The American journal of the medical sciences最新文献

Background and aims: Type 2 diabetes mellitus (DM) is a modifiable risk factor for atrial fibrillation (AF). Some fibrotic and inflammatory markers associated with DM may contribute to structural fibrosis and electrical remodeling in AF. This cross-sectional study aimed to assess the pathophysiological interrelationships between DM and AF by comparing diverse circulating and cardiac structural markers in patients diagnosed with either condition or both.

Methods and results: Data were collected retrospectively from the medical records of 647 eligible adults: DM group (n = 192, mean age 55 years), AF group (n = 160, 61.8 years), AF+DM group (n = 154, 64.2 years), and control group (n = 141, 51.2 years). Additional biomarkers (transforming growth factor-β1 (TGF-β1) and glycated albumin) were determined from blood specimens in a subgroup of participants. AF patients exhibited lower levels of HDL, LDL and total cholesterol relative to controls, regardless of DM status. LDL-cholesterol was significantly more depressed in AF patients, particularly those with co-occurring DM. Triglyceride, fasting plasma glucose and HbA1c levels did not differ in the AF and control groups, and were the highest in the DM group, followed by AF+DM patients. TGF-β1 was depressed in AF patients, in contrast to its moderate level in AF+DM patients. Creatinine was significantly more elevated in AF patients, especially those with DM. AF patients also exhibited left atrial and ventricular enlargement, whether or not DM co-occurred.

Conclusions: Findings suggest differential relationships between DM and AF with additive or interactive effects on some markers, including LDL, creatinine and TGF-β1, which could result in excess risk of adverse outcomes.

Background: Evusheld®, a combination of monoclonal antibodies Tixagevimab and Cilgavimab, was developed for pre-exposure prophylaxis (PrEP) of coronavirus disease 2019 (COVID-19) in immunocompromised patients. However, real-world long-term data on its effectiveness against SARS-CoV-2 Omicron variants remain limited.

Methods: A retrospective cohort was conducted on patients ≥18 years old who received the Evusheld from December 1, 2021, to January 31, 2023, at six Ascension hospitals in Southeast Michigan. Patients included were those with active solid tumor and hematologic malignancies or undergoing immunosuppressive treatment, including CAR-T therapy, biologic agents, or high-dose corticosteroids (≥20 mg prednisone or equivalent per day for ≥2 weeks). Data collected included patient demographics, development of COVID-19 post-Evusheld, ICU length of stay (LOS), hospital LOS, ventilation requirement and duration, and mortality within six months post-therapy.

Results: Among 663 patients screened, 316 were included after excluding duplicates and patients that did not receive the ordered Evusheld regimen. Among them, 204 patients received two doses of Evusheld and 112 received only one dose. In the two-dose group, 18 (8.8%) tested positive for COVID-19 within 180 days post-Evusheld, while 11 (9.8%) in the one-dose group tested positive. Notably, none of the COVID-positive patients in either group required hospitalization, mechanical ventilation, or succumbed to the disease.

Conclusions: Within six months of Evusheld administration, immunocompromised patients showed no episodes of rehospitalization, mechanical ventilation, or death, and experienced low rates of severe COVID-19.

Background: Diabetes mellitus (DM) is a key risk factor for atherosclerotic cardiovascular diseases (ASCVDs), which remain a leading cause of morbidity and mortality worldwide. We aim to evaluate trends and disparities in ASCVD-related mortality in US adults aged 45+ with DM from 1999-2019.

Methods: We extracted data from the CDC WONDER database using ICD-10 codes E10-E14 for DM and I25.0 and I25.1 for ASCVDs. Age-adjusted mortality rates (AAMRs) and crude death rates (CDRs) per 100,000 by sex, race/ethnicity, age group, and geographic regions were used. AAMRs and CDRs were analyzed using the Joinpoint Regression Program to calculate annual percentage changes (APCs) and average APCs (AAPCs).

Results: From 1999 to 2019, 453,572 ASCVD-related deaths occurred in 45+ year adults with DM. Overall, AAMR decreased from 22.22 to 16.11 [AAPC: -1.63 %, (-1.83 to -1.47)]. Females experienced a larger decline (AAPC -2.76 %) than males (-0.80 %). By race/ethnicity, non-Hispanic American Indians/Alaska Natives had the highest AAMR (32.36), and Asian/Pacific Islanders the lowest (12.85); Hispanics saw the steepest decline (-3.41 %). CDRs rose with age, from 3.16 (45-54 years) to 84.17 (85+), with the greatest decrease in the 65-74 group (-2.04 %). Regionally, the Midwest had the highest AAMR (19.86), and the South had the smallest decline (-1.44 %). Non-metropolitan areas had higher AAMRs (20.33) and smaller declines (-0.52 %) than metropolitan areas (18.17; -1.94 %).

Conclusions: Our study reveals a decline in ASCVD-related mortality in DM patients in the US from 1999-2019. However, marked disparities persist across demographics and regions. Targeted health policy measures are needed to address these disparities.

Background: Diabetes mellitus (DM) is a metabolic disorder that lacks specific early diagnostic markers and is often associated with serious complications and comorbidities. The triglyceride-glucose index (TyG) and the triglyceride-glucose-body mass index (TyG-BMI) are key metabolic indicators related to insulin resistance and β-cell dysfunction. However, their association with the development of type 2 diabetes mellitus (T2DM) remains unclear. This study aimed to examine the relationship between TyG and TyG-BMI levels and the incidence of T2DM, evaluate their predictive performance, and support the identification of populations at high risk for T2DM.

Methods: Data were obtained from the 2009 China Health and Nutrition Survey (CHNS), including 9498 participants. TyG and TyG-BMI were calculated, and their associations with T2DM risk were assessed using a Cox regression model. Predictive performance was evaluated with receiver operating characteristic (ROC) curve analysis.

Results: In the overall population, including both sexes, individuals aged >50 years and ≤50 years, and both urban and rural residents, higher TyG and TyG-BMI levels were independently associated with T2DM, showing a linear dose-response relationship. Both indicators demonstrated predictive value for T2DM, with TyG-BMI showing stronger associations, a larger area under the ROC curve, and greater clinical relevance.

Conclusions: These results suggest that both TyG and TyG-BMI are useful predictors of T2DM, with TyG-BMI providing superior predictive accuracy. These findings support the use of these indices in the early screening of high-risk T2DM populations.

Background: Frailty has been linked to worse health outcomes, longer hospital stays, higher complications, and mortality. In general, higher morbidity and mortality especially with any invasive cardiac procedure. The impact of frailty on TEER of MR is further explored in this study.

Methods: The NRD was queried between 2016-2020 to compare different outcomes between LF vs HF who underwent TEER. The multivariate regression was used to compare the primary and secondary outcomes between the two cohorts and generate univariate and multivariate odd ratios (OR) . STATA V.17 was used to compute the analysis.

Results: The total patients were 27,062 (HF 7,456 & LF 19,606). The mean age was 81.9±7.4 and 77.2±8.6 (P<0.001) in HF vs LF, respectively. The average LOS was higher in HF at 9.22±10.58 vs 2.12±2.7 days in LF. HF had higher and statistically significant values for the following outcomes in comparison with LF: in-hospital mortality (OR 21, [13.07-33.71,] P<0.001), AKI (OR 15.91, [13.49-18.77], P<0.001), CHF (OR 1.4, [1.17-1.68], P<0.001), MI (OR 8.42, [5.44-13.03], P<0.001), needs of MCS (OR 13.27, [8.28-21.25], P<0.001), MACCE (OR 14.13, [11.03-18.1], P<0.001), PPB (OR 2.42, [1.72-3.42], P<0.001), and CT (OR 3.99, [2.22-7.15], P<0.001). The median total cost of hospitalization was higher in HF patients ($51,374 [IQR 37,277-75,989]) in comparison with LF patients ($38,492 [IQR 29,713-50,030], P<0.001).

Conclusion: HF individuals who underwent TEER of MR have higher in-hospital mortality, worse health outcomes and complications, longer hospital stay, and hence higher total healthcare costs in comparison with LF patients.

Background: Septic shock is a leading cause of mortality. Yet, blood cultures are negative in many cases, questioning the diagnosis. In the quest for characterization of "culture negative septic shock", the impact of chronic vasodilating medications was questioned.

Methods: This was a retrospective analysis of patients with vital signs compatible with septic shock (fever > 37.9 or < 36 °C and systolic blood pressure < 90 mmHg).

Results: The study included 3,726 patients (ages 65 to 90). Of these, 1,382 (37.1%) took chronic vasodilators. This group of patients had a lower rate of positive blood cultures compared to the group that did not receive vasodilators (28.5% vs. 32%; P = 0.026). They were older (median 80 vs. 78 years; P = 0.001), and their background included more cardiovascular diseases (P < 0.001). Their total length of hospital stay was shorter (median 4 vs. 6 days; P < 0.001) yet, they had a higher risk of in-hospital mortality (39% vs. 35.1%; P = 0.019). Taking chronic vasodilators was associated with decreased risk for bacteremia by 16% (P = 0.023). Older age, positive bacterial culture, and chronic vasodilation treatment were independently associated with increased risk for in-hospital mortality by 3% (HR = 1.03, 95% CI 1.02 - 1.04; P < 0.001), 36% (HR = 1.36, 95% CI 1.18 - 1.57; P < 0.001), and 21% (HR = 1.21, 95% CI 1.05 - 1.4; P = 0.009) respectively.

Conclusions: Chronic use of vasodilators amongst elderly patients presenting with fever and hypotension is associated with a higher incidence of negative blood cultures. We suggest these patients exhibit a combination of sepsis and shock rather than frank septic shock.

Cardiac Sarcoidosis (CS) is a potentially life-threatening manifestation of sarcoidosis that presents significant diagnostic and management challenges. While only 2-5 % of patients with sarcoidosis are diagnosed with CS, autopsy studies have demonstrated a prevalence as high as 25 % suggesting the condition is often under recognized likely because of lack of or nonspecific symptoms or diagnostic limitations. Considering the unreliability and invasiveness of endomyocardial biopsy, cardiac magnetic resonance imaging (CMR) and Fluorodeoxyglucose F18 (FDG) positron emission tomography (PET) have become useful diagnostic modalities in suspected cases of CS. However, there is scarce data in support of one imaging modality over the other and each has its limitations. Such limitations are depicted in the case of a patient with complete heart block and newly diagnosed sarcoidosis showing conflicting results on FDG-PET and CMR. A narrative review of current knowledge on this condition and about the imaging modalities available for the workup of CS is provided.

Objective: Sepsis remains a major global health challenge, with high mortality associated with multi-organ dysfunction, faster identification and assessment of sepsis is beneficial to guide treatment. Studies have found changes in the composition of bile acids (BAs) in the serum and stool of patients with sepsis compared to healthy individuals, so we sought to explore changes in serum BAs in patients with sepsis and their correlation with prognosis.

Methods: This prospective study enrolled healthy individuals and sepsis patients admitted to the Intensive Care Unit of the Second Affiliated Hospital of Nanjing Medical University between January 2023 and January 2024. Clinical data were collected, and serum levels of 15 BAs were quantified using liquid chromatography-tandem mass spectrometry. Patients were categorized into groups based on 28-day outcomes, severity of illness, and infection source for subsequent analysis.

Results: Compared with healthy individuals, the secondary BAs in sepsis patients were significantly lower, among which ursodeoxycholic acid (UDCA) is below the reference range. Compared with the survivors, the taurocholic acid (TCA) and taurodeoxycholic acid (TDCA) of the non-survivors of sepsis were significantly increased, while the UDCA was further decreased. Patients with pulmonary infection exhibited higher overall BA levels than those with abdominal infection. Both TCA and TDCA correlated positively with bilirubin, while UDCA correlated negatively with SOFA scores, C-reactive protein, and procalcitonin. In univariate COX regression, UDCA was associated with 28-day mortality (HR =0.990, P=0.042). ROC analysis showed that the area under the curve for UDCA predicting 28-day mortality was 0.643 (P=0.034).

Conclusions: Secondary BAs were significantly reduced in sepsis patients, with UDCA showing the most pronounced decrease. This reduction becomes even more substantial in non-survivors. The overall BA levels were significantly higher in patients with pulmonary infection than in those with abdominal infection. UDCA was negatively correlated with SOFA score, CRP, and PCT in sepsis patients, and combining it with other indicators improves the prediction of sepsis prognosis. These results indicate that UDCA may exert a protective effect in sepsis.