Magnitude of bacteraemia is a predictor of mortality during 1 year of follow-up

2008 ◽  
Vol 137 (1) ◽  
pp. 94-101 ◽  
Author(s):  
K. O. GRADEL ◽  
M. SØGAARD ◽  
C. DETHLEFSEN ◽  
H. NIELSEN ◽  
H. C. SCHØNHEYDER
Keyword(s):  
Surgical Patients ◽  
Adjusted Risk ◽  
High Magnitude ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Cox's Regression ◽  
First Time ◽  
Long Term Mortality

SUMMARYWe evaluated magnitude of bacteraemia as a predictor of mortality, comprising all adult patients with a first-time mono-microbial bacteraemia. The number of positive bottles [1 (reference), 2, or 3] in the first positive blood culture (BC) was an index of magnitude of bacteraemia. We used Cox's regression analysis to determine age and comorbidity adjusted risk of mortality at days 0–7, 8–30, and 31–365. Of 6406 patients, 31·1% had BC index 1 (BCI 1), 18·3% BCI 2, and 50·6% BCI 3. BCI 3 patients had increased risk of mortality for days 0–7 (1·30, 95% CI 1·10–1·55) and days 8–30 (1·37, 95% CI 1·12–1·68), but not thereafter. However, in surgical patients mortality increased only beyond day 7 (8–30 days: 2·04, 95% CI 1·25–3·33; 31–365 days: 1·27, 95% CI 0·98–1·65). Thus, high magnitude of bacteraemia predicted mortality during the first month with a shift towards long-term mortality in surgical patients.

scholarly journals Relationship between cardiac biomarker concentrations and long-term mortality in subjects with osteoarthritis

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242814
Author(s):  
Martin Rehm ◽  
Gisela Büchele ◽  
Raphael Simon Peter ◽  
Rolf Erwin Brenner ◽  
Klaus-Peter Günther ◽  
...  
Keyword(s):  
High Sensitivity ◽  
Cardiac Biomarkers ◽  
Continuous Variables ◽  
Prognostic Information ◽  
Cardiac Biomarker ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Long Term Mortality

Osteoarthritis (OA) is associated with adverse cardio-metabolic features. N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponins T and I (hs-cTnT and hs-cTnI) are well-characterized cardiac markers and provide prognostic information. The objective was to assess the association of cardiac biomarker concentrations with long-term mortality in subjects with OA. In a cohort of 679 OA subjects, undergoing hip or knee replacement during 1995/1996, cardiac biomarkers were measured and subjects were followed over 20 years. During a median follow-up of 18.4 years, 332 (48.9%) subjects died. Median of hs-cTnT, hs-cTnI, and NT-proBNP at baseline was 3.2 ng/L, 3.9 ng/L, and 96.8 ng/L. The top quartile of NT-proBNP was associated with increased risk of mortality (Hazard Ratio (HR) 1.79, 95% confidence interval (CI) 1.17–2.73) after adjustment for covariates including troponins (hs-cTnT HR 1.30 (95% CI 0.90–1.89), hs-cTnI HR 1.32 (95% CI 0.87–2.00) for top category). When biomarker associations were evaluated as continuous variables, only NT-proBNP (HR per log-unit increment 1.34, 95% CI 1.16–1.54) and hs-cTnI (HR 1.38, 95% CI 1.11–1.72) showed robust results. Elevated cardiac biomarker concentrations predicted an increased risk of long-term mortality and strongest for NT-proBNP and hs-cTnI. These results might help to identify subjects at risk and target preventive efforts early.

Long-term mortality rates and associated risk factors following primary and revision knee arthroplasty

2022 ◽  
Vol 104-B (1) ◽  
pp. 45-52
Author(s):  
Liam Zen Yapp ◽  
Nick D. Clement ◽  
Matthew Moran ◽  
Jon V. Clarke ◽  
A. Hamish R. W. Simpson ◽  
...  
Keyword(s):  
General Population ◽  
Knee Arthroplasty ◽  
Mortality Rates ◽  
Factors Associated ◽  
Revision Knee Arthroplasty ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Male Sex ◽  
Long Term Mortality

Aims The aim of this study was to determine the long-term mortality rate, and to identify factors associated with this, following primary and revision knee arthroplasty (KA). Methods Data from the Scottish Arthroplasty Project (1998 to 2019) were retrospectively analyzed. Patient mortality data were linked from the National Records of Scotland. Analyses were performed separately for the primary and revised KA cohorts. The standardized mortality ratio (SMR) with 95% confidence intervals (CIs) was calculated for the population at risk. Multivariable Cox proportional hazards were used to identify predictors and estimate relative mortality risks. Results At a median 7.4 years (interquartile range (IQR) 4.0 to 11.6) follow-up, 27.8% of primary (n = 27,474/98,778) and 31.3% of revision (n = 2,611/8,343) KA patients had died. Both primary and revision cohorts had lower mortality rates than the general population (SMR 0.74 (95% CI 0.73 to 0.74); p < 0.001; SMR 0.83 (95% CI 0.80 to 0.86); p < 0.001, respectively), which persisted for 12 and eighteight years after surgery, respectively. Factors associated with increased risk of mortality after primary KA included male sex (hazard ratio (HR) 1.40 (95% CI 1.36 to 1.45)), increasing socioeconomic deprivation (HR 1.43 (95% CI 1.36 to 1.50)), inflammatory polyarthropathy (HR 1.79 (95% CI 1.68 to 1.90)), greater number of comorbidities (HR 1.59 (95% CI 1.51 to 1.68)), and periprosthetic joint infection (PJI) requiring revision (HR 1.92 (95% CI 1.57 to 2.36)) when adjusting for age. Similarly, male sex (HR 1.36 (95% CI 1.24 to 1.49)), increasing socioeconomic deprivation (HR 1.31 (95% CI 1.12 to 1.52)), inflammatory polyarthropathy (HR 1.24 (95% CI 1.12 to 1.37)), greater number of comorbidities (HR 1.64 (95% CI 1.33 to 2.01)), and revision for PJI (HR 1.35 (95% 1.18 to 1.55)) were independently associated with an increased risk of mortality following revision KA when adjusting for age. Conclusion The SMR of patients undergoing primary and revision KA was lower than that of the general population and remained so for several years post-surgery. However, approximately one in four patients undergoing primary and one in three patients undergoing revision KA died within tenten years of surgery. Several patient and surgical factors, including PJI, were associated with the risk of mortality within ten years of primary and revision surgery. Cite this article: Bone Joint J 2022;104-B(1):45–52.

Abstract 2099: Pretransplant Toxoplasma Gondii Seropositivity Amongst Heart Transplant Recipients Is Associated With An Increased Risk Of All-cause And Cardiac Mortality

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Satish Arora ◽  
Pål Jenum ◽  
Pål Aukrust ◽  
Halvor Rollag ◽  
Arne Andreassen ◽  
...  
Keyword(s):  
Toxoplasma Gondii ◽  
Heart Transplant ◽  
Acute Cellular Rejection ◽  
Serum Samples ◽  
Regulatory Changes ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Cellular Rejection

Chronic Toxoplasma gondii (T. gondii ) infection is known to trigger potentially adverse immuno-regulatory changes, but the long-term implication for heart transplant (HTx) recipients has not been assessed previously. Hence, we evaluated the risk of mortality, development of cardiac allograft vasculopathy (CAV) and acute cellular rejection amongst T. gondii seropositive HTx recipients and the four donor/recipient seropairing groups. Methods: Frozen pre-HTx serum samples of 288 recipients and 246 donors were evaluated for T. gondii serostatus using Platelia IgG immunoassay method. All patients had also undergone prospective serostatus evaluation using alternative assays and results determined by the two methods were compared. Follow-up data regarding mortality, CAV development and acute cellular rejection was available for all patients. Results: Overall, 211 (73%) recipients were seronegative and 77 (27%) were seropositive. In total, 82 recipients died, 76 developed CAV and 82 had significant cellular rejection. Recipient seropositivity was associated with a significantly higher risk of all-cause mortality (hazard ratio [HR], 1.9; 95% CI, 1.1–3.4; p= 0.02) and CAV mortality (HR=4.4; 95% CI, 1.3–15.6, p=0.02), but was not associated with earlier CAV development or higher rejection score. Donor/recipient seropairing status was not a risk factor for any endpoint. Conclusions: T. gondii seropositivity amongst HTx recipients is associated with a significantly increased risk of long-term total, and in particular CAV-related, mortality. This may be mediated via immunoregulatory changes triggered by chronic T. gondii infection and needs to be explored further.

scholarly journals Increased mortality in patients with corticosteroid-dependent asthma: a nationwide population-based study

2019 ◽  
Vol 54 (5) ◽  
pp. 1900804 ◽  
Author(s):  
Hyun Lee ◽  
Jiin Ryu ◽  
Eunwoo Nam ◽  
Sung Jun Chung ◽  
Yoomi Yeo ◽  
...  
Keyword(s):  
Baseline Period ◽  
Population Based ◽  
High Dose ◽  
Population Based Study ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Korean National Health Insurance ◽  
Independent Cohort ◽  
Long Term Mortality

IntroductionChronic systemic corticosteroid (CS) therapy is associated with an increased risk of mortality in patients with many chronic diseases. However, it has not been elucidated whether chronic systemic CS therapy is associated with increased mortality in patients with asthma. The aim of this study was to determine the effects of chronic systemic CS therapy on long-term mortality in adult patients with asthma.MethodsA population-based matched cohort study of males and females aged ≥18 years with asthma was performed using the Korean National Health Insurance Service database from 2005 to 2015. Hazard ratio (HR) with 95% confidence interval for all-cause mortality among patients in the CS-dependent cohort (CS use ≥6 months during baseline period) relative to those in the CS-independent cohort (CS use <6 months during baseline period) was evaluated.ResultsThe baseline cohort included 466 941 patients with asthma, of whom 8334 were CS-dependent and 458 607 were CS-independent. After 1:1 matching, 8334 subjects with CS-independent asthma were identified. The HR of mortality associated with CS-dependent asthma relative to CS-independent asthma was 2.17 (95% CI 2.04–2.31). In patients receiving low-dose CS, the HR was 1.84 (95% CI 1.69–2.00); in patients receiving high-dose CS, the HR was 2.56 (95% CI 2.35–2.80).ConclusionsIn this real-world, clinical practice, observational study, chronic use of systemic CS was associated with increased risk of mortality in patients with asthma, with a significant dose–response relationship between systemic CS use and long-term mortality.

P0792FAT ATTENUATION INDEX OF CORONARY ARTERY IN COMPUTED TOMOGRAPHY ANGIOGRAPHY PREDICTS LONG-TERM OUTCOME IN CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nam-Jun Cho ◽  
Soon hyo Kwon ◽  
Bo Da Nam ◽  
Kyoungin Choi
Keyword(s):  
Coronary Artery ◽  
Kidney Disease ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Adjusted Risk ◽  
Attenuation Index ◽  
All Cause Mortality ◽  
Long Term Mortality

Abstract Background and Aims Perivascular fat attenuation index (FAI) of coronary artery represents the degree of coronary inflammation. High coronary artery FAI in computed tomography angiography (CTA) is associated with increased all-cause and cardiac mortality in general population. However, the ability of the perivascular FAI using coronary CTA to predict long term outcome in chronic kidney disease (CKD) patients is unknown. Method This is a single center retrospective study. We analyzed coronary FAIs on CTA for CKD including patients with end stage renal disease (ESRD). The patients with percutaneous coronary intervention or coronary artery bypass graft were excluded. Mapping and analysis of perivascular FAI were performed around proximal three major coronary arteries. We assessed the prognostic value of FAI of CTA for long-term mortality (data from the Korean National Statistical Office) with Cox regression models, adjusted for age, sex, dialysis vintage, and clinical parameters. Results Between January 2012 and June 2018, 268 CKD patients were included. Mean age of this cohort was 64.5 ± 12.0 years, and 132 (49.3%) participants were men. 109 (44.7%) participants has diabetic kidney disease, and 179 (66.4%) participants were on hemodialysis. Median follow-up after coronary CTA was 29.2 (15.1 − 46.3) months. During follow-up, there were 43 (20.6%) deaths. The optimum cut-off value of FAI around the left anterior descending artery (LAD) was ascertained as -65.5 Hounsfield unit. The high perivascular FAI around the LAD was significantly associated with higher adjusted risk of all-cause mortality (hazard ratio, 2.15; 95% CI, 1.07–4.32). In ESRD subgroup, the high perivascular FAI group also has higher adjusted risk of all-cause mortality compared to low perivascular FAI group (hazard ratio, 2.43; 95% CI, 1.16–5.09). Conclusion The perivascular FAI around LAD predicts the long-term mortality in patients with CKD. This could provide the chance of early primary intervention in CKD patients.

scholarly journals Risk of Venous Thromboembolism after New Onset Heart Failure

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Nathaniel R. Smilowitz ◽  
Qi Zhao ◽  
Li Wang ◽  
Sulena Shrestha ◽  
Onur Baser ◽  
...  
Keyword(s):  
Heart Failure ◽  
Venous Thromboembolism ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk ◽  
New Diagnosis ◽  
Over Time ◽  
Long Term Mortality ◽  
New Onset

AbstractNew-onset heart failure (HF) is associated with cardiovascular morbidity and mortality. It is uncertain to what extent HF confers an increased risk of venous thromboembolism (VTE). Adults ≥65 years old hospitalized with a new diagnosis of HF were identified from Medicare claims from 2007–2013. We identified the incidence, predictors and outcomes of VTE in HF. We compared VTE incidence during follow-up after HF hospitalization with a corresponding period 1-year prior to the HF diagnosis. Among 207,535 patients with a new HF diagnosis, the cumulative incidence of VTE was 1.4%, 2.5%, and 10.5% at 30 days, 1 year, and 5 years, respectively. The odds of VTE were greatest immediately after new-onset HF and steadily declined over time (OR 2.2 [95% CI 2.0–2.3], OR 1.5 [1.4–1.7], and OR 1.2 [1.2–1.3] at 0–30 days, 4–6 months, and 7–9 months, respectively). Over 26-month follow-up, patients with HF were at two-fold higher risk of VTE than patients without HF (adjusted HR 2.31 [2.18–2.45]). VTE during follow-up was associated with long-term mortality (adjusted HR 1.60, 95% CI 1.56–1.64). In conclusion, patients with HF are at increased risk of VTE early after a new HF diagnosis. VTE in patients with HF is associated with long-term mortality.

Abstract 1852: The Association Between Perioperative Complications, Intermediate Survival and Use of Aprotinin During Isolated Coronary Bypass Grafting Surgery

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Niv Ad ◽  
Alan M Speir ◽  
Michelle Harrison ◽  
Sharon L Hunt ◽  
Scott D Barnett
Keyword(s):  
Renal Failure ◽  
Adverse Outcome ◽  
Perioperative Complications ◽  
Coronary Bypass ◽  
Coronary Bypass Grafting ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Mortality Estimates ◽  
Long Term Mortality

Introduction: Aprotinin during CABG has been linked to increased rates of perioperative complications and increased long-term mortality. We report our results for the association of CABG, aprotinin use and intermediate survival. Methods: Subjects were 1,679 isolated CABG, on-pump, cases with no prior hx of renal failure or dialysis between 2001 and 2002. Aprotinin pts were additionally propensity matched to non-aprotinin pts to control for pt acuity. Increased EuroSCORE (E) indicates increased pt acuity. Results: Aprotinin pts (n=817) presented as older (63.7 vs. 61.2, p=0.05), increased E (6.5 vs. 4.1, p=0.05), and urgent operative status (61.7% vs. 41.6%, p=0.05). This group experienced greater rates of perioperative prolonged ventilation (8.7%% vs. 4.8%, p=0.01), acute renal failure (4.3% vs. 2.0%, p=0.01), 30d mortality (2.2% vs. 1.0%, p=0.06) and signif. decreased unmatched 5-year survival (86.1%, vs. 92.8%, p=0.001). Aprotinin use was not signif. assoc. with increased intermediate mortality (HR: 1.26; 95% CI: 0.66–2.41) but cases with high E (6+) were (HR: 5.47; 95% CI: 2.98–10.08). Moderate E was not signif. assoc. with mortality (HR: 1.75; 95% CI: 0.91–3.35) nor was any aprotinin-E interaction term (HR: 1.00; 95% CI: 0.93–1.08). After matching, controls were signif. less at risk of mortality at 5 years, (91.3% vs. 88.1%, p=0.05; Figure 1 ). Conclusions: Our results suggest that pts with aprotinin experienced higher rates of perioperative complications; however, the pts in this group were generally at higher risk for adverse outcome. Aprotinin use may convey an increased risk of intermediate mortality, but after matching, mortality estimates are greatly reduced.

scholarly journals Epilepsy-associated long-term mortality after aneurysmal subarachnoid hemorrhage

Neurology ◽  
2017 ◽  
Vol 89 (3) ◽  
pp. 263-268 ◽  
Author(s):  
Jukka Huttunen ◽  
Antti Lindgren ◽  
Mitja I. Kurki ◽  
Terhi Huttunen ◽  
Juhana Frösen ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Causes Of Death ◽  
University Hospital ◽  
Study Cohort ◽  
Catchment Population ◽  
Risk Of Death ◽  
Increased Risk ◽  
Long Term Mortality

Objective:To elucidate the epilepsy-associated causes of death and subsequent excess long-term mortality among 12-month survivors of subarachnoid hemorrhage from saccular intracranial aneurysm (SIA-SAH).Methods:The Kuopio SIA Database (kuopioneurosurgery.fi) includes all SIA-SAH patients admitted to the Kuopio University Hospital from its defined catchment population in Eastern Finland. The study cohort consists of 779 patients, admitted from 1995 to 2007, who were alive at 12 months after SIA-SAH. Their use of reimbursable antiepileptic drugs and the causes of death (ICD-10) were fused from the Finnish national registries from 1994 to 2014.Results:The 779 12-month survivors were followed up until death (n = 197) or December 31, 2014, a median of 12.0 years after SIA-SAH. Epilepsy had been diagnosed in 121 (15%) patients after SIA-SAH, and 34/121 (28%) had died at the end of follow-up, with epilepsy as the immediate cause of death in 7/34 (21%). In the 779 patients alive at 12 months after SIA-SAH, epilepsy was an independent risk factor for mortality (hazard ratio 1.8, 95% confidence interval 1.1–3.0).Conclusions:Comorbid epilepsy in 12-month survivors of SIA-SAH is associated with increased risk of death in long-term follow-up. Survivors of SIA-SAH require long-term dedicated follow-up, including identification and effective treatment of comorbid epilepsy to prevent avoidable deaths.

Abstract 16958: Comparison of Clinical and Hemodynamic Outcomes Between Redo Surgical Aortic Valve Replacement versus Transcatheter Valve in Valve in Patient With Failed Aortic Bioprostheses

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sebastien Hecht ◽  
Jeremy Bernard ◽  
Lionel Tastet ◽  
nancy cote ◽  
Erwan Salaun ◽  
...  
Keyword(s):  
Lower Risk ◽  
Surgical Aortic Valve Replacement ◽  
Increased Risk ◽  
Long Term Follow Up ◽  
Valve In Valve ◽  
Transcatheter Valve ◽  
Valve Implantation ◽  
Long Term Mortality

Introduction: Transcatheter valve-in-valve implantation (ViV) has emerged as an alternative to redo surgery (REDO) for the treatment of failed surgical aortic bioprostheses. However, there are few studies comparing clinical and hemodynamic outcomes between REDO and ViV in both the short- and long- term follow-up. Objective: The aim of this study was to compare hemodynamic and clinical outcomes between REDO and ViV. Methods: A total of 184 patients who underwent REDO or ViV at our institution between 2003 and 2017 were included in this study. Clinical and transthoracic echocardiography (TTE) data were collected for each patient. TTE was performed prior and after the reintervention and were retrospectively analyzed in an echocardiography core laboratory. An inverse propensity treatment weighting (IPTW) was used to compare outcomes between groups. Results: 104 patients underwent REDO and 80 underwent ViV. Prevalence of suboptimal valve hemodynamics (mean gradient ≥ 20 mmHg and/or ≥ moderate aortic regurgitation) following reintervention was higher in ViV group (29.8% vs. 61.3%, p<0.001), the rate of novel permanent pacemaker tended to be higher with REDO (10.6% vs. 3.8%, p=0.08). During a median follow-up of 5.0 (3.7-7.5) years, 60 patients died. There was a trend toward higher rate of 30-day mortality in the REDO vs. ViV group (8.6% vs. 2.5%, OR [95% CI]: 3.70[0.77-17.6], p=0.10) and a trend toward lower risk of long-term mortality in REDO (HR [95% CI]: 0.61[0.33-1.14], p=0.12). In multivariate cox proportional analysis adjusted for age, sex, EuroSCORE 2, ViV was significantly associated with increased risk of long-term mortality (HR [95% CI]: 2.28[1.25-4.15], p=0.03). Results were confirmed in IPTW analyses (30-day mortality in REDO vs. ViV: 3.39[3.25-3.53], p<0.001; long-term mortality: 0.70[0.69-0.71], p<0.001). Conclusions: ViV was associated with lower risk of 30-day but higher risk of long-term mortality compared to REDO.

Long-term mortality after first psychiatric admission

1997 ◽  
Vol 170 (1) ◽  
pp. 43-46 ◽  
Author(s):  
Prakash C. Naik ◽  
Steffan Davies ◽  
Ann M. Buckley ◽  
Alan S. Lee
Keyword(s):  
Causes Of Death ◽  
Consecutive Series ◽  
Significant Excess ◽  
Psychiatric Admission ◽  
Expected Mortality ◽  
First Time ◽  
Long Term Mortality ◽  
Made In

BackgroundLittle is known about the long-term mortality and causes of death after first psychiatric admission.MethodA consecutive series of 87 patients admitted for the first time from a strictly defined catchment area to Saxondale Hospital, Nottinghamshire, who were discharged in 1974 and 1975, were traced in 1992 to either their general practitioner or death. The causes of their deaths were ascertained and the observed mortality was compared with expected mortality.ResultsTwelve subjects had died. None had committed suicide, and there were no open verdicts or accidental deaths. Although the observed mortality was higher than expected, there was no significant excess.ConclusionsThere may be little scope for reducing suicide rates by targeting patients for careful follow-up after discharge from their first psychiatric admission. More research is required before large investments are made in potentially fruitless interventions to achieve the objectives ofThe Health of the Nation.

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