Clinical Implications of Metabolic Risk Factors in Lung Transplant Recipients
Notice bibliographique
Résumé
RATIONALE: Metabolic risk factors (RF) have been associated with cardiovascular morbidity and poor graft survival in kidney and liver transplant recipients but have not been wellstudied in lung transplantation (LTx). We aimed to evaluate the prevalence of metabolic RF pre-and post-LTx, and test our hypothesis that pre-transplant metabolic RF are associated with an increased risk of chronic lung allograft dysfunction (CLAD) with detrimental effects on exercise capacity and post-LTx survival. METHODS: Single center, retrospective cohort study of LTx recipients listed 2014-2015 in the Toronto Lung Transplant Program. Clinical characteristics and pre-and post-LTx metabolic RF (hypertension, hyperlipidemia, diabetes, and obesity with BMI 30 kg/m 2 ) were abstracted from medical records. Subjects were categorized by number of pre-LTx metabolic RF present: 0; 1-2; and 3-4. Post-LTx six-minute walk distance (6MWD), CLAD and mortality within three-years post-transplant were compared across groups using one-way ANOVA and multivariable regression adjusting for age, sex, and diagnosis. RESULTS: 227 LTx recipients [median age 58 years, 60% males, BMI: 24.9 5.1 kg/m 2 , and 54% with interstitial lung disease (ILD)] were studied. Pre-LTx RF prevalence was: hypertension in 63 patients (28%), hyperlipidemia in 79 (35%), diabetes in 40 (18%) and obesity in 44 (19%). 43% of LTx recipients had no RF, 46% had 1-2 and 11% had 3-4 at time of transplant. The prevalence of 3-4 RF post-LTx was 26% at one and 34% at three-years, with obesity rates increasing to 31% by three-years. LTx recipients with 3-4 RF were more likely to have ILD (69%) as primary diagnosis compared to the other two RF groups (ILD 52%, p=0.01), but no differences were observed with respect to age, sex or pre-LTx 6MWD (cohort 304 m 108). Based on pre-LTx risk groups, there were significant differences in 6MWD improvement across groups in the first two-years post-transplant (Figure), which remained significant after adjustment for age, sex, and diagnosis. By three-years post-LTx, incidence of CLAD was 55/227 (24%) and all-cause mortality was 64/227 (28%), but no independent differences were observed between risk groups with respect to CLAD [3-4 vs. 1-2 RF; HR: 1.67 95% CI (0.8 -3.7), p=0.13] or all-cause mortality [HR: 1.74 95% (0.9 -3.4), p=0.14]. CONCLUSION: Metabolic RF were prevalent pre-and post-LTx, and were associated with lower exercise capacity post-LTx, but not CLAD or survival. Future studies exploring lifestyle interventions aimed at improving pre-and post-LTx metabolic RF and functional capacity are needed.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».