P0184RISK PREDICTION FOR DEATH AND END-STAGE RENAL DISEASE DOES NOT PARALLEL REAL-LIFE TRAJECTORY OF OLDER PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE - A ROMANIAN CENTER EXPERIENCE

Abstract Background and Aims In Europe, the share of the elderly (≥65 years of age) in the total population is estimated to increase from 19.2% in 2016 to 29.1% by 2080. In 2016, European Renal Best Practice (ERBP) group published a clinical practice guideline on management of older patients with CKD stage3b or higher (eGFR<45ml/min/1.73 m2). Two risk stratifications scores were emphasized: Bansal score for prognosticating risk of death in medium term, and Kidney Failure Risk Equation (KFRE) for estimating progression of CKD stage 3b or 4 to ESRD. Our group, as part of the ERBP team, aimed to evaluate and apply the framework proposed by the guideline, consisting of risk prediction for both mortality and progression to ESRD in a cohort of elderly patients with advanced CKD. After dividing the population in groups of risk, we described their real-life trajectory in terms of either reaching ESRD/death. Method In this retrospective cohort study we included patients aged ≥65 years with CKD stage 3b-4, evaluated at the Outpatient Nephrology Department of Dr. C. I. Parhon Hospital from Iași, Romania, between October 2016 – October 2018. Individual risk for mortality was predicted using Bansal score, a nine-variable equation model. A total score of 7 (associated with a mortality risk of 53.82%) was established as cut-off value to differentiate between 2 groups: high risk of mortality (Bansal ≥ 7) and low risk of mortality (Bansal < 7), given the fact that the ERBP guidelines don’t define a threshold for high risk in respect to mortality outcome. According to the algorithm proposed by the guideline, individual risk for progression to ESRD at 5 years was calculated in the low mortality risk group, using the 4-variable Kidney Failure Risk Equation (KFRE). Results The final cohort included 958 patients, with a mean age of 74 years (SD: 7), and with similar gender distribution (50.6% female vs. 49.4% male). Predicted trajectory in terms of reaching ESRD / death: When we applied Bansal score for mortality, the total study population (N=958) was divided in two groups: N1 with high risk of mortality, which comprised more than half of the cohort (548 patients, 57.2%) and N2 with low risk of mortality (410 patients, 42.8%). Individual risk of progression to ESRD was then estimated in N2 group, using 4-variable KFRE. Nearly ¾ of this group (75.4%, 309 subjects) presented a low-risk of progression and ¼ (24.6%, 101 subjects) had high-risk. Real-life trajectory in terms of reaching ESRD / death: From the entire cohort, 31 patients started renal replacement therapy (RRT) and 164 patients died as their first clinical event. The RRT initiation rate was 3.6% of N1 group (20 subjects) versus 2.7% of N2 group (11 subjects). The mortality rate was 15.5% of N1 group (85 deaths) versus 19.3% of N2 group (79 deaths). Figure 1 depicts the real-life trajectory of the population groups in terms of reaching ESRD / death. Conclusion In a large population from Eastern Europe, the application of the algorithm from the Clinical Practice Guideline on management of older patients with advanced CKD showed that risk prediction for death and end-stage renal disease does not parallel the real-life trajectory of the population. More than half of the subjects had a high risk of mortality, however we found similar death rates in the 2 groups (high versus low risk of mortality). Also, the RRT initiation rates were similar, irrespective of predicted mortality risk or kidney failure risk, suggesting that implementing the guideline in real-life settings is still a challenge.

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Risk prediction for death and end-stage renal disease does not parallel the real-life trajectory of older patients with advanced chronic kidney disease – a Romanian center experience.

Archives of Medical Science ◽

10.5114/aoms/128741 ◽

2021 ◽

Author(s):

Nastasa Andra ◽

APETRII MUGUREL ◽

Onofriescu Mihai ◽

Nistor Ionut ◽

Voroneanu Luminita ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Mortality Risk ◽

Older Patients ◽

Real Life ◽

Low Risk ◽

Advanced Chronic Kidney Disease ◽

Risk Of Progression ◽

Life Trajectory ◽

End Stage

IntroductionIn 2016, the European Renal Best Practice (ERBP) group published a guideline on the management of older adults with advanced chronic kidney disease (CKD). Two risk scores were highlighted: Bansal score for mortality, and Kidney Failure Risk Equation (KFRE) for estimating progression to end-stage kidney disease (ESRD). Our group, as part of the ERBP team, aimed to apply these risk prediction tools in a cohort of older adults with eGFR <45 ml/min/1.73 m2.Material and methodsThis retrospective study included adults aged ≥65 years with CKD stage 3b-4, evaluated at a Romanian Outpatient Nephrology Department between October 2016 – October 2018. Bansal score was calculated for all subjects and then KFRE was used in the low mortality risk group. Outcomes were death or reaching ESRD. These outcomes were used to compare the difference between the estimated trajectory and real-life trajectory of patients. They were followed up until September 2019.ResultsFrom the total population (N=958 patients), more than half (N1=548, 57.2%) had a high mortality risk. In the remaining group with low mortality risk (N2=410, 42.8%), a significant percentage (75.4%) presented a low risk of progression to ESRD. Real-life events consisted of 164 deaths and 31 dialysis initiations. We found similar death rates in the two groups (high versus low risk of mortality). There was no difference in the rate of dialysis initiation between subjects with a high or low risk of progression to ESRD.ConclusionsRisk prognostication for death and ESRD did not parallel the real-life trajectory of our older patients with advanced CKD.

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A Prediction Model for Metachronous Peritoneal Carcinomatosis in Patients with Stage T4 Colon Cancer after Curative Resection

Cancers ◽

10.3390/cancers13112808 ◽

2021 ◽

Vol 13 (11) ◽

pp. 2808

Author(s):

Tzong-Yun Tsai ◽

Jeng-Fu You ◽

Yu-Jen Hsu ◽

Jing-Rong Jhuang ◽

Yih-Jong Chern ◽

...

Keyword(s):

Colon Cancer ◽

High Risk ◽

Prediction Model ◽

Prediction Error ◽

Area Under The Curve ◽

Low Risk ◽

Brier Score ◽

Individual Risk ◽

T4 Colon Cancer ◽

Testing Set

(1) Background: The aim of this study was to develop a prediction model for assessing individual mPC risk in patients with pT4 colon cancer. Methods: A total of 2003 patients with pT4 colon cancer undergoing R0 resection were categorized into the training or testing set. Based on the training set, 2044 Cox prediction models were developed. Next, models with the maximal C-index and minimal prediction error were selected. The final model was then validated based on the testing set using a time-dependent area under the curve and Brier score, and a scoring system was developed. Patients were stratified into the high- or low-risk group by their risk score, with the cut-off points determined by a classification and regression tree (CART). (2) Results: The five candidate predictors were tumor location, preoperative carcinoembryonic antigen value, histologic type, T stage and nodal stage. Based on the CART, patients were categorized into the low-risk or high-risk groups. The model has high predictive accuracy (prediction error ≤5%) and good discrimination ability (area under the curve >0.7). (3) Conclusions: The prediction model quantifies individual risk and is feasible for selecting patients with pT4 colon cancer who are at high risk of developing mPC.

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Validation of the Zwolle score for selection of very low-risk STEMI patients treated with primary angioplasty

European Heart Journal ◽

10.1093/ehjci/ehaa946.1840 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Cordero ◽

B Cid ◽

P Monteiro ◽

J.M Garcia-Acuna ◽

M Rodriguez-Manero ◽

...

Keyword(s):

Hospital Mortality ◽

Risk Score ◽

Mortality Risk ◽

Area Under The Curve ◽

Coronary Intervention ◽

Low Risk ◽

Individual Risk ◽

Care Organization ◽

Grace Score ◽

Selection Of

Abstract Background The Zwolle risk score was designed to stratify the actual in-hospital mortality risk of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (p-PCI) but, also, for decision-making related to patients location in an intensive care unit or not. Since the GRACE score continues being the gold-standard for individual risk assessment in STEMI in most institutions we assessed the specificity of both scores for in-hospital mortality. Methods We assessed the accuracy of Zwolle risk score for in-hospital mortality estimation as compared to the GRACE score in all patients admitted for STEMI in 3 tertitary hospitals. Patients with Zwolle risk score <3 would qualify as “low risk”, 3–5 as “intermediate risk” and ≥6 as “high risk”. Patients with GRACE score <140 were classified as low-risk. Specificity, sensitivity and classification were assessed by ROC curves and the area under the curve (AUC). Results We included 4,446 patients, mean age 64.7 (13.6) years, 24% women and 39% with diabetes. Mean GRACE score was 157.3 (4.9) and Zwolle was 2.8 (3.3). In-hospital mortality was 10.6% (471 patients). Patients who died had higher GRACE score (218.4±4.9 vs. 149.6±37.5; p<0.001) and Zwolle score (7.6±4.3 vs. 2.3±2.18; p<0.001); a statistically significant increase of in-hospital mortality risk, adjusted adjusted by age, gender and revascularization, was observed with both scores (figure). A total of 1,629 patients (40.0%) were classified as low risk by the GRACE score and 2,962 (66.6%) by the Zwolle score; in-hospital mortality was 1.6% and 2.7%, respectively. Moreover, the was a significant increase of in-hospital mortality rate according to Zwolle categories (2.7%; 13.0%; 41.6%)The AUC of both score was the same (p=0.49) but the specificity of GRACE score <140 was 43.1% as compared to 72.6% obtained by Zwolle score <3; patients accurately classified was also lower with the GRACE score threshold (48.8% vs. 73.7%). Conclusions Selection of low-risk STEMI patients treated with p-PCI based on the Zwolle risk score has higher specificity than the GRACE score and might be useful for the care organization in clinical practice. Funding Acknowledgement Type of funding source: None

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Temporal Trend in Young-Onset Type 2 Diabetes - the Macrovascular and Mortality Risk: Study of UK Primary Care Electronic Medical Records

10.2337/figshare.12357320 ◽

2020 ◽

Author(s):

Digsu N. Koye ◽

Joanna Ling ◽

John Dibato ◽

Kamlesh Khunti ◽

Olga Montvida ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Risk Factor ◽

High Risk ◽

Mortality Risk ◽

Cardiometabolic Risk ◽

Low Risk ◽

Young Onset ◽

Onset Type

Objectives: To evaluate temporal prevalence trend, cardiometabolic risk factors, and the risk of atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality (ACM) in incident young- and usual-onset type 2 diabetes. Research Design and Methods: From the UK primary care database, 370,854 people with new diagnosis of type 2 diabetes from 2000 to 2017 were identified. Analyses were conducted by age groups (18-39, 40-49, 50-59, 60-69, 70-79 years) and high/low risk status without history of ASCVD at diagnosis - ≥ two of current smoking, high SBP, high LDL-C or chronic kidney disease were classified as high-risk. Results: Proportion of people aged <50 years at diagnosis increased during 2000-2010 and then stabilised. The incidence rates of ASCVD and ACM declined in people aged ≥50 years, but did not decrease in people <50 years. Compared to people aged ≥50 years, those aged 18-39 years at diagnosis had higher obesity (71% obese), higher HbA1c (8.6%), 71% had high LDL-C, while only 18% were on cardio-protective therapy. Although 2% in this age group had ASCVD at diagnosis, 23% were identified as high-risk. In the 18-39 years group, the adjusted average years to ASCVD /ACM in high-risk individuals (years (95% CI): 9.1 (8.2–10.0) /9.3 (8.1–10.4)) were similar to those with low-risk (years (95% CI): 10.0 (9.5 – 10.5) /10.5 (9.7–11.2)). However, individuals ≥50 years with high-risk were likely to experience an ASCVD event 1.5 - 2 years earlier and death 1.1 – 1.5 years earlier compared to low-risk groups (p<0.01). Conclusions: Unlike usual-onset, young-onset type 2 diabetes have similar cardiovascular and mortality risk irrespective of their cardiometabolic risk factor status at diagnosis. The guidelines on the management of young-onset type 2 diabetes for intensive risk-factor management and cardioprotective therapies need to be urgently re-evaluated through prospective studies.

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Risk category system to identify pituitary adenoma patients with AIP mutations

Journal of Medical Genetics ◽

10.1136/jmedgenet-2017-104957 ◽

2018 ◽

Vol 55 (4) ◽

pp. 254-260 ◽

Cited By ~ 16

Author(s):

Francisca Caimari ◽

Laura Cristina Hernández-Ramírez ◽

Mary N Dang ◽

Plamena Gabrovska ◽

Donato Iacovazzo ◽

...

Keyword(s):

Pituitary Adenoma ◽

Family History ◽

High Risk ◽

Pituitary Adenomas ◽

Univariate Analysis ◽

Low Risk ◽

Individual Risk ◽

Risk Category ◽

Moderate Risk ◽

Category System

BackgroundPredictive tools to identify patients at risk for gene mutations related to pituitary adenomas are very helpful in clinical practice. We therefore aimed to develop and validate a reliable risk category system for aryl hydrocarbon receptor-interacting protein (AIP) mutations in patients with pituitary adenomas.MethodsAn international cohort of 2227 subjects were consecutively recruited between 2007 and 2016, including patients with pituitary adenomas (familial and sporadic) and their relatives. All probands (n=1429) were screened for AIP mutations, and those diagnosed with a pituitary adenoma prospectively, as part of their clinical screening (n=24), were excluded from the analysis. Univariate analysis was performed comparing patients with and without AIP mutations. Based on a multivariate logistic regression model, six potential factors were identified for the development of a risk category system, classifying the individual risk into low-risk, moderate-risk and high-risk categories. An internal cross-validation test was used to validate the system.Results1405 patients had a pituitary tumour, of which 43% had a positive family history, 55.5% had somatotrophinomas and 81.5% presented with macroadenoma. Overall, 134 patients had an AIP mutation (9.5%). We identified four independent predictors for the presence of an AIP mutation: age of onset providing an odds ratio (OR) of 14.34 for age 0-18 years, family history (OR 10.85), growth hormone excess (OR 9.74) and large tumour size (OR 4.49). In our cohort, 71% of patients were identified as low risk (<5% risk of AIP mutation), 9.2% as moderate risk and 20% as high risk (≥20% risk). Excellent discrimination (c-statistic=0.87) and internal validation were achieved.ConclusionWe propose a user-friendly risk categorisation system that can reliably group patients into high-risk, moderate-risk and low-risk groups for the presence of AIP mutations, thus providing guidance in identifying patients at high risk of carrying an AIP mutation. This risk score is based on a cohort with high prevalence of AIP mutations and should be applied cautiously in other populations.

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Assessing the impact of a targeted electronic medical record intervention on growth factor usage in cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.262 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 262-262

Author(s):

Jordan Bernens ◽

Kara Hartman ◽

Brendan F. Curley ◽

Sijin Wen ◽

Jame Abraham ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Febrile Neutropenia ◽

Cancer Patients ◽

Medical Record ◽

Electronic Medical Record ◽

Low Risk ◽

Individual Risk ◽

Individual Risk Factors ◽

The Impact

262 Background: Patients receiving chemotherapy are at risk for febrile neutropenia following treatment. The American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) recommend screening patients for risk of febrile neutropenia and risk stratification based on likelihood of febrile neutropenia events. Prophylactic growth factors (G-CSF) should be in patients receiving high-risk regimens or intermediate-risk regimens with individual risk factors. The impact of electronic medical record system (EMR) implementation on compliance with G-CSF support guidelines has not been studied. Methods: At West Virginia University/Mary Babb Randolph Cancer Center we conducted an IRB approved retrospective chart review of cancer patients receiving chemotherapy from January 1, 2007 to August 1, 2008 (pre-EMR) and January 1, 2011 to December 31, 2011 (post-EMR). We reviewed the chemotherapy regimens and patient risk factors for developing febrile neutropenia, and determined if the G-CSF usage was consistent with guideline recommendations. Results: Compliance with prophylactic G-CSF guidelines was 75.6% in the post-EMR arm, compared to 67.5% in the pre-EMR arm (p=0.041, ch-square). The post EMR data of 1,042 new chemotherapy initiations showed: (see Table). The appropriateness of usage in high and low risk patients were the most compliant, as G-CSF orders were built into chemotherapy plans of high risk regimens and omitted from low risk regimens. Conclusions: Appropriate prophylactic G-CSF usage can be improved when orders are integrated into standard chemotherapy order sets in an EMR. An area of further improvement would include automatic identification of individual risk factors by the EMR. [Table: see text]

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Is safety of childhood growth hormone therapy related to dose? Data from a large observational study

Acta Endocrinologica ◽

10.1530/eje-15-1017 ◽

2016 ◽

Vol 174 (5) ◽

pp. 681-691 ◽

Cited By ~ 10

Author(s):

Lars Sävendahl ◽

Effie Pournara ◽

Birgitte Tønnes Pedersen ◽

Oliver Blankenstein

Keyword(s):

Growth Hormone ◽

High Risk ◽

Observational Study ◽

Mortality Risk ◽

Growth Hormone Treatment ◽

Risk Group ◽

Safety Data ◽

Hormone Treatment ◽

Low Risk ◽

Intermediate Risk

AbstractObjectiveConcerns have been raised of increased mortality risk in adulthood in certain patients who received growth hormone treatment during childhood. This study evaluated the safety of growth hormone treatment in childhood in everyday practice.DesignNordiNet®International Outcome Study (IOS) is a noninterventional, observational study evaluating safety and effectiveness of Norditropin®(somatropin; Novo Nordisk A/S, Bagsvaerd, Denmark).MethodsLong-term safety data (1998–2013) were collected on 13 834 growth hormone treated pediatric patients with short stature. Incidence rates (IRs) of adverse events (AEs) defined as adverse drug reactions (ADRs), serious ADRs (SADRs), and serious AEs (SAEs) were calculated by mortality risk group (low/intermediate/high). The effect of growth hormone dose on IRs and the occurrence of cerebrovascular AEs were investigated by the risk group.ResultsWe found that 61.0% of patients were classified as low-risk, 33.9% intermediate-risk, and 5.1% high-risk. Three hundred and two AEs were reported in 261 (1.9%) patients during a mean (s.d.) treatment duration of 3.9 (2.8) years. IRs were significantly higher in the high- vs the low-risk group (high risk vs low risk—ADR: 9.11 vs 3.14; SAE: 13.66 vs 1.85; SADR: 4.97 vs 0.73 events/1000 patient-years of exposure;P< 0.0001 for all). Except for SAEs in the intermediate-risk group (P= 0.0486) in which an inverse relationship was observed, no association between IRs and growth hormone dose was found. No cerebrovascular events were reported.ConclusionsWe conclude that safety data from NordiNet®IOS do not reveal any new safety signals and confirm a favorable overall safety profile in accordance with other pediatric observational studies. No association between growth hormone dose and the incidence of AEs during growth hormone treatment in childhood was found.

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Estimating kidney failure risk using electronic medical records

Kidney360 ◽

10.34067/kid.0005592020 ◽

2021 ◽

pp. 10.34067/KID.0005592020

Author(s):

Felipe S. Naranjo ◽

Yingying Sang ◽

Shoshana H. Ballew ◽

Nikita Stempniewicz ◽

Stephan C. Dunning ◽

...

Keyword(s):

Electronic Medical Records ◽

Kidney Failure ◽

Medical Records ◽

Individual Risk ◽

Systematic Bias ◽

Risk Equation ◽

Protein Levels ◽

Urine Dipstick ◽

Urine Albumin ◽

Failure Risk

Background: The 4-variable kidney failure risk equation (KFRE) is a well-validated tool for patients with GFR <60 ml/min/1.73 m2 that incorporates age, sex, GFR, and urine albumin-to-creatinine ratio (ACR) to forecast individual risk of kidney failure. Implementing the KFRE in the electronic medical record is challenging, however, due to low ACR testing in clinical practice. The aim of this study was to determine, when ACR is missing, whether to impute ACR from PCR or dipstick protein for use in the 4-variable KFRE or to use the 3-variable KFRE that does not require ACR. Methods: Using electronic health records from OptumLabs® Data Warehouse, patients with eGFR <60 ml/min/1.73 m2 were categorized based on the availability of ACR testing within the previous 3 years. For patients missing ACR, we extracted urine protein-to-creatinine (PCR) and dipstick protein results, comparing the discrimination of the 3-variable KFRE (age, sex, GFR) with the 4-variable KFRE estimated using imputed ACR from PCR and dipstick protein levels. Results: There were 976,299 patients in 39 health care organizations; 59.0% were women, mean age was 72 years and mean eGFR was 47 ml/min/1.73m2. The proportion with ACR testing was 19.3% within the previous 3 years. An additional 1.7% had an available PCR and 36.3% had a dipstick protein; the remaining 42.8% had no form of albuminuria testing. The 4-variable KFRE had significantly better discrimination than the 3-variable KFRE among patients with ACR testing, PCR testing and urine dipstick protein levels, even with imputed ACR for the latter two groups. Calibration of the 4-variable KFRE was acceptable in each group, but the 3-variable equation showed systematic bias in the groups that lacked ACR or PCR testing. Conclusion: Implementation of the KFRE in electronic medical records should incorporate ACR even if only imputed from PCR or urine dipstick protein levels.

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Kidney Failure Risk Equation and Cost of Care in Patients with Chronic Kidney Disease

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.06770521 ◽

2021 ◽

pp. CJN.06770521 ◽

Cited By ~ 1

Author(s):

Bhanu Prasad ◽

Meric Osman ◽

Maryam Jafari ◽

Lexis Gordon ◽

Navdeep Tangri ◽

...

Keyword(s):

High Risk ◽

Prescription Drugs ◽

Kidney Failure ◽

Hospital Admissions ◽

Low Risk ◽

Content Type ◽

Physician Visits ◽

Risk Equation ◽

Risk Of Progression ◽

Risk Patients

Background and objectivesPatients with CKD exhibit heterogeneity in their rates of progression to kidney failure. The kidney failure risk equation (KFRE) has been shown to accurately estimate progression to kidney failure in adults with CKD. Our objective was to determine health care utilization patterns of patients on the basis of their risk of progression.Design, setting, participants, & measurementsWe conducted a retrospective cohort study of adults with CKD and eGFR of 15–59 ml/min per 1.73 m2 enrolled in multidisciplinary CKD clinics in the province of Saskatchewan, Canada. Data were collected from January 1, 2004 to December 31, 2012 and followed for 5 years (December 31, 2017). We stratified patients by eGFR and risk of progression and compared the number and cost of hospital admissions, physician visits, and prescription drugs.ResultsIn total, 1003 adults were included in the study. Within the eGFR of 15–29 ml/min per 1.73 m2 group, the costs of hospital admissions, physician visits, and drug dispensations over the 5-year study period comparing high-risk patients with low-risk patients were (Canadian dollars) $89,265 versus $48,374 (P=0.008), $23,423 versus $11,231 (P<0.001), and $21,853 versus $16,757 (P=0.01), respectively. Within the eGFR of 30–59 ml/min per 1.73 m2 group, the costs of hospital admissions, physician visits, and prescription drugs were $55,944 versus $36,740 (P=0.10), $13,414 versus $10,370 (P=0.08), and $20,394 versus $14,902 (P=0.02) in high-risk patients in comparison with low-risk patients, respectively, for progression to kidney failure.ConclusionsIn patients with CKD and eGFR of 15–59 ml/min per 1.73 m2 followed in multidisciplinary clinics, the costs of hospital admissions, physician visits, and drugs were higher for patients at higher risk of progression to kidney failure by the KFRE compared with patients in the low-risk category. The high-risk group of patients with CKD and eGFR of 15–29 ml/min per 1.73 m2 had stronger association with hospitalizations costs, physician visits, and drug utilizations.

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Mortality of site-specific cancer in patients with schizophrenia: A systematic review and meta-analysis

10.21203/rs.2.12760/v1 ◽

2019 ◽

Author(s):

Liwei Ni ◽

Yuming Long ◽

Xuya Yuan ◽

Jianhao Xu ◽

Jialong Tao ◽

...

Keyword(s):

Prostate Cancer ◽

Lung Cancer ◽

Colon Cancer ◽

High Risk ◽

Mortality Rate ◽

Mortality Risk ◽

Meta Analysis ◽

Site Specific ◽

Risk Of Mortality ◽

Male Patients

Abstract Background: Numerous studies have reported contradicting results on the relationship between cancer mortality and schizophrenia. Our aim is to quantify the mortality rate of common site-specific cancers among patients with schizophrenia and to synthesize the available research evidence. Method: We performed a systemic search of the PubMed, EMBASE and Web of Science databases. Studies reporting the mortality rate of different cancer in patients with schizophrenia were included. A random-effects model was applied to calculate the pooled relative risks (RRs) with 95% confidence intervals (95%CIs). Results: Seven studies consisting of a total of 1,162,971 participants with schizophrenia were included in this meta-analysis. Data regarding mortality risk of breast, colon, lung and prostate cancer among schizophrenia patients were subjected to quantitative analysis. Pooled results showed significant increases in mortality risk of breast cancer (RR = 1.97, 95%CI 1.38–2.83), lung cancer (RR = 1.93, 95%CI 1.46–2.54) and colon cancer (RR = 1.69, 95%CI 1.60–1.80) in patients with schizophrenia compared with those in the general population or control group. The mortality risk of prostate cancer increased in male patients, although no significant difference was detected (RR = 1.58, 95% CI 0.79–3.15). Increased risks of mortality from lung and colon cancer were observed in female patients (RR = 2.49, 95%CI 2.40–2.59 and RR = 2.42, 95%CI 1.39–4.22, respectively) and elevated risks of mortality from lung and colon cancer in male patients (RR = 2.40, 95%CI 2.30–2.50 and RR = 1.90, 95%CI 1.71–2.11, respectively) were detected. Conclusions: Individuals with schizophrenia have a significantly high risk of mortality from breast, colon, and lung cancer and a high risk of mortality from prostate cancer.

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