European Journal of Clinical Investigation最新文献

{"title":"Branched-chain amino acids and all-cause mortality in patients with liver cirrhosis, and the onset of diabetes in liver transplant recipients.","authors":"Yakun Li, Mateo Chvatal-Medina, Maria Camila Trillos-Almanza, Margery A Connelly, Han Moshage, Stephan J L Bakker, Vincent E de Meijer, Hans Blokzijl, Robin P F Dullaart","doi":"10.1111/eci.70096","DOIUrl":"https://doi.org/10.1111/eci.70096","url":null,"abstract":"<p><strong>Background and aims: </strong>Branched-chain amino acids (BCAA) have gained increasing recognition for their role in liver disease. This study investigated plasma BCAA alterations in patients with cirrhosis and liver transplant recipients (LTRs) and examined their associations with all-cause mortality and new-onset type 2 diabetes in LTRs.</p><p><strong>Methods: </strong>Plasma BCAA concentrations were measured using nuclear magnetic resonance spectroscopy in 129 patients with cirrhosis and 367 LTRs from the TransplantLines cohort study (NCT03272841), and compared with 4834 participants from the population-based PREVEND cohort. Kaplan-Meier survival analysis and Cox regression analysis were performed.</p><p><strong>Results: </strong>Total BCAA levels were significantly lower in patients with cirrhosis and LTRs than in PREVEND participants (p < .001). While total BCAA levels increased post-transplant, they remained lower than those in PREVEND (p < .001). The highest total BCAA tertile was associated with better survival versus the lowest BCAA tertile in patients with cirrhosis (log-rank p = .002). In Cox regression analysis adjusted for relevant co-variates, higher total BCAA levels were also associated with reduced mortality in patients with cirrhosis (HR .19 [95% CI: .04-.86], p = .031). In LTRs, the highest total BCAA tertile conferred a higher probability of new-onset diabetes (log-rank p = .004) but was not linked to mortality (log-rank p = .65). After adjusting for age, sex, and immunosuppressant use, the highest tertile of total BCAA levels remained independently associated with new-onset diabetes in LTRs (HR 1.42 [95% CI: 1.10-1.82], p = .006).</p><p><strong>Conclusions: </strong>Total BCAA levels increase after liver transplantation. In patients with cirrhosis, higher total BCAA levels are associated with reduced all-cause mortality. Although this association is not evident in LTRs, higher total BCAA levels are strongly linked to an increased risk of new-onset type 2 diabetes, warranting further investigation.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70096"},"PeriodicalIF":4.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher afamin concentrations are associated with higher fatty liver indices: Population-based KORA F4/FF4 study.","authors":"Corinna Niersmann, Anna Zhu, Haifa Maalmi, Xinting Cai, Jana Nano, Wolfgang Rathmann, Wolfgang Koenig, Toshinari Takamura, Barbara Kollerits, Hans Dieplinger, Annette Peters, Michael Roden, Florian Kronenberg, Barbara Thorand, Christian Herder","doi":"10.1111/eci.70095","DOIUrl":"https://doi.org/10.1111/eci.70095","url":null,"abstract":"<p><strong>Background: </strong>Previous studies suggest that afamin is associated with steatotic liver diseases (SLD). However, the exact role of afamin in SLD development and fibrogenesis remains unclear. Potential modifying effects of sex and glucose tolerance status have also not been examined. Therefore, we investigated the associations of afamin with steatotic liver diseases and fibrosis defined by non-invasive tests and assessed for possible effect modifications.</p><p><strong>Methods: </strong>This study included 3080 participants from the population-based KORA F4/FF4 cohort. Cross-sectional and prospective associations (follow-up time 6.5 years) between afamin and NAFLD liver fat score (NAFLD LFS), hepatic steatosis index, fatty liver index and the fibrosis-4 index were assessed using multiple linear regression models. Models were adjusted for age, sex, body mass index, smoking status, alcohol consumption, physical activity, metabolic parameters, medication and subclinical inflammation.</p><p><strong>Results: </strong>In the cross-sectional analysis, afamin concentrations were positively associated with NAFLD LFS (β = .32; 95% CI .27-.37), hepatic steatosis index (β = .33; 95% CI .26-.39) and fatty liver index (β = 1.78; 95% CI 1.47-2.08) (all p < .001), but not with fibrosis-4 index. In the prospective analysis, higher afamin levels were associated with a higher increase only in NAFLD LFS (p < .001). Cross-sectional and prospective associations between afamin and NAFLD LFS were more pronounced in men than in women (p_interaction < .001 and .022; respectively). Cross-sectional associations between afamin and NAFLD LFS were also stronger in individuals with prediabetes or diabetes compared to those with normal glucose tolerance (p_interaction < .001).</p><p><strong>Conclusion: </strong>Higher afamin concentrations are positively associated with NAFLD LFS with potential effect modification by sex and glucose tolerance status.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70095"},"PeriodicalIF":4.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First-line diagnostic tests to intercept primary heart involvement in systemic sclerosis: Clinical associations from the SPRING-SIR registry.","authors":"Antonio Tonutti, Francesca Motta, Rossella De Angelis, Edoardo Cipolletta, Clodoveo Ferri, Gianluigi Bajocchi, Silvia Bellando-Randone, Cosimo Bruni, Martina Orlandi, Giovanni Zanframundo, Rosario Foti, Giovanna Cuomo, Alarico Ariani, Edoardo Rosato, Gemma Lepri, Francesco Girelli, Elisabetta Zanatta, Silvia Laura Bosello, Ilaria Cavazzana, Francesca Ingegnoli, Fabio Cacciapaglia, Giuseppe Murdaca, Giuseppina Abignano, Giorgio Pettiti, Alessandra Della Rossa, Maurizio Caminiti, Anna Maria Iuliano, Giovanni Ciano, Lorenzo Beretta, Gianluca Bagnato, Ennio Lubrano, Ilenia De Andres, Luca Idolazzi, Marta Saracco, Cecilia Agnes, Corrado Campochiaro, Marco Fornaro, Federica Lumetti, Amelia Spinella, Luca Magnani, Giacomo De Luca, Veronica Codullo, Elisa Visalli, Carlo Iandoli, Antonietta Gigante, Greta Pellegrino, Erika Pigatto, Maria Grazia Lazzaroni, Enrico De Lorenzis, Gianna Mennillo, Marco Di Battista, Giuseppa Pagano-Mariano, Federica Furini, Licia Vultaggio, Simone Parisi, Clara Lisa Peroni, Gerolamo Bianchi, Enrico Fusaro, Gian Domenico Sebastiani, Marcello Govoni, Salvatore D'Angelo, Franco Cozzi, Franco Franceschini, Serena Guiducci, Lorenzo Dagna, Andrea Doria, Dilia Giuggioli, Valeria Riccieri, Carlo Salvarani, Florenzo Iannone, Marco Matucci-Cerinic, Carlo Selmi, Maria De Santis","doi":"10.1111/eci.70094","DOIUrl":"https://doi.org/10.1111/eci.70094","url":null,"abstract":"<p><strong>Introduction: </strong>Primary heart involvement (pHI) is an overlooked and poorly characterised complication of systemic sclerosis (SSc), associated with the risk of heart failure, arrhythmia and death. Despite consensus definition by the World Scleroderma Foundation/Heart Failure Association (WSF/HFA), diagnostic criteria and risk factors remain poorly elucidated.</p><p><strong>Methods: </strong>Out of 1922 patients in the Italian national SPRING registry, we excluded those with potentially confounding conditions according to WSF/HFA, and those with incomplete ECG or echocardiographic assessment, resulting in 600 subjects with clearly defined parameters to intercept SSc-pHI. Cross-sectional and longitudinal analyses were performed to identify factors associated with pHI.</p><p><strong>Results: </strong>ECG and/or echocardiographic signs of SSc-pHI were identified in 25% of patients at enrollment and were associated with older age (OR 1.04; 95% CI 1.02-1.06), diffuse cutaneous SSc (OR 1.85; 95% CI 1.05-3.26) and intestinal symptoms (OR 1.79; 95% CI 1.03-3.08). Diastolic dysfunction (62%) and conduction disturbances (34%) were the most frequent phenotypes, while diffuse hypokinesia with reduced ejection fraction was the least common (3%). During follow-up, new-onset signs of pHI were observed in an additional 25% of patients, particularly in those with skeletal muscle involvement (HR 2.83; 95% CI 1.01-7.73).</p><p><strong>Conclusions: </strong>pHI is a severe complication potentially affecting one-quarter of patients with SSc. Early detection is crucial, particularly in those with diffuse skin fibrosis, muscular involvement and intestinal manifestations.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70094"},"PeriodicalIF":4.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144559601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated factor VIIa-antithrombin complexes are associated with stroke or cardiovascular death in patients with atrial fibrillation.","authors":"Elżbieta Szczygieł-Pilut, Michał Błaż, Elżbieta Pociask, Elżbieta Paszek, Anetta Undas","doi":"10.1111/eci.70091","DOIUrl":"https://doi.org/10.1111/eci.70091","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is associated with a prothrombotic state. We investigated whether factor VIIa-antithrombin (FVIIa-AT) complexes, a marker of tissue factor (TF) exposure, are associated with thromboembolic events in AF.</p><p><strong>Methods: </strong>In 224 nonvalvular AF patients (66% men, median age 69 years, median CHA₂DS₂VASc score 4), 71% on direct oral anticoagulants, we measured FVIIa-AT complexes, along with endogenous thrombin potential (ETP), von Willebrand factor (VWF) and 8-isoprostane, reflecting oxidative stress. During a median follow-up of 53 [interquartile range, IQR 47-57] months, we recorded a composite endpoint: ischemic stroke, systemic thromboembolism or cardiovascular (CV) death.</p><p><strong>Results: </strong>FVIIa-AT complexes (median 145 [IQR 125-170] pM) were higher in patients with permanent AF (p < .001), vascular disease (p = .02), previous stroke (p < .001) and smoking (p = .006) as compared with patients without these comorbidities. FVIIa-AT correlated with NT-proBNP (r = .15, p = .022) and ETP (r = .25, p < .001). During follow-up, the composite endpoint was recorded in 30 patients (13.4%, 3.0% per year) including 20 with ischemic stroke (8.9%, 2.0% per year, respectively). Patients with the composite endpoint had 29.2% higher baseline FVIIa-AT complexes compared with the remainder. Patients with FVIIa-AT complexes in the top quartile (>170 pM) had an increased risk of the composite endpoint (HR 12.0, 95% CI 5.2-28.0, p < .0001). FVIIa-AT complexes, along with VWF, remained independently associated with the composite endpoint.</p><p><strong>Conclusions: </strong>This study is the first to show that high plasma FVIIa-AT complexes are independently associated with thromboembolic events or CV death in AF, suggesting the need for more potent anticoagulation to suppress the residual TF-mediated coagulation.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70091"},"PeriodicalIF":4.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incretin system and glucagon secretion in patients with chronic pancreatitis.","authors":"Gea Ciccarelli, Gianfranco Di Giuseppe, Giulia Gliozzo, Laura Soldovieri, Giuseppe Quero, Enrico Celestino Nista, Michela Brunetti, Francesca Cinti, Sara Sofia De Lucia, Bolette Hartmann, Andrea Mari, Antonio Gasbarrini, Sergio Alfieri, Alfredo Pontecorvi, Jens Juul Holst, Andrea Giaccari, Teresa Mezza","doi":"10.1111/eci.70093","DOIUrl":"https://doi.org/10.1111/eci.70093","url":null,"abstract":"<p><strong>Background: </strong>Diabetes of the exocrine pancreas (DEP) is an underdiagnosed form of diabetes, prevalently caused by acute and chronic pancreatitis (CP). The contribution of incretin system dysfunction and the role of glucagon levels in the pathogenesis of DEP remain unclear. The aim of our study is to assess the secretion of glucagon like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP) and glucagon, along with the incretin effect, in individuals with and without CP. By comparing these parameters within the same glucose tolerance class, we seek to elucidate specific hormonal alterations that characterize DEP.</p><p><strong>Methods: </strong>To pursue this aim, we conducted a cross-sectional study on 32 patients with chronic pancreatitis (wCP) and 60 patients without chronic pancreatitis (w/oCP), who were administered an oral glucose tolerance test, a hyperglycemic clamp and a mixed meal test with measurement of glucose, insulin, C-peptide, GLP-1, GIP and glucagon.</p><p><strong>Results: </strong>The comparison between individuals wCP and w/oCP showed worse beta-cell function and lower incretin effect for the former, but incretin and glucagon levels were similar. Diabetes prevalence was higher in the group wCP than in the group w/oCP (56% vs. 33%). Thus, to evaluate the differences determined by CP, we found it necessary to stratify individuals according to glucose tolerance class. After stratification, we found that both groups had similar beta-cell function, incretin effect and incretin and glucagon secretion.</p><p><strong>Conclusions: </strong>Therefore, incretin and glucagon levels and the incretin effect varied according to glucose tolerance, not the presence or absence of CP. Similar defects in incretin secretion and effects are responsible for diabetes development in individuals wCP and w/oCP.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70093"},"PeriodicalIF":4.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced mitochondrial respiration in peripheral blood mononuclear cells (PBMCs) from young children with overweight/obesity and insulin resistance.","authors":"Eugenia Carvalho, Reid D Landes, Matthew Cotter, Leanna M Delhey, Elisabet Børsheim, Shannon Rose","doi":"10.1111/eci.70090","DOIUrl":"https://doi.org/10.1111/eci.70090","url":null,"abstract":"<p><strong>Background: </strong>Studies implicating dysfunctional mitochondrial respiration in metabolic tissues in the development of insulin resistance in obesity have only included adults. Peripheral blood mononuclear cells (PBMCs) and platelets have been found to reflect systemic mitochondrial fitness and bioenergetic health. We sought to identify bioenergetic differences in PBMCs and platelets from children with obesity and insulin resistance and determine associations with whole-body metabolism and/or biomarkers of metabolic health and inflammation.</p><p><strong>Methods: </strong>We stratified prepubertal children (ages 5-10 years) into three groups: normal weight insulin sensitive (N-IS; n = 20), overweight/obese insulin sensitive (O-IS; n = 28) and overweight/obese insulin resistant (O-IR; n = 17). We measured oxygen consumption rate and proton efflux rate in PBMCs and platelets. We estimated whole-body resting metabolic rate by bioimpedance and dietary fatty acid oxidation by oral deuterated palmitate and quantifying recovery of D₂O in urine. We used ANOVA for comparisons among groups and Spearman correlations for associations between circulating cell bioenergetics and whole-body metabolism and biomarkers.</p><p><strong>Results: </strong>O-IS and O-IR PBMCs exhibited increased maximal mitochondrial respiration and spare respiratory capacity compared to N-IS. Bioenergetics shifted towards glycolysis in O-IS PBMCs as compared to both N-IS and O-IR PBMCs. In platelets, glycolysis and ATP production rates were decreased in O-IR compared to O-IS children. PBMC respiration positively correlated with BMIz, HOMA-IR and fasting glucose and insulin, but negatively correlated with inflammatory cytokines. Dietary fatty acid oxidation was higher in O-IS compared to N-IS children and positively correlated with PBMC spare respiratory capacity. Resting metabolic rate correlated positively with several parameters of PBMC mitochondrial respiration.</p><p><strong>Conclusions: </strong>PBMCs from young children with overweight/obesity exhibit adaptations to the metabolic stressors associated with insulin resistance, and PBMC metabolism correlates well with whole-body metabolism.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70090"},"PeriodicalIF":4.4,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoimmunity in MASLD: Focus on autoantibodies, anti-apolipoprotein A1 IgG and G protein-coupled receptors.","authors":"Sabrina Pagano, Emmanuel Somm, François R Jornayvaz, Nicolas Vuilleumier","doi":"10.1111/eci.70092","DOIUrl":"https://doi.org/10.1111/eci.70092","url":null,"abstract":"<p><strong>Background: </strong>The increasing prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), represents a significant public health concern, as it is closely linked to rising obesity rates and metabolic syndrome, affecting approximately 30% of the global population. In addition, MASLD, along with its more severe form, metabolic dysfunction-associated steatohepatitis (MASH), increases the risk of cardio-metabolic diseases and hepatocellular carcinoma. In recent years, multiple G-protein-coupled receptors (GPCRs) have been identified as potential therapeutic targets for these disorders. Additionally, autoimmunity is believed to potentially play a role in the development of mechanisms contributing to the pathogenesis of MASLD/MASH. This narrative review examines the diverse autoantibodies associated with the disease, with a particular emphasis on antibodies targeting apolipoprotein A-1 (AAA-1) and their relationship with anti-GPCRs antibodies.</p><p><strong>Results: </strong>Several autoantibodies have been identified in up to 30% of individuals with MASLD/MASH, both with and without concomitant autoimmune diseases. Among the anti-GPCR autoantibodies identified in MASLD to date are those targeting the angiotensin II type 1 receptor and the endothelin-1 type A receptor. While the contribution of this class of autoantibodies to MASLD/NASH remains unclear, AAA-1 appears to be pathogenic, acting as pro-steatotic and pro-inflammatory mediators. Additionally, current data suggest shared functional responses between anti-GPCR antibodies and AAA1 in cell-based assays used to detect anti-GPCR presence.</p><p><strong>Conclusion: </strong>A better understanding of the role of humoral autoimmunity and the interactions among its various components in the metabolic dysfunction underlying MASLD/MASH has the potential to open new perspectives for early detection and therapeutic interventions.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70092"},"PeriodicalIF":4.4,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating gender medicine into modern healthcare: Progress and barriers.","authors":"Rubén Fuentes Artiles, Caroline E Gebhard, Catherine Gebhard","doi":"10.1111/eci.70089","DOIUrl":"https://doi.org/10.1111/eci.70089","url":null,"abstract":"<p><strong>Background: </strong>Sex and gender are fundamental determinants of health, influencing disease risk, diagnosis, treatment, and outcomes across medical disciplines. While sex refers to biological characteristics, gender encompasses sociocultural dimensions, including behaviours and identities.</p><p><strong>Results: </strong>The field of gender medicine has evolved significantly from its roots in the women's health movement of the 1960s and 1970s, which initially sought to address reproductive rights and the systematic exclusion of women from clinical research. Over time, the focus has expanded to recognize sex- and gender-based differences in all populations, including men and gender-diverse individuals. Despite progress, persistent challenges remain. Many clinical guidelines inadequately incorporate sex and gender considerations, and women continue to be underrepresented in clinical trials, resulting in suboptimal efficacy and a higher incidence of adverse effects in women. Recent initiatives, including government-funded research programs, specialized gender medicine professorships and regulatory measures promoting equitable clinical trial participation, represent positive steps forward. However, a systematic, interdisciplinary approach is required to fully integrate gender-sensitive medicine into research, education and clinical practice. This narrative review explores the historical development of gender medicine, current advancements and remaining challenges. We highlight the need for improved research methodologies, policy changes and targeted interventions to ensure equitable healthcare. A structured action plan emphasizing regulatory support, education, industry involvement and public awareness is essential to accelerate the field's integration.</p><p><strong>Conclusion: </strong>Recognising and addressing sex- and gender-sensitive health differences will lead to more personalised and effective medical care, ultimately improving health outcomes for all individuals.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70089"},"PeriodicalIF":4.4,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cross-lagged analysis of the relationship between quality of life and kidney function in CKD patients.","authors":"Graziella D'Arrigo, Mercedes Gori, Carmela Marino, Patrizia Pizzini, Graziella Caridi, Francesco Marino, Giovanna Parlongo, Annalisa Pitino, Giovanni S F Bruno, Giovanni Tripepi, Francesca Mallamaci, Carmine Zoccali","doi":"10.1111/eci.70087","DOIUrl":"https://doi.org/10.1111/eci.70087","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) significantly impacts patient well-being, with declining glomerular filtration rate (eGFR) often leading to worsening quality of life (QoL). However, the directionality of the eGFR-QoL relationship remains unclear due to limitations of prior cross-sectional and longitudinal studies.</p><p><strong>Methods: </strong>This study applied cross-lagged analysis to investigate the reciprocal relationship between eGFR and QoL (measured using SF-36 Physical and Mental Component Scores [PCS and MCS]) over 36 months in 422 CKD patients recruited from nephrology units in Southern Italy. Generalized Method of Moments (GMM) models tested two hypotheses: (1) PCS as a determinant of MCS, or vice versa; and (2) eGFR as a determinant of MCS/PCS, or vice versa.</p><p><strong>Results: </strong>Cross-lagged analysis confirmed that lower eGFR significantly predicted declines in both PCS and MCS in subsequent visits (p < .05). At the same time, the reverse relationship (QoL affecting eGFR) was not statistically significant. Multivariable models, adjusting for potential confounders including demographic factors, comorbidities, and socioeconomic status, confirmed these findings.</p><p><strong>Conclusion: </strong>Kidney function decline leads to worsening QoL, whereas deterioration in QoL does not impact eGFR decline. These findings support prioritising interventions that slow the progression of CKD as a means to preserve quality of life. This study highlights the utility of cross-lagged analysis in nephrology research and underscores the importance of early chronic kidney disease (CKD) management to maintain patient well-being.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70087"},"PeriodicalIF":4.4,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical associations and prognosis in Asian and European patients with symptom-controlled atrial fibrillation: Insights from two prospective registries in Europe and Asia.","authors":"Wee Siong Teo, Manlin Zhao, Tommaso Bucci, Steven Ho Man Lam, Hongyu Liu, Yang Chen, Giuseppe Boriani, Hung-Fat Tse, Tze-Fan Chao, Gregory Y H Lip","doi":"10.1111/eci.70086","DOIUrl":"https://doi.org/10.1111/eci.70086","url":null,"abstract":"<p><strong>Background: </strong>Clinical associations and prognosis of patients with symptom-controlled AF (scAF) remain poorly understood.</p><p><strong>Methods: </strong>We analysed data from the Asian-Pacific Heart Rhythm Society and EURObservational Research Programme registries. Based on the European Heart Rhythm Association (EHRA) score, patients were classified as scAF (EHRA I or II) or symptomatic AF (EHRA III or IV). Clinical characteristics were examined by logistic regression, and prognosis was assessed by Cox models. The primary outcome was composed of all-cause death and major cardiovascular events. Interaction analyses were performed to investigate ethnic differences.</p><p><strong>Results: </strong>Among 13,577 AF patients (mean age 69.0 ± 11.6 years; 38.7% female), 11,470 (84.5%) had scAF. Asians were more likely to be scAF, characterised by younger age and lower cardiovascular burden compared to Europeans. Diabetes mellitus was significantly associated with scAF only in Asians (adjusted odd ratio [aOR] 1.43, 95% confidence interval [CI] 1.03-2.04, p_interaction = 0.021). The associations with hypertension (aOR 1.29, 95% CI 0.98-1.70, p_interaction = 0.004) and prior ischemic stroke (aOR 1.75, 95% CI 0.96-3.58, p_interaction = 0.045) were more evident in Asians. Patients with scAF showed a notable association with increased likelihood of using vitamin K antagonists (aOR 1.19, 95% CI 1.07-1.33), which was more prominent in Asians. In both Asians and Europeans, scAF was associated with reduced rhythm control management. Compared to non-scAF, European patients with scAF had a reduced risk of the composite outcome, but the association was non-significant in Asians (p_interaction = 0.594).</p><p><strong>Conclusion: </strong>Asians and Europeans with scAF demonstrate clinically relevant differences in terms of overall prevalence, related risk factors, and clinical management.</p>","PeriodicalId":12013,"journal":{"name":"European Journal of Clinical Investigation","volume":" ","pages":"e70086"},"PeriodicalIF":4.4,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}