Search

Background: It was studied if early suPAR-guided anakinra treatment can prevent severe respiratory failure (SRF) of COVID-19. Methods: A total of 130 patients with suPAR ≥6 ng/ml were assigned to subcutaneous anakinra 100 mg once daily for 10 days. Primary outcome was SRF incidence by day 14 defined as any respiratory ratio below 150 mmHg necessitating mechanical or non-invasive ventilation. Main secondary outcomes were 30-day mortality and inflammatory mediators; 28-day WHO-CPS was explored. Propensity-matched standard-of care comparators were studied. Results: 22.3% with anakinra treatment and 59.2% comparators (hazard ratio, 0.30; 95% CI, 0.20–0.46) progressed into SRF; 30-day mortality was 11.5% and 22.3% respectively (hazard ratio 0.49; 95% CI 0.25–0.97). Anakinra was associated with decrease in circulating interleukin (IL)−6, sCD163 and sIL2-R; IL-10/IL-6 ratio on day 7 was inversely associated with SOFA score; patients were allocated to less severe WHO-CPS strata. Conclusions: Early suPAR-guided anakinra decreased SRF and restored the pro-/anti-inflammatory balance. Funding: This study was funded by the Hellenic Institute for the Study of Sepsis, Technomar Shipping Inc, Swedish Orphan Biovitrum, and the Horizon 2020 Framework Programme. Clinical trial number: NCT04357366.

Carotid‐femoral pulse wave velocity (cfPWV) is the gold standard method for assessing arterial stiffness. This study evaluated automated brachial‐ankle PWV (baPWV) taken by a professional oscillometric blood pressure monitor (Microlife WatchBP Office Vascular) versus reference cfPWV (Complior device). Subjects recruited from a hypertension outpatient clinic had duplicate baPWV and cfPWV measurements (randomized crossover design) and carotid ultrasonography. Of 102 subjects recruited, 101 had valid baPWV measurements. Four subjects were excluded and 97 were analyzed (age 58.3 ± 11.4 years, men 70%, hypertensives 76%, diabetics 17%, cardiovascular disease 10%, smokers 23%). The mean difference between baPWV (13.1 ± 1.8 m/s) and cfPWV (9.1 ± 1.8 m/s) was 4.0 ± 1.4 m/s (P <.01) with close association between them (r = 0.70, P <.01). baPWV and cfPWV were correlated with age (r 0.54/0.49 respectively), systolic blood pressure (0.45/0.50), carotid intima‐media thickness (0.31/0.44), and carotid distensibility coefficient (−0.47/−0.34) (all P <.05; no difference between the two methods, z test). There was reasonable agreement (77%) between the two methods in identifying subjects at the top quartile of their distributions (kappa 0.39, P <.01). The areas under the receiver operating characteristic curves for the identification of carotid plaques were comparable for cfPWV and baPWV (0.79 and 0.74 respectively, P = NS). Automated baPWV measurement by a professional oscillometric blood pressure monitor is feasible and observer‐independent. baPWV values differ from those by cfPWV, yet they are closely correlated, have reasonable agreement in detecting increased arterial stiffness and give similar associations with carotid stiffness and atherosclerosis. [ABSTRACT FROM AUTHOR]

Blood pressure (BP) monitors equipped with atrial fibrillation (AF) detection algorithm are attractive screening tools for AF in elderly hypertensives. This study assessed the diagnostic accuracy of a novel cuffless pocket-size self-BP monitor (Freescan, Maisense) equipped with an AF detection algorithm, which displays results for the detection of "AF" or "Arrhythmia" during routine BP measurement. Subjects aged >65 years or 60-65 years with hypertension, diabetes, or cardiovascular disease were subjected to BP measurements using the Freescan device with simultaneous continuous Holter electrocardiography (ECG) monitoring. Readings with device notification "Instability" (29%) or "Error" (20%) were discarded. Data from 136 subjects with five valid Freescan BP measurements were analyzed (age 73.8 ± 7.1 years, males 63%, treated hypertensives 88%, AF in ECG 21%). Analysis of 680 Freescan readings vs ECG revealed specificity 99%, sensitivity 67%, and diagnostic accuracy 93% for AF diagnosis. When the "Arrhythmia" notification was considered as AF diagnosis, the sensitivity was improved (93%, 96%, and 93%, respectively). Analysis of AF diagnosis in subjects (diagnosis defined as at least three of five readings indicating "AF" or "Arrhythmia") revealed specificity, sensitivity, and diagnostic accuracy for AF detection at 94%, 100%, and 95%, respectively. These data suggest that the Freescan cuffless device could be used as a useful screening tool for AF detection during routine self-measurement of BP in the elderly. [ABSTRACT FROM AUTHOR]

There is increasing interest in unattended automated office blood pressure (OBP) measurement, which gives lower blood pressure values than the conventional auscultatory OBP. Whether unattended automated OBP differs from standardized attended automated OBP performed using the same device and measurement protocol remains uncertain. A systematic review and meta-analysis of studies (aggregate data) comparing unattended vs attended automated OBP using the same device and measurement protocol (conditions, number of measurements, visits) was performed. Ten eligible studies (n = 1004, weighted age 60.8 ± 4.2 [SD] years, 55% males) were analyzed. Unattended OBP (pooled systolic/diastolic 133.9 [95% CI: 129.7, 138]/80.6 [95% CI: 77, 84.2] mm Hg) did not differ from attended OBP (135.3 [95% CI: 130.9, 139.6]/81 [95% CI: 77.6, 84.3] mm Hg); pooled systolic OBP difference -1.3, 95% CI: -4.3, 1.7 mm Hg and diastolic -0.4, 95% CI: -1.2, 0.3 mm Hg. Nine of ten studies achieved high quality score and no publication bias was identified. Meta-regression analysis did not reveal any effect of age, gender, or attended systolic OBP on the unattended-attended systolic OBP difference (P = NS for all). However, there was a trend toward higher attended than unattended OBP at higher OBP levels. These data suggest that, when the same device and measurement protocol are used, attended automated OBP provides similar blood pressure values as unattended automated OBP. Although unattended automated OBP is theoretically advantageous as it ensures that standardized conditions and measurement protocol are used, attended automated OBP, if carefully performed, appears to be a reasonable and practical alternative. [ABSTRACT FROM AUTHOR]