Risk of diabetes mellitus among users of immune checkpoint inhibitors: A population‐based cohort study

Chan, Jeffrey Shi Kai; Lee, Sharen; Kong, Dicken; Lakhani, Ishan; Ng, Kenrick; Dee, Edward Christopher; Tang, Pias; Lee, Yan Hiu Athena; Satti, Danish Iltaf; Wong, Wing Tak; Liu, Tong; Tse, Gary

doi:10.1002/cam4.5616

Cited by 4 publications

(3 citation statements)

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“…Propensity scores were calculated and then used for matching and IPTW, as used previously to reduce the imbalances between groups and reducing observed confounders. 43,44 The clinical implications of this study are as follows (1) To our best knowledge, it is the first study to observe the association between urine ketone and NOAF in critically ill patients; (2) The results of this study may be useful for future studies to establish diagnostic or predictive models for NOAF. There are some limitations in the present study.…”

Section: Discussionmentioning

confidence: 98%

The association between urine ketone and new‐onset atrial fibrillation in critically ill patients

Zhang,

Tse

et al. 2023

Pacing Clinical Electrophis

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BACKGROUND AND AIMSNew‐onset atrial fibrillation (NOAF) is a common manifestation in critically ill patients. There is a paucity of evidence indicating a relationship between urinary ketones and NOAF.METHODSCritically ill patients with urinary ketone measurements from the Medical Information Mart for Intensive Care (MIMIC‐IV) database were included. The primary outcome was NOAF Propensity score matching was performed following by multivariable logistic regression.RESULTSA total of 24,688 patients with available data of urine ketone were included in this study. The urine ketone of 4014 patients was tested positive. The average age of the included participants was 63.8 years old, and 54.5% of them were male. Result of the fully‐adjusted binary logistic regression model showed that patients with positive urinary ketone was associated with a significantly lower risk of NOAF (Odds ratio, 0.79, 95% CI 0.7–0.9), compared with those with negative urinary ketone. In the subgroup analysis according to diabetic status, compared with nondiabetics, patients with diabetes had lower risk of NOAF (p‐values for interaction < 0.05). Results of other subgroup analyses according to gender, age, infection, myocardial infarction, and congestive heart failure were consistent with the primary analysis.CONCLUSIONSPositive urinary ketone body may be associated with reduced risk of NOAF in critically ill patients during intensive care unit hospitalization. Further studies are needed to clarify the underlying mechanisms.

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Section: Discussionmentioning

confidence: 98%

The association between urine ketone and new‐onset atrial fibrillation in critically ill patients

Zhang,

Tse

et al. 2023

Pacing Clinical Electrophis

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“…Recent years have witnessed a proliferation of reports of immune-related adverse events in cancer patients undergoing ICIs therapy, some of which proved fatal. [5][6][7] Among these cases, while the incidence of adverse cardiovascular events induced by ICIs therapy remains relatively low, severe outcomes, including fatalities, have occurred in certain patients, especially myocarditis. 8,9 However, it has been only a few years for ICIs to be used clinically, and there is limited understanding of their cardiovascular toxicity.…”

Section: Introductionmentioning

confidence: 99%

“…Nonetheless, the activation of the immune system through ICIs can precipitate immune‐mediated damage. Recent years have witnessed a proliferation of reports of immune‐related adverse events in cancer patients undergoing ICIs therapy, some of which proved fatal 5–7 . Among these cases, while the incidence of adverse cardiovascular events induced by ICIs therapy remains relatively low, severe outcomes, including fatalities, have occurred in certain patients, especially myocarditis 8,9 …”

Section: Introductionmentioning

confidence: 99%

Cardiovascular adverse events associated with immune checkpoint inhibitors: A retrospective multicenter cohort study

Zheng,

Chen,

Song

et al. 2024

Cancer Medicine

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BackgroundOver the past decade, immune checkpoint inhibitors (ICIs) have significantly transformed cancer treatment. However, ICIs inevitably may cause a spectrum of immune‐related adverse events, among which cardiovascular toxicity, particularly myocarditis, while infrequent, has garnered increasing attention due to its high fatality rate.MethodsWe conducted a multicenter retrospective study to characterize ICI‐associated cardiovascular adverse events. Logistic regression was performed to explore the risk factors for the development of myocarditis and severe myocarditis. Receiver operating characteristic curves were conducted to assess the diagnostic abilities of cardiac biomarkers to distinguish different cardiovascular toxicities, and the performance and calibration were evaluated using Hosmer–Lemeshow test.ResultsForty‐four patients were identified, including thirty‐five myocarditis, five heart failure, three arrhythmias, and one myocardial infarction. Compared with other patients, myocarditis patients had higher cardiac troponin‐I (cTnI) levels (p < 0.001), higher creatine kinase levels (p = 0.003), higher creatine kinase isoenzyme‐MB (CK‐MB) levels (p = 0.013), and shorter time to the incidence of adverse cardiovascular events (p = 0.022) after ICI treatment. Twenty‐one patients (60%) were classified as severe myocarditis, and they presented higher cardiac troponin I (cTnI) levels (p = 0.013), higher N‐terminal pro‐B‐type natriuretic peptide levels (p = 0.031), higher creatine kinase levels (p = 0.018), higher CK‐MB levels (p = 0.026), and higher neutrophil to lymphocyte ratio (NLR) levels (p = 0.016) compared to non‐severe myocarditis patients after ICI treatment. Multivariate logistic regression showed that CK‐MB (adjusted odds ratio [OR]: 1.775, 95% confidence interval [CI]: 1.055–2.984, p = 0.031) was the independent risk factor of the development of ICI‐associated myocarditis, and cTnI (adjusted OR: 1.021, 95% CI: 1.002–1.039, p = 0.03) and NLR (adjusted OR: 1.890, 95% CI: 1.026–3.483, p = 0.041) were the independent risk factors of ICI‐associated severe myocarditis. The receiver operating characteristic curve showed an area under curve of 0.785 (95% CI: 0.642 to 0.928, p = 0.013) for CK‐MB, 0.765 (95% CI: 0.601 to 0.929, p = 0.013) for cTnI, and 0.773 for NLR (95% CI: 0.597 to 0.948, p = 0.016).ConclusionsElevated CK‐MB after ICI treatment is the independent risk factor for the incidence of ICI‐associated myocarditis, and elevated cTnI and NLR after ICI treatment are the independent risk factors for the development of ICI‐associated severe myocarditis. CK‐MB, cTnI, and NLR demonstrated a promising predictive utility for the identification of ICI‐associated myocarditis and severe myocarditis.

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