bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unveiling the influence of hyponatremia on morbidity, mortality, and resource utilization in colorectal carcinoma: Insights from a 5-year nationwide study.
Authors: Hotwani Priya , Kumar Vikash , Vachhani Bhavyakumar , Gaddam Mrunanjali , Jayakumar Jayalekshmi , Ginjupalli Manasa , Sanghvi Ankushi , Nanavaty Dhairya , Clement Jincy 
Published: June 2024

e15657 Background: Historically, Hyponatremia has been associated with higher mortality rates and longer hospital stays in patients with solid tumors. The existing literature contains limited information on the connection between hyponatremia and Colorectal cancer (CRC). Thus, our study aimed to assess the impact of hyponatremia on mortality, morbidity, and resource usage in patients with CRC. Methods: A retrospective analysis using the National Inpatient Sample database and International Classification of Diseases, Tenth Revision codes was conducted to examine the impact of hyponatremia on mortality, morbidity, and resource utilization in patients with CRC. Categorical variables were compared using chi-square tests, while continuous variables were compared using t-tests. Multivariable regression analyses were performed, adjusting for demographics, hospital-level characteristics, and relevant comorbidities. Confounding variables were adjusted using multivariate logistic and linear regression analyses. These included gender, race, Charlson Comorbidity Index, chronic kidney disease, congestive heart failure, cirrhosis, nephrotic syndrome, hypothyroidism, adrenal insufficiency, alcohol use disorder, and admission for hypovolemia or psychogenic polydipsia and various patient and hospital characteristics. Results: A total of 337,190 patients with a primary diagnosis of colon cancer were included in the study, of which 12.6% (3,369) presented with hyponatremia (Table 1). The in-hospital mortality rate was 7.8% for patients with hyponatremia, compared to 4.1% for patients without hyponatremia. After adjusting for confounding factors, hyponatremia was found to significantly increase the odds of mortality (adjusted odds ratio [aOR] for mortality 1.85, 95% confidence interval [CI]: 1.68–2.03, P < 0.01). Patients with colon cancer and hyponatremia also had higher odds of developing sepsis (OR = 2.60), acute kidney injury (OR = 2.63), peritonitis (OR = 2.25), and ICU admission (OR = 2.12) (Table 1). Additionally, hyponatremia was associated with increased resource utilization, as evidenced by a longer mean length of stay and higher mean total hospital charges. Conclusions: This retrospective analysis demonstrated that hyponatremia significantly increases mortality, morbidity, and resource utilization in individuals with CRC. Patients with colorectal cancer and hyponatremia have substantially higher mortality rates, underscoring the importance of monitoring sodium levels and implementing appropriate interventions to prevent and manage this electrolyte imbalance. The high incidence rates of sepsis, acute kidney injury, and peritonitis, along with frequent ICU admissions, provide further evidence of the negative impact of hyponatremia on patient outcomes.
Unveiling the influence of SGLT2 inhibitors on clinical outcomes in patients with cancer with therapy-related cardiac dysfunction: A meta-analysis and systemic review.
Authors: Shafique Nouman , Shaikh Safia , Irshad Khurram , Muhibullah - , Qadeer Abdul , Pulipati Yochitha , Tariq Sheraz Ahmad , Bajwa Shammas , Kaur Navneet , Memon Roha Saeed , Ahmed Shahroze , Naqvi Syed Mujtaba Ali , Umer Ahmed Muaaz , Akbar Usman Ali , Khan Sana , Javeed Zainab , Ghaffar Ali , Gillani Muhammad Usama , Raza Munis , Kirchoff Robert W. 
Published: June 2024

e24003 Background: Cancer patients undergoing chemotherapy suffer from a variable degree of cancer therapy–related cardiac dysfunction and heart failure (HF). It is known that sodium glucose co-transporter 2 (SGLT2) inhibitors improve outcomes in patients with HF independent of diabetes mellitus and left ventricular ejection fraction; our study aims to investigate the potential benefits of SGLT2 inhibitory therapy specifically in cancer patients undergoing chemotherapy. Methods: We performed an electronic search on PubMed, Embase, and Cochrane, from the inception of databases till January 29, 2024, to identify all the articles that compared the use of SGLT2 inhibitors in adult (≥18 years) with type 2 diabetes mellitus and exposure to cardiotoxic antineoplastic therapy, subsequently diagnosed with cardiomyopathy, heart failure, or LVEF < 40%. The data was extracted and pooled using a random effects model to calculate the odds ratio (OR) with a respective 95% confidence interval (CI). R software (v.4.3) was used for all statistical analyses. Results: Our search identified three observational studies with a total of 3,164 patients (SGLT2- inhibitor group: 1,550; Control group: 1,614). We found that the use of SGLT2 inhibitors was associated with a lower risk of all-cause mortality (OR: 0.25 [0.20, 0.31]; I2 = 16%; p < 0.001), hospitalizations from heart failure (OR: 0.25 [0.10, 0.62]; I2 = 0%; p = 0.003), and acute exacerbation of heart failure (OR: 0.35 [0.27, 0.47]; I2 = 0%; p < 0.001). Conclusions: Our findings suggest a favorable association between the use of SGLT2 inhibitors and reduced mortality, as well as improved cardiac clinical outcomes in cancer patients undergoing chemotherapy. However, further validation through large-scale studies and randomized controlled trials across diverse malignancies is warranted to establish the efficacy of these drugs. [Table: see text]
Incidence of cardiotoxicity after high cumulative dose of anthracyclines in adult patients with advanced soft tissue sarcomas: A systematic review and meta-analysis.
Authors: Maravilla Rachelle Diane Bautista , Franco Paula Isabel Gimena , Alcala Gale Rizzae Mercado , Pilapil John Christopher Agsalud , Gorospe Agnes Evangelista , Pascual-Panganiban Anna Marie Mangune 
Published: June 2024

e24004 Background: The risk of anthracycline-related cardiotoxicity increases with cumulative dose, with most available literature based from studies on breast cancer patients. Although soft tissue sarcomas are heterogenous entities, anthracycline-based chemotherapy is considered the most active regimen. This study aims to clarify the incidence of cardiotoxicity among patients with advanced soft tissue sarcomas who receive a high cumulative dose of anthracyclines. Methods: We performed a systematic search across PubMed, Cochrane, Google Scholar, and ASCO and ESMO references. Studies were eligible if they (1) investigated soft tissue sarcoma patients, (2) receiving high cumulative doses of doxorubicin ( > 450mg/m2), lipodox ( > 550mg/m2) or epirubicin ( > 900mg/m2), and (3) reported the incidence of cardiotoxicity (clinical and subclinical). Three authors independently assessed validity of the articles using the Cochrane Tool for randomized trials and the Newcastle-Ottawa scale for cohorts. Pooled analysis was performed using MetaXL with the random effects model. Pooled incidence with 95% CI and heterogeneity (Cochran's Q) were determined. Results: For doxorubicin, 4 studies with 168 patients without pre-existing cardiomyopathy, and a mean age of 47 years were included. At a mean cumulative dose of 651.1mg/m2, clinical cardiotoxicity was seen in 2.6% (0.62–5.62%,Q3) while subclinical cardiotoxicity was seen in 23.8%(17.67%-30.53%,Q86). For epirubicin, we included 3 studies with 109 patients, without pre-existing cardiomyopathy, and mean age of 39 years. At a cumulative dose of 1128.33mg/m2, clinical cardiotoxicity was seen in 5.3% (1.74–10.38%,Q25), and subclinical cardiotoxicity was seen in 13.4% (7.62%-20.50%,Q37). Conclusions: The incidence of cardiotoxicity in patients with advanced soft tissue sarcomas receiving high cumulative dose of anthracyclines is comparable with existing data on breast, lymphoma and leukemia patients. Subclinical cardiotoxicity is more prominent. Majority of the patients received cardioprotective strategies during their treatment (dexrazoxane or continuous infusions of doxorubicin). Evidence with regard to lipodox is lacking.
Arterial stiffness and aortic hemodynamics as predictors for new or worsening cardiovascular events in childhood cancer survivors: A report from the St. Jude lifetime cohort.
Authors: Maharaj Arun , Dhaduk Rikeenkumar , Mulrooney Daniel A. , Armstrong Gregory T. , Wogksch Matthew , Hudson Melissa M. , Ehrhardt Matthew J. , Duprez Daniel , Dixon Stephanie B. , Krull Kevin R. , Ness Kirsten K. 
Published: June 2024

e24006 Background: Survival following childhood cancer has improved due to advances in treatment and supportive care. However, survivors are at high risk of cardiovascular diseases (CVDs) later in life. Aortic artery stiffening, captured by measuring the speed and magnitude of forward and reflected pulse waves, is an independent predictor of CVD and mortality in the general population. Methods: We evaluated associations between vascular function and new or worsening CVDs [coronary artery disease (CAD), cardiomyopathy, and hypertension (HTN)] among a subset (n = 249) of St. Jude Lifetime Cohort (SJLIFE) participants who had baseline vascular function assessment and returned for a standard follow up study visit (mean age at baseline (years) ± standard deviation: 34 ± 9 years, follow-up: 39 ± 9 years). CVD conditions were graded (dichotomized as grades 0-1 and 2-4) using the Common Terminology Criteria for Adverse Events (CTCAE). Aortic stiffness, brachial and aortic blood pressure (BP), and aortic wave reflection (augmented pressure, augmentation index (AIx), AIx adjusted to a heart rate of 75 beats/min (AIx75), time and magnitude of the forward and reflected waves) were assessed using wave separation analyses. T-tests were used to test mean values between the groups with higher (2-5) and lower (0-1) grades. These tests informed the selection of identified variables for multivariate logistic models, which were adjusted for age, sex, race, body mass index, physical activity, smoking status, drinking behavior and vasoactive medications. Results: Most participants had a history of Hodgkin lymphoma (53.8%) or leukemia (20.5%) and 25.7% other diagnoses. There were 169 (67.9%) participants who had cranial/neck radiation, 167 (67.9%) received anthracyclines, and 150 (60.2%) alkylating agents. At baseline 38.2% had ≥grade 2 HTN, 9.2% cardiomyopathy, and 4% CAD. Having ≥ grade 2 CVDs was significantly associated with augmented markers of brachial and aortic BP, arterial stiffness, and wave reflection. Regression analyses revealed that AIx75 ≥ 17% was associated with an increased risk of new or worsening HTN (odds ratio (OR) 3.29, 95% confidence interval (CI) 1.03-10.48) and new or worsening cardiomyopathy (OR 4.06, 95% CI 1.02-16.16) an average of 5 years after baseline vascular testing. Conclusions: Childhood cancer survivors diagnosed with grades 2-4 CVDs at a baseline visit had elevated aortic stiffness and augmented indices of wave reflection compared to those with < grade 2 CVDs. Elevated AIx75 was associated with new or worsening HTN and cardiomyopathy five years later. Early detection and treatment of vascular dysfunction may ameliorate CVD late effects in childhood cancer survivors.
The metabolic profiles of patients with autologous hematopoietic stem cell transplantation with graft versus host disease.
Authors: Dunham Alden J. , Benyahia Steven , Kansara Bhargav , Ellis Lauren , Eichelberger Gerry Samantha , Ekram Jahanzaib , Alomar Mohammed 
Published: June 2024

e24010 Background: Graft versus host disease (GvHD) is a serious inflammatory complication of hematopoietic stem cell transplant (HSCT) and a leading contributor to morbidity and mortality in HSCT patients. Previous studies have identified increased risk of cardiovascular death in HSCT patients who develop GvHD and characterized echocardiographic changes associated with chronic GvHD. However, details of the metabolic derangements in HSCT patients who develop GvHD remain poorly studied. Methods: This is a retrospective study of patients who underwent HSCT at H. Lee Moffitt Cancer Center and later developed severe chronic GVHD at 1 year. Metabolic data including weight, blood pressure, and lipid profile were recorded at baseline and at 1 year after HSCT. Results: Between January 1, 2010, and December 31, 2020, 1805 patients who received allogeneic HSCT were reviewed. At 1 year, 371 patients (20.5%) had severe GVHD. Compared to baseline, patients had higher total cholesterol (209 vs 183 mg/dL, P < 0.001), high-density lipoprotein (61 vs 47 mg/dL, P < 0.001), and triglycerides (211 vs 163 mg/dL, P < 0.001) at 1 year of follow up. Low-density lipoprotein values were not significantly different (107 vs 102 mg/dL, p = 0.15). Patient weight was significantly less at 1 year (163 vs 183 lbs, p < 0.001). Although blood pressure was not significantly different between baseline and 1 year, more patients were placed on antihypertensive medications at 1 year (50% vs 31%). Conclusions: This study finds that patients who undergo allogeneic HSCT and subsequently develop severe GVHD are at risk for metabolic derangements that may worsen cardiovascular health. We specifically demonstrate an increased need for antihypertensive therapy and elevations in total cholesterol and serum triglycerides. Further research is needed on the impact of these derangements on major adverse cardiac events and the role of cardiovascular risk factor management in these patients.
Comparison of infective endocarditis in patients with and without malignancy: A propensity score matched analysis.
Authors: Winn Soe , Kansakar Sajog , Shikhrakar Shreeja , Guragain Ashish , Chudy-Onwugaje Dilichukwu 
Published: June 2024

e24030 Background: Cancer patients are at a higher risk of infective endocarditis (IE) due to immunosuppressed state, indwelling catheters and recurrent infections. Due to the clinical scenario being relatively uncommon, there is lack of real-world data on prevalence, trends and outcomes of IE in cancer patients. Methods: We extracted data from the National Inpatient Sample (NIS) Database from 2016 to 2020. We included all admissions ≥18 years old with a principal diagnosis of IE with and without a cancer diagnosis using International Classification of Diseases Tenth Revision (ICD-10) codes. Propensity score matching was performed to balance hospital characteristics, patient demographics and comorbidities between the two groups. Univariate logistic regression was performed in the balanced cohorts. The primary outcome was inpatient mortality. Analysis was performed using STATA-MP, version 14.2. Results: A total of 70,225 admissions for IE were identified between 2016-2020, of which 2,294 (3.27%) had a history or active cancer. The annual number of admissions for IE did not show a significant change (p trend = 0.56); however, the proportion of IE patients with cancer doubled from 2.33% to 4.61% (p trend < 0.01) over the study period. After propensity score matching, there was no significant difference in in-hospital mortality (odds ratio [OR] 1.30, 95% CI 0.79-2.16, p = 0.31) between IE patients with and without cancer. Cohort with cancer had lower odds of experiencing respiratory failure (OR 0.52, 95% CI 0.33-0.83, p < 0.01) and stroke (OR 0.35, 95% CI 0.25-0.49, p < 0.01), although venous thromboembolism was more common in cohort with cancer (OR 3.03, 95% CI 1.76-5.21, p < 0.01). There was no difference in acute kidney injury or shock between the two groups. Cohort with cancer was less likely to undergo valve replacement surgery (OR 0.42, 95% CI 0.31-1.24, p < 0.01). The median length of stay (11 days vs 14 days, p < 0.01) and hospital charges ($70,698 vs $86,763, p < 0.01) were higher in the cohort without cancer. Conclusions: Underlying cancer was seen in growing proportion of admissions for IE over the study period. The pattern of complications was different between patients with and without cancer, which underscores the importance of cancer history in management of IE. Although there was no difference in mortality between patients with and without cancer, patients with cancer were less likely to undergo valve replacement surgery during the admission. Further research is needed to explore the specific factors influencing treatment decisions and long-term outcomes in cancer patients with IE.
Racial disparities in acute myocardial infarction outcomes in patients with cancer: A nationwide analysis.
Authors: Winn Soe , Kansakar Sajog , Shikhrakar Shreeja , Guragain Ashish , Chudy-Onwugaje Dilichukwu 
Published: June 2024

e24031 Background: Cancer patients and survivors face an elevated risk of coronary artery disease due to shared risk factors. Risk is further heightened by cancer itself as well as its treatment. Acute myocardial infarction (AMI) is becoming a leading cause of death among this demographic, owing to significant advancements in cancer survival in recent decades. While racial disparities in outcomes and resource utilization in AMI hospitalizations are well-documented, data on patients with cancer remain limited. Methods: We extracted data from the National Inpatient Sample (NIS) Database from 2016 to 2020. We included all admissions with a principal diagnosis of AMI and a cancer diagnosis using ICD-10 codes. Patients were stratified by their race as – White, Black, Hispanic, Asian and others. Multivariate logistic regression was performed to assess outcomes while adjusting for hospital characteristics, patient demographics and comorbidities between the groups. The primary outcome was inpatient mortality. Results: Out of 3,190,929 admissions for AMI, 93,279 (2.9%) had co-morbid cancer. Among this subset, the majority were White patients (70.9%), followed by Black (11.0%), Hispanic (8.5%), Asian (2.7%), and others (6.9%). Asian patients, compared to White patients, had higher in-hospital mortality (adjusted odds ratio [aOR] 1.52, 95% CI 1.12-2.07, p < 0.01). There was no difference in mortality among other racial groups. There were no differences in complications such as respiratory failure, acute kidney injury, stroke, and vascular complications between the cohorts, although Black patients had lower odds of cardiogenic shock (aOR 0.78, 95% CI 0.62-0.98, p = 0.03) compared to White patients. Compared to White patients, there were lower odds of undergoing coronary angiogram in Black (aOR 0.75, 95% CI 0.68-0.83, p < 0.01), Hispanic (aOR 0.87, 95% CI 0.76-0.99, p = 0.43), and Asian patients (aOR 0.64, 95% CI 0.53-0.79, p < 0.01). Similarly, there were lower odds of undergoing percutaneous coronary intervention (PCI) in Black (aOR 0.64, 95% CI 0.57-0.72, p < 0.01), Hispanic (aOR 0.79, 95% CI 0.68-0.91, p < 0.01), and Asian patients (aOR 0.71, 95% CI 0.56-0.88, p > 0.01). Likewise, there were lower odds of undergoing coronary artery bypass grafting (CABG) in Black (aOR 0.58, 95% CI 0.45-0.76, p < 0.01) and Hispanic patients (aOR 0.70, 95% CI 0.50-0.98, p < 0.04). Conclusions: Cancer patients presenting with AMI experience similar mortality and complications across all races, although in-hospital mortality for Asian was higher compared to White patients. However, significant racial disparities exist in interventions being performed in this patient population. Coronary angiogram, PCI and CABG was performed more often in White patients than other races. Additional research is required to identify the factors contributing to this racial disparity and provide guidance for interventions aimed at improving outcomes.
Analysis of the fecal metagenome in pelvic radiation survivors with or without chronic gastrointestinal toxicity.
Authors: Nelson Bailey , Apewokin Senu , Esslinger Hope , Kharofa Jordan 
Published: June 2024

e24041 Background: Whole pelvis radiation therapy (WPRT) is often used as a definitive or adjuvant treatment in patients with genitourinary, gynecologic, and gastrointestinal (GI) malignancies. Irradiation of nearby bowel can cause acute and chronic GI symptoms, which can affect patients’ quality of life. Radiation therapy has been shown to alter the microbial flora and may select for pathogenic species, which may enhance toxicity. Characteristics of the fecal metagenome in patients with or without chronic GI toxicity is unknown. Severity of GI symptoms can vary between patients who receive a similar radiation dose to normal bowel; therefore, there is a critical need to evaluate the interaction of RT and microbial species in the development of toxicity. Methods: An institutional database was used to identify survivors that completed WPRT for prostate, gynecologic, and anal cancer within the last 5 years. Patients were excluded if they had evidence of recurrent disease requiring additional therapy. Eligible patients were asked to participate via telephone. Consenting patients provided a stool sample and completed a customized PRO-CTCAE form (scale 1-5) assessing chronic GI symptoms. Comprehensive shotgun metagenomics were performed on stool. Stool was sequenced using an Illumina NextSeq500. The fecal metagenome in patients with or without chronic GI symptoms were compared. Patients were dichotomized by PRO-CTCAE diarrhea score (0-1 [mild] vs ≥2 [moderate-severe]). Raw reads were processed with Kneaddata for trimming, Kracken2 for taxonomic profiling, and Bracken for abundance estimation for bacterial, fungal and viral genomes using sequences from the National Center for Bioinformatics to determine quantitative genus and species differences. For microbial diversity assessments, estimated inverse Simpson and Shannon indices were performed. Results: Fecal metagenome and PRO-CTCAE results were available for 13 survivors. Thirty percent (n = 4) of patients reported moderate to severe diarrhea. The mean age was 66 years, 38% were male, 46% received concurrent or adjuvant chemotherapy, and the mean time from completion of WPRT to stool analysis was 34 months (range 14-62 months). Conventional radiation bowel constraints were met for each patient. Several species were enriched in patients with mild GI toxicity. Notably, Akkermansia muciniphilia had the largest differential enrichment in patients with without chronic GI toxicity. Conclusions: In this cohort of patients, A. muciniphilia, a mucin-degrading bacteria that modulates the gut barrier integrity and mucin layer thickness, was enriched in patients with no to mild diarrhea compared to patients with moderate to severe diarrhea. A. muciniphilia supplementation has been shown to decrease systemic inflammation in Western diet-fed mice. Evaluation of A. muciniphilia as a radioprotective gut bacterium warrants further evaluation.