scholarly journals Death rates and causes of death in cohorts of serum hepatitis patients followed up for more than 20 years

2001 ◽  
Vol 126 (1) ◽  
pp. 89-96 ◽  
Author(s):  
S. GJERULDSEN ◽  
M. ABDELNOOR ◽  
S. OPJORDSMOEN ◽  
B. MYRVANG

A cohort of 214 drug addicts with serum hepatitis and a cohort of 193 hepatitis patients without drug addiction were examined in respect of death rates, causes of death and a number of risk factors for reduced survival. The death rate was significantly higher among the drug addicts than among non-addicts. The annual mortality rate was 1·5% in the drug addict group and 0·7% in the non-addict group. The highest relative risk of death was 860 for female drug addicts in age group 15–24 compared to females of the same age in the general population. The most prevalent cause of death in the drug addict group was drug overdose (53%), whereas in the other group 66% died from various somatic diseases. Hepatitis or complications of viral hepatitis played no role as cause of death among the drug addicts, and infections as a whole were also responsible for very few deaths. For male drug addicts, imprisonment before admission and leaving hospital without the doctors' permission were risk factors for early death.

2013 ◽  
Vol 4 (2) ◽  
pp. 86-92 ◽  
Author(s):  
Anne K. Nitter ◽  
Karin Ø. Forseth

AabstractIntroductionChronic musculoskeletal pain represents a significant health problem among adults in Norway. The prevalence of chronic pain is reported to be 35-53% in cross sectional studies of both genders. For many years, it has been a common opinion among medical doctors that chronic pain may indeed reduce a person’s quality of life, but not affect life expectancy. However, over the previous two decades, reports about mortality and cause of death in individuals with chronic pain have been published. So far, several studies conclude that there is an increased mortality in patients with chronic pain, but it is not clear what causes this. Increased occurrences of cardio-vascular death or cancer death have been reported in some studies, but not verified in other studies.Aims of the studyThe aims of this study were to estimate the mortality rate in females with different extent of pain, to identify potential risk factors for death and to investigate if the causes of death differ according to prior reported pain.MethodsThis is a prospective population-based study of all women between 20 and 50 years registered in Arendal, Norway, in 1989 (N = 2498 individuals). At follow-up in 2007, 2261 living females were retraced, 89 had died.All subjects received a questionnaire containing questions about chronic pain (pain ≥ 3 months duration in muscles, joints, back or the whole body) as well as 13 sub-questions about pain-modulating factors, non-specific health complaints and sleep problems, by mail in 1990, 1995 and 2007. Only subjects who answered the questionnaire in 1990 were included in the analyses. Of the deceased, 71 had answered the questionnaire in 1990.A multivariate model for cox regression analysis was used in order to clarify if chronic pain, sleep problems, feeling anxious, frightened or nervous and number of unspecific health were risk factors for death.The causes of death of 87 of the deceased individuals were obtained by linking the ID-number with the Norwegian Cause of Death Registry.ResultsThe ratio of deceased responders was 2% (14/870) among those with no pain versus 5% (57/1168) among those with chronic pain at baseline. When separating into chronic regional pain and chronic widespread pain, the mortality rate was respectively 4% and 8% in the different groups. Age adjusted hazard ratio for mortality rate in individuals with initially chronic pain was [HR 2.5 (CI 1.4–4.5)] compared to pain free individuals. In the multivariate analysis, having chronic pain [HR 2.1 (1.1–4.2)] and feeling anxious, frightened or nervous [HR 3.2 (1.8–5.6)] were associated with increased risk of death. There was no difference in death from cardiovascular disease or malignancies between the groups of pain free individuals vs. the group of individuals with chronic pain.ConclusionThe mortality rate was significantly higher for individuals with chronic pain compared to pain free individuals, adjusted for age. In addition, feeling anxious, frightened or nervous were risk factors for death. There was an increase in all-cause mortality.


Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 37-38
Author(s):  
Monica Else ◽  
Stuart J Blakemore ◽  
Jonathan C Strefford ◽  
Daniel Catovsky

* These authors contributed equally Introduction Causes of death and, in particular, deaths due to infection have not been widely studied in randomised trials in chronic lymphocytic leukaemia (CLL). With long-term follow-up (median 13 years), we were able to examine the cause of death in 600/777 patients in the LRF CLL4 trial. Blood samples taken at randomization from 499 patients were available, allowing us to examine the relationship between deaths due to infection and a large panel of genes which are commonly mutated in CLL. Several gene mutations have been linked to earlier death in the LRF CLL4 trial, including mutations of TP53, NOTCH1, SF3B1, EGR2 and MAPK-ERK (Gonzalez et al, J Clin Oncol 2011; 29:2223-9; Oscier et al, Blood 2013; 121:468-75; Young et al, Leukemia 2017; 31:1547-54; Blakemore et al, Leukemia 2020; 34:1760-4). In this study we aimed to identify gene mutations which were specifically associated with death due to infection. Methods In LRF CLL4 patients were randomized between 1999-2004 to receive chlorambucil or fludarabine, with or without cyclophosphamide. Follow-up continued until September 2016. Causes of death were assessed centrally by the principal investigator. Results In the LRF CLL4 trial 614 of 777 patients (79%) died before the end of follow-up. The cause of death was known in 600 patients. Deaths tended to be multifactorial, but infection was a cause of death in 258 patients (43%). Fatal infections were pneumonia (67%), and/or sepsis (38%) and/or opportunistic infections such as aspergillus (11%). Patients who died of infection were more likely than those who died of other causes to have received more than one line of treatment and to have died in the winter months (Table 1). Mutations of BRAF, FBXW7, NRAS and XPO1 were significantly associated with death due to infection versus other deaths. However, with multiple hypothesis testing, NRAS was the only genetic mutation to survive a false discovery rate (FDR) q-value = 0.05 (odds ratio: 17, P = 0.0004). No other significant differences were found between patients who died of infection versus those whose death did not have an infectious cause. In particular, the rate of deaths due to infection was not influenced by other demographic or laboratory factors, nor by the randomised treatment, the response to treatment, or the size/experience of the CLL treatment centre. In multivariate analysis the factors most significantly associated with death from infection versus all other deaths were mutations of the BRAF, FBXW7, NRAS and XPO1 genes (Table 1). Of the 499 patients in the trial for whom gene mutation data were available, 73 (15%) carried one or more of the four gene mutations BRAF (6%), FBXW7 (2%), NRAS (2%) and XPO1 (6%) (Table 2). Only six of these 73 remained alive. Death was caused by infection in 46/67 assessable patients (69%) who had a mutation of one or more of these four genes versus only 129/333 patients (39%) without any of these mutations (odds ratio: 3.46 [95% C.I. 1.98-6.07] P<0.0001). In order to test the robustness of our results, the same analysis was repeated in the full trial, comparing the patients who died of infection with all the other trial patients, including those who remained alive. The presence of one or more of the four gene mutations BRAF, FBXW7, NRAS and XPO1 was the most significant predictor of death from infection in univariate analysis in this larger dataset (odds ratio: 3.92 [95% C.I. 2.34-6.59] P<0.0001). Patients who died of infection lost on average 2 years 4 months of life compared with the median overall survival of all the other trial patients (6 years 11 months, log-rank P<0.0001). Conclusion Patients in LRF CLL4 were at some risk of death due to infection, irrespective of their demographic characteristics, disease stage and treatment history. Nevertheless, those who had received more lines of treatment were particularly at risk, as were those who carried a BRAF, FBXW7, NRAS or XPO1 mutation. A meta-analysis of datasets from other trials could be important to assess the validity of the link between these gene mutations and deaths from infections in patients with CLL and possibly other leukaemias and lymphomas. Careful management of infection risk, together with prophylaxis against infection, may be important in patients who carry one or more of these mutations. Disclosures No relevant conflicts of interest to declare.


Sexual Health ◽  
2006 ◽  
Vol 3 (2) ◽  
pp. 103 ◽  
Author(s):  
Kathy Petoumenos ◽  
Matthew G. Law ◽  
on behalf of the Australian HIV Observational Database

Introduction: Mortality rates in HIV-infected people remain high in the era of highly active antiretroviral treatment (HAART). The objective of this paper was to examine causes of deaths in the Australian HIV Observational Database (AHOD) and compare risk factors for HIV-related and HIV-unrelated deaths. Methods: Data from AHOD, an observational study of people with HIV attending medical sites between 1999 and 2004, were analysed. Primary and underlying causes of death were ascertained by sites completing a standardised cause of death form. Causes of death were then coded as HIV-related or HIV-unrelated. Risk factors for HIV-related and unrelated deaths were assessed using survival analysis among patients who had a baseline and at least one follow-up CD4 and RNA measure. Results: The AHOD had enrolled 2329 patients between 1999 and 2004. During this time, a total of 105 patients died, with a crude mortality rate of 1.58 per 100 person years. Forty-two (40%) deaths were HIV-related (directly attributable to an AIDS event), 55 (52%) HIV-unrelated (all other causes), and eight had unknown cause of death. Independent risk factors for HIV-related deaths were low CD4 count and receipt of a larger number of antiretroviral treatment combinations. Among HIV-unrelated deaths, low CD4 count and older age were independent risk factors. Conclusions: In AHOD in the HAART era, mortality in people with HIV remains around 10-fold higher than in the general population. In our analyses, HIV-unrelated deaths were associated with more advanced HIV disease in a similar way to HIV-related deaths.


2019 ◽  
Vol 7 ◽  
pp. 817-823
Author(s):  
Rokas Šimakauskas ◽  
Martinas Baltuonis ◽  
Sigitas Laima ◽  
Sigitas Chmieliauskas ◽  
Dmitrij Fomin ◽  
...  

Introduction. Pulmonary thromboembolism (PTE) is not an uncommon cause of sudden, unexpected death. Autopsy is the gold standard for cause of death determination in cases of suspected PTE. Mortality rates due to PTE are not estimated accurately. Objective. The aim of this study was to analyze distribution patterns and risk factors of sudden deaths due to PTE. Methods. Retrospective analysis of Lithuanian State Forensic Medicine Service autopsy data, period 2014-2018. A total of 4533 cases were reviewed; 80 cases met the criteria of immediate cause of death being PTE and were included in the study. PTE epidemiology, risk factors, clinical and pathoanatomical characteristics were described by reviewing scientific literature and statistical databases. Results. PTE as the cause of sudden death was diagnosed in 37(46.25%) men and 43(53.75%) women. Median age at the time of death was 62.8±17.2 years. Death occurred in hospital in 21(26.25%) cases. Trauma was the underlying cause of PTE in 11(13.75%) cases; 9(81.8%) patients were admitted to hospital after a traumatic event. Cardiac hypertrophy was observed in 70(87.5%) autopsies. Abdominal subcutaneous fat thickness was 4.08±2.64 cm in men and 5.35±2.69 cm in women. Deep vein thrombosis (DVT) was confirmed upon microscopic examination in all cases, being the underlying cause of death in 67(83.75%) cases. Conclusion. Sudden death due to PTE usually occurs at an older age and in absence of medical care. PTE is common after sustaining severe traumatic injuries which, when not immediately lethal, are managed in hospital. Cardiac hypertrophy and obesity may increase risk of death due to PTE. Undiagnosed and untreated DVT is often the underlying cause of sudden death due to PTE.


2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii182-ii183
Author(s):  
Maciej Harat ◽  
Maciej Blok ◽  
Joanna Kowalewska ◽  
Iza Miechowicz

Abstract PURPOSE/OBJECTIVE(S) Stereotactic radiosurgery (SRS) in patients with risk factors other than the number of intracranial metastases remains controversial. Here we define factors related to early death after SRS alone and compared SRS alone with WBRT in high-risk patients. The aim of our study was to verify if optimal brain treatment may extend survival in patients with poor prognosis and select optimal candidates. MATERIALS AND METHODS In this prospectively collected data, 180 patients with brain metastases and adverse prognostic factors not previously treated with WBRT were analyzed. SRS patients were divided into training (n=82) and validation (n=48) cohorts and compared to retrospective data of WBRT patients (n=50). Overall survival (OS) and probability of 3-month survival in relation to risk factors were defined by univariable and multivariable analyses. RESULTS In multivariable analysis, GPA (OR 0.44, 95%CI 0.21-0.95; p=0.001), extensive extracranial disease (OR 0.13, 95%CI 0.02-0.66; p=0.013), and serious neurological deficits (OR 0.13, 95%CI 0.04-0.45; p=0.001) were associated with early death. If one factor was favorable, 73% (training) and 92% (validation) of patients survived 3 months. Patients with coexisting GPA< 2, serious neurological deficits, and extracranial extensive disease had the highest risk of death within 3 months (AUC 0.822 training; 0.932 validation). Median survival of the WBRT and SRS cohorts was 86 days (interquartile range (IQR): 38-172 days) and 201 days (IQR: 86-not reached), respectively (p< 0.0001). OS in very high-risk patients (GPA< 2) was significantly longer in the SRS vs. WBRT group (123 vs. 58 days; p=0.008). CONCLUSIONS Extracranial oligometastatic disease, intact neurological status, or GPA ≥2 should be present to justify SRS in patients with 1-10 brain metastases. SRS alone is a viable treatment option in comparison to WBRT and most importantly survival benefits may be expected even for high-risk patients (GPA< 2).


Stroke ◽  
2021 ◽  
Author(s):  
Maria Carlsson ◽  
Tom Wilsgaard ◽  
Stein Harald Johnsen ◽  
Liv-Hege Johnsen ◽  
Maja-Lisa Løchen ◽  
...  

Background and Purpose: Data on long-term survival after intracerebral hemorrhage (ICH) are scarce. In a population-based nested case-control study, we compared long-term survival and causes of death within 5 years in 30-day survivors of first-ever ICH and controls, assessed the impact of cardiovascular risk factors on 5-year mortality, and analyzed time trend in 5-year mortality in ICH patients over 2 decades. Methods: We included 219 participants from the population-based Tromsø Study, who after the baseline participation had a first-ever ICH between 1994 to 2013 and 1095 age- and sex-matched participants without ICH. Cumulative survival was presented using the Kaplan-Meier method. Hazard ratios (HRs) for mortality and for the association between cardiovascular risk factors and 5-year mortality in 30-day survivors were estimated by stratified Cox proportional hazards models. Trend in 5-year mortality was assessed by logistic regression. Results: Risk of death during follow-up (median time, 4.8 years) was increased in the ICH group compared with controls (HR, 1.62 [95% CI, 1.27–2.06]). Cardiovascular disease was the leading cause of death, with a higher proportion in ICH patients (22.9% versus 9.0%; P <0.001). Smoking increased the risk of 5-year mortality in cases and controls (HR, 1.59 [95% CI, 1.15–2.19]), whereas serum cholesterol was associated with 5-year mortality in cases only (HR, 1.39 [95% CI, 1.04–1.86]). Use of anticoagulants at ICH onset increased the risk of death (HR, 2.09 [95% CI, 1.09–4.00]). There was no difference according to ICH location (HR, 1.15 [95% CI, 0.56–2.37]). Five-year mortality did not change during the study period (odds ratio per calendar year, 1.01 [95% CI, 0.93–1.09]). Conclusions: Survival rates were significantly lower in cases than in controls, driven by a 2-fold increased risk of cardiovascular death. Smoking, serum cholesterol, and use of anticoagulant drugs were associated with increased risk of death in ICH patients. Five-year mortality rates in ICH patients remained stable over time.


2019 ◽  
Vol 76 (3) ◽  
pp. 278-283
Author(s):  
Dragan Mitrovic ◽  
Ivana Savic ◽  
Radmila Jankovic

Background/Aim. Autopsy studies rarely investigate the causes of natural death in psychiatric population. The aim of this study was to examine the causes of death among the subjects with various psychiatric disorders in whom a clinical (pathoanatomical) autopsy was requested. Methods. The study group included 118 patients (65% men, 35% women, mean age 58.2 ? 13.6 years) with a psychiatric diagnosis, in whom a clinical autopsy was performed. We compared the distribution of causes of natural death among psychiatric patients and other patients, representatives of the general population who died of natural causes. We also analyzed the difference between clinical diagnoses of cause of death and the autopsy findings in psychiatric patients. Results. Psychiatric patients died earlier than the control group (58 vs. 69 years), usually due to the respiratory (46%) and cardiovascular diseases (37%). The most common diagnoses in psychiatric patients were organic psychoses and dementias (F00-F09) and schizophrenia and schizoaffective disorders (F20-F29). Majority of the patients (55%) died in general hospitals vs. specialized psychiatric hospitals (45%) due to somatic diseases. There was a significant difference in the distribution of causes of death compared to the control group in which the cardiovascular diseases dominated. Even in 64% of psychiatric patients there was a discrepancy between the clinical diagnosis of the cause of death and definite autopsy findings. Conclusion. The assessment of somatic diseases in psychiatric patients is insufficient, especially in specialized psychiatric hospitals. That leads to a significant discrepancy between clinical diagnosis of the cause of death and autopsy findings. Therefore, it is necessary to pay additional attention in diagnostics and treatment of somatic diseases in these patients to improve their health care.


2021 ◽  
Vol 11 (4) ◽  
pp. 33606-33606
Author(s):  
Shahram Jahanmanesh ◽  
◽  
Sareh Farhadi ◽  
Fares Najari ◽  
◽  
...  

Background: Determining the cause of death among drug addicts in Residential Rehab Campuses (RRCs) is of paramount importance, since it may prevent and reduce morbidity and mortality rates. Therefore, the present study was done to investigate the cause of death among drug addicts in RRCs in Kahrizak Dissection Hall, Tehran Province, Iran, from September 2011 to September 2019. Methods: In this descriptive cross-sectional study, a total number of 166 drug addicts, who had died in the RRCs located in Tehran, Iran were examined, and the findings were analyzed using the SPSS v. 26. Moreover, the Chi-square test was utilized to compare the results. Results: In this study, the most important causes of death, were infections, drug side effects, Myocardial Infarction (MI), and drowning, respectively. The highest frequency of death had occurred in the 31-40-year-old age group and was mostly observed in unmarried individuals. The most common causes of death were infection among the single and divorced ones and were MI for married cases. Toxicological results were generally negative in 60.84% of the cases. Also, 86.74% of the cases were non-pathological with regard to the brain tissue samples and 65.66% of the individuals had no pathological cardiac lesions. Besides, the most common microscopic findings of the lungs were associated with pulmonary edema. In the trauma group and also drug side effects and drowning groups, the most frequent pathological findings were pulmonary hemorrhage and pulmonary edema, respectively. As a whole, 69.87% of the deaths had occurred in the RRCs and 55.42% of them were assumed natural in terms of mode of occurrence. Conclusion: The majority of the deaths in the RRCs should not have occurred if the given centers were authorized and the illegal centers were closed. Moreover, these centers should have proper management with the presence of resident physicians and trained medical staff as well as necessary medical equipment, proper nutrition, no access to drugs and other illicit substances, along with adherence to hygienic principles to minimize mortality rates among the drug addicts living in the RRCs.


2019 ◽  
Author(s):  
John N Morris ◽  
Elizabeth Howard ◽  
Sabrina Egge ◽  
Erez Schachter ◽  
Fredrik Sjostrand

Abstract Background : Care planning has become more complex as nursing homes now are serving an ever more complex patient population. The primary purpose of this project is to identify, among persons admitted to and remaining up to 12 months, in a long-term care setting, those at more imminent risk of death, revealing the relevant risk factors and summarizing these factors within a Risk of Death Scale. Design : Longitudinal analysis of a national cohort of nursing home admissions from all United States facilities during years 2011 and 2012. Setting and Participants : Cohort included 1,536,842 admissions (764,002 for 2011, 772,840 for 2012). Repeated assessments are required every 90 days, with an additional assessment at discharge. Follow-up data over three years were examined. Methods : The Risk of Death Scale is based on two sub-scales. One included five very high risk of death measures. The second was composed of an additional eighteen risk factors. The dependent variable against which these models were developed was death by 365 days. Death rates are described from one-month post-admission to three years post-admission. Results : The Risk of Death Scale has twelve graded levels. The lowest four categories of the scale (0-3) represent approximately half the cohort and have one-year death rates that range from 3% to 15.5%, whereas the mean of the whole cohort is 24.2% at one year. The top four categories represent about 7% of the cohort and have one-year death rates ranging from 55.8% to 90.5%. The death rates increased steadily across the scale scores, a pattern that held through the three-year post admission period. Conclusions/Implications : The Risk of Death Scale for new admissions to nursing homes rests on a broad spectrum of 23 independent variables – including measures of prognosis, treatments, diagnoses, clinical status, function, cognitive status, and age. Almost 10% of the sample (n=149,073) had a risk score of 7 or greater and the average one-year mortality for this group was 68.6% (range of 47.5-90.5%).


Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3465-3465 ◽  
Author(s):  
Bradley M. Augustson ◽  
Gulnaz Begum ◽  
Nicola J. Barth ◽  
Janet A. Dunn ◽  
Gareth J. Morgan ◽  
...  

Abstract Introduction: Early mortality in newly dignosed patients with multiple myeloma (MM) is attributed to active disease and co-morbid factors, however there is little information regarding the exact mode of these deaths in the literature. The aim of this study is to analyse presentation features and clinical management of early mortality patients to identify strategies to avoid these deaths. Methods: 3107 patients entered into the UK MRC trials from 1980–2002 had newly diagnosed (MM) with evidence of MM related organ or tissue impairment. These patients were randomised to melphalan based therapy (n=848 patients), ABCM (n= 1967), intensive therapy (n=231) or cyclophosphamide (n=61). Presentation laboratory and clinical information was collected from the centrally stored patient files. Early death was defined as occurring within 60 days of diagnosis. The main and contributory causes of death were ascertained from the final clinical summary and post-mortem reports. Whether the final illness developed at home or hospital, delay in presentation, pre-morbid illness, bone pain and medications were specifically assessed. Results: 299 MM patients (10%) who entered MRC trials died within 60 days of diagnosis. The incidence of early mortality in ABCM treated patients aged over 65 years did not change for the periods 1982–87 to 1988–1992, and 1993–2002 (p=0.19). Patients who died early were older, had significantly worse skeletal disease, higher β2-microglobulin, lower platelet counts and more renal dysfunction, than the remaining MRC trial patients (P<0.0001 all parameters). However some early deaths occurred in patients with overall good prognostic features and 11% of patients dying within 60 days had a serum β2-microglobulin <4mg/l. The most common cause of early death was bacterial infection (45%). This was often associated with bone pain and delay in presentation to hospital. Renal failure (14% of early deaths) was associated with light chain disease, hypercalcaemia or a precipitating event such as dehydration or medications and infection. Vascular disease (13%) was associated with older age, and pre-existing vascular risk factors. Sudden death (10%), bleeding (5%), pulmonary embolus (3%) and orthopaedic complication (3%) accounted for the remaining deaths with no cause determined for 8% of cases. Conclusions: With intensive treatment and emerging therapies the long-term outlook for MM patients is improving. However we find in patients over 65 yrs receiving conventional therapy, the incidence of early death has remained constant since 1982 despite advances in supportive care. It is most commonly due to bacterial infection, renal failure and vascular complications in patients with poor prognostic indicators. Effective analgesia, avoidance of dehydration and nephrotoxic agents, attention to vascular risk factors, patient education and prompt presentation may contribute to reducing such deaths. One small trial has shown a survival benefit from prophylactic antibiotics; this requires further study given that 50% of early deaths were attributable to infection as a major or the main cause of death. Renal failure was a major or the main cause of death in 28% of patients highlighting the need for renal care and outcome of the current UK MERIT trial that is assessing the role of plasma exchange.


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