Impact of P-wave indices in prediction of atrial fibrillation—Insight from loop recorder analysis

Background

Several P-wave indices are associated with the development of atrial fibrillation (AF). However, previous studies have been limited in their ability to reliably diagnose episodes of AF. Implantable loop recorders allow long-term, continuous, and therefore more reliable detection of AF.

Hypothesis

The aim of this study is to identify and evaluate ECG parameters for predicting AF by analyzing patients with loop recorders.

Methods

This study included 366 patients (mean age 62 ± 16 years, mean LVEF 61 ± 6%, 175 women) without AF who underwent loop recorder implantation between 2010–2020. Patients were followed up on a 3 monthly outpatient interval.

Results

During a follow-up of 627 ± 409 days, 75 patients (20%) reached the primary study end point (first detection of AF). Independent predictors of AF were as follows: age ≥68 years (hazard risk [HR], 2.66; 95% confidence interval [CI], 1.668–4.235; p < .001), P-wave amplitude in II <0.1 mV (HR, 2.11; 95% CI, 1.298–3.441; p = .003), P-wave terminal force in V₁ ≤ −4000 µV × ms (HR, 5.3; 95% CI, 3.249–8.636; p < .001, and advanced interatrial block (HR, 5.01; 95% CI, 2.638–9.528; p < .001). Our risk stratification model based on these independent predictors separated patients into 4 groups with high (70%), intermediate high (41%), intermediate low (18%), and low (4%) rates of AF.

Conclusions

Our study indicated that P-wave indices are suitable for predicting AF episodes. Furthermore, it is possible to stratify patients into risk groups for AF using simple ECG parameters, which is particularly important for patients with cryptogenic stroke.

     

Smoking,plasma cotinine and risk of atrial fibrillation: the Hordaland Health Study

Background

Cigarette smoking has been identified as a major modifiable risk factor for coronary heart disease and mortality. However, findings on the relationship between smoking and atrial fibrillation (AF ) have been inconsistent. Furthermore, findings from previous studies were based on self‐reported smoking.

Objective

To examine the associations of smoking status and plasma cotinine levels, a marker of nicotine exposure, with risk of incident AF in the Hordaland Health Study.

Methods

We conducted a prospective analysis of 6682 adults aged 46‐74 years without known AF at baseline. Participants were followed via linkage to the Cardiovascular Disease in Norway (CVDNOR ) project and the Cause of Death Registry. Smoking status was assessed by both questionnaire and plasma cotinine levels.

Results

A total of 538 participants developed AF over a median follow‐up period of 11 years. Using questionnaire data, current smoking (HR : 1.41, 95% CI : 1.09–1.83), but not former smoking (HR : 1.03, 95% CI : 0.83–1.28), was associated with an increased risk of AF after adjustment for gender, age, body mass index, hypertension, physical activity and education. Using plasma cotinine only, the adjusted HR (95% CI ) was 1.40 (1.12–1.75) for participants with cotinine ≥85 nmol L^?1 compared to those with cotinine <85 nmol L^?1. However, the risk increased with elevated plasma cotinine levels until 1199 nmol L^?1 (HR : 1.55, 95% CI : 1.16–2.05 at the third group vs. the reference group) and plateaued at higher levels.

Conclusions

Current, but not former smokers, had a higher risk of developing AF . Use of plasma cotinine measurement corroborated this finding.

     

The inflammatory biomarker YKL‐40 at admission is a strong predictor of overall mortality

Objectives

YKL‐40 is an inflammatory biomarker associated with disease activity and mortality in patients with diseases characterized by inflammation and tissue remodelling. The aim of this study was to describe the prognostic value of YKL‐40 in an unselected patient population.

Design

In consecutive patients admitted to hospital during a 1‐year period, blood was collected and information regarding final diagnosis and mortality was collected. Median follow‐up time was 11.5 years.

Setting

District hospital, Copenhagen, Denmark.

Patients

A total of 1407 patients >40 years of age were admitted acutely.

Main outcome measure

All‐cause mortality.

Results

Median YKL‐40 was increased in patients (157 μg L^?1, range 13–7704 μg L^?1) compared to healthy controls (40 μg L^?1, range 29–58 μg L^?1; P < 0.001). Patients with YKL‐40 in the highest quartile had a hazard ratio (HR) of 7.1 [95% confidence interval (CI) 4.2–12.0] for all‐cause mortality in the first year and 3.4 (95% CI 2.8–4.2) in the total study period, compared to those in the lowest quartile (HR = 1). The HR for death for all patients with YKL‐40 above the normal age‐corrected 95th percentile was 2.1 (95% CI 1.6–2.7) after 1 year and 1.5 (95% CI 1.3–1.7) during the total study period, compared to patients with YKL‐40 below the age‐corrected 95th percentile. The results of multivariable analysis showed that YKL‐40 was an independent biomarker of mortality; this was most significant in the first year. YKL‐40 was a marker of prognosis in all disease categories. The HR for death was increased in patients with YKL‐40 above the normal age‐corrected 95th percentile in healthy subjects independent of type of disease (all P < 0.001).

Conclusion

The level of YKL‐40 at admission is a strong predictor of overall mortality, independent of diagnosis and could be useful as a biomarker in the acute evaluation of all patients.

     

Associations of low sex hormone-binding globulin and androgen excess in early pregnancy with fasting and post-prandial hyperglycaemia,gestational diabetes,and its severity

Aims

We studied whether androgen excess and low sex hormone-binding globulin (SHBG) measured in early pregnancy are independently associated with fasting and post-prandial hyperglycaemia, gestational diabetes (GDM), and its severity.

Materials and Methods

This nationwide case–control study included 1045 women with GDM and 963 non-diabetic pregnant controls. We measured testosterone (T) and SHBG from biobanked serum samples (mean 10.7 gestational weeks) and calculated the free androgen index (FAI). We first studied their associations with GDM and secondly with the type of hyperglycaemia (fasting, 1 and 2 h glucose concentrations during the oral glucose tolerance test), early-onset GDM (<20 gestational weeks) and the need for anti-diabetic medication.

Results

After adjustments for gestational weeks at sampling, pre-pregnancy BMI, and age, women with GDM had 3.7% (95% CI 0.1%–7.3%) lower SHBG levels, 3.1% (95% CI 0.1%–6.2%) higher T levels, and 4.6% (95% CI 1.9%–7.3%) higher FAI levels than controls. SHBG was inversely associated with fasting glucose, whereas higher FAI and T were associated with higher post-prandial glucose concentrations. Women with early-onset GDM had 6.7% (95% CI 0.7%–12.7%) lower SHBG levels and women who needed insulin for fasting hyperglycaemia 8.7% (95% CI 1.8%–14.8%) lower SHBG levels than other women with GDM.

Conclusions

Lower SHBG levels were associated especially with early-onset GDM, higher fasting glucose and insulin treatment, whereas androgen excess was associated with higher post-prandial glucose values. Thus, a low SHBG level may reflect the degree of existing insulin resistance, while androgen excess might impair post-prandial insulin secretion.

     

Higher FT4 level within the normal range predicts the outcome of cryoballoon ablation in paroxysmal atrial fibrillation patients without structural heart disease

Background

Accumulated evidence has indicated that a high-normal FT4 level is an independent risk factor for the clinical progression of AF. However, the association between elevated FT4 concentration within the normal range and AF recurrence after cryoballoon ablation in China is unknown.

Methods

This retrospective and observational study included 453 AF patients who underwent cryoballoon ablation from January 2016 to August 2018. Patients were classified into quartiles based on preprocedural serum FT4 concentration. The clinical characteristics of the patients and the long-term rate of AF recurrence after ablation were assessed.

Results

After a mean follow-up period of 17.4 ± 9.0 months, 91 (20.1%) patients suffered from AF recurrence. The AF recurrence rate by FT4 quartile was 17.7%, 19.0%, 21.4%, and 22.3% for participants with FT4 in quartile 1, 2, 3, and 4, respectively (p < .001). On multivariate Cox regression, FT4 concentration (HR: 1.187, 95% CI: 1.093–1.290, p < .001) and left atrial diameter (HR: 1.052, 95% CI: 1.014–1.092, p = .007) were significant predictors of AF recurrence. When stratifying for AF type, the rate of postoperative recurrence was independently increased as FT4 concentration increased in paroxysmal AF, but not in persistent AF (p < .001 in paroxysmal AF and p = .977 in persistent AF).

Conclusion

Higher FT4 level within the normal range predicted the outcome of cryoballoon ablation in Chinese paroxysmal AF patients without structural heart disease.

     

Early repolarization pattern in adult females with eating disorders

Introduction

The risk of cardiovascular death is increased in patients with eating disorders (ED), but the background for this is unknown. Early repolarization pattern (ERP) on the electrocardiogram (ECG) has been associated with increased risk of sudden cardiac death.

Methods

We investigated the prevalence of ERP in 233 female patients with anorexia nervosa (AN) and bulimia nervosa (BN) (age 18–35 years) compared with 123 healthy female controls.

Results

Early repolarization pattern was present in 52 (22%) of ED patients (16 (15%) AN patients and 36 (29%) BN patients) and 17 (14%) of healthy controls. When adjusting for age, BMI, heart rate, use of selective serotonin reuptake inhibitors (SSRI), and potassium level, the odds ratio (OR) for ERP was 2.1 (95% CI 1.1–4.2, p = .03). There was an increased prevalence of inferolateral ERP in patients with ED compared with healthy controls (OR = 4.3, 95% CI 1.7–11.3, p = .003) as well as ERP with a downward/horizontal sloping ST segment (OR = 3.1, 95% CI 1.3–7.6, p = .01). Additionally, J-point elevation >0.2 mV was more prevalent in patients with ED (OR = 3.3, 95% CI 1.1–9.7, p = .03).

Conclusion

The prevalence of ERP was increased in patients with ED compared with healthy controls. This finding may provide a possible explanation for the increased cardiovascular mortality in ED patients.

     

Acute effect of multiple ozone metrics on mortality by season in 34 Chinese counties in 2013–2015

Background

Although numerous multicentre studies have estimated the association between ozone exposure and mortality, there are currently no nationally representative multicentre studies of the ozone–mortality relationship in China.

Objective

To investigate the effect on total (nonaccidental) and cause‐specific mortality of short‐term exposure to ambient ozone, and examine different exposure metrics.

Methods

The effects of short‐term exposure to ozone were analysed using various metrics (daily 1‐h maximum, daily 8‐h maximum and daily average) on total (nonaccidental) and cause‐specific (circulatory and respiratory) mortality from 2013 to 2015 in 34 counties in 10 cities across China. We used distributed lag nonlinear models for estimating county‐specific relative risk of mortality and combined the county‐specific relative rates by conducting a random‐effects meta‐analysis.

Results

In all‐year analyses, a 10 μg m^?3 increase in daily average, daily 1‐h maximum and daily 8‐h maximum ozone at lag02 corresponded to an increase of 0.6% (95% CI : 0.33, 0.88), 0.26% (95% CI : 0.12, 0.39) and 0.37% (95% CI : 0.2, 0.55) in total (nonaccidental) mortality, 0.66% (95% CI : 0.28, 1.04), 0.31% (95% CI : 0.11, 0.51) and 0.39% (95% CI : 0.16, 0.62) in circulatory mortality, and 0.57% (95% CI : ?0.09, 1.23), 0.11% (95% CI : ?0.22, 0.44) and 0.22% (95% CI : ?0.28, 0.72) in respiratory mortality, respectively. These estimates had a different seasonal pattern by cause of death. In general, the seasonal patterns were consistent with the times of year when ozone concentrations are highest.

Conclusions

Our findings suggest that in China, the acute effects of ozone are more closely related to daily average exposure than any other metric.

     

Low 25 (OH) vitamin D levels are associated with increased prevalence of nonalcoholic fatty liver disease and significant liver fibrosis

Aims

Evidence on the role of 25-Hydroxyvitamin D (25(OH)D) in the occurrence and progression of nonalcoholic fatty liver disease (NAFLD) is conflicting and population-based data are scarce. Here, we assess the association between 25(OH)D levels, NAFLD and liver fibrosis in the general population.

Materials and Methods

This is an analysis of data from the 2017–2018 cycle of the National Health and Nutrition Examination Survey. We included adult participants with available data on vibration-controlled transient elastography (VCTE) and without viral hepatitis and significant alcohol consumption. Steatosis and fibrosis were diagnosed by the median values of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), respectively. 25(OH)D was measured by high performance liquid chromatography-tandem mass spectrometry.

Results

A total of 3970 participants (1928 men and 2042 women) were included in the study. The prevalence of NAFLD (CAP ≥ 274 dB/m) and significant liver fibrosis (LSM ≥ 8 kPa) were 41.7% (95% CI 39.4–44.0) and 8.4% (95% CI 7.0–9.9), respectively, while 21.1% (95% CI 17.3–25.4) of participants had low 25(OH)D levels (<50 nmol/L). A multivariable logistic regression model adjusted for age, sex, race-ethnicity, body mass index, waist circumference, calendar period, diabetes, chronic kidney disease, and vitamin D supplementation showed that compared with participants with low 25(OH)D, those with optimal levels (≥75 nmol/L) had lower odds of both NAFLD (OR 0.73, 95% CI 0.55–0.98 p = 0.038) and significant liver fibrosis (OR 0.65, 95% CI 0.44–0.96, p = 0.033).

Conclusions

An inverse relationship was found between 25(OH)D and NAFLD and fibrosis, suggesting a possible role of vitamin D in NAFLD occurrence and progression.

     

Association between subclinical thyroid dysfunction and change in bone mineral density in prospective cohorts

Background

Subclinical hyperthyroidism (SH yper) has been associated with increased risk of hip and other fractures, but the linking mechanisms remain unclear.

Objective

To investigate the association between subclinical thyroid dysfunction and bone loss.

Methods

Individual participant data analysis was performed after a systematic literature search in MEDLINE /EMBASE (1946–2016). Two reviewers independently screened and selected prospective cohorts providing baseline thyroid status and serial bone mineral density (BMD ) measurements. We classified thyroid status as euthyroidism (thyroid‐stimulating hormone [TSH ] 0.45–4.49 mIU/L), SH yper (TSH < 0.45 mIU/L) and subclinical hypothyroidism (SH ypo, TSH ≥ 4.50–19.99 mIU/L) both with normal free thyroxine levels. Our primary outcome was annualized percentage BMD change (%ΔBMD) from serial dual X‐ray absorptiometry scans of the femoral neck, total hip and lumbar spine, obtained from multivariable regression in a random‐effects two‐step approach.

Results

Amongst 5458 individuals (median age 72 years, 49.1% women) from six prospective cohorts, 451 (8.3%) had SH ypo and 284 (5.2%) had SH yper. During 36 569 person‐years of follow‐up, those with SH yper had a greater annual bone loss at the femoral neck versus euthyroidism: %ΔBMD = ?0.18 (95% CI: ?0.34, ?0.02; I ² = 0%), with a nonstatistically significant pattern at the total hip: %ΔBMD = ?0.14 (95% CI: ?0.38, 0.10; I ² = 53%), but not at the lumbar spine: %ΔBMD = 0.03 (95% CI: ?0.30, 0.36; I ² = 25%); especially participants with TSH < 0.10 mIU/L showed an increased bone loss in the femoral neck (%Δ BMD = ?0.59; [95% CI: ?0.99, ?0.19]) and total hip region (%ΔBMD = ?0.46 [95% CI: ?1.05, ?0.13]). In contrast, SH ypo was not associated with bone loss at any site.

Conclusion

Amongst adults, SH yper was associated with increased femoral neck bone loss, potentially contributing to the increased fracture risk.

     

The prognostic significance of T-wave inversion according to ECG lead group during long-term follow-up in the general population

Background

Inverted T waves in the electrocardiogram (ECG) have been associated with coronary heart disease (CHD) and mortality. The pathophysiology and prognostic significance of T-wave inversion may differ between different anatomical lead groups, but scientific data related to this issue is scarce.

Methods

A representative sample of Finnish subjects (n = 6,354) aged over 30 years underwent a health examination including a 12-lead ECG in the Health 2000 survey. ECGs with T-wave inversions were divided into three anatomical lead groups (anterior, lateral, and inferior) and were compared to ECGs with no pathological T-wave inversions in multivariable-adjusted Fine–Gray and Cox regression hazard models using CHD and mortality as endpoints.

Results

The follow-up for both CHD and mortality lasted approximately fifteen years (median value with interquartile ranges between 14.9 and 15.3). In multivariate-adjusted models, anterior and lateral (but not inferior) T-wave inversions associated with increased risk of CHD (HR: 2.37 [95% confidence interval 1.20–4.68] and 1.65 [1.27–2.15], respectively). In multivariable analyses, only lateral T-wave inversions associated with increased risk of mortality in the entire study population (HR 1.51 [1.26–1.81]) as well as among individuals with no CHD at baseline (HR 1.59 [1.29–1.96]).

Conclusions

The prognostic information of inverted T waves differs between anatomical lead groups. T-wave inversion in the anterior and lateral lead groups is independently associated with the risk of CHD, and lateral T-wave inversion is also associated with increased risk of mortality. Inverted T wave in the inferior lead group proved to be a benign phenomenon.

     

Clinical utility of 12-lead electrocardiogram in evaluating heart disease in patients with muscular dystrophy: Assessment of left ventricular hypertrophy,conduction disease,and cardiomyopathy

Introduction

Heart disease remains a leading cause of mortality in patients with muscular dystrophy (MD), and cardiac assessment by standard imaging modalities is challenging due to the prominence of physical limitations.

Methods

In this prospective cohort study of 169 MD patients and 34 negative control patients, we demonstrate the clinical utility of a 12-lead electrocardiogram (ECG) as an effective modality for the assessment of cardiac status in patients with MD. We assessed the utility of conventional criteria for electrocardiogram-indicated left ventricular hypertrophy (ECG-LVH) as well as ECG morphologies.

Results

Cornell voltage, Cornell voltage-duration, Sokolow–Lyon voltage, and Romhilt-Estes point score criteria demonstrated low sensitivity and minimal positive predictive value for ECG-LVH when compared with cardiac imaging. Patients with LBBB had a high probability of a cardiomyopathy (relative risk [RR], 2.75; 95% confidence interval [CI], 2.14–3.53; p < .001), and patients with QRS fragmentation (fQRS) had a high probability of a cardiomyopathy (RR, 1.76; 95% CI, 1.20–2.59; p = .004), requiring cardiac medication and device intervention. We found that an R/S ratio >1 in V1 and V2 is highly specific (specificity, 0.89; negative predictive value [NPV], 0.89 and specificity, 0.82; NPV, 0.89, respectively) for patients with dystrophinopathies compared with other types of MD.

Conclusion

The identification of LBBB and fQRS was linked to cardiomyopathy in patients with MD, while ECG-LVH was of limited utility. Importantly, these findings can be applied to effectively screen a broad cohort of MD patients for structural heart disease and prompt further evaluation and therapeutic intervention.

     

Estimated glomerular filtration rate and the risk–benefit profile of intensive blood pressure control amongst nondiabetic patients: a post hoc analysis of a randomized clinical trial

Background

The Systolic Blood Pressure Intervention Trial (SPRINT ; ClinicalTrials.gov , NCT 01206062) reported reduced cardiovascular events by intensive blood pressure (BP ) control amongst hypertensive patients without diabetes. However, the risk–benefit profile of intensive BP control may differ across estimated glomerular filtration rate (eGFR ) levels.

Methods

This is a post hoc analysis of the SPRINT . Nondiabetic hypertensive adults (n  = 9361) with eGFR >20 mL per min per 1.73 m² were enrolled from 102 US facilities between November 2010 and March 2013 and were followed up until August 2015 (median follow‐up, 3.26 years). Patients were randomly assigned to either a systolic BP target of <120 or <140 mmHg (for intensive or standard treatment, respectively). The outcomes of interests were the development of (i) fatal and nonfatal major cardiovascular events and (ii) acute kidney injury (AKI ).

Results

The cardiovascular benefit from intensive treatment was attenuated with lower eGFR (P _interaction = 0.019), whereas eGFR did not modify the adverse effect on AKI (P _interaction = 0.179). Amongst 891 participants with eGFR <45 mL per min per 1.73 m², intensive treatment did not reduce the cardiovascular outcome (54/446 vs. 54/445 events in the standard group, respectively; hazard ratio [HR ], 0.92; 95% CI , 0.62–1.38) with an absolute rate difference (ARD ) of ?0.02 (95% CI , ?0.07 to +0.03) per 100 patient‐years, whereas it increased AKI (62/446 vs. 38/445 events in the standard group; HR , 1.73; 95% CI , 1.12–2.66) with an ARD of +1.93 (95% CI , +1.88 to +1.97) per 100 patient‐years.

Conclusions

Intensive BP control may provide little or no benefit and even be harmful for patients with moderate‐to‐advanced chronic kidney disease.

     

Lactobacillus reuteri reduces bone loss in older women with low bone mineral density: a randomized,placebo‐controlled,double‐blind,clinical trial

Background

The importance of the gut microbiome for bone metabolism in mice has recently been demonstrated, but no studies are available in humans. Lactobacillus reuteri ATCCPTA 6475 (L. reuteri 6475) has been reported to increase bone mineral density (BMD ) in mice but its effect on the human skeleton is unknown. The objective of this trial was to investigate if L. reuteri 6475 affects bone loss in older women with low BMD .

Methods

In this double‐blind, placebo‐controlled study, women from the population who were 75 to 80 years old and had low BMD were randomized to orally receive 10¹⁰ colony‐forming units of L. reuteri 6475 daily or placebo. The predefined primary end‐point was relative change after 12 months in tibia total volumetric BMD (vBMD ).

Results

Ninety women were included and 70 completed the study. L. reuteri 6475 reduced loss of total vBMD compared to placebo both in the intention‐to‐treat (ITT ) analysis [?0.83% (95% confidence interval [CI ], ?1.47 to ?0.19%) vs. ?1.85% (95% CI , ?2.64 to ?1.07%); mean difference 1.02% (95% CI , 0.02–2.03)] and per protocol analysis [?0.93% (95% CI , ?1.45 to ?0.40) vs. ?1.86% (95% CI , ?2.35 to ?1.36); mean difference 0.93% (95% CI , 0.21–1.65)]. In general, similar but smaller effects were observed in the secondary bone variable outcomes, but these differences did not reach statistical significance in the ITT population. Adverse events did not differ between groups.

Conclusions

Supplementation with L. reuteri 6475 should be further explored as a novel approach to prevent age‐associated bone loss and osteoporosis.

     

Electrocardiographic predictors of early recurrence of atrial fibrillation

Background

Electrical cardioversion (ECV) is an effective method for restoring sinus rhythm after atrial fibrillation (AF). However, early recurrence of AF occurs in a significant number of patients after ECV. This study aimed to identify electrocardiographic (ECG) predictors of early AF recurrence after ECV.

Methods

A total of 272 patients with persistent AF undergoing successful ECV were consecutively enrolled in this study. We investigated clinical, echocardiographic, and ECG data. The 12-lead ECG parameters were measured during sinus rhythm right after ECV using a digital caliper. The early AF recurrence was defined as recurrence within 2 months.

Results

Of the 272 patients, 165 patients (60.7%) experienced an early AF recurrence. Maximum P-wave duration (PWD) in limb leads (OR: 1.086; 95% CI: 1.019–1.157; p = .012) and P-terminal force (PTF) in V₁ (OR: 1.019; 95% CI: 1.004–1.033; p = .011) were independent predictors of early AF recurrence after ECV. The optimal cutoff value of the maximum PWD in limb leads for predicting early AF recurrence was 134 ms, characterized by 90.3% sensitivity and 72.0% specificity. Likewise, the optimal cutoff value of PTF in V₁ was 50 ms × mm, characterized by 80.0% sensitivity and 64.5% specificity.

Conclusion

A longer PWD (>134 ms) and a larger PTF (>50 ms × mm) were useful predictors of early recurrence of AF after successful ECV in clinical practice. A more effective rhythm control therapy such as catheter ablation or rate control strategy rather than a repeat ECV should be considered.

     

Red Blood Cell Distribution Width as a Predictor of 28-Day Mortality in Critically Ill Patients With Alcohol Use Disorder

Background

Patients with alcohol use disorder (AUD) are common attendees of the intensive care unit (ICU). Early assessment of the prognosis for critically ill patients with AUD is conducive for formulating comprehensive treatment measures and improving survival rates. The purpose of this study was to explore the predictive value of red blood cell distribution width (RDW) for 28-day mortality in critically ill patients with AUD.

Methods

2,884 patients with AUD were recruited retrospectively. Data from the MIMIC-III database were collected and analyzed. A receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value of RDW. The Kaplan–Meier method and Cox regression models were used to evaluate prognostic factors.

Results

Of the 2,884 patients, there were 344 nonsurvivors (11.9%). The nonsurvivors had a higher RDW than the survivors (p < 0.001). According to ROC curve analysis, the area under the curve predicted by RDW for 28-day mortality was 0.728 (95% CI, 0.700 to 0.755) and the optimal cutoff value was 15.45% (sensitivity: 67.2%; specificity: 67.3%). Length of stay in ICU, length of stay in hospital, in-hospital mortality, and 28-day mortality in patients with an RDW > 15.45% were significantly higher than in those with an RDW ≤ 15.45% (p < 0.001). Cox regression analysis showed that an RDW > 15.45% was an independent prognostic indicator for 28-day mortality in critically ill patients with AUD (HR = 1.964, 95% CI: 1.429 to 2.698).

Conclusions

High RDW was associated with increased short-term mortality risks in critically ill patients with AUD.

     

Association of Prenatal Alcohol Exposure and Offspring Depression: A Negative Control Analysis of Maternal and Partner Consumption

Background

Previous research has suggested that intrauterine alcohol exposure is associated with a variety of adverse outcomes in offspring. However, few studies have investigated its association with offspring internalizing disorders in late adolescence.

Methods

Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), we investigated the associations of maternal drinking in pregnancy with offspring depression at age 18 and 24 (n = 13,480). We also examined partner drinking as a negative control for intrauterine exposure for comparison.

Results

Offspring of mothers that consumed any alcohol at 18 weeks gestation were at increased risk of having a diagnosis of depression (fully adjusted model: OR 1.17, 95% CI 1.02 to 1.34), but there was no clear evidence of association between partners’ alcohol consumption at 18 weeks gestation during pregnancy and increased risk of offspring depression (fully adjusted model: OR 0.87, 95% CI 0.74 to 1.01). Postestimation tests found a positive difference between the association of maternal and partner alcohol use on offspring depression, showing a stronger association for maternal compared with partner alcohol use (OR 1.41, CI 1.07 to 1.84).

Conclusions

Maternal drinking in pregnancy was associated with increased risk of offspring depression at age 18. Residual confounding may explain this association, but the negative control comparison of paternal drinking provides some evidence that it may be causal, and this warrants further investigation.

     

Prevalence of fetal alcohol spectrum disorder in Greater Manchester,UK: An active case ascertainment study

Background

Despite high levels of prenatal alcohol exposure in the UK, evidence on the prevalence of fetal alcohol spectrum disorders (FASD) is lacking. This paper reports on FASD prevalence in a small sample of children in primary school.

Methods

A 2-phase active case ascertainment study was conducted in 3 mainstream primary schools in Greater Manchester, UK. Schools were located in areas that ranged from relatively deprived to relatively affluent. Initial screening of children aged 8–9 years used prespecified criteria for elevated FASD risk (small for age; special educational needs; currently/previously in care; significant social/emotional/mental health symptoms). Screen-positive children were invited for detailed ascertainment of FASD using gold standard measures that included medical history, facial dysmorphology, neurological impairment, executive function, and behavioral difficulties.

Results

Of 220 eligible children, 50 (23%) screened positive and 12% (26/220) proceeded to Phase 2 assessment. Twenty had a developmental disorder, of whom 4 had FASD and 4 were assessed as possible FASD. The crude prevalence rate of FASD in these schools was 1.8% (95% CI: 1.0%, 3.4%) and when including possible cases was 3.6% (2.1%, 6.3%). None of these children had previously been identified with a developmental diagnosis.

Conclusions

FASD was found to be common in these schools and most of these children's needs had not previously been identified. A larger, more definitive study that uses a random sampling technique stratified by deprivation level to select schools is needed to make inferences regarding the population prevalence of FASD.

     

Does the skin heat up before it breaks down in diabetic foot ulceration?

Aims

Most diabetic foot ulcers are caused by tissue stress from being ambulatory in people without protective sensation. These ulcers are suggested to be preceded by local skin temperature increase due to inflammation of the underlying tissue, a so-called hotspot. Evidence to support this mechanism of ulcer development is meagre at best. We investigated if foot ulcers are preceded by increased skin temperature in people with diabetes and foot ulcer history.

Material and Methods

Participants measured temperature at 6–8 plantar foot locations each day for 18 months and identified a hotspot with a temperature difference >2.2°C between corresponding foot locations for two consecutive days.

Results

Twenty-nine of 151 participants developed a non-traumatic ulcer while adhering to temperature measurements. In the 2 months prior to ulceration, 8 (28%) had a true hotspot (i.e. at/adjacent to the ulcer location) and the hotspot was on average no longer present 9 days before ulceration. Seven (24%) participants had a false hotspot (i.e. at another location) and 14 (48%) had no hotspot.

Conclusions

The skin of the majority of the ulcers does not heat up before it breaks down or, when it does, not directly before breakdown, questioning the foot temperature increase—uslcer association.

     

Estimated Prevalence of Harmful Alcohol Consumption in Pregnant and Nonpregnant Women in Saxony-Anhalt (NorthEast Germany) Using Biomarkers

Background

Alcohol consumption is commonly accepted in Western societies and is a known risk factor in pregnancy, which could lead to fetal alcohol spectrum disorders (FASDs). Prevalence of alcohol consumption during pregnancy is mostly unknown. Prevalence estimates in publications based on questionnaires are limited by possible underreporting due to social stigmatization. The aim of this study was to estimate the prevalence of harmful alcohol consumption in a large cohort of pregnant women using different biomarkers related to alcohol consumption and compare the findings with those of non-pregnant women

Methods

Routine parameters known to be influenced by alcohol consumption (γ-glutamyltransferase, GGT; carbohydrate-deficient transferrin, CDT/%CDT; mean corpuscular/cell volume, MCV; combined parameter of GGT and %CDT, GGT-CDT) were analyzed in serum samples of 2,182 pregnant women and 743 non-pregnant, age-matched females. Data were tested for (i) differences between pregnant and non-pregnant women and (ii) changes across the 3 trimesters of pregnancy.

Results

Prevalence rates differ greatly according to the parameter and cutoff, which reflects the limitations of assessing alcohol consumption with biomarkers. The prevalence of harmful alcohol consumption on the basis of a single or several elevated parameters was 13.8% (95% CI: 12.4 to 15.2) in pregnant women and 18.6% (95% CI: 15.8 to 21.4) in non-pregnant women, though 85.0% of the elevated measurements were attributable to an isolated elevation in %CDT only. Using GGT-CDT as the parameter with the highest specificity according to the literature, the estimated prevalence of harmful alcohol consumption in pregnancy is 0.5% (95% CI: 0.2 to 0.7).

Conclusion

Estimated prevalence rates differ greatly with respect to the biomarkers and cutoffs used. The use of CDT/%CDT alone appears to overestimate harmful alcohol consumption during pregnancy.