A nationwide population cohort study: Irritable bowel syndrome is a risk factor of osteoporosis

BackgroundThe goal of the study is to determine the relationship between irritable bowel syndrome (IBS) and osteoporosis in Taiwan.Materials and methodsWe collected data from the National Health Insurance (NHI) program in Taiwan. The sample in this study consisted of 31,892 patients enrolled from 2000 to 2009 and diagnosed by the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). We divided the sample into 2 cohorts based on whether they had IBS, and formed subgroups based on age, sex, enrolment year, and enrolment month.ResultsAge and gender did not differ statistically among the 2 cohorts. Results show that IBS is more correlated with urbanization and the occupation of business. The IBS cohort had a higher incidence of osteoporosis than the non-IBS cohort (6.90 vs 4.15 per 1000 person-years; HR = 1.65, 955 CI = 1.54–1.77). Female patients aged 40–59 years had the highest risk of developing osteoporosis (HR = 4.42, 95% CI = 3.37–5.79 in the IBS cohort; HR = 4.41, 95% CI = 3.67–5.29 in the non-IBS cohort, respectively). In IBS patients less than 40 years of age, female patients had a significant 2.18-fold greater risk of developing osteoporosis than male patients (HR = 2.18, 95% CI = 1.09–4.38).ConclusionsIBS is a risk factor for osteoporosis in Taiwan.     

Long-term risk of acute coronary syndrome in patients with cholangitis: A 13-year nationwide cohort study

Background & aimsPatients with cholangitis may exhibit repeated and chronic inflammation of the biliary tract despite successful medical or surgical treatments. This nationwide cohort study examined the association between cholangitis and the subsequent development of acute coronary syndrome (ACS).MethodsWe identified a cohort of 37 676 patients who were diagnosed with cholangitis between January 1998 and December 2010, and a comparison cohort of 150 704 subjects frequency matched by age, sex, and index year after excluding comorbidities for ACS. Both cohorts were followed until the end of 2010 to measure the incidence of ACS. Both incidence rate ratios and hazard ratios of ACS were estimated by age and sex.ResultsSex-specific analysis showed that males were at a higher incidence of ACS than females in both groups with (16.2 vs 11.5 per 10 000 person-years) and without (18.7 vs 12.5 per 10 000 person-years) cholangitis. The incidence of ACS also increased with age no matter having or not having cholangitis. The age stratified analysis revealed that the risk of ACS was significantly higher in patients with cholangitis younger than 65 years old. The multivariable Cox proportional hazard model demonstrated that cholangitis was significantly associated with ACS (adjusted hazard ratio [HR] = 1.18; 95% confidence interval [CI], 1.03–1.35) after adjusting age and sex in the model.ConclusionsThis study suggests that patients with cholangitis are at an elevated risk of ACS. Awareness of the potential ACS risk for patients with cholangitis is important for patients and clinicians.     

Adult asthmatics increase the risk of acute coronary syndrome: A nationwide population-based cohort study

ObjectivesFew studies have examined the risk of acute coronary syndrome (ACS) in asthmatics. We investigate the effects of asthma on the risk of ACS development in an Asian population.MethodsAsthma patients aged ≥ 18 years were identified, and asthma-free controls were randomly selected from the general population and frequency-matched according to age, sex, index year, and baseline comorbidity by using the National Health Insurance Research Database. Both cohorts were followed up until the end of 2011 to measure the incidence of ACS. The risk of ACS was analyzed using Cox proportional hazards regression models.ResultsWe observed the asthmatic patients for 97,506 person–years and followed the nonasthmatic people for 193,423 person–years. The incidence density rate of ACS increased in all groups of the asthmatic patients compared with those of the controls when the data were stratified according to sex, age, and comorbidities. The hazard ratio (HR) of ACS was 1.66-fold greater in the asthmatic cohort than in the nonasthmatic cohort, after adjusting for sex, age, and comorbidities (95% confidence interval [CI]: 1.31–2.11). The adjusted HR of developing ACS increased substantially as age and the frequency of asthmatic exacerbation and hospitalization increased.ConclusionsAsthma is an independent risk factor of ACS, and poor control of asthma increases the risk of ACS development in a dose-dependent manner.     

People with tuberculosis are associated with a subsequent risk of depression

BackgroundThere is some evidence that the prevalence of depression in patients with tuberculosis (TB) is higher than those in the general population. However, the incidence of depression after Mycobacterium tuberculosis infection remains unknown. Our aim was to assess the association between TB and the subsequent risk of depression.MethodsWe conducted a retrospective cohort study using data from the National Health Insurance (NHI) system of Taiwan. The TB cohort included 9020 patients who were newly diagnosed and recruited between 2000 and 2010. Each patient was randomly frequency-matched for age, sex and the year of index date with four people without TB from the general population. The newly diagnosed depression was followed up until the end of 2011. The relative risks of depression were estimated using Cox proportional hazard models after adjusting for age, sex, index year and comorbidities.ResultsThe overall incidence rate of depression was 1.54-fold higher in the TB cohort as compared with the controlled cohort (8.15 vs. 5.29 per 1000 person-years, 95% confidence interval [CI] = 1.45–1.64). Stratified analyses by gender, age group, monthly income and comorbidities revealed that the adjusted hazard ratio (HR) of depression was higher in males as well as individuals older than 65 years with a low monthly income and comorbidities.ConclusionPeople who have been diagnosed with TB have a significantly higher risk of developing depression compared with those in the general population. We should pay more attention to this group of individuals and ensure that they are offered appropriate support.     

Impact of long-term gastric acid suppression on spontaneous bacterial peritonitis in patients with advanced decompensated liver cirrhosis

ObjectiveRecent studies have presented conflicting results on the association between gastric acid suppression and spontaneous bacterial peritonitis (SBP). The long-term effects of gastric acid suppression on SBP in cirrhotic patients remain unclear. This study evaluated the risk of SBP in advanced decompensated cirrhotic patients with long-term gastric acid suppression.MethodsUsing the Taiwan National Health Insurance Research Database, we identified 4788 patients with decompensated cirrhosis from 1998 to 2011. The SBP incidence rate was compared among proton pump inhibitor (PPI), H2-receptor antagonist (H2RA), and control cohorts. Multivariate Cox proportional hazards regressions analysis was conducted to confirm the association between gastric acid suppression and SBP.ResultsTotally, 4788 patients were analyzed: 1870 in the PPI cohort, 1728 in the H2RA cohort, and 1190 in the control cohort. The overall incidences of SBP were 16.8, 11.9, and 9.80 per 1000 person-years in the PPI, H2RA, and control cohorts, respectively. The adjusted hazard ratio (aHR) of SBP during the follow-up period was 1.16- (95% confidence interval [CI], 0.72–1.86) and 1.00-fold (95% CI, 0.63–1.57) higher in the PPI and H2RA cohorts, respectively, than in the control cohort; the result was non-significant. Compared with the control cohort, patients with > 180 days of PPI therapy had significantly higher risks of SBP, with an aHR of 2.28 (95% CI, 1.37–3.78).ConclusionsLong-term PPI use is associated with a high risk of SBP in advanced decompensated cirrhotic patients. Well-designed prospective studies are necessary to evaluate the safety of long-term PPI use in such patients.     

Proteinuria predicts 10-year cancer-related mortality in patients with type 2 diabetes

BackgroundWe conducted a cohort study to determine if proteinuria predicts cancer-related mortality in type 2 diabetic subjects.MethodsBetween July 1996 and June 2003, we enrolled 646 type 2 diabetic subjects. Participants were followed-up until December 31, 2008. The vital status was ascertained by linking records with computerized death certificates in Taiwan.ResultsDuring a median follow-up of 10.4 years, 158 subjects had died, including 59 from cancers. Subjects with proteinuria had a hazard ratio (HR) of 2.77 (95% CI 1.82–4.21) for all-cause mortality and 1.99 (95% CI 1.00–3.94) for cancer-related mortality after adjustment for demographic factors and medical conditions. Specifically, proteinuria showed a trend of increased colon cancer death. The presence of proteinuria significantly improved the predictive ability of cancer-related mortality (increase in concordance statistics or area under the ROC curve = 0.03). Patients with both proteinuria and estimated glomerular filtration rate < 60 ml/min per 1.73 m² showed higher HR for all-cause mortality than patients with proteinuria only (adjusted HRs (95% CI), 4.01 (2.42–6.67) vs. 2.69 (1.51–4.79), both p < 0.01).ConclusionsProteinuria can predict 10-year all-cause and cancer-related mortalities independently in type 2 diabetic subjects, over and above the established risk factors associated with type 2 diabetes.     

Disease severity does not affect the interval between IBD diagnosis and the development of CRC: Results from two large,Dutch case series

BackgroundThe increased risk of colorectal cancer (CRC) in patients with inflammatory bowel disease (IBD) is well established. The incidence of IBD-related CRC however, differs markedly between cohorts from referral centers and population-based studies. In the present study we aimed to identify characteristics potentially explaining these differences in two cohorts of patients with IBD-related CRC.MethodsPALGA, a nationwide pathology network and registry in The Netherlands, was used to search for patients with IBD-associated CRC between 1990 and 2006. Patients from 7 referral hospitals and 78 general hospitals were included. Demographic and disease specific parameters were collected retrospectively using patient charts.ResultsA total of 281 patients with IBD-associated CRC were identified. Patients from referral hospitals had a lower median age at IBD diagnosis (26 years vs. 28 years (p = 0.02)), while having more IBD-relapses before CRC diagnosis than patients from general hospitals (3.8 vs. 1.5 (p < 0.01)). In patients from referral hospitals, CRC was diagnosed at a younger age (47 years vs. 51 years (p = 0.01)). However, the median interval between IBD diagnosis and diagnosis of CRC was similar in both cohorts (19 years in referral hospitals vs. 17 years in general hospitals (p = 0.13)).ConclusionsIBD patients diagnosed with CRC treated in referral hospitals in The Netherlands are younger at both the diagnosis of IBD and CRC than IBD patients with CRC treated in general hospitals. Although patients from referral centers appeared to have a more severe course of IBD, the interval between IBD and CRC diagnosis was similar.     

Major Adverse Cardiovascular Events and Mortality in Systemic Lupus Erythematosus Patients After Successful Delivery: A Population-based Study

BackgroundLimited data exist regarding the incidence rate and hazard ratios (HRs) of major adverse cardiovascular events and mortality in the successful-delivery women with or without systemic lupus erythematosus.MethodsA retrospective, population-based cohort study was performed on 1,132,089 parturients from 1999 to 2003. The Kaplan-Meier method and the log-rank test were used to examine the effect of systemic lupus erythematosus on the incidence of major adverse cardiovascular events and mortality. Cox-proportional hazard regression modeling was used to determine the adjusted HRs of systemic lupus erythematosus on the risk of major adverse cardiovascular events and mortality among successful-delivery women.Resultssystemic lupus erythematosus group has the highest risk for major adverse cardiovascular events and mortality. The incidence rate of major adverse cardiovascular events and all-causes mortality among lupus women was 194.67 and 438.82 per 100,000 patients per year, respectively. Lupus women had higher incidence rates of major adverse cardiovascular events, including myocardial infarction, (HR, 54.43; confidence interval [CI], 16.04–184.78; P < 0.0001), heart failure (HR, 11.10; CI, 2.71–45.52; P < 0.0001), percutaneous coronary intervention (HR, 228.32; CI, 43.34–1203.00; P < 0.0001), stroke (HR, 8.02; CI, 3.79–16.99; P < 0.0001) and maternal death (HR, 11.68; CI, 7.97–17.10; P < 0.0001).ConclusionsAlthough major adverse cardiovascular events and mortality are rare events in women of reproductive age, the incidence rates have increased approximately 10-fold among lupus women with successful delivery. Clinicians should note the possibility of persisting major adverse cardiovascular events and death in young women with lupus and successful delivery.     

Inflammatory bowel diseases increase future ischemic stroke risk: A Taiwanese population-based retrospective cohort study

Background and aimsThis cohort study assessed the association between inflammatory bowel disease (IBD) and the risk of future ischemic stroke.MethodsThe IBD cohort comprised adult patients (≥ 20 years old) who had received either ambulatory or inpatient care between 1998 and 2011 and IBD-free controls were randomly selected from the general population and frequency matched according to age, sex, and index year (included 18,392 patients with IBD and 73,568 control patients). Both cohorts with ischemic stroke before the index date and the ischemic stroke cases diagnosed within one year after the index date were excluded. We observed the study patients until the incidence of ischemic stroke, death, withdrawal from the insurance program, or they were lost to follow-up, or the end of 2011.ResultsThe risk of ischemic stroke was 1.12-fold (95% CI, 1.02–1.23) higher among the IBD cohort than among the non-IBD cohort. Compared to the subjects without IBD, the adjusted HR of ischemic stroke was 1.15 (95% CI 1.04–1.28) in the Crohn's disease (CD) patients and 1.01 (95% CI 0.84–1.21) in the ulcerative colitis (UC) group. The risk of developing ischemic stroke significantly increased with the increased frequency of IBD exacerbation and hospitalization. Furthermore, the adjusted HR among the CD patients increased in conjunction with the number of medical visits, from 1.07 to 6.36 and the adjusted HR among the UC patients also increased in conjunction with the number of medical visits, from 1.11 to 2.10.ConclusionsIBD exhibited an increased risk of developing ischemic stroke.     

Cholesterol in midlife increases the risk of Alzheimer's disease during an up to 43-year follow-up

PurposeVascular risk factors in midlife may play a role in the development of cognitive decline, dementia and Alzheimer’ disease (AD). The role of serum total cholesterol has yielded inconsistent results in diverse cohorts.ObjectiveTo analyze the relationship between the midlife cholesterol level and AD in late life in a homogenous cohort of Caucasian men.MethodsThe Helsinki Businessmen Study is a cohort of male business executives who have been followed-up since 1964. Midlife cholesterol level was available in 3293 men, of whom 205 developed a register-verified AD. Cognitively intact men in 2007 (n = 844) served as controls, and logistic regression adjusted for age and cardiovascular risk factors was used to investigate the association between cholesterol and AD.ResultsAt baseline, the men with subsequent AD diagnosis had 0.4 mmol/L higher total cholesterol level than controls (6.7 vs 6.3 mmol/L). In adjusted analyses 1 mmol/L rise in total cholesterol was associated with a 22% increased risk of AD (odds ratio [OR] 1.22, 95% confidence interval 1.06 to 1.40, P = 0.005). Risk of AD (OR with 95% CI) also increased in a stepwise manner from the lowest to highest quartile of midlife cholesterol from 1.0 (referent) to 1.6 (1.01–2.6), 1.9 (1.2–3.0), and 2.0 (1.2–3.3), respectively.ConclusionIn this longitudinal study with up to 43 years of follow-up, higher serum total cholesterol in early midlife was clearly associated with a higher risk of AD in late life.     

Vascular access type and mortality in elderly incident hemodialysis patients

IntroductionThe ideal vascular access type for elderly hemodialysis (HD) patients remains debatable. The aim of this study was to analyze the association between patterns of vascular access use within the first year of HD and mortality in elderly patients.MethodsSingle-center retrospective study of 99 incident HD patients aged ≥ 80 years from January 2010 to May 2021. Patients were categorized according to their patterns of vascular access use within the first year of HD: central venous catheter (CVC) only, CVC to arteriovenous fistula (AVF), AVF to CVC, and AVF only. Baseline clinical data were compared among groups. Survival outcomes were analyzed using Kaplan–Meier survival curves and Cox's proportional hazards model.ResultsWhen compared with CVC to AVF, mortality risk was significantly higher among CVC only patients and similar to AVF only group [HR 0.93 (95% CI 0.32–2.51)]. Ischemic heart disease [HR 1.74 (95% CI 1.02–2.96)], lower levels of albumin [HR 2.16 (95% CI 1.28–3.64)] and hemoglobin [HR 4.10(95% CI 1.69–9.92)], and higher levels of c-reactive protein [HR 1.87(95% CI 1.11–3.14)] were also associated with increased mortality risk in our cohort, p < 0.05.ConclusionOur findings suggested that placement of an AVF during the early stages of dialysis was associated with lower mortality compared to persistent CVC use among elderly patients. AVF placement appears to have a positive impact on survival outcomes, even in those who started dialysis with a CVC.     

Effect modification of hyperlipidemia and hypertension on the association between type 2 diabetes and gout

AimsWe evaluated the association between type 2 diabetes and gout by a retrospective cohort study.MethodsData of 17,259 male and 18,318 female patients with type 2 diabetes were retrieved for the 1998–2010 period. These patients were matched to a comparison group (n = 34,518 and n = 36,636, respectively) in a 1:2 ratio by age and region.ResultsWe found that patients with type 2 diabetes after adjustment for hyperlipidemia and hypertension had a lower risk of incident gout than the matched population (incidence rate ratio, men: 0.39 [95% CI: 0.36–0.42]; women: 0.78 [0.72–0.84]). Specifically, type 2 diabetes alone without hyperlipidemia and hypertension was associated with a reduced risk of incident gout in men (adjusted relative risk [RR]: 0.29, 95% CI: 0.22–0.39), but not in women (0.86, 95% CI: 0.55–1.36). We found that insulin users with hyperlipidemia and hypertension associated with risk of incident gout and no sex-specific differences were noted (adjusted RR, men: 1.28 [95% CI: 1.11–1.48]; women: 1.32 [95% CI: 1.14–1.53]). Specifically, insulin users alone without hyperlipidemia and hypertension were not statistically significantly associated with gout risk (P ≥ .0954).ConclusionsThe results of this study indicated that hyperlipidemia and hypertension modified the association between type 2 diabetes and gout.     

Low serum creatinine is a type 2 diabetes risk factor in men and women: The Yuport Health Checkup Center cohort study

AimType 2 diabetes (T2D) is a risk factor for muscle loss and subsequent frailty. The reverse association, however, may also happen. This study examined whether serum creatinine level, an indicator of muscle mass, predicted diabetes development. In addition, a role for body mass index (BMI) as an effect modifier of creatinine levels was evaluated.MethodsThis cohort study included 9667 subjects without diabetes or hypertension and with normal creatinine levels at baseline. Multiple-adjusted hazard ratios (HRs) for associations between baseline creatinine and diabetes development were estimated using the Cox proportional-hazards model. Stratified analyses based on BMI were also performed.ResultsDuring the follow-up period (mean: 5.6 years), 287 (5.5%) men and 115 (2.3%) women developed T2D. HR in men with serum creatinine ≤ 0.7 mg/dL compared with 0.9–1.2 mg/dL was 1.40 (95% CI: 1.05–1.87) after adjusting for age, BMI, blood pressure and fasting plasma glucose at baseline, whereas the adjusted HR in women with creatinine ≤ 0.5 mg/dL compared with 0.7–1.1 mg/dL was 1.69 (95% CI: 1.04–2.76). In a subgroup analysis stratified by BMI, interactions between BMI and baseline creatinine levels for T2D were statistically significant in women with the lowest creatinine levels (P = 0.08 for interaction).ConclusionLow serum creatinine levels, a surrogate marker of muscle mass, predict T2D development in both genders, even after excluding the effect of diabetic and prediabetic glomerular hyperfiltration. BMI modified the association between creatinine and diabetes development in women.     

Risk factors associated with adverse drug events among older adults in emergency department

BackgroundLittle is known about the emergency department (ED) visits from drug-related injury among older adults in Taiwan. This study seeks to identify risk factors associated with adverse drug events (ADEs) leading to ED visits.MethodsWe prospectively conducted a case–control study of patients 65 years and older presenting to the ED. ED visits between March 1, 2009 and Feb 28, 2010 identified by investigators for suspected ADEs were further assessed by using the Naranjo Adverse Drug Reaction probability scale. For each patient with an ADE, a control was selected and time-matched from the ED population of the study hospital. The association between the risk of adverse drug events and triage, age, gender, serum alanine transaminase (ALT), serum creatinine, number of medications, and Charlson Comorbidity Index scores were analyzed using logistic regression.ResultsOf 20,628 visits, 295 ADEs were physician-documented in older adults. Independent risk factors for ADEs included number of medications (adjusted odds ratio [OR] = 4.1; 95% confidence interval [CI] 2.4–6.9 for 3–7 drugs; adjusted OR = 6.4; 95% CI 3.7–11.0 for 8 or more drugs) and increased concentration of serum creatinine (adjusted OR = 1.5; 95% CI 1.1–2.2). Diuretics, analgesics, cardiovascular agents, anti-diabetic agents and anticoagulants were the medications most commonly associated with an ADE leading to ED visits.ConclusionsThis study suggests that prevention efforts should be focused on older patients with renal insufficiency and polypharmacy who are using high risk medications such as anticoagulants, diuretics, cardiovascular agents, analgesics, and anti-diabetic agents.     

Effects of hepatitis B virus infection,alanine aminotransferase,aspartate aminotransferase and gamma-glutamyl transferase on prediabetes and diabetes mellitus: A cohort study

Introduction and objectivesThe purpose of this study was to confirm whether hepatitis B virus (HBV) infection and the levels of liver enzymes would increase the risk of prediabetes and diabetes mellitus (DM) in China.Materials and methodsA total of 10,741 individuals was enrolled in this prospective cohort study. Cox regression analysis was used to calculate the Hazard ratios (HRs) to evaluate the relationships between HBV infection and the risk of DM and prediabetes. Decision trees and dose response analysis were used to explore the effects of liver enzymes levels on DM and prediabetes.ResultsIn baseline population, HBV infection ratio was 5.31%. In non-adjustment model, the HR of DM in HBV infection group was 1.312 (95% CI, 0.529–3.254). In model adjusted for gender, age and liver cirrhosis, the HR of DM in HBV infection group were 1.188 (95% CI, 0.478–2.951). In model adjusted for gender, age, liver cirrhosis, smoking, drinking, the HR of DM was 1.178 (95% CI, 0.473–2.934). In model further adjusted for education, family income and occupation, the HR of DM was 1.230 (95% CI, 0.493–3.067). With the increases of levels of Alanine aminotransferase (ALT), Aspartate aminotransferase (AST) and Gamma-glutamyl transferase (GGT), the risk of prediabetes was gradually increasing (P_{non-linearity} < 0.05). There were dose-response relationships between ALT, GGT and the risk of DM (P_{non-linearity} < 0.05).ConclusionsHBV infection was not associated with the risk of prediabetes and DM. The levels of liver enzymes increased the risk of prediabetes and DM.     

The relationship between secondary hyperparathyroidism and thyroid cancer in end stage renal disease: A population based cohort study

ObjectivesWe conducted a retrospective cohort study to investigate the risk of cancer in end stage renal disease (ESRD) patients with secondary hyperparathyroidism (HPT).Patients and methodsThis study investigated the elevated overall cancer risk in ESRD patients with secondary HPT in Taiwan. We used a population-based retrospective cohort consisting of original claims data of 1 million beneficiaries randomly sampled from the Taiwan National Health Insurance Research Database (NHIRD). We calculated the hazard ratios (HRs) and 95% confidence intervals (CIs) of cancer in the ESRD with secondary HPT and comparison cohorts, using the Cox proportional hazards regression model.ResultsWe observed that ESRD patients with secondary HPT exhibited a 10.1-fold increased risk of thyroid cancer than did ESRD patients without this parathyroid complication, after adjusting for comorbidities (95% confidence interval = 1.12–91.0).ConclusionThese phenomena indicate that ESRD patients with secondary HPT are at greater risk of thyroid cancer. Physicians should be alert for occult thyroid cancer in ESRD patients with secondary HPT.     

Chronic obstructive pulmonary disease is associated with increased recurrent peptic ulcer bleeding risk

BackgroundThe association between chronic obstructive pulmonary disease (COPD) and the risk of recurrent peptic ulcer bleeding (PUB) remains unclear. In this study, we compared the risk of recurrent PUB between patients with and those without COPD.MethodsUsing the Taiwan National Health Insurance Research Database, we first selected patients newly diagnosed with PUB in 2002–2009. Two groups comprising 13,732 COPD cases and 13,732 non-COPD matched controls were created using propensity score matching, thereby making the differences in basic demographics, medication use, and disease conditions between the two groups negligible. Cox proportional hazard regression was used to evaluate the risk of recurrent PUB during the follow-up period.ResultsThe cumulative recurrence rate of PUB was significantly higher in the patients with COPD than in the non-COPD matched controls (2 years: 10.8% vs 9.3%; 6 years: 18.3% vs 15.7%, P all < 0.05), with an adjusted hazard ratio (HR) of 1.17 (95% confidence interval [CI], 1.08–1.26, P < 0.001) and 1.19 (95% CI, 1.12–1.26, P < 0.001) within 2-year and 6-year follow-ups, respectively. Patients with COPD using steroids were at a marginally higher risk of recurrent PUB than those who did not use steroids. Multivariate stratified analysis revealed similar results in many subgroups.ConclusionsThe risk of recurrent PUB is higher in patients with COPD than in patients without COPD.     

Comparison of fracture risk between patients with ileal pouch-anal anastomosis for ulcerative colitis and the general population

BackgroundRestorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for ulcerative colitis (UC). Little is known of how the operation affects bone metabolism and fracture risk. The aim of this retrospective cohort study was to investigate fracture risk and serum markers of bone metabolism following IPAA in a national cohort of Danish UC patients.MethodsDiagnostic codes for 1757 patients and 8785 controls were obtained from the National Patient Register while blood results were collected from a regional database. Postoperative fracture free survival was evaluated on a Kaplan–Meier plot. Fracture hazard ratios (HR) after IPAA were calculated from Cox proportional hazards regression analysis.ResultsFracture risk after IPAA was significantly reduced (adjusted HR = 0.49, 95% CI: 0.43; 0.55, p < 0.001). Prior fractures and alcoholism independently increased fracture risk significantly. Osteoporotic fracture risk after IPAA was reduced, significantly for wrist fractures (aHR = 0.39, 95% CI: 0.22; 0.71, p = 0.002), and borderline insignificantly for spine fractures (aHR = 0.51, 95% CI: 0.26; 1.01, p = 0.054). Vitamin D and calcium levels were significantly higher in the patient group (61.2 nmol/L vs. 58.9 nmol/L, p = 0.04 and 1.24 mmol/L vs. 1.21 mmol/L, p < 0.01, respectively), while parathyroid hormone and phosphate levels were significantly lower (4.9 pmol/L vs. 6.2 pmol/L, p < 0.01 and 1.08 mmol/L vs. 1.12 mmol/L, p < 0.01, respectively).ConclusionFracture risk after IPAA is significantly reduced compared to the general population. Prospective studies are needed to verify the biochemical results.     

Prognosis of Stage A or B Heart Failure Patients With Elevated B-type Natriuretic Peptide Levels

BackgroundHeart failure (HF) patients have a poor prognosis, yet outcomes might be improved by early identification of risk. We investigated the prognostic value of B-type natriuretic peptide (BNP) in patients at risk for HF (American College of Cardiology [ACC]/American Heart Association [AHA] HF Stages A and B), and compared prognosis with Stage C/D patients.Methods and ResultsOutpatients referred for echocardiogram (n = 829) were stratified by ACC/AHA HF stage and BNP levels (cutpoint of 100 pg/mL). Primary outcome was death or cardiac hospitalization at 1 year. BNP levels increased with increasing numbers of cardiovascular risk factors and with HF stage. Stage A/B patients with high BNP had a similar or worse prognosis than Stage C/D patients with low BNP. In fact, the prognosis of Stage C/D patients with low BNP did not significantly differ from the prognosis of Stage A/B patients with low BNP (adjusted HR 1.21, 95% CI 0.62–2.37), whereas Stage A/B patients with high BNP did have a significantly worse prognosis (adjusted HR 1.91, 95% CI 1.11–3.28).ConclusionsIndividuals without any history of HF but with BNP ≥100 pg/mL are at equal or higher risk than those with a HF history whose BNP is <100 pg/mL. BNP may be useful to identify asymptomatic individuals at high risk for future cardiovascular events.