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Gregg C Fonarow - One of the best experts on this subject based on the ideXlab platform.
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an obesity paradox in acute heart failure analysis of body mass index and inhospital mortality for 108927 patients in the acute decompensated heart failure national registry
American Heart Journal, 2007Co-Authors: Gregg C Fonarow, Preethi Srikanthan, Maria Rosa Costanzo, Guillermo Cintron, Margarita LopatinAbstract:Background Prior studies on chronic systolic heart failure (HF) have demonstrated that body mass index (BMI) is inversely associated with mortality, the so-called obesity paradox. The aim of this study was to determine whether BMI influences the mortality risk in acute decompensated HF, a subject not previously studied. Methods The Acute Decompensated Heart Failure National Registry was analyzed for acute HF hospitalizations in 263 hospitals in the United States from October 2001 through December 2004. Patients with documented height and weight were divided into BMI (measured in kilograms per square meter) Quartiles. Inhospital mortality by BMI quartile for all the patients and for those with reduced (n = 43255) and preserved (n = 37901) systolic function was assessed. Results Body mass index Quartiles in the 108927 hospitalizations were QI (16.0-23.6 kg/m 2 ), QII (23.7-27.7 kg/m 2 ), QIII (27.8-33.3 kg/m 2 ), and QIV (33.4-60.0 kg/m 2 ). Patients in the higher BMI Quartiles were younger, had more diabetes, and had a higher left ventricular ejection fraction. Inhospital mortality rates decreased in a near-linear fashion across successively higher BMI Quartiles. After adjustments for age, sex, blood urea nitrogen, blood pressure, creatinine, sodium, heart rate, and dyspnea at rest, BMI quartile still predicted mortality risk. For every 5-U increase in BMI, the odds of risk-adjusted mortality was 10% lower (95% CI 0.88-0.93, P Conclusions In this cohort of hospitalized patients with HF, higher BMI was associated with lower inhospital mortality risk. The relationship between BMI and adverse outcomes in HF appears to be complex and deserving of further study.
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an obesity paradox in acute heart failure analysis of body mass index and inhospital mortality for 108 927 patients in the acute decompensated heart failure national registry
American Heart Journal, 2007Co-Authors: Gregg C Fonarow, Preethi Srikanthan, Maria Rosa Costanzo, Guillermo Cintron, Margarita LopatinAbstract:Background Prior studies on chronic systolic heart failure (HF) have demonstrated that body mass index (BMI) is inversely associated with mortality, the so-called obesity paradox. The aim of this study was to determine whether BMI influences the mortality risk in acute decompensated HF, a subject not previously studied. Methods The Acute Decompensated Heart Failure National Registry was analyzed for acute HF hospitalizations in 263 hospitals in the United States from October 2001 through December 2004. Patients with documented height and weight were divided into BMI (measured in kilograms per square meter) Quartiles. Inhospital mortality by BMI quartile for all the patients and for those with reduced (n = 43255) and preserved (n = 37901) systolic function was assessed. Results Body mass index Quartiles in the 108927 hospitalizations were QI (16.0-23.6 kg/m 2 ), QII (23.7-27.7 kg/m 2 ), QIII (27.8-33.3 kg/m 2 ), and QIV (33.4-60.0 kg/m 2 ). Patients in the higher BMI Quartiles were younger, had more diabetes, and had a higher left ventricular ejection fraction. Inhospital mortality rates decreased in a near-linear fashion across successively higher BMI Quartiles. After adjustments for age, sex, blood urea nitrogen, blood pressure, creatinine, sodium, heart rate, and dyspnea at rest, BMI quartile still predicted mortality risk. For every 5-U increase in BMI, the odds of risk-adjusted mortality was 10% lower (95% CI 0.88-0.93, P Conclusions In this cohort of hospitalized patients with HF, higher BMI was associated with lower inhospital mortality risk. The relationship between BMI and adverse outcomes in HF appears to be complex and deserving of further study.
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relation of loop diuretic dose to mortality in advanced heart failure
American Journal of Cardiology, 2006Co-Authors: Shervin Eshaghian, Tamara B Horwich, Gregg C FonarowAbstract:Although loop diuretics are widely used in heart failure (HF), their effect on outcomes has not been evaluated in large clinical trials. This study sought to determine the dose-dependent relation between loop diuretic use and HF prognosis. A cohort of 1,354 patients with advanced systolic HF referred to a single center was studied. Patients were divided into Quartiles of equivalent total daily loop diuretic dose: 0 to 40, 41 to 80, 81 to 160, and >160 mg. The cohort was 76% male, with a mean age of 53 ± 13 years and a mean ejection fraction of 24 ± 7%. The mean diuretic dose equivalence was 107 ± 87 mg. The diuretic quartile groups were similar in terms of gender, body mass index, ischemic cause of HF, history of hypertension, and spironolactone use, but the highest quartile was associated with a smaller ejection fraction and lower serum sodium and hemoglobin levels but higher serum blood urea nitrogen and creatinine levels. There was a decrease in survival with increasing diuretic dose (83%, 81%, 68%, and 53% for Quartiles 1, 2, 3, and 4, respectively). Even after extensive co-variate adjustment (age, gender, ischemic cause of HF, the ejection fraction, body mass index, pulmonary capillary wedge pressure, peak oxygen consumption, β-blocker use, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, digoxin use, statin use, serum sodium, blood urea nitrogen, creatinine, hemoglobin, cholesterol, systolic blood pressure, and smoking history), diuretic quartile remained an independent predictor of mortality (quartile 4 vs quartile 1 hazard ratio 4.0, 95% confidence interval 1.9 to 8.4). In conclusion, in this cohort of patients with advanced HF, there was an independent, dose-dependent association between loop diuretic use and impaired survival. Higher loop diuretic dosages identify patients with HF at particularly high risk for mortality.
Margarita Lopatin - One of the best experts on this subject based on the ideXlab platform.
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an obesity paradox in acute heart failure analysis of body mass index and inhospital mortality for 108927 patients in the acute decompensated heart failure national registry
American Heart Journal, 2007Co-Authors: Gregg C Fonarow, Preethi Srikanthan, Maria Rosa Costanzo, Guillermo Cintron, Margarita LopatinAbstract:Background Prior studies on chronic systolic heart failure (HF) have demonstrated that body mass index (BMI) is inversely associated with mortality, the so-called obesity paradox. The aim of this study was to determine whether BMI influences the mortality risk in acute decompensated HF, a subject not previously studied. Methods The Acute Decompensated Heart Failure National Registry was analyzed for acute HF hospitalizations in 263 hospitals in the United States from October 2001 through December 2004. Patients with documented height and weight were divided into BMI (measured in kilograms per square meter) Quartiles. Inhospital mortality by BMI quartile for all the patients and for those with reduced (n = 43255) and preserved (n = 37901) systolic function was assessed. Results Body mass index Quartiles in the 108927 hospitalizations were QI (16.0-23.6 kg/m 2 ), QII (23.7-27.7 kg/m 2 ), QIII (27.8-33.3 kg/m 2 ), and QIV (33.4-60.0 kg/m 2 ). Patients in the higher BMI Quartiles were younger, had more diabetes, and had a higher left ventricular ejection fraction. Inhospital mortality rates decreased in a near-linear fashion across successively higher BMI Quartiles. After adjustments for age, sex, blood urea nitrogen, blood pressure, creatinine, sodium, heart rate, and dyspnea at rest, BMI quartile still predicted mortality risk. For every 5-U increase in BMI, the odds of risk-adjusted mortality was 10% lower (95% CI 0.88-0.93, P Conclusions In this cohort of hospitalized patients with HF, higher BMI was associated with lower inhospital mortality risk. The relationship between BMI and adverse outcomes in HF appears to be complex and deserving of further study.
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an obesity paradox in acute heart failure analysis of body mass index and inhospital mortality for 108 927 patients in the acute decompensated heart failure national registry
American Heart Journal, 2007Co-Authors: Gregg C Fonarow, Preethi Srikanthan, Maria Rosa Costanzo, Guillermo Cintron, Margarita LopatinAbstract:Background Prior studies on chronic systolic heart failure (HF) have demonstrated that body mass index (BMI) is inversely associated with mortality, the so-called obesity paradox. The aim of this study was to determine whether BMI influences the mortality risk in acute decompensated HF, a subject not previously studied. Methods The Acute Decompensated Heart Failure National Registry was analyzed for acute HF hospitalizations in 263 hospitals in the United States from October 2001 through December 2004. Patients with documented height and weight were divided into BMI (measured in kilograms per square meter) Quartiles. Inhospital mortality by BMI quartile for all the patients and for those with reduced (n = 43255) and preserved (n = 37901) systolic function was assessed. Results Body mass index Quartiles in the 108927 hospitalizations were QI (16.0-23.6 kg/m 2 ), QII (23.7-27.7 kg/m 2 ), QIII (27.8-33.3 kg/m 2 ), and QIV (33.4-60.0 kg/m 2 ). Patients in the higher BMI Quartiles were younger, had more diabetes, and had a higher left ventricular ejection fraction. Inhospital mortality rates decreased in a near-linear fashion across successively higher BMI Quartiles. After adjustments for age, sex, blood urea nitrogen, blood pressure, creatinine, sodium, heart rate, and dyspnea at rest, BMI quartile still predicted mortality risk. For every 5-U increase in BMI, the odds of risk-adjusted mortality was 10% lower (95% CI 0.88-0.93, P Conclusions In this cohort of hospitalized patients with HF, higher BMI was associated with lower inhospital mortality risk. The relationship between BMI and adverse outcomes in HF appears to be complex and deserving of further study.
Michael G. Shlipak - One of the best experts on this subject based on the ideXlab platform.
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higher plasma cystatin c is associated with mortality after acute respiratory distress syndrome findings from a fluid and catheter treatment trial factt substudy
Critical Care, 2020Co-Authors: Carolyn M Hendrickson, Michael G. Shlipak, Yuenting D Kwong, Annika Belzer, Michael A Matthay, Kathleen D LiuAbstract:Cystatin C is a well-validated marker of glomerular filtration rate in chronic kidney disease. Higher plasma concentrations of cystatin C are associated with worse clinical outcomes in heterogenous populations of critically ill patients and may be superior to creatinine in identifying kidney injury in critically ill patients. We hypothesized that elevated levels of plasma cystatin C in patients with acute respiratory distress syndrome (ARDS) would be associated with mortality risk. In a retrospective study, cystatin C was measured by nephelometry on plasma obtained at enrollment from 919 patients in the Fluid and Catheter Treatment Trial. Multivariable logistic regression was performed testing the association between Quartiles of cystatin C and 60-day mortality. Analyses were stratified by acute kidney injury (AKI) status identified in the first 7 days after enrollment by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Cystatin C was significantly higher among those patients who died compared to those who survived to 60 days [1.2 (0.9–1.9) mg/L vs. 0.8 (0.6–1.2) mg/L, p < 0.001]. Compared to the lower three Quartiles, subjects in the highest quartile of cystatin C had a significantly higher odds of death at 60 days [OR 1.8 (1.2–2.6), p = 0.003 in adjusted analyses]; the odds of death incrementally rose in higher cystatin C Quartiles compared to the lowest quartile (OR 1.1, 1.8, and 2.5). In adjusted analyses stratified by AKI status, compared to subjects in the lower three Quartiles, subjects in the highest quartile of cystatin C with AKI had a significantly higher odds of death at 60 days both in participants with AKI [OR 1.6 (1.0–2.4), p = 0.048] and those without AKI [OR 2.4 (1.2–5.0), p = 0.017]. In adjusted analyses, there was no significant association between sex-stratified baseline creatinine Quartiles and mortality. Higher plasma levels of cystatin C on enrollment were strongly associated with mortality at 60 days in patients with ARDS with and without AKI identified by creatinine-based definitions. Compared to creatinine, cystatin C may be a better biomarker of kidney function in patients with ARDS and therefore identify patients with multiple organ failure at higher risk of death.
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association between human fetuin a and the metabolic syndrome data from the heart and soul study
Circulation, 2006Co-Authors: Michael G. Shlipak, Markus Ketteler, Vincent Brandenburg, Sadia Ali, Mary A WhooleyAbstract:Background— Fetuin-A is a multifunctional hepatic secretory protein that inhibits the action of insulin in experimental animals. We evaluated the association between human serum fetuin-A and the metabolic syndrome (MetS) in a cohort of persons with coronary artery disease. Methods and Results— We defined MetS by the National Cholesterol Education Program criteria among 711 nondiabetic outpatients with coronary artery disease. The mean age was 67 years, and 82% were male. We divided participants into Quartiles by serum fetuin-A concentrations. A total of 45% of participants (80 of 177) in the highest quartile of fetuin-A had MetS compared with 24% of participants (42 of 177) in the lowest quartile (odds ratio, 2.7; 95% confidence interval, 1.7 to 4.2; P<0.001). This association persisted after adjustment for potential confounding variables, including hypertension, body mass index, and inflammatory biomarkers (adjusted odds ratio, 2.0; 95% confidence interval, 1.1 to 3.5; P=0.02). Higher fetuin-A Quartiles ...
Kathleen D Liu - One of the best experts on this subject based on the ideXlab platform.
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higher plasma cystatin c is associated with mortality after acute respiratory distress syndrome findings from a fluid and catheter treatment trial factt substudy
Critical Care, 2020Co-Authors: Carolyn M Hendrickson, Michael G. Shlipak, Yuenting D Kwong, Annika Belzer, Michael A Matthay, Kathleen D LiuAbstract:Cystatin C is a well-validated marker of glomerular filtration rate in chronic kidney disease. Higher plasma concentrations of cystatin C are associated with worse clinical outcomes in heterogenous populations of critically ill patients and may be superior to creatinine in identifying kidney injury in critically ill patients. We hypothesized that elevated levels of plasma cystatin C in patients with acute respiratory distress syndrome (ARDS) would be associated with mortality risk. In a retrospective study, cystatin C was measured by nephelometry on plasma obtained at enrollment from 919 patients in the Fluid and Catheter Treatment Trial. Multivariable logistic regression was performed testing the association between Quartiles of cystatin C and 60-day mortality. Analyses were stratified by acute kidney injury (AKI) status identified in the first 7 days after enrollment by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Cystatin C was significantly higher among those patients who died compared to those who survived to 60 days [1.2 (0.9–1.9) mg/L vs. 0.8 (0.6–1.2) mg/L, p < 0.001]. Compared to the lower three Quartiles, subjects in the highest quartile of cystatin C had a significantly higher odds of death at 60 days [OR 1.8 (1.2–2.6), p = 0.003 in adjusted analyses]; the odds of death incrementally rose in higher cystatin C Quartiles compared to the lowest quartile (OR 1.1, 1.8, and 2.5). In adjusted analyses stratified by AKI status, compared to subjects in the lower three Quartiles, subjects in the highest quartile of cystatin C with AKI had a significantly higher odds of death at 60 days both in participants with AKI [OR 1.6 (1.0–2.4), p = 0.048] and those without AKI [OR 2.4 (1.2–5.0), p = 0.017]. In adjusted analyses, there was no significant association between sex-stratified baseline creatinine Quartiles and mortality. Higher plasma levels of cystatin C on enrollment were strongly associated with mortality at 60 days in patients with ARDS with and without AKI identified by creatinine-based definitions. Compared to creatinine, cystatin C may be a better biomarker of kidney function in patients with ARDS and therefore identify patients with multiple organ failure at higher risk of death.
Mark W Frohlich - One of the best experts on this subject based on the ideXlab platform.
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lower baseline prostate specific antigen is associated with a greater overall survival benefit from sipuleucel t in the immunotherapy for prostate adenocarcinoma treatment impact trial
Urology, 2013Co-Authors: Gerald W Chodak, Mark W FrohlichAbstract:Objective To explore the prognostic and predictive value of baseline variables in 512 patients with metastatic castration-resistant prostate cancer from the phase III Immunotherapy for Prostate Adenocarcinoma Treatment (IMPACT) trial who were randomized to receive sipuleucel-T or control. Methods The most powerful of these prognostic factors, baseline prostate-specific antigen (PSA), was subdivided into Quartiles to evaluate treatment effect patterns. Cox regression analyses were used to assess predictors of overall survival (OS) and sipuleucel-T treatment effect within PSA Quartiles. Median OS was estimated by the Kaplan-Meier method. Results PSA was the strongest baseline prognostic factor ( P 134 ng/mL). Estimated improvement in median survival varied from 13.0 months in the lowest baseline PSA quartile to 2.8 months in the highest quartile. Estimated 3-year survival in the lowest PSA quartile was 62.6% for sipuleucel-T patients and 41.6% for control patients, representing a 50% relative increase. Conclusion The greatest magnitude of benefit with sipuleucel-T treatment in this exploratory analysis was observed among patients with better baseline prognostic factors, particularly those with lower baseline PSA values. These findings suggest that patients with less advanced disease may benefit the most from sipuleucel-T treatment and provide a rationale for immunotherapy as an early treatment strategy in sequencing algorithms for metastatic castration-resistant prostate cancer.
