Ksenija Vučur - Academia.edu (original) (raw)

Papers by Ksenija Vučur

Research paper thumbnail of Kliničko značenje nultih biopsija transplantiranih bubrega i tankih glomerularnih bazalnih membrana u nultim biopsijama transplantiranih bubrega

Aim. To investigate morphological findings of zero-time biopsies analyzed at the Department of Ne... more Aim. To investigate morphological findings of zero-time biopsies analyzed at the Department of Nephropathology and Electron Microscopy, Dubrava University Hospital, Zagreb. Materials and methods. The retrospective search of data was performed for the period from 2006 to 2018. A total of 316 zero-time renal biopsies were analyzed. Glomerular basement membrane (GBM) thickness was remeasured in 84 zero-time biopsies and 80 protocol biopsies of the same patients 12 months after transplantation. Results and conclusion. The acute tubular injury was present in 90% and glomerular pathology in 17% of zero-time biopsies, with thin basement membranes (TBM ) being the most common entity (13%). Chronic graft changes were evaluated according to Banff classification. Most cases showed Banff scores ci0 (82.6%) and ct0 (65.1%). Banff scores cv2 and cv3 were present in 13% and ah2 and ah3 in 36.4% of specimens. Among 84 remeasured zero-time samples, TBM was present in 26 patients (31%). There were no...

Research paper thumbnail of First Croatian Prospective Peripheral Artery Disease Registry (CRO-PAD): What have we learned in the past 10 years?

The first Croatian Prospective Peripheral Artery Disease Registry (CRO-PAD) was created in 2010, ... more The first Croatian Prospective Peripheral Artery Disease Registry (CRO-PAD) was created in 2010, with the aim to collect, organize and present data about patients with PAD. The purpose was to evaluate risk factors, prognosticators, longitudinal outcomes, and therapeutic development in order to improve patients' healthcare and disease outcomes. Patients and Methods: The occurrence of major adverse cardiovascular events (MACE), defined as composite endpoint of acute myocardial infarction, stroke, and death was assessed in 1084 symptomatic PAD patients admitted to the University Hospital between January 2010 and January 2020 (65% men, age 70±10 years). Multivariate Cox regression analysis adjusted for age, gender, traditional cardiovascular risk factors, polyvascular disease, chronic limb threatening ischemia (CLTI), atrial fibrillation (AF), anemia, statin treatment, and impaired renal function was applied to assess the independent predictors of MACE. Results: During median follow-up period of 44 months (interquartile range, 23-59 months), 370 patients (34%) experienced MACE. Compared to patients without MACE, these patients were older, more likely to have diabetes, hypertension, CLTI, polyvascular disease, AF, anemia, and renal impairment. In multivariate regression analysis, age (HR 1.03, 95% CI 1.02-1.04), polyvascular disease (HR 1.42, 95% CI 1.15-1.77), CLTI (HR 1.91, 95% CI 1.54-2.36), AF (HR 1.54, 95% CI 1.18-2.01) and anemia (HR 1.65, 95% CI 1.31-2.06) remained independent predictors of MACE. Patients with both polyvascular involvement and CLTI were four times more likely to experience MACE compared to those with PAD alone (Figure 1). Conclusion: Polyvascular involvement, critical limb ischemia, anemia, and AF were independent predictors of MACE in symptomatic PAD patients during long-term follow-up.

Research paper thumbnail of Diabetes and Critical Limb Ischemia: The Deadly Duo in Patients with Symptomatic Peripheral Artery Disease

-Infl ammation plays an important role in the initiation and progression of peripheral artery dis... more -Infl ammation plays an important role in the initiation and progression of peripheral artery disease (PAD). Patients with diabetes have an increased risk of developing PAD. Data regarding the prognostic implication of diabetes and infl ammation in PAD patients are scarce. Th e aim of the study was to investigate the impact of diabetes and infl ammation on all-cause mortality in patients with symptomatic PAD and preserved left ventricular ejection fraction (LVEF >50%). Th e study was conducted at the Sestre milosrdnice University Hospital Center between January 2010 and January 2014 on 319 consecutive patients with symptomatic PAD and preserved LVEF (66.5% men, mean age 70±10 years, ankle brachial index 0.58±0.14). Th irty-eight (12%) patients died during median follow up period of 24 months (interquartile range, 16-34 months). On univariate analysis, C-reactive protein was signifi cantly associated with all-cause mortality (HR 2.21, 95% CI 1.09-4.48). After multivariate regression analysis, age (HR 1.07, 95% CI 1.02-1.11), diabetes (HR 2.24, 95% CI 1.04-4.82), and critical limb ischemia (HR 2.22, 95% CI 1.03-4.80) remained the only independent predictors for all-cause mortality. Diabetes and critical limb ischemia are independently associated with an increased risk of mortality in symptomatic PAD patients with preserved LVEF.

Research paper thumbnail of Diabetes – a risk factor and prognosticator in peripheral artery disease

Endocrine Oncology and Metabolism

Research paper thumbnail of Prognostic Significance of Microvascular Injury in Kidney Transplant Recipients

Research paper thumbnail of Burnout among Croatian physicians: a cross-sectional national survey

Croatian Medical Journal

AimTo investigate the prevalence of burnout syndrome among physicians of all specialties, includi... more AimTo investigate the prevalence of burnout syndrome among physicians of all specialties, including residents and non-specialists, on a national level in Croatia.MethodsThis cross-sectional study, conducted in October 2017, used anonymous online survey based on the Maslach Burnout Inventory Human Services Survey. The Croatian version of the inventory was assessed for acceptability, factorial validity, and reliability. Key dimensions of burnout – emotional exhaustion, depersonalization, and lack of personal accomplishment were assessed. Respondents scoring high for emotional exhaustion or depersonalization were defined as burned-out.ResultsThe response rate was 18% (2557/14 427). Respondents’ median age was 41 years (range 25-80), and 68% (1737/2557) were women. Good sampling adequacy and scale reliability were confirmed. Factorial validity suggested the presence of three overall factors, and no items were eliminated. Sixty-three percent of physicians were burned-out. High score on emotional exhaustion, depersonalization, and reduced personal accomplishment were found in 58%, 29%, and 52% of respondents, respectively. As many as 16% of the respondents simultaneously experienced high levels of all three burnout dimensions. Multivariate logistic regression analysis revealed that residents and physicians in tertiary or primary care were at an increased risk of burnout, while physicians working in institutes were at a decreased risk.ConclusionActive national measures are needed to reduce the high prevalence of burnout among Croatian physicians.

Research paper thumbnail of Diabetes, renal dysfunction, inflammation, and anemia: the deadly quartet in peripheral artery disease

Endocrine Oncology and Metabolism, 2016

Research paper thumbnail of The prognostic role of atrial fibrillation in patients with symptomatic peripheral artery disease and preserved left ventricular systolic function

Cardiologia Croatica, 2014

Research paper thumbnail of Inflammation, platelet activity, renal function and major cardiovascular events in patients with severe peripheral artery disease

Cardiologia Croatica, 2013

Inflammatory markers and impaired renal function are the predictors of adverse outcome in patient... more Inflammatory markers and impaired renal function are the predictors of adverse outcome in patients with peripheral arterial disease (PAD). Despite interrelated pathophysiology between inflammation, platelets and renal function, these risk factors have not been examined together in the clinical setting. Therefore, the purpose of the study was to investigate their prognostic impact in PAD patients and to verify if they could add to the prognostic power of the ankle/brachial index (ABI). Patients and Methods: The occurrence of major adverse cardiovascular events (MACE, defined as composite endpoint of death, myocardial infarction, stroke, percutaneous coronary intervention and coronary bypass surgery) was prospectively assessed in 174 PAD patients, Fontaine stages IIb and III (66% males, mean age 69.7 years, mean ABI 0.59). C-reactive protein (CRP), leukocyte count (WBC), mean platelet volume (MPV, an indicator of platelet reactivity) and estimated glomerular filtration rate (eGFR, calculated by MDRD formula) were obtained at the time of admission. Multivariate Cox regression analysis (adjusted for age, gender, traditional, cardiovascular risk factors, ABI, body mass index, concomitant coronary and carotid disease and medications used: statins, antiplatelets, antihypertensives) was applied to assess the predictive values of biomarkers on patients` outcome. Optimal cutoff points of WBC (>7.3x10 9 /L), MPV (>7.7 fL) and eGFR (<60 ml/min) to predict MACE were calculated with ROC analysis. Comparison between c-statistics was made to assess the better ability of biomarkers in combination with ABI vs. ABI alone to predict MACE in PAD patients. Results: During a median follow-up of 24 months, 36 patients (21%) had an event. Higher baseline levels of WBC, MPV and lower eGFR were significantly associated with future MACE by univariate analysis (p<0.05), while CRP did not differ between the groups (p=0.89). After multivariable analysis, WBC (HR 2.71, 95% CI 1.29-5.69), MPV (HR 2.89, 95% CI 1.35-6.18) and eGFR (HR 2.12, 95% CI 1.05-4.25) remained significant independent predictors of cardiovascular events. The model that incorporated WBC, MPV and eGFR to ABI improved the prediction of MACE; the area under ROC curve rose from 0.57 to 0.71 (p=0.02). Conclusion: Leukocyte count, mean platelet volume and impaired renal function are independently related to future cardiovascular events in severe PAD patients, and improved the prognostic value of the ankle/brachial index.

Research paper thumbnail of C-reactive protein, renal function, and cardiovascular outcome in patients with symptomatic peripheral artery disease and preserved left ventricular systolic function

Croatian Medical Journal, 2015

To investigate the prognostic role of C-reactive protein (CRP) and renal function for the occurre... more To investigate the prognostic role of C-reactive protein (CRP) and renal function for the occurrence of major adverse cardiovascular events (MACE) in patients with symptomatic peripheral artery disease (PAD) and preserved left ventricular ejection fraction (LVEF). The occurrence of MACE, defined as composite endpoint of acute myocardial infarction, urgent coronary revascularization, stroke, and death was assessed in 319 consecutive PAD patients admitted to the University Hospital between January 2010 and January 2014 (66.5% men, mean [±standard deviation] age 70±10 years, mean ankle brachial index 0.58±0.14) with normal LVEF (&amp;amp;gt;50%). Multivariate Cox regression analysis adjusted for age, sex, traditional cardiovascular risk factors, anemia, polyvascular disease, critical limb ischemia (CLI), statin treatment, CRP (&amp;amp;gt;5 mg/L), and impaired renal function (estimated glomerular filtration rate &amp;amp;lt;60 mL/min) was applied to assess the independent predictors of MACE. During median follow-up period of 24 months (interquartile range, 16-34 months), 77 patients (24%) experienced MACE. Compared to patients without MACE, these patients were older, more likely to have CLI, polyvascular disease, anemia, elevated CRP, and impaired renal function. In multivariate regression analysis, age (HR 1.04, 95% CI 1.01-1.07), polyvascular disease (HR 1.95, 95% CI 1.23-3.09), elevated CRP (HR 1.89, 95% CI 1.18-3.02), and impaired renal function (HR 1.68, 95% C 1.01-2.78) remained independent predictors of MACE. Patients with both impaired renal function and high CRP values on admission were 3.59 times more likely to experience MACE than patients with normal CRP and preserved renal function. Elevated admission CRP and renal impairment are independent predictors of MACE in symptomatic PAD patients with preserved LVEF.

Research paper thumbnail of Kliničko značenje nultih biopsija transplantiranih bubrega i tankih glomerularnih bazalnih membrana u nultim biopsijama transplantiranih bubrega

Aim. To investigate morphological findings of zero-time biopsies analyzed at the Department of Ne... more Aim. To investigate morphological findings of zero-time biopsies analyzed at the Department of Nephropathology and Electron Microscopy, Dubrava University Hospital, Zagreb. Materials and methods. The retrospective search of data was performed for the period from 2006 to 2018. A total of 316 zero-time renal biopsies were analyzed. Glomerular basement membrane (GBM) thickness was remeasured in 84 zero-time biopsies and 80 protocol biopsies of the same patients 12 months after transplantation. Results and conclusion. The acute tubular injury was present in 90% and glomerular pathology in 17% of zero-time biopsies, with thin basement membranes (TBM ) being the most common entity (13%). Chronic graft changes were evaluated according to Banff classification. Most cases showed Banff scores ci0 (82.6%) and ct0 (65.1%). Banff scores cv2 and cv3 were present in 13% and ah2 and ah3 in 36.4% of specimens. Among 84 remeasured zero-time samples, TBM was present in 26 patients (31%). There were no...

Research paper thumbnail of First Croatian Prospective Peripheral Artery Disease Registry (CRO-PAD): What have we learned in the past 10 years?

The first Croatian Prospective Peripheral Artery Disease Registry (CRO-PAD) was created in 2010, ... more The first Croatian Prospective Peripheral Artery Disease Registry (CRO-PAD) was created in 2010, with the aim to collect, organize and present data about patients with PAD. The purpose was to evaluate risk factors, prognosticators, longitudinal outcomes, and therapeutic development in order to improve patients' healthcare and disease outcomes. Patients and Methods: The occurrence of major adverse cardiovascular events (MACE), defined as composite endpoint of acute myocardial infarction, stroke, and death was assessed in 1084 symptomatic PAD patients admitted to the University Hospital between January 2010 and January 2020 (65% men, age 70±10 years). Multivariate Cox regression analysis adjusted for age, gender, traditional cardiovascular risk factors, polyvascular disease, chronic limb threatening ischemia (CLTI), atrial fibrillation (AF), anemia, statin treatment, and impaired renal function was applied to assess the independent predictors of MACE. Results: During median follow-up period of 44 months (interquartile range, 23-59 months), 370 patients (34%) experienced MACE. Compared to patients without MACE, these patients were older, more likely to have diabetes, hypertension, CLTI, polyvascular disease, AF, anemia, and renal impairment. In multivariate regression analysis, age (HR 1.03, 95% CI 1.02-1.04), polyvascular disease (HR 1.42, 95% CI 1.15-1.77), CLTI (HR 1.91, 95% CI 1.54-2.36), AF (HR 1.54, 95% CI 1.18-2.01) and anemia (HR 1.65, 95% CI 1.31-2.06) remained independent predictors of MACE. Patients with both polyvascular involvement and CLTI were four times more likely to experience MACE compared to those with PAD alone (Figure 1). Conclusion: Polyvascular involvement, critical limb ischemia, anemia, and AF were independent predictors of MACE in symptomatic PAD patients during long-term follow-up.

Research paper thumbnail of Diabetes and Critical Limb Ischemia: The Deadly Duo in Patients with Symptomatic Peripheral Artery Disease

-Infl ammation plays an important role in the initiation and progression of peripheral artery dis... more -Infl ammation plays an important role in the initiation and progression of peripheral artery disease (PAD). Patients with diabetes have an increased risk of developing PAD. Data regarding the prognostic implication of diabetes and infl ammation in PAD patients are scarce. Th e aim of the study was to investigate the impact of diabetes and infl ammation on all-cause mortality in patients with symptomatic PAD and preserved left ventricular ejection fraction (LVEF >50%). Th e study was conducted at the Sestre milosrdnice University Hospital Center between January 2010 and January 2014 on 319 consecutive patients with symptomatic PAD and preserved LVEF (66.5% men, mean age 70±10 years, ankle brachial index 0.58±0.14). Th irty-eight (12%) patients died during median follow up period of 24 months (interquartile range, 16-34 months). On univariate analysis, C-reactive protein was signifi cantly associated with all-cause mortality (HR 2.21, 95% CI 1.09-4.48). After multivariate regression analysis, age (HR 1.07, 95% CI 1.02-1.11), diabetes (HR 2.24, 95% CI 1.04-4.82), and critical limb ischemia (HR 2.22, 95% CI 1.03-4.80) remained the only independent predictors for all-cause mortality. Diabetes and critical limb ischemia are independently associated with an increased risk of mortality in symptomatic PAD patients with preserved LVEF.

Research paper thumbnail of Diabetes – a risk factor and prognosticator in peripheral artery disease

Endocrine Oncology and Metabolism

Research paper thumbnail of Prognostic Significance of Microvascular Injury in Kidney Transplant Recipients

Research paper thumbnail of Burnout among Croatian physicians: a cross-sectional national survey

Croatian Medical Journal

AimTo investigate the prevalence of burnout syndrome among physicians of all specialties, includi... more AimTo investigate the prevalence of burnout syndrome among physicians of all specialties, including residents and non-specialists, on a national level in Croatia.MethodsThis cross-sectional study, conducted in October 2017, used anonymous online survey based on the Maslach Burnout Inventory Human Services Survey. The Croatian version of the inventory was assessed for acceptability, factorial validity, and reliability. Key dimensions of burnout – emotional exhaustion, depersonalization, and lack of personal accomplishment were assessed. Respondents scoring high for emotional exhaustion or depersonalization were defined as burned-out.ResultsThe response rate was 18% (2557/14 427). Respondents’ median age was 41 years (range 25-80), and 68% (1737/2557) were women. Good sampling adequacy and scale reliability were confirmed. Factorial validity suggested the presence of three overall factors, and no items were eliminated. Sixty-three percent of physicians were burned-out. High score on emotional exhaustion, depersonalization, and reduced personal accomplishment were found in 58%, 29%, and 52% of respondents, respectively. As many as 16% of the respondents simultaneously experienced high levels of all three burnout dimensions. Multivariate logistic regression analysis revealed that residents and physicians in tertiary or primary care were at an increased risk of burnout, while physicians working in institutes were at a decreased risk.ConclusionActive national measures are needed to reduce the high prevalence of burnout among Croatian physicians.

Research paper thumbnail of Diabetes, renal dysfunction, inflammation, and anemia: the deadly quartet in peripheral artery disease

Endocrine Oncology and Metabolism, 2016

Research paper thumbnail of The prognostic role of atrial fibrillation in patients with symptomatic peripheral artery disease and preserved left ventricular systolic function

Cardiologia Croatica, 2014

Research paper thumbnail of Inflammation, platelet activity, renal function and major cardiovascular events in patients with severe peripheral artery disease

Cardiologia Croatica, 2013

Inflammatory markers and impaired renal function are the predictors of adverse outcome in patient... more Inflammatory markers and impaired renal function are the predictors of adverse outcome in patients with peripheral arterial disease (PAD). Despite interrelated pathophysiology between inflammation, platelets and renal function, these risk factors have not been examined together in the clinical setting. Therefore, the purpose of the study was to investigate their prognostic impact in PAD patients and to verify if they could add to the prognostic power of the ankle/brachial index (ABI). Patients and Methods: The occurrence of major adverse cardiovascular events (MACE, defined as composite endpoint of death, myocardial infarction, stroke, percutaneous coronary intervention and coronary bypass surgery) was prospectively assessed in 174 PAD patients, Fontaine stages IIb and III (66% males, mean age 69.7 years, mean ABI 0.59). C-reactive protein (CRP), leukocyte count (WBC), mean platelet volume (MPV, an indicator of platelet reactivity) and estimated glomerular filtration rate (eGFR, calculated by MDRD formula) were obtained at the time of admission. Multivariate Cox regression analysis (adjusted for age, gender, traditional, cardiovascular risk factors, ABI, body mass index, concomitant coronary and carotid disease and medications used: statins, antiplatelets, antihypertensives) was applied to assess the predictive values of biomarkers on patients` outcome. Optimal cutoff points of WBC (>7.3x10 9 /L), MPV (>7.7 fL) and eGFR (<60 ml/min) to predict MACE were calculated with ROC analysis. Comparison between c-statistics was made to assess the better ability of biomarkers in combination with ABI vs. ABI alone to predict MACE in PAD patients. Results: During a median follow-up of 24 months, 36 patients (21%) had an event. Higher baseline levels of WBC, MPV and lower eGFR were significantly associated with future MACE by univariate analysis (p<0.05), while CRP did not differ between the groups (p=0.89). After multivariable analysis, WBC (HR 2.71, 95% CI 1.29-5.69), MPV (HR 2.89, 95% CI 1.35-6.18) and eGFR (HR 2.12, 95% CI 1.05-4.25) remained significant independent predictors of cardiovascular events. The model that incorporated WBC, MPV and eGFR to ABI improved the prediction of MACE; the area under ROC curve rose from 0.57 to 0.71 (p=0.02). Conclusion: Leukocyte count, mean platelet volume and impaired renal function are independently related to future cardiovascular events in severe PAD patients, and improved the prognostic value of the ankle/brachial index.

Research paper thumbnail of C-reactive protein, renal function, and cardiovascular outcome in patients with symptomatic peripheral artery disease and preserved left ventricular systolic function

Croatian Medical Journal, 2015

To investigate the prognostic role of C-reactive protein (CRP) and renal function for the occurre... more To investigate the prognostic role of C-reactive protein (CRP) and renal function for the occurrence of major adverse cardiovascular events (MACE) in patients with symptomatic peripheral artery disease (PAD) and preserved left ventricular ejection fraction (LVEF). The occurrence of MACE, defined as composite endpoint of acute myocardial infarction, urgent coronary revascularization, stroke, and death was assessed in 319 consecutive PAD patients admitted to the University Hospital between January 2010 and January 2014 (66.5% men, mean [±standard deviation] age 70±10 years, mean ankle brachial index 0.58±0.14) with normal LVEF (&amp;amp;gt;50%). Multivariate Cox regression analysis adjusted for age, sex, traditional cardiovascular risk factors, anemia, polyvascular disease, critical limb ischemia (CLI), statin treatment, CRP (&amp;amp;gt;5 mg/L), and impaired renal function (estimated glomerular filtration rate &amp;amp;lt;60 mL/min) was applied to assess the independent predictors of MACE. During median follow-up period of 24 months (interquartile range, 16-34 months), 77 patients (24%) experienced MACE. Compared to patients without MACE, these patients were older, more likely to have CLI, polyvascular disease, anemia, elevated CRP, and impaired renal function. In multivariate regression analysis, age (HR 1.04, 95% CI 1.01-1.07), polyvascular disease (HR 1.95, 95% CI 1.23-3.09), elevated CRP (HR 1.89, 95% CI 1.18-3.02), and impaired renal function (HR 1.68, 95% C 1.01-2.78) remained independent predictors of MACE. Patients with both impaired renal function and high CRP values on admission were 3.59 times more likely to experience MACE than patients with normal CRP and preserved renal function. Elevated admission CRP and renal impairment are independent predictors of MACE in symptomatic PAD patients with preserved LVEF.