Laboratory-confirmed influenza infection and acute myocardial infarction among United States senior Veterans

Previous studies established an association between laboratory-confirmed influenza infection (LCI) and hospitalization for acute myocardial infarction (AMI) but not causality. We aimed to explore the underlying mechanisms by adding biological mediators to an established study design used by earlier...

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Veröffentlicht in:PloS one 2020-12, Vol.15 (12), p.e0243248-e0243248
Hauptverfasser: Young-Xu, Yinong, Smith, Jeremy, Mahmud, Salaheddin M, Van Aalst, Robertus, Thommes, Edward W, Neupane, Nabin, Lee, Jason K H, Chit, Ayman
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container_start_page e0243248
container_title PloS one
container_volume 15
creator Young-Xu, Yinong
Smith, Jeremy
Mahmud, Salaheddin M
Van Aalst, Robertus
Thommes, Edward W
Neupane, Nabin
Lee, Jason K H
Chit, Ayman
description Previous studies established an association between laboratory-confirmed influenza infection (LCI) and hospitalization for acute myocardial infarction (AMI) but not causality. We aimed to explore the underlying mechanisms by adding biological mediators to an established study design used by earlier studies. With data on biomarkers, we used a self-controlled case-series design to evaluate the effect of LCI on hospitalization for AMI among Veterans Health Administration (VHA) patients. We included senior Veterans (age 65 years and older) with LCI between 2010 through 2015. Patient-level data from VHA electronic medical records were used to capture laboratory results, hospitalizations, and baseline patient characteristics. We defined the "risk interval" as the first 7 days after specimen collection and the "control interval" as 1 year before and 1 year after the risk interval. More importantly, using mediation analysis, we examined the role of abnormal white blood cell (WBC) and platelet count in the relationship between LCI and AMI to explore the thrombogenic nature of this association, thus potential causality. We identified 391 hospitalizations for AMI that occurred within +/-1 year of a positive influenza test, of which 31 (31.1 admissions/week) occurred during the risk interval and 360 (3.5/per week) during the control interval, resulting in an incidence ratio (IR) for AMI admission of 8.89 (95% confidence interval [CI]: 6.16-12.84). In stratified analyses, AMI risk was significantly elevated among patients with high WBC count (IR, 12.43; 95% CI: 6.99-22.10) and high platelet count (IR, 15.89; 95% CI: 3.59-70.41). We confirmed a significant association between LCI and AMI. The risk was elevated among those with high WBC or platelet count, suggesting a potential role for inflammation and platelet activation in the underlying mechanism.
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We aimed to explore the underlying mechanisms by adding biological mediators to an established study design used by earlier studies. With data on biomarkers, we used a self-controlled case-series design to evaluate the effect of LCI on hospitalization for AMI among Veterans Health Administration (VHA) patients. We included senior Veterans (age 65 years and older) with LCI between 2010 through 2015. Patient-level data from VHA electronic medical records were used to capture laboratory results, hospitalizations, and baseline patient characteristics. We defined the "risk interval" as the first 7 days after specimen collection and the "control interval" as 1 year before and 1 year after the risk interval. More importantly, using mediation analysis, we examined the role of abnormal white blood cell (WBC) and platelet count in the relationship between LCI and AMI to explore the thrombogenic nature of this association, thus potential causality. We identified 391 hospitalizations for AMI that occurred within +/-1 year of a positive influenza test, of which 31 (31.1 admissions/week) occurred during the risk interval and 360 (3.5/per week) during the control interval, resulting in an incidence ratio (IR) for AMI admission of 8.89 (95% confidence interval [CI]: 6.16-12.84). In stratified analyses, AMI risk was significantly elevated among patients with high WBC count (IR, 12.43; 95% CI: 6.99-22.10) and high platelet count (IR, 15.89; 95% CI: 3.59-70.41). We confirmed a significant association between LCI and AMI. 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We identified 391 hospitalizations for AMI that occurred within +/-1 year of a positive influenza test, of which 31 (31.1 admissions/week) occurred during the risk interval and 360 (3.5/per week) during the control interval, resulting in an incidence ratio (IR) for AMI admission of 8.89 (95% confidence interval [CI]: 6.16-12.84). In stratified analyses, AMI risk was significantly elevated among patients with high WBC count (IR, 12.43; 95% CI: 6.99-22.10) and high platelet count (IR, 15.89; 95% CI: 3.59-70.41). We confirmed a significant association between LCI and AMI. The risk was elevated among those with high WBC or platelet count, suggesting a potential role for inflammation and platelet activation in the underlying mechanism.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33306675</pmid><doi>10.1371/journal.pone.0243248</doi><tpages>e0243248</tpages><orcidid>https://orcid.org/0000-0002-2440-3352</orcidid><oa>free_for_read</oa></addata></record>
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subjects Aged
Aged, 80 and over
Biology and Life Sciences
Biomarkers
Confidence intervals
Demographic aspects
Diabetes
Distribution
Electronic health records
Electronic medical records
Epidemiology
Female
Health aspects
Health care policy
Health risks
Heart attack
Heart attacks
Hospitalization
Humans
Incidence
Infections
Influenza
Influenza, Human - complications
Influenza, Human - diagnosis
Laboratories
Leukocytes
Male
Medicare
Medicine and Health Sciences
Myocardial infarction
Myocardial Infarction - diagnosis
Myocardial Infarction - etiology
Pharmacy
Platelets
Risk analysis
Risk Factors
Statistical analysis
United States - epidemiology
Veterans
White blood cells
title Laboratory-confirmed influenza infection and acute myocardial infarction among United States senior Veterans
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