scholarly journals Delirium, frailty and mortality: interactions in a prospective study of hospitalized older people

2017 ◽  
Author(s):  
Melanie Dani ◽  
Lucy H Owen ◽  
Thomas A Jackson ◽  
Kenneth Rockwood ◽  
Elizabeth L Sampson ◽  
...  
Keyword(s):  
Cox Regression ◽  
Frailty Index ◽  
Bimodal Distribution ◽  
Mortality Rates ◽  
Acute Illness ◽  
Health States ◽  
Mortality Statistics ◽  
National Mortality ◽  
A Prospective Study ◽  
The Impact

AbstractBackgroundIt is unknown if the association between delirium and mortality is consistent for individuals across the whole range of health states. A bimodal relationship has been proposed, where delirium is particularly adverse for those with underlying frailty, but may have a smaller effect (perhaps even protective) if it is an early indicator of acute illness in fitter people. We investigated the impact of delirium on mortality in a cohort simultaneously evaluated for frailty.MethodsWe undertook an exploratory analysis of a cohort of consecutive acute medical admissions aged ≥70. Delirium on admission was ascertained by psychiatrists. A Frailty Index (FI) was derived according to a standard approach. Deaths were notified from linked national mortality statistics. Cox regression was used to estimate associations between delirium, frailty and their interactions on mortality.ResultsThe sample consisted of 710 individuals. Both delirium and frailty were independently associated with increased mortality rates (delirium: HR 2.4, 95%CI 1.8-3.3, p<0.01; frailty (per SD): HR 3.5, 95%CI 1.2-9.9, p=0.02). Estimating the effect of delirium in tertiles of FI, mortality was greatest in the lowest tertile: tertile 1 HR 3.4 (95%CI 2.1-5.6); tertile 2 HR 2.7 (95%CI 1.5-4.6); tertile 3 HR 1.9 (95% CI 1.2-3.0).ConclusionWhile delirium and frailty contribute to mortality, the overall impact of delirium on admission appears to be greater at lower levels of frailty. In contrast to the hypothesis that there is a bimodal distribution for mortality, delirium appears to be particularly adverse when precipitated in fitter individuals.

scholarly journals Mortality statistics in England and Wales: the SARS-CoV-2 paradox

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052093129 ◽  
Author(s):  
Gabrielle Harrison ◽  
Daniel Newport ◽  
Tim Robbins ◽  
Theodoros N. Arvanitis ◽  
Andrew Stein
Keyword(s):  
United Kingdom ◽  
Healthcare Utilisation ◽  
Mortality Rates ◽  
Mortality Statistics ◽  
Respiratory Mortality ◽  
The Past ◽  
The United Kingdom ◽  
National Mortality ◽  
Rebound Increase ◽  
The Impact

Objective To analyse mortality statistics in the United Kingdom during the initial phases of the severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic and to understand the impact of the pandemic on national mortality. Methods Retrospective review of weekly national mortality statistics in the United Kingdom over the past 5 years, including subgroup analysis of respiratory mortality rates. Results During the early phases of the SARS-CoV-2 pandemic in the first months of 2020, there were consistently fewer deaths per week compared with the preceding 5 years. This pattern was not observed at any other time within the past 5 years. We have termed this phenomenon the “SARS-CoV-2 paradox.” We postulate potential explanations for this seeming paradox and explore the implications of these data. Conclusions Paradoxically, but potentially importantly, lower rather than higher weekly mortality rates were observed during the early stages of the SARS-CoV-2 pandemic. This paradox may have implications for current and future healthcare utilisation. A rebound increase in non-SARS-CoV-2 mortality later this year might coincide with the peak of SARS-CoV-2 admissions and mortality.

scholarly journals Cohort Study of the Impact of Time to Antibiotic Administration on Mortality in Patients with Febrile Neutropenia

2014 ◽  
Vol 58 (7) ◽  
pp. 3799-3803 ◽  
Author(s):  
Regis G. Rosa ◽  
Luciano Z. Goldani
Keyword(s):  
Cohort Study ◽  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Cox Regression ◽  
Mortality Rates ◽  
Cox Proportional Hazards Model ◽  
Rank Test ◽  
Antibiotic Administration ◽  
Cox Regression Analysis ◽  
The Impact

ABSTRACTThe time to antibiotic administration (TTA) has been proposed as a quality-of-care measure in febrile neutropenia (FN); however, few data regarding the impact of the TTA on the mortality of adult cancer patients with FN are available. The objective of this study was to determine whether the TTA is a predictor of mortality in adult cancer patients with FN. A prospective cohort study of all consecutive cases of FN, evaluated from October 2009 to August 2011, at a single tertiary referral hospital in southern Brazil was performed. The TTA was assessed as a predictive factor for mortality within 28 days of FN onset using the Cox proportional hazards model. Kaplan-Meier curves were used for an assessment of the mortality rates according to different TTAs; the log-rank test was used for between-group comparisons. In total, 307 cases of FN (169 subjects) were evaluated. During the study period, there were 29 deaths. In a Cox regression analysis, the TTA was independently associated with mortality within 28 days (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.10 to 1.26); each increase of 1 h in the TTA raised the risk of mortality within 28 days by 18%. Patients with FN episodes with a TTA of ≤30 min had lower 28-day mortality rates than those with a TTA of between 31 min and 60 min (3.0% versus 18.1%; log-rankP= 0.0002). Early antibiotic administration was associated with higher survival rates in the context of FN. Efforts should be made to ensure that FN patients receive effective antibiotic therapy as soon as possible. A target of 30 min to the TTA should be adopted for cancer patients with FN.

scholarly journals Temporal Trends in Sepsis Incidence and Mortality in Patients With Cancer in the US Population

2021 ◽  
Vol 30 (4) ◽  
pp. e71-e79
Author(s):  
Michael A. Liu ◽  
Brianna R. Bakow ◽  
Tzu-Chun Hsu ◽  
Jia-Yu Chen ◽  
Ke-Ying Su ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Cox Regression ◽  
Temporal Trends ◽  
Mortality Rates ◽  
Hazard Ratio ◽  
Patients With Cancer ◽  
Incidence And Mortality ◽  
The Impact

Background Few population-based studies assess the impact of cancer on sepsis incidence and mortality. Objectives To evaluate epidemiological trends of sepsis in patients with cancer. Methods This retrospective cohort study included adults (≥20 years old) identified using sepsis-indicator International Classification of Diseases codes from the Nationwide Inpatient Sample database (2006-2014). A generalized linear model was used to trend incidence and mortality. Outcomes in patients with cancer and patients without cancer were compared using propensity score matching. Cox regression modeling was used to calculate hazard ratios for mortality rates. Results The study included 13 996 374 patients, 13.6% of whom had cancer. Gram-positive infections were most common, but the incidence of gram-negative infections increased at a greater rate. Compared with patients without cancer, those with cancer had significantly higher rates of lower respiratory tract (35.0% vs 31.6%), intra-abdominal (5.5% vs 4.6%), fungal (4.8% vs 2.9%), and anaerobic (1.2% vs 0.9%) infections. Sepsis incidence increased at a higher rate in patients with cancer than in those without cancer, but hospital mortality rates improved equally in both groups. After propensity score matching, hospital mortality was higher in patients with cancer than in those without cancer (hazard ratio, 1.25; 95% CI, 1.24-1.26). Of patients with sepsis and cancer, those with lung cancer had the lowest survival (hazard ratio, 1.65) compared with those with breast cancer, who had the highest survival. Conclusions Cancer patients are at high risk for sepsis and associated mortality. Research is needed to guide sepsis monitoring and prevention in patients with cancer.

Modifiable factors of 20-year blood pressure trajectories among normotensives and their associations with hypertension : a prospective study

2021 ◽  
pp. 1-11
Author(s):  
Xiaofan Zhang ◽  
Yifei Ouyang ◽  
Feifei Huang ◽  
Jiguo Zhang ◽  
Chang Su ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Influencing Factors ◽  
Regression Models ◽  
Cox Regression ◽  
Chinese Adults ◽  
Nutrition Survey ◽  
Health And Nutrition ◽  
Modifiable Factors ◽  
A Prospective Study ◽  
The Impact

Abstract Little is known about the impact of modifiable risk factors on blood pressure (BP) trajectories and their associations with hypertension (HTN). We aimed to identify BP trajectories in normotensive Chinese adults and explore their influencing factors and associations with HTN. We used data from 3436 adults with at least four BP measurements between 1989 and 2018 in the China Health and Nutrition Survey, an ongoing cohort study. We measured BP using mercury sphygmomanometers with appropriate cuff sizes in all surveys. We used group-based trajectory modelling to identify BP trajectories between 1989 and 2009 and multiple logistic and Cox regression models to analyse their influencing factors and associations with HTN in 2011–2018. We identified five systolic blood pressure (SBP) trajectories, ‘Low-increasing (LI)’, ‘Low–stable (LS)’, ‘Moderate-increasing (MI)’, ‘High-stable (HS)’ and ‘Moderate-decreasing (MD)’, and four diastolic blood pressure (DBP) trajectories classified as ‘Low-increasing (LI)’, ‘Moderate–stable (MS)’, ‘Low-stable (LS)’ and ‘High-increasing (HI)’. People with higher physical activity (PA) levels and lower waist circumferences (WC) were less likely to be in the SBP LI, MI, HS and MD groups (P < 0·05). People with higher fruit and vegetable intakes, lower WCs and salt intakes and higher PA levels were less likely to be in the DBP LI, MS and HI groups (P < 0·05). Participants in the SBP HS group (hazard ratio (HR) 2·01) or the DBP LI, MS and HI groups (HR 1·38, 1·40, 1·71, respectively) had higher risks of HTN (P < 0·05). This study suggests that BP monitoring is necessary to prevent HTN in the Chinese population.

scholarly journals Frailty and mortality: an 18-year follow-up study among Finnish community-dwelling older people

2019 ◽  
Vol 32 (10) ◽  
pp. 2013-2019 ◽  
Author(s):  
Marika Salminen ◽  
Anna Viljanen ◽  
Sini Eloranta ◽  
Paula Viikari ◽  
Maarit Wuorela ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Older People ◽  
Cox Regression ◽  
Frailty Index ◽  
Community Dwelling ◽  
Clinical Settings ◽  
Follow Up Study ◽  
Community Dwelling Older People ◽  
A Prospective Study

Abstract Background There is a lack of agreement about applicable instrument to screen frailty in clinical settings. Aims To analyze the association between frailty and mortality in Finnish community-dwelling older people. Methods This was a prospective study with 10- and 18-year follow-ups. Frailty was assessed using FRAIL scale (FS) (n = 1152), Rockwood’s frailty index (FI) (n = 1126), and PRISMA-7 (n = 1124). To analyze the association between frailty and mortality, Cox regression model was used. Results Prevalence of frailty varied from 2 to 24% based on the index used. In unadjusted models, frailty was associated with higher mortality according to FS (hazard ratio 7.96 [95% confidence interval 5.10–12.41] in 10-year follow-up, and 6.32 [4.17–9.57] in 18-year follow-up) and FI (5.97 [4.13–8.64], and 3.95 [3.16–4.94], respectively) in both follow-ups. Also being pre-frail was associated with higher mortality according to both indexes in both follow-ups (FS 2.19 [1.78–2.69], and 1.69 [1.46–1.96]; FI 1.81[1.25–2.62], and 1.31 [1.07–1.61], respectively). Associations persisted even after adjustments. Also according to PRISMA-7, a binary index (robust or frail), frailty was associated with higher mortality in 10- (4.41 [3.55–5.34]) and 18-year follow-ups (3.78 [3.19–4.49]). Discussion Frailty was associated with higher mortality risk according to all three frailty screening instrument used. Simple and fast frailty indexes, FS and PRISMA-7, seemed to be comparable with a multidimensional time-consuming FI in predicting mortality among community-dwelling Finnish older people. Conclusions FS and PRISMA-7 are applicable frailty screening instruments in clinical setting among community-dwelling Finnish older people.

Abstract 13613: Combination of Atrial Fibrillation and Frailty: Association With All-cause Mortality in Older Veterans

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Marlena Fernandez ◽  
Marie Pitteloud ◽  
Angelica Torres ◽  
Sergio Ruiz ◽  
Victor Cevallos ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cox Regression ◽  
Frailty Index ◽  
Community Dwelling ◽  
Sensory Loss ◽  
All Cause Mortality ◽  
Physiological Reserve ◽  
Icd Codes ◽  
The Impact

Background: Atrial fibrillation (AF), the commonest arrhythmia among older adults, is associated with increased mortality. Frailty constitutes a state of vulnerability to stressors resulting from multisystemic loss of physiological reserve. The study aim was to determine whether concurrent frailty and AF increases all-cause mortality in older Veterans. Methods: Retrospective cohort study of community-dwelling Veterans 60 years and older identified as having baseline AF (ICD codes) or frailty through a 30-item VA Frailty Index (VA-FI). The VA-FI was generated as a proportion of morbidity, function, sensory loss, cognition/mood and other variables. The VA-FI categorized Veterans into non-frail (robust FI≤.10, prefrail FI=>.10,<.21) and frail (FI≥.21). The combination resulted in 4 groups: Neither AF nor frailty (NoAF-F), atrial fibrillation (AF), frailty (F), and AF and frailty (AF-F). At the end of follow-up, data on mortality was aggregated and adjusted for age, gender, race, ethnicity, marital status, and BMI, the association of concurrent AF and/or frailty with all-cause mortality was determined using a Cox regression model including testing for interaction effects. Results: A total of 16391 Veterans were included, mean age 72.06 (SD=9.23) years 74.2% White, 86.7% non-Hispanic, and 97.9% male. There were 1534 (9.4%) Veterans with AF and the proportion of robust, pre-frail and frail patients was 44.3% (n=7255), 37.2% (n=6095) and 18.6% (n=3041) respectively. The 4 resulting groups were NoAF-F (12357, 75.4%), AF (993, 6.1%), F (2500, 15.3%) and AF-F (541, 3.3%). Over a median follow-up of 2025 days (IQR=245) 3917 deaths occurred. As compared with NoAF-F, AF-F, F and AF in that order had higher all-cause mortality, adjusted hazard ratio (HR)=3.24 (95%CI:2.88-3.66), p<.0005; HR=2.06 (95%CI:1.90-2.22), p<.0005; and HR=1.47 (95%CI:1.31-1.64), p<.0005 respectively. When frailty and AF were considered jointly they did not interact. Conclusions: The combination of AF and frailty at baseline represents the group with highest risk for all-cause mortality in older Veterans. Further studies may be needed to assess the impact on mortality of clinical interventions targeting both conditions.

Use of self-rated health to identify frailty and predict mortality in older adults with cancer. Results from the care study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12046-12046
Author(s):  
Mustafa Al Obaidi ◽  
Smith Giri ◽  
Nabiel Mir ◽  
Kelly Kenzik ◽  
Andrew Michael McDonald ◽  
...  
Keyword(s):  
Older Adults ◽  
Predictive Value ◽  
Cox Regression ◽  
Frailty Index ◽  
Measurement Information ◽  
Cancer Type ◽  
Cox Regression Analysis ◽  
Self Rated Health ◽  
Patient Reported ◽  
The Impact

12046 Background: Poor self-rated health (SRH) is a known predictor of mortality in the general adult population, but little is known about its use in older adults with cancer. The purpose of this study was to examine the association and ability of SRH to identify frail older adults and assess its ability to predict mortality in older adults with cancer. Methods: Using participants from the Cancer & Aging Resilience Evaluation (CARE) Registry who had undergone a geriatric assessment, we examined SRH using a single-item from the Patient-Reported Outcomes Measurement Information System (PROMIS) global health scale. SRH scores were dichotomized into Poor (poor and fair) and Good (good, very good, and excellent). Multivariable logistic regression analyses were used to examine associations between SRH and frailty (based on frailty index) and specific geriatric impairments adjusting for age, sex, comorbidity, cancer type and stage. Finally, the impact of SRH on all-cause mortality was assessed with a multivariable cox regression model. Results: A total of 708 participants with malignancy were included, median age was 68y, 41.5% male, and 74.6% White. Colorectal cancer was the most common cancer (27.1%) and 48.2% of the participants had Stage IV disease. Poor SRH was reported by 42% of participants and was associated with significantly higher odds of frailty (adjusted Odds Ratio [aOR] = 21.8; 95%CI 13.7-34.8). Similarly, poor SRH was independently associated with higher odds of impairments in Activities of Daily Living (ADL) (aOR = 5.6, 95%CI, 3.6-8.9), independent ADL (aOR = 8.4, 95%CI, 5.8-12.4), cognition (aOR = 4.6, 95%CI 2.3-9.3), malnutrition (aOR = 4.5, 95%CI 3.2-6.4), falls (aOR = 3.6, 95%CI 2.4-5.4), anxiety (aOR = 4.6, 95%CI 2.9-7.3), and depression (aOR = 5.4, 95%CI 3.0-9.7). The SRH demonstrated high sensitivity (84.3%) and specificity (78.4%) for identifying frailty, with a positive predictive value of 67% and negative predictive value of 90.6%. The 1y survival rate in those with Poor SRH was significantly worse (64.7% vs 84.3%, log rank p value < 0.001). In a multivariate cox regression analysis, poor SRH remained an independent predictor of worse survival (adjusted Hazard Ratio 2.29 [1.6-3.2], p< 0.01) after adjusting for age, sex, race, cancer type, stage, comorbidity, and planned treatment. Conclusions: Poor SRH is highly associated with frailty and could be a simple tool to identify frail older patients with cancer at risk for adverse events and increased mortality.

MO914INTRADIALYTIC RESISTANCE TRAINING HAS POSITIVE EFFECT ON SURVIVAL IN HEMODIALYSIS PATIENTS INDEPENDENTLY OF THEIR NUTRITION STATUS MEASURED BY BODY COMPOSITION MONITORING

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Marek Hudacek ◽  
Aurel Zelko ◽  
Jaroslav Rosenberger
Keyword(s):  
Body Composition ◽  
Regression Analysis ◽  
Resistance Training ◽  
Nutritional Status ◽  
Cox Regression ◽  
Multivariate Regression Analysis ◽  
Nutrition Status ◽  
Cox Regression Analysis ◽  
A Prospective Study ◽  
The Impact

Abstract Background and Aims Malnutrition is considered to be an independent predictor of mortality in hemodialysis population. Physical inactivity is also connected to worse outcomes, and patients are recommended to comply with at least some physical excercise. The aim of this study was to evaluate the survival of hemodialysed patients, taking into account the nutritional status, assessed by Body Composition Monitor. In addition, analysed the impact of three months intradialytic resistatance training. Method It was a prospective study of patients undergoing hemodialysis from three hemodialysis departments. Patients from two departments underwent three months intradialytic resistance training while those from the third department served as controls. Cox multivariate regression analysis was used to analyse patient survival depending on performing intradialytic resistance training and their nutritional status. Results The group of 90 patients included 35 women, 55 men (61%) with a mean age of 62.6 years, and a mean dialysis program duration of 49.1 months. 31 patients completed whole three months interdialytic training. In total, 80% of participants survived the follow-up period of two years. Cox regression analysis showed a statistically significant effect of the intervention: the patients who had been training had a benefit in survival (HR 4.4; 95%CI 1.003;19.267; p=0,05). The stratification by nutritional status did not change this model, it was always crucial whether patients exercised or not. Malnourished patients had also a better survival when they were training. Conclusion Malnourished hemodialysed patients have higher mortality compared to well-nourished patients. Intradialytic resistance training brings survival benefit and might reduce the adverse effects of malnutrition. Therefore we recommend this intervention even in malnourished hemodialysed patients.

scholarly journals The impact of low triiodothyronine levels on mortality is mediated by malnutrition and cardiac dysfunction in incident hemodialysis patients

2013 ◽  
Vol 169 (4) ◽  
pp. 409-419 ◽  
Author(s):  
Hyang Mo Koo ◽  
Chan Ho Kim ◽  
Fa Mee Doh ◽  
Mi Jung Lee ◽  
Eun Jin Kim ◽  
...  
Keyword(s):  
Cardiac Dysfunction ◽  
Cox Regression ◽  
Survival Rates ◽  
Mortality Rates ◽  
Left Ventricular ◽  
Cox Regression Analysis ◽  
All Cause Mortality ◽  
Echocardiographic Parameters ◽  
Stage Renal Disease ◽  
The Impact

ObjectiveLittle is known about the impact of low triiodothyronine (T3) levels on mortality in end-stage renal disease (ESRD) patients starting hemodialysis (HD) and whether this impact is mediated by malnutrition, inflammation, or cardiac dysfunction.Design and methodsA prospective cohort of 471 incident HD patients from 36 dialysis centers within the Clinical Research Center for ESRD in Korea was selected for this study. Based on the median value of T3, patients were divided into ‘higher’ and ‘lower’ groups, and all-cause and cardiovascular (CV) mortality rates were compared. In addition, associations between T3levels and various nutritional, inflammatory, and echocardiographic parameters were determined.ResultsCompared with those in the ‘higher’ T3group, albumin, cholesterol, and triglyceride levels, lean body mass estimated by creatinine kinetics (LBM-Cr), and normalized protein catabolic rate (nPCR) were significantly lower in patients with ‘lower’ T3levels. The ‘lower’ T3group also had a higher left ventricular mass index (LVMI) and a lower ejection fraction (EF). Furthermore, correlation analysis revealed significant associations between T3levels and nutritional and echocardiographic parameters. All-cause and CV mortality rates were significantly higher in patients with ‘lower’ T3levels than in the ‘higher’ T3group (113.4 vs 18.2 events per 1000 patient-years,P<0.001, and 49.8 vs 9.1 events per 1000 patient-years,P=0.001, respectively). The Kaplan–Meier analysis also showed significantly worse cumulative survival rates in the ‘lower’ T3group (P<0.001). In the Cox regression analysis, low T3was an independent predictor of all-cause mortality even after adjusting for traditional risk factors (hazard ratio=3.76,P=0.021). However, the significant impact of low T3on all-cause mortality disappeared when LBM-Cr, nPCR, LVMI, or EF were incorporated into the models.ConclusionLow T3has an impact on all-cause mortality in incident HD patients, partly via malnutrition and cardiac dysfunction.

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