Publications by authors named "Efstathia Polychronopoulou"

7 Publications

  • Page 1 of 1

Smoking and risk of COVID-19 hospitalization.

Respir Med 2021 06 17;182:106414. Epub 2021 Apr 17.

Division of Pulmonary and Critical Care Medicine. Department of Internal Medicine, University of Texas Medical Branch. Galveston, TX, USA.

Rationale: The association between smoking status and severe Coronavirus Disease 2019 (COVID-19) remains controversial.

Objective: To assess the risk of hospitalization (as a marker of severe COVID-19) in patients by smoking status: former, current and never smokers, who tested positive for the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV2) at an academic medical center in the United States.

Methods: We conducted a retrospective cohort study in patients with SARS-COV2 between March-1-2020 and January-31-2021 to identify the risk of hospitalization due to COVID-19 by smoking status.

Results: We identified 10216 SARS-COV2-positive patients with complete documentation of smoking habits. Within 14 days of a SARS-COV2 positive test, 1150 (11.2%) patients were admitted and 188 (1.8%) died. Significantly more former smokers were hospitalized from COVID-19 than current or never smokers (21.2% former smokers; 7.3% current smokers; 10.4% never smokers, p<0.0001). In univariable analysis, former smokers had higher odds of hospitalization from COVID-19 than never smokers (OR 2.31; 95% CI 1.94-2.74). This association remained significant when analysis was adjusted for age, race and gender (OR 1.28; 95% CI 1.06-1.55), but became non-significant when analysis included Body Mass Index, previous hospitalization and number of comorbidities (OR 1.05; 95% CI 0.86-1.29). In contrast, current smokers were less likely than never smokers to be hospitalized due to COVID-19.

Conclusions: Significantly more former smokers were hospitalized and died from COVID-19 than current or never smokers. This effect is mediated via age and comorbidities in former smokers.
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http://dx.doi.org/10.1016/j.rmed.2021.106414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052507PMC
June 2021

Independent and joint effects of testosterone replacement therapy and statins use on the risk of prostate cancer among White, Black and Hispanic men.

Cancer Prev Res (Phila) 2021 Apr 20. Epub 2021 Apr 20.

University of Texas McGovern Medical School.

The associations of testosterone therapy (TTh) and statins use with prostate cancer (PCa) remain conflicted. However, the joint effects of TTh and statins use on the incidence of PCa, stage and grade at diagnosis, and PCa-specific mortality (PCSM) have not been studied. We identified White (N=74181), Black (N=9157) and Hispanic (N=3313) men diagnosed with PCa in SEER-Medicare 2007-2016. Pre-diagnostic prescription of TTh and statins was ascertained for this analysis. Weighted multivariable-adjusted conditional logistic and Cox proportional hazards models evaluated the association of TTh and statins with PCa, including statistical interactions between TTh and statins. We found that TTh (OR = 0.74, 95% CI: 0.68 - 0.81) and statins (OR = 0.77, 95% CI: 0.0.75 - 0.88) were inversely associated with incident PCa. Similar inverse associations were observed with high-grade and advanced PCa in relation to TTh and statins use. TTh plus statins was inversely associated with incident PCa (OR = 0.53, 95% CI: 0.48 - 0.60), high-grade (OR = 0.43, 95% CI: 0.37 - 0.49) and advanced PCa (OR = 0.44, 95% CI: 0.35 - 0.55). Similar associations were present in White and Black men, but among Hispanics statins were associated with PCSM. Pre-diagnostic use of TTh or statins, independent or combined, was inversely associated with incident and aggressive PCa overall and in NHW and NHB men. Findings for statins and aggressive PCa are consistent with previous studies. Future studies need to confirm the independent inverse association of TTh and the joint inverse association of TTh plus statins on risk of PCa in understudied populations.
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http://dx.doi.org/10.1158/1940-6207.CAPR-21-0040DOI Listing
April 2021

US national trends in prescription opioid use after burn injury, 2007 to 2017.

Surgery 2021 Jan 17. Epub 2021 Jan 17.

Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX; Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, University of Texas Medical Branch, Galveston, TX; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX; Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX. Electronic address:

Background: Opioid misuse and overdose in the United States remain a public health emergency. Overprescribing has been recognized as a significant contributor to the epidemic. Opioids are the mainstay for pain management after burn; however, to date, no large-scale nationally representative study has evaluated outpatient opioid prescribing practices in this population.

Methods: A retrospective study was conducted of patients up to 65 years old with burn injuries between 2007 and 2017 using national commercial insurance data. The primary outcome was initial opioid prescribing after burn injury. Secondary outcomes were total days' supply, oral daily morphine milligram equivalents, and number of refills.

Results: Of the 140,753 patients with burns, 34,685 (24.6%) received an opioid prescription. The odds of prescription opioid use were lower in 2015, 2016, and 2017 compared with 2007. Interactions with age, severity (P < .0001), and region (P = .003) showed significant variation in rates of decline from 2007 to 2017, with the steepest decline in those aged <20 and in residents of Northeast United States. Prescribing rates remained stable over time among those with more severe burn injuries. The significant decline in daily opioid morphine milligram equivalents after 2013 was paralleled by an increase in days of supply (P values <.005). The odds of refill declined in 2016 and 2017.

Conclusion: While opioid prescribing after burn has declined in the past decade, significant variation remains among regions and age groups, suggesting a need to develop uniform guidelines to improve the quality of opioid prescribing and pain management protocols in burn patients.
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http://dx.doi.org/10.1016/j.surg.2020.12.011DOI Listing
January 2021

Factors associated with endometrial cancer and hyperplasia among middle-aged and older Hispanics.

Gynecol Oncol 2021 01 19;160(1):16-23. Epub 2020 Nov 19.

Department of Preventive Medicine and Population Health, USA.

Objective: While disparities in endometrial hyperplasia and endometrial cancer are well documented in Blacks and Whites, limited information exists for Hispanics. The objective is to describe the patient characteristics associated with endometrial hyperplasia symptoms, endometrial hyperplasia with atypia and endometrial cancer, and assess factors contributing to racial/ethnic differences in disease outcomes.

Methods: This single-center, retrospective study included women aged ≥50 years with ≥ two encounters for endometrial hyperplasia symptoms, endometrial hyperplasia with atypia and endometrial cancer between 2012 and 2016. Multivariate logistic regression models evaluated the predictors of endometrial cancer and hyperplasia.

Results: We included 19,865 women (4749 endometrial hyperplasia symptoms, 71 endometrial hyperplasias with atypia, 201 endometrial cancers) with mean age of 60.45 years (SD 9.94). The odds of endometrial hyperplasia symptoms were higher in non-Hispanic Blacks (Odds Ratio [OR] 1.56, 95% Confidence Interval [CI] 1.20-1.72), Hispanics (OR 1.35, 95% CI 1.22-1.49), family history of female cancer (OR 1.25, 95% CI 1.12-1.39), hypertension (OR 1.24, 95% CI 1.14-1.35), and birth control use (OR 1.29, 95% CI 1.15-1.43). Odds of endometrial cancer and atypical hyperplasia increased for ages 60-64 (OR 7.95, 95% CI 3.26-19.37; OR 3.66, 95% 1.01-13.22) and being obese (OR 1.61, 95% CI 1.08-2.41; OR: 6.60, 95% CI 2.32-18.83). Odds of endometrial cancer increased with diabetes (OR 1.68, 95% CI 1.22-2.32).

Conclusion(s): Patients with obesity and diabetes had increased odds of endometrial cancer and hyperplasia with atypia. Further study is needed to understand the exogenous estrogen effect contributing to the increased incidence among Hispanics.
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http://dx.doi.org/10.1016/j.ygyno.2020.10.033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142520PMC
January 2021

The 21-gene recurrence score in node-positive, hormone receptor-positive, HER2-negative breast cancer: a cautionary tale from an NCDB analysis.

Breast Cancer Res Treat 2021 Feb 18;185(3):667-676. Epub 2020 Oct 18.

Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-0737, USA.

Purpose: The 21-gene recurrence score assay (RS) has not been prospectively validated to predict adjuvant chemotherapy benefit in hormone receptor-positive (HR+), HER2-negative (HER2-), node-positive breast cancer patients. Nevertheless, de-escalation based on RS has been demonstrated and partially advocated by retrospective data. The purpose of this study was to identify subgroups of node-positive patients with low to intermediate RS who still benefit from adjuvant chemotherapy.

Methods: The National Cancer Database was used to identify 28,591 women with stage I-III, T1-T3, N1, HR+, HER2- breast cancer and a RS ≤ 25 between 2010 and 2016. Univariate and multivariate analyses were used to identify variables correlating with chemotherapy use and 5-year survival. Subgroup analysis was performed to discern patients in whom the use of adjuvant chemotherapy correlated with better survival.

Results: A 35% decline in chemotherapy use was observed from 2010 to 2016. Patients with younger age, higher RS, larger tumors and more positive lymph nodes, and those treated by mastectomy, axillary lymph node dissection and radiation, were more likely to receive chemotherapy. Chemotherapy use was associated with an improved 5-year survival (HR = 1.63, 95% CI 1.28-2.07). Upon subgroup analysis, this association was lost in patients > 70 years and those with a RS ≤ 11, while patients ≤ 70 with a RS of 12-25 treated with chemotherapy had an absolute 5-year survival advantage of 3.0% (HR = 1.91, 95% CI 1.42-2.57).

Conclusion: Clinicians should be cautious when considering omission of adjuvant chemotherapy in patients ≤ 70 years, with HR+, HER2-, N1 tumors and a RS 12-25, at least until the results of the anticipated RxPONDER trial become available.
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http://dx.doi.org/10.1007/s10549-020-05971-1DOI Listing
February 2021

The Long-Term Impact of Severe Burn Trauma on Musculoskeletal Health.

J Burn Care Res 2018 10;39(6):869-880

Shriners Hospitals for Children - Galveston, Galveston, Texas.

Severe burn injury causes a profound stress response that leads to muscle and bone cachexia. Evidence suggests that these deficits persist for several months or even years after injury and are associated with growth delay, increased incidence of fractures, and increased hospital admissions for musculoskeletal disorders. Thus, there is an overwhelming need to determine the optimal acute and rehabilitative strategies to mitigate these deficits and improve quality of life for burn survivors. To date, there is limited research on the long-term impact of cachexia on functional performance and overall health, as well as on the lasting impact of pharmacological, nutritional, and exercise interventions. The aim of this review is to emphasize the long-term consequences of musculoskeletal cachexia and determine the best evidence-based strategies to attenuate it. We also underline important knowledge gaps that need to be addressed in order to improve care of burn survivors.
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http://dx.doi.org/10.1093/jbcr/iry035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198740PMC
October 2018

Determinants of skeletal muscle protein turnover following severe burn trauma in children.

Clin Nutr 2019 06 4;38(3):1348-1354. Epub 2018 Jun 4.

Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA; Metabolism Unit, Shriners Hospitals for Children, Galveston, Texas, USA.

Background & Aims: Burns remain the fifth cause of non-fatal pediatric injuries globally, with muscle cachexia being a hallmark of the stress response to burns. Burn-induced muscle wasting is associated with morbidity, yet the determinants of muscle protein catabolism in response to burn trauma remains unclear. Our objective was to determine the effect of patient and injury characteristics on muscle protein kinetics in burn patients.

Methods: This retrospective, observational study was performed using protein kinetic data from pediatric patients who had severe burns (>30% of the total body surface area burned) and underwent cross-limb stable isotope infusions between 1999 and 2008 as part of prospective clinical trials. Mixed multiple regression models were used to assess associations between patient/injury characteristics and muscle protein fractional synthesis rate (FSR), net balance (NB), and rates of phenylalanine appearance (Ra; index of protein breakdown) and disappearance (Rd; index of protein synthesis) across the leg.

Results: A total of 268 patients who underwent 499 studies were analyzed. Increasing time post injury was associated with greater FSR (p < 0.001) and NB (p = 0.01). Males were more catabolic than females (as indicated by lower NB, p = 0.04 and greater Ra, p = 0.008), a consequence of higher protein breakdown rather than lower synthesis. Increasing burn size was associated with higher protein synthesis rate (as indicated by higher FSR, p = 0.019) and higher protein breakdown rates (as indicated by greater Ra, p = 0.001). FSR was negatively associated with age (p < 0.001).

Conclusions: Data from this large patient cohort show that injury severity, sex, and time post injury influence skeletal muscle wasting in burned children. These findings suggest that individual patient characteristics should be considered when devising therapies to improve the acute care and rehabilitation of burn survivors.
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http://dx.doi.org/10.1016/j.clnu.2018.05.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6279601PMC
June 2019