scholarly journals Diagnostic Accuracy with Total Adenosine Deaminase as a Biomarker for Discriminating Pleural Transudates and Exudates in a Population-Based Cohort Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Bernardo Henrique Ferraz Maranhão ◽  
Cyro Teixeira da Silva Junior ◽  
Jorge Luiz Barillo ◽  
Carmem Lucia Teixeira de Castro ◽  
Joeber Bernardo Soares de Souza ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adenosine Deaminase ◽  
Pleural Fluid ◽  
Positive Likelihood Ratio ◽  
Initial Step ◽  
Population Based ◽  
Internal Validation ◽  
Study Results ◽  
Significant Difference ◽  
Untreated Individuals

Background. An initial step in the evaluation of patients with pleural effusion syndrome (PES) is to determine whether the pleural fluid is a transudate or an exudate. Objectives. To investigate total adenosine deaminase (ADA) as a biomarker to classify pleural transudates and exudates. Methods. An assay of total ADA in pleural fluids (P-ADA) was observed using a commercial kit in a population-based cohort study. Results. 157 pleural fluid samples were collected from untreated individuals with PES due to several causes. The cause most prevalent in transudate samples (21%, n = 33 / 157 ) was congestive heart failure (79%, 26/33) and that among exudate samples (71%, n = 124 / 157 ) was tuberculosis (28.0%, 44/124). There was no significant difference in the proportion of either sex between the transudate and exudate groups. The median values of P-ADA were significantly different ( P < 0.0001 ) between both total exudates (18.4 U/L; IQR, 9.85-41.4) and exudates without pleural tuberculosis (11.0 U/L; IQR, 7.25-19.75) and transudates (6.85; IQR, 2.67-11.26). For exudates, the AUC was 0.820 (95% CI, 0.751-0.877; P < 0.001 ), with excellent discrimination. The optimum cut-off point in the ROC curve was determined as the level that provided the maximum positive likelihood ratio (PLR; 14.64; 95% CI, 2.11-101.9) and was22.0 U/L. For transudates, the AUC was 0.8245 (95% CI, 0.7470-0.9020; P < 0.0001 ). Internal validation of the AUC after 1000 resamples was evaluated with a tolerance minor than 2%. The clinical utility was equal to 92% (95% CI, 0.84 to 0.96, P < 0.05 ).Conclusions. P-ADA is a useful biomarker for distinguishing pleural exudates from transudates.

Cardiovascular Risk Associated With Ibrutinib Use in Chronic Lymphocytic Leukemia: A Population-Based Cohort Study

2021 ◽  
pp. JCO.21.00693
Author(s):  
Husam Abdel-Qadir ◽  
Nasruddin Sabrie ◽  
Darryl Leong ◽  
Andrea Pang ◽  
Peter C. Austin ◽  
...  
Keyword(s):  
Health Care ◽  
Cohort Study ◽  
Chronic Lymphocytic Leukemia ◽  
Index Date ◽  
Population Based ◽  
Lymphocytic Leukemia ◽  
Administrative Databases ◽  
Time Varying ◽  
Significant Difference ◽  
Ischemic Events

PURPOSE Ibrutinib reduces mortality in chronic lymphocytic leukemia (CLL). It increases the risk of atrial fibrillation (AF) and bleeding and there are concerns about heart failure (HF) and central nervous system ischemic events. The magnitude of these risks remains poorly quantified. METHODS Using linked administrative databases, we conducted a population-based cohort study of Ontario patients who were treated for CLL diagnosed between 2007 and 2019. We matched ibrutinib-treated patients with controls treated with chemotherapy but unexposed to ibrutinib on prior AF, age ≥ 66 years, anticoagulant exposure, and propensity for receiving ibrutinib. Study outcomes were AF-related health care contact, hospital-diagnosed bleeding, new diagnoses of HF, and hospitalizations for stroke and acute myocardial infarction (AMI). The cumulative incidence function was used to estimate absolute risks. We used cause-specific regression to study the association of ibrutinib with bleeding rates, while adjusting for anticoagulation as a time-varying covariate. RESULTS We matched 778 pairs of ibrutinib-treated and unexposed patients with CLL (N = 1,556). The 3-year incidence of AF-related health care contact was 22.7% (95% CI, 19.0 to 26.6) in ibrutinib-treated patients and 11.7% (95% CI, 9.0 to 14.8) in controls. The 3-year risk of hospital-diagnosed bleeding was 8.8% (95% CI, 6.5 to 11.7) in ibrutinib-treated patients and 3.1% (95% CI, 1.9 to 4.6) in controls. Ibrutinib-treated patients were more likely to start anticoagulation after the index date. After adjusting for anticoagulation as a time-varying covariate, ibrutinib remained positively associated with bleeding (HR, 2.58; 95% CI, 1.76 to 3.78). The 3-year risk of HF was 7.7% (95% CI, 5.4 to 10.6%) in ibrutinib-treated patients and 3.6% (95% CI, 2.2 to 5.4) in controls. There was no significant difference in the risk of ischemic stroke or AMI. CONCLUSION Ibrutinib is associated with higher risk of AF, bleeding, and HF, but not AMI or stroke.

scholarly journals Abatacept initiation in rheumatoid arthritis and the risk of cancer: a population-based comparative cohort study

Rheumatology ◽  
2018 ◽  
Vol 58 (4) ◽  
pp. 683-691 ◽  
Author(s):  
François Montastruc ◽  
Christel Renoux ◽  
Sophie Dell’Aniello ◽  
Teresa A Simon ◽  
Laurent Azoulay ◽  
...  
Keyword(s):  
Cohort Study ◽  
Skin Cancer ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Non Melanoma Skin Cancer ◽  
Increased Risk ◽  
Significant Difference ◽  
Specific Cancer ◽  
Risk Of Cancer ◽  
Melanoma Skin

Abstract Objective To assess whether abatacept as initial biological DMARD (bDMARD) in the treatment of RA, when compared with other bDMARDs, is associated with an increased risk of cancer overall and by specific cancer sites (breast, lung, lymphoma, melanoma and non-melanoma skin cancer). Methods We performed a population-based cohort study among patients newly treated with bDMARDs within the US-based Truven MarketScan population and Supplemental US Medicare from 2007 to 2014. Cox proportional hazards models were used to estimate hazard ratios and 95% CIs of any cancer (and specific cancers) associated with initiation of abatacept, compared with initiation of other bDMARDs, adjusted for age and deciles of the propensity score. Results The cohort included 4328 patients on abatacept and 59 860 on other bDMARDs, of whom 409 and 4197 were diagnosed with any cancer during follow-up (incidence rates 4.76 per 100 per year and 3.41 per 100 per year, respectively). Compared with other bDMARDs, the use of abatacept was associated with an increased incidence of cancer overall (hazard ratioadjusted 1.17; 95% CI 1.06, 1.30). Analyses by specific cancer sites showed a significantly increased incidence of non-melanoma skin cancer (hazard ratioadjusted 1.20; 95% CI 1.03, 1.39), but no significant difference for other specific cancer sites. Conclusion The use of abatacept as first bDMARD in the treatment of RA was associated with a slight increased risk of cancer overall and particularly non-melanoma skin cancer, compared with other bDMARDs. This potential signal needs to be replicated in other settings.

scholarly journals Association of Fenofibrate and Diabetic Retinopathy in Type 2 Diabetic Patients: A Population-Based Retrospective Cohort Study in Taiwan

Medicina ◽  
2020 ◽  
Vol 56 (8) ◽  
pp. 385
Author(s):  
Ying-Chieh Lin ◽  
Yu-Ching Chen ◽  
Jorng-Tzong Horng ◽  
Jui-Ming Chen
Keyword(s):  
Diabetic Retinopathy ◽  
Cohort Study ◽  
Laser Treatment ◽  
Population Based ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Significant Difference ◽  
Type 2 Diabetic

Background and Objectives: Fenofibrate, a PPAR-α agonist, has been demonstrated to reduce the progression of diabetic retinopathy (DR) and the need for laser treatment in a FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) study. However, in the subgroup of patients without pre-existing DR, there was no significant difference in the progression of DR between the fenofibrate group and the placebo group. In this study, we aim to investigate whether fenofibrate can decrease the risk of incident DR in a population-based cohort study of type 2 diabetic patients in Taiwan. Materials and Methods: A total of 32,253 type 2 diabetic patients without previous retinopathy were retrieved from 892,419 patients in 2001–2002. They were then divided into two groups based on whether they were exposed to fenofibrate or not. The patients were followed until a diagnosis of diabetic retinopathy was made or until the year 2008. Results: With a follow-up period of 6.8 ± 1.5 years and 5.4 ± 2.6 years for 2500 fenofibrate users and 29,753 non-users, respectively, the Cox proportional hazard regression analysis revealed that the hazard ratio (HR) of new onset retinopathy was 0.57 (95% CI 0.57–0.62, p < 0.001). After adjusting for hypertension; the Charlson comorbidity index (CCI); and medications such as angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), anticoagulants, gemfibrozil, statins, and hypoglycemic agents, the adjusted HR was 0.75 (95% CI 0.68–0.82, p < 0.001). The need for laser treatment has an HR and adjusted HR of 0.59 (95% CI 0.49–0.71, p < 0.001) and 0.67 (95% CI 0.56–0.81, p < 0.001), respectively. Conclusion: Our study showed that the long-term and regular use of fenofibrate may decrease the risk of incident retinopathy and the need for laser treatment in type 2 diabetic patients. Since there are limitations associated with our study, further investigations are necessary to confirm such an association.

scholarly journals Outcomes of an Inpatient Dialysis Start in Patients With Kidney Graft Failure: A Population-Based Multicentre Cohort Study

2021 ◽  
Vol 8 ◽  
pp. 205435812098537
Author(s):  
Kyla L. Naylor ◽  
Gregory A. Knoll ◽  
Eric McArthur ◽  
Amit X. Garg ◽  
Ngan N. Lam ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cumulative Incidence ◽  
Graft Failure ◽  
Population Based ◽  
Hospital Inpatient ◽  
Kidney Graft ◽  
Kidney Transplant Recipients ◽  
Increased Risk ◽  
Significant Difference ◽  
All Cause Mortality

Background: The frequency and outcomes of starting maintenance dialysis in the hospital as an inpatient in kidney transplant recipients with graft failure are poorly understood. Objective: To determine the frequency of inpatient dialysis starts in patients with kidney graft failure and examine whether dialysis start status (hospital inpatient vs outpatient setting) is associated with all-cause mortality and kidney re-transplantation. Design: Population-based cohort study. Setting: We used linked administrative healthcare databases from Ontario, Canada. Patients: We included 1164 patients with kidney graft failure from 1994 to 2016. Measurements: All-cause mortality and kidney re-transplantation. Methods: The cumulative incidence function was used to calculate the cumulative incidence of all-cause mortality and kidney re-transplantation, accounting for competing risks. Subdistribution hazard ratios from the Fine and Gray model were used to examine the relationship between inpatient dialysis starts (vs outpatient dialysis start [reference]) and the dependent variables (ie, mortality or re-transplant). Results: We included 1164 patients with kidney graft failure. More than half (55.8%) of patients with kidney graft failure, initiated dialysis as an inpatient. Compared with outpatient dialysis starters, inpatient dialysis starters had a significantly higher cumulative incidence of mortality and a significantly lower incidence of kidney re-transplantation ( P < .001). The 10-year cumulative incidence of mortality was 51.9% (95% confidence interval [CI]: 47.4, 56.9%) (inpatient) and 35.3% (95% CI: 31.1, 40.1%) (outpatient). After adjusting for clinical characteristics, we found inpatient dialysis starters had a significantly increased hazard of mortality in the first year after graft failure (hazard ratio: 2.18 [95% CI: 1.43, 3.33]) but at 1+ years there was no significant difference between groups. Limitations: Possibility of residual confounding and unable to determine inpatient dialysis starts that were unavoidable. Conclusions: In this study we identified that most patients with kidney graft failure had inpatient dialysis starts, which was associated with an increased risk of mortality. Further research is needed to better understand the reasons for an inpatient dialysis start in this patient population.

scholarly journals Diagnostic significance of pleural fluid adenosine deaminase activity in tuberculous pleurisy

1970 ◽  
Vol 5 (1) ◽  
pp. 1-5
Author(s):  
Sharmeen Ahmed ◽  
Reaz Fatema ◽  
Ahmed Abu Saleh ◽  
Mumayun Sattar ◽  
Md Ruhul Amin Miah
Keyword(s):  
Pleural Effusion ◽  
Adenosine Deaminase ◽  
Pleural Fluid ◽  
Colorimetric Method ◽  
Diagnostic Methods ◽  
Test Accuracy ◽  
Diagnostic Significance ◽  
Tuberculous Pleural Effusion ◽  
Adenosine Deaminase Activity ◽  
Significant Difference

Diagnosis of tuberculous pleural effusion (TPE) is difficult because of its non-specific clinical presentation and insufficient efficiency of conventional diagnostic methods. The study was carried out to evaluate the utility of adenosine deaminase (ADA) activity in pleural fluid for the diagnosis of TPE. ADA activity was measured in pleural fluid of 103 pleural effusion patients by colorimetric method using a commercial ADA assay kit. The diagnosis of TPE was made from pleural fluid examinations (including cytology, biochemistry, and bacteriology) and pleural biopsy. Patient with negative result of this methods were diagnosed by response of empirical treatment. Out of 130 cases, 62 (61.1%) had TPE and the remaining 41 (39.8%) had pleural effusion due to non tuberculous diseases. There was statistically significant difference (p < 0.001) between the mean of pleural fluid ADA levels (70.82±22.54 U/L) in TPE group and (30.07±22.93 U/L) in non-TPE group. Of 62 TPE cases, microscopy for AFB and culture for M.tuberculosis in pleural fluid revealed positivity in 9.6% and 22.5% cases respectively, and biopsy of pleura showed typical epithelioid granuloma in only 43.5% cases. The cut-off value of ADA for diagnosing TPE was 40 U/L using a ROC curve, with a sensitivity of 94% and specificity of 88%. Positive and negative predictive value of ADA assay were 92% and 90% respectively. The overall test accuracy was 90%. Pleural fluid ADA assay is therefore a simple, rapid, highly sensitive and specific adjunct test for diagnosis of TPE. DOI: http://dx.doi.org/10.3329/imcj.v5i1.9852   Ibrahim Med. Coll. J. 2011; 5(1): 1-5 Keywords: Pleural fluid; adenosine deaminase; tuberculous pleural effusion

scholarly journals A nationwide population-based cohort study of peripartum hysterectomy and arterial embolisation in Belgium: results from the Belgian Obstetric Surveillance System

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e016208 ◽  
Author(s):  
Griet Vandenberghe ◽  
Marine Guisset ◽  
Iris Janssens ◽  
Virginie Van Leeuw ◽  
Kristien Roelens ◽  
...  
Keyword(s):  
Cohort Study ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Population Based ◽  
Abnormal Placentation ◽  
Peripartum Hysterectomy ◽  
Obstetric Haemorrhage ◽  
Significant Difference ◽  
Depth Analysis ◽  
Invasive Placenta

ObjectivesTo assess the prevalence of major obstetric haemorrhage managed with peripartum hysterectomy and/or interventional radiology (IR) in Belgium. To describe women characteristics, the circumstances in which the interventions took place, the management of the obstetric haemorrhage, the outcome and additional morbidity of these women.DesignNationwide population-based prospective cohort study.SettingEmergency obstetric care. Participation of 97% of maternities covering 98.6% of deliveries in Belgium.ParticipantsAll women who underwent peripartum hysterectomy and/or IR procedures in Belgium between January 2012 and December 2013.ResultsWe obtained data on 166 women who underwent peripartum hysterectomy (n=84) and/or IR procedures (n=102), corresponding to 1 in 3030 women undergoing a peripartum hysterectomy and another 1 in 3030 women being managed by IR, thereby preserving the uterus. Seventeen women underwent hysterectomy following IR and three women needed further IR despite hysterectomy. Abnormal placentation and/or uterine atony were the reported causes of haemorrhage in 83.7%. Abnormally invasive placenta was not detected antenatally in 34% of cases. The interventions were planned in 15 women. Three women were transferred antenatally and 17 women postnatally to a hospital with emergency IR service. Urgent peripartum hysterectomy was averted in 72% of the women who were transferred, with no significant difference in need for transfusion. IR procedures were able to stop the bleeding in 87.8% of the attempts. Disseminated intravascular coagulation secondary to major haemorrhage was reported in 32 women (19%).ConclusionThe prevalence in Belgium of major obstetric haemorrhage requiring peripartum hysterectomy and/or IR is estimated at 6.6 (95% CI 5.7 to 7.7) per 10 000 deliveries. Increased clinician awareness of the risk factors of abnormal placentation could further improve the management and outcome of major obstetric haemorrhage. A case-by-case in-depth analysis is necessary to reveal whether the hysterectomies and arterial embolisations performed in this study were appropriate or preventable.

scholarly journals Proton Pump Inhibitors Were Associated With Reduced Pseudocysts in Acute Pancreatitis: A Multicenter Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Shengyu Zhang ◽  
Ziying Han ◽  
Yuelun Zhang ◽  
Xiaomao Gao ◽  
Shicheng Zheng ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Cohort Study ◽  
Hospital Stay ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Control Group ◽  
Total Hospital ◽  
Total Hospital Stay ◽  
Study Results ◽  
Significant Difference

Background: Acute pancreatitis (AP) is a systemic inflammatory disorder with a wide spectrum of clinical symptoms that can range from mild to severe. Previous preclinical study results suggest that proton pump inhibitors (PPIs) can inhibit exocrine pancreatic secretion and exert anti-inflammatory properties, which might in turn improve the outcome of AP.Aim: We conducted this multicenter, retrospective cohort study to investigate the potential effects of PPIs on the mortality, and total duration of hospital stay and local complication occurrence of patients with AP.Methods: A total of 858 patients with AP were included. All patients presented to the hospital within 48 h of symptom onset and were divided into the following two groups: patients who were treated with PPIs (n = 684) and those not treated with PPIs (n = 174). We used propensity score matching (PSM) analysis to reduce confounding bias before comparing the outcomes between the two groups.Results: Before PSM analysis, there were significant differences in a number of parameters between the two groups, including age, sex, hematocrit, blood urea nitrogen, peritonitis signs, Ranson’s score, and Acute Physiology Chronic Health Evaluation II score and organ failure occurrence. Before PSM, the PPIs group had a higher rate of mortality than the control group [RR = 1.065; 95% confidence ratio (CI) 1.045–1.086; p = 0.001]. After PSM, there was no significant difference in mortality (RR = 1.009; 95% CI, 0.999–1.019; p = 0.554) or total hospital stay (p = 0.856), although the PPIs group had a lower occurrence of pancreatic pseudocyst (RR = 0.416; 95% CI 0.221–0.780; p = 0.005).Conclusion: This study showed that PPIs therapy was not associated with reduced mortality or total hospital stay, but was associated with a reduction in the occurrence of pseudocysts in patients with acute pancreatitis.

scholarly journals Comparative effectiveness of surgery and radiotherapy for survival of clinically localized prostate cancer patients: A population-based coarsened exact matching retrospective cohort study

2019 ◽  
Author(s):  
Masato Yasui ◽  
Masahiko Sakaguchi ◽  
Ryousuke Jikuya ◽  
Sohgo Tsutsumi ◽  
Tomoyuki Tatenuma ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cohort Study ◽  
Elderly Patients ◽  
Cancer Patients ◽  
The Elderly ◽  
Population Based ◽  
Localized Prostate Cancer ◽  
Exact Matching ◽  
Coarsened Exact Matching ◽  
Significant Difference

Abstract Background. Radical prostatectomy and radiotherapy are currently the main treatment options for localized prostate cancer. However, not yet a large cohort study of comparison between surgery and radiation has been investigated in Japan nor Asia. Objective of this study was to compare the survival outcome between surgery and radiotherapy among patients with clinically localized prostate cancer and in the elderly and young patients. Methods. We retrospectively evaluated survival outcomes of localized prostate cancer patients (age at diagnosis ≤79 years, cT1-3) initially treated with surgery or radiotherapy. Data were collected from the population-based cancer registry of Kanagawa Prefecture, Japan. A 1:1 coarsened exact matching of age at diagnosis, clinical T stage, and cancer differentiation was made between the two treatment groups. Patients were also categorized into two groups by age at a cut-off of 70 years for analysis. Results. The cohort comprised 4,810 patients aged 50-79 years. No significant difference in CSS was observed between the two groups (p=0.612), but the surgery group had significantly better prognosis in OS (p=0.004). When stratified for age, similar tendencies were seen in the elderly group (aged 70-79 years) (p=0.961 and p=0.007, respectively). By contrast, no significant difference in either CSS or OS was found in the younger group (p=0.550 and p=0.408, respectively). Intrinsic deaths were more likely to occur in elderly patients treated with radiotherapy than in those undergoing surgery (69.3% vs 78.2%, p=0.128).Conclusions. Our data suggests that surgery provided significantly better OS than radiotherapy, particularly among the elderly. However, radiotherapy may be more appropriate in elderly patients due to less invasiveness of the procedure. Prospective trials evaluating these therapies are warranted.

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