Eosinophil count and mortality risk in incident hemodialysis patients

Abstract Background Eosinophils are traditionally known as moderators of allergic reactions; however, they have now emerged as one of the principal immune-regulating cells as well as predictors of vascular disease and mortality in the general population. Although eosinophilia has been demonstrated in hemodialysis (HD) patients, associations of eosinophil count (EOC) and its changes with mortality in HD patients are still unknown. Methods In 107 506 incident HD patients treated by a large dialysis organization during 2007–11, we examined the relationships of baseline and time-varying EOC and its changes (ΔEOC) over the first 3 months with all-cause mortality using Cox proportional hazards models with three levels of hierarchical adjustment. Results Baseline median EOC was 231 (interquartile range 155–339) cells/μL and eosinophilia (>350 cells/μL) was observed in 23.4% of patients. There was a gradual increase in EOC over time after HD initiation with a median ΔEOC of 5.1 (IQR −53–199) cells/μL, which did not parallel the changes in white blood cell count. In fully adjusted models, mortality risk was highest in subjects with lower baseline and time-varying EOC (<100 cells/μL) and was also slightly higher in patients with higher levels (≥550 cells/μL), resulting in a reverse J-shaped relationship. The relationship of ΔEOC with all-cause mortality risk was also a reverse J-shape where both an increase and decrease exhibited a higher mortality risk. Conclusions Both lower and higher EOCs and changes in EOC over the first 3 months after HD initiation were associated with higher all-cause mortality in incident HD patients.

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Fitting Marginal Structural and G-Estimation Models Under Complex Treatment Patterns: Investigating the Association Between De Novo Vitamin D Supplement Use After Breast Cancer Diagnosis and All-Cause Mortality Using Linked Pharmacy Claim and Registry Data

American Journal of Epidemiology ◽

10.1093/aje/kwz243 ◽

2019 ◽

Vol 189 (3) ◽

pp. 224-234

Author(s):

Jamie M Madden ◽

Finbarr P Leacy ◽

Lina Zgaga ◽

Kathleen Bennett

Keyword(s):

Vitamin D ◽

Cancer Diagnosis ◽

Proportional Hazards ◽

De Novo ◽

Breast Cancer Diagnosis ◽

Cox Proportional Hazards ◽

Time Varying ◽

Proportional Hazards Models ◽

Cox Proportional Hazards Models ◽

All Cause Mortality

Abstract Studies have shown that accounting for time-varying confounding through time-dependent Cox proportional hazards models may provide biased estimates of the causal effect of treatment when the confounder is also a mediator. We explore 2 alternative approaches to addressing this problem while examining the association between vitamin D supplementation initiated after breast cancer diagnosis and all-cause mortality. Women aged 50–80 years were identified in the National Cancer Registry Ireland (n = 5,417) between 2001 and 2011. Vitamin D use was identified from linked prescription data (n = 2,570). We sought to account for the time-varying nature of vitamin D use and time-varying confounding by bisphosphonate use using 1) marginal structural models (MSMs) and 2) G-estimation of structural nested accelerated failure-time models (SNAFTMs). Using standard adjusted Cox proportional hazards models, we found a reduction in all-cause mortality in de novo vitamin D users compared with nonusers (hazard ratio (HR) = 0.84, 95% confidence interval (CI): 0.73, 0.99). Additional adjustment for vitamin D and bisphosphonate use in the previous month reduced the hazard ratio (HR = 0.45, 95% CI: 0.33, 0.63). Results derived from MSMs (HR = 0.44, 95% CI: 0.32, 0.61) and SNAFTMs (HR = 0.45, 95% CI: 0.34, 0.52) were similar. Utilizing MSMs and SNAFTMs to account for time-varying bisphosphonate use did not alter conclusions in this example.

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Association of frailty with mortality in older inpatients with Covid-19: a cohort study

Age and Ageing ◽

10.1093/ageing/afaa184 ◽

2020 ◽

Vol 49 (6) ◽

pp. 915-922 ◽

Cited By ~ 7

Author(s):

Darren Aw ◽

Lauren Woodrow ◽

Giulia Ogliari ◽

Rowan Harwood

Keyword(s):

Cohort Study ◽

Mortality Risk ◽

Proportional Hazards ◽

Illness Severity ◽

Cox Proportional Hazards ◽

Acute Illness ◽

Clinical Frailty Scale ◽

Cox Proportional Hazards Models ◽

All Cause Mortality ◽

Older Inpatients

Abstract Background COVID-19 has disproportionately affected older people. Objective The objective of this paper to investigate whether frailty is associated with all-cause mortality in older hospital inpatients, with COVID-19. Design Cohort study. Setting Secondary care acute hospital. Participants Participants included are 677 consecutive inpatients aged 65 years and over. Methods Cox proportional hazards models were used to examine the association of frailty with mortality. Frailty was assessed at baseline, according to the Clinical Frailty Scale (CFS), where higher categories indicate worse frailty. Analyses were adjusted for age, sex, deprivation, ethnicity, previous admissions and acute illness severity. Results Six hundred and sixty-four patients were classified according to CFS. Two hundred and seventy-one died, during a mean follow-up of 34.3 days. Worse frailty at baseline was associated with increased mortality risk, even after full adjustment (P = 0.004). Patients with CFS 4 and CFS 5 had non-significant increased mortality risks, compared to those with CFS 1–3. Patients with CFS 6 had a 2.13-fold (95% CI 1.34–3.38) and those with CFS 7–9 had a 1.79-fold (95% CI 1.12–2.88) increased mortality risk, compared to those with CFS 1–3 (P = 0.001 and 0.016, respectively). Older age, male sex and acute illness severity were also associated with increased mortality risk. Conclusions Frailty is associated with all-cause mortality risk in older inpatients with COVID-19.

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Faster Transport Status and Mortality in Anuric Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Blood Purification ◽

10.1159/000433416 ◽

2015 ◽

Vol 40 (2) ◽

pp. 160-166 ◽

Cited By ~ 2

Author(s):

Liping Xiong ◽

Li Fan ◽

Qingdong Xu ◽

Qian Zhou ◽

Huiyan Li ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

All Cause Mortality ◽

History Of ◽

The Relationship

Background: There are limited data regarding the relationship between transport status and mortality in anuric continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: According to the dialysate to plasma creatinine ratio (D/P Cr), 292 anuric CAPD patients were stratified to faster (D/P Cr ≥0.65) and slower transport groups (D/P Cr <0.65). The Cox proportional hazards models were used to evaluate the association of transport status with mortality. Results: During a median follow-up of 22.1 months, 24% patients died, 61.4% of them due to cardiovascular disease (CVD). Anuric patients with faster transport were associated with an increased risk of all-cause mortality (HR (95% CI) = 2.16 (1.09-4.26)), but not cardiovascular mortality, after adjustment for confounders. Faster transporters with pre-existing CVD had a greater risk for death compared to those without any history of CVD. Conclusion: Faster transporters were independently associated with high all-cause mortality in anuric CAPD patients. This association was strengthened in patients with pre-existing CVD.

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Activity Fractionation Moderates the Relationship of Gait Speed With Alzheimer’s Disease Risk

Innovation in Aging ◽

10.1093/geroni/igab046.614 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 161-162

Author(s):

Yang An ◽

Jennifer Schrack ◽

Pei-Lun Kuo ◽

Amal Wanigatunga ◽

Eleanor Simonsick ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Gait Speed ◽

Proportional Hazards ◽

Disease Risk ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Models ◽

Relationship Of ◽

The Relationship

Abstract Older adults with slow gait have a modestly elevated risk of Alzheimer’s disease (AD). Whether strategies to maintain function, such as interlacing periods of activity and rest, modify this relationship is unknown. We analyzed 577 initially cognitively normal participants aged 50+(53%women,26%Black) who had baseline data on gait speed and fractionation via ActiHeart. Diagnoses of mild cognitive impairment (MCI)/AD were adjudicated during an average 7.3years follow-up. We examined gait speed, fractionation, and their interaction with MCI/AD risk using Cox proportional-hazards models, adjusted for demographics and APOE-e4. Each 0.2m/sec faster gait speed was associated with 24% lower risk of MCI/AD(p=0.04). Fractionation was not associated with MCI/AD risk(p>0.05). There was a significant gait*fractionation interaction(p=0.013). At high fractionation, gait was not predictive of MCI/AD. Slow gait speed is less predictive of future MCI/AD in individuals who fractionate their activity to maintain function, possibly indicating brain function that drives such compensatory strategy is still conserved.

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Abstract 58: Age-specific Exercise Capacity Threshold for All-cause Mortality Risk in Men

Circulation ◽

10.1161/circ.129.suppl_1.58 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Peter Kokkinos ◽

Jonathan Myers ◽

Charles Faselis ◽

Xuemei Sui ◽

Jiajia Zhang ◽

...

Keyword(s):

Exercise Capacity ◽

Clinical Assessment ◽

Mortality Risk ◽

Proportional Hazards ◽

Age Groups ◽

Cardiac Risk ◽

Cox Proportional Hazards ◽

Peak Exercise ◽

Cox Proportional Hazards Models ◽

All Cause Mortality

Introduction: Exercise capacity is inversely associated with mortality risk. However, there is no age-specific standardized exercise capacity threshold to guide clinical assessment of mortality risk. Hypothesis: We assessed the hypothesis that an age-specific standardized threshold can be defined based on maximal exercise capacity (METs) to assess mortality risk across age groups. Methods: Peak exercise capacity was assessed in 18,102 men (mean age: 58±11) at DC and Palo Alto CA VA Medical Centers. We stratified the cohort into four age-groups (<50; 50-59; 60-69; and ≥70 yrs of age). We applied Cox proportional hazards models with spline function of MET to define the MET level associated with no increase in mortality risk (hazard ratio (HR)=1.0). We formed five additional age-specific fitness categories based on METs achieved above and below this threshold (T1; n=3,705): T2=T1-2 METs (n=4,884); T3; T1->2 METs (n=1,692); T4=T1+2 METs (n=4,646); T5=T1+2-4 METs (n=1,874) and T6=T1+>4 METs (n=1,301). Results: The MET thresholds for the aforementioned age groups were identified as 8; 7; 6; and 5 METs, respectively. There were 5,103 deaths (median follow-up=10.8 yrs; 208,108 person-yrs). Cox proportional hazards analysis adjusted for age, cardiac risk factors, medications and muscle-wasting disease revealed 19% (HR=1.19; CI: 1.10-1.28) and 46% (HR=1.46; CI:1.33-1.60) higher all-cause mortality risk for those with exercise capacity 2 and >4 METs below the threshold, respectively. For those with an exercise capacity 2; 4 and >4 METs above the threshold, mortality risk was lower by 27% (HR= 0.73; CI:0.66-0.79), 35% (HR= 0.65; CI: 0.58-0.74), and 48% (HR=0.52; CI:0.45-0.62), respectively (p<0.001 for all comparisons). The trends for mortality risk were similar for each age category (Table). Conclusions: We identified an age-specific MET threshold for fitness-related clinical assessment of mortality risk in men.

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High School Quality and 56-Year All-Cause Mortality Risk Across Race and Ethnicity

Innovation in Aging ◽

10.1093/geroni/igaa057.1632 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 505-506

Author(s):

Dominika Seblova ◽

Kelly Peters ◽

Susan Lapham ◽

Laura Zahodne ◽

Tara Gruenewald ◽

...

Keyword(s):

High School ◽

Mortality Risk ◽

Race And Ethnicity ◽

Proportional Hazards ◽

School Quality ◽

Cox Proportional Hazards ◽

School Level ◽

Lower Mortality ◽

All Cause Mortality ◽

Race Ethnicity

Abstract Having more years of education is independently associated with lower mortality, but it is unclear whether other attributes of schooling matter. We examined the association of high school quality and all-cause mortality across race/ethnicity. In 1960, about 5% of US high schools participated in Project Talent (PT), which collected information about students and their schools. Over 21,000 PT respondents were followed for mortality into their eighth decade of life using the National Death Index. A school quality factor, capturing term length, class size, and teacher qualifications, was used as the main predictor. First, we estimated overall and sex-stratified Cox proportional hazards models with standard errors clustered at the school level, adjusting for age, sex, composite measure of parental socioeconomic status, and 1960 cognitive ability. Second, we added an interaction between school quality and race/ethnicity. Among this diverse cohort (60% non-Hispanic Whites, 23% non-Hispanic Blacks, 7% Hispanics, 10% classified as another race/s) there were 3,476 deaths (16.5%). School quality was highest for Hispanic respondents and lowest for non-Hispanic Blacks. Non-Hispanic Blacks also had the highest mortality risk. In the whole sample, school quality was not associated with mortality risk. However, higher school quality was associated with lower mortality among those classified as another race/s (HR 0.75, 95% CI: 0.56-0.99). For non-Hispanic Blacks and Whites, the HR point estimates were unreliable, but suggest that higher school quality is associated with increased mortality. Future work will disentangle these differences in association of school quality across race/ethnicity and examine cause-specific mortality.

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Dietary Omega-3 Fatty Acid Intake and Mortality in CKD Population: A 1999–2014 NHANES Analysis

American Journal of Nephrology ◽

10.1159/000520027 ◽

2021 ◽

pp. 1-10

Author(s):

Wei-Lan Li ◽

Nan-Hui Zhang ◽

Shu-Wang Ge ◽

Gang Xu

Keyword(s):

Cardiovascular Disease ◽

Fatty Acid ◽

Proportional Hazards ◽

Early Death ◽

Cox Proportional Hazards ◽

Omega 3 ◽

Pufa Intake ◽

Dietary Recall ◽

Cox Proportional Hazards Models ◽

All Cause Mortality

Introduction: High risk of early death, especially contributed to cardiovascular disease, exists in patients who have chronic kidney disease (CKD). And the burden of cardiovascular disease is able to be lightened by an increase in omega-3 polyunsaturated fatty acid (omega-3 PUFA). A diet high in omega-3 PUFA in the general population is protective, although it is inconclusive about its beneficial role in the CKD population. Methods: From the 1999 to 2014 National Health and Nutrition Examination Surveys (NHANES), we can collect 2,990 participants who suffered from CKD, who were classified into 4 groups: <0.86, 0.87–1.30, 1.31–1.92, and 1.93–9.65 g/day based on NHANES 24-h dietary recall questionnaire dietary omega-3 PUFA. Moreover, their mortality details were available to be obtained by linking NHANES to the National Death Index. The associations between dietary omega-3 PUFA and mortality were evaluated by constructing multivariable Cox proportional hazards models. Results: Over 8 years of a median follow-up, 864 deaths were recorded. The adjusted hazard ratios (95% confidence interval) for all-cause mortality of the diseased people with CKD in the 2nd (0.87–1.30 g/day), 3rd (0.87–1.30 g/day), and 4th (1.93–9.65 g/day) quartiles of dietary omega-3 PUFA were 0.94 (0.72, 1.23), 0.74 (0.54, 1.02), and 0.67 (0.48, 0.93), respectively, versus those with the lowest quartile of dietary omega-3 PUFA intake (<0.86 g/day) (p for trend = 0.011). Conclusion: There may be a inverse relation of dietary omega-3 PUFA intake and all-cause mortality in patients with CKD. Therefore, an increase of dietary omega-3 PUFA may be encouraged to be used clinically in patients with CKD.

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Association of circulating tumor cells (CTC) with survival outcomes in patients (pts) with metastatic castration-sensitive prostate cancer (mCSPC) in a real-world cohort.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.6_suppl.59 ◽

2021 ◽

Vol 39 (6_suppl) ◽

pp. 59-59

Author(s):

Umang Swami ◽

Taylor Ryan McFarland ◽

Benjamin Haaland ◽

Adam Kessel ◽

Roberto Nussenzveig ◽

...

Keyword(s):

Real World ◽

Proportional Hazards ◽

De Novo ◽

Progression Free Survival ◽

Cox Proportional Hazards ◽

Eligibility Criteria ◽

Free Survival ◽

Cox Proportional Hazards Models ◽

Risk Of Progression ◽

The Relationship

59 Background: In mCSPC, baseline CTC counts have been shown to correlate with PSA responses and progression free survival (PFS) in small studies in the context of androgen deprivation therapy (ADT) without modern intensification with docetaxel or novel hormonal therapy. Similar correlation of CTC count with PSA responses and PFS was recently reported from an ongoing phase 3 trial in mCSPC setting (SWOG1216) without reporting the association in the context of ADT intensification. Furthermore, none of these studies correlated CTCs with overall survival (OS). Herein we evaluated whether CTCs were associated with outcomes including OS in a real world mCPSC population treated with intensified as well as non-intensified ADT. Methods: Eligibility criteria: new mCSPC receiving ADT with or without intensification and enumeration of baseline CTCs by FDA cleared Cell Search CTC assay. The relationship between CTC counts (categorized as: 0, 1-4, and ≥5/7.5 ml) and both PFS and OS was assessed in the context of Cox proportional hazards models, both unadjusted and adjusted for age, Gleason, PSA at ADT initiation, de novo vs. non-de novo status, and ADT intensification vs. non-intensification therapy. Results: Overall 99 pts were identified. Baseline characteristics are summarized in Table. In unadjusted analyses, CTC counts of ≥5 as compared to 0 were strongly associated with inferior PFS (hazard ratio [HR] 3.38, 95% CI 1.85-6.18; p < 0.001) and OS (HR 4.44 95% CI 1.63-12.10; p = 0.004). In multivariate analyses, CTC counts of ≥5 as compared to 0 continued to be associated with inferior PFS (HR 5.49, 95% CI 2.64-11.43; p < 0.001) and OS (HR 4.00, 95% CI 1.31-12.23; p = 0.015). Within the ADT intensification subgroup also, high CTC counts were associated with poor PFS and OS. For PFS, the univariate HR for CTC ≥5 vs. 0 was 4.87 (95% CI 1.66-14.30; p = 0.004) and multivariate HR for CTC ≥5 vs. 0 was 7.43 (95% CI 1.92-28.82; p = 0.004). For OS, the univariate HR for CTC ≥5 vs. 0 was 15.88 (95% CI 1.93-130.58; p = 0.010) and multivariate HR for CTC ≥5 vs. 0 was 24.86 (95% CI 2.03-304.45; p = 0.012). Conclusions: To best of our knowledge this is the first study to show that high baseline CTC counts are strongly associated with inferior PFS as well as OS in pts with newly diagnosed mCSPC, even in those who received intensified ADT therapy. Identifying these pts at highest risk of progression and death can help with counselling and prognostication in clinics as well as design and enrollment in future clinical trials. [Table: see text]

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Triiodothyronine (T3), inflammation and mortality risk in patients with acute myocardial infarction

European Thyroid Journal ◽

10.1530/etj-21-0085 ◽

2022 ◽

Author(s):

Salman Razvi ◽

Avais Jabbar ◽

Arjola Bano ◽

Lorna Ingoe ◽

Peter Carey ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Confidence Interval ◽

Mortality Risk ◽

Fold Increase ◽

Lower Serum ◽

Reactive Protein ◽

All Cause Mortality ◽

Relationship Of ◽

The Relationship

Objectives: To study the relationship between serum free T3 (FT3), C-reactive protein (CRP), and all-cause mortality in patients with acute myocardial infarction (AMI). Design: Prospective multicentre longitudinal cohort study. Methods: Between December 2014 and December 2016, thyroid function and CRP were analysed in AMI (both ST- and non-ST-elevation) patients from the ThyrAMI-1 study. The relationship of FT3 and CRP at baseline with all-cause mortality up to June 2020 was assessed. Mediation analysis was performed to evaluate if CRP mediated the relationship between FT3 and mortality. Results: In 1919 AMI patients [29.2% women, mean (SD) age 64.2 (12.1) years and 48.7% STEMI] followed over a median (inter-quartile range) period of 51 (46 to 58) months, there were 277 (14.4%) deaths. Overall, lower serum FT3 and higher CRP levels were associated with higher risk of mortality. When divided into tertiles based on levels of FT3 and CRP, the group with the lowest FT3 and highest CRP levels had 2.5-fold increase in mortality risk [adjusted hazard ratio (95% confidence interval) of 2.48 (1.82 to 3.16)] compared to the group with the highest FT3 and lowest CRP values. CRP mediated 9.8% (95% confidence interval 6.1 to 15.0%) of the relationship between FT3 and mortality. Conclusions: In AMI patients, lower serum FT3 levels on admission are associated with a higher mortality risk, which is partly mediated by inflammation. Adequately designed trials to explore potential benefits of T3 in AMI patients are required.

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AUTOMATED MEASUREMENT OF MUSCLE DENSITY ON COMPUTED TOMOGRAPHY (CT) PREDICTS ALL-CAUSE MORTALITY IN OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.3234 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S883-S883

Author(s):

Leon Lenchik ◽

Ryan Barnard ◽

Robert D Boutin ◽

Stephen B Kritchevsky ◽

Ashley A Weaver ◽

...

Keyword(s):

Proportional Hazards ◽

Learning Algorithm ◽

Cox Proportional Hazards ◽

Muscle Density ◽

National Lung Screening Trial ◽

Cox Proportional Hazards Models ◽

All Cause Mortality ◽

Automated Machine Learning ◽

Lung Screening ◽

Paraspinous Muscle

Abstract The purpose was to examine the association of paraspinous muscle density (CT surrogate of myosteatosis) with all-cause mortality in 6803 men and 4558 women, age 60-69 years (mean age 63.6) in the National Lung Screening Trial. Our fully-automated machine learning algorithm: 1) selected the appropriate CT series, 2) chose a single CT image at the level of T12 vertebra, 3) segmented the left paraspinous muscle, and 4) recorded the muscle density in Hounsfield Units (HU). Association between baseline muscle density and all-cause mortality was determined using Cox proportional hazards models, adjusted for age, race, body mass index, pack years of smoking, and presence of diabetes, lung disease, cardiovascular disease, and cancer at enrollment. After a mean 6.44 ± 1.06 years of follow-up, 635 (9.33%) men and 265 (5.81%) women died. In men, lower muscle density on baseline CT examinations was associated with increased all-cause mortality (HR per SD = 0.90; CI = 0.83, 0.99; p=0.03). Each standard deviation (7.8 HU) decrease in muscle density was associated with a 10% increase in mortality. In women, the association did not reach significance.

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