Welcome to the ECIM 2021 Virtual Congress Programme Scheduling

Background and Aims

Hip fractures have a mortality rate of 20% in the year following the fracture. Therefore, patients presenting with hip fractures should be assessed and prescribed anti-resorptive bone protective therapy (ABPT) to reduce the risk of further fractures. In our institution, this decision is undertaken by specialists only.

The aim of this study is to compare the proportion of patients commenced on ABPT by surgical interns following the introduction of a Clinical Decision Support System (CDSS) in January 2020 to support appropriate ABPT prescribing amongst non-specialists.

Methods

The study compares the orthogeriatric patient cohort before and after CDSS introduction within the same time period (Jan 1st to June 30th) in 2019 and 2020. Data were extracted from the Irish Hip Fracture Database and statistically analyzed using SPSS. The Mann-Whitney two-tailed test was employed to calculate statistical significance.

Results

In 2019, 31% (55/178) of patients admitted during the study period (n=178) did not receive orthogeriatric specialist input and only 27% (15/55) of these had ABPT prescribed during their admission. In 2020, 17% (32/185) of patients admitted (n=185) did not receive specialist input; however, 44% (14/32) of these were commenced on ABPT. Overall, more patients were prescribed ABPT in 2020 (78%;146/185) as compared to 55% (98/178) in 2019 (z-score 6.57069; p-value <0.01). The number of patients awaiting specialist outpatient appointments before being prescribed ABPT also dropped from 40% (71/178) in 2019 to 13% (24/185) in 2020 (p-value <0.01).

Conclusions

A CDSS improves ABPT prescribing and reduces specialist appointments. This could reduce long-term mortality rates and future healthcare costs.

Background and Aims

No definitive molecular associations have been described that could explain the difference in outcomes after endovascular treatment in diabetic patients with peripheral artery disease (PAD) and chronic limb-threatening ischemia (CLTI).

This study describes the relationship between the level of the major cytokines involved in diabetic atherosclerosis and the correlation of inflammatory biomarkers at baseline with outcomes after endovascular procedures in diabetic patients with PAD and CLTI. In particular, we studied the TNF-a, IL-6, CRP and osteoprotegerin (OPG) levels.

Methods

We evaluated the relationship between the levels of the major cytokines associated with diabetic atherosclerosis and the outcomes after endovascular procedures in diabetic patients with PAD and CLTI.

Results

299 patients with below-the-knee occlusive disease undergoing an angioplasty procedure were enrolled. The levels of key cytokines, osteoprotegerin (OPG), tumor necrosis factor-a (TNF-a), interleukin-6 (IL-6) and C-reactive protein (CRP), were measured and Major Adverse Limb Events (MALE) and Major Adverse Cardiovascular Events (MACE) were assessed at 1, 3, 6 and 12 months post procedure.

There was a linear trend from lowest to highest quartile for each cytokine at baseline and incident MALE. A linear association between increasing levels of each cytokine and incident MACE was also observed. Receiver operating characteristics (ROC) models were constructed using clinical and laboratory risk factors and the inclusion of cytokines significantly improved the prediction of incident events.

Conclusions

We demonstrated that elevated OPG, TNF-a, IL-6 and CRP levels at baseline correlate with worse vascular outcomes in diabetic patients with PAD and CLTI undergoing an endovascular procedure.

Background and Aims

Decompensated heart failure is a common cause of admission to Internal Medicine ward. Urea-creatinine ratio (U/C) and low natremia (Na) previously showed prognostic value in this context. This study aims to assess the impact of both predictors on the hospitalization outcome.

Methods

We retrospectively studied all cases of decompensated heart failure admitted to an Internal Medicine ward during an one year period. Urea-creatinine and Na measures at the hospital admission were recorded. We selected all cause in-hospital death as the primary outcome. The sample was divided in 4 groups: A) U/C < 60 and Na ≥135 mEq/L, B) U/C < 60 and Na < 135 mEq/L, C) U/C ≥ 60 and Na ≥ 135 mEq/L D) U/C ≥ 60 and Na < 135 mEq/L. We performed a multivariate analysis of the predictors using logistic regression.

Results

The study included 271 patients (96 men and 175 women), with a mean age of 79.2 years. Sixty seven (24.7%) patients had U/C ≥ 60. Ninety one (33.6%) had Na < 135 mEq/L. The overall in-hospital mortality was 11.8%. There were differences across the groups (A: 4.4%, B: 14.9%, C: 20.9%, D: 29.2%, p < 0.001). The two markers independently predicted this outcome (U/C > 60: odds ratio 3.7, p=0.001 Na < 135 mEq/L: odds ratio 2.5, p=0.017).

Conclusions

Urea-creatinine ratio and hyponatremia are simple biomarkers that predict increased mortality for decompensated heart failure hospitalizations. These markers could be useful in clinical practice and should be the object of further research.

Background and Aims

Background: In patients with chronic hepatitis C (CHC), presence of steatosis before and after sustained virological response (SVR) has been demonstrated and linked to metabolic alterations. Aim: to define the impact of post SVR steatosis on fibrosis improvement evaluated by Fibroscan in CHC patients after viral eradication.

Methods

Methods: 794 patients with CHC achieving SVR were enrolled in 2 Italian Liver Units. Data were collected the day of DAAs starting and six months after SVR. Fibroscan diagnosed steatosis (by controlled attenuation parameter (CAP) ≥ 248 dB/m) and fibrosis (by liver stiffness measurement LSM).

Results

Results: Mean age was 64±16 ys, 50% males, genotype 3 in 7%. Patients with baseline steatosis (365, 46%) presented significantly higher baseline LSM values compared to their counterpart (10.6±7.8 vs 9.4±7.4 kPa; p=0.04). After SVR, steatosis (CAP ≥ 248 dB/m) developed in 125 out of 429 (29%) without steatosis at enrollment, whereas persisted in 243 (66%) of patients with baseline steatosis. LSM significantly reduced after SVR (10±7.6 vs 8.2±7.2 kPa, p<0.001), even in presence of hepatic steatosis post SVR (10.3±7.3 vs 8.2±6.6 kPa; p<0.001). However, when the analysis was differentiated between patients with persistence and new onset steatosis, a significantly reduction of LSM in patients with persistence (10.8±7.8 vs 8.0±5.7 kPa, p<0.001) but not in those with new onset steatosis (9.4±6.4 vs 8.7±8.0 kPa, p=0.12) was confirmed.

Conclusions

Conclusion: New onset steatosis but not persistence of baseline steatosis prevents fibrosis improvement after SVR, possibly suggesting the presence of two different type of post SVR steatosis.

Background and Aims

Chronic HCV infection causes liver and cardiovascular damage. A procoagulant imbalance has been reported in patients with chronic hepatitis C (CHC) and has been found to be associated with the severity of liver fibrosis. Aim: to evaluate whether the eradication of HCV by Direct-acting antiviral agents (DAAs) leads to a modification of procoagulant imbalance and whether this is related to a reduction of liver damage.

Methods

From 2017 to 2019, 70 patients with CHC (mean age 58.9 + 10.5 years) without cirrhosis were enrolled. Anthropometric, clinical and biochemical parameters, cardiovascular damage by intima-media thickness, (IMT) and E/A ratio, liver fibrosis by Liver stiffness measurement (LSM) and coagulation parameters through the evaluation of endogenous thrombin potential (ETP) with/without thrombomodulin, and antithrombin and protein C (PC) – factor VIII ratio, were determined at enrollment and at 6 and 12 months after sustained viral response (SVR.

Results

At enrolment indexes of procoagulant imbalance were significantly higher in patients with CHC than in controls of general population (FVIII/PC ratio 1.7+0.7 vs 1.1+0.3; ETP ratio 0.8+0.1 vs 0.6+0.2, p<0.0001). Compared to baseline, coagulation (FVIII/PC 1.8±0.8 vs 1.3±0.5, p<0.0001) and liver fibrosis (LMS 6.4±4.8 vs 5.2±1.7 kPa,p=0.03) parameters significantly improved at 6 months after SVR, while these parameters remained stable at 12 months. No modification of IMT and E/A ratio was observed after SVR.

Conclusions

After HCV eradication by DAAs, both procoagulant imbalance and liver fibrosis improve, strengthening the direct link between coagulation alteration and HCV virus, while changes in carotid atherosclerosis may require longer follow-up to be highlighted.

Background and Aims

The aim of the study is to estimate the effectiveness of the distance monitoring of blood pressure (BP) in patients with arterial hypertension (AH).

Methods

1121 patients with AH (SBP – systolic 151.4 ± 9.1, DBP -diastolic 96.9 ± 10.3) are included in the pilot project, of which 37% are men. The average age was 52.0 ± 12.0. The patients independently measured BP twice a day and entered the SBP and DBP results on self-control diaries in electronic form, or transmitted data from the tonometer via the installed mobile application.

Results

a survey of patients with AH showed that before the study, only 15.2% (171 people) carried out regular monitoring of BP. Reached by the results of 6 months, the average level of SBP and DBP were 135.5 ± 10.1 and 85.8 ± 6.3 mm Hg respectively. During the implementation of the pilot project, the proportion of people who achieved target BP values ​​by 2.6 times increased, which occurred against the background of an increase of 1.7 times the frequency of prescribing two-component antihypertensive therapy, 1.9 times - a three-component one.

Conclusions

The use of up-to-dates methods of remote control of BP with BP monitors with the function of remote data transmission contributes to an increase in the frequency of prescribing combined antihypertensive therapy, which was accompanied by an increase in the proportion of patients who have reached target BP and reduced burden on emergency medical teams.

Background and Aims

This study investigates the relationship between non-alcoholic fatty liver disease (NAFLD) and subclinical coronary artery disease (as measured by Coronary Artery Calcium Score (CACS)) in a healthy Asian population.

Methods

The SingHEART population consists of healthy subjects aged 21-69 years without prior cardiovascular disease or diabetes. CAC was detected using an electron beam CT scanner, scored using the Agatston method, and further stratified into CACS >0, >10, and >100. Hepatic steatosis was simultaneously diagnosed by radiologists from the CT-slices. NAFLD was defined as the presence of hepatic steatosis in the absence of alcoholic consumption > 20g/day.

Results

Of 663 subjects, the overall prevalence of NAFLD was 8.30%. 194 (29.4%) subjects demonstrated coronary artery calcification (CACS> 0), amongst which 147 (22.2%) had CACS>10, and 60 (9.04%) had CACS>100. Participants with NAFLD were more likely to have CACS>0 (p=0.014) and >10 (p=0.003). After multivariable adjustment, the association between NAFLD and CACS>0 was attenuated, however NAFLD was still significantly associated with CACS>10 (Odds Ratio [95% CI]: 2.19 [1.01-4.76]).

Conclusions

NAFLD is not uncommon even in lower risk, healthy populations and is associated with at least mild subclinical coronary atherosclerosis. This highlights a subset who may benefit from preventative strategies to mitigate progression to known cardiovascular disease.

Background and Aims

It is well-established that oral gluten challenge of treated CeD patients induces a flux of gluten-specific T cells into peripheral blood. However, the activation profile of these cells remains uncertain. We investigated the transcriptome and phenotype of such cells following gluten challenge to identify a read-out for antigen-specific responses.

Methods

Treated CeD patients underwent a 3-day gluten challenge. Blood was sampled on day 6 after challenge. PBMCs were stained with HLA-DQ:gluten-tetramers (tet). Tet⁺ and tet^- gut-homing (integrin β7⁺) effector-memory T (T_EM) cells were sorted on day 6 for bulk RNA-sequencing. Tet⁺ cells were analysed by a mass cytometry staining panel designed based on differentially expressed (DE) genes coding for cell surface markers.

Results

We observed a clear increase in gut-homing gluten-specific effector-memory T cells in blood 6 days after initiation of gluten challenge in all participants (4 vs. 53 tet⁺ integrin β7⁺ T_EM / 10⁶ CD4⁺ cells) and detected over 3000 DE protein coding genes, among them 94 DE genes coding for cell surface markers after gluten challenge. The markers selected for mass spectrometry correlated well with RNA levels except for CD47, CD52, CD103 and CD314 (NKG2D).

Conclusions

Transcriptome analysis from gut-homing, gluten-specific CD4⁺ T cells in blood after gluten re-exposure revealed 94 DE genes coding for cell surface markers. Based on the phenotypical similarity with gluten-specific T cells from the intestine and formation of a distinct cell cluster, gluten-specific T cells from blood after gluten challenge may serve as an alternative outcome measure in clinical drug trials.