Thomas A Gerds

IT University of Copenhagen, København, Capital Region, Denmark

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Publications (132)402.09 Total impact

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    ABSTRACT: Aim Although the relation between stroke risk factors and stroke in patients with atrial fibrillation (AF) has been extensively examined, only few studies have explored the association of AF and the risk of ischaemic stroke/systemic thromboembolism/transient ischaemic attack (stroke/TE/TIA) in the presence of concomitant stroke risk factors. Methods and results From nationwide registries, all persons who turned 50, 60, 70, or 80 from 1997 to 2011 were identified. Persons receiving warfarin were excluded. The absolute risk of stroke/TE/TIA was reported for a 5-year period, as was the absolute risk ratios for AF vs. no AF according to prior stroke and the number of additional risk factors. The study cohort comprised of 3 076 355 persons without AF and 48 189 with AF. For men aged 50 years, with no risk factors, the 5-year risk of stroke was 1.1% (95% confidence interval 1.1–1.1); with AF alone 2.5% (1.8–3.2); with one risk factor and no prior stroke or AF 2.5% (2.3–2.7); and with one factor, no prior stroke and AF 2.9% (1.4–4.3). In men aged 50 years with prior stroke as the only risk factor, 5-year risk was 10.2% (9.1–11.3). In men aged 70 years, the corresponding risks were 4.8% (4.7–4.9), 6.8% (5.7–7.9), 6.6% (6.3–6.8), 8.7 (7.4–9.9), and 19.1% (18.1–20.1), respectively. In women aged 50 years, the risk was of 0.7% (0.7–0.7), 2.1% (0.9–3.2), 1.6% (1.4–1.8), 4.1% (0.6–7.6), and 7.2% (6.3–8.2), respectively, and in women aged 70 years 3.4% (3.3–3.5), 8.2% (7.0–9.5), 4.6% (4.4–4.8), 9.1% (7.5–10.6), and 15.4% (14.5–16.4), respectively. Conclusions Stroke/TE/TIA risk was particularly increased when prior stroke/TE/TIA was present. Atrial fibrillation is associated with an increase in risk of stroke/TE/TIA in the absence of other risk factors but only a moderate increase in risk when other risk factors are present.
    No preview · Article · Feb 2016 · Europace
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    ABSTRACT: Background The prognostic value of PSA kinetics in untreated prostate cancer (PCa) patients is debatable. We investigated the association between PSA doubling time (PSAdt), PSA velocity (PSAvel), and PSAvel risk count (PSAvRC) and PCa mortality in a cohort of patients with localised PCa managed on watchful waiting.
    No preview · Article · Dec 2015 · Annals of Oncology
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    Full-text · Dataset · Dec 2015
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    ABSTRACT: Background In patients with ischemic stroke of non-cardioembolic origin, acetylsalicylic acid, clopidogrel, or a combination of acetylsalicylic acid and dipyridamole are recommended for the prevention of a recurrent stroke. The purpose of this study was to examine the risk of bleeding or recurrent stroke associated with these three treatments. Methods Patients who were discharged with first-time ischemic stroke from 2007–2010, with no history of atrial fibrillation were identified from Danish nationwide registries. Hazard ratios (HRs) and 1-year risks of recurrent ischemic stroke and bleeding were calculated for each antiplatelet regimen. Results Among patients discharged after first-time ischemic stroke, 3043 patients were treated with acetylsalicylic acid, 12,295 with a combination of acetylsalicylic acid and dipyridamole, and 3885 with clopidogrel. Adjusted HRs for clopidogrel versus the combination of acetylsalicylic acid and dipyridamole were 1.02 (95 % confidence interval [CI]: 0.89–1.17) for ischemic stroke and 1.06 (95 % CI: 0.83–1.35) for bleeding. Adjusted HRs for acetylsalicylic acid versus the combination of acetylsalicylic acid and dipyridamole were 1.48 (95 % CI: 1.31–1.67) for stroke and 1.47 (95 % CI: 1.18–1.82) for bleeding. Clopidogrel versus acetylsalicylic acid yielded HRs of 0.69 (95 % CI: 0.59–0.81) and 0.72 (95 % CI: 0.55–0.96) for stroke and bleeding, respectively. The 1-year predicted risks associated with acetylsalicylic acid, the combination of acetylsalicylic acid and dipyridamole, and clopidogrel were 11.1 (95 % CI: 10.2–12.2), 7.7 (95 % CI: 7.3–8.3), and 8.0 (95 % CI: 6.9–8.7) for ischemic stroke, respectively; while, the risks for bleeding were 3.4 (95 % CI: 2.8–3.9), 2.4 (95 % CI: 2.1–2.7), and 2.4 (95 % CI: 1.9–2.9), respectively. Conclusion Clopidogrel and the combination of acetylsalicylic acid and dipyridamole were associated with similar risks for recurrent ischemic stroke and bleeding; whereas acetylsalicylic acid was associated with higher risks for both ischemic stroke and bleeding. The latter finding may partially be explained by selection bias.
    Full-text · Article · Dec 2015 · BMC Neurology
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    ABSTRACT: Objectives: A recent alarming finding suggested an increased risk of renal tumors among long-term lithium users. The objectives of the present study were to estimate rates of renal and upper urinary tract tumors (RUT), malignant and benign, among individuals exposed to successive prescriptions for lithium, anticonvulsants, and other psychotropic agents used for bipolar disorder, and among unexposed individuals. Methods: This was a nationwide, population-based longitudinal study including time-specific data from all individuals exposed to lithium (n = 24,272) or anticonvulsants (n = 386,255), all individuals with a diagnosis of bipolar disorder (n = 9,651), and a randomly selected sample of 1,500,000 from the Danish population. The study period was from 1995 to 2012, inclusive. Outcomes were hazard rate ratios (HR) for RUT in three groups: (i) combined malignant and benign, (ii) malignant, and (iii) benign. Analyses were adjusted for the number of prescriptions for lithium/anticonvulsants, antipsychotic agents, antidepressants, and use of all other types of medication; age; gender; employment status; calendar year; and a diagnosis of bipolar disorder. Results: Continued treatment with lithium was not associated with increased rates of RUT [adjusted HR malignant or benign: 0.67-1.18, p (trend) = 0.70; adjusted HR malignant: 0.61-1.34, p (trend) = 0.90; adjusted HR benign: 0.74-1.18, p (trend) = 0.70]. Similarly, continued treatment with anticonvulsants was not associated with increased rates of RUT [adjusted HR malignant or benign: 0.97-1.18, p (trend) = 0.10; adjusted HR malignant: 0.82-1.15, p (trend) = 0.80; adjusted HR benign: 0.94-1.36, p (trend) = 0.20]. The associations were confirmed among the 9,651 patients with a diagnosis of bipolar disorder. Conclusions: Treatment with lithium is not associated with increased rates of RUT.
    No preview · Article · Nov 2015 · Bipolar Disorders
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    ABSTRACT: Importance: Lithium is the main mood stabilizing drug for bipolar disorder. However, it is controversial whether long-term maintenance treatment with lithium or other drugs for bipolar disorder causes chronic kidney disease (CKD). Objective: To compare rates of CKD and in particular rates of end-stage CKD among individuals exposed to successive prescriptions of lithium, anticonvulsants, or other drugs used for bipolar disorder. Design, setting, and participants: This is a Danish nationwide population-based study of 2 cohorts. Cohort 1 comprised a randomly selected sample of 1.5 million individuals among all persons who were registered in Denmark on January 1, 1995, all patients with a diagnosis of a single manic episode or bipolar disorder between January 1, 1994, and December 31, 2012 (n =10 591), and all patients exposed to either lithium (n = 26 731) or anticonvulsants (n=420 959). Cohort 2 included the subgroup of 10 591 patients diagnosed as having bipolar disorder. Main outcomes and measures: Possible CKD, definite CKD, and end-stage CKD (defined as long-term dialysis or renal transplantation). Results: A total of 14 727 (0.8%), 18 762 (1.0%), and 3407 (0.2%) in cohort 1 and 278 (2.6%), 319 (3.0%), and 62 (0.6%) in cohort 2 were diagnosed as having possible, definite, or end-stage CKD, respectively. Based on the total sample and not considering diagnoses, use of lithium was associated with an increased rate of definite CKD (0 prescriptions: hazard ratio [HR] = 1.09, 95% CI, 0.81-1.45; ≥60 prescriptions: HR = 3.65, 95% CI, 2.64-5.05; P for trend < .001) and possible CKD (0 prescriptions: HR = 1.01, 95% CI, 0.79-1.30; ≥60 prescriptions: HR = 2.88, 95% CI, 2.17-3.81; P for trend < .001), whereas use of anticonvulsants, antipsychotics, or antidepressants was not. Neither use of lithium nor use of any other drug class was associated with increasing rates of end-stage CKD. In patients with bipolar disorder, use of lithium was associated with an increased rate of definite CKD (1-2 prescriptions: HR = 0.89, 95% CI, 0.39-2.06; ≥60 prescriptions: HR = 2.54, 95% CI, 1.81-3.57; P for trend < .001) or possible CKD (1-2 prescriptions: HR = 1.26, 95% CI, 0.65-2.43; ≥60 prescriptions, HR = 2.48, 95% CI, 1.80-3.42; P for trend < .001), as was use of anticonvulsants (definite CKD, 1-2 prescriptions: HR = 1.23, 95% CI, 0.76-1.99; ≥60 prescriptions, HR = 2.30, 95% CI, 1.53-3.44; P for trend < .001; possible CKD, 1-2 prescriptions: HR = 1.11, 95% CI, 0.70-1.76; ≥60 prescriptions: HR = 1.97, 95% CI, 1.34-2.90; P for trend < .001). There was no such association with antipsychotics or antidepressants. Also in patients with bipolar disorder, use of lithium was not significantly associated with an increased rate of end-stage CKD, whereas use of anticonvulsants was (1-2 prescriptions, HR = 0 [95% CI, 0.00-infinity]; 30-39 prescriptions: HR = 3.23, 95% CI, 1.26-8.27; ≥60 prescriptions: HR = 2.06, 95% CI, 0.82-5.16; P for trend = .002). Conclusions and relevance: Maintenance treatment with lithium or anticonvulsants as practiced in modern care is associated with an increased rate of CKD. However, use of lithium is not associated with an increased rate of end-stage CKD. The associations between use of medication and CKD may at least partly be attributed to bias.
    No preview · Article · Nov 2015 · JAMA Psychiatry
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    ABSTRACT: In a competing risks setting, the cumulative incidence of an event of interest describes the absolute risk for this event as a function of time. For regression analysis, one can either choose to model all competing events by separate cause-specific hazard models or directly model the association between covariates and the cumulative incidence of one of the events. With a suitable link function, direct regression models allow for a straightforward interpretation of covariate effects on the cumulative incidence. In practice, where data can be right-censored, these regression models are implemented using a pseudo-value approach. For a grid of time points, the possibly unobserved binary event status is replaced by a jackknife pseudo-value based on the Aalen-Johansen method. We combine a stagewise regression technique with the pseudo-value approach to provide variable selection while allowing for time-varying effects. This is implemented by coupling variable selection between the grid times, but determining estimates separately. The effect estimates are regularized to also allow for model fitting with a low to moderate number of observations. This technique is illustrated in an application using clinical cancer registry data from hepatocellular carcinoma patients. The results are contrasted with traditional hazard-based modeling. In addition to a more straightforward interpretation, when using the proposed technique, the identification of time-varying effect patterns on the cumulative incidence is seen to be feasible with a moderate number of observations. Copyright © 2015 John Wiley & Sons, Ltd.
    No preview · Article · Oct 2015 · Statistics in Medicine
  • Eva Lauridsen · Thomas Gerds · Jens Ove Andreasen
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    ABSTRACT: AimTo analyze the risk of pulp canal obliteration (PCO), pulp necrosis (PN), repair-related resorption (RRR), infection-related resorption (IRR), ankylosis-related resorption (ARR), marginal bone loss (MBL), and tooth loss (TL) for teeth involved in an alveolar process fracture and to identify possible risk factors.Material and methodA total of 91 patients with 223 traumatized teeth.StatisticsThe risks of PCO, PN, RRR, IRR, ARR, MBL, and TL were analyzed separately for teeth with immature and mature root development using Kaplan–Meier and Aalen–Johansen methods. Possible risk factors for PN (age, fracture in relation to apex, displacement, gingival injury, degree of repositioning, type of splint, duration of splinting, treatment delay, and antibiotics) were analyzed for mature teeth using Cox regression. The level of significance was 5%.ResultsImmature: No severe complications (PN, IRR, ARR, MBL, or TL) were diagnosed during follow up. Mature: Estimated risk after a 10-year follow up: PN: 56% (95% confidence interval (CI): 48.1–63.9), IRR: 2.5% (95% CI: 0–5.1), ARR: 2.1% (95% CI: 0.1–4.1), MBL: 2.4% (95% CI: 0.3–4.4), and TL: 7.8% (95% CI: 0–15.7). The following factors significantly increased the risk of PN in teeth with mature root development: fracture in relation to apex (hazard ratio (HR): 2.6 (95% CI: 0.2 – 5.7), P = 0.01), displacement in the horizontal part of the fracture >2 mm (HR: 1.8; 95% CI: 1.1–3.2, P = 0.03), incomplete repositioning (HR: 2.1 (95% CI: 1.3–3.5), P = 0.003), and age >30 years (HR: 2.3 (95% CI: 1.1–4.6), P = 0.02). The type of splint (rigid or flexible), the duration of splinting (more or less than 4 weeks), and the administration of antibiotics did not affect the risk of PN.Conclusion Teeth involved in alveolar process fractures appear, apart from PN, to have a good prognosis. A conservative treatment approach is recommended.
    No preview · Article · Oct 2015 · Dental Traumatology
  • Randi Grøn · Thomas A Gerds · Per K Andersen
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    ABSTRACT: Poisson regression is an important tool in register-based epidemiology where it is used to study the association between exposure variables and event rates. In this paper, we will discuss the situation with 'large n and small p', where n is the sample size and p is the number of available covariates. Specifically, we are concerned with modeling options when there are time-varying covariates that can have time-varying effects. One problem is that tests of the proportional hazards assumption, of no interactions between exposure and other observed variables, or of other modeling assumptions have large power due to the large sample size and will often indicate statistical significance even for numerically small deviations that are unimportant for the subject matter. Another problem is that information on important confounders may be unavailable. In practice, this situation may lead to simple working models that are then likely misspecified. To support and improve conclusions drawn from such models, we discuss methods for sensitivity analysis, for estimation of average exposure effects using aggregated data, and a semi-parametric bootstrap method to obtain robust standard errors. The methods are illustrated using data from the Danish national registries investigating the diabetes incidence for individuals treated with antipsychotics compared with the general unexposed population. Copyright © 2015 John Wiley & Sons, Ltd.
    No preview · Article · Oct 2015 · Statistics in Medicine
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    ABSTRACT: Heavy drinking following liver transplantation decreases survival. Little is known of predictors of heavy drinking, which should guide clinicians identifying patients at high risk of return to heavy drinking after transplantation. We calculated the cumulative incidence of heavy drinking among patients transplanted for alcoholic liver disease in Denmark 1990-2013. We then analyzed pre-transplant demographic and psychiatric characteristics as predictors of post-transplant heavy drinking. Information was obtained from medical records, from nationwide registries and by interview. Among 156 liver-transplanted patients, the cumulative incidence of heavy drinking was 18%, 24% and 27% after 5, 10 and 15 years post-transplant. In univariate analyses of pre-transplant predictors of heavy drinking after transplantation, younger age (p < 0.001), being retired (p = 0.007), anxiety (p = 0.04), personality disorder (p = 0.05) and no lifetime diagnosis of alcohol dependence (p = 0.03) were associated with heavy drinking after transplantation. Smoking (p = 0.06) tended to be associated, whereas depression (p = 0.7) or being married was not (p = 0.7). In the multivariate analysis, only younger age (p = 0.03), being retired (p = 0.007) and no lifetime diagnosis of alcohol dependence (p = 0.003) remained significant predictors. Heavy drinking after transplantation decreased survival beyond 5 years post-transplant (p = 0.004). There is a high incidence of heavy drinking after liver transplantation for alcoholic cirrhosis in Denmark. Younger age, being retired and no lifetime diagnosis of alcohol dependence were predictors of heavy drinking after transplantation.
    No preview · Article · Jul 2015 · Scandinavian Journal of Gastroenterology
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    ABSTRACT: Background Biomarkers predicting response to primary androgen deprivation therapy (ADT) and risk of castration-resistant prostate cancer (CRPC) is lacking. We aimed to analyse the predictive value of ERG expression for development of CRPC.Methods In total, 194 patients with advanced and/or metastatic prostate cancer (PCa) treated with first-line castration-based ADT were included. ERG protein expression was analysed in diagnostic specimens using immunohistochemistry (anti-ERG, EPR3864). Time to CRPC was compared between ERG subgroups using multiple cause-specific Cox regression stratified on ERG-status. Risk reclassification and time-dependent area under the ROC curves were used to assess the discriminative ability of ERG-status. Time to PSA-nadir, proportion achieving PSA-nadir ≤0.2 ng/ml, and risk of PCa-specific death were secondary endpoints.ResultsMedian follow-up was 6.8 years (IQR: 4.9–7.3). In total, 105 patients (54.1%) were ERG-positive and 89 (45.9%) were ERG-negative. No difference in risk of CRPC was observed between ERG subgroups (P = 0.51). Median time to CRPC was 3.9 years (95%CI: 3.2–5.1) and 4.5 years (95%CI: 2.3-not reached) in the ERG-positive and ERG-negative group, respectively. Compared to a model omitting ERG-status, the ERG-stratified model showed comparable AUC values 1 year (77.6% vs. 78.0%, P = 0.82), 2 years (71.7% vs. 71.8%, P = 0.85), 5 years (68.5% vs. 69.9%, P = 0.32), and 8 years (67.9% vs. 71.4%, P = 0.21) from ADT initiation. No differences in secondary endpoints were observed.ConclusionsERG expression was not associated with risk of CRPC suggesting that ERG is not a candidate biomarker for predicting response to primary ADT in patients diagnosed with advanced and/or metastatic PCa. Prostate © 2015 Wiley Periodicals, Inc.
    Full-text · Article · May 2015 · The Prostate

  • No preview · Article · Apr 2015 · European Urology Supplements

  • No preview · Article · Apr 2015 · European Urology Supplements
  • Michael W Kattan · Thomas A Gerds
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    ABSTRACT: Choosing to replace or maintain an existing cancer staging system is a difficult task. The system plays a critical role in patient counselling and treatment decision making because the staging system conveys prognosis. Many issues may be considered when deciding the preferred system (i.e. old or new), such as the level of evidence for one or more factors included in the system or the general opinions of expert clinicians. However, given the major objective of estimating prognosis on an ordinal scale, we argue that the rival staging system candidates should be compared on their ability to predict outcome. We sought to outline an algorithm that would compare two rival ordinal systems on their predictive ability. We devised an algorithm based largely on the concordance index, which is appropriate for comparing two models in their ability to rank observations. We demonstrate our algorithm with a prostate cancer staging system example. We have provided an algorithm for selecting the preferred staging system based on prognostic accuracy. It appears to be useful for the purpose of selecting between two ordinal prediction models. © The Author(s) 2015.
    No preview · Article · Feb 2015 · Clinical Trials
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    ABSTRACT: Background: Telehealth interventions for patients with chronic obstructive pulmonary disease (COPD) have focused primarily on stable outpatients. Telehealth designed to handle the acute exacerbation that normally requires hospitalization could also be of interest. The aim of this study was to compare the effect of home-based telehealth hospitalization with conventional hospitalization for exacerbation in severe COPD. Materials and methods: A two-center, noninferiority, randomized, controlled effectiveness trial was conducted between June 2010 and December 2011. Patients with severe COPD admitted because of exacerbation were randomized 1:1 either to home-based telehealth hospitalization or to continue standard treatment and care at the hospital. The primary outcome was treatment failure defined as re-admission due to exacerbation in COPD within 30 days after initial discharge. The noninferiority margin was set at 20% of the control group's risk of re-admission. Secondary outcomes were mortality, need for manual or mechanical ventilation or noninvasive ventilation, length of hospitalization, physiological parameters, health-related quality of life, user satisfaction, healthcare costs, and adverse events. Results: In total, 57 patients were randomized: 29 participants in the telehealth group and 28 participants in the control group. Testing the incidence of re-admission within 30 days after discharge could not confirm noninferiority (lower 95% confidence limit [CL], -24.8%; p=0.35). Results were also nonsignificant at 90 days (lower 95% CL, -16.2%; p=0.33) and 180 days (lower 95% CL, -16.6%; p =0.33) after discharge. Superiority testing on secondary outcomes showed nonsignificant differences between groups. Healthcare costs have not yet been evaluated. Conclusions: Whether home-based telehealth hospitalization is noninferior to conventional hospitalization requires further investigation. The results indicate that a subgroup of patients with severe COPD can be treated for acute exacerbation at home using telehealth, without the physical presence of health professionals and with a proper organizational "back-up."
    Full-text · Article · Feb 2015 · Telemedicine and e-Health
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    ABSTRACT: Objectives Maternal body mass index (BMI), birth weight, and preschool BMI may help identify children at high risk of overweight as they are (1) similarly linked to adolescent overweight at different stages of the obesity epidemic, (2) linked to adult obesity and metabolic alterations, and (3) easily obtainable in health examinations in young children. The aim was to develop early childhood prediction models of adolescent overweight, adult overweight, and adult obesity.Methods Prediction models at various ages in the Northern Finland Birth Cohort born in 1966 (NFBC1966) were developed. Internal validation was tested using a bootstrap design, and external validation was tested for the model predicting adolescent overweight using the Northern Finland Birth Cohort born in 1986 (NFBC1986).ResultsA prediction model developed in the NFBC1966 to predict adolescent overweight, applied to the NFBC1986, and aimed at labelling 10% as “at risk” on the basis of anthropometric information collected until 5 years of age showed that half of those at risk in fact did become overweight. This group constituted one-third of all who became overweight.Conclusions Our prediction model identified a subgroup of children at very high risk of becoming overweight, which may be valuable in public health settings dealing with obesity prevention.
    No preview · Article · Jan 2015 · Obesity
  • Frank Eriksson · Thomas Alexander Gerds · Emmanuel Lesaffre
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    ABSTRACT: The marginal approach and the conditional approach are two different ways to model clustered dental failure time data. We compare the two approaches in the context of a Cox regression analysis, where the aim is to estimate the effect of a covariate (e.g., dental treatment) on the risk of failure. Specifically, we treat within-cluster correlation as if it was introduced by unobserved cluster level covariates, and study the small sample behaviour of the marginal and the conditional approach. We show that in a non-randomized setting where an unobserved cluster variable is correlated with the variable of interest, both the marginal and the conditional approaches can give misleading results. We argue that this is an important message, since most often it is assumed that the frailty term and the covariates of interest are independent.
    No preview · Article · Dec 2014 · Statistical Modelling
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    ABSTRACT: Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are assumed to increase bleeding risk, but their actual relation to serious bleeding in patients with atrial fibrillation (AF) who are receiving antithrombotic medication is unknown. Objective: To investigate the risk for serious bleeding and thromboembolism associated with ongoing NSAID and antithrombotic therapy. Design: Observational cohort study. Setting: Nationwide registries. Patients: Danish patients with AF hospitalized between 1997 and 2011. Measurements: Absolute risk for serious bleeding and thromboembolism with ongoing NSAID and antithrombotic therapy, assessed by using Cox models. Results: Of 150 900 patients with AF (median age, 75 years [interquartile range, 65 to 83 years]; 47% female), 53 732 (35.6%) were prescribed an NSAID during a median follow-up of 6.2 years (interquartile range, 2.1 to 14.0 years). There were 17 187 (11.4%) and 19 561 (13.0%) occurrences of serious bleeding and thromboembolism, respectively. At 3 months, the absolute risk for serious bleeding within 14 days of NSAID exposure was 3.5 events per 1000 patients compared with 1.5 events per 1000 patients without NSAID exposure. The risk difference was 1.9 events per 1000 patients. In patients selected for oral anticoagulant therapy, the absolute risk difference was 2.5 events per 1000 patients. Use of NSAIDs was associated with increased absolute risks for serious bleeding and thromboembolism across all antithrombotic regimens and NSAID types. An NSAID dosage above the recommended minimum was associated with a substantially increased hazard ratio for bleeding. Limitation: Observational design and unmeasured confounders. Conclusion: Use of NSAIDs was associated with an independent risk for serious bleeding and thromboembolism in patients with AF. Short-term NSAID exposure was associated with increased bleeding risk. Physicians should exercise caution with NSAIDs in patients with AF.
    No preview · Article · Nov 2014 · Annals of internal medicine
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    ABSTRACT: Background Transit-time flow measurement (TTFM) is a commonly used intraoperative method for evaluation of coronary artery bypass graft (CABG) anastomoses. This study was undertaken to determine whether TTFM can also be used to predict graft patency at one year postsurgery. Methods Three hundred forty-five CABG patients with intraoperative graft flow measurements and one year angiographic follow-up were analyzed. Graft failure was defined as more than 50% stenosis including the string sign. Logistic regression analysis was used to analyze the risk of graft failure after one year based on graft vessel type, anastomatic configuration, and coronary artery size. ResultsNine hundred eighty-two coronary anastomoses were performed of which 12% had signs of graft failure at one year angiographic follow-up. In internal mammary arteries (IMAs), analysis showed a 4% decrease in graft failure odds for every 1mL/min increase in TTFM (OR=0.96, CI=[0.93; 0.99], p=0.005). ROC analysis showed good discriminative ability for TTFM alone AUC=69.5% in IMA grafts. For single-vein grafts the decrease in graft failure odds was 2% for every 1mL/min increase in TTFM (OR=0.98; CI=[0.97; 1.00], p=0.059) and AUC of 59.9%. There were no significant relationships between TTFM and graft failure in other graft types or graft configurations. Conclusion The TTFM method has good discriminative ability for assessing the risk of graft failure in certain graft types within the first year after CABG surgery and is a valuable instrument for intraoperative quality assessment of bypass grafts. doi: 10.1111/jocs.12471 (J Card Surg 2015;30:47-52)
    No preview · Article · Nov 2014 · Journal of Cardiac Surgery
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    ABSTRACT: Background Compelling biomarkers identifying prostate cancer patients with a high risk of progression during active surveillance (AS) are needed. Objective To examine the association between ERG expression at diagnosis and the risk of progression during AS. Design, setting, and participants This study included 265 patients followed on AS with prostate-specific antigen (PSA) measurements, clinical examinations, and 10–12 core rebiopsies from 2002 to 2012 in a prospectively maintained database. ERG immunohistochemical staining was performed on diagnostic paraffin-embedded formalin-fixed sections with a ready-to-use kit (anti-ERG, EPR3864). Men were characterised as ERG positive if a minimum of one tumour focus demonstrated ERG expression. Outcome measurements and statistical analysis Overall AS progression was defined as clinical progression: increased clinical tumour category ≥cT2b by digital rectal examination and ultrasound, and/or histopathologic progression: upgrade of Gleason score, more than three positive cores or bilateral positive cores, and/or PSA progression: PSA doubling time <3 yr. Risk of progression was analysed using multiple cause-specific Cox regression and stratified cumulative incidences (Aalen-Johansen method). Curatively intended treatment, watchful waiting, and death without progression were treated as competing events. Results and limitations A total of 121 of 142 ERG-negative and 96 of 123 ERG-positive patients had complete diagnostic information. In competing risk models, the ERG-positive group showed significantly higher incidences of overall AS progression (p < 0.0001) and of the subgroups PSA progression (p < 0.0001) and histopathologic progression (p < 0.0001). The 2-yr cumulative incidence of overall AS progression was 21.7% (95% confidence interval [CI], 14.3–29.1) in the ERG-negative group compared with 58.6% (95% CI, 48.7–68.5) in the ERG-positive group. ERG positivity was a significant predictor of overall AS progression in multiple Cox regression (hazard ratio: 2.45; 95% CI, 1.62–3.72; p < 0.0001). The main limitation of this study is its observational nature. Conclusions In our study, ERG positivity at diagnosis can be used to estimate the risk of progression during AS. If confirmed, ERG status can be used to individualise AS programmes. Patient summary The tissue biomarker ERG identifies active surveillance patients with an increased risk of disease progression.
    Full-text · Article · Nov 2014 · European Urology

Publication Stats

2k Citations
402.09 Total Impact Points

Institutions

  • 2009-2015
    • IT University of Copenhagen
      København, Capital Region, Denmark
    • Herlev Hospital
      • Department of Pathology
      Herlev, Capital Region, Denmark
  • 2012
    • Catholic University of Louvain
      Лувен-ла-Нев, Walloon, Belgium
  • 2003-2008
    • University of Freiburg
      • Institute of Medical Biometry and Medical Informatics
      Freiburg, Baden-Württemberg, Germany
  • 2004
    • Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e.V.
      Freiburg, Baden-Württemberg, Germany