scholarly journals Factors associated with fatal stroke in glioma patients: a population analysis

2021 ◽  
Author(s):  
Kai Jin ◽  
Paul M Brennan ◽  
Michael TC Poon ◽  
Cathie LM Sudlow ◽  
Jonine D Figueroa
Keyword(s):  
Cancer Treatment ◽  
Brain Tumour ◽  
Cox Regression ◽  
Tumour Size ◽  
Malignant Gliomas ◽  
Tumour Response ◽  
Stroke Mortality ◽  
Factors Associated ◽  
Fatal Stroke ◽  
Increased Risk

AbstractImportanceBrain tumour patients have the highest stroke mortality rates among all cancer types, but the factors associated with fatal stroke in brain tumour remain unknown.ObjectiveWe aimed to examine to what extent brain tumour grade, a marker of biological aggressiveness, tumour size and cancer treatment each associated with stroke mortality in glioma. Gliomas include the most common malignant types of brain cancer.Design, setting, participantsA retrospective, observational cohort study using the US National Cancer Institute’s Surveillance Epidemiology and End Results program. We identified adult patients with a primary diagnosis of malignant gliomas in 2000 to 2018 (N=72,252). The primary outcome of interest was death from cerebrovascular disease. Adjusted hazard ratio (aHR) and 95% confidence interval (CI) were calculated using cause-specific Cox regression model to determine associations with tumour characteristics: grades II-IV, tumour size and cancer treatment (surgery, radiotherapy, chemotherapy) associated with stroke mortality after adjustment for age, sex, race, marital status and calendar years.ResultsIn patients with glioma, increased risk for stroke mortality was observed in patients with higher grade (Grade III: aHR=1.19, 95% CI=0.88-1.61, p>0.05; Grade IV: aHR=1.94, 95% CI=1.39-2.71 compared to Grade II, p<0.001), and those with larger brain tumours (size=3-6 cm: aHR=1.93, 95%CI 1.31 -2.85, p<0.001, size>9cm: aHR=2.07, 95% CI=1.40-3.06, p<0.001 compared to size < 3cm). Having treatment was associated with decreased risk: surgery (yes VS no: aHR= 0.65; p<0.01), radiation (yes VS no: aHR= 0.66, p<0.01), chemotherapy (yes VS no: aHR=0.49, p<0.001).ConclusionsHigher grade and tumour size are strongly associated with increased stroke mortality. This implicates tumour biology and/or the systemic tumour response which require further investigation in prospective studies to determine strategies to mitigate this risk.

scholarly journals Elevated Cancer-Specific Mortality Among HIV-Infected Patients in the United States

2015 ◽  
Vol 33 (21) ◽  
pp. 2376-2383 ◽  
Author(s):  
Anna E. Coghill ◽  
Meredith S. Shiels ◽  
Gita Suneja ◽  
Eric A. Engels
Keyword(s):  
Cancer Treatment ◽  
Cox Regression ◽  
B Cell Lymphoma ◽  
The United States ◽  
Cancer Stage ◽  
Infected People ◽  
Patients With Cancer ◽  
Increased Risk ◽  
Specific Mortality ◽  
Cancer Specific Mortality

Purpose Despite advances in the treatment of HIV, HIV-infected people remain at increased risk for many cancers, and the number of non–AIDS-defining cancers is increasing with the aging of the HIV-infected population. No prior study has comprehensively evaluated the effect of HIV on cancer-specific mortality. Patients and Methods We identified cases of 14 common cancers occurring from 1996 to 2010 in six US states participating in a linkage of cancer and HIV/AIDS registries. We used Cox regression to examine the association between patient HIV status and death resulting from the presenting cancer (ascertained from death certificates), adjusting for age, sex, race/ethnicity, year of cancer diagnosis, and cancer stage. We included 1,816,461 patients with cancer, 6,459 (0.36%) of whom were HIV infected. Results Cancer-specific mortality was significantly elevated in HIV-infected compared with HIV-uninfected patients for many cancers: colorectum (adjusted hazard ratio [HR], 1.49; 95% CI, 1.21 to 1.84), pancreas (HR, 1.71; 95% CI, 1.35 to 2.18), larynx (HR, 1.62; 95% CI, 1.06 to 2.47), lung (HR, 1.28; 95% CI, 1.17 to 1.39), melanoma (HR, 1.72; 95% CI, 1.09 to 2.70), breast (HR, 2.61; 95% CI, 2.06 to 3.31), and prostate (HR, 1.57; 95% CI, 1.02 to 2.41). HIV was not associated with increased cancer-specific mortality for anal cancer, Hodgkin lymphoma, or diffuse large B-cell lymphoma. After further adjustment for cancer treatment, HIV remained associated with elevated cancer-specific mortality for common non–AIDS-defining cancers: colorectum (HR, 1.40; 95% CI, 1.09 to 1.80), lung (HR, 1.28; 95% CI, 1.14 to 1.44), melanoma (HR, 1.93; 95% CI, 1.14 to 3.27), and breast (HR, 2.64; 95% CI, 1.86 to 3.73). Conclusion HIV-infected patients with cancer experienced higher cancer-specific mortality than HIV-uninfected patients, independent of cancer stage or receipt of cancer treatment. The elevation in cancer-specific mortality among HIV-infected patients may be attributable to unmeasured stage or treatment differences as well as a direct relationship between immunosuppression and tumor progression.

scholarly journals Abandoning resectional intent in patients initially deemed suitable for esophagectomy: a nationwide study of risk factors and outcomes

2020 ◽  
Author(s):  
David Edholm ◽  
Mats Lindblad ◽  
Gustav Linder
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Advanced Disease ◽  
Gastroesophageal Junction ◽  
Neoadjuvant Treatment ◽  
Multivariable Logistic Regression Analysis ◽  
Factors Associated ◽  
Gastroesophageal Junction Cancer ◽  
Increased Risk ◽  
Impact On Survival

Summary The main curative treatment modality for esophageal cancer is resection. Patients initially deemed suitable for resection may become unsuitable, most commonly due to signs of generalized disease or having become unfit for surgery. The aim was to assess risk factors for abandoning esophagectomy and its impact on survival. All patients diagnosed with an esophageal or gastroesophageal junction cancer in the Swedish National Register for Esophageal and Gastric Cancer from 2006–2016 were included and risk factors associated with becoming ineligible for resection were analyzed in multivariable logistic regression analysis. Overall survival was explored by multivariable Cox regression models. Among 1,792 patients planned for resection, 189 (11%) became unsuitable for resection before surgery and 114 (6%) had exploratory surgery without resection. Intermediate and high educational levels were associated with an increased probability of resection (odds ratio (OR) 1.46, 95% CI 1.05–2.05, OR 1.92, 95% CI 1.28–2.87, respectively) as was marital status (married: OR 1.37, 95% CI 1.01–1.85). Clinically advanced disease (cT4: OR 0.38, 95% CI 0.16–0.87; cN3: OR 0.27, 95% CI 0.09–0.81) and neoadjuvant treatment were associated with a decreased probability of resection (OR 0.62, 95% CI 0.46–0.88). Five-year survival for non-resected patients was only 4.5% although neoadjuvant treatment was associated with improved survival (HR 0.75, 95% CI 0.56–0.99). Non-resected patients with squamous cell carcinoma had comparatively reduced survival (HR 1.64, 95% CI 1.10–2.43). High socioeconomic status was associated with an increased probability of completing the plan to resect whereas clinically advanced disease and neoadjuvant treatment were independent factors associated with increased risk of abandoning resectional intent.

Exposure To ABO Compatible But Non-Group Identical Blood and In-Hospital Mortality

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3651-3651
Author(s):  
Richard J Cook ◽  
Nancy Heddle ◽  
Ker-Ai Lee ◽  
Yang Liu ◽  
Rebecca Barty, MLT ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Research Funding ◽  
Cox Regression ◽  
Type A ◽  
Blood Type ◽  
Hospital Death ◽  
Trauma Patients ◽  
Factors Associated ◽  
Blood Types ◽  
Increased Risk

Abstract Background Transfusions that are ABO compatible but not group identical (mismatched) are given for a variety of reasons including inventory availability, avoiding wastage from outdating, and clinical urgency. A recent observation at our centre suggested that patient outcome was different for those patients that received a transfusion of units with a compatible but mismatched ABO group compared to those receiving ABO group identical blood. Hence, we performed a retrospective hospital registry study to explore the association between mismatched blood and in-hospital mortality in transfused patients. Study Design Our patient/blood utilization database included 35,487 transfused hospitalized patients from 3 acute care academic centres from April 1, 2002 to October 31, 2011. Information on transfused RBCs included duration of storage (days) and ABO type. Patient data included: sex; age; hemoglobin; creatinine; diagnosis; interventions; ABO blood group and hospital discharge status. Factors associated with mismatched blood and in-hospital mortality were examined using generalized estimating equations to account for the potential serial dependence over multiple transfusions. The effect of exposure to ABO mismatched blood on in-hospital death was examined through Cox regression with time-dependent strata defined by: year of first admission; disease group; and the cumulative number of units transfused (≤ 7 days of storage; > 7 days but ≤ 28 days storage; and, >28 days of storage); and, controlling for available baseline and time-varying characteristics. Results 18,843 patients (blood groups A, B and AB), with complete covariates contributed to the analysis. Factors associated with transfusion of mismatched blood included: younger patient age (p<0.0001); lower hemoglobin (p<0.0001); higher creatinine (p<0.0001); intervention during hospitalization (OR=4.6, p<0.0001); and, patient ABO group whereby blood types A and B were much less likely to receive a mismatched unit compared to type AB patients (p<0.0001). There was a statistically significant interaction between patient blood type and the effect of receiving mismatched blood (p=0.034) with type A patients incurring a 79% higher risk of death (RR=1.79, 95% CI: 1.20, 2.67; p=0.0047); other patient blood types did not suggest increased risk. Similar results were observed when suspected trauma patients (≥ 6 units within 24 hours) were excluded from the analysis (Table 1). Conclusion Controlling for known potential confounders through Cox regression yielded evidence of increased risk of in-hospital mortality among blood type A patients receiving group O red cells. This association remained after suspected trauma patients were excluded from the analyses. Further study of the association observed in this study is warranted. Disclosures: Cook: CIHR: Research Funding. Heddle:CIHR: Research Funding; Canadian Blood Services: Membership on an entity’s Board of Directors or advisory committees, Research Funding; Health Canada: Research Funding. Eikelboom:CIHR: Research Funding.

scholarly journals Acquired infection during neonatal and pediatric extracorporeal membrane oxygenation

Perfusion ◽  
2018 ◽  
Vol 33 (6) ◽  
pp. 472-482 ◽  
Author(s):  
Katherine Cashen ◽  
Ron Reeder ◽  
Heidi J. Dalton ◽  
Robert A. Berg ◽  
Thomas P. Shanley ◽  
...  
Keyword(s):  
Viral Infections ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Secondary Analysis ◽  
Hazard Ratio ◽  
Research Network ◽  
Factors Associated ◽  
Increased Risk ◽  
Neonatal Icu ◽  
Pediatric Icu

Introduction: Our objectives are to (1) describe the pathogens, site, timing and risk factors for acquired infection during neonatal and pediatric ECMO and (2) explore the association between acquired infection and mortality. Methods: Secondary analysis of prospective data collected by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014. Clinical factors associated with acquired infection were assessed with multivariable Cox regression. Factors associated with mortality were assessed with logistic regression. Results: Of 481 patients, 247 (51.3%) were neonates and 400 (83.2%) received venoarterial ECMO. Eighty (16.6%) patients acquired one or more infections during ECMO; 60 (12.5%) patients had bacterial, 21 (4.4%) had fungal and 11 (2.3%) had viral infections. The site of infection included respiratory for 53 (11.0%) patients, bloodstream for 21 (4.4%), urine for 20 (4.2%) and other for 7 (1.5%). Candida species were most common. Median time to infection was 5.2 days (IQR 2.3, 9.6). On multivariable analysis, a greater number of procedures for ECMO cannula placement was independently associated with increased risk of acquired infection during ECMO (Hazard Ratio 2.13 (95% CI 1.22, 3.72), p<0.01) and receiving ECMO in a neonatal ICU compared to a pediatric or cardiac ICU was associated with decreased risk (Hazard Ratio pediatric ICU 4.25 (95% CI 2.20, 8.20), cardiac ICU 2.91 (95% CI 1.48, 5.71), neonatal ICU as reference, p<0.001). Acquired infection was not independently associated with mortality. Conclusion: ECMO procedures and location may contribute to acquired infection risk; however, acquired infection did not predict mortality in this study.

scholarly journals Incidence of hypothyroidism after treatment for breast cancer—a Danish matched cohort study

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Anne Mette Falstie-Jensen ◽  
Buket Ö. Esen ◽  
Anders Kjærsgaard ◽  
Ebbe L. Lorenzen ◽  
Jeanette D. Jensen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Cancer Treatment ◽  
Cumulative Incidence ◽  
Breast Cancer Survivors ◽  
Cox Regression ◽  
Metastatic Breast ◽  
Incidence Rates ◽  
Diagnostic Codes ◽  
Increased Risk

Abstract Background Breast cancer survivors (BCS) may have increased risk of hypothyroidism, but risk according to treatment modality is unclear. We estimated the incidence of hypothyroidism in women with breast cancer, and according to cancer treatment. Methods Using nationwide registries, we identified all Danish women aged ≥ 35 years diagnosed with non-metastatic breast cancer (1996–2009). We matched up to five cancer-free women (controls) for each BCS. We excluded women with prevalent thyroid disease. Cancer treatment was chemotherapy with or without radiotherapy (RT) targeting the breast/chest wall only, or also the lymph nodes (RTn). We identified hypothyroidism using diagnostic codes, and/or levothyroxine prescriptions. We calculated the cumulative incidence, incidence rates (IR) per 1000 person-years, and used Cox regression to estimate hazard ratios (HR) and associated 95% confidence intervals (CIs) of hypothyroidism, adjusting for comorbidities. Results We included 44,574 BCS and 203,306 matched controls with 2,631,488 person-years of follow-up. BCS had a slightly higher incidence of hypothyroidism than controls [5-year cumulative incidence, 1.8% (95%CI = 1.7–1.9) and 1.6% (95%CI = 1.5–1.6), respectively]. The overall IR was 4.45 (95%CI = 4.25–4.67) and 3.81 (95%CI = 3.73–3.90), corresponding to an adjusted HR = 1.17 (95%CI = 1.11–1.24). BCS who received RTn with chemotherapy (HR = 1.74, 95%CI = 1.50–2.02) or without chemotherapy (HR = 1.31, 95%CI = 1.14–1.51) had an elevated risk of hypothyroidism compared with matched controls and compared with BCS who underwent surgery alone [HR = 1.71, 95%CI = 1.45–2.01 and HR = 1.36, 95%CI = 1.17–1.58, respectively]. Conclusions BCS have an excess risk of hypothyroidism compared with age-matched controls. BCS and those working in cancer survivorship settings ought to be aware that this risk is highest in women treated with radiation therapy to the lymph nodes and chemotherapy.

Primary Surgery vs Radiotherapy for Early Stage Oral Cavity Cancer

2017 ◽  
Vol 158 (4) ◽  
pp. 649-659 ◽  
Author(s):  
Mark A. Ellis ◽  
Evan M. Graboyes ◽  
Amy E. Wahlquist ◽  
David M. Neskey ◽  
John M. Kaczmar ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Oral Cavity ◽  
Cox Regression ◽  
Early Stage ◽  
Multivariable Analysis ◽  
Cox Regression Analysis ◽  
Factors Associated ◽  
Primary Surgery ◽  
Increased Risk ◽  
Low Volume

Objective The goal of this study is to determine the effect of primary surgery vs radiotherapy (RT) on overall survival (OS) in patients with early stage oral cavity squamous cell carcinoma (OCSCC). In addition, this study attempts to identify factors associated with receiving primary RT. Study Design Retrospective cohort study. Setting National Cancer Database (NCDB, 2004-2013). Subjects and Methods Reviewing the NCDB from 2004 to 2013, patients with early stage I to II OCSCC were identified. Kaplan-Meier estimates of survival, Cox regression analysis, and propensity score matching were used to examine differences in OS between primary surgery and primary RT. Multivariable logistic regression analysis was performed to identify factors associated with primary RT. Results Of the 20,779 patients included in the study, 95.4% (19,823 patients) underwent primary surgery and 4.6% (956 patients) underwent primary RT. After adjusting for covariates, primary RT was associated with an increased risk of mortality (adjusted hazard ratio [aHR], 1.97; 99% confidence interval [CI], 1.74-2.22). On multivariable analysis, factors associated with primary RT included age ≥70 years, black race, Medicaid or Medicare insurance, no insurance, oral cavity subsite other than tongue, clinical stage II disease, low-volume treatment facilities, and earlier treatment year. Conclusion Primary RT for early stage OCSCC is associated with increased mortality. Approximately 5% of patients receive primary RT; however, this percentage is decreasing. Patients at highest risk for receiving primary RT include those who are elderly, black, with public insurance, and treated at low-volume facilities.

Incident gonorrhoea and chlamydia among a prospective cohort of men who have sex with men in Kisumu, Kenya

2020 ◽  
Vol 96 (7) ◽  
pp. 521-527 ◽  
Author(s):  
Fredrick Otieno ◽  
George Ng'ety ◽  
Duncan Okall ◽  
Carolyne Aketch ◽  
Eve Obondi ◽  
...  
Keyword(s):  
Cox Regression ◽  
Sub Saharan Africa ◽  
Repeated Testing ◽  
Factors Associated ◽  
Increased Risk ◽  
High Incidence ◽  
Hiv Testing And Counselling ◽  
Sub Saharan ◽  
Sex With Men ◽  
Adjusted Model

ObjectiveSTIs disproportionately affect men who have sex with men (MSM) in sub-Saharan Africa. We identified factors associated with incident Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections among MSM in the Anza Mapema cohort study in Kisumu, Kenya.MethodsWe enrolled 711 MSM who underwent HIV testing and counselling, medical history and examination, and collection of demographic and behavioural information. They also provided urine and rectal swab specimens for CT and NG testing by qualitative PCR at baseline and at months 6 and 12. Separate multivariable Cox regression models identified factors associated with first incident urethral or rectal infection.ResultsAmong the 619 men aged 18–54 years included in this analysis, there were 83 first incident urethral CT/NG infections (14.4 cases per 100 person-years (PY)) and 40 first incident rectal infections (6.84 cases per 100 PY), and an overall incidence of 18.0 cases per 100 PY (95% CI 14.8 to 21.8). Most urethral (84%) and rectal (81%) infections were asymptomatic. In the adjusted model, the risk of first incident urethral CT/NG decreased by 4% for each 1-year increase in age and was 41% lower for men who reported their partner used condom at last sexual encounter. Men who were HIV-positive had a 68% less risk of urogenital CT/NG compared with those who were negative. Men who reported being usually receptive or versatile as compared with usually insertive had an 81% increased risk of incident urogenital CT/NG.ConclusionOur study demonstrated a high incidence of urethral CT/NG infection, with somewhat lower incidence of rectal CT/NG infection, despite repeated testing and treatment, highlighting the need for preventive interventions to decrease the burden of CT/NG among Kenyan MSM. Most infections were asymptomatic, and routine aetiological screening for STIs is recommended.

scholarly journals Patient survival and risk of death after prostate cancer treatment in the Brazilian Unified Health System

2017 ◽  
Vol 51 (0) ◽  
Author(s):  
Sonia Faria Mendes Braga ◽  
Mirian Carvalho de Souza ◽  
Raphael Romie de Oliveira ◽  
Eli Iola Gurgel Andrade ◽  
Francisco de Assis Acurcio ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Health System ◽  
Cancer Treatment ◽  
Clinical Staging ◽  
National Database ◽  
Patient Death ◽  
Factors Associated ◽  
Risk Of Death ◽  
Unified Health System ◽  
Increased Risk

ABSTRACT OBJECTIVE Analyze the probability of specific survival and factors associated with the risk of death of patients with prostate cancer who received outpatient cancer treatment in the Brazilian Unified Health System, Brazil. METHODS Retrospective cohort study using the National Database of Oncology, developed through the deterministic-probabilistic pairing of health information systems: outpatient (SIA), hospital (SIH) and mortality (SIM). The probability of overall and specific survival was estimated by the time elapsed between the date of the first ambulatory treatment, from 2002 to 2003, until the patient’s death or the end of the study. Fine and Gray’s model of competing-risks regression was adjusted according to the variables: age of diagnostic, region of residence, tumor clinical staging, type of outpatient cancer treatment and hospitalization in the assessment of factors associated with risk of patient death. RESULTS Of 16,280 patients studied, the average age was 70 years, approximately 25% died due to prostate cancer and 20% for other causes. The probability of overall survival was 0.50 (95%CI 0.49–0.52) and the specific was 0.70 (95%CI 0.69–0.71). The factors associated with the risk of patient death were: stage III (HR = 1.66; 95%CI 1.39–1.99) and stage IV (HR = 3.49; 95%CI 2.91–4.18), chemotherapy (HR = 2.34; 95%CI 1.76–3.11) and hospitalization (HR = 1.6; 95%CI 1.55–1.79). CONCLUSIONS The late diagnosis of the tumor, palliative treatments, and worse medical condition were factors related to the worst survival and increased risk of death from prostate cancer patients in Brazil.

scholarly journals Population-Based analysis for newly diagnosed hepatocellular carcinoma with brain metastases

2019 ◽  
Author(s):  
Jincheng Feng ◽  
Georgios Polychronidis ◽  
Ulrike Heger ◽  
Arianeb Mehrabi ◽  
Katrin Hoffmann
Keyword(s):  
Hepatocellular Carcinoma ◽  
Bone Metastasis ◽  
Brain Metastases ◽  
Cox Regression ◽  
Population Based ◽  
Rank Test ◽  
Newly Diagnosed ◽  
Cancer Specific Survival ◽  
Factors Associated ◽  
Increased Risk

Abstract Background: There is little population-based data on hepatocellular carcinoma (HCC) with brain metastases at initial diagnosis published. This study aimed to estimate incidence of brain metastases in initial metastatic HCC and its impact on prognosis. Methods: Newly diagnosed HCC cases from 2010 to 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were screened for the presence of brain metastases. Data were stratified by age and ethnicity. Multivariable logistic and Cox regression were used to identify factors associated with brain metastases and factors associated with overall survival (OS) and cancer-specific survival (CSS), respectively. Kaplan-Meier method and log-rank test were used for survival analysis. Results : 141 cases presenting with brain metastases were identified, accounting for 0.35% of all HCC cases and 2.37% of cases with metastatic HCC disease. The incidence rate was highest among cases with age 50-59 (2.74%), respectively. Ethnicity was not associated with the presence of brain metastases at the time of HCC diagnosis. However, African American patients presented significantly lower disease-specific survival (median time: 1month; interquartile range (IQR):0-3.0 months). Initial lung or bone metastasis was independently associated with an increased risk of the presence of brain metastases (odds ratio (OR) 12.62, 95%CI 8.40-18.97), but not associated with worse OS and CSS among brain metastases cases. Conclusions: The study shows population-based incidence and survival of brain metastases at diagnosis of HCC. Brain metastases are most prevalent in initial metastatic HCC patients with lung or bone metastasis. The results may contribute to consider screening of the brain among HCC with initial lung or bone metastasis.

scholarly journals Improving CHA2DS2-VASc stratification of non-fatal stroke and mortality risk using the Intermountain Mortality Risk Score among patients with atrial fibrillation

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000907 ◽  
Author(s):  
Kevin G Graves ◽  
Heidi T May ◽  
Kirk U Knowlton ◽  
Joseph B Muhlestein ◽  
Victoria Jacobs ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
Risk Score ◽  
Mortality Risk ◽  
Cox Regression ◽  
Complete Blood Count ◽  
Predictive Ability ◽  
Stroke Mortality ◽  
Fatal Stroke ◽  
Systemic Nature

BackgroundOral anticoagulation (OAC) therapy guidelines recommend using CHA2DS2-VASc to determine OAC need in atrial fibrillation (AF). A usable tool, CHA2DS2-VASc is challenged by its predictive ability. Applying components of the complete blood count and basic metabolic profile, the Intermountain Mortality Risk Score (IMRS) has been extensively validated. This study evaluated whether use of IMRS with CHA2DS2-VASc in patients with AF improves prediction.MethodsPatients with AF undergoing cardiac catheterisation (N=10 077) were followed for non-fatal stroke and mortality (mean 5.8±4.1 years, maximum 19 years). CHA2DS2-VASc and IMRS were calculated at baseline. IMRS categories were defined based on previously defined criteria. Cox regression was adjusted for demographic, clinical and treatment variables not included in IMRS or CHA2DS2-VASc.ResultsIn women (n=4122, mean age 71±12 years), the composite of non-fatal stroke/mortality was stratified (all p-trend <0.001) by CHA2DS2-VASc (1: 12.6%, 2: 22.8%, >2: 48.1%) and IMRS (low: 17.8%, moderate: 40.9%, high risk: 64.5%), as it was for men (n=5955, mean age 68±12 years) by CHA2DS2-VASc (<2: 15.7%, 2: 30.3%, >2: 51.8%) and IMRS (low: 19.0%, moderate: 42.0%, high risk: 65.9%). IMRS stratified stroke/mortality (all p-trend <0.001) in each CHA2DS2-VASc category.ConclusionsUsing IMRS jointly with CHA2DS2-VASc in patients with AF improved the prediction of stroke and mortality. For example, in patients at the OAC treatment threshold (CHA2DS2 -VASc = 2), IMRS provided ≈4-fold separation between low and high risk. IMRS provides an enhancing marker for risk in patients with AF that reflects the underlying systemic nature of this disease that may be considered in combination with the CHA2DS2-VASc score.

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