Risk Comorbidities Research Articles

Cardiorespiratory fitness and risk of heart failure with preserved ejection fraction.

Preventive strategies for heart failure with preserved ejection fraction (HFpEF) include pharmacotherapies and lifestyle modifications. However, the association between cardiorespiratory fitness (CRF) assessed objectively by a standardized exercise treadmill test (ETT) and the risk of HFpEF has not been evaluated. Thus, we evaluated the association between CRF and HFpEF incidence. We assessed CRF in US Veterans (624 551 men; mean age 61.2 ± 9.7 years and 43 179 women; mean age 55.0 ± 8.9 years) by a standardized ETT performed between 1999 and 2020 across US Veterans Affairs Medical Centers. All had no evidence of heart failure or myocardial infarction prior to completion of the ETT. We assigned participants to one of five age- and gender-specific CRF categories (quintiles) based on peak metabolic equivalents (METs) achieved during the ETT and four categories based on CRF changes in those with two ETT evaluations (n = 139 434) ≥1.0 year apart. During a median follow-up of 10.1 years (interquartile range 6.0-14.3 years), providing 6 879 229 person-years, there were 16 493 HFpEF events with an average annual rate of 2.4 events per 1000 person-years. The adjusted risk of HFpEF decreased across CRF categories as CRF increased, independent of comorbidities. For fit individuals (≥10.5 METs) the hazard ratio (HR) was 0.48 (95% confidence interval [CI] 0.46-0.51) compared with least fit (≤4.9 METs; referent). Being unfit carried the highest risk (HR 2.88, 95% CI 2.67-3.11) of any other comorbidity. The risk of unfit individuals who became fit was 37% lower (HR 0.63, 95% CI 0.57-0.71), compared to those who remained unfit. Higher CRF levels are independently associated with lower HFpEF in a dose-response manner. Changes in CRF reflected proportional changes in HFpEF risk, suggesting that the HFpEF risk was modulated by CRF.

(116) Breaking the Silence: Should I Be Concerned About Penile Fracture when Injecting Collagenase Clostridium Histolyticum?

Abstract Introduction Collagenase clostridium histolyticum (CCH) was first approved by the FDA in December 2013 for the nonsurgical management of Peyronie’s disease (PD) in men who are otherwise healthy. Penile fracture (PF) is a rare but concerning adverse event with known association with CCH administration. Objective To determine the risk of PF in men with PD who are receiving CCH and correlations between the risk of PF and comorbidities previously excluded in studies investigating the safety of CCH, namely the IMPRESS trial. Methods The TriNetX database was used to measure the rate of hospital visits for penile fracture using the ICD-10 code S39.840A. Results were limited to patients who were diagnosed with PD (ICD-10 N48.9) and were seen between July 2013 to July 2023. Patients were excluded if they had a history of surgical intervention for PD, including plaque excision and grafting, penile plication, and insertion of inflatable penile prosthesis. An odds ratio (OR) was calculated to compare the rates of PF between patients who had and had not received CCH. For those who received CCH, OR’s were calculated to determine if the presence of certain comorbidities increased the risk of PF. Results Within the examined time period, 44,542 patients with PD experienced 280 PF’s. The rate of PF in those who had and had not received CCH were 1.25% (N = 37) and 0.59% (N = 243) respectively, OR 2.122 (95% CI: 1.499-3.001, p<0.0001). Tobacco use, diabetes mellitus, peripheral vascular disease, hypertension, hyperlipidemia, erectile dysfunction, and hypogonadism were not associated with an increased risk of PF in men receiving CCH (p>0.05) (Table 1). Conclusions While the rate of PF following CCH use for PD was low at 1.25%, this was significantly higher than in those who did not receive CCH. Despite this, men who were previously excluded from studies examining the safety of CCH use for PD due to comorbidity burden were without an increased rate of PF, suggesting that these men may be able to receive CCH without additional risk of PF. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Antares Pharma, Clarus Therapeutics, Coloplast.

Comprehensive Evaluation of COVID-19 Vaccines Antibody Response Among Healthcare Professionals: A Multi-Center Study in Iran

Background: The coronavirus disease 2019 (COVID-19) vaccines are very good at protecting individuals from serious illness, needing hospital care, and dying from different strains of the virus. However, vaccines might not completely prevent individuals from catching and spreading the virus, and this might depend on some personal factors. Objectives: To find out the immune response of COVID-19 vaccines, this cross-sectional study conducted within June 2021 to May 2023 assessed different types of COVID-19 vaccine antibody responses among healthcare professionals and their associations with demographic factors and comorbidity risk factors. Methods: This descriptive-analytical study was conducted on recruited healthcare professionals from Sina, Imam Khomeini Complex, 501 AJA, Baqiayatallah, and Firoozgar hospitals in Tehran, Iran. The vaccines whose antibody response was investigated in this study are Sinopharm® (China), AstraZeneca® (United Kingdom), Sputnik® (Russia), and Covaxin® (India). Anti-spike, anti-receptor-binding domain (RBD), and anti-neutralizing immunoglobulin G (IgG) were evaluated by commercial kits according to instructions. Results: This study involved 1 029 healthcare workers who were over 18 years old. The average age was 41.48 ± 9.9 years, and 602 (58.5%) of them were male. The vaccines they received were Sputnik V (392 or 38.16%), AstraZeneca (335 or 32.61%), Baharat (45 or 4.3%), and Sinopharm (255 or 24.82%). The Covaxin and AstraZeneca vaccines increased both anti-RBD and anti-neutralizing IgG Ab levels; however, the Sinopharm vaccine increased only the latter. The Sputnik vaccine was the least effective. Gender and diabetes influenced the antibody levels, but age did not. Conclusions: This study revealed the substantial effectiveness of COVID-19 vaccines in generating robust antibody responses among healthcare professionals. All four vaccine types, Sinopharm, AstraZeneca, Sputnik, and Covaxin, elicited significant antibody responses in over 70% of participants, highlighting the crucial role of vaccination in building defense against COVID-19.

Metabolic Abnormalities Following Tirzepatide Monotherapy in Japanese Patients with Type 2 Diabetes: A Phase 3 SURPASS J-mono Post Hoc Analysis.

The presence of metabolic abnormalities in patients with type 2 diabetes (T2D) increases the risk of cardiovascular disease and other comorbidities. This analysis compared the effects of tirzepatide (5, 10, and 15mg) and dulaglutide 0.75mg on the prevalence of metabolic abnormalities in Japanese patients with T2D. This was a post hoc analysis of SURPASS J-mono, a multicenter, randomized, double-blind, active-controlled, parallel-group, phase 3 trial that compared the efficacy and safety of tirzepatide monotherapy (5, 10, and 15mg) to dulaglutide 0.75mg in Japanese patients with T2D. Thresholds for abnormalities were based on the Japanese criteria for metabolic syndrome. Proportions of participants meeting a composite endpoint (visceral fat accumulation measured by waist circumference plus two or more of dyslipidemia, hypertension, or hyperglycemia) or individual component thresholds were calculated at baseline and week 52 for the overall population and for baseline body mass index (BMI) subgroups (< 25, 25 to < 30, and ≥ 30kg/m2). Of 636 randomized participants, 431 (67.8%) met the composite endpoint at baseline, with similar findings observed across treatment arms. At week 52, the proportion of participants on treatment that met the composite endpoint was 31.7%, 23.0%, and 14.2% in the tirzepatide 5-, 10-, and 15-mg arms, respectively, and 56.5% in the dulaglutide arm (p < 0.001). A higher proportion met the composite endpoint at baseline in the BMI 25 to < 30 and ≥ 30kg/m2 subgroups (73.2-79.3%) compared with the < 25kg/m2 subgroup (45.3%), with reductions observed across all BMI subgroups treated with tirzepatide. The proportion of participants with individual metabolic abnormalities showed similar trends to those observed for the composite endpoint. Tirzepatide was consistently superior to dulaglutide across all assessments. Tirzepatide reduced the prevalence of multiple metabolic abnormalities, indicating tirzepatide may have metabolic benefit in Japanese patients with T2D. ClinicalTrials.gov, NCT03861052.

Comorbidity risk and distribution characteristics of chronic diseases in the elderly population in China

BackgroundThe risk of comorbid chronic diseases in elderly people is an important problem affecting their health and quality of life. We analyzed the incidence of chronic diseases for combinations of chronic diseases analyzed.MethodsWe used the original data to construct hypothetical cohorts of elderly individuals that evolved with age. The complex network was used to reduce the dimensionality of disease. The multistate transition model is used to calculate the incidence of each chronic disease, exploring comorbidity characteristics and rules.Results(1) By using complex network, seven chronic diseases were screened out in men, including hypertension, diabetes, heart disease, stroke, chronic lung disease, arthritis and dyslipidemia; six chronic diseases in women showed significant comorbidity except chronic lung disease. (2) Incidence show differences in age and sex; incidence of chronic diseases generally increased with age. (3) The marginal risk increases with the number of basic chronic diseases associated with comorbidities. (4) When hypertension is present as a basic disease, its impact on the risk of other chronic diseases is much less than that of other chronic diseases. (5) When diseases occur as basic chronic diseases, hypertension–heart disease and diabetes–dyslipidemia are combinations that have the greatest impact on each other in men; hypertension–heart disease in women.ConclusionsThe incidence of chronic diseases in patients who have chronic diseases and will form comorbidities differs from that in healthy states, and the related effects of different chronic diseases also differ. Among these conditions, hypertension is caused by a special mechanism.

Evaluating an epilepsy clinical nurse specialist development programme

There is a demand across the country for highly trained epilepsy specialist nurses (ESNs) due to the increasing number of patients that this long-term condition affects. It is estimated that 65 million people worldwide are affected by epilepsy. If not treated and supported effectively, epilepsy comes with high risk of mortality, comorbidities, stigma and high potential costs to the NHS. Patients who do not have access to a highly trained ESNs can be significantly and negatively affected by wrong diagnosis, gaps in knowledge when facing general care, incorrect and, on occasion, detrimental treatment options, poor epilepsy education and advocacy. Furthermore, patients living in rural areas often do not have access to large tertiary centres or neurologists with an interest in epilepsy. Due to this, access to ESNs running nurse-led clinics in smaller hospitals and community settings is vital to improving patient care. Nonetheless, there is a shortage of highly trained ESNs. The ESN development programme discussed in this article was formed as a concerted action to address recruitment challenges and widen the area and scope of care for people with an epilepsy diagnosis.

Metabolic syndrome and its associated factors among adults with cardiac diseases: A cross-sectional comparative group study.

There is limited information about the extent of metabolic syndrome (MetS) among subjects with cardiac diseases in Ethiopia. Therefore, this study aimed to determine the prevalence and associated factors of MetS among adults with cardiac diseases. A cross-sectional study was conducted at Hawassa University Comprehensive Specialized Hospital in southern-Ethiopia between May 2021 and August 2021. Data pertaining to the study were collected from 319 participants (153 cardiac and 166 non-cardiac groups) using the WHO stepwise approach. The International Diabetes Federation (IDF) and the revised National Cholesterol Education Program: Adult Treatment Panel III (ATP) were used to define MetS. The prevalence of MetS was 44.2% and 50.2% in IDF and ATP III, respectively. Among the cardiac group, 54.9% had MetS in IDF criteria, compared to 34.3% in the non-cardiac group (p < .001); whereas, it was 60.1% in the cardiac group and 41% in non-cardiac group (p < .001) by ATP III. Age >60 years, waist-height ratio ≥5, high waist-hip ratio, body mass index 25-29.9 and ≥30 kg/m2 were significantly associated with higher odds of MetS in both IDF and ATP III. Also, smoking history and monthly income were associated with MetS by ATP III, while being female was associated with higher odds of MetS by IDF. More than half of the subjects with cardiac diseases developed MetS as compared to non-cardiac controls. Periodic screening and focusing on the identified modifiable high-risk factors such as body weight, smoking, and central adiposity is important to effectively mitigate the risk of further comorbidity and complications in this high-risk population.

Abstract WP269: Food Desert Residence as a Contributing Risk Factor for Acute Ischemic Stroke Patients

Background: Research suggests that residing in a food desert (FD) area may negatively impact health by increasing cardiovascular risk factors. The USDA defines FD as an area of low income in addition to low access to grocery stores at a 1 (urban) or 10-mile (rural) radius and/or low vehicle access. This study aims to assess sociodemographic profile and stroke risk factors among individuals residing in FDs within the predominantly rural state of South Carolina (SC). Methods: Deidentified administrative discharge data included all individuals admitted to SC hospitals between 2010 and 2019 with ICD-9/10 codes for ischemic stroke. Public USDA census tract data were used to define FDs based on patients’ residential addresses at time of admission, with encrypted linkages provided by SC’s clinical data warehouse. Stroke risk factors were compared between those residing in a FD vs. not via chi-square analyses. Results: Out of the identified 63,330 patients with an index ischemic stroke event, 36.8% were classified as residing within a USDA defined FD. Acute stroke patients residing within a FD were significantly more likely to be younger (age &lt;65), of black race, and without health insurance (all p&lt;.0001). FD residents were significantly more likely to have comorbid hypertension (OR 1.14, 95%CI 1.09, 1.19), type 2 diabetes (OR 1.21, 95%CI 1.17, 1.25), heart failure (OR 1.14, 95%CI 1.09, 1.19), and chronic kidney disease (OR 1.24, 95%CI 1.18, 1.30) associated with acute stroke hospital admission. Also, those residing in FDs were significantly more likely to have a history of obesity (OR 1.17, 95%CI 1.11, 1.23), mental health (OR 1.14, 95%CI 1.10, 1.18), tobacco use (OR 1.28, 95%CI 1.23, 1.33), and substance abuse (OR 1.40, 95%CI 1.35, 1.45). There were no significant differences noted in terms of sex/gender, dyslipidemia, discharge disposition, or case fatality. Conclusion: Stroke patients living within FDs are at heightened risks of comorbidities associated with ischemic stroke. Limitations in access to high quality food and suboptimal nutrition may be a contributing risk factor. Future studies focusing on shopping and eating behaviors among those living within FDs are needed to further reduce health disparities within rural and urban geographic locations nationwide.

Influence of idiopathic epilepsy on blood pressure and electrocardiography in dogs treated with phenobarbital.

Dogs with idiopathic epilepsy (IE) experience a shortened lifespan, neurobehavioral changes, and an increased risk of comorbidities during the interictal period. There have been several reports of sudden death in humans with epilepsy, suggesting changes in cardiac rhythm secondary to seizures. In veterinary medicine, there are still no such conclusive studies. The present study aimed to evaluate blood pressure values, electrocardiographic findings, and laboratory parameters in dogs with IE treated with phenobarbital and to correlate these findings with possible cardiac alterations. Twenty-one dogs were divided into 11 healthy dogs and 10 idiopathic epileptic dogs for blood analysis, computerized electrocardiogram, and oscillometer-based blood pressure measurement. QRS complex and S-T interval values differed significantly between groups, but blood pressure values were not significantly different. IE can occur with alterations in cardiac conduction and is a pathological condition.

Response to prone positioning in COVID-19 patients with acute respiratory distress syndrome: a retrospective observational study

BackgroundCOVID-19 pneumonia and respiratory failure are the leading causes of death in COVID-19 patients. Prone positioning was hypothesized to improve oxygenation in ARDS patients and is being studied in COVID-19, but the current evidence is still unclear regarding survival and hospitalization. We aimed to investigate the effect of prone positioning on oxygenation in patients with COVID-19 pneumonia and ARDS and to examine the factors associated with better/worse outcomes.MethodsA retrospective record-based cohort study included all confirmed COVID-19 patients with pneumonia and ARDS who underwent prone positioning admitted to King Fahad Hospital, Medina, Saudi Arabia, during 2020–2021.ResultsThis study included 75 cases (mean age 60.3 ± 15.7 year, 50 (66.7%) males), and all fulfilled the definition of ARDS. There was a significant improvement in oxygenation (PaO2 and PaO2/FIO2) following prone positioning (53.5 ± 6.8 vs. 60.4 ± 8.2 mmHg, p < 0.001 for PaO2 supine and prone and 120.3 ± 35 vs. 138 ± 40.2, p < 0.001 for PaO2/FIO2 supine and prone respectively). There was no significant difference in age, gender, smoking, or number of comorbidities between survivors and non-survivors. Survivors had significantly higher baseline PaO2 (p 0.018) and PF ratio (p 0.001) compared to non-survivors. They had also less severe inflammation and organ damage observed as significantly lower ferritin (p 0.001), D-dimer (p 0.026), aspartate aminotransferase (p 0.02), urea (p 0.032), creatinine (p 0.001), and higher platelet counts (p 0.001). Intubation and high-moderate comorbidity risk categories were associated with non-survival (p 0.001 and p 0.014, respectively).ConclusionProne positioning is useful in the improvement of oxygenation in intubated and awake patients with COVID-19 pneumonia and ARDS. Intubation and high comorbidity risk categories were associated with non-survival.

Increased healthcare burden and comorbidity risks of pediatric patients with dystrophic epidermolysis bullosa: Analysis of Nationwide Emergency Department Sample 2015-2019.

Dystrophic epidermolysis bullosa (DEB) describes a rare genetic blistering disorder characterized by fragile skin. This study aimed to classify the frequency, demographics, cost, and comorbidities associated with emergency department (ED) visits due to DEB. The Nationwide Emergency Department Sample (NEDS) was analyzed for pediatric (age <18) ED visits from 2015 to 2019. DEB was identified with ICD-10-CM code Q81.2. Weighted frequency, prevalence, and 95% confidence intervals (CIs) of comorbidities were determined among ED visits with and without a DEB diagnosis. From 2015 to 2019, 53 (weighted 242) cases of DEB among 27,223,220 pediatric ED visits were captured. Patients with DEB were more likely to visit the ED in summer compared with those without a diagnosis of DEB (35.7% vs. 21.4%, P < .05). More than half of patients with DEB were admitted to the hospital (56.2%, 95% CI: 39.3-72.5, P < .001) versus only 3.4% (95% CI: 3.1-3.7) of other patients. For ED visits with a secondary DEB diagnosis, the top three primary diagnoses were fever, constipation, and bone marrow transplant aftercare. Patients with DEB had higher rates of hypertension, cellulitis, sepsis, acute and chronic kidney injury, esophageal obstruction, gastroesophageal reflux disease, cardiomyopathy, and anxiety, compared to patients without DEB (all P < .001). DEB is a complex blistering disorder with multisystemic manifestations. Patients with DEB have significantly higher admission rates and commonly present with infectious or gastrointestinal complications. Understanding the features of ED visits due to DEB can better prepare healthcare teams and improve patient outcomes.

Biological sex-related differences in the postprandial triglyceride response to intermittent hypoxaemia in young adults: a randomized crossover trial.

Obstructive sleep apnoea is characterized by chronic intermittent hypoxaemia and is independently associated with an increased risk of metabolic comorbidities (e.g. type II diabetes and ischaemic heart disease). These comorbidities could be attributable to hypoxaemia-induced alterations in blood lipid profiles. However, it remains unclear whether intermittent hypoxaemia alters triglyceridaemia differently between biological sexes. Therefore, we used a randomized crossover design to examine whether 6h of moderate intermittent hypoxaemia (15hypoxaemic cycles/h, 85% oxyhaemoglobin saturation) alters plasma triglyceride levels differently between men and women after a high-fat meal. Relative to men, women displayed lower levels of total triglycerides, in addition to denser triglyceride-rich lipoprotein triglycerides (TRL-TG; mainly very low-density lipoprotein triglycerides and chylomicron remnant triglycerides) and buoyant TRL-TG (mainly chylomicron triglycerides) during normoxia (ambient air) and intermittent hypoxaemia (sex × time: all P ≤ 0.008). Intermittent hypoxaemia led to higher triglyceride levels (condition: all P ≤ 0.016); however, this effect was observed only in men (sex × condition: all P ≤ 0.002). Compared with normoxia, glucose levels were higher in men and lower in women during intermittent hypoxaemia (sex × condition: P<0.001). The different postprandial responses between biological sexes occurred despite similar reductions in mean oxyhaemoglobin saturation and similar elevations in insulin levels, non-esterified fatty acid levels and mean heart rate (sex × condition: all P ≥ 0.185). These results support growing evidence showing that intermittent hypoxaemia impacts men and women differently, and they might help to explain biological sex-related discrepancies in the rate of certain comorbidities associated with intermittent hypoxaemia. KEY POINTS: Intermittent hypoxaemia is a key characteristic of obstructive sleep apnoea and alters lipid metabolism in multiple tissues, resulting in increased circulating triglyceride levels, an important risk factor for cardiometabolic diseases. Circulating triglyceride levels are regulated differently between biological sexes, with women typically displaying much lower fasting and postprandial triglyceride levels than men, partly explaining why women of all ages experience lower mortality rates from cardiometabolic diseases. In this study, healthy young men and women consumed a high-fat meal and were then exposed to 6h of intermittent hypoxaemia or ambient air. We show that postprandial triglyceride levels are significantly lower in women compared with men and that intermittent hypoxaemia leads to higher postprandial triglyceride levels in men only. These results might help us to understand better why women living with obstructive sleep apnoea experience lower rates of cardiometabolic diseases (e.g. type II diabetes and ischaemic heart disease) than men living with obstructive sleep apnoea.

Exploring clinical indicator variations in stroke patients with multiple risk factors: focus on hypertension and inflammatory reactions

BackgroundStroke stands as the second leading cause of death worldwide. Currently, extensive research has been conducted on stroke risk factors. However, when stroke patients contend with multiple risk factors, the impact on clinical indicators remains uncertain.ObjectivesThis study seeks to investigate potential significant variations among distinct ranges of clinical indicators in instances where stroke patients experience multiple risk factors and various ischemic stroke subtypes.Material and methodsThe research encompassed 440 stroke patients admitted to the First People's Hospital of Wenling City, Zhejiang Province, China. These patients were classified based on the type and quantity of risk factors and subtypes of ischemic stroke they presented. The χ2 test was employed to assess the relationship between the risk of comorbid diseases and clinical indicators in stroke patients.ResultsThe results of our study have underscored a significant correlation between various comorbid risk factors in stroke patients and the patients' age (P < 0.010). Furthermore, we observed noteworthy disparities in the plasma levels of IL-2, IL-4, IL-6, IL-10, TNF-α, and INF-γ between patients devoid of risk factors and those presenting with comorbid risk factors associated with stroke. Significant differences in INF-γ were observed between the two subtypes of ischemic stroke, namely lacunar infarction and cardioembolic stroke.ConclusionAge is correlated with an elevated risk of stroke. Individuals exhibiting multiple stroke risk factors and diverse ischemic stroke subtypes commonly present with abnormal lipid levels and imbalances in Th1/Th2 cytokines. These factors significantly contribute to the onset and progression of stroke. Furthermore, inflammatory responses, particularly those induced by atherosclerosis, play a pivotal role in the genesis of stroke and exert a substantial influence on its prognosis.

Clinical Characteristics and Treatment Outcomes of Prurigo Nodularis: A Retrospective Study.

Prurigo nodularis (PN) is a complex chronic skin disease characterized by severe pruritic nodules. PN is often associated with mental health disorders and chronic medical comorbidities. Until recently, PN treatment has been challenging and difficult. This study aims to describe the demographic, clinical characteristics, and comorbidities associated with PN. Also, we aim to describe the effectiveness of systemic therapies, including methotrexate, cyclosporine, and narrow band ultraviolet (NB-UVB) in adult patients with PN. This is a retrospective chart review of adult patients diagnosed with PN at Hamilton Health Science Center and/or McMaster University in Hamilton, Ontario, between 2015 and 2023. The study included 81 patients (57% female). The mean age was 52.8 years, and the mean age of PN diagnosis was 50 years. Reported symptoms included: itching (100%), dry skin (53%), pain (17%), and burning sensation (5%). Lower and upper extremities were the most common areas involved in 93% and 69%, respectively. Mental health disorders were present in 79% of patients, with depression (58%) and anxiety (52%) being the most common. Atopic dermatitis was the most common skin comorbidity noted. Treatments used included cyclosporine, and NB-UVB, and MTX, which resulted in significant improvement of pruritus in 38%, 35%, and 31% of patients, respectively, at week 16. PN is associated with increased risk of mental health disorders and other medical comorbidities. Cyclosporine, methotrexate, and NB-UVB therapy may be effective treatment options, however clinicians must consider the potential short- and long-term adverse effects of these treatments.

Risk of cardiovascular comorbidities before and after the onset of rheumatic diseases

ObjectivesTo elucidate the risk and temporal relationship of cardiovascular (CV) comorbidities in rheumatic diseases. MethodsPatients in the FinnGen study diagnosed between 2000 and 2014 with seropositive (n = 2368) or seronegative (n = 916) rheumatoid arthritis (RA), ankylosing spondylitis (AS, n = 715), psoriatic arthritis (PsA, n = 923), systemic lupus erythematosus (SLE, n = 190), primary Sjogren's syndrome (pSS, n = 412) or gout (n = 2034) were identified from healthcare registries. Each patient was matched based on age, sex, and birth region with twenty controls without any rheumatic conditions. Overall risk ratios (RR) were calculated by comparing the prevalence of seven CV diseases between patients and controls. Logistic regression models were used for estimating odds ratios (OR) for CV comorbidities before and after the onset of rheumatic diseases. ResultsThe RR for ‘any CVD’ varied from 1.14 (95 % confidence interval [CI] 1.02–1.26) in PsA to 2.05 (95 % CI 1.67–2.52) in SLE. Patients with SLE or gout demonstrated over two-fold risks for several CV comorbidities. Among CV comorbidities, venous thromboembolism (VTE) showed the highest effect sizes in several rheumatic diseases. The ORs for CV comorbidities were highest within one year before and/or after the onset of the rheumatic disease. However, in gout the excess risk of CV disease was especially high before gout diagnosis. ConclusionsThe risk of CV comorbidities was elevated in all studied rheumatic diseases, with highest risks observed in SLE and gout. The risk for CV diseases was highest immediately before and/or after rheumatic disease diagnosis, highlighting the increased risk for CV comorbidities across all rheumatic diseases very early on the disease course.

P1122 Comorbidities Associated with Pediatric Onset Inflammatory Bowel Diseases: A Population-Based Study

Abstract Background Inflammatory bowel disease (IBD) can be associated with various disorders, including dermatological, rheumatological, or psychiatric conditions. However, little is known about the incidence of these co-morbidities in paediatric-onset IBD at the population-based level. Methods All patients diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) before the age of 17 between 1988 and 2011, and included in the EPIMAD population-based registry, were followed retrospectively until 2013. In this population, we collected information on comorbidities present at diagnosis, as well as events related to the development of a new chronic condition, hospitalization, or an infectious event of interest (as pneumopathy, meningitis, or pyelonephritis) reported in the medical records during the follow-up period. Results A total of 1,344 patients were included, comprising 1,007 (74.9%) with CD and 337 (25.1%) with UC. The median age at diagnosis was 14.3 years (IQR [11.7; 16.0]). During a median follow-up of 8.3 years ([4.3-13.9]), 361 (26.9%) patients exhibited at least one comorbidity. At diagnosis, 9.4% (95% CI [7.8% - 11.0%]) of patients had at least one comorbidity. The cumulative incidence of comorbidity was 13% (95% CI [11% - 14%]) at 1 year after diagnosis and 20% (95% CI [17% - 22%]) at 5 years. No association was found between the risk of comorbidity and the clinical characteristics at IBD diagnosis. However, the cumulative incidence of comorbidity was higher in the diagnosis period 2001-2011 than in the period 1988-1993 (HR=1.7 [1.2-2.2]; p&amp;lt;0.001). The most frequent comorbidities were infectious (5.6%), dermatological (5.5%), and pulmonary (5.3%) (Figure 1). The most common infectious events included bacteraemia, digestive tract infection with Clostridioides difficile, and viral infection with Herpesviridae or parvovirus B19, with a cumulative incidence during follow-up of 1.2%, 1.0%, and 0.9%, respectively. During follow-up, viral infections with HBV, HCV, or HIV were observed in 0.2% of patients, and pneumopathy was diagnosed in 0.7% of patients. Eczema and asthma were the predominant dermatological and pulmonary comorbidities, affecting 2.6% and 5.1% of patients, respectively. Conclusion In this paediatric-onset IBD population-based cohort, the most common comorbidities were infectious, dermatological, and pulmonary. Bacteraemia emerged as the most prevalent severe infectious event during follow-up, affecting 1.2% of patients.

Stratification of Kidney Transplant Recipients Into Five Subgroups Based on Temporal Disease Trajectories.

Kidney transplantation is the treatment of choice for patients with end-stage renal disease. Considerable clinical research has focused on improving graft survival and an increasing number of kidney recipients die with a functioning graft. There is a need to improve patient survival and to better understand the individualized risk of comorbidities and complications. Here, we developed a method to stratify recipients into similar subgroups based on previous comorbidities and subsequently identify complications and for a subpopulation, laboratory test values associated with survival. First, we identified significant disease patterns based on all hospital diagnoses from the Danish National Patient Registry for 5752 kidney transplant recipients from 1977 to 2018. Using hierarchical clustering, these longitudinal patterns of diseases segregate into 3 main clusters of glomerulonephritis, hypertension, and diabetes. As some recipients are diagnosed with diseases from >1 cluster, recipients are further stratified into 5 more fine-grained trajectory subgroups for which survival, stratified complication patterns as well as laboratory test values are analyzed. The study replicated known associations indicating that diabetes and low levels of albumin are associated with worse survival when investigating all recipients. However, stratification of recipients by trajectory subgroup showed additional associations. For recipients with glomerulonephritis, higher levels of basophils are significantly associated with poor survival, and these patients are more often diagnosed with bacterial infections. Additional associations were also found. This study demonstrates that disease trajectories can confirm known comorbidities and furthermore stratify kidney transplant recipients into clinical subgroups in which we can characterize stratified risk factors. We hope to motivate future studies to stratify recipients into more fine-grained, homogenous subgroups to better discover associations relevant for the individual patient and thereby enable more personalized disease-management and improve long-term outcomes and survival.

Healthcare Utilization Differences Among Primary Care Patients Using Telemedicine in the Veterans Health Administration: a Retrospective Cohort Study

BackgroundThe COVID-19 pandemic encouraged telemedicine expansion. Research regarding follow-up healthcare utilization and primary care (PC) telemedicine is lacking.ObjectiveTo evaluate whether healthcare utilization differed across PC populations using telemedicine.DesignRetrospective observational cohort study using administrative data from veterans with minimally one PC visit before the COVID-19 pandemic (March 1, 2019–February 28, 2020) and after in-person restrictions were lifted (October 1, 2020–September 30, 2021).ParticipantsAll veterans receiving VHA PC services during study period.Main MeasuresVeterans’ exposure to telemedicine was categorized as (1) in-person only, (2) telephone telemedicine (≥ 1 telephone visit with or without in-person visits), or (3) video telemedicine (≥ 1 video visit with or without telephone and/or in-person visits). Healthcare utilization 7 days after index PC visit were compared. Generalized estimating equations estimated odds ratios for telephone or video telemedicine versus in-person only use adjusted for patient characteristics (e.g., age, gender, race, residential rurality, ethnicity), area deprivation index, comorbidity risk, and intermediate PC visits within the follow-up window.Key ResultsOver the 2-year study, 3.4 million veterans had 12.9 million PC visits, where 1.7 million (50.7%), 1.0 million (30.3%), and 649,936 (19.0%) veterans were categorized as in-person only, telephone telemedicine, or video telemedicine. Compared to in-person only users, video telemedicine users experienced higher rates per 1000 patients of emergent care (15.1 vs 11.2; p < 0.001) and inpatient admissions (4.2 vs 3.3; p < 0.001). In adjusted analyses, video versus in-person only users experienced greater odds of emergent care (OR [95% CI]:1.18 [1.16, 1.19]) inpatient (OR [95% CI]: 1.29 [1.25, 1.32]), and ambulatory care sensitive condition admission (OR [95% CI]: 1.30 [1.27, 1.34]).ConclusionsTelemedicine potentially in combination with in-person care was associated with higher follow-up healthcare utilization rates compared to in-person only PC. Factors contributing to utilization differences between groups need further evaluation.

The Influence of Metabolic Syndrome on Potential Aging Biomarkers in Participants with Metabolic Syndrome Compared to Healthy Controls.

Biological aging is a physiological process that can be altered by various factors. The presence of a chronic metabolic disease can accelerate aging and increase the risk of further chronic diseases. The aim of the study was to determine whether the presence of metabolic syndrome (MetS) affects levels of markers that are associated with, among other things, aging. A total of 169 subjects (58 with MetS, and 111 without metabolic syndrome, i.e., non-MetS) participated in the study. Levels of telomerase, GDF11/15, sirtuin 1, follistatin, NLRP3, AGEs, klotho, DNA/RNA damage, NAD+, vitamin D, and blood lipids were assessed from blood samples using specific enzyme-linked immunosorbent assay (ELISA) kits. Telomerase (p < 0.01), DNA/RNA damage (p < 0.006) and GDF15 (p < 0.02) were higher in MetS group compared to non-MetS group. Only vitamin D levels were higher in the non-MetS group (p < 0.0002). Differences between MetS and non-MetS persons were also detected in groups divided according to age: in under 35-year-olds and those aged 35-50 years. Our results show that people with MetS compared to those without MetS have higher levels of some of the measured markers of biological aging. Thus, the presence of MetS may accelerate biological aging, which may be associated with an increased risk of chronic comorbidities that accompany MetS (cardiovascular, inflammatory, autoimmune, neurodegenerative, metabolic, or cancer diseases) and risk of premature death from all causes.

Societal costs of sepsis in the Netherlands

BackgroundSepsis is a life-threatening syndrome characterized by acute loss of organ function due to infection. Sepsis survivors are at risk for long-term comorbidities, have a reduced Quality of Life (QoL), and are prone to increased long-term mortality. The societal impact of sepsis includes its disease burden and indirect economic costs. However, these societal costs of sepsis are not fully understood. This study assessed sepsis’s disease-related and indirect economic costs in the Netherlands.MethodsSepsis prevalence, incidence, sepsis-related mortality, hospitalizations, life expectancy, QoL population norms, QoL reduction after sepsis, and healthcare use post-sepsis were obtained from previous literature and Statistics Netherlands. We used these data to estimate annual Quality-adjusted Life Years (QALYs), productivity loss, and increase in healthcare use post-sepsis. A sensitivity analysis was performed to analyze the burden and indirect economic costs of sepsis under alternative assumptions, resulting in a baseline, low, and high estimated burden. The results are presented as a baseline (low–high burden) estimate.ResultsThe annual disease burden of sepsis is approximately 57,304 (24,398–96,244; low–high burden) QALYs. Of this, mortality accounts for 26,898 (23,166–31,577) QALYs, QoL decrease post-sepsis accounts for 30,406 (1232–64,667) QALYs. The indirect economic burden, attributed to lost productivity and increased healthcare expenditure, is estimated at €416.1 (147.1–610.7) million utilizing the friction cost approach and €3.1 (0.4–5.7) billion using the human capital method. Cumulatively, the combined disease and indirect economic burdens range from €3.8 billion (friction method) to €6.5 billion (human capital method) annually within the Netherlands.ConclusionsSepsis and its complications pose a substantial disease and indirect economic burden to the Netherlands, with an indirect economic burden due to production loss that is potentially larger than the burden due to coronary heart disease or stroke. Our results emphasize the need for future studies to prevent sepsis, saving downstream costs and decreasing the economic burden.