79 results on '"Shuo-Ming Ou"'
Search Results
2. Echocardiographic features of left ventricular dysfunction and outcomes in chronic kidney disease
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Shuo-Ming Ou, Chieh-Ju Chao, Ming-Tsun Tsai, Kuo-Hua Lee, Wei-Cheng Tseng, Pin-Jie Bin, Yao-Ping Lin, Chien-Yi Hsu, and Der-Cherng Tarng
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Cardiology and Cardiovascular Medicine - Abstract
ObjectiveHeart failure (HF) imposes a substantial burden and the prevalence of HF is high in patients with chronic kidney disease (CKD). HF results in multiple hospital admissions, but whether HF subtypes worsen long-term outcomes and renal function in patients with CKD remains inconclusive.MethodsThe study comprised 10 904 patients with CKD aged ≥20 years who underwent echocardiography between 1 January 2011 and 31 December 2018. The patients were stratified into four groups: non-HF, HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF) and HF with preserved ejection fraction (HFpEF). The primary end points were all-cause mortality, major adverse cardiovascular events (MACEs) and adverse renal outcomes.ResultsIn inverse probability of treatment weighting-adjusted method, the risk of all-cause mortality and MACEs relative to the non-HF group was greatest in the HFrEF group (HR 3.18 (95% CI 2.57 to 3.93) and HR 3.83 (95% CI 3.20 to 4.59)), followed by the HFmrEF (HR 2.75 (95% CI 2.22 to 3.42) and HR 3.08 (95% CI 2.57 to 3.69)) and HFpEF (HR 1.85 (95% CI 1.59 to 2.15) and HR 2.43 (95% CI 2.16 to 2.73) groups. In addition, the HFrEF group had the greatest risks of end-stage renal disease (HR 2.58 (95% CI 1.94 to 3.44)) compared with other groups.ConclusionsHF is associated with subsequent worse clinical outcomes, which may be more pronounced in patients with HFrEF, followed by those with HFmrEF and those with HFpEF relative to non-HF group.
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- 2022
3. Plasma Galectin-9 Is a Useful Biomarker for Predicting Renal Function in Patients Undergoing Native Kidney Biopsy
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Ming-Tsun, Tsai, Ruey-Bing, Yang, Shuo-Ming, Ou, Wei-Cheng, Tseng, Kuo-Hua, Lee, Chih-Yu, Yang, Fu-Pang, Chang, and Der-Cherng, Tarng
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Medical Laboratory Technology ,General Medicine ,Pathology and Forensic Medicine - Abstract
Context.— Galectin-9 reduces tissue damage in certain immune-mediated glomerular diseases. However, its role in structural and functional renal changes in patients with varying types of chronic kidney disease (CKD) is less clear. Objective.— To investigate the association between plasma galectin-9 levels, proteinuria, tubulointerstitial lesions, and renal function in different CKD stages. Design.— We measured plasma galectin-9 levels in 243 patients undergoing renal biopsy for determining the CKD etiology. mRNA and protein expression levels of intrarenal galectin-9 were assessed by quantitative real-time polymerase chain reaction and immunostaining. Relationships between plasma galectin-9, clinical characteristics, and tubulointerstitial damage were analyzed with logistic regression. We investigated galectin-9 expression patterns in vitro in murine J774 macrophages treated with differing stimuli. Results.— To analyze the relationship between galectin-9 and clinical features, we divided the patients into 2 groups according to median plasma galectin-9 levels. The high galectin-9 group tended to be older and to have decreased renal function, higher proteinuria, and greater interstitial fibrosis. After multivariable adjustment, elevated plasma galectin-9 levels were independently associated with stage 3b or higher CKD. An analysis of gene expression in the tubulointerstitial compartment in the biopsy samples showed a significant positive correlation between intrarenal galectin-9 mRNA expression and plasma galectin-9 levels. Immunohistochemistry confirmed increased galectin-9 expression in the renal interstitium of patients with advanced CKD, and most galectin-9–positive cells were macrophages, as determined by double-immunofluorescence staining. In vitro experiments showed that galectin-9 expression in macrophages was significantly increased after interferon-γ stimulation. Conclusions.— Our findings suggest that plasma galectin-9 is a good biomarker for diagnosing advanced CKD.
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- 2022
4. Prediction of the risk of developing end-stage renal diseases in newly diagnosed type 2 diabetes mellitus using artificial intelligence algorithms
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Shuo-Ming Ou, Ming-Tsun Tsai, Kuo-Hua Lee, Wei-Cheng Tseng, Chih-Yu Yang, Tz-Heng Chen, Pin-Jie Bin, Tzeng-Ji Chen, Yao-Ping Lin, Wayne Huey-Herng Sheu, Yuan-Chia Chu, and Der-Cherng Tarng
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Computational Mathematics ,Computational Theory and Mathematics ,Genetics ,Molecular Biology ,Biochemistry ,Computer Science Applications - Abstract
Objectives Type 2 diabetes mellitus (T2DM) imposes a great burden on healthcare systems, and these patients experience higher long-term risks for developing end-stage renal disease (ESRD). Managing diabetic nephropathy becomes more challenging when kidney function starts declining. Therefore, developing predictive models for the risk of developing ESRD in newly diagnosed T2DM patients may be helpful in clinical settings. Methods We established machine learning models constructed from a subset of clinical features collected from 53,477 newly diagnosed T2DM patients from January 2008 to December 2018 and then selected the best model. The cohort was divided, with 70% and 30% of patients randomly assigned to the training and testing sets, respectively. Results The discriminative ability of our machine learning models, including logistic regression, extra tree classifier, random forest, gradient boosting decision tree (GBDT), extreme gradient boosting (XGBoost), and light gradient boosting machine were evaluated across the cohort. XGBoost yielded the highest area under the receiver operating characteristic curve (AUC) of 0.953, followed by extra tree and GBDT, with AUC values of 0.952 and 0.938 on the testing dataset. The SHapley Additive explanation summary plot in the XGBoost model illustrated that the top five important features included baseline serum creatinine, mean serum creatine within 1 year before the diagnosis of T2DM, high-sensitivity C-reactive protein, spot urine protein-to-creatinine ratio and female gender. Conclusions Because our machine learning prediction models were based on routinely collected clinical features, they can be used as risk assessment tools for developing ESRD. By identifying high-risk patients, intervention strategies may be provided at an early stage.
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- 2023
5. Pentraxin 3 Predicts Arteriovenous Fistula Functional Patency Loss and Mortality in Chronic Hemodialysis Patients
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Heng-Cheng Tsai, Shuo-Ming Ou, Chih-Cheng Wu, Chin-Chou Huang, Jyh-Tong Hsieh, Po-Yu Tseng, Chiu-Yang Lee, Chih-Yu Yang, and Der-Cherng Tarng
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Aged, 80 and over ,Male ,Middle Aged ,Serum Amyloid P-Component ,Arteriovenous Shunt, Surgical ,C-Reactive Protein ,Renal Dialysis ,Risk Factors ,Nephrology ,Arteriovenous Fistula ,Humans ,Kidney Failure, Chronic ,Prospective Studies ,Vascular Patency ,Aged ,Retrospective Studies - Abstract
Introduction: Viable vascular access is the lifeline for hemodialysis patients. In the nondialysis population, emerging evidence suggests that circulating pentraxin 3 (PTX3), neutrophil gelatinase-associated lipocalin (NGAL), and chitinase-3-like protein 1 (CHI3L1) are associated with cardiovascular inflammation and endothelial injury. However, predictive values of these three biomarkers on arteriovenous fistula (AVF) outcomes are unknown. Methods: This prospective observational cohort study enrolled 135 hemodialysis patients using AVF and then followed them for 3 years. Plasma levels of PTX3, NGAL, and CHI3L1 were measured. Patients were followed up prospectively for two clinical outcomes, including AVF functional patency loss and death. Cox proportional hazards regression models were used to analyze hazard ratios for the commencement of AVF functional patency loss and mortality. Results: Among 135 patients, the mean age was 66.0 ± 15.7 years old and 48.1% were male. The plasma level of PTX3, NGAL, and CHI3L1 was 2.8 ± 2.3 ng/mL, 349.2 ± 111.4 ng/mL, and 185.5 ± 66.8 ng/mL, respectively. During a 3-year follow-up period, the plasma level of PTX3 was an independent predictor for AVF functional patency loss (per 1 ng/mL increase, HR 1.112 [95% CI: 1.001–1.235], p = 0.048). Besides, patients with higher plasma levels of PTX3 were more likely to suffer from cardiovascular mortality (per 1 ng/mL increase, HR 1.320 [95% CI: 1.023–1.703], p = 0.033), infectious mortality (per 1 ng/mL increase, HR 1.394 [95% CI: 1.099–1.769], p = 0.006), and all-cause mortality (per 1 ng/mL increase, HR 1.233 [95% CI: 1.031–1.476], p = 0.022). Conclusions: The plasma level of PTX3, not NGAL or CHI3L1, was associated with higher risks of AVF functional patency loss in chronic hemodialysis patients, showing its value in reflecting AVF endothelial dysfunction. Furthermore, PTX3 also predicts mortality in chronic hemodialysis patients.
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- 2022
6. The strategy of diminishing age gap effect on different donor-recipient combinations in living donor kidney transplantation
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Fang-Cheng Kuo, Tsai-Hun Wu, Che-Chuan Loong, Niang-Cheng Lin, Shuo-Ming Ou, and Cheng-Yen Chen
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General Medicine - Abstract
The disparity between kidney donation and the number of uremic patients on the waiting list has increased the demand for older live-donor kidneys (OLK). However, the donor-recipient age gap may have an impact on the recipient's outcome.Patients who underwent living donor kidney transplantation at our institute between 2005 and 2019 were enrolled and categorized into four donor-recipient groups according to age (≥ 50 years and50 years). The Estimated Post-Transplant Survival (EPTS) score was used to quantify the recipient's condition. Adjusted models analyzed recipient outcomes and related risks among the four groups.Of the 154 pairs of live donors and recipients, OLK did not influence overall or death-censored graft survival. The four donor-recipient combinations had similar recipient outcomes, except it slightly worsened in the "old donor to young recipient" group. The EPTS score (adjusted HR 1.02, 95% CI 1.01-1.04, p = 0.014) and rejection (adjusted HR 4.26, 95% CI 1.36-13.37, p = 0.013) were significant risk factors for overall and death-censored graft survival, respectively. Recipients with pre-transplant diabetes or prior solid organ transplantation could have amplified risk effects. The main causes of graft loss were death in older recipients and chronic rejection in younger recipients.OLK is safe for young recipients. Nevertheless, adequate immunosuppression should be maintained to prevent rejection and subsequent graft loss, especially for those receiving second kidney transplantation. In contrast, older recipients should avoid overt immunosuppression and control their comorbidities, such as diabetes-related complications to improve their long-term outcomes.
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- 2022
7. Sacubitril/Valsartan in Patients With Heart Failure and Concomitant End-Stage Kidney Disease
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Chih‐Yuan Niu, Shang‐Feng Yang, Shuo‐Ming Ou, Cheng‐Hsueh Wu, Po‐Hsun Huang, Chung‐Lieh Hung, Chih‐Ching Lin, and Szu‐Yuan Li
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Heart Failure ,Aminobutyrates ,Biphenyl Compounds ,Tetrazoles ,Stroke Volume ,Ventricular Function, Left ,Angiotensin Receptor Antagonists ,Drug Combinations ,Ventricular Dysfunction, Left ,Potassium ,Humans ,Kidney Failure, Chronic ,Valsartan ,Neprilysin ,Cardiology and Cardiovascular Medicine - Abstract
Background Heart failure with reduced ejection fraction (HFrEF) is a chronic disease with substantial mortality. Management of HFrEF has seen significant breakthrough after the launch of neprilysin inhibitor. The PARADIGM‐HF (Prospective Comparison of ARNI with ACEI to Determine Impacton Global Mortality and Morbidity in Heart Failure) trial showed that sacubitril/valsartan significantly reduces HFrEF mortality and the heart failure hospitalization rate. However, in patients with advanced kidney disease, who have the highest prevalence of heart failure, the efficacy and safety of sacubitril/valsartan remains uncertain. We aim to study the efficiency of sacubitril/valsartan in patients with end‐stage kidney disease. Methods and Results Heart function was screened by echocardiogram among all patients with end‐stage kidney disease in 2 hospitals. Patients with HFrEF received either sacubitril/valsartan or conventional treatment. Fifteen echocardiographic parameters were compared before and after treatment. After 1‐year sacubitril/valsartan treatment, parameters of systolic (left ventricular ejection fraction 31.3% to 45.1%, P P =0.006; left ventricular internal diameter at end‐systole phase 47.2 to 40.1 mm, P =0.005), and diastolic (E/A ratio 1.3 to 0.8, P =0.009; E/Med e' ratio 25.3 to 18.8, P =0.010) function improved in patients with HFrEF and end‐stage kidney disease. These parameters were unchanged in the conventional treatment group. Serum potassium did not increase in the sacubitril/valsartan group. Conclusions Sacubitril/valsartan improves left ventricular systolic and diastolic function in patients with HFrEF and end‐stage kidney disease.
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- 2022
8. Associations of atrial fibrillation with renal function decline in patients with chronic kidney disease
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Der Cherng Tarng, Tz Heng Chen, Yuan Chia Chu, and Shuo Ming Ou
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Male ,medicine.medical_specialty ,030232 urology & nephrology ,Renal function ,Disease ,030204 cardiovascular system & hematology ,Kidney ,urologic and male genital diseases ,Egfr decline ,Risk Assessment ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,Humans ,Medicine ,In patient ,Renal Insufficiency, Chronic ,Retrospective Studies ,business.industry ,Atrial fibrillation ,medicine.disease ,Propensity score matching ,Kidney Failure, Chronic ,Female ,Cardiology and Cardiovascular Medicine ,business ,Cohort study ,Kidney disease - Abstract
BackgroundChronic kidney disease (CKD) is known to increase the risk of atrial fibrillation (AF) development, but the relationship between AF and subsequent renal function decline in patients with CKD is not well understood. In this study, we explored the role of AF on renal outcomes among patients with CKD.MethodsIn a retrospective hospital-based cohort study, we identified patients with CKD aged ≥20 years from 1 January 2008 to 31 December 2018. The patients were divided into AF and non-AF groups. We matched each patient with CKD and AF to two non-AF CKD controls according to propensity scores. The outcomes of interest included estimated glomerular filtration rate (eGFR) decline of ≥20%, ≥30%, ≥40% and ≥50%, and end-stage renal disease (ESRD).ResultsAfter propensity score matching, 6731 patients with AF and 13 462 matched controls were included in the analyses. Compared with the non-AF group, the AF group exhibited greater risks of eGFR decline ≥20% (HR 1.43; 95% CI 1.33 to 1.53), ≥30% (HR 1.50; 95% CI 1.36 to 1.66), ≥40% (HR 1.62; 95% CI 1.41 to 1.85) and ≥50% (HR 1.82; 95% CI 1.50 to 2.20), and ESRD (HR 1.22; 95% CI 1.12 to 1.34). Higher CHA2DS2-VASc scores were associated with greater risks of eGFR decline and ESRD.ConclusionsIn patients with CKD, AF was associated with greater risks of subsequent renal function decline. CHA2DS2-VASc scores may be a useful risk stratification scheme for predicting the risk of renal function decline.
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- 2021
9. Urinary Galectin-3 as a Novel Biomarker for the Prediction of Renal Fibrosis and Kidney Disease Progression
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Shuo-Ming Ou, Ming-Tsun Tsai, Huan-Yuan Chen, Fu-An Li, Kuo-Hua Lee, Wei-Cheng Tseng, Fu-Pang Chang, Yao-Ping Lin, Ruey-Bing Yang, and Der-Cherng Tarng
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galectin-3 ,kidney disease progression ,renal biopsy ,renal fibrosis ,urinary biomarkers ,Medicine (miscellaneous) ,General Biochemistry, Genetics and Molecular Biology - Abstract
Plasma galectin-3 (Gal-3) is associated with organ fibrosis, but whether urinary Gal-3 is a potential biomarker of kidney disease progression has never been explored. Between 2018 and 2021, we prospectively enrolled 280 patients who underwent renal biopsy and were divided into three groups based on their urinary Gal-3 levels (
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- 2022
10. Influence of Dialysis Membranes on Clinical Outcomes: From History to Innovation
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Yee-An Chen, Shuo-Ming Ou, and Chih-Ching Lin
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Process Chemistry and Technology ,Chemical Engineering (miscellaneous) ,Filtration and Separation - Abstract
Dialysis membranes were traditionally classified according to their material compositions (i.e., as cellulosic or synthetic) and on the basis of the new concept of the sieving coefficient (determined by the molecular weight retention onset and molecular weight cut-off). The advantages of synthetic polymer membranes over cellulose membranes are also described on the basis of their physical, chemical, and structural properties. Innovations of dialysis membrane in recent years include the development of medium cutoff membranes; graphene oxide membranes; mixed-matrix membranes; bioartificial kidneys; and membranes modified with vitamin E, lipoic acid, and neutrophil elastase inhibitors. The current state of research on these membranes, their effects on clinical outcomes, the advantages and disadvantages of their use, and their potential for clinical use are outlined and described.
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- 2022
11. Associations of high anti-CMV IgG titer with renal function decline and allograft rejection in kidney transplant patients
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Tz-Heng Chen, Shuo-Ming Ou, and Der-Cherng Tarng
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Adult ,Male ,Graft Survival ,Cytomegalovirus ,General Medicine ,Middle Aged ,Antiviral Agents ,Kidney Transplantation ,Transplant Recipients ,Cohort Studies ,Immunoglobulin G ,Cytomegalovirus Infections ,Humans ,Immunologic Factors ,Renal Insufficiency ,Aged ,Retrospective Studies - Abstract
An anti-cytomegalovirus (CMV) immunoglobulin G (IgG) antibody is produced after primary CMV infection and generally persists after the primary infection. However, it is not well-known about the relationship between anti-CMV IgG titer and outcomes in kidney transplant recipients. We, therefore, aimed to explore the role of anti-CMV IgG titer on the risks of CMV disease development, allograft rejection, renal function decline, and mortality.In a hospital-based study, we identified 179 CMV-seropositive kidney transplant recipients between January 2013 and December 2017. These patients were divided into low and high anti-CMV IgG titer groups, respectively. The cutoff level of anti-CMV IgG titer was determined by receiver operating characteristic curve analysis. The outcomes evaluated included CMV disease, decrease of ≥15% in estimated glomerular filtration rate (eGFR), biopsy-proven allograft rejection, and all-cause mortality.The high anti-CMV IgG titer group (≥846.2 AU/mL) exhibited a higher risk of CMV disease (adjusted hazard ratio [aHR], 3.77; 95% CI, 1.47-9.68; p = 0.006), eGFR decline ≥15% (aHR, 2.00; 95% CI, 1.19-3.35; p = 0.009), and renal allograft rejection (aHR, 2.95; 95% CI, 1.11-7.87; p = 0.030) than the low titer group (846.2 AU/mL).In kidney transplant recipients, a high anti-CMV IgG titer was associated with higher risks for developing CMV disease, undergoing allograft rejection, and eGFR decline.
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- 2021
12. Identification of Galectin-3 as Potential Biomarkers for Renal Fibrosis by RNA-Sequencing and Clinicopathologic Findings of Kidney Biopsy
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Shuo-Ming Ou, Ming-Tsun Tsai, Huan-Yuan Chen, Fu-An Li, Wei-Cheng Tseng, Kuo-Hua Lee, Fu-Pang Chang, Yao-Ping Lin, Ruey-Bing Yang, and Der-Cherng Tarng
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Medicine (General) ,Pathology ,medicine.medical_specialty ,kidney biopsy ,Renal function ,RNA-sequencing analysis ,R5-920 ,galectin-3 ,Biopsy ,medicine ,Renal fibrosis ,Original Research ,Kidney ,Proteinuria ,Predictive marker ,medicine.diagnostic_test ,business.industry ,General Medicine ,interstitial fibrosis ,medicine.disease ,medicine.anatomical_structure ,Galectin-3 ,Medicine ,tubular atrophy ,medicine.symptom ,business ,chronic kidney disease ,Kidney disease - Abstract
Background: Galectin-3 (Gal-3) is a multifunctional glycan-binding protein shown to be linked to chronic inflammation and fibrogenesis. Plasma Gal-3 is associated with proteinuria and renal dysfunction, but its role has never been confirmed with kidney biopsy results. In our study, we aimed to explore the expression of Gal-3 in biopsy-proven patients, and we tested the hypothesis that chronic kidney disease (CKD) leads to upregulation of plasma Gal-3 expression in corresponding biopsy findings and RNA sequencing analysis.Method: In 249 patients (male/female: 155/94, age: 57.2 ± 16.3 years) who underwent kidney biopsy, plasma levels of Gal-3 were measured to estimate the association of renal fibrosis. Relationships between plasma Gal-3 levels, estimated glomerular filtration rate (eGFR) and renal histology findings were also assessed. We further examined the gene expression of Gal-3 in RNA-sequencing analysis in biopsy-proven patients.Results: Compared to patients without CKD, CKD patients had higher levels of plasma Gal-3 (1,016.3 ± 628.1 pg/mL vs. 811.6 ± 369.6 pg/ml; P = 0.010). Plasma Gal-3 was inversely correlated with eGFR (P = 0.005) but not with proteinuria. Higher Gal-3 levels were associated with interstitial fibrosis, tubular atrophy and vascular intimal fibrosis. RNA-sequencing analysis showed the upregulation of Gal-3 in fibrotic kidney biopsy samples, and the differentially expressed genes were mainly enhanced in immune cell activation and the regulation of cell-cell adhesion.Conclusions: Plasma Gal-3 levels are inverse correlated with eGFR but positively correlated with renal fibrosis, which may be involved in the immune response and associated pathways. These findings support the role of Gal-3 as a predictive marker of renal fibrosis.
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- 2021
13. Sepsis and the Risks of Long-Term Renal Adverse Outcomes in Patients With Chronic Kidney Disease
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Shuo-Ming Ou, Kuo-Hua Lee, Ming-Tsun Tsai, Wei-Cheng Tseng, Yuan-Chia Chu, and Der-Cherng Tarng
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General Medicine - Abstract
BackgroundSepsis is known to cause renal function fluctuations during hospitalization, but whether these patients discharged from sepsis were still at greater risks of long-term renal adverse outcomes remains unknown.MethodsFrom 2011 to 2018, we included 1,12,628 patients with chronic kidney disease (CKD) aged ≥ 20 years. The patients with CKD were further divided into 11,661 sepsis group and 1,00,967 non-sepsis group. The following outcome of interest was included: all-cause mortality, readmission for acute kidney injury, estimated glomerular filtration rate decline ≥50% or doubling of serum creatinine, and end-stage renal disease.ResultsAfter propensity score matching, the sepsis group was at higher risks of all-cause mortality [hazard ratio (HR) 1.39, 95% CI, 1.31–1.47], readmission for acute kidney injury (HR 1.67, 95% CI 1.58–1.76), eGFR decline ≥ 50% or doubling of serum creatinine (HR 3.34, 95% CI 2.78–4.01), and end-stage renal disease (HR 1.43, 95% CI 1.34–1.53) than non-sepsis group.ConclusionsOur study found that patients with CKD discharged from hospitalization for sepsis have higher risks of subsequent renal adverse events.
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- 2021
14. AN69 Filter Membranes with High Ultrafiltration Rates during Continuous Venovenous Hemofiltration Reduce Mortality in Patients with Sepsis-Induced Multiorgan Dysfunction Syndrome
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Shuo-Ming Ou, Wei-Cheng Tseng, Ming Tsun Tsai, Kuo-Hua Lee, Der-Cherng Tarng, Chih Yu Yang, and Yao-Ping Lin
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medicine.medical_specialty ,multiple organ failure ,medicine.medical_treatment ,Ultrafiltration ,Urology ,Renal function ,Filtration and Separation ,TP1-1185 ,intensive care unit ,Article ,law.invention ,Sepsis ,Chemical engineering ,law ,Hemofiltration ,medicine ,Chemical Engineering (miscellaneous) ,business.industry ,Chemical technology ,Process Chemistry and Technology ,Multiorgan dysfunction ,blood purification ,medicine.disease ,Intensive care unit ,Membrane ,Continuous venovenous hemofiltration ,critical medicine ,TP155-156 ,business - Abstract
Polyacrylonitrile (AN69) filter membranes adsorb cytokines during continuous venovenous hemofiltration (CVVH). Although high-volume hemofiltration has shown limited benefits, the dose-effect relationship in CVVH with AN69 membranes on severe sepsis remains undetermined. This multi-centered study enrolled 266 patients with sepsis-induced multiorgan dysfunction syndrome (MODS) who underwent CVVH with AN69 membranes between 2014 and 2015. We investigated the effects of ultrafiltration rates (UFR) on mortality. We categorized patients that were treated with UFR of 20–25 mL/kg/h as the standard UFR group (n = 124) and those that were treated with a UFR >, 25 mL/kg/h as the high UFR group (n = 142). Among the patient characteristics, the baseline estimated glomerular filtration rates (eGFR) <, 60 mL/min/1.73 m2, hemoglobin levels <, 10 g/dL, and a sequential organ failure assessment (SOFA) score ≥15 at CVVH initiation were independently associated with in-hospital mortality. In the subgroup analysis, for patients with SOFA scores that were ≥15, the 90-day survival rate was higher in the high UFR group than in the standard UFR group (HR 0.54, CI: 0.36–0.79, p = 0.005). We concluded that in patients with sepsis-induced MODS, SOFA scores ≥15 predicted a poor rate of survival. High UFR setting >, 25 mL/kg/h in CVVH with AN69 membranes may reduce the mortality risk in these high-risk patients.
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- 2021
15. Antithrombotic Therapy for Chronic Kidney Disease Patients With Concomitant Atrial Fibrillation and Coronary Artery Disease
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Kuo-Hua Lee, Shuo-Ming Ou, Yuan-Chia Chu, Yao-Ping Lin, Ming-Tsun Tsai, and Der-Cherng Tarng
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medicine.medical_specialty ,medicine.medical_treatment ,acute myocardial infarction ,Cardiovascular Medicine ,Coronary artery disease ,Internal medicine ,Antithrombotic ,medicine ,Diseases of the circulatory (Cardiovascular) system ,atrial fibrillation ,Myocardial infarction ,cardiovascular diseases ,anticoagulation ,Stroke ,Original Research ,business.industry ,Warfarin ,Percutaneous coronary intervention ,Atrial fibrillation ,thromboembolism ,medicine.disease ,stroke ,RC666-701 ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Kidney disease ,medicine.drug - Abstract
Background: Oral anticoagulants (OAC) plus antiplatelets is recommended for patients with atrial fibrillation (AF) and coronary artery disease (CAD) to reduce thromboembolism. However, there is limited evidence regarding antithrombotic therapy for patients with concomitant chronic kidney disease (CKD), AF, and CAD, especially those not undergoing percutaneous coronary intervention. We aimed to use real-world data assessing the efficacy and safety of antithrombotic regimens in this population.Methods: We used a single-center database of 142,624 CKD patients to identify those receiving antithrombotic therapy for AF and CAD between 2010 and 2018. Patients taking warfarin or direct OAC (DOAC) alone were grouped in the OAC monotherapy (n = 537), whereas those taking OAC plus antiplatelets were grouped in the combination therapy (n = 2,391). We conducted propensity score matching to balance baseline covariates. The endpoints were all-cause mortality, major adverse cardiovascular events, and major bleedings.Results: After 1:4 matching, the number of patients in OAC monotherapy and combination therapy were 413 and 1,652, respectively. Between the two groups, combination therapy was associated with higher risks for ischemic stroke (HR 2.37, CI 1.72–3.27), acute myocardial infarction (HR 6.14, CI 2.51–15.0), and hemorrhagic stroke (HR 3.57, CI 1.35–9.81). The results were consistent across CKD stages. In monotherapy, DOAC users were associated with lower risks for all-cause mortality, AMI, and gastrointestinal bleeding than warfarin, but the stroke risk was similar between the two subgroups.Conclusions: For patients with concomitant CKD, AF and CAD not undergoing PCI, OAC monotherapy may reduce stroke and AMI risks. DOAC showed more favorable outcomes than warfarin.
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- 2021
16. Long-term prognosis of vascular access in hemodialysis patients with systemic lupus erythematosus: a retrospective cohort study
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Shuo Ming Ou, Fan Yu Chen, Chia Hao Chan, Yung Tai Chen, Ming Tsun Tsai, Wen Sheng Liu, Chun Fan Chen, Ann Charis Tan, Fu An Chen, Tz Heng Chen, Chih Ching Lin, and Szu Yuan Li
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Science ,Vascular access ,Arteriovenous fistula ,030204 cardiovascular system & hematology ,Risk Assessment ,Article ,End stage renal disease ,End-stage renal disease ,03 medical and health sciences ,Blood Vessel Prosthesis Implantation ,Systemic lupus erythematosus ,0302 clinical medicine ,Arteriovenous Shunt, Surgical ,Renal Dialysis ,Risk Factors ,Internal medicine ,medicine ,Humans ,Lupus Erythematosus, Systemic ,cardiovascular diseases ,Vascular Diseases ,skin and connective tissue diseases ,030203 arthritis & rheumatology ,First episode ,Dialysis adequacy ,Multidisciplinary ,business.industry ,Incidence (epidemiology) ,Graft Occlusion, Vascular ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Prognosis ,Haemodialysis ,Treatment Outcome ,Arteriovenous Fistula ,Medicine ,Kidney Failure, Chronic ,Female ,Hemodialysis ,business - Abstract
Patients with systemic lupus erythematosus (SLE) have a higher risk of vascular complications. This retrospective cohort study aimed to analyze the differences in the risk of arteriovenous fistula or graft (AVF/AVG) dysfunction in hemodialysis patients with and without SLE from Taiwan’s National Health Insurance Database over a 10-year period. AVF/AVG dysfunction is defined as the occurrence of the first episode of intervention after vascular access creation. A total of 1366 HD patients with SLE had higher incidence rates of AVF/AVG dysfunction than 4098 non-SLE HD patients in the following 4 periods: (1) after 1 year (incidence rates = 15.21% and 13.01%, respectively; subdistribution hazard ratio (SHR) = 1.16; P = 0.007), (2) 1st-to-10th-year period (15.36% and 13.25%; SHR = 1.16; P = 0.007), (3) 5th-to-10th-year period (11.91% and 8.1%; SHR = 1.42; P = 0.003), and (4) overall period (23.53% and 21.66%; SHR = 1.09; P = 0.027). In conclusion, there were significantly higher incidence rates of AVF/AVG dysfunction in SLE patients during the long-term follow-up period. Vascular access function should be monitored regularly by clinical examinations, especially after 1 year and during 5 to 10 years, to improve AVF/AVG patency and dialysis adequacy in SLE patients undergoing maintenance hemodialysis.
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- 2020
17. Artificial Intelligence for Risk Prediction of Rehospitalization with Acute Kidney Injury in Sepsis Survivors
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Shuo-Ming Ou, Kuo-Hua Lee, Ming-Tsun Tsai, Wei-Cheng Tseng, Yuan-Chia Chu, and Der-Cherng Tarng
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rehospitalization ,sepsis ,machine learning ,acute kidney injury ,sepsis survivors ,artificial intelligence ,Medicine ,Medicine (miscellaneous) ,Article - Abstract
Sepsis survivors have a higher risk of long-term complications. Acute kidney injury (AKI) may still be common among sepsis survivors after discharge from sepsis. Therefore, our study utilized an artificial-intelligence-based machine learning approach to predict future risks of rehospitalization with AKI between 1 January 2008 and 31 December 2018. We included a total of 23,761 patients aged ≥ 20 years who were admitted due to sepsis and survived to discharge. We adopted a machine learning method by using models based on logistic regression, random forest, extra tree classifier, gradient boosting decision tree (GBDT), extreme gradient boosting, and light gradient boosting machine (LGBM). The LGBM model exhibited the highest area under the receiver operating characteristic curves (AUCs) of 0.816 to predict rehospitalization with AKI in sepsis survivors and followed by the GBDT model with AUCs of 0.813. The top five most important features in the LGBM model were C-reactive protein, white blood cell counts, use of inotropes, blood urea nitrogen and use of diuretics. We established machine learning models for the prediction of the risk of rehospitalization with AKI in sepsis survivors, and the machine learning model may set the stage for the broader use of clinical features in healthcare.
- Published
- 2022
18. Comparative Efficacy of Sodium-Glucose Co-Transporters 2 Inhibitor and Glucagon-Like Peptide-1 Receptor Agonist in Cardiovascular and Renal Protection in Patients with Type 2 Diabetes Mellitus
- Author
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Shuo-Ming Ou, Yuan-Chia Chu, Yao-Ping Lin, Kuo-Hua Lee, Ming-Tsun Tsai, and Der-Cherng Tarng
- Published
- 2020
19. Association between influenza vaccination and the reduced risk of acute kidney injury among older people: A nested case-control study
- Author
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Pei Wen Chao, Shu-Chen Kuo, Shuo Ming Ou, Yi Jung Lee, Hung Meng Huang, Yung Tai Chen, and Chia Hsiang Shih
- Subjects
Male ,medicine.medical_specialty ,Databases, Factual ,Influenza vaccine ,Taiwan ,Comorbidity ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Lower risk ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Influenza, Human ,Epidemiology ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Aged, 80 and over ,business.industry ,Vaccination ,Odds ratio ,Acute Kidney Injury ,Confidence interval ,Logistic Models ,Influenza Vaccines ,Case-Control Studies ,Nested case-control study ,Cohort ,Female ,business ,Risk Reduction Behavior - Abstract
Objective The objective of this study is to determine whether vaccination against influenza is associated with a reduced risk of acute kidney injury (AKI) in a nationwide cohort of adults aged ≥65 years. Methods We investigated a total of 13,270 patients aged ≥65 years who were hospitalized for AKI between 2000 and 2013 from Taiwan's National Health Insurance Research Database. Each AKI case was matched with one control subject according to duration of follow-up, age, sex, monthly income, urbanization level, and baseline comorbidities. Odds ratios (ORs) for AKI associated with exposure to the influenza vaccine in the previous year were calculated in a nested case-control analysis. Results Influenza vaccination in the previous year was associated with a lower risk of AKI (adjusted OR 0.67, 95% confidence interval [CI] 0.63–0.72). Compared with a reference group of unvaccinated individuals with no influenza infection, vaccination with no influenza infection was associated with a lower risk of AKI (adjusted OR 0.68, 95% CI 0.64–0.73). Lack of vaccination and presence of influenza infection was associated with a higher risk of AKI (adjusted OR 1.78, 95% CI 1.57–2.01), whereas the risk of AKI was insignificant in vaccinated patients who developed influenza (adjusted OR 1.01, 95% CI 0.69–1.18). Conclusions The risk of AKI was 37% lower among older people who received vaccination against influenza in a real-world setting. Further work is required to clarify causality.
- Published
- 2018
20. Nephrotic syndrome complicated with femoral vein catheter-related phlegmasia cerulea dolens: A case report
- Author
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Wen-Chun Chen and Shuo-Ming Ou
- Subjects
medicine.medical_specialty ,business.industry ,Fulminant ,Deep vein ,medicine.medical_treatment ,Femoral vein ,Hematology ,Thrombolysis ,030204 cardiovascular system & hematology ,medicine.disease ,Thrombosis ,Surgery ,03 medical and health sciences ,Catheter ,0302 clinical medicine ,medicine.anatomical_structure ,Nephrology ,Medicine ,cardiovascular diseases ,030212 general & internal medicine ,business ,Nephrotic syndrome ,Phlegmasia cerulea dolens - Abstract
Nephrotic syndrome is a well-known risk factor of deep vein thrombosis (DVT). Catheter-related DVT under the setting of nephrotic syndrome may be presented as a more fulminant form, phlegmasia cerulea dolens. Phlegmasia cerulea dolens may lead to severe obstruction of venous drainage of the extremities and presents with compartment syndrome that impairs arterial perfusion. Aggressive management with thrombolysis and/or thrombectomy are considered with simultaneous anticoagulant treatment.
- Published
- 2018
21. Risk and impact of tuberculosis in patients with multiple myeloma*
- Author
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Chun Kuang Tsai, Leh Kiong Huon, Chia Jen Liu, Yu Ting Lee, Tzeng Ji Chen, Yao Chung Liu, Shuo Ming Ou, Chiu Mei Yeh, Ai Seon Kuan, and Jin Hwang Liu
- Subjects
Male ,Cancer Research ,medicine.medical_specialty ,Tuberculosis ,Taiwan ,Comorbidity ,Kaplan-Meier Estimate ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Prednisone ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Tuberculosis, Pulmonary ,Aged ,business.industry ,Incidence ,Incidence (epidemiology) ,Hazard ratio ,Hematology ,Middle Aged ,medicine.disease ,Confidence interval ,Surgery ,Oncology ,030220 oncology & carcinogenesis ,Cohort ,Female ,Multiple Myeloma ,business ,Cohort study ,medicine.drug - Abstract
We investigated the risk and impact of mycobacterium tuberculosis (TB) infection in patients with multiple myeloma (MM). We identified 3979 MM patients from Taiwan's National Health Insurance database between 2000 and 2011 and compared the incidence rates of TB infection in these patients with 15,916 randomly selected age-, sex-, and comorbidity-matched subjects without MM. The risk of TB was higher in the myeloma cohort (adjusted hazard ratio [HR] 3.11, 95% confidence interval [CI] 2.41-4.02). Risk factors for MM patients contracting TB were age ≥65 (adjusted HR 1.93, 95% CI 1.19-3.15), alcohol use disorder (adjusted HR 2.86, 95% CI 1.24-6.62), and steroid daily dose equivalent to prednisone 5 mg or more (adjusted HR 2.38, 95% CI 1.50-3.77). MM patients with TB had a higher mortality risk than those without (adjusted HR 2.03, 95% CI 1.54-2.67). The incidence of TB is significantly higher in MM patients.
- Published
- 2017
22. Association of pre-hospital theophylline use and mortality in chronic obstructive pulmonary disease patients with sepsis
- Author
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Yen-Tao Hsu, Hsi Chu, Peter C. Hou, Shuo-Ming Ou, Ran-Chou Chen, Chia-Jen Shih, Raghu Seethala, Sadeq A. Quraishi, Yu-Ning Shih, Gyorgy Frendl, Yung Tai Chen, and Imoigele P. Aisiku
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Taiwan ,030204 cardiovascular system & hematology ,Lower risk ,law.invention ,Sepsis ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,0302 clinical medicine ,Theophylline ,Risk Factors ,law ,Internal medicine ,Outcome Assessment, Health Care ,medicine ,Humans ,Hospital Mortality ,Propensity Score ,Aged ,Aged, 80 and over ,Mechanical ventilation ,COPD ,business.industry ,Proportional hazards model ,Middle Aged ,medicine.disease ,Respiration, Artificial ,Intensive care unit ,Bronchodilator Agents ,Hospitalization ,Intensive Care Units ,030228 respiratory system ,Anesthesia ,Cohort ,Female ,business ,medicine.drug - Abstract
Background Although theophylline has been shown to have anti-inflammatory effects, the therapeutic use of theophylline before sepsis is unknown. The aim of our study was to determine the effect of theophylline on COPD patients presenting with sepsis. Methods This nationwide, population-based, propensity score-matched analysis used data from the linked administrative databases of Taiwan's National Health Insurance program. Patients with COPD who were hospitalized for sepsis between 2000 and 2011 were divided into theophylline users and non-users. The primary outcome was 30-day mortality. The secondary outcome was in-hospital death, intensive care unit admission, and need for mechanical ventilation. Cox proportional hazard model and conditional logistic regression were used to calculate the risk between groups. Results A propensity score-matched cohort of 51,801 theophylline users and 51,801 non-users was included. Compared with non-users, the 30-day (HR 0.931, 95% CI 0.910–0.953), 180-day (HR 0.930, 95% CI 0.914–0.946), 365-day (HR 0.944, 95% CI 0.929–0.960) and overall mortality (HR 0.965, 95% CI 0.952–0.979) were all significantly lower in theophylline users. Additionally, the theophylline users also had lower risk of in-hospital death (OR 0.895, 95% CI 0.873–0.918) and need for mechanical ventilation (OR 0.972, 95% CI 0.949–0.997). Conclusions Theophylline use is associated with a lower risk of sepsis-related mortality in COPD patients. Pre-hospital theophylline use may be protective to COPD patients with sepsis.
- Published
- 2017
23. The First Reported Case of Cytomegalovirus Gastritis in a Patient With End-Stage Renal Disease
- Author
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Der Cherng Tarng, Chi Hao Liu, An Hang Yang, and Shuo Ming Ou
- Subjects
medicine.medical_specialty ,Pathology ,Nausea ,Biopsy ,medicine.medical_treatment ,Congenital cytomegalovirus infection ,Gastroenterology ,Organ transplantation ,End stage renal disease ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,Internal medicine ,Gastroscopy ,medicine ,Humans ,Esophagus ,Aged ,business.industry ,Stomach ,Endoscopy ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,Gastritis ,Cytomegalovirus Infections ,Vomiting ,Kidney Failure, Chronic ,Female ,030211 gastroenterology & hepatology ,Hemodialysis ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Cytomegalovirus (CMV) infection is a common infectious complication in immunocompromised patients. The colon is the most common site of CMV infection in the gastrointestinal tract. Rarely, however, invasion of the upper gastrointestinal tract, such as the esophagus or stomach, has been reported. Herein, we describe the first reported case of CMV gastritis in a patient with end-stage renal disease and uremic symptoms (including nausea, vomiting, and poor appetite) who had begun hemodialysis therapy. This patient was not a transplant recipient and was not receiving immunosuppressant treatment. As CMV gastritis is easily over looked in patients with end-stage renal disease, physicians should maintain a high index of suspicion and establish the diagnosis as early as possible using an upper GI endoscopic biopsy and adequate staining.
- Published
- 2018
24. Dipeptidyl peptidase-4 inhibitors and cardiovascular risks in patients with pre-existing heart failure
- Author
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Hung Ta Chen, Shu-Chen Kuo, Yung Tai Chen, Tzeng Ji Chen, Chia Jen Shih, and Shuo Ming Ou
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,Dipeptidyl Peptidase 4 ,Population ,Myocardial Infarction ,Taiwan ,030204 cardiovascular system & hematology ,Risk Assessment ,Brain Ischemia ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Cause of Death ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Propensity Score ,education ,Stroke ,Aged ,Proportional Hazards Models ,Cause of death ,Heart Failure ,Dipeptidyl-Peptidase IV Inhibitors ,education.field_of_study ,business.industry ,Incidence ,Middle Aged ,Protective Factors ,medicine.disease ,Hospitalization ,Treatment Outcome ,Diabetes Mellitus, Type 2 ,Heart failure ,Cohort ,Physical therapy ,Female ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment - Abstract
Background Although recent clinical trials raised concerns about the risk for heart failure (HF) in dipeptidyl peptidase-4 (DPP-4) inhibitor use, data on the cardiovascular risks in the patients with pre-existing HF are still lacking. Methods We used Taiwan9s National Health Insurance Research Database to identify 196 986 patients diagnosed with type 2 diabetes mellitus (T2DM) who had previous history of HF between 2009 and 2013. This population included 30 204 DPP-4 inhibitor users and 166 782 propensity score-matched DPP-4 inhibitor non-users. The outcomes of interest were all-cause mortality, combination of myocardial infarction (MI) and ischaemic stroke, and hospitalisation for HF. Results The incidence in DPP-4 users compared with non-users was 67.02 vs 102.85 per 1000 person-years for all-cause mortality, 37.89 vs 47.54 per 1000 person-years for the combination of MI and ischaemic stroke, 12.70 vs 16.18 per 1000 person-years for MI and 26.37 vs 32.46 per 1000 person-years for ischaemic stroke. The risk of all-cause mortality was lower in DPP-4 inhibitor users (HR 0.67, 95% CI 0.64 to 0.70), combination of MI and stroke (HR 0.81, 95% CI 0.76 to 0.87), MI (HR 0.80, 95% CI 0.71 to 0.89) and ischaemic stroke (HR 0.83, 95% CI 0.76 to 0.89) than in non-users. Notably, the risk of hospitalisation for HF did not differ significantly between groups. The results were similar after accounting for death as a competing risk. Conclusions In this nationwide T2DM cohort, the risks of mortality and the combination of MI and ischaemic stroke were lower for patients receiving DPP-4 inhibitors than for those who did not receive such treatment. DPP-4 inhibitor use was not associated with a higher risk of hospitalisation for HF even in patients with pre-existing HF.
- Published
- 2016
25. Long-Term Mortality and Major Adverse Cardiovascular Events in Sepsis Survivors. A Nationwide Population-based Study
- Author
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Chia Jen Shih, Tzeng Ji Chen, Shuo Ming Ou, Shu-Chen Kuo, Yung Tai Chen, Ching Min Tseng, Hsi Ning Chu, Yi Jung Lee, and Pei Wen Chao
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,education.field_of_study ,Proportional hazards model ,business.industry ,Population ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,medicine.disease ,Sudden cardiac death ,Sepsis ,03 medical and health sciences ,0302 clinical medicine ,Heart failure ,Epidemiology ,medicine ,030212 general & internal medicine ,Myocardial infarction ,Intensive care medicine ,business ,education ,Stroke - Abstract
Rationale: Patients with sepsis who survive to hospital discharge may present with ongoing high morbidity and mortality. However, little is known about the risk of long-term, all-cause mortality and cardiovascular outcomes after sepsis.Objectives: Our study aimed to investigate the long-term clinical outcomes in sepsis survivors.Methods: In this nationwide population-based study, data from patients with sepsis were retrieved from Taiwan’s National Health Insurance Research Database between 2000 and 2002. Each sepsis survivor was 1:1 propensity-matched to control subjects from two different control populations: subjects who were in the general population and subjects who were hospitalized for a nonsepsis diagnosis. The primary outcomes were all-cause mortality, major adverse cardiovascular events, myocardial infarction, heart failure, stroke, and sudden cardiac death or ventricular arrhythmia.Measurements and Main Results: Compared with matched population control subjects, sepsis survivors had higher risks...
- Published
- 2016
26. Association Between Use of Dipeptidyl Peptidase-4 Inhibitors and the Risk of Acute Kidney Injury: A Nested Case-Control Study
- Author
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Shuo-Ming Ou, Yuan-Hao Lo, Chia-Jen Shih, Shu-Chen Kuo, Yi-Jung Lee, and Yung Tai Chen
- Subjects
Male ,medicine.medical_specialty ,Databases, Factual ,Taiwan ,Administration, Oral ,Comorbidity ,Type 2 diabetes ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Odds Ratio ,medicine ,Humans ,Hypoglycemic Agents ,Longitudinal Studies ,030212 general & internal medicine ,Intensive care medicine ,Aged ,Dipeptidyl-Peptidase IV Inhibitors ,business.industry ,Acute kidney injury ,Case-control study ,General Medicine ,Odds ratio ,Acute Kidney Injury ,medicine.disease ,Diabetes Mellitus, Type 2 ,Case-Control Studies ,Nested case-control study ,Cohort ,Female ,Risk assessment ,business - Abstract
Objective To examine the risk of acute kidney injury (AKI) in a nationwide cohort of patients with type 2 diabetes initiating dipeptidyl peptidase-4 (DPP-4) inhibitors. Patients and Methods This nested case-control study of a cohort of adult DPP-4 inhibitor users with type 2 diabetes who were hospitalized for AKI between January 1, 2010, and December 31, 2013, was conducted using Taiwan's National Health Insurance Research Database. Each AKI case was matched with one control subject according to duration of follow-up, age, sex, urbanization level, monthly income, comorbidity severity, and well-known predisposing factors for AKI. Odds ratios (ORs) for AKI were calculated according to current, recent, or past use of DPP-4 inhibitors. Results A total of 6752 cases with AKI and 6752 matched controls were analyzed. The exposure prevalence of DPP-4 inhibitor use in the previous year was higher among patients with AKI (adjusted OR, 1.20; 95% CI, 1.05-1.36; P =.006). In a stratified analysis, the association was significant for current DPP-4 inhibitor use (adjusted OR, 1.26; 95% CI, 1.08-1.48; P =.004), but not for recent or past use. Conclusion In this large contemporary cohort, DPP-4 inhibitor users had an increased risk of AKI development compared with nonusers. Further research is warranted to investigate the mechanism underlying this association.
- Published
- 2016
27. Observed Blood Pressure and Mortality Among People Aged 65 Years and Older: A Community-Based Cohort Study
- Author
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Yung Tai Chen, Chi Hung Lin, Shuo Ming Ou, Der Cherng Tarng, and Chia Jen Shih
- Subjects
Male ,Gerontology ,Diastole ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Outcome Assessment, Health Care ,Humans ,Medicine ,030212 general & internal medicine ,General Nursing ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Cardiovascular mortality ,Proportional hazards model ,business.industry ,Health Policy ,Blood Pressure Determination ,Retrospective cohort study ,General Medicine ,Blood pressure ,Hypertension ,Female ,Observational study ,Geriatrics and Gerontology ,Older people ,business ,Demography ,Cohort study - Abstract
The 2014 Eighth Joint National Committee guidelines for hypertension management emphasize the upper limit of blood pressure (BP) as the target for treatment in the elderly population. Given the uncertainty regarding optimal BP range, we aimed to investigate the association between observed BP and subsequent mortality in older people.We extracted data from 128,765 participants ≥65 years of age who underwent annual health examinations in a retrospective, observational community-based study from 2001 to 2010. Seated BP was measured using an oscillometric device. The outcomes were all-cause and cardiovascular mortality.As compared to participants with systolic BP at 130 to 139 mm Hg, the risk of all-cause mortality was significantly higher among those with110 (adjusted hazard ratios [aHRs], 1.12; 95% confidence interval [CI], 1.05-1.20), 140 to 149 (aHR, 1.08; 95% CI, 1.03-1.14), 150 to 159 (aHR, 1.07; 95% CI, 1.01-1.17), 160 to 169 (aHR, 1.11; 95% CI, 1.04-1.19), and ≥170 mm Hg (aHR, 1.25; 95% CI, 1.17-1.33), whereas the differences were not significant for those with 110 to119 (aHR, 1.06; 95% CI, 1.00-1.12) and 120 to 129 mm Hg (aHR, 1.03; 95% CI, 0.97-1.08). Similarly, diastolic BP at 40 to 79 mm Hg was associated with the lowest risk of all-cause mortality. The J-shaped curve relationship between BP and cardiovascular mortality was also observed.Observed systolic and diastolic BP other than 110 to 139 and 40 to 79 mm Hg, respectively, were associated with a worse outcome. Our large cohort study supports the J-shaped mortality with observed BP in older people.
- Published
- 2016
28. Long-Term Outcomes in Critically Ill Septic Patients Who Survived Cardiopulmonary Resuscitation*
- Author
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Yu Ning Shih, Chia Jen Shih, Shu-Chen Kuo, Hsi Ning Chu, Shuo Ming Ou, Szu Yuan Li, Yung Tai Chen, and Pei Wen Chao
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,Critical Illness ,medicine.medical_treatment ,Taiwan ,Comorbidity ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Sepsis ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Risk Factors ,Epidemiology ,Long term outcomes ,medicine ,Humans ,Hospital Mortality ,Cardiopulmonary resuscitation ,Intensive care medicine ,Survival rate ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Critically ill ,Age Factors ,030208 emergency & critical care medicine ,Middle Aged ,Prognosis ,medicine.disease ,Cardiopulmonary Resuscitation ,Heart Arrest ,Survival Rate ,Cohort ,Female ,Observational study ,business - Abstract
To evaluate the long-term survival rate of critically ill sepsis survivors following cardiopulmonary resuscitation on a national scale.Retrospective and observational cohort study.Data were extracted from Taiwan's National Health Insurance Research Database.A total of 272,897 ICU patients with sepsis were identified during 2000-2010. Patients who survived to hospital discharge were enrolled. Post-discharge survival outcomes of ICU sepsis survivors who received cardiopulmonary resuscitation were compared with those of patients who did not experience cardiopulmonary arrest using propensity score matching with a 1:1 ratio.None.Only 7% (n = 3,207) of sepsis patients who received cardiopulmonary resuscitation survived to discharge. The overall 1-, 2-, and 5-year postdischarge survival rates following cardiopulmonary resuscitation were 28%, 23%, and 14%, respectively. Compared with sepsis survivors without cardiopulmonary arrest, sepsis survivors who received cardiopulmonary resuscitation had a greater risk of all-cause mortality after discharge (hazard ratio, 1.38; 95% CI, 1.34-1.46). This difference in mortality risk diminished after 2 years (hazard ratio, 1.11; 95% CI, 0.96-1.28). Multivariable analysis showed that independent risk factors for long-term mortality following cardiopulmonary resuscitation were male sex, older age, receipt of care in a nonmedical center, higher Charlson Comorbidity Index score, chronic kidney disease, cancer, respiratory infection, vasoactive agent use, and receipt of renal replacement therapy during ICU stay.The long-term outcome was worse in ICU survivors of sepsis who received in-hospital cardiopulmonary resuscitation than in those who did not, but this increased risk of mortality diminished at 2 years after discharge.
- Published
- 2016
29. Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and the risk of major adverse cardiac events in patients with diabetes and prior stroke
- Author
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Shu-Chen Kuo, Chia Jen Shih, Der Cherng Tarng, Chih Yu Yang, Szu Yuan Li, Yung Tai Chen, Shuo Ming Ou, Hung Ta Chen, and Pei Wen Chao
- Subjects
Male ,Risk ,medicine.medical_specialty ,Databases, Factual ,Hyperkalemia ,Physiology ,Myocardial Infarction ,Taiwan ,Angiotensin-Converting Enzyme Inhibitors ,Comorbidity ,030204 cardiovascular system & hematology ,Cohort Studies ,Angiotensin Receptor Antagonists ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Internal medicine ,Internal Medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Stroke ,Aged ,Proportional Hazards Models ,biology ,business.industry ,Acute kidney injury ,Angiotensin-converting enzyme ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,Intention to Treat Analysis ,Hospitalization ,Diabetes Mellitus, Type 2 ,Cardiovascular Diseases ,Hypertension ,biology.protein ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Renin-angiotensin-aldosterone system blockers are the preferred antihypertensive medications in patients with diabetes and prior stroke. This study aimed to compare the effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in terms of major adverse cardiac events (MACEs) in patients with diabetes who survived ischemic stroke.We conducted an observational, nationwide, propensity score-matched cohort study using Taiwan's National Health Insurance Research Database. Patients aged at least 20 years with type 2 diabetes who initiated ACEI (n = 15,959) or ARB (n = 23,929) use within 90 days after discharge for first ischemic stroke between January 2000 and December 2011 were allocated to ACEI and ARB groups, respectively. The primary outcomes were MACEs (myocardial infarction, ischemic stroke, and cardiovascular mortality). The secondary outcomes were hospitalization for acute kidney injury and hyperkalemia. Intention-to-treat and as-treated models were used.Intention-to-treat analysis showed no significant difference between the ACEI and ARB groups in the outcomes of MACEs [hazard ratio (HR), 0.99; 95% confidence interval (CI), 0.95-1.04], including ischemic stroke (HR, 1.01; 95% CI, 0.97-1.06), myocardial infarction (HR, 1.06; 95% CI, 0.95-1.18), and cardiovascular mortality (HR, 0.98; 95% CI, 0.91-1.06). As-treated analysis produced similar results. Additionally, the groups showed no difference in the risk of hospitalization for acute kidney injury or hyperkalemia.Our study supports the hypothesis that the risks of MACEs and two additional secondary outcomes in patients with diabetes who survived ischemic stroke did not differ according to ACEI versus ARB use.
- Published
- 2016
30. Increased risk of pulmonary tuberculosis in patients with gastroesophageal reflux disease
- Author
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Tzeng Ji Chen, Vincent Yi Fong Su, Wen Chien Fan, Jia Yih Feng, Chia Jen Liu, Shuo Ming Ou, Yu Wen Hu, S. H. Chien, Wei Juin Su, C. M. Yeh, and Li Yu Hu
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Databases, Factual ,Taiwan ,Comorbidity ,Kaplan-Meier Estimate ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Risk factor ,Tuberculosis, Pulmonary ,Proportional Hazards Models ,Asthma ,Chi-Square Distribution ,business.industry ,Incidence ,Incidence (epidemiology) ,Case-control study ,Proton Pump Inhibitors ,Middle Aged ,medicine.disease ,humanities ,digestive system diseases ,Infectious Diseases ,Histamine H2 Antagonists ,030228 respiratory system ,Case-Control Studies ,Multivariate Analysis ,Gastroesophageal Reflux ,GERD ,Female ,business ,Chi-squared distribution ,Cohort study - Abstract
Background Previous studies have suggested a close correlation between gastroesophageal reflux disease (GERD) and various respiratory disorders. However, the association between GERD and tuberculosis (TB) remains unexplored. Methods Using data retrieved from Taiwan's National Health Insurance Research Database from 2000 to 2009, this longitudinal nationwide cohort study included a total of 63,930 patients with GERD and controls matched by age, sex and comorbidities. Risk factors associated with the development of pulmonary TB (PTB) were investigated. Results Active PTB was documented in 65 (0.20%) patients with GERD and 41 (0.13%) matched cohorts within 1 year of GERD diagnosis. The incidence rate of PTB in the GERD group and the matched cohort was respectively 24.1 and 15.2 cases per 10,000 person-years. In multivariate analysis, GERD was an independent risk factor for PTB (adjusted HR 1.63, 95%CI 1.10-2.40, P = 0.015). Among patients with GERD, independent predictors for PTB included older age, male sex, chronic obstructive pulmonary disease, asthma and exposure to proton pump inhibitors (PPIs). Conclusion Patients with GERD have a significantly increased risk of PTB within 1 year of GERD diagnosis. Exposure to PPIs is an independent predictor for PTB among patients with GERD.
- Published
- 2016
31. Association of sleep apnoea with chronic kidney disease in a large cohort from Taiwan
- Author
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Yuan-Hao Lo, Yung Tai Chen, Hsi Chu, Shuo-Ming Ou, Kun Ta Chou, and Chia-Jen Shih
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Hazard ratio ,Retrospective cohort study ,030204 cardiovascular system & hematology ,medicine.disease ,Confidence interval ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Diabetes mellitus ,Epidemiology ,Cohort ,medicine ,Physical therapy ,030212 general & internal medicine ,business ,Kidney disease - Abstract
Background and objective Recent observational studies have shown that sleep apnoea (SA) is associated with increased risk of incident CKD. However, the contribution of SA relative to common traditional CKD risk factors remains unknown. The aims of this study were to investigate the long-term risk of incident CKD events following SA diagnosis and compare the relative contributions of SA, diabetes and hypertension. Methods Data were retrieved from Taiwan's National Health Insurance Research Database during the period between 2000 and 2010 for this retrospective cohort study. The cohorts are composed of patients (age ≥ 20 years) newly diagnosed with SA and matched subjects without SA. The two cohorts were followed until the occurrence of CKD, death or the end of 2010. Results The sample is composed of 43 434 individuals (8687 patients with SA and 34 747 matched non-SA subjects). A total of 157 new CKD events in patients with SA and 298 events in the matched non-SA cohort were recorded during a mean follow-up period of 3.9 years (incidence rates, 4.5 and 2.2/per 1000 person-years). The risk of CKD development was greater among patients with SA than in the matched non-SA cohort (adjusted hazard ratio (aHR) 1.58, 95% confidence interval ( CI): 1.29–1.94). The contribution of SA to the CKD hazard was similar to that of hypertension (aHR 1.17, 95% CI: 0.68–2.01, P = 0.56), whereas that of diabetes remained significantly higher (aHR 2.17, 95% CI: 1.21–3.90, P = 0.01). Conclusion SA was associated with an increase in the risk of CKD incidence similar to that of hypertension. See Editorial, page 578
- Published
- 2016
32. Risks of Death and Stroke in Patients Undergoing Hemodialysis With New-Onset Atrial Fibrillation
- Author
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Shuo Ming Ou, Der Cherng Tarng, Chia Jen Shih, Szu Yuan Li, Yi Jung Lee, Chih Ching Lin, Shu-Chen Kuo, Pei Wen Chao, Chih Yu Yang, Po Hsun Huang, and Yung Tai Chen
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Statistics as Topic ,Taiwan ,030232 urology & nephrology ,030204 cardiovascular system & hematology ,Competing risks ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,Risk Factors ,Physiology (medical) ,Atrial Fibrillation ,medicine ,Humans ,In patient ,Hospital Mortality ,Intensive care medicine ,Stroke ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Atrial fibrillation ,Middle Aged ,medicine.disease ,New onset atrial fibrillation ,Population Surveillance ,Cohort ,Oral anticoagulant ,Female ,Hemodialysis ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background— Whether oral anticoagulant use should be considered in patients undergoing hemodialysis with atrial fibrillation (AF) remains controversial because of the uncertainty regarding risk-benefit assessments. The purpose of this study was to investigate the risk of ischemic stroke in patients undergoing hemodialysis with new-onset AF, in comparison with those without arrhythmia. Methods and Results— This nationwide, population-based, propensity score–matched cohort study used data from Taiwan’s National Health Insurance Research Database during 1998 to 2011 for patients on hemodialysis with new-onset nonvalvular AF and matched subjects without arrhythmia. The clinical end points were ischemic stroke (fatal or nonfatal), all-cause death, and other serious adverse cardiovascular events. In comparison with the matched cohort, patients with AF (n=6772) had higher risks of ischemic stroke (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [CI], 1.13–1.43), all-cause death (aHR, 1.59; 95% CI, 1.52–1.67), in-hospital cardiovascular death (aHR, 1.83; 95% CI, 1.71–1.94), myocardial infarction (aHR, 1.33; 95% CI, 1.17–1.51), and hospitalization for heart failure (aHR, 1.90; 95% CI, 1.76–2.05). After considering in-hospital death as a competing risk, AF significantly increased the risk of heart failure (HR, 1.56; 95% CI, 1.45–1.68), but not those of ischemic stroke and myocardial infarction. Additionally, the predictive value of the CHA 2 DS 2 –VASc score for ischemic stroke was diminished in the competing-risk model. Conclusions— The risk of stroke was only modestly higher in patients undergoing hemodialysis with new-onset AF than in those without AF, and it became insignificant when accounting for the competing risk of in-hospital death.
- Published
- 2016
33. Association of estimated glomerular filtration rate with all-cause and cardiovascular mortality: the role of malnutrition-inflammation-cachexia syndrome
- Author
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Chi Hung Lin, Chia-Jen Shih, Chih-Kang Chiang, Der-Cherng Tarng, Shuo-Ming Ou, Szu-Chun Hung, and Yung Tai Chen
- Subjects
medicine.medical_specialty ,business.industry ,Hazard ratio ,030232 urology & nephrology ,Renal function ,030204 cardiovascular system & hematology ,medicine.disease ,Gastroenterology ,Confidence interval ,Cachexia ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Physiology (medical) ,Internal medicine ,Sarcopenia ,medicine ,Orthopedics and Sports Medicine ,business ,Body mass index ,Cohort study ,Kidney disease - Abstract
Background Previous studies have demonstrated that high estimated glomerular filtration rate (eGFR) is paradoxically associated with an increased risk of mortality, and the association becomes more predominant in older people. However, the role of malnutrition–inflammation–cachexia syndrome (MICS) in the association between eGFR and mortality has never been explored. Methods We conducted a community-based cohort study using data from the Taipei City Elderly Health Examination Database, collected during the period 2001–10. All participants aged ≥65 years were included and stratified by the absence or presence of MICS, which is defined as the presence of at least one of the following markers: body mass index
- Published
- 2016
34. Adult narcoleptic patients have increased risk of cancer: A nationwide population-based study
- Author
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Yi Han Hsiao, Szu Yuan Li, Shuo Ming Ou, Kun Ta Chou, Tzeng Ji Chen, Ching Min Tseng, Yung Tai Chen, Diahn-Warng Perng, and Chi Wei Tao
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Databases, Factual ,Epidemiology ,Population ,Malignancy ,Cohort Studies ,Risk Factors ,Neoplasms ,Internal medicine ,medicine ,Humans ,education ,Aged ,Narcolepsy ,education.field_of_study ,business.industry ,Incidence ,Incidence (epidemiology) ,Cancer ,Middle Aged ,medicine.disease ,Comorbidity ,Oncology ,Cohort ,Female ,business ,Cancer risk ,Cohort study ,Demography - Abstract
Background The comorbidity profile, especially cancer risk, of narcoleptic patients has seldom been explored. We used a nationwide database to evaluate the risk of cancer among adult narcoleptic patients. Methods We conducted the cohort study using National Health Insurance Research Database from 2000 to 2009. Standardized incidence ratios (SIRs) of cancers were calculated to compare the cancer incidence of the study cohort with that of the general population. Results 2833 narcoleptic patients were identified after excluding patients with antecedent malignancy and age younger than 18 years old. The study cohort was observed for 15,913 person-years during a 10-year period. The median follow-up interval was 5.6 ± 3.0 years. Seventy-four cancers occurred in during the follow-up. The risk of all cancers was found significantly increased in adult narcoleptic patients (SIR 1.32; 95% CI, 1.04–1.66, p = 0.0248). Regarding sex, the overall cancer risk was increased in female patients (SIR 1.52; 95% CI, 1.05–2.13, p = 0.026). Furthermore, females were found to have more head and neck cancers (SIR 6.17; 95% CI, 1.66-15.80, p = 0.009) and gastric cancers (SIR 4.87; 95% CI, 1.31–12.48, p = 0.02). For males, the incidence of overall and specific cancer types was not significantly increased. Conclusions Adult narcoleptic patients had a higher risk for cancer. Further research is warranted to elucidate the mechanism underlying its association.
- Published
- 2015
35. Title Page / Table of Contents / Preface
- Author
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Hiroki Hase, Subramanyam Venkata Sreepada, Masahiro Eriguchi, Connie M. Rhee, Pavan Kumar Rao Navva, Shunsuke Yamada, Kirsten L. Johansen, Shuo-Ming Ou, Norio Hanafusa, Nobuhiko Joki, Agnes Shin-Man Choy, Yoshitaka Kurihara, Tammy L. Sirich, Rieko Eriguchi, Kamyar Kalantar-Zadeh, Karopadi Shivanand Nayak, Naoki Kimata, Philip Kam-Tao Li, Tetsuo Shoji, Yoshitsugu Obi, Druckerei Stückle, Timothy W. Meyer, Kenichi Kokubo, Hisae Tanaka, Ken Tsuchiya, Takashi Akiba, Takanari Kitazono, Kosaku Nitta, Hiroshi Tsukao, Hideki Hirakata, Kazuhiko Tsuruya, Kozue Kobayashi, Yuri Tanaka, and Hirosuke Kobayashi
- Subjects
Nephrology ,media_common.quotation_subject ,Art history ,Table of contents ,Hematology ,General Medicine ,Art ,Title page ,media_common - Published
- 2015
36. Effects on Clinical Outcomes of Adding Dipeptidyl Peptidase-4 Inhibitors Versus Sulfonylureas to Metformin Therapy in Patients With Type 2 Diabetes Mellitus
- Author
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Chih Yu Yang, Szu Yuan Li, Der Cherng Tarng, Shuu Jiun Wang, Hsi Chu, Yi Jung Lee, Chia Jen Shih, Shu-Chen Kuo, Chih Ching Lin, Pei Wen Chao, Yung Tai Chen, Shuo Ming Ou, and Tzeng Ji Chen
- Subjects
Oncology ,medicine.medical_specialty ,endocrine system diseases ,business.industry ,digestive, oral, and skin physiology ,nutritional and metabolic diseases ,Type 2 Diabetes Mellitus ,General Medicine ,Type 2 diabetes ,Hypoglycemia ,medicine.disease ,Lower risk ,Metformin ,Endocrinology ,Internal medicine ,Diabetes mellitus ,Internal Medicine ,medicine ,business ,Stroke ,Dipeptidyl peptidase-4 ,medicine.drug - Abstract
In a large observational database study of add-on treatments to metformin, the addition of dipeptidyl peptidase-4 (DPP-4) inhibitors was associated with a lower risk for all-cause mortality, stroke...
- Published
- 2015
37. U-Shaped Association Between Serum Uric Acid Levels With Cardiovascular and All-Cause Mortality in the Elderly: The Role of Malnourishment
- Author
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Wei‐Cheng Tseng, Yung‐Tai Chen, Shuo‐Ming Ou, Chia‐Jen Shih, Der‐Cherng Tarng, Chih‐Yu Yang, Yao‐Ping Lin, Yi‐Fang Chuang, Liang‐Kung Chen, Kwua‐Yun Wang, Yu‐Hsin Chen, Ming‐Tsun Tsai, Yi‐Sheng Lin, Szu‐Chun Hung, Ko‐Lin Kuo, Tung‐Po Hung, Fen‐Hsiang Hu, Nien‐Jung Chen, Yu‐Chi Chen, Chi‐Hung Lin, Tung‐Hu Tsai, Shie‐Liang Hsieh, Yau‐Huei Wei, Chih‐Cheng Hsu, Jia‐Sin Liu, Yu‐Kang Chang, and Ming‐Han Chiang
- Subjects
Male ,medicine.medical_specialty ,Aging ,Time Factors ,Epidemiology ,Taiwan ,Nutritional Status ,Disease ,Hyperuricemia ,030204 cardiovascular system & hematology ,Risk Assessment ,elderly ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,uric acid ,Risk Factors ,Internal medicine ,Cause of Death ,Medicine ,Humans ,030212 general & internal medicine ,Longitudinal Studies ,Geriatric Assessment ,Aged ,Original Research ,business.industry ,Proportional hazards model ,Serum uric acid ,Hazard ratio ,Malnutrition ,Age Factors ,medicine.disease ,Prognosis ,mortality ,Nutrition Assessment ,chemistry ,Cardiovascular Diseases ,Cohort ,malnourishment ,Uric acid ,Female ,Mortality/Survival ,Cardiology and Cardiovascular Medicine ,business ,All cause mortality ,Biomarkers - Abstract
Background The link between elevated serum uric acid ( SUA ) levels and cardiovascular disease ( CVD )–related mortality in the elderly population remains inconclusive. Nutritional status influences both SUA and CVD outcomes. Therefore, we investigated whether SUA ‐predicted mortality and the effect‐modifying roles of malnourishment in older people. Methods and Results A longitudinal Taiwanese cohort including 127 771 adults 65 years and older participating in the Taipei City Elderly Health Examination Program from 2001 to 2010 were stratified by 1‐mg/dL increment of SUA . Low SUA (2 . Study outcomes were all‐cause and CVD ‐related mortality. Cox models were used to estimate hazard ratios ( HRs ) of mortality, after adjusting for 20 demographic and comorbid covariates. Over a median follow‐up of 5.8 years, there were 16 439 all‐cause and 3877 CVD ‐related deaths. Compared with the reference SUA strata of 4 to SUA HR , 1.16; 95% confidence interval, 1.07–1.25) and ≥8 mg/dL ( HR , 1.13; confidence interval, 1.06–1.21), with progressively elevated risks at both extremes. Similarly, increasingly higher CVD ‐related mortality was found at the SUA level HR , 1.19; confidence interval, 1.00–1.40) and ≥7 mg/dL ( HR , 1.17; confidence interval, 1.04–1.32). Remarkably, among the low SUA (CVD ‐related mortality. This modifying effect of malnourishment remained consistent across subgroups. Conclusions SUA ≥8 or CVD ‐related mortality in the elderly, particularly in those with malnourishment.
- Published
- 2018
38. Incidence and risk of seizures in Alzheimer's disease: A nationwide population-based cohort study
- Author
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Chiu Mei Yeh, Tzeng Ji Chen, Chia Jen Liu, Shuu Jiun Wang, Yung Yang Lin, Chia-Hsiung Cheng, and Shuo Ming Ou
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Population ,Taiwan ,Comorbidity ,Kaplan-Meier Estimate ,Epilepsy ,Alzheimer Disease ,Risk Factors ,Seizures ,medicine ,Humans ,Cumulative incidence ,Registries ,education ,Aged ,Proportional Hazards Models ,Retrospective Studies ,education.field_of_study ,Proportional hazards model ,business.industry ,Incidence ,Incidence (epidemiology) ,Hazard ratio ,Age Factors ,medicine.disease ,Confidence interval ,Neurology ,Cohort ,Female ,Neurology (clinical) ,business ,Follow-Up Studies - Abstract
The reported incidence and risk factors mediating seizures in Alzheimer's disease (AD) have been extremely inconsistent and relevant data is lacking in Asia. We investigated the incidence rate and risk of seizures in AD and in a large, nationwide cohort from Han Chinese. A retrospective population-based study was conducted on the data from Taiwan's National Health Insurance Research Database from 2000 to 2010. To reduce selection bias, we applied propensity scores, wherein 981 patients with AD were matched to 3835 non-AD controls from a pool of 1000,000 randomly sampled cohort dataset. This approach was based on age, sex, comorbidities and previous brain conditions. Incidence rate, cumulative incidence and hazard ratios (HRs) were estimated. During the 10-year follow-up period (mean follow-up time, 4.02 years), 44 out of 937 AD patients (4.7%) developed seizures. The incidence rate in the AD cohort (11.9 per 1000 person-years) was higher than that in the matched cohort (5.7 per 1000 person-years), with an adjusted HR of 1.85 (95% confidence interval [CI], 1.20-2.83, p=0.005). The mean duration from the diagnosis of AD to the occurrence of seizure is 3.6 years. The Cox regression analysis revealed that AD itself is a significant predictor after adjustment for confounders (HR=2.01, 95% CI, 1.40-2.90, p
- Published
- 2015
39. Periodontal Disease and Risks of Kidney Function Decline and Mortality in Older People: A Community-Based Cohort Study
- Author
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Yung Tai Chen, Szu Chun Hung, Der Cherng Tarng, Chi Hung Lin, Shuo Ming Ou, and Chia Jen Shih
- Subjects
Male ,medicine.medical_specialty ,Taiwan ,Renal function ,Logistic regression ,Cohort Studies ,Periodontal disease ,Risk Factors ,Internal medicine ,medicine ,Humans ,Longitudinal Studies ,Mortality ,Renal Insufficiency, Chronic ,Risk factor ,Periodontal Diseases ,Aged ,Aged, 80 and over ,business.industry ,medicine.disease ,Logistic Models ,Cardiovascular Diseases ,Nephrology ,Creatinine ,Physical therapy ,Female ,Observational study ,Older people ,business ,Glomerular Filtration Rate ,Kidney disease ,Cohort study - Abstract
Background The association between periodontal disease and chronic kidney disease in older people is controversial, and evidence for a causal link between kidney function decline and subsequent mortality risk is limited. Study Design Longitudinal, observational, community-based cohort study. Setting & Participants Participants were citizens 65 years or older who received the Taipei City Government–sponsored Annual Elderly Health Examination Program during 2005 to 2010, including dental status assessment and biochemical examinations. Predictors Participants with periodontal disease defined by the World Health Organization Community Periodontal Index of Treatment Need criteria. Outcomes All-cause and cardiovascular mortality and estimated glomerular filtration rate (eGFR) decline ≥ 30% over 2 years. Results Of 100,263 study participants, 13,749 (13.7%) had periodontal disease. In a mean follow-up of 3.8 years, all-cause and cardiovascular mortality rates in those with periodontal disease (11.5% and 2.6%, respectively) were higher compared with those without periodontal disease (6.7% and 1.6%, respectively). After adjustment for demographic characteristics, comorbid conditions, and biochemistry data, adjusted HRs for all-cause and cardiovascular mortality were 1.34 (95% CI, 1.26-1.42) and 1.25 (95% CI, 1.13-1.41), respectively. The frequency of eGFR decline ≥ 30% over 1-, 2-, and 3-years' follow-up in those with periodontal disease was 1.8%, 3.7%, and 4.0%, respectively. In a logistic regression model, adjusted ORs of the detrimental effect of periodontal disease on 30% eGFR decline in participants over 1-, 2-, or 3-years' follow-up were 1.03 (95% CI, 0.85-1.25), 1.62 (95% CI, 1.41-1.87), and 1.59 (95% CI, 1.37-1.86), respectively. In subgroup analyses according to age, sex, and comorbid conditions, risks for eGFR decline and mortality remained consistent. Limitations Results may not be generalizable to other non-Asian ethnic populations. Conclusions The results indicate that periodontal disease is a risk factor for all-cause and cardiovascular mortality and eGFR decline ≥ 30% over 2 to 3 years in older people.
- Published
- 2015
40. Bidirectional association between the risk of comorbidities and the diagnosis of retinal vein occlusion in an elderly population: A nationwide population-based study
- Author
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Chia-Jen Shih, Shuo-Ming Ou, Shu-Yu Ou, Yung Tai Chen, Yi-Jung Lee, and Chia-Hsiang Shih
- Subjects
Male ,medicine.medical_specialty ,Databases, Factual ,Population ,Taiwan ,Comorbidity ,Cohort Studies ,Risk Factors ,Internal medicine ,Retinal Vein Occlusion ,medicine ,Humans ,education ,Aged ,Aged, 80 and over ,education.field_of_study ,business.industry ,Vascular disease ,Incidence (epidemiology) ,Hazard ratio ,Odds ratio ,medicine.disease ,Surgery ,Cerebrovascular Disorders ,Cardiovascular Diseases ,Population Surveillance ,Cohort ,Female ,Cardiology and Cardiovascular Medicine ,business ,Mace ,Dyslipidemia - Abstract
Background Retinal vein occlusion (RVO) is the second most common retinal vascular disease, with peak incidence at 70years of age. However, the bidirectional association between the risk of comorbidities and the diagnosis of RVO in this population is uncertain. Methods A population-based cohort of 1,784,960 patients 70years of age and older retrieved from the Taiwan National Health Insurance Research Database between 2000 and 2010. Risks of comorbidities were assessed 5years before and after the diagnosis of RVO. Results In our study, 3393 subjects had central RVO (CRVO) and 6688 subjects had branch RVO (BRVO). Before the diagnosis of RVO, patients showed increased risks for the following comorbidities: hypertension (odds ratio [OR]=1.83, 95% confidence interval [CI], 1.74–1.93), dyslipidemia (OR=1.29, [1.23–1.35]), DM (OR=1.29, [1.23–1.35]), liver disease (OR=1.22, [1.16–1.29]), renal disease (OR=1.30, [1.23–1.37]), and cerebrovascular disease (OR=1.16, [1.11–1.21]). After the diagnosis of RVO, patients were at greater risk of developing DM (adjusted hazard ratio [AHR]=1.12, [1.06–1.19]), PAD (AHR=1.17, [1.08–1.27]), and MACE (AHR=1.35, [1.25–1.46]); however, the risk of all-cause mortality was unchanged. Elderly patients with CRVO had a significantly higher risk of all-cause mortality (AHR=1.09, [1.02–1.17]), whereas patients with BRVO showed no significant differences in mortality. Conclusion This study suggests bidirectional association between the risk of comorbidities and the diagnosis of RVO in an elderly population.
- Published
- 2015
41. Risk of tuberculosis among healthcare workers in an intermediate-burden country: A nationwide population study
- Author
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Szu Yuan Li, Hsi Chu, Yu Ning Shih, Yi Jung Lee, Yen Tao Hsu, Shu-Chen Kuo, Chia Jen Shih, Der Cherng Tarng, Shuo Ming Ou, Ran Chou Chen, and Yung Tai Chen
- Subjects
Adult ,Male ,Microbiology (medical) ,Pediatrics ,medicine.medical_specialty ,Tuberculosis ,Health Personnel ,health care facilities, manpower, and services ,education ,Population ,Antitubercular Agents ,Taiwan ,Cohort Studies ,Young Adult ,Risk Factors ,Environmental health ,Epidemiology ,medicine ,Humans ,Developing Countries ,Tuberculosis, Pulmonary ,History of tuberculosis ,education.field_of_study ,business.industry ,Incidence ,Incidence (epidemiology) ,Hazard ratio ,medicine.disease ,Infectious Diseases ,Population study ,Female ,business ,Follow-Up Studies ,Cohort study - Abstract
Summary Objective The potential association between healthcare workers (HCWs) and the risk of clinically active tuberculosis (TB) in countries with intermediate TB burdens remains unclear. Methods A nationwide, population-based cohort study was performed by using Taiwan National Health Insurance Database during 2000–2010. We included HCWs and non-HCWs without history of tuberculosis matched at a 1:1 ratio according to age, sex, monthly income, underlying comorbidities, and concomitant medications. All subjects were followed from the date of enrollment until TB occurrence, death, or 31 December 2010. Results The study population comprised 11,811 healthcare workers and 11,811 matched subjects. 62 HCWs and 38 control subjects developed TB during a median follow-up period of 9.4 years. The incidence of TB was higher among HCWs than among matched subjects (61.08 vs . 37.81 per 100,000 person-years). The risk of TB was also greater among HCWs (adjusted hazard ratio [aHR], 1.62; 95% confidence interval [CI], 1.08–2.43), particularly for pulmonary TB in comparison with extrapulmonary TB (aHR, 1.56; 95% CI, 1.02–2.39). Among different job categories of HCWs, we found that only nurses had a significantly increased risk of developing TB (aHR, 2.55; 95% CI, 1.37–4.72) compared to the matched cohort. Conclusions HCWs are associated independently with a higher risk of developing TB in this intermediate-burden country. Therefore, the importance of TB surveillance among HCWs should be emphasized.
- Published
- 2014
42. Long-Term Clinical Outcome of Major Adverse Cardiac Events in Survivors of Infective Endocarditis
- Author
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Hsi Chu, Shuo Ming Ou, Yi Jung Lee, Der Cherng Tarng, Shu-Chen Kuo, Yung Tai Chen, Szu Yuan Li, Chia Jen Shih, Wu Chang Yang, Pei Wen Chao, and Chih Yu Yang
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Population ,Myocardial Infarction ,Sudden cardiac death ,Risk Factors ,Physiology (medical) ,Internal medicine ,Outcome Assessment, Health Care ,medicine ,Humans ,Endocarditis ,Survivors ,Myocardial infarction ,education ,Intensive care medicine ,Stroke ,Aged ,Heart Failure ,education.field_of_study ,business.industry ,Arrhythmias, Cardiac ,Middle Aged ,medicine.disease ,Death, Sudden, Cardiac ,Heart failure ,Infective endocarditis ,Female ,Morbidity ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - Abstract
Background— Substantial infective endocarditis (IE)–related morbidity and mortality may occur even after successful treatment. However, no previous study has explored long-term hard end points (ie, stroke, myocardial infarction, heart failure, cardiovascular death) in addition to all-cause mortality in IE survivors. Methods and Results— A nationwide population-based cohort study was conducted among IE survivors identified with the use of the Taiwan National Health Insurance Research Database during 2000 to 2009. IE survivors were defined as those who survived after discharge from first hospitalization with a diagnosis of IE. A total of 10 116 IE survivors were identified. IE survivors were matched to control subjects without IE at a 1:1 ratio through the use of propensity scores. The primary outcomes were stroke, myocardial infarction, readmission for heart failure, and sudden cardiac death or ventricular arrhythmia. The secondary outcomes were repeat IE and all-cause mortality. Compared with the matched cohort, IE survivors had higher risks of ischemic stroke (adjusted hazard ratio [aHR], 1.59; 95% confidence interval [CI], 1.40–1.80), hemorrhagic stroke (aHR, 2.37; 95% CI, 1.90–2.96), myocardial infarction (aHR, 1.44; 95% CI, 1.17–1.79), readmission for heart failure (aHR, 2.24; 95% CI, 2.05–2.43), sudden death or ventricular arrhythmia (aHR, 1.69; 95% CI, 1.44–1.98), and all-cause death (aHR, 2.27; 95% CI, 2.14–2.40). Risk factors for repeat IE were older age, male sex, drug abuse, and valvular replacement after an initial episode of IE. Conclusion— Despite treatment, the risk of long-term major adverse cardiac events was substantially increased in IE survivors.
- Published
- 2014
43. Increased risk of urinary calculi in patients with migraine: A nationwide cohort study
- Author
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Kuan Po Peng, Min Juei Tsai, Yung Tai Chen, Chao Hsiun Tang, Shuu Jiun Wang, Shuo Ming Ou, and Chia Jen Shin
- Subjects
Adult ,Male ,Topiramate ,medicine.medical_specialty ,Migraine Disorders ,Urinary system ,Taiwan ,Cohort Studies ,Risk Factors ,Internal medicine ,medicine ,Humans ,Retrospective Studies ,business.industry ,Incidence ,Hazard ratio ,General Medicine ,Middle Aged ,medicine.disease ,Confidence interval ,Migraine ,Anesthesia ,Propensity score matching ,Cohort ,Female ,Urinary Calculi ,Neurology (clinical) ,business ,medicine.drug ,Cohort study - Abstract
Objective Whether migraine is associated with urinary calculi is an unresolved issue, although topiramate, a migraine-preventive agent, is known to contribute to this complication. This study investigates the association between migraine and the risk of urinary calculi. Methods We identified a total of 147,399 patients aged ≥18 years with migraine diagnoses recorded in the Taiwan National Health Insurance Research Database between 2005 and 2009. Each patient was randomly matched with one individual without headache using propensity scores. All participants were followed from the date of enrollment until urinary calculi development, death, or the end of 2010. Results The risk of urinary calculi was greater in the migraine than the control cohort (adjusted hazard ratio (aHR), 1.58; 95% confidence interval (CI), 1.52–1.63; p Conclusions Our study showed migraine was associated with an increased risk of urinary calculi, independent of topiramate use. A higher frequency of clinic visits was associated with a greater risk.
- Published
- 2014
44. Serum adrenomedullin and urinary thromboxane B 2 help early categorizing of acute kidney injury in decompensated cirrhotic patients: A prospective cohort study
- Author
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Shiang-Fen Huang, Han-Chieh Lin, Yun-Cheng Hsieh, Wen‐Chien Fan, Hung-Cheng Tsai, Shou-Dong Lee, Yen‐Bo Su, Ying-Ying Yang, Tzu-Hao Li, Ming-Chih Hou, Chang-Youh Tsai, Shuo-Ming Ou, Lee-Won Chong, Chih-Wei Liu, Chia Chang Huang, and Kuei-Chuan Lee
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Urinary system ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Hepatorenal syndrome ,Internal medicine ,medicine ,Prospective cohort study ,Acute tubular necrosis ,Hepatology ,business.industry ,Acute kidney injury ,medicine.disease ,Adrenomedullin ,030104 developmental biology ,Infectious Diseases ,Endocrinology ,030211 gastroenterology & hepatology ,Azotemia ,Terlipressin ,business ,hormones, hormone substitutes, and hormone antagonists ,circulatory and respiratory physiology ,medicine.drug - Abstract
Aims Increases in the systemic vasodilator adrenomedullin and the renal vasoconstrictors thromboxane A2 (TXA2) in cirrhotic patients are pathogenic factors for the development of functional acute-kidney-injury, including pre-renal azotemia (PRA) and hepatorenal syndrome (HRS), which is associated with high mortality. This study aims to find biomarkers which can diagnose HRS in early stage for treating it as soon as possible. Methods Acute decompensated cirrhotic patients who had been admitted to hospital were enrolled in this prospective cohort study. Blood and urinary samples were collected immediately after admission. In addition to initially categorizing acute-kidney-injury cases into PRA, acute tubular-necrosis (ATN) and HRS groups, their final diagnosis was adjudicated by a nephrologist and a hepatologist who checked the corrected and misclassification rates for significant biomarkers. Results The cutoff values for serum adrenomedullin and urinary TXB2, when used as predictors for functional acute kidney injury {[adrenomedullin] >283 pg/mL, urinary TXB2 > 978 (pg/mg urinary creatinine)}, for HRS {[adrenomedullin] >428, urinary TXB2 > 1604}, and for good terlipressin plus albumin treatment responders {[adrenomedullin] > 490; urinary TXB2 > 1863}, were observed. HRS patients who can't be treated, due to high mortality, had significantly higher serum adrenomedullin and urinary TXB2 levels compared to HRS patients receiving standard treatment. In addition to predicting 60-day mortality, a combination of these two markers further increased diagnostic accuracy for HRS among functional acute-kidney-injury. Conclusions Prompt diagnosis of HRS by differentiating it from PRA and ATN can be achieved by using serum adrenomedullin and urinary TXB2 in acute de-compensated cirrhotic patients. In combination with severe clinical courses, these two markers are useful to select HRS patients who can't be treated.
- Published
- 2017
45. Serum adrenomedullin and urinary thromboxane B
- Author
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Chih-Wei, Liu, Chia-Chang, Huang, Hung-Cheng, Tsai, Yen-Bo, Su, Shiang-Fen, Huang, Kuei-Chuan, Lee, Yun-Cheng, Hsieh, Tzu-Hao, Li, Chang-Youh, Tsai, Lee-Won, Chong, Shuo-Ming, Ou, Ying-Ying, Yang, Wen-Chien, Fan, Ming-Chih, Hou, Han-Chieh, Lin, and Shou-Dong, Lee
- Abstract
Increases in the systemic vasodilator adrenomedullin and the renal vasoconstrictors thromboxane AAcute decompensated cirrhotic patients who had been admitted to hospital were enrolled in this prospective cohort study. Blood and urinary samples were collected immediately after admission. In addition to initially categorizing AKI cases into PRA, acute tubular necrosis (ATN), and HRS groups, their final diagnosis was adjudicated by a nephrologist and a hepatologist who checked the corrected and misclassification rates for significant biomarkers.The cut-off values for serum adrenomedullin and urinary thromboxane BPrompt diagnosis of HRS by differentiating it from PRA and ATN can be achieved by using serum adrenomedullin and urinary TXB
- Published
- 2017
46. Long‐Term Risk of Cardiovascular Events in Patients With Chronic Kidney Disease Who Have Survived Sepsis: A Nationwide Cohort Study
- Author
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Chia Jen Shih, Pei-Wen Chao, Shuo Ming Ou, and Yung Tai Chen
- Subjects
Adult ,Male ,medicine.medical_specialty ,Epidemiology ,Taiwan ,030204 cardiovascular system & hematology ,Risk Assessment ,sepsis ,Sepsis ,cardiovascular events ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Cardiovascular Disease ,Cause of Death ,medicine ,Humans ,In patient ,Survivors ,030212 general & internal medicine ,Renal Insufficiency, Chronic ,Intensive care medicine ,Original Research ,Retrospective Studies ,business.industry ,Incidence ,Middle Aged ,Prognosis ,medicine.disease ,infection ,Survival Rate ,Long term risk ,Cardiovascular Diseases ,Population Surveillance ,Female ,Cardiology and Cardiovascular Medicine ,business ,Cardiovascular outcomes ,chronic kidney disease ,Follow-Up Studies ,Kidney disease ,Cohort study - Abstract
Background Long‐term cardiovascular outcomes after sepsis in patients with chronic kidney disease are not well known. We aimed to examine the risk of subsequent cardiovascular events in patients with chronic kidney disease discharged after hospitalization for sepsis in Taiwan. Methods and Results Using complete claims data for patients with chronic kidney disease from Taiwan's National Health Insurance Research Database, we identified patients with sepsis who survived hospitalization between 2000 and 2010. Each sepsis survivor was propensity score–matched to one nonsepsis hospitalized control patient. Cox regression models were used to estimate the hazard ratios ( HR s) of clinical outcomes, including major adverse cardiovascular events (myocardial infarction and ischemic stroke), hospitalization for heart failure, and all‐cause death. Among 66 961 sepsis survivors, the incidence rates of all‐cause mortality and major adverse cardiovascular events during the study period were 288.51 and 47.05 per 1000 person‐years, respectively. In comparison with matched hospitalized nonsepsis control patients, sepsis survivors had greater risks of major adverse cardiovascular events ( HR , 1.42; 95% CI , 1.37–1.47), myocardial infarction ( HR , 1.39; 95% CI , 1.32–1.47), ischemic stroke ( HR , 1.46; 95% CI , 1.40–1.52), hospitalization for heart failure ( HR , 1.55; 95% CI , 1.51–1.59), and all‐cause mortality ( HR , 1.56; 95% CI , 1.54–1.58). The results remained unchanged in analyses of several subgroups of patients, and were similar in analyses accounting for the competing risk of death. Conclusions Our findings highlight the association of sepsis with a significantly increased long‐term risk of cardiovascular events among survivors in the chronic kidney disease population.
- Published
- 2017
47. Pyogenic liver abscess in end-stage renal disease patients: A nationwide longitudinal study
- Author
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Tzen Wen Chen, Chien-Tsai Liu, Lung Wen Tsai, Chia Jen Shih, Shuo Ming Ou, Tzeng Ji Chen, Pei Wen Chao, Yung Tai Chen, and Szu Yuan Li
- Subjects
Pyogenic liver abscess ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Mortality rate ,Incidence (epidemiology) ,Hazard ratio ,Hematology ,respiratory system ,urologic and male genital diseases ,medicine.disease ,female genital diseases and pregnancy complications ,End stage renal disease ,Surgery ,stomatognathic system ,Nephrology ,Internal medicine ,Cohort ,medicine ,lipids (amino acids, peptides, and proteins) ,Renal replacement therapy ,Hemodialysis ,business - Abstract
End-stage renal disease (ESRD) patients are more prone to infectious disease because of their immunocompromised status. However, the association between pyogenic liver abscess (PLA) and ESRD remains not clear. The aim of our study is to evaluate the incidence, risk factors, and outcomes of PLA in ESRD patients. We recruited all incident ESRD patients from the Taiwan National Health Insurance database from 1998 to 2006. The incidence rate of PLA in ESRD patients was compared with that of a randomly selected non-ESRD control group matched for age, sex gender, Charlson comorbidity score, diabetes mellitus, and cirrhosis. Among the 57,761 incident dialysis patients, there were 538 cases of PLA. The incidence rate of PLA was 18.20 per 10,000 person-years in the ESRD cohort and 6.34 per 10,000 person-years in matched control cohort. The rate of PLA was significantly higher in the ESRD cohort (hazard ratio 3.63, 95% confidence interval 2.83–4.65, P
- Published
- 2014
48. Temperature variation and the incidence of cluster headache periods: A nationwide population study
- Author
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Yung Tai Chen, Y-Jung Lee, Shuo-Ming Ou, Shuu Jiun Wang, Szu-Yuan Li, Chao-Hsiun Tang, and Albert C. Yang
- Subjects
Pediatrics ,medicine.medical_specialty ,business.industry ,Cluster headache ,Incidence (epidemiology) ,General Medicine ,medicine.disease ,Disease cluster ,medicine ,Population study ,Neurology (clinical) ,Variation (astronomy) ,business ,Demography - Abstract
Background Cluster headache (CH) is well known to show a seasonal predilection; however, the impact of temperature and other meteorological factors on cluster periods (or bouts) has not been established. Methods This nationwide survey included 758 patients with episodic CH retrieved from the Taiwan National Health Insurance Research Database from 2005 to 2009. Corresponding meteorological recordings were obtained from the Central Weather Bureau. A case-crossover study design was used to investigate the association between cluster periods and meteorological factors. Results A total of 2452 episodes of cluster periods were recorded. The cluster periods were most frequent in the autumn and least frequent in the winter. Seasonal changes from winter to spring and from autumn to winter also increased the frequency of cluster periods. The risk of cluster periods increased when there was a higher mean temperature on event days (odds ratio (OR), 1.014, 95% confidence interval (CI), 1.005–1.023, p = 0.003) or within seven to 56 days. Either an increase or a decrease in temperature (0.05℃/day) following a warm period (mean temperature ≥26℃) was associated with the onset of cluster periods. In contrast, a greater increase in temperature (0.15℃/day) following a cold period (mean temperature Discussion Our study shows that temperature is associated with precipitating or priming cluster periods. The influence depends on the temperature of the preceding periods.
- Published
- 2014
49. Amiodarone and the risk of cancer
- Author
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Kun Ta Chou, Shuo Ming Ou, Elizabeth Ya Hsuan Lin, Chia Jen Liu, Tzeng Ji Chen, Yu Chin Lee, Yu Wen Hu, Cheng Hwai Tzeng, and Vincent Yi Fong Su
- Subjects
Cancer Research ,medicine.medical_specialty ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,Population ,Hazard ratio ,Cancer ,medicine.disease ,Surgery ,Oncology ,Internal medicine ,Cohort ,medicine ,Skin cancer ,Lung cancer ,education ,business ,Cohort study - Abstract
BACKGROUND: In postmarketing surveillance, the US Food and Drug Administration has reported the development of lung masses, thyroid cancer, and skin cancer after amiodarone therapy. METHODS: Using the Taiwan National Health Insurance Research database, the authors conducted a population-based cohort study. Patients who were treated with amiodarone between 1997 and 2008 were enrolled. Those with antecedent cancer were excluded. Standardized incidence ratios (SIRs) of cancers were calculated to compare the cancer incidence of the study cohort with that of the general population. A multivariate Cox regression model was used to evaluate the association between cumulative defined daily doses (cDDDs) of amiodarone and cancer occurrence. RESULTS: The study included 6418 subjects, with a median follow-up of 2.57 years. A total of 280 patients developed cancer. The risk of cancer increased with borderline significance (SIR, 1.12; 95% confidence interval [95% CI], 0.99-1.26 [P = .067]). Male patients had a higher risk (SIR, 1.18; 95% CI, 1.02-1.36 [P = .022]). The total cohort of patients and the male patients with > 180 cDDDs within the first year were found to have SIRs of 1.28 (95% CI, 1.00-1.61; P = .046) and 1.46 (95% CI, 1.11-1.89; P = .008), respectively. After adjustment for age, sex, and comorbidities, the hazards ratio was 1.98 (95% CI, 1.22-3.22; P = .006) for the high tertile of cDDDs compared with the low tertile. CONCLUSIONS: The results of the current study indicate that amiodarone may be associated with an increased risk of incident cancer, especially in males, with a dose-dependent effect. Cancer 2013;119:1699–1705. © 2013 American Cancer Society.
- Published
- 2013
50. Acute cholecystitis in end-stage renal disease patients: A nation-wide longitudinal study
- Author
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Yung Tai Chen, Tzen Wen Chen, Shuo Ming Ou, Tzeng Ji Chen, Lung Wen Tsai, Pei Wen Chao, and Szu Yuan Li
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Cholecystitis, Acute ,Taiwan ,End stage renal disease ,Cohort Studies ,Risk Factors ,Internal medicine ,medicine ,Humans ,Longitudinal Studies ,Renal replacement therapy ,Risk factor ,Intensive care medicine ,Dialysis ,Aged ,Retrospective Studies ,Hepatology ,business.industry ,Incidence ,Gastroenterology ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Hospitalization ,Renal Replacement Therapy ,Case-Control Studies ,Cohort ,Cholecystitis ,Kidney Failure, Chronic ,Female ,business ,Cohort study - Abstract
The objective of this study was to evaluate the risks of acute cholecystitis among end-stage renal disease patients and compare the incidence between two dialysis modality.In this retrospective cohort study, records of fifty thousand end-stage renal disease patients older than 20 years of age from 1998 to 2007 and an age, gender, Charlson's score, diabetes, and dyslipidemia matched control cohort were retrieved from Taiwan National Health Insurance Research Database. Hospitalizations for acute cholecystitis were retrieved using ICD-9-CM diagnosis codes and ICD-9-CM operation codes from in-patient claims.The incidence rates were 5.8 per 1000 patient-years in the end-stage renal disease patients and 0.92 per 1000 patient-years in the control group. End-stage renal disease was an independent risk factor for acute cholecystitis. In the end-stage renal disease patients, independent risk factors were old age, higher Charlson's score, diabetes, severe liver disease, atrial fibrillation, and haemodialysis (all p0.05). However, the peritoneal dialysis patients had a higher mortality rate after developing acute cholecystitis.Acute cholecystitis is not uncommon in end-stage renal disease patients. The independent risk factors were older age, higher Charlson's score, atrial fibrillation, severe liver disease, diabetes, and dialysis modality. Haemodialysis patients had a higher risk of acute cholecystitis than PD patients.
- Published
- 2013
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