentioned, the study of the pathophysiological mechanisms, biochemical aspects, and dynamics of the morphological remodeling of doxorubicin-induced cardiovascular homeostasis disturbances will enable finding new targets of pharmacological therapy, which either in the short or long perspectives, will have a beneficial effect, improving both the quality of life and prognosis of oncological patients. This article covers a versatile overview of the molecular mechanisms of doxorubicin-induced cardiotoxicity. The pathogenesis of cardiotoxicity assessment could help to explore specific molecular mechanisms that initiate cardiovascular alteration that may favorably affect the future development of targeted drugs that could prevent cardiovascular events in cancer patients.

Decision tree-based machine learning analysis of intraoperative vasopressor use to optimize neurological improvement in acute spinal cord injury.

Previous work has shown that maintaining mean arterial pressures (MAPs) between 76 and 104 mm Hg intraoperatively is associated with improved neurological function at discharge in patients with acute spinal cord injury (SCI). However, whether temporary fluctuations in MAPs outside of this range can be tolerated without impairment of recovery is unknown. This retrospective study builds on previous work by implementing machine learning to derive clinically actionable thresholds for intraoperative MAP management guided by neurological outcomes. Seventy-four surgically treated patients were retrospectively analyzed as part of a longitudinal study assessing outcomes following SCI. Each patient underwent intraoperative hemodynamic monitoring with recordings at 5-minute intervals for a cumulative 28,594 minutes, resulting in 5718 unique data points for each parameter. The type of vasopressor used, dose, drug-related complications, average intraoperative MAP, and time spent in an extreme MAP range (< 76 mm Hg or > 104 mm Hg) were collected. Outcomes were evaluated by measuring the change in American Spinal Injury Association Impairment Scale (AIS) grade over the course of acute hospitalization. Features most predictive of an improvement in AIS grade were determined statistically by generating random forests with 10,000 iterations. Recursive partitioning was used to establish clinically intuitive thresholds for the top features. At discharge, a significant improvement in AIS grade was noted by an average of 0.71 levels (p = 0.002). The hemodynamic parameters most important in predicting improvement were the amount of time intraoperative MAPs were in extreme ranges and the average intraoperative MAP. Patients with average intraoperative MAPs between 80 and 96 mm Hg throughout surgery had improved AIS grades at discharge. All patients with average intraoperative MAP > 96.3 mm Hg had no improvement. A threshold of 93 minutes spent in an extreme MAP range was identified after which the chance of neurological improvement significantly declined. Finally, the use of dopamine as compared to norepinephrine was associated with higher rates of significant cardiovascular complications (50% vs 25%, p < 0.001). An average intraoperative MAP value between 80 and 96 mm Hg was associated with improved outcome, corroborating previous results and supporting the clinical verifiability of the model. Additionally, an accumulated time of 93 minutes or longer outside of the MAP range of 76-104 mm Hg is associated with worse neurological function at discharge among patients undergoing emergency surgical intervention for acute SCI.

Impact of neoadjuvant therapy on postoperative complications in non-small-cell lung cancer patients subjected to anatomic lung resection

ObjectiveTo study the impact of neoadjuvant therapies on postoperative complications and mortality among non-small-cell lung cancer (NSCLC) patients subjected to anatomic lung resection and included in the Spanish cohort of the video-assisted thoracic surgery (GE-VATS) multicenter database. MethodsThe study included a total of 3085 patients from 33 centers between December 2016 and March 2018. We performed a comparative analysis of the complications and mortality in patients who received neoadjuvant therapies (n = 263) versus those who did not (n = 2822). A propensity score-matched analysis was used to adjust for potential confounders. Association between exposure in two groups and outcomes were estimated by logistic regression weighted by inverse of probability of receiving the treatment that actually received. ResultsIn the unadjusted analysis, the chemotherapy (CT) and chemoradiotherapy (CRT) group presented a higher frequency of ICU readmissions, reinterventions, empyema, cardiovascular complications, a greater frequency of atrial fibrillation, and an increased need for blood product transfusions. In the adjusted group, CT and CRT patients had a higher rate of cardiovascular complications (CT p = 0.002; OR 2.29; 95% CI 1.34–3.94 and CRT p = 0.001; OR 2.90; 95% CI 1.52-5-52), arrhythmias (CT p = 0.013; OR 2.23; 95% CI 1.18–4.20 and CRT p = 0.046; OR 2.22; 95% CI 1.01–4.90) and transfussions (CT p = 0.042; OR 2.95; 95% CI 1.04–8.35 and CRT p < 0.001; OR 7.74; 95% CI 3.01-19-92). ConclusionsBased on our series, neoadjuvant CT and CRT were associated with a higher rate of cardiovascular complications, arrhythmias and transfussions in patients with NSCLC subjected to anatomic lung resection.

KCNJ5 Somatic Mutation Is Associated With Higher Aortic Wall Thickness and Less Calcification in Patients With Aldosterone-Producing Adenoma.

ObjectivePrimary aldosteronism (PA) is the most common type of secondary hypertension, and it is associated with a higher rate of cardiovascular complications. KCNJ5 somatic mutations have recently been identified in aldosterone-producing adenoma (APA), however their influence on vascular remodeling and injury is still unclear. The aim of this study was to investigate the association between KCNJ5 somatic mutation status and vascular status.MethodsWe enrolled 179 APA patients who had undergone adrenalectomy from a prospectively maintained database, of whom 99 had KCNJ5 somatic mutations. Preoperative clinical, biochemical and imaging data of abdominal CT, including abdominal aortic calcification (AAC) score, aortic diameter and wall thickness at levels of superior (SMA) and inferior (IMA) mesenteric arteries were analyzed.ResultsAfter propensity score matching for age, sex, body mass index, triglycerides and low-density lipoprotein, there were 48 patients in each KCNJ5 (+) and KCNJ5 (-) group. Mutation carriers had a lower AAC score (217.3 ± 562.2 vs. 605.6 ± 1359.1, P=0.018), higher aortic wall thickness (SMA level: 2.2 ± 0.6 mm vs. 1.8 ± 0.6 mm, P=0.006; IMA level: 2.4 ± 0.6 mm vs. 1.8 ± 0.7 mm, P<0.001) than non-carriers. In multivariate analysis, KCNJ5 mutations were independently associated with AAC score (P=0.014) and aortic wall thickness (SMA level: P<0.001; IMA level: P=0.004). After adrenalectomy, mutation carriers had less aortic wall thickness progression than non-carriers (Δthickness SMA: -0.1 ± 0.8 mm vs. 0.9 ± 0.6 mm, P=0.024; IMA: -0.1 ± 0.6 mm vs. 0.8 ± 0.7 mm, P=0.04).ConclusionKCNJ5 mutation carriers had less calcification burden of the aorta, thickened aortic wall, and less wall thickness progression than non-carriers.

New-Onset Diabetes as a Complication After Kidney Transplant: Incidence and Outcomes.

Diabetes after kidney transplant is a common complication. It may increase the risk of cardiovascular disease and mortality after kidney transplant. The aim of this study was to examine the effects of diabetes that developed after transplant on outcomes in kidney transplant recipients. This study included renal allograft recipients without diabetes who received transplants from 2008 to 2019 in our Department of Nephrology at Sahloul Hospital (Tunisia). Demographic and clinical data at transplant time and clinical events during the study period were collected. Patient and graft survival rates were analyzed. Patients with and without diabetes after transplant were compared. In the 257 patients (median age of 36 years) included in our study, the overall incidence of diabetes after transplant was 21.8%. Laboratory data (serum cholesterol, serum creatinine at discharge, and 24-hour proteinuria) were similar in those with and without diabetes after transplant. We observed no significant differences in cardiovascular diseases and infectious complication rates between patients with and without diabetes after transplant. There was also no significant difference in graft loss at 5 years between those with and without diabetes after transplant (P = .582). The 5-year patient survival rate in kidney transplant recipients with diabetes after transplant was 87.5%. There was no significant difference in death rate between those with and without diabetes after transplant (P = .566). Diabetes after transplant affected graft and patient survival and increased the incidence of posttransplant cardiovascular disease. The incidence and impact of diabetes after transplant can be minimized through pre- and posttransplant screening to identify patients at higher risk.

P231 Emergency Colectomy for IBD Is Not Associated with Increased Risk of Postoperative Infection, Reoperation or Readmission

Abstract Background The current literature suggests that IBD patients have worse outcomes after emergency surgery when compared to elective surgery. We hypothesized that this association will be lost after matching cohorts of emergency and elective patients. We aimed to confirm the current emergency IBD surgery literature in a large cohort of unmatched IBD patients. We then aimed to determine if postoperative outcomes are worse in matched patients undergoing elective vs emergency colectomy. Methods We utilized the NSQIP PUF IBD Cohort 2005–2019 to assess 30-day outcomes in adult IBD patients undergoing emergency vs elective colectomy. Our primary outcome was any complication. Our secondary endpoints were readmission, reoperation, and mortality. Univariable and multivariable logistic regression models were used to examine the association between emergency surgery and complications in the unmatched cohort. Propensity-score matching was performed to match emergency patients to non-emergency patients on a 1:1 basis. A logistic regression model was used to assign a propensity score to each patient using emergency surgery as the outcome. All preoperative and perioperative characteristics were included in the model except those with &amp;gt; 20% missing data. The probability of emergency surgery based on these factors was used as the propensity score. A greedy matching algorithm was used to find the best controls matches for each case. A Love plot was used to show the covariate balance. Conditional logistic regression were used to evaluate the association between outcomes and emergency surgery on the matched sample. Results A total of 16,790 patients (15,849 elective, 941 emergency) were included in the unmatched cohort analysis. 30-day outcomes in 21 categories including length of stay, surgical site infection, sepsis, death and cardiovascular, renal and thrombotic complications were worse in the emergency cohort (Table 1). After matching, 632 sets were constructed. The majority of adverse outcomes demonstrated in the unmatched cohort lost significance. Only unplanned intubation (OR 2.6, p=.006), &amp;gt;48 hours on a ventilator (OR 2.8, p&amp;lt;.001), septic shock (OR 3.6, p&amp;lt;.001) and any complication (OR 1.3, p=.03) retained significance (Table 2). Conclusion In concordance with the current literature, we demonstrated increased rates of postoperative infection, cardiovascular and renal complications, reoperation and length of stay in unmatched groups of IBD patients undergoing emergency vs elective surgery. However, the majority of these complications were not significantly different after propensity matching. This suggests that emergency surgery is not associated with poorer outcomes in terms of length of stay, mortality and most morbidities as previously thought.

Contrast induced nephropathy after percutaneous coronary intervention: Observational Study

The incidence of Contrast-induced nephropathy (CIN) varies because of differences among the published studies in the definition of CIN, the proportion of high-risk patients, the types of contrast media, and the use of preventive measures. The purpose of our study was to determine the incidence of CIN among patients admitted for ST-Elevation Myocardial Infarction (STEMI) in the department of cardiology of Nabeul Hospital Center. Eighty patients were included. All the patients were admitted for a STEMI in the cardiology department of Nabeul Hospital Center from January 2020 to June 2020. The overall pooled CIN incidence was 8% The forest plots showed positive associations between CIN and the presence of hypertension, diabetes mellitus, history of prior myocardial infarction, age, stenosis of left anterior descending artery, Killip class ≥ 2, decreased left ventricular ejection fraction, lower estimated glomerular filtration rate, and left ventricular ejection fraction < 40%. At a median follow-up of 12 months, major cardiovascular events including cardiovascular death, reinfarction, and stroke were more frequents in patients with CIN (12.5% vs. 2.5%, P -value < 0.001). Contrast-induced nephropathy is common after PCI in patients with STEMI and always leads to a poor prognosis. It is associated with increased rate of cardio-vascular complications at medium and long-term follow-up.