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1.
  • Andersen, Lars Norvang, et al. (författare)
  • Levy Processes with Two-Sided Reflection
  • 2015
  • Ingår i: Lecture Notes in Mathematics. - Cham : Springer International Publishing. - 0075-8434. ; 2149, s. 67-182
  • Tidskriftsartikel (refereegranskat)abstract
    • Let X be a Levy process and V the reflection at boundaries 0 and b > 0. A number of properties of V are studied, with particular emphasis on the behaviour at the upper boundary b. The process V can be represented as solution of a Skorokhod problem V(t) = V(0)+X(t)+L(t)-U(t) where L, U are the local times (regulators) at the lower and upper barrier. Explicit forms of V in terms of X are surveyed as well as more pragmatic approaches to the construction of V, and the stationary distribution pi is characterised in terms of a two-barrier first passage problem. A key quantity in applications is the loss rate l(b) at b, defined as E-pi U(1). Various forms of l(b) and various derivations are presented, and the asymptotics as b -> infinity is exhibited in both the light-tailed and the heavy-tailed regime. The drift zero case EX(1) = 0 plays a particular role, with Brownian or stable functional limits being a key tool. Further topics include studies of the first hitting time of b, central limit theorems and large deviations results for U, and a number of explicit calculations for Levy processes where the jump part is compound Poisson with phase-type jumps.
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2.
  • Apostolaki-Hansson, Trine, et al. (författare)
  • Prognosis of Intracerebral Hemorrhage Related to Antithrombotic Use : An Observational Study From the Swedish Stroke Register (Riksstroke)
  • 2021
  • Ingår i: Stroke. - 1524-4628. ; 52:3, s. 966-974
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND AND PURPOSE: To date, large studies comparing mortality and functional outcome of intracerebral hemorrhage (ICH) during oral anticoagulant (OAC), antiplatelet, and nonantithrombotic use are few and show discrepant results. METHODS: We used data on 13 291 patients with ICH registered in Riksstroke between 2012 and 2016 to compare 90-day mortality and functional outcome following OAC-related ICH (n=2300), antiplatelet-related ICH (n=3637), and nonantithrombotic ICH (n=7354). Univariable and multivariable Cox regression analyses, with adjustment for relevant confounders, were used to compare 90-day mortality. Early (≤24 hours and 1-7 days) and late (8-90 days) mortality was also studied in subgroup analyses. Univariable and multivariable 90-day functional outcome, based on self-reported modified Rankin Scale, was determined using logistic regression. RESULTS: Patients with antithrombotic treatment were more often prestroke dependent, older, and had a larger comorbidity burden compared with patients without antithrombotic treatment. At 90 days, antiplatelet and OAC were associated with an increased death rate in multivariable analysis (antiplatelet ICH: hazard ratio, 1.23 [95% CI, 1.14-1.33]; OAC ICH: hazard ratio, 1.40 [95% CI, 1.26-1.57]) compared with nonantithrombotic ICH (reference). OAC ICH and antiplatelet ICH were associated with higher risk of early mortality (≤24 hours: OAC ICH: hazard ratio, 1.93 [95% CI, 1.57-2.38]; antiplatelet ICH: hazard ratio, 1.32 [95% CI, 1.13-1.54]). In multivariable analysis, the odds ratios for the association of antiplatelet and OAC treatment on functional dependency (modified Rankin Scale score, 3-5) at 90 days were nonsignificant (antiplatelet: odds ratio, 1.07 [95% CI, 0.92-1.24]; OAC: odds ratio, 0.96 [95% CI, 0.76-1.22]). CONCLUSIONS: In this large observational study, we found that 90-day mortality outcome was worse not only in OAC ICH but also in antiplatelet ICH, compared with patients with nonantithrombotic ICH. Antiplatelet ICH is common and is a serious condition with poor clinical outcome. Further studies are, therefore, warranted in determining the appropriate clinical management of these patients.
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3.
  • Apostolaki-Hansson, Trine, et al. (författare)
  • Reversal Treatment in Oral Anticoagulant-Related Intracerebral Hemorrhage—An Observational Study Based on the Swedish Stroke Register
  • 2020
  • Ingår i: Frontiers in Neurology. - : Frontiers Media SA. - 1664-2295. ; 11
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Intracerebral hemorrhage (ICH) is the most serious adverse effect of oral anticoagulant (OAC) treatment. The effect of OAC reversal therapy on outcome is uncertain. We compared 90-day survival and functional outcome in patients with OAC-ICH who received OAC reversal therapy with those who did not. Methods: Data from The Swedish Stroke Register (Riksstroke) for all registered cases of OAC-ICH during 2017 (572 patients) were used to obtain information on reversal (n = 369) and non-reversal (n = 203) treatment receiving patients. Univariate and multivariate Cox regression analysis stratified for level of consciousness (LOC) on admission, and adjustment for relevant baseline variables, was used to compare 90-day Hazard Ratios (HR) for mortality. Results: Sixty-five percent of patients received reversal treatment. These patients were younger, more often pre-stroke independent and alert at presentation. Withholding reversal treatment was associated with an increased death rate (HR = 1.47; 95% CI: 1.08–2.01) in a Cox regression model stratified for LOC and adjusted for baseline imbalances. Additional factors associated with an increased 90-day death rate were male sex (HR = 1.42; 95% CI: 1.06–1.92), age (HR = 1.05; 95% CI: 1.02–1.07), and intraventricular hemorrhage (HR = 2.41; CI: 1.77–3.29). Conclusion: In this large observational study 35% of patients with OAC-ICH did not receive reversal treatment. Patients receiving OAC-reversal treatment had an improved 90-day mortality outcome compared to those not receiving treatment. Mortality was strongly related to LOC. Further, and larger, studies are required to determine which patient groups may benefit from reversal therapy and in whom non-reversal is adequate.
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4.
  • Asmussen, Sören, et al. (författare)
  • Loss rates for Lévy processes with two reflecting barriers
  • 2007
  • Ingår i: Mathematics of Operations Research. - : Institute for Operations Research and the Management Sciences (INFORMS). - 0364-765X .- 1526-5471. ; 32:2, s. 308-321
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • Let {Xt} be a Lévy process which is reflected at 0 and K>0. The reflected process {VtK} is constructed as VtK = V0K + Xt + Lt0 - LtK where{Lt0} and {LtK} are the local times at 0 and K, respectively. We consider the loss rate lK, defined by lK=E KL1K where E K is the expectation under the stationary measure K. The main result of the paper is the identification of lK in terms of K and the characteristic triplet of {Xt}. We also derive asymptotics of lK as K when EXt <0 and the Lévy measure of {Xt} is light-tailed.
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5.
  • Asmussen, S, et al. (författare)
  • Performance analysis with truncated heavy-tailed distributions
  • 2005
  • Ingår i: Methodology and Computing in Applied Probability. - : Springer Science and Business Media LLC. - 1573-7713 .- 1387-5841. ; 7:4, s. 439-457
  • Tidskriftsartikel (refereegranskat)abstract
    • This paper deals with queues and insurance risk processes where a generic service time, resp. generic claim, has the form U boolean AND K for some r.v. U with distribution B which is heavy-tailed, say Pareto or Weibull, and a typically large K, say much larger than EU. We study the compound Poisson ruin probability psi(u) or, equivalently, the tail P(W > u) of the M/G/1 steady-state waiting time W. In the first part of the paper, we present numerical values of psi(u) for different values of K by using the classical Siegmund algorithm as well as a more recent algorithm designed for heavy-tailed claims/service times, and compare the results to different approximations of psi(u) in order to figure out the threshold between the light-tailed regime and the heavy-tailed regime. In the second part, we investigate the asymptotics as K -> infinity of the asymptotic exponential decay rate gamma = gamma((K)) in a more general truncated Levy process setting, and give a discussion of some of the implications for the approximations.
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6.
  • Asmussen, S, et al. (författare)
  • Transient properties of many-server queues and related QBDs
  • 2004
  • Ingår i: Queueing Systems. - 0257-0130. ; 46:3-4, s. 249-270
  • Tidskriftsartikel (refereegranskat)abstract
    • The time tau(n) of first passage from queue length x to queue lengthn > x in a many-server queue with both the arrival process and service intensities governed by a finite Markov process is considered. The mean and the Laplace transform are computed as solutions of systems of linear equations coming out by optional stopping of a martingale obtained as a stochastic integral of the exponential Wald martingale for Markov additive processes. Compared to existing techniques for QBD's, the approach has the advantage of being far more efficient for large n.
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7.
  • Dahlbäck, Charlotte, et al. (författare)
  • Abnormal ductus venosus pulsatility index in the absence of concurrent umbilical venous pulsations does not indicate worsening fetal condition.
  • 2013
  • Ingår i: Ultrasound in Obstetrics & Gynecology. - : Wiley. - 1469-0705 .- 0960-7692. ; 42:3, s. 322-328
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Recordings of blood flow velocity waveform in the ductus venosus (DV) and the umbilical vein (UV) are routinely used in order to predict the fetal condition in high-risk pregnancies. This study investigates the relationship between pathological blood flow in the two vessels and perinatal outcome. METHODS: High-risk pregnancies (n=11865) admitted during 1993-2011 for blood flow examinations, including recordings of DV pulsatility index for veins (PIV) and UV pulsations, were included. The results were related to perinatal outcome, using the last Doppler examination prior to delivery in analysis. RESULTS: Abnormal DV PIV was observed in 3,96%, intra-abdominal UV-pulsations in 1,3% and pulsations in the cord in 0,7% of the cases. As expected, the rate of UV-pulsations increased with increasing DV PIV z-score. Fetuses with a pathological DV PIV, but without UV pulsations showed no signs of compromise. This was also true for cases with a DV PIV >4 SD above the mean (53.7 % had a steady flow in the UV). In contrast, the occurrence of UV-pulsations seems to be an indicator of fetal compromise regardless of level of DV PIV. CONCLUSIONS: Abnormal fetal venous blood velocity is related to adverse outcome of high-risk pregnancies. However, abnormal DV PIV is not an indicator of fetal compromise unless UV-pulsations are concurrently present and should be regarded as an artifact and not an indication for emergency delivery.
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8.
  • Drescher, Conrad, et al. (författare)
  • Diverging Trends in the Incidence of Spontaneous Intracerebral Hemorrhage in Sweden 2010-2019 : An Observational Study from the Swedish Stroke Register (Riksstroke)
  • 2023
  • Ingår i: Neuroepidemiology. - 0251-5350. ; 57:6, s. 367-376
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Although ischemic stroke incidence has decreased in Sweden over the past decade, trends in spontaneous intracerebral hemorrhage (ICH) incidence are less well delineated. In this time period, there has been a dramatic increase in use of oral anticoagulants (OAC). The aim of our study was to investigate incidence trends in spontaneous first-ever ICH in Sweden between 2010 and 2019, with a focus on non-OAC-associated and OAC-associated ICH. Methods: We included patients (≥18 years) with first-ever ICH registered in the hospital-based Swedish Stroke Register (Riksstroke) 2010-2019. Data were stratified by non-OAC and OAC ICH and analyzed for 2010-2012, 2013-2016, and 2017-2019. Incidence rates are shown as crude and age-specific per 100,000 person-years. Results: Between 2010 and 2019, 22,289 patients with first-ever ICH were registered; 18,325 (82.2%) patients with non-OAC ICH and 3,964 (17.8%) patients with OAC ICH. Annual crude incidence (per 100,000) of all first-ever ICH decreased by 10% from 29.5 (95% CI 28.8-30.3) to 26.7 (95% CI 26.0-27.3) between 2010-2012 and 2017-2019. The crude incidence rate of non-OAC ICH decreased by 20% from 25.7 (95% CI 25.0-26.3) to 20.7 (95% CI 20.1-21.2), whereas OAC ICH increased by 56% from 3.86 (95% CI 3.61-4.12) to 6.01 (95% CI 5.70-6.32). The proportion of OAC ICH of all first-ever ICH increased between 2010-2012 and 2017-2019 from 13.1% to 22.5% (p < 0.001). Proportional changes were largest in the age group ≥85 years with a decrease in non-OAC ICH by 32% from 155 (95% CI 146-164) to 106 (95% CI 98.6-113) and an increase in OAC ICH by 155% from 25.7 (95% CI 22.1-29.4) to 65.5 (95% CI 59.9-71.2). Conclusion: Incidence of first-ever ICH in Sweden decreased by 10% between 2010 and 2019. We found diverging trends with a 20% decrease in non-OAC-associated ICH and a 56% increase in OAC-associated ICH. Further research on ICH epidemiology, analyzing non-OAC and OAC-associated ICH separately, is needed to follow up these diverging trends including underlying risk factors.
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9.
  • Drescher, Conrad, et al. (författare)
  • Epidemiology of First and Recurrent Ischemic Stroke in Sweden 2010-2019 : A Riksstroke Study
  • 2023
  • Ingår i: Neuroepidemiology. - : S. Karger AG. - 0251-5350 .- 1423-0208. ; 56:6, s. 433-442
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Ischemic stroke incidence appears to have decreased during the last decades, but most studies focus on the first-ever events and epidemiological data on recurrent stroke are scarce. The aim of our study was to investigate trends in incidence, risk factors, and medication in patients with first-ever and recurrent ischemic stroke between 2010 and 2019 in Sweden. Methods: We included patients (≥18 years old) with ischemic stroke registered in the hospital-based Swedish Stroke Register (Riksstroke) 2010-2019. The coverage of Riksstroke was consistently high (about 90%) during this period. Data were stratified by first-ever and recurrent ischemic stroke in three different time periods (2010-2012, 2013-2016, and 2017-2019) and shown as crude and age-specific incidence rates per 100,000 person-years. Statistics Sweden provided census data on the Swedish population in different age groups. Results: During the study period, 201,316 cases of ischemic stroke were registered in Riksstroke, including 153,865 (76.4%) cases of first-ever ischemic stroke and 46,248 (23.0%) cases of recurrent ischemic stroke (0.6% of cases unclassified). The crude incidence of first-ever ischemic stroke decreased by 17% from 216 (95% CI 214-218) to 179 (95% CI 177-181) between 2010-2012 and 2017-2019, whereas recurrent ischemic stroke decreased by 33% from 72 (95% CI 71-73) to 48 (95% CI 47-49). Between these time periods, diminishing ischemic stroke incidence was seen in all age groups with highest decline noted in those aged 75-84 years (928 [95% CI 914-943] to 698 [95% CI 686-709];-25% in first-ever ischemic stroke and 361 [95% CI 351-370] to 219 [95% CI 213-226];-39% in recurrent ischemic stroke) and ≥85 years (1,674 [95% CI 1,645-1,703] to 1,295 [95% CI 1,270-1,320];-23% in first-ever ischemic stroke and 683 [95% CI 664-702] to 423 [95% CI 409-437];-38% in recurrent ischemic stroke). Treatment with anticoagulants in patients with atrial fibrillation and lipid-lowering drugs increased considerably in patients with first-ever and recurrent ischemic stroke both at admission and discharge during the study period. Conclusion: Whereas both first-ever and recurrent ischemic stroke rates declined in Sweden between 2010 and 2019, the proportional decline was almost double for recurrent ischemic stroke than for first-ever ischemic stroke and most pronounced in the elderly. Increased use of secondary preventive drugs, in particular anticoagulants in atrial fibrillation, appears to have contributed, but further studies on precise causes for the decline in recurrent ischemic stroke are needed.
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10.
  • Eckersten, Dag, et al. (författare)
  • Impact of Kidney Transplantation on Reproductive Hormone Levels in Males : A Longitudinal Study
  • 2018
  • Ingår i: Nephron. - : S. Karger AG. - 1660-8151 .- 2235-3186. ; 138, s. 192-201
  • Tidskriftsartikel (refereegranskat)abstract
    • Background/Aims: Male patients with end-stage renal disease suffer from sexual disturbances and infertility. Disturbances in the hypothalamic-pituitary-gonadal axis are one of the causes of this. Decreased testosterone synthesis in Leydig cells of the testes and hyperprolactinemia are common. Kidney transplantation, unlike hemodialysis, normalizes these changes. However, how kidney transplantation affects Sertoli cell function is poorly understood. This study is aimed at investigating the changes in fertility-related hormones in men before, during, and after renal transplantation. Methods: This longitudinal and prospective single center study enrolled 12 men undergoing living donor kidney transplantation. Plasma levels of creatinine, cystatin C, and serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, testosterone, sex hormone-binding globulin, inhibin B, and anti-Müllerian hormone (AMH) were assayed at 10 different time points before, during, and after kidney transplantation. Results: A rapid decrease in creatinine and cystatin C levels indicated successful renal transplantation. High pre-transplantation plasma levels of prolactin (mean 516 ± 306 mIE/L) and LH (9.4 ± 4.7 IU/L) were normalized after 7 days (248 ± 161 mIE/L and 6.1 ± 3.1 IU/L, respectively). Testosterone decreased rapidly during transplantation and increased again one week post-transplantation. Sertoli cell-derived hormone inhibin B decreased after transplantation, and there was a small non-significant trend of increased AMH after 12 months. Conclusion: Sertoli cell function, based on AMH and inhibin B levels, does not improve to the same extent or as fast as Leydig cell function after kidney transplantation, as determined by testosterone and LH levels.
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11.
  • Eckersten, Dag, et al. (författare)
  • MicroRNA-155 and Anti-Müllerian Hormone : New Potential Markers of Subfertility in Men with Chronic Kidney Disease
  • 2017
  • Ingår i: Nephron Extra. - : S. Karger AG. - 1664-5529. ; 7:1, s. 33-41
  • Tidskriftsartikel (refereegranskat)abstract
    • Background/Aims: Men with terminal renal failure are often infertile. Anti-müllerian hormone (AMH), a marker of Sertoli cell function, is decreased among men with chronic kidney disease (CKD). Recently, a microRNA, miR-155, has been shown to be a potential marker for subfertility. We studied miR-155 and semen parameters in patients with CKD who were not yet on dialysis. We also aimed to study possible associations between AMH, miR-155, and semen parameters to evaluate them as markers of fertility. Methods: Thirty male patients with CKD 1–4 as well as 18 healthy controls were enrolled. Results: Serum levels of miR-155 were significantly higher among men with CKD stages 1–2 (4.51 ± 3.81 [p = 0.01]) and stages 3–4 (2.75 ± 1.77 [p = 0.006]) than in controls (1.09 ± 0.44). Sperm concentration was significantly lower among men with CKD 3–4 (42 ± 29) ×106/mL compared to controls (88 ± 42) ×106/mL (p = 0.011). High levels of miR-155 were associated with a relatively low sperm concentration (p = 0.02) and with a low total sperm number (p = 0.005). Low AMH levels were associated with a decreased percentage of motile sperm cells (p = 0.02). Conclusions: We conclude that men with stage 3–4 CKD had lower sperm concentrations than healthy fertile men and that increased serum miR-155 in men with stage 1–4 CKD was associated with semen parameters that indicate subfertility. Low AMH levels were associated with a low percentage of the total number of motile sperm cells. miR-155 and AMH may be potential markers of subfertility in men with CKD.
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12.
  • Enhörning, Sofia, et al. (författare)
  • Seasonal variation of vasopressin and its relevance for the winter peak of cardiometabolic disease : A pooled analysis of five cohorts
  • 2022
  • Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 292:2, s. 365-376
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Vasopressin concentration is typically higher at night, during stress, and in males, but readily lowered by water intake. Vasopressin is also a causal candidate for cardiometabolic disease, which shows seasonal variation. Objective: To study whether vasopressin concentration varies by season in a temperate climate. Methods: The vasopressin surrogate marker copeptin was analyzed in fasting plasma samples from five population-based cohorts in Malmö, Sweden (n = 25,907, 50.4% women, age 18–86 years). We investigated seasonal variation of copeptin concentration and adjusted for confounders in sinusoidal models. Results: The predicted median copeptin level was 5.81 pmol/L (7.18 pmol/L for men and 4.44 pmol/L for women). Copeptin exhibited a distinct seasonal pattern with a peak in winter (mid-February to mid-March) and nadir in late summer (mid-August to mid-September). The adjusted absolute seasonal variation in median copeptin was 0.62 pmol/L (95% confidence interval [CI] 0.50; 0.74, 0.98 pmol/L [95% CI 0.73; 1.23] for men and 0.46 pmol/L [95% CI 0.33; 0.59] for women). The adjusted relative seasonal variation in mean log copeptin z-score was 0.20 (95% CI 0.17; 0.24, 0.18 [95% CI 0.14; 0.23] in men and 0.24 [95% CI 0.19; 0.29] in women). The observed seasonal variation of copeptin corresponded to a risk increase of 4% for incident diabetes mellitus and 2% for incident coronary artery disease. Conclusion: The seasonal variation of the vasopressin marker copeptin corresponds to increased disease risk and mirrors the known variation in cardiometabolic status across the year. Moderately increased water intake might mitigate the winter peak of cardiometabolic disease.
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13.
  • Gavriilidou, N N, et al. (författare)
  • Anthropometric reference data for elderly Swedes and its disease-related pattern.
  • 2015
  • Ingår i: European Journal of Clinical Nutrition. - : Springer Science and Business Media LLC. - 1476-5640 .- 0954-3007. ; 69:9, s. 1066-1075
  • Tidskriftsartikel (refereegranskat)abstract
    • Anthropometric measurement is a noninvasive and cost-efficient method for nutritional assessment. The study aims to present age- and gender-specific anthropometric reference data for Swedish elderly in relation to common medical conditions, and also formulate prediction equations for such anthropometric measurements.
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14.
  • Gavriilidou, N N, et al. (författare)
  • High degree of BMI misclassification of malnutrition among Swedish elderly population: Age-adjusted height estimation using knee height and demispan.
  • 2015
  • Ingår i: European Journal of Clinical Nutrition. - : Springer Science and Business Media LLC. - 1476-5640 .- 0954-3007. ; 69:5, s. 565-571
  • Tidskriftsartikel (refereegranskat)abstract
    • Background/Objectives:The degree of misclassification of obesity and undernutrition among elders owing to inaccurate height measurements is investigated using height predicted by knee height (KH) and demispan equations.Subjects/Methods:Cross-sectional investigation was done among a random heterogeneous sample from five municipalities in Southern Sweden from a general population study 'Good Aging in Skåne' (GÅS). The sample comprised two groups: group 1 (KH) including 2839 GÅS baseline participants aged 60-93 years with a valid KH measurement and group 2 (demispan) including 2871 GÅS follow-up examination participants (1573 baseline; 1298 new), aged 60-99 years, with a valid demispan measurement. Participation rate was 80%. Height, weight, KH and demispan were measured. KH and demispan equations were formulated using linear regression analysis among participants aged 60-64 years as reference. Body mass index (BMI) was calculated in kg/m(2).Results:Undernutrition prevalences in men and women were 3.9 and 8.6% by KH, compared with 2.4 and 5.4% by standard BMI, and more pronounced for all women aged 85+ years (21% vs 11.3%). The corresponding value in women aged 85+ years by demispan was 16.5% vs 10% by standard BMI. Obesity prevalences in men and women were 17.5 and 14.6% by KH, compared with 19.0 and 20.03% by standard BMI. Values among women aged 85+ years were 3.7% vs 10.4% by KH and 6.5% vs 12.7% by demispan compared with the standard.Conclusions:There is an age-related misclassification of undernutrition and obesity attributed to inaccurate height estimation among the elderly. This could affect the management of patients at true risk. We therefore propose using KH- and demispan-based formulae to address this issue.European Journal of Clinical Nutrition advance online publication, 10 September 2014; doi:10.1038/ejcn.2014.183.
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15.
  • Gavriilidou, Nivetha Natarajan, et al. (författare)
  • Mortality risk relationship using standard categorized BMI or knee-height based BMI – does the overweight/lower mortality paradox hold true?
  • 2024
  • Ingår i: Aging clinical and experimental research. - 1594-0667 .- 1720-8319. ; 36:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The body mass index (BMI) is prone to misclassification of obesity due to age-related height loss and resulting measurement errors. Knee-height based BMI (KH-BMI) has not been previously studied in relation to mortality risk in older adults. Aim: To evaluate the age- and sex-specific mortality risk relationship using classic BMI and knee height predicted BMI (KH-BMI) overweight and obesity in a 15-year follow-up study including older Swedish adults aged 60–93 years. Methods: A 15-year follow-up study among 2,786 individuals aged ≥ 60 years. Height, weight and KH were measured. KH-predicted height was estimated using formulated gender-specific equations. Classic BMI and KH-BMI (kg/m2) were calculated. Mortality data was obtained from the Swedish death registry. Questionnaires were used to collect data on obesity-related lifestyle factors and comorbidities. Results: Cox regression revealed that using the classic BMI, when comparing with the normal/underweight reference group, there was a mortality risk among overweight men (HR = 0.67, 0.52–0.87), overweight women (HR = 0.79, 0.65–0.97), and obese men (HR = 0.60, 0.41–0.89) aged ≥ 80 years old. Using the KH-BMI, only overweight men and overweight women aged ≥ 80 years had a lower mortality risk, men (HR = 0.71, 0.55–0.92); women (HR = 0.77, 0.62–0.95) after adjusting for obesity-related lifestyle factors and comorbidities. Discussion: There is evidence that obesity is overestimated by the BMI, in comparison with the KH-BMI classification. In terms of mortality risk and after adjusting for height, there remains a paradoxical protective association between overweight and mortality. Conclusion: Regardless of classic BMI or KH-BMI estimation, overweight men and women aged ≥ 80 years had a lower mortality risk compared to normal/underweight men and women ≥ 80 years.
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16.
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17.
  • Legrand, Helen, et al. (författare)
  • Prevalence and determinants of differences in cystatin C and creatinine-based estimated glomerular filtration rate in community-dwelling older adults : A cross-sectional study
  • 2017
  • Ingår i: BMC Nephrology. - : Springer Science and Business Media LLC. - 1471-2369. ; 18:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Differences in cystatin C and creatinine-based estimated glomerular filtration rate (EGFR) can lead to clinical uncertainty. Existing EGFR equations perform poorly in a subset of individuals. This study aims to describe the prevalence of differences between cystatin C-based (EGFRcys) and creatinine-based (EGFRcreat) EGFR in older adults and to explore which subsets of individuals may be most affected by differing estimations. Methods: In this cross-sectional study, participants from a cohort of community-dwelling older adults were examined at a baseline visit in 2001-2004 as part of the larger "Good Aging in Skåne" study. Exposure variables were obtained from questionnaires, interviews, examinations, and medical records. Blood samples were taken during the baseline visit, cryopreserved, and analyzed at a later time for biomarkers. The CKD-EPI equations were used to estimate GFR. Initial descriptive analyses were performed on 2931 individuals. A total of 2532 participants were included in the final multiple linear regression. Results: Nearly two-Thirds of participants had EGFR differences exceeding 10%, with nearly 20 % of participants having EGFR differences exceeding 30%. Smoking, age, body mass index (BMI), C-reactive protein (CRP), glucocorticoid use, and mean EGFR were correlated with differences between EGFRcreat and EGFRcys. Conclusions: Differences between EGFRcreat and EGFRcys are common and often of large magnitude in this community-dwelling population of older adults. The finding of multiple non-GFR determinants correlated to differences in GFR estimations can help direct future research to improve EGFR equations for subgroups prone to conflicting GFR estimations or to guide choice of biomarker for GFR estimation in these subgroups.
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18.
  • Lin, Annie, et al. (författare)
  • Coronary Artery Restenosis in Women by History of Preeclampsia
  • 2022
  • Ingår i: Journal of the American Heart Association. - : Wiley-Blackwell Publishing Inc.. - 2047-9980. ; 11:18
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: A history of preeclampsia is associated with increased risk of coronary artery disease and experimental evidence suggests that a history of preeclampsia also increases the risk of restenosis. However, the extent to which a history of preeclampsia is associated with risk of restenosis after percutaneous coronary intervention in women is unknown.Methods and Results: We included 6065 parous women aged <= 65 years with first percutaneous coronary intervention on 9452 segments 2006 to 2017, linking nationwide data on percutaneous coronary intervention and delivery history in Sweden. Main outcomes were clinical restenosis and target lesion revascularization within 2 years. We accounted for segment-, procedure-, and patient-related potential predictors of restenosis in proportional hazards regression models. Restenosis occurred in 345 segments (3.7%) and target lesion revascularization was performed on 383 patients (6.3%). A history of preeclampsia was neither significantly associated with risk of restenosis (predictor-accounted hazard ratio [HR], 0.71 [95% CI, 0.41-1.23]) nor target lesion revascularization (0.74 [95% CI, 0.51-1.07]) compared with a normotensive pregnancy history. When term and preterm preeclampsia were investigated separately, segments in women with a history of term preeclampsia had a lower risk of restenosis (predictor-accounted HR, 0.45 [95% CI, 0.21-0.94]). A history of preeclampsia was not significantly associated with death by any cause within 2 years of the index procedure (predictor-accounted HR 1.06, [95% CI, 0.62-1.80]).Conclusions: A history of preeclampsia was not associated with increased risk of restenosis but instead some evidence pointed to a decreased risk. To facilitate future studies and allow for replication, concomitant collection of data on pregnancy complication history and percutaneous coronary intervention outcomes in women is warranted.
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19.
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20.
  • Luoto, Johannes, et al. (författare)
  • Emphysema severity index (ESI) associated with respiratory death in a large Swedish general population
  • 2022
  • Ingår i: Respiratory Medicine. - : Elsevier BV. - 0954-6111. ; 200
  • Tidskriftsartikel (refereegranskat)abstract
    • Recently, it has been shown and validated that presence and severity of emphysema on computed tomography could be estimated by a novel spirometry based index, the emphysema severity index (ESI). However, the clinical relevance of the index has not been established. We conducted cox-regression analyses with adjustment for age, smoking, sex, forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) to study whether ESI was associated with all-cause, respiratory and non-respiratory 10-year mortality. Study population was all participants with acceptable spirometry from the Gott Åldrande i Skåne study, a Swedish general population aged 65–102 years old. ESI is expressed as a continuous numeric parameter on a scale ranging from 0 to 10. Out of the 4453 participants in the main study, 3974 was included in the final analysis. Higher age, higher ESI, lower FEV1 and male sex increased hazard of respiratory death. ESI was significantly correlated to respiratory death but not non-respiratory death, while high age, male sex and low FEV1 was associated with non-respiratory as well as respiratory death. Current smoking habits increased the hazard of respiratory death but did not reach significance (p 0.066) One unit increase in ESI increased hazard of all-cause death by 20% (p 0.0002) and hazard of respiratory death by 57% (p < 0.0001). The ESI is a novel clinical marker of emphysema severity that is associated with respiratory death specifically. Since it can be derived from standard spirometry there are potential benefits for clinical practice in terms of more individualised prognosis and treatment alternatives.
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21.
  • Luoto, Johannes, et al. (författare)
  • Incidence of airflow limitation in subjects 65-100 years of age.
  • 2016
  • Ingår i: European Respiratory Journal. - : European Respiratory Society (ERS). - 1399-3003 .- 0903-1936. ; 47:2, s. 461-472
  • Tidskriftsartikel (refereegranskat)abstract
    • The true incidence of chronic obstructive pulmonary disease is largely unknown, because the few longitudinal studies performed have used diagnostic criteria no longer recommended by either the European Respiratory Society or the American Thoracic Society (ATS).We studied the incidence and significance of airflow limitation in a population-based geriatric sample using both an age-dependent predicted lower limit of normal (LLN) value and a fixed-ratio spirometric criterion.Out of 2025 subjects with acceptable spirometry at baseline, 984 subjects aged 65-100 years completed a 6-year follow-up visit. Smoking habits were registered at baseline. Exclusion criteria were non-acceptable spirometry performance according to ATS criteria and inability to communicate. Airflow limitation was defined both according to forced expiratory volume in 1 s (FEV1)/forced vital capacity ratio <0.7 and
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22.
  • Luoto, Johannes, et al. (författare)
  • Relative and absolute lung function change in a general population aged 60-102 years
  • 2019
  • Ingår i: The European respiratory journal. - : European Respiratory Society (ERS). - 1399-3003 .- 0903-1936. ; 53:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Data on longitudinal lung function change in the elderly are scarce. Uncertainty remains about whether to use absolute or relative change and how it relates to subject demographics.We studied absolute and relative forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) change in a population-based geriatric sample using a repeated measurements model adjusted for age, sex, smoking habits, heart failure, hypertension, diabetes, coronary heart disease, educational level, occupation, alcohol consumption, C-reactive protein (CRP) and body mass index. 3736 participants aged 60-102 years completed between one and five spirometries during 13.5 years of follow-up. Lung volumes, FEV1 quotient (Q) and Global Lung Initiative (GLI)-2012 and National Health and Nutrition Examination Survey (NHANES) III z-scores were presented from 6932 spirometries.Adjusted absolute change per year (95% CI) was -51.7 (-63.7--39.9) mL for FEV1 and -56.2 (-73.6--38.8) mL for FVC. Adjusted relative change per year was -2.97 (-3.53--2.40)% for FEV1 and -2.46 (-3.07--1.85)% for FVC. Risk factors for increased relative FVC and FEV1 decline were female sex, higher age, current smoking habits, elevated CRP (nonsignificant for FEV1, p=0.057) and low educational level. For increased absolute decline the risk factors were male sex and being a current smoker for FEV1 and low education for FVC.Relative but not absolute change correlated significantly with clinically relevant markers of functional status and may be superior to absolute change in risk factor analysis. Cross-sectional reduction in terms of FEV1Q was ∼1 unit per 10 years for both sexes. Proportions of subjects with results below lower limit of normal using NHANES III were close to anticipated, but were two to four times higher than expected using GLI-2012.
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23.
  • Mattsson, Kristina, et al. (författare)
  • Incident Cardiovascular Disease in Women With Type 1 or Type 2 Diabetes Following a Hypertensive Disorder of Pregnancy
  • 2024
  • Ingår i: Hypertension. - 1524-4563. ; 81:4, s. 897-905
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The extent to which a history of hypertensive disorders of pregnancy is associated with incident cardiovascular disease also among women with diabetes is unknown.METHODS: In this nationwide register-based cohort study, parous women aged 18 to 69 years with a first delivery in the Swedish Medical Birth Register, regardless of diabetic status at that time, and a subsequent clinical visit in the Swedish National Diabetes Register were included. Time to first cardiovascular disease event (myocardial infarction, stroke, or heart failure) before age 70 years by hypertensive disorders of pregnancy history was separately analyzed by diabetes type using Cox regression models that included conventional risk factors.RESULTS: In total, 1748 (18.9%) of 9230 women with type 1 and 5904 (10.6%) of 55 773 women with type 2 diabetes had their first delivery complicated by a hypertensive disorder of pregnancy. Median time (25-75th percentile) between first delivery and start of follow-up was 3.3 (1.4-13.0) years for women with type 1 and 29.8 (22.4-35.6) years for women with type 2 diabetes. In modeling, the risk for any cardiovascular disease event among women with a history of hypertensive disorders of pregnancy was generally 10% to 20% higher, with main models estimating hazard ratios to 1.20 (95% CI, 0.99-1.47) for women with type 1 and 1.15 (95% CI, 1.02-1.29) for women with type 2 diabetes.CONCLUSIONS: In women with diabetes, a history of hypertensive disorders of pregnancy was associated with an increased risk of incident cardiovascular disease and should be considered as a risk enhancer.
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24.
  • Månsson, Tomas, et al. (författare)
  • Impaired kidney function is associated with lower cognitive function in the elder general population. Results from the Good Aging in Skåne (GÅS) cohort study
  • 2019
  • Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 19:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: A possible connection on vascular basis between impaired kidney function and cognitive dysfunction has been suggested in previous studies. Contradictory results regarding specific cognitive domains have been reported. The aim for this study was to investigate the association between kidney function and specific cognitive domains. Methods: In this cross-sectional design, data from the general population based cohort study "Good aging in Skåne" (GÅS) was used. The sample included 2931 subjects ages 60 to 93 randomly selected from the southern part of Sweden. Estimated glomerular filtration rate (eGFR) for both creatinine and cystatine C was calculated using the chronic kidney disease epidemiology collaboration (CKD-EPI) equation. The subjects underwent a test battery of neuropsychological tests assessing global cognitive function, learning and memory, language, complex attention, executive function, perceptual motor and meta-memory. Adjustments were made for age, sex, education and country of origin. Results: After adjustment for demographic variables, impaired kidney function was associated with 0.41 points worse result in MMSE, 0.56 points worse result in recognition, 0.66 points worse result in word fluency, 0.45 points worse result in digit cancellation, 0.99 points worse result in pattern comparison, and 3.71 s longer time to finish TMT B-A. Associations to cognitive function was also noted for mildly impaired kidney function defined as eGFR 45- < 60 ml/min/1,73m2. No association was found between kidney function and meta-memory. Conclusions: Impaired kidney function as well as the severity of impaired kidney function is associated with impairment in learning and memory, language, complex attention, executive function and global cognitive function, but not meta-memory.
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25.
  • Nilsson, Erik, et al. (författare)
  • Associations of central and brachial blood pressure with cognitive function : a population-based study
  • 2016
  • Ingår i: Journal of Human Hypertension. - : Nature Publishing Group. - 0950-9240 .- 1476-5527. ; 30:2, s. 95-99
  • Tidskriftsartikel (refereegranskat)abstract
    • Previous observational studies on the association between brachial blood pressure (BP) and cognition have reported conflicting results. Central BP has been hypothesized to be more strongly related to cognition than brachial BP. The aim of this study was to assess the association between brachial as well as central BP and cognitive function, both cross-sectionally and with brachial BP measured 17 years before cognitive testing. The study population comprised 2548 individuals aged 61-85 years at follow-up (61.4% women). The cognitive tests administered were A Quick Test of cognitive speed and the Mini Mental State Examination. In fully adjusted linear regressions, small but significant cross-sectional associations were found between higher BP (systolic, diastolic and pulse pressure) and worse results on both of the cognitive tests (P-values <0.05). No significant prospective associations were found. Central BP did not show a stronger association than brachial BP did. After stratification, significant results were mainly found in the group taking BP-lowering drugs at follow-up. In summary, these findings add to existing evidence on the relationship between BP and cognition, but they do not support a superior role of central compared with brachial BP in the elderly.
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26.
  • Nilsson, Erik D., et al. (författare)
  • Copeptin, a Marker of Vasopressin, Predicts Vascular Dementia but not Alzheimer's Disease
  • 2016
  • Ingår i: Journal of Alzheimer's Disease. - : IOS Press. - 1387-2877 .- 1875-8908. ; 52:3, s. 1047-1053
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Copeptin is a reliable surrogate marker for the neurohypophyseal hormone vasopressin. Elevated plasma level of copeptin has been associated with cardiovascular and metabolic disease risk.OBJECTIVE: To investigate the association between copeptin and risk of dementia.METHODS: In all, 18,240 individuals from Malmö, Sweden, were examined between 2002 and 2006 (mean age 69.3 years, 69.8% men). Incident cases of dementia until 31 December 2009 were identified by linkage with the Swedish National Patient Register. To validate the dementia diagnoses, medical records as well as laboratory and neuroimaging data were carefully reviewed. Baseline level of copeptin was measured in frozen plasma in: (1) all participants who were diagnosed with dementia during follow-up, (2) a random sample of 5100 individuals of the cohort.RESULTS: During a median follow-up of 4.2 years, there were 374 incident dementia cases (age range 60-83 years at baseline): 120 were classified as Alzheimer's disease (AD), 84 as vascular dementia (VaD), and 102 as mixed dementia. In logistic regressions adjusted for cardiovascular risk factors, baseline level of copeptin predicted incident VaD (Odds ratio (OR) 1.30 per 1 SD increase in log copeptin, 95% CI 1.03-1.64). Copeptin did not predict incidence of all-cause dementia (OR 1.05, 95% CI 0.94-1.18), AD (OR 0.97, 95% CI 0.79-1.18), or mixed dementia (OR 0.85, 95% CI 0.68-1.05).CONCLUSION: Elevated plasma level of copeptin is a risk marker for incident VaD, but not for incident AD. This suggests that the vasopressin hormonal system might be involved in the development of VaD.
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27.
  • Nilsson, Erik D., et al. (författare)
  • No independent association between pulse wave velocity and dementia : a population-based, prospective study.
  • 2017
  • Ingår i: Journal of Hypertension. - : Lippincott Williams & Wilkins. - 0263-6352 .- 1473-5598. ; 35:12, s. 2462-2467
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Carotid-femoral pulse wave velocity (CFPWV), a marker of aortic stiffness, has been associated with cognitive test results and markers of cerebral small vessel disease, but its association with dementia has not been studied in detail. Our aim was to assess the association of CFPWV with prevalent and incident dementia in a large population-based study.METHODS: In total, CFPWV was measured in 3056 participants of the Malmö Diet and Cancer study 2007-2012 (age range 61-85 years). Individuals scoring below preset cut-offs on cognitive screening tests were thoroughly evaluated for prevalent dementia. Also, dementia diagnoses were retrieved from the Swedish National Patient Register up until 31 December 2014, and then validated through medical records and neuroimaging findings.RESULTS: We identified 159 cases of dementia, of which 57 were classified as prevalent, and 102 as incident during a median follow-up of 4.6 years. In fully adjusted logistic regressions, CFPWV was not associated with prevalent all-cause dementia (odds ratio 0.95 per 1 m/s increase in CFPWV, 95% confidence interval 0.83-1.08), and it did not predict incident all-cause dementia (odds ratio 1.00, 95% confidence interval 0.91-1.09). Neither was CFPWV associated with subtypes of dementia (Alzheimer's disease, vascular dementia, mixed dementia), although the number of cases in subgroups were low.CONCLUSION: No independent association was found between CFPWV and dementia. It remains a matter of debate why CFPWV repeatedly has been associated with cognitive test results and markers of cerebral small vessel disease, but not with dementia.
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28.
  • Nilsson, Erik, et al. (författare)
  • Nonlinear association between pulse wave velocity and cognitive function : a population-based study
  • 2014
  • Ingår i: Journal of Hypertension. - : Lippincott Williams & Wilkins. - 0263-6352 .- 1473-5598. ; 32:11, s. 2152-2157
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Arterial stiffness has been hypothesized to contribute to cognitive decline. However, previous studies have reported inconsistent results. The aim of this cross-sectional study was to investigate the association between carotid-femoral pulse wave velocity (cfPWV), a marker of arterial stiffness, and cognitive function.METHODS: The study population comprised 2637 individuals from the population-based Malmö Diet and Cancer Study (mean age 72.1 years, 60.8% women). During the follow-up examinations between 2007 and 2012, cfPWV and results on the a quick test of cognitive speed (AQT) and Mini Mental State Examination (MMSE) cognitive tests were measured.RESULTS: After adjustments for demographics and traditional cardiovascular risk factors, a linear association was found between cfPWV and AQT (B = 0.37; P = 0.039). On the basis of hypothesis that individuals with high cfPWV values have worse cognitive function than can be inferred from a linear association, cfPWV was dichotomized at the 90th percentile (the binary variable denoted cfPWV >13.8). When cfPWV >13.8 was added to the model, the linear association between continuous cfPWV and AQT disappeared (B = -0.08; P = 0.72), but cfPWV >13.8 was highly significant (B = 4.81; P = 0.004). In the adjusted model with MMSE as outcome variable, cfPWV >13.8 also reached a statistically significant effect.CONCLUSION: Arterial stiffness was inversely associated with cognitive function in a nonlinear fashion, with individuals in the top decentile of cfPWV explaining the association. Results from linear regressions should thus be interpreted with caution because, even when statistical significance is reached, they can be explained by pronounced nonlinearity.
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29.
  • Overton, Marieclaire, et al. (författare)
  • Diagnostic Stability of Mild Cognitive Impairment, and Predictors of Reversion to Normal Cognitive Functioning
  • 2020
  • Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 48:5-6, s. 317-329
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Studies that investigate predictive factors for spontaneous recovery (reversion) from mild cognitive impairment (MCI) are only beginning to emerge, and the long-term course of MCI is not properly understood. We aimed to investigate stability of the MCI diagnosis, predictors for reversion, as well as the trajectory of MCI over the course of 12 years. Materials and Methods: Data were drawn from the Swedish population study: Good Aging in Skåne with MCI defined according to the expanded Mayo Clinic criteria. A total of 331 participants, aged 60-95 years with MCI, were used to investigate 6-year MCI stability and reversion, and 410 participants were used to inspect 12-year MCI trajectory. Predictors for reversion included demographical factors, psychological status, and factors tied to the cognitive testing session and the operationalization of the MCI criteria. Results: Over half (58%, 95% CI 52.7-63.3) of the participants reverted back to normal cognitive functioning at 6-year follow-up. Of those with stable MCI, 56.5% (95% CI 48.2-64.8) changed subtype. A total of 23.9% (95% CI 13.7-34.1) of the 6-year follow-up reverters re-transitioned back to MCI at 12-year follow-up. ORs for reversion were significantly higher in participants with lower age (60-year-olds: OR 2.19, 95% CI 1.08-4.43, 70-year-olds: OR 3.11, 95% CI 1.27-7.62), better global cognitive functioning (OR 1.15, 95% CI 1.03-1.29), good concentration (OR 2.53, 95% CI 1.06-6.05), and single-domain subtype (OR 2.68, 95% CI 1.51-4.75). Conclusion: Our findings provide further support that MCI reversion to normal cognitive functioning as well as re-transitioning to MCI is fairly common, suggesting that the MCI trajectory does not necessarily lead straight to dementia. Additionally, assessment of factors associated with reversion can aid clinicians to make accurate MCI progression prognosis.
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30.
  • Overton, Marieclaire, et al. (författare)
  • Prevalence and Incidence of Mild Cognitive Impairment across Subtypes, Age, and Sex
  • 2019
  • Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 47:4-6, s. 219-232
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The purpose of this study was to report on the prevalence and incidence of mild cognitive impairment (MCI) across age, sex, and subtypes according to various criteria in a population-based sample. Methods: The sample was drawn from the Swedish Good Aging in Skåne (GÅS) population study, and data from 3,752 participants aged 60 years and more were used to calculate the MCI prevalence. The incidence was calculated using 2,093 participants with 6-year follow-up data. MCI was defined according to the expanded Mayo Clinic criteria: cognitive complaint, objective cognitive impairment (two different criteria depending on the severity of impairment), preserved functional abilities, and no dementia. Results: The prevalence estimates ranged from 5.13 to 29.9% depending on age and severity of impairment. The incidence rates of overall MCI were 22.6 (95% confidence interval [CI]: 19.6-25.9) and 8.67 (95% CI: 7.0-10.7) per 1,000 person-years for less severe and severe cognitive impairment, respectively. The highest prevalence and incidence estimates were found for "non-amnestic MCI single domain." The older age groups had a higher prevalence, and no sex or age differences in MCI incidence were detected. Conclusion: Our findings concur with previous research advocating that MCI is a heterogeneous concept, since the prevalence and incidence estimates differed substantially according to age, MCI subtype, and severity of cognitive impairment.
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31.
  • Overton, Marieclaire, et al. (författare)
  • Test administrator effects on cognitive performance in a longitudinal study of ageing
  • 2016
  • Ingår i: Cogent Psychology. - : Informa UK Limited. - 2331-1908. ; 3:1
  • Tidskriftsartikel (refereegranskat)abstract
    • In longitudinal studies, changes in participants’ cognitive performances can partly be attributed to variations in the testing situation (testing specific factors), such as, different test administrators or different testing environments. Focusing on test administrator influence, testing specific factors were examined in a Swedish longitudinal study of ageing. Test scores from 6,686 examinations revealed significant test administrator effects on all instruments measuring speed of processing, episodic memory and spatial ability. 1.4–3.5% of the total variation in test scores was explained by the factor attributed to the test administrator. Further, results indicated task familiarity on speed scores, and fatigue attributable to the time of day of the testing session for memory and spatial ability. Participants tested in the testing centre performed significantly better than participants who received home visits. This study provides evidence that testing specific factors are tangible concerns in longitudinal ageing studies.
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32.
  • Overton, Marieclaire, et al. (författare)
  • Up to speed : Birth cohort effects observed for speed of processing in older adults: Data from the Good Ageing in Skåne population study
  • 2018
  • Ingår i: Intelligence. - : Elsevier BV. - 0160-2896. ; 67, s. 33-43
  • Tidskriftsartikel (refereegranskat)abstract
    • Neuropsychological test-based norms are vital for accurate assessment of older adults’ level of cognition. Hence, it is important that these scores are not conflated with birth cohort effects. With data drawn from the Swedish Good Ageing in Skåne (GÅS) population study, this study examined birth cohort effects on test scores measuring several cognitive domains. A time-lag design with three distinct birth years, separated by 5–7 years, and with two age-matched samples of older participants, was used. Participants aged 60 were born 1942–1955 and those aged 81 were born 1920–1933. Results reveal significant (p < 0.05) birth cohort effects on speed of processing, episodic memory, attention, executive functioning and vocabulary test scores. Effect sizes for specific cohort comparisons (e.g. 1942–43 vs. 1947–48) were modest (Cohen's d = 0.19–0.43). When adjusting for participants’ level of education classified in years or in categories, birth cohort effects on test scores remained stable. Findings support the presence of birth cohort effects in samples of older adults, showing that participants’ level of education cannot fully account for these effects. Thus, neuropsychological test scores should routinely be examined for birth cohort effects in cross-sectional data for a correct assessment of cognition.
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33.
  • Pehrson, Moa, et al. (författare)
  • Coronary artery restenosis and target lesion revascularisation in women by pregnancy history
  • 2023
  • Ingår i: Open heart. - : BMJ Publishing Group Ltd. - 2053-3624 .- 2398-595X. ; 10:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundWomen's pregnancy history is associated with incident risk of coronary artery disease with some evidence also suggesting a relevance for prognosis following treatment.ObjectivesTo study the associations between maternal history of preterm delivery, a history of small for gestational age infant, parity and age at first delivery with clinical restenosis after percutaneous coronary intervention (PCI).MethodsIn this prospective cohort study, we included 6027 women <65 years undergoing their first PCI 2006-2017, merging clinical register data on PCI procedures in Sweden with comprehensive registry data on deliveries since 1973. We used proportional hazards regression to study the association between aspects of pregnancy history and clinical restenosis in per-segment analyses, and with target lesion revascularisation (TLR) in per-patient analyses. We adjusted models for procedural-related and patient-related predictors of restenosis.ResultsDuring 15 981 segment-years of follow-up, 343 (3.7%) events of clinical restenosis occurred. We found no strong evidence of associations between the studied aspects of pregnancy history and clinical restenosis following PCI. For example, the restenosis HR for a history of preterm delivery in the fully adjusted model was 1.09 (95% CI 0.77 to 1.55) and the TLR HR was 1.18 (95% CI 0.91 to 1.52).ConclusionRisk of restenosis following treatment with PCI did not differ by the studied aspects of pregnancy history, including preterm delivery, in young and middle-aged women. Larger studies are needed to obtain more precise estimates.
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34.
  • Pehrson, Moa, et al. (författare)
  • Long-Term Outcome Following Coronary Artery Stenting by History of Preterm Delivery
  • 2022
  • Ingår i: JACC: Advances. - : Elsevier BV. - 2772-963X. ; 1:5
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundWomen are at a greater risk of a major adverse cardiovascular event (MACE) after percutaneous coronary intervention than men. A history of preterm delivery is a female-specific risk factor for coronary artery disease, but its relevance in the treatment of coronary artery disease is unknown.ObjectivesThe purpose of this study was to analyze the association between a history of preterm delivery and MACE after the first coronary artery stenting.MethodsWe included a nationwide sample of 5,766 Swedish women aged ≤65 years receiving their first coronary stent during 2006 to 2017. To adjust for periprocedural characteristics and estimate the association between a history of preterm delivery and MACE at >30 days from stenting, we used proportional hazards regression. We also investigated mortality by history of preterm delivery.ResultsDuring a median follow-up time of 3.7 years (IQR: 1.3-6.7 years), 1,200 (20.8%) women had a MACE. In total, 963 (16.7%) women had a history of preterm delivery. A history of preterm delivery was associated with a higher risk of MACE (adjusted HR: 1.19; 95% CI: 1.03-1.38) and mortality (adjusted HR ratio: 1.38; 95% CI: 1.02-1.85). Similar associations were observed when excluding women with a history of hypertensive disorders of pregnancy or diabetes. Subgroup analyses suggested that women with a history of early preterm delivery had lower risk of MACE than those who had late preterm delivery (P = 0.04).ConclusionsHistory of preterm delivery is associated with worse prognosis following the first coronary artery stenting in women and warrants consideration as a risk factor also in the secondary prevention setting.
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35.
  • Pihlsgård, Mats (författare)
  • Local martingales with two reflecting barriers
  • 2015
  • Ingår i: Journal of Applied Probability. - 1475-6072. ; 52:4, s. 1062-1075
  • Tidskriftsartikel (refereegranskat)abstract
    • We give an account of the characteristics that result from reflecting a drifting local martingale (i.e. the sum of a local martingale and a multiple of its quadratic variation process) in 0 and b > 0. We present conditions which guarantee the existence of finite moments of what is required to keep the reflected process within its boundaries. Also, we derive an associated law of large numbers and a central limit theorem which apply when the input is continuous. Similar results for integrals of the paths of the reflected process are also presented. These results are in close agreement to what has previously been shown for Brownian motion.
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36.
  • Pihlsgård, Mats (författare)
  • Loss rate asymptotics in a GI/G/1 queue with finite buffer
  • 2005
  • Ingår i: Stochastic Models. - : Informa UK Limited. - 1532-6349 .- 1532-4214. ; 21:4, s. 913-931
  • Tidskriftsartikel (refereegranskat)abstract
    • We consider the stationary loss rate l(K) of a GI/G/1 queue with finite buffer of size K. Let X-n = U-n - T-n, n >= 1 where U-n is the service time, T-n is the interarrival time and let rho be the traffic intensity. We derive sharp asymptotics for the loss rate as K -> infinity, in the cases (i): rho > 1, and (ii): rho < 1 and X-n non-lattice with light tails. We also look at another reflection, related to Moran's dam model. As an example, we look at the PH/PH/1 case, where we show how to compute the asymptotic loss rate as well as the exact one and illustrate our results numerically.
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37.
  • Pihlsgård, Mats, et al. (författare)
  • On the Dynamics of Semimartingales with Two Reflecting Barriers
  • 2013
  • Ingår i: Journal of Applied Probability. - 1475-6072. ; 50:3, s. 671-685
  • Tidskriftsartikel (refereegranskat)abstract
    • We consider a semimartingale X which is reflected at an upper barrier T and a lower barrier S, where S and T are also semimartingales such that T is bounded away from S. First, we present an explicit construction of the reflected process. Then we derive a relationship in terms of stochastic integrals linking the reflected process and the local times at the respective bathers to X, S, and T. This result reveals the fundamental structural properties of the reflection mechanism. We also present a few results showing how the general relationship simplifies under additional assumptions on X, S, and T, e.g. if we take X, S, and T to be independent martingales (which satisfy some extra technical conditions).
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38.
  • Pihlsgård, Mats (författare)
  • Two-Barrier Problems in Applied Probability: Algorithms and Analysis
  • 2005
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • This thesis consists of five papers (A-E). In Paper A, we study transient properties of the queue length process in various queueing settings. We focus on computing the mean and the Laplace transform of the time required for the queue length starting at $x0. We define the loss rate due to the reflection. The main result is sharp asymptotics for the loss rate as $K$ tends to infinity. As a major example, we consider the case where the increments of the random walk may be written as the difference between two phase-type distributed random variables. In this example we perform an explicit comparison between asymptotic and exact results for the loss rate. Paper C deals with queues and insurance risk processes where a generic service time, respectively generic claim, has a truncated heavy-tailed distribution. We study the compound Poisson ruin probability (or, equivalently, the tail of the M/G/1 steady-state waiting time) numerically. Furthermore, we investigate the asymptotics of the asymptotic exponential decay rate as the truncation level tends to infinity in a more general truncated Lévy process set-up. Paper D is a sequel of Paper B. We consider a Lévy process reflected at 0 and $K$>0 and define the loss rate. The first step is to identify the loss rate, which is non-trivial in the Lévy process case. The technique we use is based on optional stopping of the Kella-Whitt martingale for the reflected process. Once the identification is performed, we derive asymptotics for the loss rate in the case of a light-tailed Lévy measure. Paper E is also a sequel of Paper B. We present an algorithm for simulating the loss rate for a reflected random walk. The algorithm is efficient in the sense of bounded relative error. Key words: many-server queues, quasi birth-death processes, Kella-Whitt martingale, optional stopping, heterogeneous servers, reflected random walks, loss rate, Lundberg's equation, Cramér-Lundberg approximation, Wiener-Hopf factorization, asymptotics, phase-type distributions, reflected Lévy processes, light tails, efficient simulation.
  •  
39.
  • Pihlsgård, Per, et al. (författare)
  • Volatile compounds in the production of liquid beet sugar
  • 2000
  • Ingår i: Journal of agricultural and food chemistry. - : American Chemical Society (ACS). - 0346-718X .- 0021-8561 .- 1520-5118. ; 48:10, s. 4844-4850
  • Tidskriftsartikel (refereegranskat)abstract
    • Samples from different parts of a beet sugar factory and refinery were analyzed with respect to volatile compounds by means of liquid-liquid extraction followed by gas chromatography-mass spectrometry (GC-MS). A limited number of the samples were analyzed by means of gas phase extraction (headspace) followed by GC-MS. Selected compounds were followed through the sugar manufacturing process. The behavior of different compounds varied greatly throughout the process, with some compounds such as geosmin (trans-1,10-dimethyl-trans-9-decalol), dimethyl disulfide, and propionic and hexanoic acid present at the beginning of the process but disappearing rapidly after further processing. Other compounds, such as indole, dihydrobenzofuran, and 2-phenylethanol, were not detected at the start of the process but were formed later on and removed in the final product. In the final product, three pyrazines remained at fairly low concentrations, together with 3-methylcyclopentadione, ethylhexanol, and methyl pyrrole ketone.
  •  
40.
  • Rydelius, Anna, et al. (författare)
  • Longitudinal study of cognitive function in glioma patients treated with modern radiotherapy techniques and standard chemotherapy
  • 2020
  • Ingår i: Acta Oncologica. - 0284-186X. ; 59:9, s. 1091-1097
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Cognitive function is an important outcome measure in patients with brain tumor, providing information about the patient’s clinical situation, treatment effects and possible progressive disease. The aim of this longitudinal study was to evaluate effects of the currently used radiation and chemotherapy treatment on cognitive function and to investigate associations between cognitive function at baseline and progression as well as overall survival. Methods: 32 patients newly diagnosed with malignant glioma were evaluated at baseline with CNS Vital Signs (CNS-VS), a computerized standardized neuropsychological test battery, prior to arc-based radiotherapy and concomitant chemotherapy with Temozolomide. CNS-VS measures the cognitive functions known to be affected in patients with brain tumor, covering nine cognitive domains. Follow-up cognitive evaluations were performed in 26 patients after 3.5 months and in 13 patients 1 year after treatment start. Results: Overall cognitive scores were lower in the studied patient cohort at baseline compared to standardized domain scores. At 3.5 months follow-up cognitive functioning was slightly decreased, but only in 1/9 cognitive domains–visual memory–where significant changes were found compared to baseline test results. Similarly, at 12 months follow-up no significant changes in cognitive test results were seen compared to baseline examination, except for a decrease in the visual memory domain. In relation to early progression, the most significant cognitive deficits were dysfunctional visual memory and low executive functioning at baseline. Low executive function at baseline correlated most significantly with shorter overall survival. Conclusion: The present study suggests that the currently used arc-based radiotherapy and chemotherapy might affect cognitive function less negatively than previously described during treatment and in the first year after treatment in malignant glioma patients. In general, a high cognitive test score at baseline was associated with longer time to progression and with longer survival.
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41.
  • Sederholm Lawesson, Sofia, 1973-, et al. (författare)
  • Association Between History of Adverse Pregnancy Outcomes and Coronary Artery Disease Assessed by Coronary Computed Tomography Angiography.
  • 2023
  • Ingår i: JAMA. - : American Medical Association (AMA). - 1538-3598 .- 0098-7484. ; 329:5, s. 393-404
  • Tidskriftsartikel (refereegranskat)abstract
    • Adverse pregnancy outcomes are recognized risk enhancers for cardiovascular disease, but the prevalence of subclinical coronary atherosclerosis after these conditions is unknown.To assess associations between history of adverse pregnancy outcomes and coronary artery disease assessed by coronary computed tomography angiography screening.Cross-sectional study of a population-based cohort of women in Sweden (n=10528) with 1 or more deliveries in 1973 or later, ascertained via the Swedish National Medical Birth Register, who subsequently participated in the Swedish Cardiopulmonary Bioimage Study at age 50 to 65 (median, 57.3) years in 2013-2018. Delivery data were prospectively collected.Adverse pregnancy outcomes, including preeclampsia, gestational hypertension, preterm delivery, small-for-gestational-age infant, and gestational diabetes. The reference category included women with no history of these exposures.Coronary computed tomography angiography indexes, including any coronary atherosclerosis, significant stenosis, noncalcified plaque, segment involvement score of 4 or greater, and coronary artery calcium score greater than 100.A median 29.6 (IQR, 25.0-34.9) years after first registered delivery, 18.9% of women had a history of adverse pregnancy outcomes, with specific pregnancy histories ranging from 1.4% (gestational diabetes) to 9.5% (preterm delivery). The prevalence of any coronary atherosclerosis in women with a history of any adverse pregnancy outcome was 32.1% (95% CI, 30.0%-34.2%), which was significantly higher (prevalence difference, 3.8% [95% CI, 1.6%-6.1%]; prevalence ratio, 1.14 [95% CI, 1.06-1.22]) compared with reference women. History of gestational hypertension and preeclampsia were both significantly associated with higher and similar prevalence of all outcome indexes. For preeclampsia, the highest prevalence difference was observed for any coronary atherosclerosis (prevalence difference, 8.0% [95% CI, 3.7%-12.3%]; prevalence ratio, 1.28 [95% CI, 1.14-1.45]), and the highest prevalence ratio was observed for significant stenosis (prevalence difference, 3.1% [95% CI, 1.1%-5.1%]; prevalence ratio, 2.46 [95% CI, 1.65-3.67]). In adjusted models, odds ratios for preeclampsia ranged from 1.31 (95% CI, 1.07-1.61) for any coronary atherosclerosis to 2.21 (95% CI, 1.42-3.44) for significant stenosis. Similar associations were observed for history of preeclampsia or gestational hypertension among women with low predicted cardiovascular risk.Among Swedish women undergoing coronary computed tomography angiography screening, there was a statistically significant association between history of adverse pregnancy outcomes and image-identified coronary artery disease, including among women estimated to be at low cardiovascular disease risk. Further research is needed to understand the clinical importance of these associations.
  •  
42.
  • Sennfält, Stefan, et al. (författare)
  • Ischemic stroke patients with prestroke dependency : Characteristics and long-term prognosis
  • 2021
  • Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 143:1, s. 78-88
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: This paper aims at examining the clinical characteristics of ischemic stroke patients with different levels of prestroke functional dependency, their long-term outcome, and determinants of five-year mortality. Materials and methods: We describe demographics, comorbidity, treatment, as well as long-term mortality, and functional status of 5899 prestroke-dependent ischemic stroke patients stratified by dependency level and compared to a concurrent cohort of 14 148 prestroke-independent patients. The study was based on 2016 survey data from Riksstroke, the Swedish national stroke register, and patients were followed up at three months, 12 months, and either at three or five years. We used Cox regression for mortality predictor analysis and multiple imputation was performed to minimize bias from loss to follow-up. Results: With increasing level of prestroke dependency, comorbidity burden was higher, drug prescription lower, and prognosis less favorable. At three years, the proportion that had died or deteriorated were 82.6%, 87.5%, and 86.3% in moderate, moderately severe, and severe dependency, respectively. In moderate dependency, prognosis was relatively favorable: Three-month mortality was half of that seen in severe dependency (25.3% versus 49.6%). Differences in overall outcome between groups of varying prestroke functional dependency level were statistically significant (P <.05) at all follow-up time points. Conclusions: There was great heterogeneity between groups of different level of prestroke dependency; those of moderate dependency had a relatively favorable prognosis. Patients of different prestroke level of dependency need to be addressed separately, and further research is needed characterizing this group and exploring management strategies.
  •  
43.
  • Sennfält, Stefan, et al. (författare)
  • Long-term outcome after ischemic stroke in relation to comorbidity – An observational study from the Swedish Stroke Register (Riksstroke)
  • 2020
  • Ingår i: European Stroke Journal. - : SAGE Publications. - 2396-9873 .- 2396-9881. ; 5:1, s. 36-46
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Comorbidity in stroke is common, but comprehensive reports are sparse. We describe prevalence of comorbidity and the prognostic impact on mortality and functional outcome in a large national ischemic stroke cohort. Methods: We used outcome data from a long-term follow-up survey conducted in 2016 by the Swedish Stroke Register (Riksstroke). Those included in the study were 11 775 pre-stroke functionally independent patients with first-ever ischemic stroke followed up at three months and 12 months (all patients), and three years (2013 cohort) or five years (2011 cohort). Pre-stroke comorbidity data for 16 chronic conditions were obtained from the Swedish National Patient Register, the Swedish Prescribed Drugs Register and the Riksstroke register. Individuals were grouped according to number of conditions: none (0), low (1), moderate (2–3) or high (≥4). Co-occurrence was analysed using hierarchical clustering, and multivariable analyses were used to estimate the prognostic significance of individual conditions. Results: The proportion of patients without comorbidity was 24.8%; 31.8% had low comorbidity; 33.5% had moderate comorbidity and 9.9% had high comorbidity. At 12 months, the proportion of poor outcome (dead or dependent: mRS ≥3) was 24.8% (no comorbidity), 34.7% (low), 45.2% (moderate) and 59.4% (high). At five years, these proportions were 37.7%, 50.3%, 64.3%, and 81.7%, respectively. There was clustering of cardiovascular conditions and substantial negative effects of dementia, kidney, and heart failure. Conclusion: Comorbidity is common and has a strong impact on mortality and functional outcome. Our results highlight the need for health systems to shift focus to a comprehensive approach in stroke care that includes multimorbidity as a key component.
  •  
44.
  • Timpka, Simon, et al. (författare)
  • Short-term association between outdoor temperature and the hydration-marker copeptin : a pooled analysis in five cohorts
  • 2023
  • Ingår i: EBioMedicine. - : Elsevier BV. - 2352-3964. ; 95
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Whereas outdoor temperature is linked to both mortality and hydration status, the hormone vasopressin, measured through the surrogate copeptin, is a marker of cardiometabolic risk and hydration. We recently showed that copeptin has a seasonal pattern with higher plasma concentration in winter. Here, we aimed to investigate the association between outdoor temperature and copeptin.METHODS: Copeptin was analysed in fasting plasma from five cohorts in Malmö, Sweden (n = 26,753, 49.7% men, age 18-86 years). We utilized a multivariable adjusted non-linear spline model with four knots to investigate the association between short-term temperature (24 h mean apparent) and log copeptin z-score.FINDINGS: We found a distinct non-linear association between temperature and log copeptin z-score, with both moderately low and high temperatures linked to higher copeptin concentration (p < 0.0001). Between 0 °C and nadir at the 75th temperature percentile (corresponding to 14.3 °C), log copeptin decreased 0.13 z-scores (95% CI 0.096; 0.16), which also inversely corresponded to the increase in z-score log copeptin between the nadir and 21.3 °C.INTERPRETATION: The J-shaped association between short-term temperature and copeptin resembles the J-shaped association between temperature and mortality. Whereas the untangling of temperature from other seasonal effects on hydration warrants further study, moderately increased water intake constitutes a feasible intervention to lower vasopressin and might mitigate adverse health effects of both moderately cold and hot outdoor temperatures.FUNDING: Swedish Research Council, Å Wiberg, M Stephen, A Påhlsson, Crafoord and Swedish Heart-Lung Foundations, Swedish Society for Medical Research and Swedish Society of Medicine.
  •  
45.
  • Vikhareva, Olga, et al. (författare)
  • Strategies to increase the rate of vaginal deliveries after cesarean without negative impact on outcomes
  • 2022
  • Ingår i: Midwifery. - : Elsevier BV. - 0266-6138. ; 106
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To compare the rate of vaginal birth after cesarean section (VBAC), including the maternal and perinatal outcomes, in two historical cohorts before and after the implementation of specific changes in the clinical practice. Design: A retrospective cohort study. Setting: Skåne University Hospital in Malmö, Sweden. Participants: including all women with one previous cesarean section (CS), who delivered during two 4-year periods: 2005–2008 (Group I) and 2013–2016 (Group II). Methods: Medical records were retrieved from the hospital's computerized medical system. The surgical reports of all women delivered by repeat CS were reviewed and the appearance of the lower uterine segment at CS was assessed. The primary outcome was VBAC. Secondary maternal outcomes were uterine rupture/dehiscence, hysterectomy and blood loss. The secondary perinatal outcomes were cord blood pH < 7.05 and perinatal mortality rate. Differences for categorical data were studied using the chi-square test and Fisher's exact test. To assess differences for continuous data t-tests were used. To determine which factors predicted VBAC both univariate and multivariate logistic regression analysis with the likelihood ratio test were performed. A two-tailed P-value < 0.05 was considered statistically significant Findings: 2017 patients were included to the study: 792 patients in Group I and 1225 in Group II. The rate of trial of labor after cesarean (TOLAC) was 65.0% and 76.9% and the VBAC rate was 49.8% and 62.0% in Group I and II respectively (p < 0.0001). Maternal and perinatal adverse outcomes were not statistically different between the two groups. Key conclusions and implications for practice: Appropriate management of women with one previous CS might increase the VBAC rate without a negative impact on maternal or perinatal outcomes. The antenatal teamwork has the greatest contribution to VBAC rate by increasing the number of women undergoing TOLAC.
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46.
  • Werner, Karin, et al. (författare)
  • Combining Cystatin C and Creatinine Yields a Reliable Glomerular Filtration Rate Estimation in Older Adults in Contrast to β-Trace Protein and β2-Microglobulin
  • 2017
  • Ingår i: Nephron. - : S. Karger AG. - 1660-8151 .- 2235-3186. ; 137, s. 29-37
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The glomerular filtration rate (GFR) is the most important measure of kidney function and chronic kidney disease (CKD). This study aims to validate commonly used equations for estimated GFR (eGFR) based on creatinine (cr), cystatin C (cys), β-trace protein (BTP), and β2-microglobulin (B2M) in older adults. Method: We conducted a validation study with 126 participants aged between 72 and 98 with a mean measured GFR (mGFR) by iohexol clearance of 54 mL/min/1.73 m2. The eGFR equations (CKD-Epidemiology collaboration [CKD-EPI], Berlin Initiative Study [BIS], Full Age Spectrum [FAS], Modification of Diet in Renal Disease [MDRD]cr, Caucasian-Asian-Pediatric-Adult [CAPA]cys, Lund-Malmö Revised [LM-REV]cr, and MEAN-LM-CAPAcr-cys), were assessed in terms of bias (median difference: eGFR-mGFR), precision (interquartile range of the differences), and accuracy (P30: percentage of estimates ±30% of mGFR). The equations were compared to a benchmark equation: CKD-EPIcr-cys. Results: All cystatin C-based equations underestimated the GFR compared to mGFR, whereas bias was mixed for the equations based only on creatinine. Accuracy was the highest for CKD-EPIcr-cys (98%) and lowest for MDRD (82%). Below mGFR 45 mL/min/1.73 m2 only equations incorporating cystatin C reached P30 accuracy >90%. CKD-EPIcr-cys was not significantly more accurate than the other cystatin C-based equations. In contrast, CKD-EPIcr-cys was significantly more accurate than all creatinine-based equations except LM-REVcr. Conclusion: This study confirms that it is reasonable to use equations incorporating cystatin C and creatinine in older patients across a wide spectrum of GFR. However, the results call into question the use of creatinine alone below mGFR 45 mL/min/1.73 m2. B2M and BTP do not demonstrate additional value in eGFR determination in older adults.
  •  
47.
  • Werner, Karin, et al. (författare)
  • Cystatin C and creatinine-based eGFR levels and their correlation to long-term morbidity and mortality in older adults
  • 2019
  • Ingår i: Aging clinical and experimental research. - : Springer Science and Business Media LLC. - 1594-0667 .- 1720-8319. ; 31:10, s. 1461-1469
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The prevailing diagnostic criteria for CKD are age-independent, but have been challenged in light of the eGFR decline associated with normal aging. The stages of CKD communicate magnitude of risk of ESRD, cardiovascular morbidity, and mortality. Aims: This study aims to provide more insight into the morbidity and mortality associated with eGFR levels corresponding to the current CKD stages in older adults. Methods: The 2931 older adults in the Good Aging in Skåne study were randomized from the general population. The exposure variable used was eGFR level (CKD-EPI based on creatinine and cystatin C) with eGFR 60–89 mL/min/1.73 m2 as a reference; the outcomes were mortality, acute cardiovascular disease, congestive heart failure, and rapid kidney function decline (RKFD; defined as a decline in eGFR by 3 mL/min/1.73 m2 per year or more). Results: The mean age at baseline was 73 (SD 11) and mean follow-up time 11 (SD 5) years. Mortality was higher at lower eGFR levels with adjusted HR (95% CI) being 1.58 (1.34–1.88), 1.22 (1.05–1.41), 1 (reference), and 0.90 (0.67–1.21) for eGFR < 45, 45–59, 60–89 and ≥ 90 mL/min/1.73 m2, respectively. For acute CVD the adjusted HR (95% CI) were 1.23 (0.81–1.87), 1.21 (0.87–1.69), 1 (reference), and 0.53 (0.28–1.00) for the same eGFR levels. Conclusions: This study confirms that mortality in older adults increases with decreasing eGFR at eGFR levels below today’s threshold for CKD. The correlation was less certain for lower eGFR and incident cardiovascular disease.
  •  
48.
  • Werner, Karin, et al. (författare)
  • Male sex and vascular risk factors affect cystatin C-derived renal function in older people without diabetes or overt vascular disease.
  • 2014
  • Ingår i: Age and Ageing. - : Oxford University Press (OUP). - 1468-2834 .- 0002-0729. ; 43:3, s. 411-417
  • Tidskriftsartikel (refereegranskat)abstract
    • Background/objectives: to explore the effect of ageing on renal function with cystatin C as the marker of glomerular filtration rate (GFR) in the general population without vascular disease or diabetes.Design: a cross-sectional analysis of a healthy subset from the Good Aging in Skåne-cohort study representative of the Swedish general population.Subjects: 1252 participants without vascular disease and diabetes (43.9% men) of whom 203 were over 80 years old were included from the original cohort of 2931.Methods: plasma cystatin C and plasma creatinine were used as markers for GFR. Estimated GFR (eGFR) was calculated with three chronic kidney disease epidemiology collaboration (CKD-EPI) formulas involving cystatin C, creatinine or both.Results: the median for plasma cystatin C was 0.93 mg/l (60-69 years old), 1.04 (70-79 years old) and 1.24 (80+ years old). The difference in mg/l between the 5th and 95th percentile was 0.46, 0.62 and 0.90 for these age groups. Male sex increased the age effect on plasma cystatin C levels with 0.004 mg/l/year (P = 0.03), adjusted for vascular risk factors. Smoking, lower HDL and higher diastolic blood pressure were associated with higher cystatin C levels. 54.7% (CKD-EPI creatinine) to 73.9% (CKD-EPI cystatin C) of the 80+ had an eGFR < 60 ml/min/1.73 m(2).Conclusion: non-diabetics without overt vascular disease exhibit an age related but heterogeneous decline in renal function. The ageing effect is more pronounced in men. At least half of healthy 80+ years old could be expected to have at least CKD Stage 3 with eGFR < 60 ml/min/1.73 m(2).
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