RESUMEN
Background: Rapid diagnostic clinics (RDCs) provide a streamlined holistic pathway for patients presenting with non-site specific (NSS) symptoms concerning of malignancy. The current study aimed to: 1) assess the prevalence of anxiety and depression, and 2) identify a combination of patient characteristics and symptoms associated with severe anxiety and depression at Guy's and St Thomas' Foundation Trust (GSTT) RDC in Southeast London. Additionally, we compared standard statistical methods with machine learning algorithms for predicting severe anxiety and depression. Methods: Patients seen at GSTT RDC between June 2019 and January 2023 completed the General Anxiety Disorder Questionnaire (GAD-7) and Patient Health Questionnaire (PHQ-8) questionnaires, at baseline. We used logistic regression (LR) and 2 machine learning (ML) algorithms (random forest (RF), support vector machine (SVM)) to predict risk of severe anxiety and severe depression. The models were constructed using a set of sociodemographic and clinical variables. Results: A total of 1734 patients completed GAD-7 and PHQ-8 questionnaires. Of these, the mean age was 59 years (Standard Deviation: 15.5), and 61.5% (n:1067) were female. Prevalence of severe anxiety (GAD-7 score ≥15) was 13.8% and severe depression (PHQ-8 score≥20) was 9.3%. LR showed that a combination of previous mental health condition (PMH, Adjusted Odds Rario (AOR) 3.28; 95% confidence interval (CI) 2.36-4.56), symptom duration >6 months (AOR 2.20; 95%CI 1.28-3.77), weight loss (AOR 1.88; 95% CI 1.36-2.61), progressive pain (AOR 1.71; 95%CI 1.26-2.32), and fatigue (AOR 1.36; 95%CI 1.01-1.84), was positively associated with severe anxiety. Likewise, a combination PMH condition (AOR 3.95; 95%CI 2.17-5.75), fatigue (AOR 2.11; 95%CI 1.47-3.01), symptom duration >6 months (AOR 1.98; 95%CI 1.06-3.68), weight loss (AOR 1.66; 95%CI 1.13-2.44), and progressive pain (AOR 1.50; 95%CI 1.04-2.16), was positively associated with severe depression. LR and SVM had highest accuracy levels for severe anxiety (LR: 86%, SVM: 85%) and severe depression (SVM: 89%, LR: 86%). Conclusion: High prevalence of severe anxiety and severe depression was found. PMH, fatigue, weight loss, progressive pain, and symptoms >6 months emerged as combined risk factors for both these psychological comorbidities. RDCs offer an opportunity to alleviate distress in patients with concerning symptoms by expediting diagnostic evaluations.
RESUMEN
Introducción y objetivos. La grasa visceral presenta una intensa actividad metabólica relacionada con el desarrollo de aterotrombosis. El tejido adiposo subcutáneo secreta en mayor cantidad las adipocitocinas leptina y adiponectina que el tejido adiposo visceral. El tejido adiposo epicárdico secreta mediadores inflamatorios; esta actividad proinflamatoria es mayor que la del tejido adiposo subcutáneo. En este trabajo tratamos de determinar y comparar la expresión de adiponectina y leptina en el tejido adiposo epicárdico y subcutáneo humano. Métodos. Para el análisis se extrajo una muestra de tejido adiposo epicárdico y tejido adiposo subcutáneo de 46 pacientes en los que se había realizado cirugía cardiaca, bypass coronario o reemplazo valvular aórtico/mitral. La expresión proteica y génica de la adiponectina y la leptina fue analizada mediante inmunohistoquímica y RT-PCR, respectivamente. Los niveles de expresión de ARN mensajero se analizaron mediante la técnica comparativa de PCR en tiempo real, en ambos tejidos. Resultados. Hay diferencias significativas de expresión de ARN mensajero de la adiponectina y la leptina entre el tejido adiposo epicárdico y subcutáneo, con una menor expresión de la adiponectina y la leptina en la grasa epicárdica. En comparación con los varones, las mujeres muestran una mayor expresión de adiponectina y leptina en tejido adiposo epicárdico. Conclusiones. El tejido adiposo epicárdico expresa menos adiponectina y leptina que el subcutáneo. Hay una expresión diferencial entre varones y mujeres en cuanto a la expresión de adiponectina y leptina en el tejido adiposo epicárdico
Introduction and objectives. The high level of metabolic activity present in visceral adipose tissue is associated with the development of atherothrombosis. Subcutaneous adipose tissue secretes larger quantities of the adipocytokines leptin and adiponectin than visceral adipose tissue. Epicardial adipose tissue secretes inflammatory mediators, and the resulting proinflammatory activity is greater than that associated with subcutaneous adipose tissue. The aim of this study was to compare adiponectin and leptin expression in human epicardial and subcutaneous adipose tissue. Methods. Samples of both epicardial and subcutaneous adipose tissue were taken from 46 patients who were undergoing heart surgery, coronary artery bypass surgery, or aortic or mitral valve replacement. Levels of protein and gene expression of leptin and adiponectin were assessed immunohistochemically and by RT-PCR, respectively. Levels of mRNA expression in the 2 adipose tissue types were compared by real-time quantitative PCR. Results. Significant differences were found between adiponectin and leptin mRNA expression in epicardial and subcutaneous adipose tissue, with epicardial adipose tissue exhibiting lower levels of adiponectin and leptin expression. Moreover, adiponectin and leptin mRNA expression in epicardial adipose tissue was higher in women than men. Conclusions. Adiponectin and leptin expression is lower in epicardial than in subcutaneous adipose tissue. Moreover, there are differences in adiponectin and leptin expression in epicardial adipose tissue between women and men