European Journal of Internal Medicine最新文献

英文中文

Clinically relevant bleeding according to location of metastases in cancer-associated thrombosis 根据癌症相关血栓的转移位置确定临床相关出血。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.ejim.2024.10.019

Victor Garcia-Garcia , Maria Barca-Hernando , Sergio Lopez-Ruz , Carmen Rosa-Linares , Teresa Elias-Hernandez , Remedios Otero-Candelera , Henry Andrade-Ruiz , Luis Jara-Palomares

Background

Patients with cancer-associated thrombosis (CAT) face a heightened risk of clinically relevant bleeding (CRB). However, the relationship between these risks and the location of metastasis remains unclear.

Methods

A single-center, non-interventional study of consecutive patients was conducted between 2007 and 2022, involving patients with CAT (n = 1,277). Our primary objectives were: 1) To estimate the rate of CRB based on metastasis location. 2) To assess the long-term risk of CRB.

Results

Over a median follow-up of 14.2 months, 144 CRB were observed. The most frequent cancers were colon (19.2 %), lung (16.1 %), and breast (12.4 %). Fifty-two per-cent had metastases. Compared to patients without metastases, metastasis locations associated with CRB were lung metastases (rate 10.0 per 100 patients/year; 95 % confidence interval [CI] 6.6 to 14.6; risk ratio [RR]: 2; 95 % CI: 1.3–3.1), liver metastases (rate 10.1 per 100 patients/year; 95 % CI 6.5–14.9; RR: 2.0; 95 % CI: 1.3–3.2) and adenopathy metastases (rate 11.9 per 100 patients/year; 95 % CI 6.8–19.3; RR: 2.4; 95 % CI: 1.4–4.1). Multivariate analysis of variables associated to CRB at long term follow-up included ECOG > 1 (HR 3.0, 95 % CI 1.7–5.3), bladder cancer (HR 2.5, 95 % CI 1.3–4.8), prostate cancer (HR 2.2, 95 % CI 1.1–4.8) and lung metastases (HR 2.1, 95 % CI 1.3–3.6).

Conclusions

The bleeding rate seem differ depending on the location of metastasis. Additionally, lung metastasis was found to be associated with a long-term risk of CRB. These findings may justify the use of low dose of anticoagulation, although clinical trials need to demonstrate the efficacy and safety of this strategy.

背景：癌症相关血栓形成（CAT）患者面临着更高的临床相关出血（CRB）风险。然而，这些风险与转移位置之间的关系仍不清楚：2007年至2022年期间，我们对连续患者进行了一项单中心、非干预性研究，涉及CAT患者（n = 1,277）。我们的主要目标是1）根据转移位置估算 CRB 的发生率。2）评估CRB的长期风险：中位随访时间为 14.2 个月，共观察到 144 例 CRB。最常见的癌症是结肠癌（19.2%）、肺癌（16.1%）和乳腺癌（12.4%）。52%的患者有癌症转移。与没有转移的患者相比，与 CRB 相关的转移部位是肺转移（每 100 名患者/年的转移率为 10.0；95 % 置信区间 [CI] 为 6.6 至 14.6；风险比 [RR]：2；95 % CI：1.3-3.1）、肝转移（比率为每 100 例患者 10.1 例/年；95 % 置信区间 [CI] 6.5-14.9 ；RR：2.0；95 % CI：1.3-3.2）和腺病转移（比率为每 100 例患者 11.9 例/年；95 % 置信区间 [CI] 6.8-19.3 ；RR：2.4；95 % CI：1.4-4.1）。对长期随访中与 CRB 相关变量的多变量分析包括 ECOG > 1（HR 3.0，95 % CI 1.7-5.3）、膀胱癌（HR 2.5，95 % CI 1.3-4.8）、前列腺癌（HR 2.2，95 % CI 1.1-4.8）和肺转移（HR 2.1，95 % CI 1.3-3.6）：结论：转移部位不同，出血率也不同。结论：出血率似乎因转移部位而异，此外，肺转移与 CRB 的长期风险相关。这些发现可能证明使用小剂量抗凝治疗是合理的，但临床试验需要证明这一策略的有效性和安全性。

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引用次数: 0

Clinical characteristics and outcomes of Takotsubo syndrome in patients with chronic obstructive pulmonary disease 慢性阻塞性肺病患者塔克次氏综合征的临床特征和预后。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.ejim.2024.10.026

Luca Arcari , Giacomo Tini , Michela Zuccanti , Giovanni Camastra , Alessandro Cianca , Emanuela Belmonte , Giulio Montefusco , Riccardo Scirpa , Claudia Malerba , Fabrizio Lupparelli , Matteo Sclafani , Viviana Maestrini , Beatrice Musumeci , Emanuele Barbato , Luca Cacciotti

Background

takotsubo syndrome (TTS) is an acute heart failure syndrome characterized by a relevant comorbid background, including chronic obstructive pulmonary disease (COPD). However, TTS patients with COPD are still not well characterized.

Aim

to describe the clinical characteristics and outcomes of patients with TTS and COPD.

Methods

n = 440 TTS patients were dichotomized according to the presence of COPD. Endpoint of the study were in-hospital complications (composite of death, major arrhythmias, cardiogenic shock and acute pulmonary edema), TTS recurrence and long-term mortality at follow-up.

Results

mean age of the population was 72±11, 10 % males. COPD prevalence was 16 % (n = 69). On subgroup analysis, patients with COPD were more likely smokers (41 % vs 13 %, p < 0.001), with higher rates of dyspnea and physical triggers at presentation (52 % vs 18 %, p < 0.001 and 52 % vs 32 %, p = 0.001 respectively) and lower left ventricular ejection fraction (36 % vs 39 %, p = 0.035) In-hospital complications were more common in patients with COPD (26 % vs 13 %, p = 0.006), driven by higher rates of acute pulmonary edema (19 % vs 6 %, p < 0.001) and cardiogenic shock (10 % vs 4 %, p = 0.023). At multivariable logistic regression analysis, COPD was independently associated with in-hospital complications occurrence (Odds Ratio 2.10, 95 % CI 1.09–4.05; p = 0.027). At univariable Cox regression analysis COPD was associated with TTS recurrence (Hazard Ratio (HR 9.82, 95 % CI 3.2–30.12; p < 0.001)), at multivariable Cox regression analysis with long-term mortality (HR 2.97, 95 % CI 1.44–6.12; p = 0.003).

Conclusion

COPD marks a vulnerable TTS phenotype including higher risk of in-hospital complications, long-term recurrence and mortality.

背景：Takotsubo 综合征（TTS）是一种急性心力衰竭综合征，具有相关的合并症背景，包括慢性阻塞性肺疾病（COPD）。目的：描述 TTS 和 COPD 患者的临床特征和预后。方法：根据是否存在 COPD 对 n = 440 名 TTS 患者进行二分法。研究终点为院内并发症（死亡、严重心律失常、心源性休克和急性肺水肿的综合）、TTS复发和随访时的长期死亡率。慢性阻塞性肺病发病率为 16%（n = 69）。亚组分析显示，慢性阻塞性肺病患者更可能是吸烟者（41 % vs 13 %，p < 0.001），发病时呼吸困难和身体诱因的比例更高（分别为 52 % vs 18 %，p < 0.001 和 52 % vs 32 %，p = 0.001），左心室射血分数更低（36 % vs 39 %，p = 0.035）慢性阻塞性肺病患者的院内并发症更常见（26 % vs 13 %，p = 0.006），原因是急性肺水肿（19 % vs 6 %，p < 0.001）和心源性休克（10 % vs 4 %，p = 0.023）的发生率更高。在多变量逻辑回归分析中，慢性阻塞性肺病与院内并发症的发生有独立关联（Odds Ratio 2.10，95 % CI 1.09-4.05；p = 0.027）。在单变量 Cox 回归分析中，慢性阻塞性肺病与 TTS 复发相关（危险比 (HR 9.82, 95 % CI 3.2-30.12; p < 0.001)），在多变量 Cox 回归分析中与长期死亡率相关（HR 2.97, 95 % CI 1.44-6.12; p = 0.003）：结论：慢性阻塞性肺病标志着一种脆弱的 TTS 表型，包括较高的院内并发症、长期复发和死亡率风险。

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引用次数: 0

Diagnostic value of pleural calprotectin in differentiating complex parapneumonic effusions 胸膜钙蛋白在鉴别复杂性肺旁积液方面的诊断价值。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.ejim.2024.09.002

Ourania S. Kotsiou , Nikolaos D. Karakousis , Dimitrios Papagiannnis , Garyfallia Perlepe , Konstantinos I. Gourgoulianis

引用次数: 0

Hyperchloremic metabolic acidosis potentially benefiting sodium bicarbonate therapy: A multi-center cohort study 高胆红素血症代谢性酸中毒可能有益于碳酸氢钠治疗：一项多中心队列研究。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.ejim.2024.10.001

Lingfei Tong , Shuiyan Wu , Deping Li , Yanmei Cao , Huaqing Liu

Background

The use of sodium bicarbonate for metabolic acidosis has been a topic of debate, primarily due to the lack of clinical efficacy evidence. This study aims to identify which types of patients with various acid-base balance parameters can benefit from sodium bicarbonate therapy.

Methods

Patients diagnosed with metabolic acidosis were screened from a large multi-center critical care database to form a retrospective cohort. Mortality curves, logistic regression analysis, simulation methods, and propensity scores were used to compare data between sodium bicarbonate (SOB group) and non-treated (Non-SOB group) patients.

Results

There was an interaction between baseline chloride, anion gap levels and sodium bicarbonate therapy on patients' in-hospital death. As chloride levels increased, the in-hospital mortality curves of the SOB group and Non-SOB group gradually converged, with the difference narrowing from approximately 20 % to 10 %, and then gradually widened with the increase of the anion gap. Furthermore, when patients had high chloride levels (≥112 mmol/L), those in the SOB group exhibited a higher incidence of hypernatremia, hypokalemia, and hypocalcemia at 24 h, and a lower incidence of hyperchloremia. Patients in SOB group also had a lower simulated mortality. Among patients treated with sodium bicarbonate, those with low chloride had more difficulty in normalizing pH compared to those with high chloride.

Conclusions

This study identified an interaction between baseline chloride and sodium bicarbonate therapy on patient survival. Hyperchloremic metabolic acidosis may potentially benefit from sodium bicarbonate therapy. Further prospective randomized controlled studies are warranted.

背景：主要由于缺乏临床疗效证据，使用碳酸氢钠治疗代谢性酸中毒一直是一个争论不休的话题。本研究旨在确定哪些类型、不同酸碱平衡参数的患者可从碳酸氢钠治疗中获益：方法：从一个大型多中心重症监护数据库中筛选出被诊断为代谢性酸中毒的患者，组成一个回顾性队列。采用死亡率曲线、逻辑回归分析、模拟方法和倾向评分来比较碳酸氢钠治疗组（SOB 组）和非碳酸氢钠治疗组（Non-SOB 组）患者的数据：结果：基线氯化物、阴离子间隙水平和碳酸氢钠治疗对患者院内死亡之间存在交互作用。随着氯化物水平的增加，SOB 组和非 SOB 组的院内死亡率曲线逐渐趋同，差异从约 20% 缩小到 10%，然后随着阴离子间隙的增加而逐渐扩大。此外，当患者氯化物水平较高（≥112 mmol/L）时，SOB 组患者在 24 小时内出现高钠血症、低钾血症和低钙血症的几率较高，而出现高氯血症的几率较低。SOB 组患者的模拟死亡率也较低。在接受碳酸氢钠治疗的患者中，与高氯化物患者相比，低氯化物患者更难使pH值恢复正常：这项研究确定了基线氯化物和碳酸氢钠治疗对患者存活率的影响。高氯代谢性酸中毒可能会从碳酸氢钠治疗中获益。有必要进一步开展前瞻性随机对照研究。

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引用次数: 0

Associations of cardiovascular health and exercise capacity with moderate-to-vigorous physical activity prior to enrolment to cardiac rehabilitation in coronary artery disease patients 心血管健康和运动能力与冠状动脉疾病患者心脏康复前中等至剧烈身体活动的关系

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.ejim.2024.12.030

Tim Kambič , Esmée A. Bakker , Thijs M.H. Eijsvogels , Vedran Hadžić , Mitja Lainscak

引用次数: 0

Different impact of chronic kidney disease in older patients with heart failure according to frailty 慢性肾病对老年心力衰竭患者的影响因体弱程度而异。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.ejim.2024.12.001

Pablo Díez-Villanueva , César Jiménez-Méndez , Ángel Pérez-Rivera , Eduardo Barge Caballero , Javier López , Carolina Ortiz , Clara Bonanad , Josebe Goirigolzarri , Alberto Esteban Fernández , Marta Cobo , Nuria Montes , Albert Ariza-Solé , Manuel Martínez-Sellés , Fernando Alfonso

Background

Chronic kidney disease (CKD) and frailty are often present in older patients with heart failure (HF). Our aim was to evaluate the association of CKD and frailty in one-year mortality in a cohort of older (≥75 years) outpatients with HF

Methods

Our data come from the FRAGIC study (“impacto de la FRAGilidad y otros síndromes Geriátricos en el manejo clínico y pronóstico del paciente anciano ambulatorio con Insuficiencia Cardíaca"), a multicenter prospective registry conducted in 16 cardiology services in Spain which included ≥75 years outpatients with HF. Renal function was assessed according to CKD-EPI formula. A comprehensive geriatric assessment was performed and frailty was identified according to visual mobility scale (frail if VMS≥2). Survival rates were analyzed by Cox regression model.

Results

We included 499 patients, mean age 81.4 ± 4.3 years, 38 % women. Mean estimated glomerular filtration rate (eGFR) was 52.1 ± 17.5 ml/min/1.72 m². Patients were classified in normal renal function (eGFR≥60 ml/min/1.72m², 182 patients, 36 %), moderately impaired (eGFR 30–59 ml/min/1.72m², 261 patients, 52.7 %) and severely impaired (eGFR<30 ml/min/1.72m², 56 patients, 11.3 %). Patients with severe CKD were older, more often female, and presented a worse clinical profile, with higher comorbidity burden and frailty. After a median follow up of 371 days, 58 patients (11.6 %) died. Mortality was higher in patients with worse renal function (8.8 %, 11 % and 21 % according to renal function subgroups, respectively, p = 0.036) and frailty in the univariate analysis. However, only frailty, according to VMS, but not severe renal dysfunction, was independently associated with one year mortality.

Conclusions

Most HF patients≥75 years have renal dysfunction. CKD is a marker of worse prognosis in elderly patients with chronic HF, but it does not independently associate one-year mortality in the presence of frailty.

背景：慢性肾脏疾病（CKD）和虚弱常存在于老年心力衰竭（HF）患者中。方法：我们的数据来自FRAGIC研究（“FRAGilidad y otros的影响síndromes Geriátricos en el manejo clínico y pronóstico del paciente anciano ambulatorio不充分Cardíaca”），这是一项多中心前瞻性登记研究，在西班牙的16个心脏病中心进行，其中包括≥75岁的HF门诊患者。根据CKD-EPI公式评估肾功能。进行全面的老年评估，并根据视觉活动能力量表（VMS≥2则虚弱）确定虚弱。生存率采用Cox回归模型分析。结果：纳入499例患者，平均年龄81.4±4.3岁，女性占38%。平均估计肾小球滤过率（eGFR）为52.1±17.5 ml/min/1.72 m2。患者分为肾功能正常（eGFR≥60 ml/min/1.72m2, 182例，36%）、中度肾功能受损（eGFR 30-59 ml/min/1.72m2, 261例，52.7%）、重度肾功能受损（eGFR2, 56例，11.3%）。严重CKD患者年龄较大，多为女性，临床表现较差，合并症负担和虚弱程度较高。中位随访371天后，58例患者（11.6%）死亡。单因素分析中，肾功能较差（按肾功能亚组分别为8.8%、11%和21%，p = 0.036）和虚弱的患者死亡率较高。然而，根据VMS，只有虚弱，而不是严重的肾功能不全，与1年死亡率独立相关。结论：大多数≥75岁的HF患者存在肾功能不全。CKD是老年慢性心衰患者预后较差的一个标志，但在存在虚弱的情况下，它并不能独立地与一年死亡率相关。

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引用次数: 0

Outcomes and readmissions in octogenarians and nonagenarians undergoing catheter ablation for atrial fibrillation in the United States.

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-01-31 DOI: 10.1016/j.ejim.2025.01.025

Siddharth Agarwal, Usama Qamar, Charu Debnath

引用次数: 0

Beyond creatinine: New methods to measure renal function? 肌酐之外：测量肾功能的新方法？

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-01-31 DOI: 10.1016/j.ejim.2025.01.015

M Salman Sheikh, Kianoush B Kashani

Accurate assessment of kidney function is essential for diagnosing and managing chronic kidney disease (CKD) and acute kidney injury (AKI), adjusting drug dosages, and predicting clinical outcomes. Despite its ubiquitous use, serum creatinine has significant limitations, necessitating the exploration of alternative and complementary biomarkers and technologies. This review revisits the benefits and limitations of serum creatinine, explores other kidney function biomarkers such as Cystatin C and ProEnkephalin, and examines traditional gold-standard techniques, including creatinine clearance, radioisotopes, and inulin clearance. Furthermore, it highlights innovations in real-time glomerular filtration rate (GFR) measurement, such as transdermal monitoring using MB-102 and dual fluorescent tracers. We conclude with a discussion on the development, validation, and clinical integration of these advancements, which may redefine renal function assessment in the years to come.

引用次数: 0

Lipoprotein(a) and prothrombotic effects: Evidence from a genetic association study: Prothrombotic effects of lipoprotein(a). 脂蛋白（a）和促血栓形成作用：遗传关联研究的证据：脂蛋白（a）的促血栓形成作用。

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-01-31 DOI: 10.1016/j.ejim.2025.01.021

Elena Olmastroni, Julius L Katzmann, Federica Galimberti, Ulrich Laufs, Alberico L Catapano

Background: It is unknown whether lipoprotein(a) [Lp(a)] has prothrombotic effects contributing to its association with the risk of myocardial infarction (MI).

Methods: In 410,177 participants of UK Biobank, associations of LPA genetic variants and observed Lp(a) concentrations with the risk of venous thromboembolism (VTE) and MI were investigated, stratified by scores of genetic variants influencing coagulation through the thrombin and platelet pathways (denoted as F2/F5 and GUCY1A3 scores, respectively). Risk estimates are expressed as hazard ratio (HR) and 95% confidence interval (95% CI).

Results: Neither LPA genetic variants nor observed Lp(a) concentration were associated with the risk of incident VTE (HR per 100 nmol/L higher Lp(a) 1.02, 95% CI 1.00-1.04, p=0.13). In contrast, there was a strong association with the risk of incident MI (HR per 100 nmol/L higher Lp(a) 1.31, 95% CI 1.29-1.33, p<0.001). The F2/F5 score was associated with a stepwise decrease in the risk of VTE, and the GUCY1A3 score with a stepwise decrease in the risk of MI. However, the associations of LPA genetic variants and observed Lp(a) concentrations with the risk of MI were not modified by stratification for either of the coagulation scores.

Conclusion: The association between Lp(a) and MI was not modified by genetically determined levels of coagulation activity through the thrombin or platelet pathway. Our findings do not support the notion that the increased risk of MI caused by elevated Lp(a) is due to prothrombotic effects.

{"title":"Lipoprotein(a) and prothrombotic effects: Evidence from a genetic association study: Prothrombotic effects of lipoprotein(a).","authors":"Elena Olmastroni, Julius L Katzmann, Federica Galimberti, Ulrich Laufs, Alberico L Catapano","doi":"10.1016/j.ejim.2025.01.021","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.01.021","url":null,"abstract":"<p><strong>Background: </strong>It is unknown whether lipoprotein(a) [Lp(a)] has prothrombotic effects contributing to its association with the risk of myocardial infarction (MI).</p><p><strong>Methods: </strong>In 410,177 participants of UK Biobank, associations of LPA genetic variants and observed Lp(a) concentrations with the risk of venous thromboembolism (VTE) and MI were investigated, stratified by scores of genetic variants influencing coagulation through the thrombin and platelet pathways (denoted as F2/F5 and GUCY1A3 scores, respectively). Risk estimates are expressed as hazard ratio (HR) and 95% confidence interval (95% CI).</p><p><strong>Results: </strong>Neither LPA genetic variants nor observed Lp(a) concentration were associated with the risk of incident VTE (HR per 100 nmol/L higher Lp(a) 1.02, 95% CI 1.00-1.04, p=0.13). In contrast, there was a strong association with the risk of incident MI (HR per 100 nmol/L higher Lp(a) 1.31, 95% CI 1.29-1.33, p<0.001). The F2/F5 score was associated with a stepwise decrease in the risk of VTE, and the GUCY1A3 score with a stepwise decrease in the risk of MI. However, the associations of LPA genetic variants and observed Lp(a) concentrations with the risk of MI were not modified by stratification for either of the coagulation scores.</p><p><strong>Conclusion: </strong>The association between Lp(a) and MI was not modified by genetically determined levels of coagulation activity through the thrombin or platelet pathway. Our findings do not support the notion that the increased risk of MI caused by elevated Lp(a) is due to prothrombotic effects.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Building on the UTILY Study: Exploring uncharted aspects of multidrug-resistant pathogens in urinary tract infections.

IF 5.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Internal Medicine

Pub Date : 2025-01-31 DOI: 10.1016/j.ejim.2025.01.026

Heng Xiao, Wen Xiao, Xinmin Deng

引用次数: 0

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