Aging metrics incorporating cognitive and physical function capture mortality risk: results from three prospective cohort studies

Abstract Background: The aims of this study were to: 1) describe the proportions of vulnerable persons identified by three existing aging metrics that incorporate cognitive and physical function; 2) examine the associations of the three metrics with mortality; and 3) develop and validate a new simple functional score for mortality prediction. Methods: The three aging metrics were the combined presence of cognitive impairment and physical frailty (CI-PF), the frailty index (FI), and the motoric cognitive risk syndrome (MCR). We operationalized them with data from two large cohort studies: the China Health and Retirement Longitudinal Study (CHARLS) and the US National Health and Nutrition Examination Survey (NHANES). Logistic regression models or Cox proportional hazard regression models, and receiver operating characteristic curves were used to examine the associations of the three metrics with mortality. A new functional score was developed and validated in the Rugao Ageing Study (RAS), an independent dataset. Results: In CHARLS, the proportions of vulnerable persons identified by CI-PF, FI, and MCR were 2.2%, 16.6%, and 19.6%, respectively. Each metric predicted mortality after adjustment for age and sex, with some variations in the strength of the associations (CI-PF, odds ratio (OR)=2.87, 95% confidence interval (CI)=1.74, 4.74; FI, OR=1.94, 95% CI=1.50, 2.50; MCR, OR=1.27, 95% CI=1.00, 1.62). CI-PF and FI had additional predictive utility beyond age and sex, as demonstrated by integrated discrimination improvement, and continuous net reclassification improvement (all P <0.001). These results were replicated in NHANES. Furthermore, we developed a new functional score by selecting six self-reported items from CI-PF and FI in CHARLS, and demonstrated that it predicted mortality risk. This functional score was further validated in RAS. To facilitate the quick screening of persons with deteriorations in cognitive and physical function, we introduced a publicly available online tool designed for this new functional score. Conclusions: Despite the inherent differences in the aging metrics incorporating cognitive and physical function, they consistently capture mortality risk. The findings support the incorporation of cognitive and physical function for risk stratification in both Chinese and US persons, but call for caution when applying them in specific study settings.

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Frailty trajectories in the oldest old: Is the level or the rate of change more predictive of mortality?

10.1101/2021.10.01.21264405 ◽

2021 ◽

Author(s):

Erwin Stolz ◽

Hannes Mayerl ◽

Emiel O. Hoogendijk

Keyword(s):

Older Adults ◽

Mortality Risk ◽

Oldest Old ◽

Frailty Index ◽

Mortality Prediction ◽

Rate Of Change ◽

Strong Increase ◽

Joint Models ◽

Improved Model ◽

The Impact

BACKGROUND: It is unclear whether frailty index (FI) change captures mortality risk better than and independently of the current FI level, i.e. whether a regular FI assessment among older adults provides additional insights for mortality risk stratification or not. METHODS: We used data from the LASA 75-PLUS-study, which monitored health among 508 older adults (75+) between 2016-2019 every 9 months. Joint models for longitudinal and time-to-event data were used to assess the impact of both current FI and within-person FI change during the last year on mortality risk. RESULTS: 20% of the participants died during 4.5 years of follow-up. Adding within-person FI change to the current FI model improved model fit and it showed that FI increases during the last year were associated with a strong increase in mortality risk. Consequently, the effect of the current FI decreased considerably and became statistically non-significant. CONCLUSIONS: The rate of FI change was more important than the current FI level for short-term mortality prediction among the oldest old, which highlights the benefits of regular frailty assessments.

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Comparing Charlson and Elixhauser comorbidity indices with different weightings to predict in-hospital mortality: an analysis of national inpatient data

BMC Health Services Research ◽

10.1186/s12913-020-05999-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Narayan Sharma ◽

René Schwendimann ◽

Olga Endrich ◽

Dietmar Ausserhofer ◽

Michael Simon

Keyword(s):

Hospital Mortality ◽

Patient Population ◽

Generalized Additive Models ◽

Routine Data ◽

Predictive Performance ◽

Population Based ◽

Mortality Prediction ◽

Additive Models ◽

General Hospitals ◽

Net Reclassification Improvement

Abstract Background Understanding how comorbidity measures contribute to patient mortality is essential both to describe patient health status and to adjust for risks and potential confounding. The Charlson and Elixhauser comorbidity indices are well-established for risk adjustment and mortality prediction. Still, a different set of comorbidity weights might improve the prediction of in-hospital mortality. The present study, therefore, aimed to derive a set of new Swiss Elixhauser comorbidity weightings, to validate and compare them against those of the Charlson and Elixhauser-based van Walraven weights in an adult in-patient population-based cohort of general hospitals. Methods Retrospective analysis was conducted with routine data of 102 Swiss general hospitals (2012–2017) for 6.09 million inpatient cases. To derive the Swiss weightings for the Elixhauser comorbidity index, we randomly halved the inpatient data and validated the results of part 1 alongside the established weighting systems in part 2, to predict in-hospital mortality. Charlson and van Walraven weights were applied to Charlson and Elixhauser comorbidity indices. Derivation and validation of weightings were conducted with generalized additive models adjusted for age, gender and hospital types. Results Overall, the Elixhauser indices, c-statistic with Swiss weights (0.867, 95% CI, 0.865–0.868) and van Walraven’s weights (0.863, 95% CI, 0.862–0.864) had substantial advantage over Charlson’s weights (0.850, 95% CI, 0.849–0.851) and in the derivation and validation groups. The net reclassification improvement of new Swiss weights improved the predictive performance by 1.6% on the Elixhauser-van Walraven and 4.9% on the Charlson weights. Conclusions All weightings confirmed previous results with the national dataset. The new Swiss weightings model improved slightly the prediction of in-hospital mortality in Swiss hospitals. The newly derive weights support patient population-based analysis of in-hospital mortality and seek country or specific cohort-based weightings.

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785 Reported Restful Sleep Predicting Emotional Distress: Does Exercise (and its modalities) moderate?

SLEEP ◽

10.1093/sleep/zsab072.782 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A305-A306

Author(s):

Jesse Moore ◽

Ellita Williams ◽

Collin Popp ◽

Anthony Briggs ◽

Judite Blanc ◽

...

Keyword(s):

Logistic Regression ◽

Aerobic Exercise ◽

Regression Models ◽

Regression Analyses ◽

Logistic Regression Models ◽

The Past ◽

Strengthening Exercise ◽

Waking Up ◽

The Relationship ◽

Age And Sex

Abstract Introduction Literature shows that exercise moderates the relationship between sleep and emotional distress (ED.) However, it is unclear whether different types of exercise, such as aerobic and strengthening, affect this relationship differently. We investigated the moderating role of two types of exercise (aerobic and strengthening) regarding the relationship between ED and sleep. Methods Our analysis was based on data from 2018 National Health Interview Survey (NHIS), a nationally representative study in which 2,814 participants provided all data. Participants were asked 1) “how many days they woke up feeling rested over the past week”, 2) the Kessler 6 scale to determine ED (a score >13 indicates ED), and 3) the average frequency of strengthening or aerobic exercise per week. Logistic regression analyses were performed to determine if the reported days of waking up rested predicted level of ED. We then investigated whether strengthening or aerobic exercise differentially moderated this relationship. Covariates such as age and sex were adjusted in the logistic regression models. Logistic regression analyses were performed to determine if subjective reporting of restful sleep predicted level of ED. We investigated whether strengthening exercise or aerobic exercise differentially moderated this relationship. Covariates such as age and sex were adjusted in the logistic regression models. Results On average, participants reported 4.41 restful nights of sleep (SD =2.41), 3.43 strengthening activities (SD = 3.19,) and 8.47 aerobic activities a week (SD=5.91.) We found a significant association between days over the past week reporting waking up feeling rested and ED outcome according to K6, Χ2(1) = -741, p= <.001. The odds ratio signified a decrease of 52% in ED scores for each unit of restful sleep (OR = .48, (95% CI = .33, .65) p=<.001.) In the logistic regression model with moderation, aerobic exercise had a significant moderation effect, Χ2(1) = .03, p=.04, but strengthening exercise did not. Conclusion We found that restful sleep predicted reduction in ED scores. Aerobic exercise moderated this relationship, while strengthening exercise did not. Further research should investigate the longitudinal effects of exercise type on the relationship between restful sleep and ED. Support (if any) NIH (K07AG052685, R01MD007716, K01HL135452, R01HL152453)

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Absolute mortality risk assessment of COVID-19 patients: the Khorshid COVID Cohort (KCC) study

BMC Medical Research Methodology ◽

10.1186/s12874-021-01340-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hamid Reza Marateb ◽

Maja von Cube ◽

Ramin Sami ◽

Shaghayegh Haghjooy Javanmard ◽

Marjan Mansourian ◽

...

Keyword(s):

Risk Assessment ◽

Hospital Admission ◽

Mortality Risk ◽

Regression Models ◽

Assessment Method ◽

Point Of View ◽

Statistical Point ◽

Hazard Regression ◽

Risk Assessment Method ◽

Discharge From Hospital

Abstract Background Already at hospital admission, clinicians require simple tools to identify hospitalized COVID-19 patients at high risk of mortality. Such tools can significantly improve resource allocation and patient management within hospitals. From the statistical point of view, extended time-to-event models are required to account for competing risks (discharge from hospital) and censoring so that active cases can also contribute to the analysis. Methods We used the hospital-based open Khorshid COVID Cohort (KCC) study with 630 COVID-19 patients from Isfahan, Iran. Competing risk methods are used to develop a death risk chart based on the following variables, which can simply be measured at hospital admission: sex, age, hypertension, oxygen saturation, and Charlson Comorbidity Index. The area under the receiver operator curve was used to assess accuracy concerning discrimination between patients discharged alive and dead. Results Cause-specific hazard regression models show that these baseline variables are associated with both death, and discharge hazards. The risk chart reflects the combined results of the two cause-specific hazard regression models. The proposed risk assessment method had a very good accuracy (AUC = 0.872 [CI 95%: 0.835–0.910]). Conclusions This study aims to improve and validate a personalized mortality risk calculator based on hospitalized COVID-19 patients. The risk assessment of patient mortality provides physicians with additional guidance for making tough decisions.

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Intake of Fish and Marine n-3 Polyunsaturated Fatty Acids and Risk of Cardiovascular Disease Mortality: A Meta-Analysis of Prospective Cohort Studies

Nutrients ◽

10.3390/nu13072342 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2342

Author(s):

Lan Jiang ◽

Jinyu Wang ◽

Ke Xiong ◽

Lei Xu ◽

Bo Zhang ◽

...

Keyword(s):

Cardiovascular Disease ◽

Fatty Acids ◽

Polyunsaturated Fatty Acids ◽

Cohort Studies ◽

Mortality Risk ◽

Prospective Cohort ◽

Meta Analysis ◽

Pufa Intake ◽

Prospective Cohort Studies ◽

Cvd Mortality

Previous epidemiological studies have investigated the association of fish and marine n-3 polyunsaturated fatty acids (n-3 PUFA) consumption with cardiovascular disease (CVD) mortality risk. However, the results were inconsistent. The purpose of this meta-analysis is to quantitatively evaluate the association between marine n-3 PUFA, fish and CVD mortality risk with prospective cohort studies. A systematic search was performed on PubMed, Web of Science, Embase and MEDLINE databases from the establishment of the database to May 2021. A total of 25 cohort studies were included with 2,027,512 participants and 103,734 CVD deaths. The results indicated that the fish consumption was inversely associated with the CVD mortality risk [relevant risk (RR) = 0.91; 95% confidence intervals (CI) 0.85−0.98]. The higher marine n-3 PUFA intake was associated with the reduced risk of CVD mortality (RR = 0.87; 95% CI: 0.85–0.89). Dose-response analysis suggested that the risk of CVD mortality was decreased by 4% with an increase of 20 g of fish intake (RR = 0.96; 95% CI: 0.94–0.99) or 80 milligrams of marine n-3 PUFA intake (RR = 0.96; 95% CI: 0.94–0.98) per day. The current work provides evidence that the intake of fish and marine n-3 PUFA are inversely associated with the risk of CVD mortality.

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Frailty Changes Predict Mortality in 4 Longitudinal Studies of Aging

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa266 ◽

2020 ◽

Author(s):

Erwin Stolz ◽

Emiel O Hoogendijk ◽

Hannes Mayerl ◽

Wolfgang Freidl

Keyword(s):

Mortality Risk ◽

Clinical Decision Making ◽

Frailty Index ◽

Credible Interval ◽

Clinical Decision ◽

Population Based ◽

Time To Event Data ◽

Longitudinal Aging Study Amsterdam ◽

Aging Study ◽

Longitudinal Aging Study

Abstract Background Baseline frailty index (FI) values have been shown to predict mortality among older adults, but little is known about the effects of changes in FI on mortality. Methods In a coordinated approach, we analyzed data from 4 population-based cohorts: the Health and Retirement Study (HRS), the Survey of Health, Ageing and Retirement in Europe (SHARE), the English Longitudinal Survey of Ageing (ELSA), and the Longitudinal Aging Study Amsterdam (LASA), comprising a total of 24 961 respondents (65+), 95 897 observations, up to 9 repeated FI assessments, and up to 23 years of mortality follow-up. The effect of time-varying FI on mortality was modeled with joint regression models for longitudinal and time-to-event data. Results Differences (of 0.01) in current FI levels (hazard ratio [HR] = 1.04, 95% credible interval [CI] = 1.03–1.05) and baseline FI levels (HR = 1.03, 95% CI = 1.03–1.05) were consistently associated with mortality across studies. Importantly, individuals with steeper FI growth also had a higher mortality risk: An increase in annual FI growth by 0.01 was associated with an increased mortality risk of HR = 1.56 (95% CI = 1.49–1.63) in HRS, HR = 1.24 (95% CI = 1.13–1.35) in SHARE, HR = 1.40 (95% CI = 1.25–1.52) in ELSA, and HR = 1.71 (95% CI = 1.46–2.01) in LASA. Conclusions FI changes predicted mortality independently of baseline FI differences. Repeated assessment of frailty and individual’s frailty trajectory could provide a means to anticipate further health deterioration and mortality and could thus support clinical decision making.

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Treatment Time or Convection Volume in HDF: What Drives the Reduced Mortality Risk?

Blood Purification ◽

10.1159/000430903 ◽

2015 ◽

Vol 40 (1) ◽

pp. 53-58 ◽

Cited By ~ 1

Author(s):

Camiel L.M. de Roij van Zuijdewijn ◽

Menso J. Nubé ◽

Piet M. ter Wee ◽

Peter J. Blankestijn ◽

Renée Lévesque ◽

...

Keyword(s):

Confidence Intervals ◽

Mortality Risk ◽

Survival Benefit ◽

Regression Models ◽

Cox Regression ◽

Treatment Time ◽

High Volume ◽

P Values ◽

Hazard Ratios

Background/Aims: Treatment time is associated with survival in hemodialysis (HD) patients and with convection volume in hemodiafiltration (HDF) patients. High-volume HDF is associated with improved survival. Therefore, we investigated whether this survival benefit is explained by treatment time. Methods: Participants were subdivided into four groups: HD and tertiles of convection volume in HDF. Three Cox regression models were fitted to calculate hazard ratios (HRs) for mortality of HDF subgroups versus HD: (1) crude, (2) adjusted for confounders, (3) model 2 plus mean treatment time. As the only difference between the latter models is treatment time, any change in HRs is due to this variable. Results: 114/700 analyzed individuals were treated with high-volume HDF. HRs of high-volume HDF are 0.61, 0.62 and 0.64 in the three models, respectively (p values <0.05). Confidence intervals of models 2 and 3 overlap. Conclusion: The survival benefit of high-volume HDF over HD is independent of treatment time.

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Advanced cognitive impairment among older nursing home residents

BMC Geriatrics ◽

10.1186/s12877-021-02336-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tadeja Gracner ◽

Patricia W. Stone ◽

Mansi Agarwal ◽

Mark Sorbero ◽

Susan L Mitchell ◽

...

Keyword(s):

Risk Factors ◽

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Nursing Home ◽

Cognitive Impairment ◽

Mortality Risk ◽

Advanced Disease ◽

Nursing Home Residents ◽

Functional Score ◽

Data Set

Abstract Background Though work has been done studying nursing home (NH) residents with either advanced Alzheimer’s disease (AD) or Alzheimer’s disease related dementia (ADRD), none have distinguished between them; even though their clinical features affecting survival are different. In this study, we compared mortality risk factors and survival between NH residents with advanced AD and those with advanced ADRD. Methods This is a retrospective observational study, in which we examined a sample of 34,493 U.S. NH residents aged 65 and over in the Minimum Data Set (2011–2013). Incident assessment of advanced disease was defined as the first MDS assessment with severe cognitive impairment (Cognitive Functional Score equals to 4) and diagnoses of AD or ADRD. Demographics, functional limitations, and comorbidities were evaluated as mortality risk factors using Cox models. Survival was characterized with Kaplan-Maier functions. Results Of those with advanced cognitive impairment, 35 % had AD and 65 % ADRD. At the incident assessment of advanced disease, those with AD had better health compared to those with ADRD. Mortality risk factors were similar between groups (shortness of breath, difficulties eating, substantial weight-loss, diabetes mellitus, heart failure, chronic obstructive pulmonary disease, and pneumonia; all p < 0.01). However, stroke and difficulty with transfer (for women) were significant mortality risk factors only for those with advanced AD. Urinary tract infection, and hypertension (for women) only were mortality risk factors for those with advanced ADRD. Median survival was significantly shorter for the advanced ADRD group (194 days) compared to the advanced AD group (300 days). Conclusions There were distinct mortality and survival patterns of NH residents with advanced AD and ADRD. This may help with care planning decisions regarding therapeutic and palliative care.

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Abstract P73: Comparison of Hospital-Acquired Anemia and TIMI Bleeding for Mortality Prediction in Patients with Acute Myocardial Infarction

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_2.ap73 ◽

2011 ◽

Vol 4 (suppl_2) ◽

Author(s):

Adam C Salisbury ◽

Amit P Amin ◽

Karen P Alexander ◽

Frederick A Masoudi ◽

Yan Li ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

At Risk ◽

Assessment Tool ◽

Mortality Prediction ◽

Logistic Regression Models ◽

Net Reclassification Improvement ◽

Risk Patients ◽

Poor Outcomes ◽

Hospital Acquired

Background: In-hospital bleeding and new onset, hospital acquired anemia (HAA) are both associated with higher mortality in acute myocardial infarction (AMI). Since bleeding is variably defined and often poorly documented, HAA could be a better method to identify at-risk patients, if its prognostic ability were at least as good as documented bleeding. We directly compared the association of HAA and TIMI bleeding with 1-year mortality. Methods: Among 2,803 AMI patients who were not anemic at admission in the 24-center TRIUMPH registry, the presence and severity of HAA and TIMI bleeding were prospectively collected to identify their relative discrimination of 1-year mortality. Logistic regression models, accounting for clustering using generalized estimating equations, were fit for 1) no bleeding, TIMI minimal, minor and major bleeding and 2) no HAA, mild (hemoglobin (Hgb) > 11 g/dl), moderate (Hgb 9 - 11 g/dl) and severe HAA (Hgb < 9 g/dl). Discrimination was compared using c-statistics and reclassification was assessed using the integrated discrimination improvement (IDI), which measures a model's improvement in average sensitivity without sacrificing average specificity vs. another model, and the continuous net reclassification improvement (NRI), to identify the proportion of patients correctly reclassified by the HAA model. Results: HAA was more common (mild: 33%, moderate: 10%, severe 2%) than TIMI bleeding (minimal: 5%, minor: 3%, major 1%). Over 1-year follow-up, 111 patients (4%) died. The HAA model was superior to TIMI bleeding model for 1-year mortality prediction (c-statistic 0.60 vs. 0.51, p<0.001). The IDI of the HAA vs. the bleeding model was 0.009 (95% CI 0.005 - 0.014) and the relative IDI was 0.26 (26% better average discrimination), with a NRI of 0.32 (0.13-0.50) - 17% of patients with events were correctly reclassified to a higher risk while 14% of patients without events were correctly reclassified to a lower risk by the HAA model. Conclusions: HAA is better than TIMI bleeding for identifying 1-year mortality after AMI hospitalization, and may better identify patients without recognized bleeding who are also at risk for poor outcomes. HAA may be useful to identify high-risk patients and as a quality assessment tool.

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MO398DETERIORATION OF RENAL OUTCOMES AND INCREASED MORTALITY RISK DUE TO ACUTE KIDNEY INJURY AFTER ORTHOTOPIC LIVER TRANSPLANTATION: SYSTEMATIC REVIEW AND META-ANALYSIS OF COHORT STUDIES

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab082.0052 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Boby Pratama Putra ◽

Felix Nugraha Putra

Keyword(s):

Liver Transplantation ◽

Acute Kidney Injury ◽

Cohort Studies ◽

Orthotopic Liver Transplantation ◽

Mortality Risk ◽

Random Effect ◽

Kidney Injury ◽

Cochrane Library ◽

Ckd Progression ◽

Renal Outcomes

Abstract Background and Aims Orthotopic liver transplantation (OLT) procedure is increased as incremental end-stage liver disease patients’ prevalence. Acute kidney injury (AKI) is one of most common post-OLT complications that is associated with poor renal outcomes and increased mortality risk although the results are still inconclusive. This study aims to measure the risk of deterioration of renal outcomes and mortality risk due to AKI incidence in post-OLT patients. Method We did comprehensive searching using predefined terms in online databases of Pubmed, EMBASE, ScienceDirect, and The Cochrane Library, to include all relevant studies from 2000-2020. We included all cohort studies that reported AKI incidence in post-OLT patients and accessed the risk of 3-month renal replacement therapy (RRT) need, 1-year chronic kidney disease (CKD) progression, and 1-year mortality rate. We used The Newcastle-Ottawa Scale for cohort study for accessing bias risk. We conducted analysis to pooled risk ratio (RR) with 95% confidence interval (CI) using random-effect heterogeneity test. Results We included 10 cohort studies met our inclusion criteria. The AKI incidence significantly both increases the need of RRT in post-OLT patients (pooled RR = 8.41. 95% CI = 2.82 to 25.09, p = 0.0001, I2 = 0%) then leads the CKD progression in one year (pooled RR = 6.76. 95% CI = 2.03 to 22.51, p = 0.002, I2 = 84%). The post-OLT patients who suffered from AKI has significant incremental 1-year mortality risk (pooled RR = 7.27. 95% CI = 4.34 to 12.18, p<0.00001, I2 = 5%). Conclusion The incidence of AKI in post-OLT patients significantly increase the deterioration of renal outcomes and mortality risks. However, further trials are needed to establish the causalities.

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