Objective
Our aim is to describe characteristics of liver transplant patients undergoing percutaneous coronary interventions (PCI) as well as in‐hospital outcomes including the mortality and ...peri‐procedural complications from the largest publicly available inpatient database in the United States from 2002 to 2014.
Background
Outcomes of PCI are well studied in patients with end‐stage liver disease but not well studied in patients who receive liver transplant (LT).
Methods
Data derived from Nationwide Inpatient Sample (NIS) were analyzed for years 2002–2014. Adult Hospitalizations with PCI were identified using ICD‐9‐CM procedure codes. LT status and various complications were identified by using previously validated ICD‐9‐CM diagnosis codes. Endpoints were in‐hospital mortality and peri‐procedural complications. Propensity match analysis was performed to compare the endpoints between two groups.
Results
During the study period, 8,595,836 patients underwent PCI; 4,080 (0.04%) patients had prior LT status. 93% of patients were above age 59 years, 79% were males and 69% were nonwhites. Out of the total patients with LT status, 73% had hypertension, 57% had diabetes mellitus, and 47% had renal failure. Post‐PCI complications were studied further in both liver and non‐LT patients after 1:1 propensity match which showed the incidence of acute kidney injury (AKI) was higher in LT group (12.3 vs 10.7%, p = .024) but dialysis requiring AKI was similar.
Conclusion
Among the LT recipients undergoing PCI, majority were nonwhite males. Almost more than half of the recipients had diabetes mellitus and renal failure. Incidence of AKI was higher in LT group, but other peri‐procedural complications were comparable.
(1) Although emerging evidence suggests that proton pump inhibitor (PPI)-induced dysbiosis negatively alters treatment response to immune checkpoint inhibitors (ICIs) in cancer patients, no study ...systematically investigates the association between PPIs, ICIs, and chemotherapy; (2) Cochrane Library, Embase, Medline, and PubMed were searched from inception to 20 May 2022, to identify relevant studies involving patients receiving ICIs or chemotherapy and reporting survival outcome between PPI users and non-users. Survival outcomes included overall survival (OS) and progression-free survival (PFS). Network meta-analyses were performed using random-effects models.
-scores, with a value between 0 and 1, were calculated to quantify the treatment ranking, with a higher score suggesting a higher probability of greater effectiveness. We also conducted pairwise meta-analyses of observational studies to complement our network meta-analysis; (3) We identified 62 studies involving 26,484 patients (PPI = 8834; non-PPI = 17,650), including non-small cell lung cancer (NSCLC), urothelial carcinoma (UC), melanoma, renal cell carcinoma (RCC), hepatocellular carcinoma (HCC), and squamous cell carcinoma (SCC) of the neck and head. Eight post-hoc analyses from 18 randomized-controlled trials were included in our network, which demonstrated that, in advanced NSCLC and UC, patients under ICI treatment with concomitant PPI (
-score: 0.2016) are associated with both poorer OS (HR, 1.49; 95% CI, 1.37 to 1.67) and poorer PFS (HR, 1.41; 95% CI, 1.25 to 1.61) than those without PPIs (
-score: 1.000). Patients under ICI treatment with concomitant PPI also had poorer OS (HR, 1.18; 95% CI, 1.07 to 1.31) and poorer PFS (HR, 1.30; 95% CI, 1.14 to 1.48) in comparison with those receiving chemotherapy (
-score: 0.6664), implying that PPIs may compromise ICI's effectiveness, making it less effective than chemotherapy. Our pairwise meta-analyses also supported this association. Conversely, PPI has little effect on patients with advanced melanoma, RCC, HCC, and SCC of the neck and head who were treated with ICIs; (4) "PPI-induced dysbiosis" serves as a significant modifier of treatment response in both advanced NSCLC and UC that are treated with ICIs, compromising the effectiveness of ICIs to be less than that of chemotherapy. Thus, clinicians should avoid unnecessary PPI prescription in these patients. "PPI-induced dysbiosis", on the other hand, does not alter the treatment response to ICIs in advanced melanoma, RCC, HCC, and SCC of the head and neck.
Proton pump inhibitors (PPI), one of the most commonly prescribed medications, carry a myriad of adverse events. For colorectal cancer (CRC) patients, it still remains unclear whether the concurrent ...use of proton pump inhibitors (PPI) would negatively affect chemotherapy. PubMed, Medline, Embase, and Cochrane Library were searched from inception to 10 June 2022, to identify relevant studies involving CRC patients receiving chemotherapy and reporting comparative survival outcomes between PPI users and non-users. Meta-analyses were performed using random-effects models. We identified 16 studies involving 8,188 patients (PPI = 1,789; non-PPI = 6,329) receiving either capecitabine-based or fluorouracil-based regimens. The overall survival (HR, 1.02; 95% CI, 0.91 to 1.15; I
= 0%) and progression-free survival (HR, 1.15; 95% CI, 0.98 to 1.35; I
= 29%) were similar between PPI users and non-users in patients taking capecitabine-based regimens, with low statis-tical heterogeneity. Although the subgroup analysis indicated that early-stage cancer patients taking capecitabine monotherapy with concurrent PPI had a significantly higher disease progression rate (HR, 1.96; 95% CI, 1.21 to 3.16; I
= 0%) than those who did not use PPIs, both groups had comparable all-cause mortality (HR, 1.31; 95% CI, 0.75 to 2.29; I
= 0%). On the other hand, there was little difference in both OS and PFS in both early- and end-stage patients taking capecitabine combination therapy between PPI users and non-users. Conversely, the use of concomitant PPI in patients taking fluorouracil-based regimens contributed to a marginally significant higher all-cause mortality (HR, 1.18; 95% CI, 1.00 to 1.40; I
= 74%), but with high statistical heterogeneity. In conclusion, PPI has little survival influence on CRC patients treated with capecitabine-based regimens, especially in patients taking capecitabine combination therapy. Thus, it should be safe for clinicians to prescribe PPI in these patients. Although patients treated with fluorouracil-based regimens with concomitant PPI trended toward higher all-cause mortality, results were subject to considerable heterogeneity.
identifier https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022338161.
Abstract only
Introduction
Although immune checkpoint inhibitors (ICI) have reshaped the treatment landscape for cancer patients, they carry potential risk for the development of cardiovascular ...adverse events (CVAEs).
Objectives
We attempted to identify risk factors for CVAEs in cancer patients receiving ICI.
Methods
Two investigators (C.H.H. and Y.C.) independently reviewed Medline, PubMed, and Embase from inception to May 20, 2022 to identify high quality studies. We included randomized controlled trials, prospective or retrospective cohorts that reported the risks factors for any new onset or worsening CVAEs, including cardiomyopathy, arrhythmia, heart failure, acute coronary syndrome, myocarditis, and pericarditis, in cancer patients receiving ICI. Two investigators (E.A. and M.A.) independently extracted data from included studies. Any discrepancy was resolved through discussion with senior reviewers (K.Y.C and M.N.). We performed random-effects meta-analyses on risk factors for CVAEs after the initiation of ICI. We used I-statistics (I
2
) to quantify the statistical heterogeneity.
Results
12 observational studies involving 21,912 patients (CVAEs=2,897) of any cancers were included for final qualitative and quantitative analyses. 11 covariates, including age, gender, body mass index, ever-smoking history, hypertension, type II diabetes, coronary artery disease (CAD), congestive heart failure, chronic kidney disease (CKD), chronic obstructive pulmonary disease, and stroke, were available for the meta-analyses. Our meta-analyses (Table 1) demonstrated that male gender, hypertension, CAD, and CKD were associated with increased odds for the development of CVAEs in patients taking ICI.
Conclusions
In conclusion, male gender, hypertension, CAD, and CKD were identified as significant risk factors for CVAEs in patients taking ICI. Evidence supports a strategy of proper optimization of risk factors before, during, and after the ICI treatment.
