FC 115HIGHER VARIABILITY OF SERUM PHOSPHATE IS ASSOCIATED WITH INCREASED MORTALITY RISK ONLY WHEN ASSOCIATED WITH HYPOALBUMINEMIA

Abstract Background and Aims Both hypophosphatemia and hypoalbuminemia are established risk factors for mortality in hemodialysis (HD) patients. Evidence indicates that higher variability of serum phosphate (P) is associated with higher risk of mortality. However, little is known about to what extent of this association is influenced by other risk factors, most importantly nutritional or inflammatory state. The aim of this study was to analyze the variability of serum P with all-cause mortality taking into account the interaction with the levels of albumin (Alb) Method All adult incident HD patients treated in Fresenius Medical Care North America (FMCNA) clinics between 01/2010 and 10/2018 were included. Serum P and Alb levels were averaged from month 1 to 6 after the start of dialysis (baseline). Baseline variability of P was described by coefficient of variation (CV). All-cause mortality was recorded between months 7 and 18. Cox proportional hazards models with spline terms were applied to explore the association between variability of P and Alb and all-cause mortality. Additionally, tensor product smoothing splines were computed to study the interactions of Alb and P variability and their associations with outcomes respectively. Results We enrolled 353,142 patients. The average age was 62.7 years, 58% were male, 64% were diabetic. Baseline P was 4.98 mg/dL, median serum P CV was 0.19. Baseline Alb was 3.61 g/dL. While we studied the joint effect of P variability with Alb on outcome, the association between P variability and outcomes appeared to be predominant in patients with low serum Alb levels (Fig. 1). Conclusion Higher P variability is associated with adverse outcomes but predominantly in patients with hypoalbuminemia. This suggests a major role for malnutrition and/or inflammation as explanatory factors for the association between P variability in outcome. A high P variability in this patient group can be interpreted as an additional risk factor. When studying the relation between the variability of a single parameter with outcome, the possible underlying role of “third factors” should be explored, for which the methodology used in this abstract might provide an example.

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FC 080VARIABILITY IN SERUM PHOSPHATE ASSESSED BY DIRECTIONAL CHANGE IS ASSOCIATED WITH INCREASED MORTALITY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab123.005 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Xiaoling (Janice) Ye ◽

Karlien Ter Meulen ◽

Len A Usvyat ◽

Frank Van Der Sande ◽

Constantijn Konings ◽

...

Keyword(s):

Proportional Hazards ◽

Smoothing Splines ◽

Cox Proportional Hazards ◽

Serum Phosphate ◽

P Value ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

All Cause Mortality ◽

Directional Change ◽

Wide Variability

Abstract Background and Aims Prior studies showed that there is a wide variability between serial pre-dialysis measurements of serum phosphate (P). Serum P vary can be due to changes in nutritional intake, underlying bone disorders, medication use or inflammation. Various variability markers have been investigated to study the association between P variability and its association with outcomes, however, the directional trends have not been studied in depth. We aimed to study directional changes and investigated its association with outcomes. Method All adult incident HD patients treated in Fresenius Medical Care North America (FMCNA) clinics between 01/2010 and 10/2018 were included in this retrospective cohort study. Serum P levels were averaged from month 1 to 6 after the initiation of dialysis (baseline). Baseline absolute and directional range (DR) of serum P were calculated. DR of P was calculated as: P min/max (t2) – P max/min (t1), with P (t1) and P (t2) represents the timepoint when either the min P value or max P value was measured, whichever comes first, and with t2 happened after t1. It is positive when the minimum antedates the maximum, otherwise negative. All-cause mortality was recorded between months 7 and 18. Cox proportional hazards models with spline terms were applied to explore the association between absolute and DR of P and all-cause mortality. Additionally, tensor product smoothing splines were computed to study the interactions of P with absolute P and DR of P and their joint associations with outcomes, respectably. Results We studied 353,142 patients. The average age was 62.7 years, 58% were male, 64% were diabetic. Baseline P was 4.98 mg/dL, median absolute range was 2.40 mg/dL, median DR was 1.1 mg/dL. Across different levels of P, both higher levels of absolute range and DR of P were associated with higher risk of mortality (Figure 1, Figure 2). The associations even seemed stronger in patients with lower levels of serum P and with negative DR (Figure 1). Conclusion Lower levels of serum P are independently associated with an increased risk of all-cause mortality. Whereas both a positive and negative DR of P are in general associated with increased mortality, the effects of an increase are most predominant in patients with higher levels of serum P, whereas a negative directional range are most predominant in patients with low serum P. This could be explained by the fact that patients with lower levels of P are generally malnourished or inflamed, where a further reduction indicates nutritional deterioration.

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P2524Extent and outcomes of frailty in older people with atrial fibrillation: a nationwide study using primary care data

European Heart Journal ◽

10.1093/eurheartj/ehz748.0853 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Wilkinson ◽

O Todd ◽

M Yadegarfar ◽

A Clegg ◽

C P Gale ◽

...

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

Older People ◽

Proportional Hazards ◽

Frailty Index ◽

Community Setting ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

All Cause Mortality

Abstract Background The prevalence of atrial fibrillation (AF) in older people is increasing, as is frailty. Frailty describes an increased vulnerability to adverse outcomes, whereby the balance of risk and benefit associated with an intervention may be more nuanced. However, there are limited data from a community setting on the prevalence of AF and frailty in older people. It is important to understand the burden of AF and frailty, and the associated impact on mortality and stroke disease in order to inform shared decision making with patients, and also inform guidelines for this increasing group of older people. Purpose To estimate the prevalence of AF and the burden of frailty in patients with AF, in a large primary care dataset. To report stroke and mortality by frailty group. Methods We used electronic health records of 537,051 patients in England aged 65 years or older on 31/12/2015, with follow-up for all-cause mortality and ischaemic or unclassified stroke to 11/04/2017. Patients with a history of AF were identified using Clinical Terms Version 3 (CTV-3) codes. Frailty was identified up to the point of study entry using the electronic frailty index (eFI, the proportion of deficits out of 36 possible deficits), and categorised into robust (0–0.12), mild (>0.12–0.24), moderate (>0.24–0.36) or severe (>0.36) frailty. Median CHA2DS2-VASc and ATRIA scores for patients with frailty were compared with the robust group using Mann-Whitney. The association between frailty status, all-cause mortality and stroke was calculated using Cox proportional hazards models, adjusted for age and sex. Results Of the cohort, 61,177 patients (11.4%) had AF. Of those with AF, 27,987 (45.8%) were female, and 54,734 (89.5%) had frailty. 6,443 (10.5%) were classified as robust; 20,352 (33.3%) mildly frail; 20,315 (33.2%) moderately frail; and 14,067 (23.0%) severely frail. The median number of eFI-defined deficits among patients with AF was 9 (interquartile range [IQR] 6–12). Median stroke and bleeding scores were higher in those with frailty compared with the robust group (CHA2DS2-VASc 4 [IQR 3–5] v 2 [2–3], p≤0.001; ATRIA 4 [2–6] v 1 [0–2], p≤0.001). During 73,338 patient-years of follow-up, there were 6,805 (11.1%) deaths and 945 (1.54%) strokes. Compared with the robust group, all-cause mortality and stroke were higher with increasing frailty. Mortality: mild frailty hazard ratio 1.53 (95% confidence interval 1.29–1.80); moderate frailty 2.50 (2.13–2.94); severe frailty 4.26 (3.63–5.01). Stroke: mild frailty 1.36 (0.99–1.85); moderate frailty 1.67 (1.23–2.28); severe 1.99 (1.45–2.73). Kaplan-Meier survival curves by frailty Conclusion The prevalence of AF among those aged over 65 years in primary care in England is high, the majority of whom are frail. Increasing severity of frailty was associated with higher mortality and stroke rates. The extent to which the judicious use of oral anticoagulation may improve clinical outcomes for patients with AF and frailty is currently unknown. Acknowledgement/Funding CPG: Bayer, BMS, AstraZeneca, Novartis Vifor Pharma, Menerini

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Determining the Joint Effect of Obesity and Diabetes on All-Cause Mortality and Cardiovascular-Related Mortality following an Ischemic Stroke

Stroke Research and Treatment ◽

10.1155/2018/4812712 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11 ◽

Cited By ~ 3

Author(s):

Colleen Bauza ◽

Renee’ Martin ◽

Sharon D. Yeatts ◽

Keith Borg ◽

Gayenell Magwood ◽

...

Keyword(s):

Ischemic Stroke ◽

Proportional Hazards ◽

Joint Effect ◽

Normal Weight ◽

Cox Proportional Hazards ◽

Proportional Hazards Regression ◽

Obesity And Diabetes ◽

All Cause Mortality ◽

Obese Subjects ◽

Related Mortality

Although obesity and diabetes mellitus, or diabetes, are independently associated with mortality-related events (e.g., all-cause mortality and cardiovascular-related mortality) following an ischemic stroke, little is known about the joint effect of obesity and diabetes on mortality-related events following an ischemic stroke. The aim of this study is to evaluate the joint effect of obesity and diabetes on mortality-related events in subjects with a recent ischemic stroke. Data from the multicenter Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial was analyzed for this study. The joint effect of obesity and diabetes on mortality-related events was estimated via Cox proportional hazards regression models. No difference in the hazard of all-cause mortality following an ischemic stroke was observed between obese subjects with diabetes and underweight/normal-weight subjects without diabetes. In contrast, obese subjects with diabetes had an increased hazard of cardiovascular-related mortality following an ischemic stroke compared with underweight/normal-weight subjects without diabetes. Additionally, there was evidence of an attributable proportion due to interaction as well as evidence of a highly statistically significant interaction on the multiplicative scale for cardiovascular-related mortality. In this clinical trial cohort of ischemic stroke survivors, obesity and diabetes synergistically interacted to increase the hazard of cardiovascular-related mortality.

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Management and 30-Day Mortality of Acute Coronary Syndrome in a Resource-Limited Setting: Insight From Ethiopia. A Prospective Cohort Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.707700 ◽

2021 ◽

Vol 8 ◽

Author(s):

Korinan Fanta ◽

Fekadu Bekele Daba ◽

Elsah Tegene Asefa ◽

Tsegaye Melaku ◽

Legese Chelkeba ◽

...

Keyword(s):

Risk Factors ◽

Clinical Characteristics ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Reperfusion Therapy ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Coronary Syndrome ◽

Hazards Model ◽

All Cause Mortality

Background: Despite the fact that the burden, risk factors, and clinical characteristics of acute coronary syndrome (ACS) have been studied widely in developed countries, limited data are available from sub-Saharan Africa. Therefore, this study aimed at evaluating the clinical characteristics, treatment, and 30-day mortality of patients with ACS admitted to tertiary hospitals in Ethiopia.Methods: A total of 181 ACS patients admitted to tertiary care hospitals in Ethiopia were enrolled from March 15 to November 15, 2018. The clinical characteristics, management, and 30-day mortality were evaluated by ACS subtype. The Cox proportional hazards model was used to determine the predictors of 30-day all-cause mortality. A p-value < 0.05 was considered statistically significant.Results: The majority (61%) of ACS patients were admitted with ST-segment elevation myocardial infarction (STEMI). The mean age was 56 years, with male predominance (62.4%). More than two-thirds (67.4%) of patients presented to hospital after 12 h of symptom onset. Dyslipidemia (48%) and hypertension (44%) were the most common risk factors identified. In-hospital dual antiplatelet and statin use was high (>90%), followed by beta-blockers (81%) and angiotensin-converting enzyme inhibitors (ACEIs; 72%). Late reperfusion with percutaneous coronary intervention (PCI) was done for only 13 (7.2%), and none of the patients received early reperfusion therapy. The 30-day all-cause mortality rate was 25.4%. On multivariate Cox proportional hazards model analysis, older age [hazard ratio (HR) = 1.03, 95% CI = 1.003–1.057], systolic blood pressure (HR = 0.99, 95% CI = 0.975–1.000), serum creatinine (HR = 1.32, 95% CI = 1.056–1.643), Killip class > II (HR = 4.62, 95% CI = 2.502–8.523), ejection fraction <40% (HR = 2.75, 95% CI = 1.463–5.162), and STEMI (HR = 2.72, 95% CI = 1.006–4.261) were independent predictors of 30-day mortality.Conclusions: The 30-day all-cause mortality rate was unacceptably high, which implies an urgent need to establish a nationwide program to reduce pre-hospital delay, promoting the use of guideline-directed medications, and increasing access to reperfusion therapy.

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Clinical course and risk factors of fatal adverse outcomes in COVID-19 patients in Korea: a nationwide retrospective cohort study

Scientific Reports ◽

10.1038/s41598-021-89548-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Juhyun Song ◽

Dae Won Park ◽

Jae-hyung Cha ◽

Hyeri Seok ◽

Joo Yeong Kim ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Retrospective Cohort ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

Cox Proportional Hazards Model ◽

Icu Admission ◽

Hazards Model

AbstractWe investigated association between epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) patients and clinical outcomes in Korea. This nationwide retrospective cohort study included 5621 discharged patients with COVID-19, extracted from the Korea Disease Control and Prevention Agency (KDCA) database. We compared clinical data between survivors (n = 5387) and non-survivors (n = 234). We used logistic regression analysis and Cox proportional hazards model to explore risk factors of death and fatal adverse outcomes. Increased odds ratio (OR) of mortality occurred with age (≥ 60 years) [OR 11.685, 95% confidence interval (CI) 4.655–34.150, p < 0.001], isolation period, dyspnoea, altered mentality, diabetes, malignancy, dementia, and intensive care unit (ICU) admission. The multivariable regression equation including all potential variables predicted mortality (AUC = 0.979, 95% CI 0.964–0.993). Cox proportional hazards model showed increasing hazard ratio (HR) of mortality with dementia (HR 6.376, 95% CI 3.736–10.802, p < 0.001), ICU admission (HR 4.233, 95% CI 2.661–6.734, p < 0.001), age ≥ 60 years (HR 3.530, 95% CI 1.664–7.485, p = 0.001), malignancy (HR 3.054, 95% CI 1.494–6.245, p = 0.002), and dyspnoea (HR 1.823, 95% CI 1.125–2.954, p = 0.015). Presence of dementia, ICU admission, age ≥ 60 years, malignancy, and dyspnoea could help clinicians identify COVID-19 patients with poor prognosis.

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Dissatisfaction with Married Life in Men Is Related to Increased Stroke and All-Cause Mortality

Journal of Clinical Medicine ◽

10.3390/jcm10081729 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1729

Author(s):

Shahar Lev-ari ◽

Yftach Gepner ◽

Uri Goldbourt

Keyword(s):

Risk Factors ◽

Marital Satisfaction ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Early Mortality ◽

Physically Active ◽

Relative Risks ◽

Married Life ◽

All Cause Mortality ◽

Order Of Magnitude

The objectives of this study were to assess the association between marital satisfaction and specific and all-cause mortality, and to examine whether this association is independent of other known risk factors for early mortality. In this prospective cohort, male Israeli civil servants and municipal employees (n = 8945) underwent an extensive appraisal of health and behavioral patterns and were followed for more than three decades. Cox proportional hazards analysis was used to estimate the relative risks for stroke and all-cause mortality over time across marital satisfaction categories. During the 32 years of follow-up, 5736 (64.1%) died. Dissatisfaction with married life was related to increased long-term risk of stroke (HR = 1.94; 95%CI, 1.41–2.90) and all-cause mortality (HR = 1.21; 95%CI, 1.04–1.41). The latter association was of a similar order of magnitude to other known risk factors for early mortality, such as people with a history of smoking (HR = 1.37; 95%CI, 1.30–1.48) compared to people who have never smoked and for physically inactive participants (HR = 1.21; 95%CI, 1.14–1.37) compared to physically active participants. The results of our study suggest that marital dissatisfaction may predict an elevated risk of all-cause mortality. Assessing marital satisfaction and measuring the health benefits of marital education programs for couples should be implemented as part of health promotion strategies for the general population.

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Associations of symptoms and quality of life with outcomes in patients with atrial fibrillation

Heart ◽

10.1136/heartjnl-2019-316314 ◽

2020 ◽

Vol 106 (23) ◽

pp. 1847-1852 ◽

Cited By ~ 1

Author(s):

Philipp Krisai ◽

Steffen Blum ◽

Stefanie Aeschbacher ◽

Jürg H Beer ◽

Giorgio Moschovitis ◽

...

Keyword(s):

Quality Of Life ◽

Atrial Fibrillation ◽

Proportional Hazards ◽

Cardiovascular Death ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

End Points ◽

End Point ◽

All Cause Mortality

ObjectiveWe aimed to investigate changes in atrial fibrillation (AF)-related symptoms and quality of life (QoL) over time, and their impact on prognosis.MethodsWe prospectively followed 3836 patients with known AF for a mean of 3.7 years. Information on AF-related symptoms and QoL was obtained yearly. The primary end point was a composite of stroke or systemic embolism. Main secondary end points included stroke subtypes, all-cause mortality, cardiovascular death, hospitalisation for congestive heart failure (CHF), myocardial infarction and major bleeding. We assessed associations using multivariable, time-updated Cox proportional hazards models.ResultsMean age was 72 years, 72% were male. Patients with AF-related symptoms (66%) were younger (70 vs 74 years, p<0.0001), more often had paroxysmal AF (56% vs 37%, p<0.0001) and had lower QoL (71 vs 72 points, p=0.009). The incidence of the primary end point was 1.05 and 1.02 per 100 person-years in patients with and without symptoms, respectively. The multivariable adjusted HR (aHR) (95% CIs) for the primary end point was 1.11 (0.77 to 1.59; p=0.56) for AF-related symptoms. AF-related symptoms were not associated with any of the secondary end points. QoL was not significantly related to the primary end point (aHR per 5-point increase 0.98 (0.94 to 1.03; p=0.37)), but was significantly related to CHF hospitalisations (0.92 (0.90 to 0.94; p<0.0001)), cardiovascular death (0.90 (0.86 to 0.95; p<0.0001)) and all-cause mortality (0.88 (0.86 to 0.90; p<0.0001)).ConclusionsAF-related symptoms were not associated with adverse outcomes and should therefore not be the basis for prognostic treatment decisions. QoL was strongly associated with CHF, cardiovascular death and all-cause mortality.

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Risk Factors and Blood Pressure Control Targets Associated With the Clinical Outcome of Elderly COVID-19 Patients With Hypertension: a Retrospective Cohort Study

10.21203/rs.3.rs-711780/v1 ◽

2021 ◽

Author(s):

Ting Li ◽

Maomao Wang ◽

Yifei Wang ◽

Pei Zhang ◽

Yang Wang ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cohort Study ◽

Clinical Outcome ◽

Retrospective Cohort ◽

Proportional Hazards ◽

Pressure Control ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

Blood Pressures

Abstract Background: COVID-19 is a global pandemic, especially among the elderly. Our study aimed to explore the risk factors and identify the blood pressure control targets associated with the clinical outcome of elderly COVID-19 patients with hypertension. Methods: In this retrospective cohort study, elderly COVID-19 patients who were admitted to Wuhan Huoshenshan Hospital from February 8 to 17, 2020 was included. Demographic, medical history, clinical data, and laboratory test data were collected from medical records. The adverse clinical outcomes were intensive care unit (ICU) admission and death. Difference between hypertension and non-hypertension groups were compared. Hypertension group were further divided into 3 subgroups according to their maximum blood pressures. Kaplan–Meier (K–M) method was used to find the differences both between hyperntesion and non-hypertension groups, and among the 3 hypertension subgroups. Univariable and multivariable Cox proportional hazards regression model were used to find risk factors.Results: All 133 elderly COVID-19 patients (79 patients with hypertension) were included. (1) Univariate analysis between hypertension and non-hypertension patients showed most laboratory tests were significantly (P < 0.05, or P < 0.01), particularly in adverse clinical outcomes (32.91% vs 7.41% at 30 days, P < 0.05). (2) Multivariate Cox proportional hazards models confirmed hypertension (HR 3.202, 95% CI:1.164 - 8.807) were the most important independent risk factors of outcomes in elderly patients, as well as low lymphocyte count, while the statistical difference of other values diminished. (3) Hypertension group were further divided into 3 subgroups according to their maximum blood pressures. K-M analysis showed maximum systolic blood pressure (SBP) ≥160mmHg subgroup (P < 0.01) and maximum blood pressure (DBP) ≥90mmHg subgroup (P < 0.05) experienced more adverse outcomes than others. (4) Multivariate Cox-proportional hazard model confirmed that maximum SBP≥160mmHg and maximum DBP ≥90mmHg were risk factors (HR 8.279, 95% CI: 1.346, 50.914; HR 5.080, 95% CI: 1.606,16.071; respectively). Conclusions: Hypertension is the most important independent risk factor of adverse outcomes in elderly COVID-19 patients, controlling the maximum blood pressure levels under 160/90 mmHg will decrease large part risks of adverse outcomes, the first week are key treatment period for patient prognosis.

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Combined associations of hs-CRP and cognitive function with all-cause mortality among oldest-old adults in Chinese longevity areas: a prospective cohort study

Immunity & Ageing ◽

10.1186/s12979-019-0170-y ◽

2019 ◽

Vol 16 (1) ◽

Cited By ~ 2

Author(s):

Chen Chen ◽

Yingchun Liu ◽

Zhaojin Cao ◽

Zhaoxue Yin ◽

Feng Zhao ◽

...

Keyword(s):

Cognitive Function ◽

Mortality Risk ◽

Proportional Hazards ◽

Oldest Old ◽

High Sensitivity ◽

Joint Effect ◽

Cox Proportional Hazards ◽

Old Adults ◽

All Cause Mortality ◽

Hs Crp

Abstract Background Inflammatory markers, such as high sensitivity C-reactive protein (hs-CRP), and cognitive impairment (CI) are associated with mortality; CRP is related to the deterioration of CI. However, it is still unknown whether these two indices predict mortality independent of each other. Furthermore, their joint effect on all-cause mortality has not been well established, especially in oldest-old adults. Methods Based on data from the 2012 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we included 1447 oldest-old adults (mean age 84.7 years and 58.7% were female, weighted) with information on hs-CRP (stratified by a cutoff value of 3.0 mg/L) and cognition (quantified by Mini-Mental Status Examination (MMSE) scored according to the personal educational level) at baseline. Mortality was assessed in followed 2014 and 2017 waves. Cox proportional hazards regression models were used, with adjustment for hs-CRP and cognition (mutually controlled) and several traditional mortality risk factors. Results During a median follow-up period of 32.8 months (Q1-Q3, 9.7–59.0 months), 826 participants died. Hs-CRP [HR > 3.0 mg/L vs ≤ 3.0 mg/L: 1.64 (95% CI, 1.17, 2.30)] and cognition [HR CI vs normal: 2.30 (95% CI, 1.64, 3.21)] each was independent predictor of all-cause mortality, even after accounting for each other and other covariates. Monotonic and positive associations were observed in combined analyses, in which the highest mortality risk was obtained in elders with both high hs-CRP> 3.0 mg/L and CI [HR: 3.56 (95% CI, 2.35, 5.38)].The combined effects were stronger in male and younger oldest-old (aged 80–89 years). Conclusion High hs-CRP and CI, both individually and jointly, were associated with increased all-cause mortality risks in Chinese oldest-old. Intervention strategies for preventing inflammation and maintaining adequate cognitive function may be more important in male and younger oldest-old for reducing mortality risk.

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Urine Alpha-1-Microglobulin Levels and Acute Kidney Injury, Mortality, and Cardiovascular Events following Cardiac Surgery

American Journal of Nephrology ◽

10.1159/000518240 ◽

2021 ◽

pp. 1-11

Author(s):

Jonathan G. Amatruda ◽

Michelle M. Estrella ◽

Amit X. Garg ◽

Heather Thiessen-Philbrook ◽

Eric McArthur ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Proportional Hazards ◽

Kidney Injury ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

Ckd Progression ◽

Urine Albumin ◽

All Cause Mortality

Introduction: Urine alpha-1-microglobulin (Uα1m) elevations signal proximal tubule dysfunction. In ambulatory settings, higher Uα1m is associated with acute kidney injury (AKI), progressive chronic kidney disease (CKD), cardiovascular (CV) events, and mortality. We investigated the associations of pre- and postoperative Uα1m concentrations with adverse outcomes after cardiac surgery. Methods: In 1,464 adults undergoing cardiac surgery in the prospective multicenter Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury (TRIBE-AKI) cohort, we measured the pre-and postoperative Uα1m concentrations and calculated the changes from pre- to postoperative concentrations. Outcomes were postoperative AKI during index hospitalization and longitudinal risks for CKD incidence and progression, CV events, and all-cause mortality after discharge. We analyzed Uα1m continuously and categorically by tertiles using multivariable logistic regression and Cox proportional hazards regression adjusted for demographics, surgery characteristics, comorbidities, baseline estimated glomerular filtration rate, urine albumin, and urine creatinine. Results: There were 230 AKI events during cardiac surgery hospitalization; during median 6.7 years of follow-up, there were 212 cases of incident CKD, 54 cases of CKD progression, 269 CV events, and 459 deaths. Each 2-fold higher concentration of preoperative Uα1m was independently associated with AKI (adjusted odds ratio [aOR] = 1.36, 95% confidence interval 1.14–1.62), CKD progression (adjusted hazard ratio [aHR] = 1.46, 1.04–2.05), and all-cause mortality (aHR = 1.19, 1.06–1.33) but not with incident CKD (aHR = 1.21, 0.96–1.51) or CV events (aHR = 1.01, 0.86–1.19). Postoperative Uα1m was not associated with AKI (aOR per 2-fold higher = 1.07, 0.93–1.22), CKD incidence (aHR = 0.90, 0.79–1.03) or progression (aHR = 0.79, 0.56–1.11), CV events (aHR = 1.06, 0.94–1.19), and mortality (aHR = 1.01, 0.92–1.11). Conclusion: Preoperative Uα1m concentrations may identify patients at high risk of AKI and other adverse events after cardiac surgery, but postoperative Uα1m concentrations do not appear to be informative.

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