scholarly journals Direct comparison of BNP and NT-proBNP for mortality prediction in patients with acute dyspnea

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Wussler ◽  
M Belkin ◽  
I Strebel ◽  
N Kozhuharov ◽  
N Sabti ◽  
...  
Keyword(s):  
Natriuretic Peptide ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Mortality Prediction ◽  
Percentage Change ◽  
Diagnostic Study ◽  
Acute Dyspnea ◽  
Prognostic Accuracy ◽  
Cox Proportional Hazard Models

Abstract Background It is unclear whether BNP or NT-proBNP, their admission or discharge measurement or percentage change during hospitalization are preferable for mortality prediction in patients with acute dyspnea. Purpose To directly compare BNP and NT-proBNP regarding their potential in mortality prediction in patients with acute dyspnea and in patients with dyspnea due to AHF. Methods In a prospective multicenter diagnostic study the presence of AHF was centrally adjudicated by two independent cardiologists among patients presenting with acute dyspnea. The levels of BNP and NT-proBNP were measured at presentation and discharge. Patients were stratified according to their natriuretic peptide response (responders vs. non-responders: natriuretic peptide decrease ≥25% vs. <25% before discharge). Prognostic accuracy for 720-day mortality was quantified using the area under the receiver-operating-characteristic curve (AUC). Cox proportional hazard models were constructed to identify significant predictors for 720-day mortality. Results Among 1156 patients presenting with acute dyspnea, 353 (30.5%) died within 720 days of follow-up. Prognostic accuracy for death at 720 days was significantly higher for discharge compared to admission measurements for BNP (AUC 0.750 vs. 0.711, p<0.001) and NT-proBNP (AUC 0.769 vs. 0.720, p<0.001). When directly comparing discharge measurements, NT-proBNP levels exhibited a significantly higher accuracy (p=0.013). 632 (54.6%) and 600 (51.9%) patients were BNP and NT-proBNP non-responders, respectively. Among BNP and NT-proBNP non-responders 202 (32%) and 207 (34.5%) patients died within 720 days of follow-up. After adjusting for common covariates NTproBNP response was the strongest predictor for 720-day mortality in a Cox regression model (Hazard ratio for NT-proBNP non-responders: 2.096 (95% CI 1.550–2.835), p<0.001). Results were confirmed in a sensitivity analysis of 687 (59.4%) patients with adjudicated AHF. Conclusion Percentage change of NT-proBNP during hospitalization seems to be the strongest predictor for long-term mortality in patients with acute dyspnea in general and in those with dyspnea due to AHF in particular. ROC curve for direct comparison Funding Acknowledgement Type of funding source: None

scholarly journals The natriuretic peptide MR-proANP predicts all-cause mortality and adverse outcome in community patients: a 10-year follow-up study

2017 ◽  
Vol 55 (9) ◽  
Author(s):  
Jonas Odermatt ◽  
Lara Hersberger ◽  
Rebekka Bolliger ◽  
Lena Graedel ◽  
Mirjam Christ-Crain ◽  
...  
Keyword(s):  
Natriuretic Peptide ◽  
Cox Regression ◽  
Adverse Outcome ◽  
Characteristic Curve ◽  
Physiological Role ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Blood Levels ◽  
All Cause Mortality

AbstractBackground:The precursor peptide of atrial natriuretic peptide (MR-proANP) has a physiological role in fluid homeostasis and is associated with mortality and adverse clinical outcomes in heart failure patients. Little is known about the prognostic potential of this peptide for long-term mortality prediction in community-dwelling patients. We evaluated associations of MR-proANP levels with 10-year all-cause mortality in patients visiting their general practitioner for a respiratory tract infection.Methods:In this post-hoc analysis including 359 patients (78.5%) of the original trial, we calculated cox regression models and area under the receiver operating characteristic curve (AUC) to assess associations of MR-proANP blood levels with mortality and adverse outcome including death, pulmonary embolism, and major adverse cardiac or cerebrovascular events.Results:After a median follow-up of 10.0 years, 9.8% of included patients died. Median admission MR-proANP levels were significantly elevated in non-survivors compared to survivors (80.5 pmol/L, IQR 58.6–126.0; vs. 45.6 pmol/L, IQR 34.2–68.3; p<0.001) and associated with 10-year all-cause mortality (age-adjusted HR 2.0 [95% CI 1.3–3.1, p=0.002]; AUC 0.79). Results were similar for day 7 blood levels and also for the prediction of other adverse outcomes.Conclusions:Increased MR-proANP levels were associated with 10-year all-cause mortality and adverse clinical outcome in a sample of community-dwelling patients. If diagnosis-specific cut-offs are confirmed in future studies, this marker may help to direct preventive measures in primary care.

scholarly journals Influence of Glycosylation on Diagnostic and Prognostic Accuracy of N-Terminal Pro–B-Type Natriuretic Peptide in Acute Dyspnea: Data from the Akershus Cardiac Examination 2 Study

2015 ◽  
Vol 61 (8) ◽  
pp. 1087-1097 ◽  
Author(s):  
Helge Røsjø ◽  
Mai Britt Dahl ◽  
Marit Jørgensen ◽  
Ragnhild Røysland ◽  
Jon Brynildsen ◽  
...  
Keyword(s):  
Natriuretic Peptide ◽  
Risk Model ◽  
Added Value ◽  
Acute Dyspnea ◽  
Multivariate Models ◽  
Terminal Part ◽  
Prognostic Accuracy ◽  
All Cause Mortality ◽  
Edta Plasma

Abstract BACKGROUND The N-terminal part of pro–B-type natriuretic peptide (NT-proBNP) is glycosylated, but whether glycosylation influences the diagnostic and prognostic accuracy of NT-proBNP measurements is not known. METHODS We measured NT-proBNP concentrations of 309 patients with acute dyspnea by use of standard EDTA tubes and EDTA tubes pretreated with deglycosylation enzymes. The primary cause of dyspnea was classified as heart failure (HF) or non-HF, and the diagnosis was adjudicated by 2 independent physicians. We collected information on all-cause mortality during follow-up. RESULTS In all, 142 patients (46%) were diagnosed with HF. NT-proBNP concentrations in nondeglycosylated samples distinguished HF patients from patients with non-HF related dyspnea [median 3588 (quartiles 1–3 1578–8404) vs 360 (126–1139) ng/L, P &lt; 0.001], but concentrations were markedly higher in samples pretreated with deglycosylation enzymes (total NT-proBNP) [7497 (3374–14 915) vs 798 (332–2296) ng/L, P &lt; 0.001]. The AUC to separate HF patients from patients with non-HF related dyspnea was 0.871 (95% CI 0.829–0.907) for total NT-proBNP compared with 0.852 (0.807–0.890) for NT-proBNP measurements in standard EDTA plasma. During a median follow-up of 816 days, 112 patients (36%) died. Both NT-proBNP and total NT-proBNP concentrations were associated with mortality in separate multivariate models, but only total NT-proBNP concentrations provided added value to the basic risk model of our dataset as assessed by the net reclassification index: 0.24 (95% CI 0.003–0.384). There was a graded increase in risk across total NT-proBNP quartiles, in contrast with the results for NT-proBNP measurements. CONCLUSIONS NT-proBNP concentrations were higher, and diagnostic and prognostic accuracy was improved, by pretreating tubes with deglycosylation enzymes.

scholarly journals Prognostic value of health-related quality of life in patients with acute dyspnea

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Belkin ◽  
D Wussler ◽  
I Strebel ◽  
E Michou ◽  
N Kozhuharov ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Cox Regression ◽  
Acute Dyspnea ◽  
Cox Regression Analysis ◽  
Prognostic Accuracy ◽  
Related Quality ◽  
Health Related ◽  
Complete Set ◽  
Eq Vas

Abstract Background Previous studies have shown the prognostic value of health-related quality of life (HRQL) in stable and ambulatory chronic heart failure patients. However, it is unknown whether HRQL can predict all-cause mortality in patients presenting to the emergency department (ED) after acute onset of symptoms. In order to address this unmet need, the aim of this study was to assess the prognostic value of HRQL in patients with acute dyspnea caused by acute heart failure (AHF) and other dyspnea aetiologies for 360-day mortality. Purpose To assess prognostic value of HRQL using the generic EQ-5D and visual analogue scale (EQ VAS) in patients with acute dyspnea. Methods Basics in Acute Shortness of Breath EvaLuation (BASEL V) is a prospective, multicenter, diagnostic study enrolling adult patients presenting with acute dyspnea to the ED. For this analysis, only patients with a complete set of variables necessary for calculation of EQ-5D (range 0–10; with higher score indicating worse HRQL) and EQ VAS (range 0–100; with 100 being the best imaginable health state) at baseline were included. The endpoint was the prognostic value of EQ-5D and EQ VAS at 360 days of follow-up regarding all-cause death. Prognostic accuracy was calculated using c-statistics. In a cox regression analysis EQ-5D was treated as both, a continuous and categorical variable. Adjustments were made for clinically relevant covariates (age, sex, orthopnoea, edema, level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) at presentation, history of coronary artery disease and chronic obstructive pulmonary disease, diuretics, β-blockers and ACE-inhibitors at discharge). Results Among 2605 patients enrolled, 1141 (43,8%) had a complete set of variables allowing the calculation of EQ-5D and EQ VAS. Of these patients 594 (52.1%) had an adjudicated final diagnosis of AHF. 211 (18.5%) patients died within 360 days of follow-up. Median EQ-5D was 3 (interquartile range (IQR) 1.5–5) and median EQ VAS was 50 (IQR 40–70). The prognostic accuracy for 360-day mortality was 0.65 (95% confidence interval ((CI) 0.61–0.69) and 0.58 (95% CI 0.54–0.62) for EQ-5D and EQ VAS, respectively (p=0.002). After combining EQ-5D and EQ VAS in a logistic regression model c-statistics regarding all-cause mortality within 360 days did not improve. The prognostic accuracy of EQ-5D was comparable to that of NT-proBNP (c-statistics 0.69, p=0.385). In an adjusted cox regression analysis the hazard ratio for patients with EQ-5D &gt;4 was 2.2 (95% CI 1.7–2.9; p&lt;0.001). Conclusions In patients presenting with acute dyspnea HRQL is a strong prognostic instrument. Independently of the aetiology of the dyspnea the prognostic value of the generic EQ-5D for 360-day mortality is comparable to NT-proBNP. Patients with an EQ-5D &gt;4 are at significantly higher risk for mortality within 360 days. Figure 1. Prognostic value of HRQL Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation

scholarly journals Influence of Waist-to-Hip Ratio on the Prognosis of Heart Failure Patients With Revascularized Coronary Heart Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Yingyue Zhang ◽  
Yan Zhang ◽  
Yajun Shi ◽  
Wei Dong ◽  
Yang Mu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Heart Disease ◽  
Regression Analysis ◽  
Heart Disease ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Cardiac Events ◽  
Cox Regression Analysis ◽  
Waist To Hip Ratio

Background: Heart failure (HF) is considered one of the most common complications of coronary heart disease (CHD), with a higher incidence of readmission and mortality. Thus, exploring the risk factors related to the prognosis is necessary. Moreover, the effect of the waist-to-hip ratio (WHR) on HF patients with revascularized CHD is still unclear. Thus, we aimed to assess the influence of WHR on the prognosis of HF patients with revascularized CHD.Methods: We collected data of HF patients with revascularized CHD who were referred to the Cardiac Rehabilitation Clinic of PLA Hospital from June 30, 2015, to June 30, 2019. Cox proportional hazard regression analysis was used to determine the relationship between WHR and prognosis of HF patients with revascularized CHD. Patients were divided into higher and lower WHR groups based on the cutoff WHR value calculated by the X-tile software. Cox regression analysis was used to analysis the two groups. We drew the receiver operating characteristic curve (ROC) of WHR and analyzed the differences between the two groups. Endpoints were defined as major adverse cardiac events (MACE) (including all-cause mortality, non-fatal myocardial infarction, unscheduled revascularization, and stroke).Results: During the median follow-up of 39 months and maximum follow-up of 54 months, 109 patients were enrolled, of which 91.7% were males, and the mean age was 56.0 ± 10.4 years. WHR was associated with the incidence of MACE in the Cox regression analysis (p = 0.001); an increase in WHR of 0.01 unit had a hazard ratio (HR) of 1.134 (95%CI: 1.057–1.216). The WHR cutoff value was 0.93. Patients in the higher WHR group had a significantly higher risk of MACE than those in the lower WHR group (HR = 7.037, 95%CI: 1.758–28.168). The ROC area under the curve was 0.733 at 4 years. Patients in the higher WHR group had a higher body mass index (BMI; 26.7 ± 3.5 vs. 25.4 ± 2.4, P = 0.033) than patients in the lower WHR group.Conclusions: WHR is an independent risk factor of the long-term prognosis of Chinese HF patients with revascularized CHD. Patients with WHR ≥ 0.93 require intensified treatment. Higher WHR is related to higher BMI and ΔVO2/ΔWR.

scholarly journals Lymphocyte Cell Ratios and Mortality among Incident Hemodialysis Patients

2017 ◽  
Vol 46 (5) ◽  
pp. 408-416 ◽  
Author(s):  
Christina Catabay ◽  
Yoshitsugu Obi ◽  
Elani Streja ◽  
Melissa Soohoo ◽  
Christina Park ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Cox Model ◽  
Characteristic Curve ◽  
Hemodialysis Patients ◽  
Mortality Prediction ◽  
Time Varying ◽  
Cox Models ◽  
Lymphocyte Ratio ◽  
Lymphocyte Cell

Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been previously suggested as oncologic prognostication markers. These are associated with malnutrition and inflammation, and hence, may provide benefit in predicting mortality among hemodialysis patients. Methods: Among 108,548 incident hemodialysis patients in a large U.S. dialysis organization (2007–2011), we compared the mortality predictability of NLR and PLR with baseline and time-varying covariate Cox models using the receiver operating characteristic curve (AUROC), net reclassification index (NRI), and adjusted R2. Results: During the median follow-up period of 1.4 years, 28,618 patients died. Median (IQR) NLR and PLR at baseline were 3.64 (2.68–5.00) and 179 (136–248) respectively. NLR was associated with higher mortality, which appeared stronger in the time-varying versus baseline model. PLR exhibited a J-shaped association with mortality in both models. NLR provided better mortality prediction in addition to demographics, comorbidities, and serum albumin; ΔAUROC and NRI for 1-year mortality (95% CI) were 0.010 (0.009–0.012) and 6.4% (5.5–7.3%) respectively. Additionally, adjusted R2 (95% CI) for the Cox model increased from 0.269 (0.262–0.276) to 0.283 (0.276–0.290) in the non-time-varying model and from 0.467 (0.461–0.472) to 0.505 (0.500–0.512) in the time-varying model. There was little to no benefit of adding PLR to predict mortality. Conclusions: High NLR in incident hemodialysis patients predicted mortality, especially in the short-term period. NLR, but not PLR, added modest benefit in predicting mortality along with demographics, comorbidities, and serum albumin, and should be included in prognostication approaches.

scholarly journals Electrocardiographic parameters of left ventricular hypertrophy and prediction of mortality in hemodialysis patients

2021 ◽  
Author(s):  
Matthias C. Braunisch ◽  
Peter Gundel ◽  
Stanislas Werfel ◽  
Christopher C. Mayer ◽  
Axel Bauer ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Risk Prediction ◽  
Cardiovascular Mortality ◽  
Ventricular Hypertrophy ◽  
Cox Regression ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Mortality Prediction ◽  
Prediction Of Mortality

Abstract Background In hemodialysis patients, left ventricular hypertrophy (LVH) contributes to high cardiovascular mortality. We examined cardiovascular mortality prediction by the recently proposed Peguero-Lo Presti voltage since it identifies more patients with electrocardiographic (ECG) LVH than Cornell or Sokolow-Lyon voltages. Methods A total of 308 patients on hemodialysis underwent 24 h ECG recordings. LVH parameters were measured before and after dialysis. The primary endpoint of cardiovascular mortality was recorded during a median 3-year follow up. Risk prediction was assessed by Cox regression, both unadjusted and adjusted for the Charlson Comorbidity Index and the Cardiovascular Mortality Risk Score. Results The Peguero-Lo Presti voltage identified with 21% the most patients with positive LVH criteria. All voltages significantly increased during dialysis. Factors such as ultrafiltration rate, Kt/V, body mass index, sex, and phosphate were the most relevant for these changes. During follow-up, 26 cardiovascular deaths occurred. Post-dialysis Peguero-Lo Presti cut-off as well as the Peguero-Lo Presti and Cornell voltages were independently associated with cardiovascular mortality in unadjusted and adjusted analysis. The Sokolow-Lyon voltage was not significantly associated with mortality. An optimal cut-off for the prediction of cardiovascular mortality was estimated at 1.38 mV for the Peguero-Lo Presti. Conclusions The post-dialysis Peguero-Lo Presti cut-off as well as the Peguero-Lo Presti and Cornell voltages allowed independent risk prediction of cardiovascular mortality in hemodialysis patients. Measuring the ECG LVH parameters after dialysis might allow a standardized interpretation as dialysis-specific factors influence the voltages. Graphical abstract

P5714Impact on the prognosis of treatment administrated in the daily clinical practice to patients with myocardial infarction with non-obstructive coronary arteries

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Lopez Pais ◽  
L Alvarez Rodriguez ◽  
B Izquierdo Coronel ◽  
M Pedreira Perez ◽  
R Agra Bermejo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Practice ◽  
Coronary Arteries ◽  
Cox Regression ◽  
Beta Blockers ◽  
Total Mortality ◽  
Major Adverse Cardiovascular Events ◽  
Specific Information ◽  
Diagnostic Study

Abstract Background Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) remains a challenge in cardiology clinical practice. 2016 European Society of Cardiology Working Group position paper (ESC-WGPP) recommend to treat them as the rest of myocardial infarctions, mainly with dual antiplatelet therapy (DAT), beta blockers, Angiotensin Converter Enzyme Inhibitors (ACEI), and statins. The aim of this study is to analyse the use of optimal medical treatment (OMT) of ischemic heart disease (IHD) treatment on this group of patients and its implication in their prognosis. Methods Analytical and observational study based on a retrospective cohort of MINOCA (according to the definitions of ESC-WGPP) extracted from the myocardial infarction registries of three University Hospitals during the period from 2003–2018 (N: 9371). We analysed data about the treatment of all consecutive MINOCA. Treatment prescribed was the one considered by their responsible doctors. We recorded specific information about treatment prescribed after hospitalization. Follow up analysis based on Cox regression included death from any cause and major adverse cardiovascular events ([MACE], a composite of a recurrence of myocardial infarction, stroke or transient ischemic attack or death from any cardiovascular cause) Median follow up was 52.6±32.5 months. Results Of 9371 patients initially admitted for acute myocardial infarction, 620 were classified as MINOCA (incidence 6.6%). Median age was 64.2 years old, and 40.7% were women. Regarding cardiovascular risk factors, 25.1% were smokers, 19.0% had diabetes, 42.3 had dyslipidemia and 57.7% hypertension. At discharge, 18.2% had ventricular dysfunction. DAT was prescribed in 32.4% of MINOCA patients, beta blockers in 59.5%, ACEI in 54.8% and statins in 71.9%. Statins showed impact on MINOCAs prognosis, with a significant reduction in total mortality Hazard Ratio (HR): 0.60 (95%Confidence Interval [CI]: 0.38–0.94) p 0.03. DAT had a non-significant reduction in total mortality (HR 0.64 [CI: 0.37–1.13] p 0.12). The rest of the OMT of IHD showed no significant impact on total mortality: beta blockers (HR 0.84 [CI: 0.54–1.31] p 0.45) and ACEI (1.30 [CI: 0.83–2.03] p 0.25) None of the OMT had impact on MACE after MINOCA: DAT (HR 0.97 [CI: 0.70–1.35] p 0.87), beta blockers (HR 0.92 [CI: 0.69–1.23] p 0.57), ACEI (1.13 [CI: 0.85–1.51] p 0.40) and statins (0.94 [CI: 0.69–1.30] p 0.74). Figure 1 Conclusion This study suggests that statins may be liked with a better prognosis in MINOCA, whereas the rest of conventional IHD treatments showed no difference in the course of the illness. This could be due to the heterogeneity of physiopathological mechanisms underlying the working diagnosis of MINOCA. So, following the 2016 ESC-WGPP on MINOCA recommendations, a deep diagnostic study must be performed in order to individualize the treatment.

P1182PROGNOSTIC VALUE OF CHARLSON COMORBIDITY INDEX IN PERITONEAL DIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Vincenzo Antonio Panuccio ◽  
Rocco Tripepi ◽  
Giovanni Luigi Tripepi ◽  
Giovanna Parlongo ◽  
Francesca Mallamaci
Keyword(s):  
Peritoneal Dialysis ◽  
Risk Stratification ◽  
Roc Curve ◽  
Cox Regression ◽  
Clinical Score ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Prognostic Accuracy ◽  
Dialysis Vintage

Abstract Background and Aims Mortality risk is very high in the dialysis population and the Charlson Comorbidities Index (CCI) is considered as an useful risk stratification tool in these patients. The purpose of this study was to examine the accuracy of CCI for predicting mortality in peritoneal dialysis (PD) patients and to compare the prognostic power of CCI with that of a risk prediction model jointly including a clinical score of malnutrition and the NYHA classes. Method We analyzed this problem in a series of 66 consecutive PD patients on follow-up in our unit. Their mean age was 69±14 years, 64% were male, 36% were diabetic. The median dialysis vintage was 39 months (Interquartile range 23-67 months). Results During follow-up period, 37 patients died. On univariate Cox regression analysis, CCI largely failed to predict mortality [Hazard ratio (HR): 1.08, 95% CI: 0.94-1.24, P=0.30) and this relationship did not improve (HR: 0.93, 95% CI: 0.79-1.08, P=0.32) also after data adjustment for malnutrition and NYHA classes. In the same model, malnutrition (HR: 1.98, 95% CI 1.20-3.27, P=0.007) and NYHA classes (HR: 3.15, 95% CI 1.67-5.94, P&lt;0.001) were strongly and significantly related to the risk of death. Of note, the prognostic accuracy of the model based on malnutrition and NYHA classes (ROC curve area: 74%) was higher than that provided by CCI alone (ROC curve area: 54%) and did not materially differ from that of an expanded model including CCI, malnutrition and NYHA classes (ROC curve area: 78%) Conclusion In this study, CCI did not predict survival in PD patients whereas malnutrition and NYHA score displayed a relevant prognostic accuracy for death in the same patient-population. These results generate the hypothesis, to be confirmed in a larger PD population, that CCI solely for risk stratification is unwarranted in PD patients.

scholarly journals Copeptin predicts 10-year all-cause mortality in community patients: a 10-year prospective cohort study

2016 ◽  
Vol 54 (10) ◽  
Author(s):  
Jonas Odermatt ◽  
Rebekka Bolliger ◽  
Lara Hersberger ◽  
Manuel Ottiger ◽  
Mirjam Christ-Crain ◽  
...  
Keyword(s):  
Respiratory Infection ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Hospital Setting ◽  
Acute Care Hospital ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Care Hospital ◽  
All Cause Mortality

AbstractBackground:Copeptin, the C-terminal part of the arginine vasopressin (AVP) precursor peptide, is secreted in response to stress and correlates with adverse clinical outcomes in the acute-care hospital setting. There are no comprehensive data regarding its prognostic value in the community. We evaluated associations of copeptin levels with 10-year mortality in patients visiting their general practitioner (GP) for a respiratory infection included in a previous trial.Methods:This is a post hoc analysis including data from 359 patients included in the PARTI trial. Copeptin was measured in batch-analysis on admission and after 7 days. We calculated Cox regression models and area under the receiver operating characteristic curve (AUC) to assess an association of copeptin with mortality and adverse outcome. Follow-up data were collected by GP, patient and relative tracing through phone interviews 10 years after trial inclusion.Results:After a median follow-up of 10.0 years, mortality was 9.8%. Median admission copeptin levels (pmol/L) were significantly elevated in non-survivors compared to survivors (13.8, IQR 5.9–27.8; vs. 6.3 IQR 4.1–11.5; p<0.001). Admission copeptin levels were associated with 10-year all-cause mortality [age-adjusted hazard ratio 1.7 (95% CI, 1.2–2.5); p<0.001, AUC 0.68]. Results were similar for discharge copeptin levels. Copeptin also predicted adverse outcomes defined as death, pulmonary embolism and major adverse cardiac and cerebrovascular events.Conclusions:In a sample of community-dwelling patients visiting their GP for a respiratory infection, copeptin levels were associated with 10-year all-cause mortality. In conjunction with traditional risk factors, this marker may help to better direct preventive measures in this population.

scholarly journals A nomogram to predict the progression-free survival of clival chordoma

2019 ◽  
pp. 1-9 ◽  
Author(s):  
Yixuan Zhai ◽  
Jiwei Bai ◽  
Mingxuan Li ◽  
Shuai Wang ◽  
Chuzhong Li ◽  
...  
Keyword(s):  
Cox Regression ◽  
Survival Curve ◽  
Characteristic Curve ◽  
Progression Free Survival ◽  
High Recurrence Rate ◽  
Validation Group ◽  
Ki 67 ◽  
Free Survival ◽  
Cox Regression Analysis

OBJECTIVEChordoma shows poor patient prognosis because of its high recurrence rate. Even though many clinical factors and biomarkers are reported to be associated with prognosis, no prediction model has been applied clinically. Thus, the authors aim to derive and validate a prognostic nomogram to predict progression-free survival (PFS) of chordoma.METHODSA total of 201 patients were randomly divided into a derivation group (151 cases) and a validation group (50 cases). The expression levels of biomarkers were quantified using tissue microarray analysis. A nomogram was established via univariate and multivariate Cox regression analysis in the derivation group. The predictive performance of the nomogram was then tested in the validation group.RESULTSThe mean follow-up interval was 57 months (range 26–107 months). One clinical factor and 3 biomarkers were confirmed to be associated with PFS, including degree of resection, E-cadherin, Ki-67, and VEGFA. The nomogram with these prognostic factors had areas under the receiver operating characteristic curve of 0.87 and 0.95 in the derivation group at 3 years and 5 years, respectively, compared with 0.87 and 0.84 in the validation group. Calibration and score-stratified survival curve were good in the derivation group and validation group, respectively.CONCLUSIONSThe established nomogram performs well for predicting the PFS of chordoma and for risk stratification, which could facilitate prognostic evaluation and follow-up.

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