scholarly journals Phospholipid Levels at Seroconversion are Associated with Resolution of Persistent Islet Autoimmunity: The Diabetes Autoimmunity Study in the Young

2021 ◽  
Author(s):  
Patrick M. Carry ◽  
Lauren A. Vanderlinden ◽  
Randi K. Johnson ◽  
Teresa Buckner ◽  
Oliver Fiehn ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Principal Component ◽  
Enrichment Analysis ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Islet Autoimmunity ◽  
Potential Influence ◽  
Serum Samples ◽  
Sugar Intake ◽  
Cox Proportional Hazards Models

Reversion of islet autoimmunity (IA) may point to mechanisms that prevent IA progression. We followed 199 individuals who developed IA during the Diabetes Autoimmunity Study in the Young. Untargeted metabolomics was performed in serum samples following IA. Cox-proportional hazards models were used to test if the metabolites (2,487) predicted IA reversion, two or more consecutive visits negative for all autoantibodies. We conducted a principal component analysis (PCA) of the top metabolites, |hazard ratio (HR) >1.25| and nominal p<0.01. Phosphatidylcholine (16:0_18:1(9Z) was the strongest individual metabolite (hazard ratio (HR) per 1 standard deviation: 2.16, FDR adjusted p=0.0037). Enrichment analysis identified four clusters (FDR p<0.10) characterized by an overabundance of sphingomyelin (d40:0), phosphatidylcholine (16:0_18:1(9Z)), phosphatidylcholine (30:0), and L-decanoylcarnitine. Overall, 63 metabolites met the criteria for inclusion in the PCA. PC1 (HR: 1.4, p<0.0001), PC2 (HR: 0.85, p=0.0185), and PC4 (HR: 1.28, p=0.0103) were associated with IA reversion. Given the potential influence of diet on the metabolome, we investigated whether nutrients were correlated with PCs. We identified 20 nutrients that were correlated with the PCs (p<0.05). Total sugar intake was the top nutrient. Overall, we identified an association between phosphatidylcholine, sphingomyelin, and carnitine levels and reversion of IA.

scholarly journals Phospholipid Levels at Seroconversion are Associated with Resolution of Persistent Islet Autoimmunity: The Diabetes Autoimmunity Study in the Young

2021 ◽  
Author(s):  
Patrick M. Carry ◽  
Lauren A. Vanderlinden ◽  
Randi K. Johnson ◽  
Teresa Buckner ◽  
Oliver Fiehn ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Principal Component ◽  
Enrichment Analysis ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Islet Autoimmunity ◽  
Potential Influence ◽  
Serum Samples ◽  
Sugar Intake ◽  
Cox Proportional Hazards Models

Reversion of islet autoimmunity (IA) may point to mechanisms that prevent IA progression. We followed 199 individuals who developed IA during the Diabetes Autoimmunity Study in the Young. Untargeted metabolomics was performed in serum samples following IA. Cox-proportional hazards models were used to test if the metabolites (2,487) predicted IA reversion, two or more consecutive visits negative for all autoantibodies. We conducted a principal component analysis (PCA) of the top metabolites, |hazard ratio (HR) >1.25| and nominal p<0.01. Phosphatidylcholine (16:0_18:1(9Z) was the strongest individual metabolite (hazard ratio (HR) per 1 standard deviation: 2.16, FDR adjusted p=0.0037). Enrichment analysis identified four clusters (FDR p<0.10) characterized by an overabundance of sphingomyelin (d40:0), phosphatidylcholine (16:0_18:1(9Z)), phosphatidylcholine (30:0), and L-decanoylcarnitine. Overall, 63 metabolites met the criteria for inclusion in the PCA. PC1 (HR: 1.4, p<0.0001), PC2 (HR: 0.85, p=0.0185), and PC4 (HR: 1.28, p=0.0103) were associated with IA reversion. Given the potential influence of diet on the metabolome, we investigated whether nutrients were correlated with PCs. We identified 20 nutrients that were correlated with the PCs (p<0.05). Total sugar intake was the top nutrient. Overall, we identified an association between phosphatidylcholine, sphingomyelin, and carnitine levels and reversion of IA.

scholarly journals Metformin vs sulfonylurea use and risk of dementia in US veterans aged ≥65 years with diabetes

Neurology ◽  
2017 ◽  
Vol 89 (18) ◽  
pp. 1877-1885 ◽  
Author(s):  
Ariela R. Orkaby ◽  
Kelly Cho ◽  
Jean Cormack ◽  
David R. Gagnon ◽  
Jane A. Driver
Keyword(s):  
Lower Risk ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Confounding By Indication ◽  
Cox Proportional Hazards Models ◽  
Incident Dementia ◽  
Us Veterans

Objective:To determine whether metformin is associated with a lower incidence of dementia than sulfonylureas.Methods:This was a retrospective cohort study of US veterans ≥65 years of age with type 2 diabetes who were new users of metformin or a sulfonylurea and had no dementia. Follow-up began after 2 years of therapy. To account for confounding by indication, we developed a propensity score (PS) and used inverse probability of treatment weighting (IPTW) methods. Cox proportional hazards models estimated the hazard ratio (HR) of incident dementia.Results:We identified 17,200 new users of metformin and 11,440 new users of sulfonylureas. Mean age was 73.5 years and mean HbA1c was 6.8%. Over an average follow-up of 5 years, 4,906 cases of dementia were diagnosed. Due to effect modification by age, all analyses were conducted using a piecewise model for age. Crude hazard ratio [HR] for any dementia in metformin vs sulfonylurea users was 0.67 (95% confidence interval [CI] 0.61–0.73) and 0.78 (95% CI 0.72–0.83) for those <75 years of age and ≥75 years of age, respectively. After PS IPTW adjustment, results remained significant in veterans <75 years of age (HR 0.89; 95% CI 0.79–0.99), but not for those ≥75 years of age (HR 0.96; 95% CI 0.87–1.05). A lower risk of dementia was also seen in the subset of younger veterans who had HbA1C values ≥7% (HR 0.76; 95% CI 0.63–0.91), had good renal function (HR 0.86; 95% CI 0.76–0.97), and were white (HR 0.87; 95% CI 0.77–0.99).Conclusions:After accounting for confounding by indication, metformin was associated with a lower risk of subsequent dementia than sulfonylurea use in veterans <75 years of age. Further work is needed to identify which patients may benefit from metformin for the prevention of dementia.

The Association of Prenatal Tetanus, Diphtheria, and Acellular Pertussis (Tdap) Vaccination With Attention-Deficit/Hyperactivity Disorder

2020 ◽  
Vol 189 (10) ◽  
pp. 1163-1172
Author(s):  
Tracy A Becerra-Culqui ◽  
Darios Getahun ◽  
Vicki Chiu ◽  
Lina S Sy ◽  
Hung Fu Tseng
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Confidence Interval ◽  
Attention Deficit ◽  
Proportional Hazards ◽  
International Classification Of Diseases ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Kaiser Permanente ◽  
Hyperactivity Disorder ◽  
Cox Proportional Hazards Models

Abstract As prenatal vaccinations become more prevalent, it is important to assess potential safety events. In a retrospective cohort study of Kaiser Permanente Southern California (Pasadena, California) mother-child pairs with birth dates during January 1, 2011–December 31, 2014, we investigated the association between prenatal tetanus, diphtheria, and acellular pertussis (Tdap) vaccination and risk of attention-deficit/hyperactivity disorder (ADHD) in offspring. Information on Tdap vaccination during pregnancy was obtained from electronic medical records. ADHD was defined by International Classification of Diseases codes (Ninth or Tenth Revision) and dispensed ADHD medication after age 3 years. Children were followed to the date of their first ADHD diagnosis, the end of Kaiser Permanente membership, or the end of follow-up (December 31, 2018). In Cox proportional hazards models, we estimated unadjusted and adjusted hazard ratios for the association between maternal Tdap vaccination and ADHD, with inverse probability of treatment weighting (IPTW) used to adjust for confounding. Of 128,756 eligible mother-child pairs, 85,607 were included in the final sample. The ADHD incidence rate was 3.41 per 1,000 person-years in the Tdap-vaccinated women and 3.93 per 1,000 person-years in the unvaccinated (hazard ratio = 1.01, 95% confidence interval: 0.88, 1.16). The IPTW-adjusted analyses showed no association between prenatal Tdap vaccination and ADHD in offspring (hazard ratio = 1.00, 95% confidence interval: 0.88, 1.14). In this study, prenatal Tdap vaccination was not associated with ADHD risk in offspring, supporting recommendations to vaccinate pregnant women.

scholarly journals Diagonal Earlobe Crease and Long-Term Survival After Myocardial Infarction

2021 ◽  
Author(s):  
Christian Thilo ◽  
Christine Meisinger ◽  
Margit Heier ◽  
Wolfgang Scheidt ◽  
Inge Kirchberger
Keyword(s):  
Myocardial Infarction ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Term Survival ◽  
Risk Of Death ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Artery Disease ◽  
Adjusted Model

Abstract Background: The association between the presence of a diagonal earlobe crease (DEC) and coronary artery disease (CAD) has been prescribed earlier. However, it is unclear whether patients with acute myocardial infarction (AMI) and DEC have a higher risk of dying. Methods: Study participants were persons with AMI who were included in the KORA Myocardial Infarction Registry Augsburg from August 2015 to December 2016. After taking pictures of both earlobes, two employees independently assessed the severity of DEC in 4 degrees. For analysis, the expression of the DEC was dichotomized. Information on risk factors, severity and therapy of the AMI was collected by interview and from the medical record. Vital status post AMI was obtained by population registries in 2019. The relationship between DEC and survival time was determined using Cox proportional hazards models. Results: Out of 655 participants, 442 (67.5%) showed DEC grade 2/3 and 213 (32.5%) DEC grade 0/1. Median observation period was 3.06 years (5-1577 days). During this period, 26 patients (12.2%) with DEC grade 0/1 and 92 patients (20.8%) with grade 2/3 died (hazard ratio 1.91, 95% confidence interval (CI) 1.23 - 2.96, p = 0.0037). In the fully adjusted model, patients with DEC grade 2/3 had a 1.48-fold increased risk of death compared to the DEC grade 0/1 patient group (CI 0.94 - 2.34, p = 0.0897). The fully adjusted model applied for 1-year survival revealed a significant, 2.57-fold hazard ratio of death (CI 1.07 - 6.17, p = 0.0347) for the patients with DEC grade 2/3.Conclusions: Our results indicate that DEC is independently associated with 1-year AMI survival.

scholarly journals Renal-function change after transjugular intra-hepatic portosystemic shunt placement and its relationship with survival: a single-center experience

2020 ◽  
Author(s):  
Min Lang ◽  
Angela L Lang ◽  
Brian Q Tsui ◽  
Weiping Wang ◽  
Brian K Erly ◽  
...  
Keyword(s):  
Renal Function ◽  
Mortality Risk ◽  
Proportional Hazards ◽  
De Novo ◽  
Strong Predictor ◽  
Cox Proportional Hazards ◽  
Portosystemic Shunt ◽  
Hazard Ratio ◽  
Single Center Experience ◽  
Cox Proportional Hazards Models

Abstract Background The effect of transjugular intra-hepatic portosystemic shunt (TIPS) placement on renal function and the correlation of post-TIPS Cr with mortality remain unclear. This study aimed to assess the effect of TIPS placement on renal function and to examine the relationship between post-TIPS Cr and mortality risk. Methods A total of 593 patients who underwent de novo TIPS placement between 2004 and 2017 at a single institution were included in the study. The pre-TIPS Cr level (T0; within 7 days before TIPS placement) and post-TIPS Cr levels, at 1–2 days (T1), 5–12 days (T2), and 15–40 days (T3), were collected. Predictors of Cr change after TIPS placement and the 1-year mortality rate were analysed using multivariable linear-regression and Cox proportional-hazards models, respectively. Results Overall, 21.4% of patients (n = 127) had elevated baseline Cr (≥1.5 mg/dL; mean, 2.51 ± 1.49 mg/dL) and 78.6% (n = 466) had normal baseline Cr (&lt;1.5 mg/dL; mean, 0.92 ± 0.26 mg/dL). Patients with elevated pre-TIPS Cr demonstrated a decrease in post-TIPS Cr (difference, −0.60 mg/dL), whereas patients with normal baseline Cr exhibited no change (difference, &lt;0.01 mg/dL). The 30-day, 90-day, and 1-year mortality rates were 13%, 20%, and 32%, respectively. Variceal bleeding as a TIPS-placement indication (hazard ratio = 1.731; P = 0.036), higher T0 Cr (hazard ratio = 1.834; P = 0.012), and higher T3 Cr (hazard ratio = 3.524; P &lt; 0.001) were associated with higher 1-year mortality risk. Conclusion TIPS placement improved renal function in patients with baseline renal dysfunction and the post-TIPS Cr level was a strong predictor of 1-year mortality risk.

Informal Caregiver Support Policies Change Use of Vocational Assistance Services for Individuals With Disabilities

2021 ◽  
pp. 107755872110185
Author(s):  
Megan Shepherd-Banigan ◽  
Valerie A. Smith ◽  
Karen M. Stechuchak ◽  
Courtney H. Van Houtven
Keyword(s):  
Confidence Interval ◽  
Supported Employment ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Care Recipient ◽  
Gi Bill ◽  
Individuals With Disabilities ◽  
Caregiver Support ◽  
Cox Proportional Hazards Models

Support policies for caregivers improves care-recipient access to care and effects may generalize to nonhealth services. Using administrative data from the U.S. Department of Veterans Affairs (VA) for veterans <55 years, we assessed the association between enrollment in a VA caregiver support program and veteran use of vocational assistance services: the post-9/11 GI Bill, VA vocational rehabilitation and employment (VR&E), and supported employment. We applied instrumental variables to Cox proportional hazards models. Caregiver enrollment in the program increased veteran supported employment use (hazard ratio = 1.35, 95% confidence interval [1.14, 1.53]), decreased VR&E use (hazard ratio = 0.84, 95% confidence interval [0.76, 0.92]), and had no effect on the post-9/11 GI Bill. Caregiver support policies could increase access to some vocational assistance for individuals with disabilities, particularly supported employment, which is integrated into health care. Limited coordination between health and employment sectors and misaligned incentives may have inhibited effects for the post-9/11 GI Bill and VR&E.

scholarly journals Association between sinusitis and relapse and changes in the myeloperoxidase–antineutrophil cytoplasmic antibody in microscopic polyangiitis

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243572
Author(s):  
Hiroya Tanaka ◽  
Makoto Yamaguchi ◽  
Takayuki Katsuno ◽  
Hirokazu Sugiyama ◽  
Shiho Iwagaitsu ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Microscopic Polyangiitis ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
University Hospital ◽  
Cox Proportional Hazards Models ◽  
Medical University ◽  
Risk Of Relapse

Previous studies have evaluated the risk factors for relapse of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and the biomarkers of AAV for predicting relapse. However, little is known about the association between the presence of sinusitis and relapse and changes in the ANCA levels in AAV. This single-center, retrospective cohort study included 104 consecutive patients who were newly diagnosed with myeloperoxidase (MPO)-ANCA-positive microscopic polyangiitis (MPA) between 2006 and 2018 and were treated at the Aichi Medical University Hospital in Japan. The relationships between sinusitis and relapse of vasculitis and elevated MPO-ANCA levels were assessed using multivariate Cox proportional hazards models that were adjusted for clinically relevant factors. During the entire follow-up period (median, 24 months; interquartile range, 7–54 months), 93 (89.4%) patients achieved remission. After achieving remission, 38 (40.9%) patients experienced at least one relapse (13 [65.0%] in the sinusitis group; 25 [34.3%] in the non-sinusitis group). Sinusitis was identified as a significant predictor of relapse (adjusted hazard ratio: 2.41, 95% confidence interval [CI]: 1.19–4.88; P = 0.015). Furthermore, sinusitis was more likely to be associated with elevated MPO-ANCA levels (adjusted hazard ratio: 2.59, 95% CI: 1.14–5.92; P = 0.024). In conclusion, sinusitis was associated with a higher risk of relapse and elevated MPO-ANCA levels in MPA patients, suggesting that careful management may be required to reduce the risk of relapse in patients with sinusitis. Further studies are needed to elucidate the optimal treatment strategy for these patients.

Survival analysis in primary progressive apraxia of speech and agrammatic aphasia

2020 ◽  
pp. 10.1212/CPJ.0000000000000919
Author(s):  
Jennifer L. Whitwell ◽  
Peter Martin ◽  
Joseph R. Duffy ◽  
Heather M. Clark ◽  
Rene L. Utianski ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Apraxia Of Speech ◽  
Primary Progressive ◽  
Risk Of Death ◽  
Baseline Visit ◽  
Cox Proportional Hazards Models ◽  
Point Increase ◽  
Agrammatic Aphasia

ABSTRACTObjective:To compare survival among patients with different combinations of apraxia of speech (AOS) and agrammatic aphasia, including those with isolated AOS (primary progressive apraxia of speech, PPAOS), both AOS and agrammatic aphasia (AOS+PAA) and isolated agrammatic aphasia (progressive agrammatic aphasia, PAA).Methods:One-hundred-and-nine patients were recruited who had any combination of AOS and agrammatic aphasia (42 PPAOS, 56 AOS+PAA and 11 PAA) and were followed longitudinally, with 57 patients having since died. Cox proportional hazards models were used to quantify the relative risk of death across diagnoses. Adjusted survival curves are presented based on this model. We also assessed the influence of AOS and aphasia severity on survival.Results:PPAOS had the longest survival (median survival of 5.97 years from baseline visit), followed by PAA (5.26 years) and then AOS+PAA (4.33 years). AOS+PAA had a greater risk of death than PPAOS, with a hazard ratio of 3.01 (Lower/upper CI= 1.66/5.46, p<0.001). Risk of death did not differ between PAA and the other groups. All results accounted for age and time from onset to baseline visit. AOS severity, independent of syndromic diagnosis, was associated with greater risk of death, with a hazard ratio of 1.35 for a one-point increase in severity. Aphasia severity was not associated with risk of death.Conclusions:Individuals with PPAOS have better survival and reduced risk of death compared to AOS+PAA individuals. This finding will help improve prognostic estimates for these patients and supports the value of distinguishing PPAOS from AOS+PAA.

scholarly journals Artificial Intelligence–Electrocardiography to Predict Incident Atrial Fibrillation

2020 ◽  
Vol 13 (12) ◽  
Author(s):  
Georgios Christopoulos ◽  
Jonathan Graff-Radford ◽  
Camden L. Lopez ◽  
Xiaoxi Yao ◽  
Zachi I. Attia ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Atrial Fibrillation ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Model Output ◽  
Genomic Epidemiology ◽  
Logit Transformation ◽  
Cox Proportional Hazards Models

Background: An artificial intelligence (AI) algorithm applied to electrocardiography during sinus rhythm has recently been shown to detect concurrent episodic atrial fibrillation (AF). We sought to characterize the value of AI–enabled electrocardiography (AI-ECG) as a predictor of future AF and assess its performance compared with the CHARGE-AF score (Cohorts for Aging and Research in Genomic Epidemiology–AF) in a population-based sample. Methods: We calculated the probability of AF using AI-ECG, among participants in the population-based Mayo Clinic Study of Aging who had no history of AF at the time of the baseline study visit. Cox proportional hazards models were fit to assess the independent prognostic value and interaction between AI-ECG AF model output and CHARGE-AF score. C statistics were calculated for AI-ECG AF model output, CHARGE-AF score, and combined AI-ECG and CHARGE-AF score. Results: A total of 1936 participants with median age 75.8 (interquartile range, 70.4–81.8) years and median CHARGE-AF score 14.0 (IQR, 13.2–14.7) were included in the analysis. Participants with AI-ECG AF model output of >0.5 at the baseline visit had cumulative incidence of AF 21.5% at 2 years and 52.2% at 10 years. When included in the same model, both AI-ECG AF model output (hazard ratio, 1.76 per SD after logit transformation [95% CI, 1.51–2.04]) and CHARGE-AF score (hazard ratio, 1.90 per SD [95% CI, 1.58–2.28]) independently predicted future AF without significant interaction ( P =0.54). C statistics were 0.69 (95% CI, 0.66–0.72) for AI-ECG AF model output, 0.69 (95% CI, 0.66–0.71) for CHARGE-AF, and 0.72 (95% CI, 0.69–0.75) for combined AI-ECG and CHARGE-AF score. Conclusions: In the present study, both the AI-ECG AF model output and CHARGE-AF score independently predicted incident AF. The AI-ECG may offer a means to assess risk with a single test and without requiring manual or automated clinical data abstraction.

scholarly journals Prognostic Significance of Chronic Kidney Disease (CKD-EPI Equation) and Anemia in Patients with Chronic Heart Failure Secondary to Chagas Cardiomyopathy

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Marcelo Arruda Nakazone ◽  
Maurício Nassau Machado ◽  
Ana Paula Otaviano ◽  
Ana Maria Silveira Rodrigues ◽  
Augusto Cardinalli-Neto ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Proportional Hazards ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Disease Epidemiology ◽  
Chagas Cardiomyopathy ◽  
Cox Proportional Hazards Models

Background. Few studies regarding chronic kidney disease (CKD) and anemia have been conducted in patients with Chagas cardiomyopathy (CC). We evaluated the risk prediction performance of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and anemia in CC patients. Methods. From 2000 to 2010, a total of 232 patients were studied in a single-center retrospective study. CKD was defined as creatinine clearance <60 mL/min/1.73 m2 according to CKD-EPI equation. Anemia was defined as hemoglobin <12 g/dL (women) and <13 g/dL (men). Cox proportional hazards models were used to establish predictors for death. Results. At baseline, 98 individuals (42.2%) had criteria for CKD and 41 (17.7%) for anemia. During follow-up, 136 patients (58.6%) died. Independently, CKD and anemia were not associated with all-cause mortality. However, when they coexisted, an additional risk was attributed for these patients. Cox proportional hazard models analysis identified systolic blood pressure (hazard ratio, 0.99; 95% confidence interval (CI), 0.98 to 1.00; P=0.015), implantable cardioverter-defibrillator (hazard ratio, 0.48; 95% CI, 0.27 to 0.85; P=0.012), left anterior fascicular block (hazard ratio, 1.52; 95% CI, 1.08 to 2.13; P=0.017), left ventricular end-diastolic diameter (hazard ratio, 1.04; 95% CI, 1.02 to 1.06; P<0.001), and serum sodium (hazard ratio, 0.95; 95% CI, 0.92 to 0.99; P=0.020) as independent predictors for death. Conclusions. CKD and anemia are not independent predictors for long-term mortality in CC patients. However, the prognosis is poorer in individuals with both comorbidities.

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