COPD exacerbations: the impact of long versus short courses of oral corticosteroids on mortality and pneumonia: nationwide data on 67 000 patients with COPD followed for 12 months

IntroductionA large group of patients with chronic obstructive pulmonary disease (COPD) are exposed to an overload of oral corticosteroids (OCS) due to repeated exacerbations. This is associated with potential serious adverse effects. Therefore, we evaluated the impact of a recommended reduction of OCS duration in 2014 on the risk of pneumonia hospitalisation and all-cause mortality in patients with acute exacerbation of COPD (AECOPD).MethodsThis was a nationwide observational cohort study that was based on linked administrative registry data between 1 January 2010 and 31 October 2017. 10 152 outpatients with COPD (median age 70 years) treated with either a short (≤250 mg) or long course (>250 mg) of OCS for AECOPD were included in the study. Cox proportional hazards regression models were used to derive an estimation of multivariable adjusted HRs (aHRs) for pneumonia hospitalisation or all-cause mortality combined and pneumonia hospitalisation and all-cause mortality, separately.ResultsThe long course of OCS treatment for AECOPD was associated with an increased 1-year risk of pneumonia hospitalisation or all-cause mortality (aHR 1.3, 95% CI 1.1 to 1.4; p<0.0001), pneumonia hospitalisation (aHR 1.2, 95% CI 1.0 to 1.3; p=0.0110) and all-cause mortality (aHR 1.8, 95% CI 1.5 to 2.2; p<0.0001) as compared with the short course of OCS treatment. These results were confirmed in several sensitivity analyses.ConclusionThe change of recommendations from long courses to short courses of OCS for AECOPD in 2014 was strongly associated with a decrease in pneumonia admissions and all-cause mortality, in favour of short courses of OCS.

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Impact of the Changes in the Frequency of Social Participation on All-Cause Mortality in Japanese Older Adults: A Nationwide Longitudinal Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19010270 ◽

2021 ◽

Vol 19 (1) ◽

pp. 270

Author(s):

Keiichi Shimatani ◽

Mayuko T. Komada ◽

Jun Sato

Keyword(s):

Older Adults ◽

Social Participation ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Risk Of Mortality ◽

All Cause Mortality ◽

Japanese Older Adults ◽

The Impact

Previous studies have shown that more frequent social participation was associated with a reduced risk of mortality. However, limited studies have explored the changes in the frequency of social participation in older adults. We investigated the impact of the changes in the frequency of social participation on all-cause mortality in Japanese older adults aged 60 years and older. The current study, conducted as a secondary analysis, was a retrospective cohort study using open available data. The participants were 2240 older adults (45.4% male and 54.6% female) sampled nationwide from Japan who responded to the interview survey. Changes in the frequency of social participation were categorized into four groups (none, initiated, decreased, and continued pattern) based on the responses in the baseline and last surveys. The Cox proportional-hazards model showed a decreased risk of all-cause mortality in decreased and continued patterns of social participation. Stratified analysis by sex showed a decreased risk of mortality in the continued pattern only among males. The results of the current study suggest that the initiation of social participation at an earlier phase of life transition, such as retirement, may be beneficial for individuals.

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Abstract P288: Exposure To Psychological And Physical Challenges Immediately Prior To Myocardial Infarction And Increased 10-year Mortality

Circulation ◽

10.1161/circ.129.suppl_1.p288 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Loes Smeijers ◽

Elizabeth Mostofsky ◽

Willem J Kop ◽

Murray A Mittelman

Keyword(s):

Physical Activity ◽

Myocardial Infarction ◽

Mortality Rate ◽

Proportional Hazards ◽

Coffee Consumption ◽

Cox Proportional Hazards ◽

Sensitivity Analyses ◽

Risk Indicator ◽

All Cause Mortality

Objective: To examine the association between exposure to psychological (anger, anxiety) and physical (high activity levels, coffee consumption) challenge immediately prior to myocardial infarction (MI) as risk indicator of mortality at 10-year follow-up. Methods: Participants of the Determinants of Myocardial Infarction Onset Study (N=2176, mean age 60.1±12.5 yrs, 29.2% women) were interviewed to assess exposure to several potential triggers immediately prior to MI, including anger, anxiety, physical activity and coffee. All-cause mortality was assessed using the National Death Index for 10 years follow-up. We constructed Cox proportional hazards models with 95% confidence intervals to examine the relationship between exposure to these potential triggers in the 2 hours prior to MI onset and the rate of all-cause mortality, adjusting for demographic and clinical characteristics. Results: Exposure to anger, anxiety, physical activity or coffee consumption prior to MI was associated with a 30% higher mortality rate over 10 years (HR=1.30, 95%CI=1.06-1.59, p =0.011) compared to patients who were not exposed to any of these potential triggers. This association was stronger for the first 3 years of follow-up (HR=1.59, 95%CI=1.16-2.19, p =0.004) and weaker for years 3 to 10 (HR=1.14, 95%CI=0.88-1.48, p =0.32). In separate analyses for each exposure, there was a higher mortality rate associated with anxiety (HR=1.44, 95%CI=1.09-1.91, p =0.010) and a suggestion of a higher rate for anger (HR=1.33, 95%CI=0.97-1.81, p =0.075), but no association for physical activity or coffee consumption. Sensitivity analyses showed stronger associations for women than men, and patients aged 65 and older compared to younger patients. Discussion: MI following episodes of anger, anxiety, physical activity or coffee consumption is associated with higher all-cause mortality in the following 10 years. This association was strongest for anxiety and slightly lower for anger but there was no evidence of a higher mortality rate among MI patients reporting physical activity or coffee consumption immediately prior to MI.

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Garlic Consumption and All-Cause Mortality among Chinese Oldest-Old Individuals: A Population-Based Cohort Study

Nutrients ◽

10.3390/nu11071504 ◽

2019 ◽

Vol 11 (7) ◽

pp. 1504 ◽

Cited By ~ 1

Author(s):

Shi ◽

Lv ◽

Mao ◽

Yuan ◽

Yin ◽

...

Keyword(s):

Proportional Hazards ◽

Oldest Old ◽

Experimental Studies ◽

Population Based ◽

Cox Proportional Hazards ◽

Sensitivity Analyses ◽

Protective Effects ◽

All Cause Mortality

In vitro and in vivo experimental studies have shown garlic has protective effects on the aging process; however, there is no evidence that garlic consumption is associated with all-cause mortality among oldest-old individuals (≥80 years). From 1998 to 2011, 27,437 oldest-old participants (mean age: 92.9 years) were recruited from 23 provinces in China. The frequencies of garlic consumption at baseline and at age 60 were collected. Cox proportional hazards models adjusted for potential covariates were constructed to estimate hazard ratios (HRs) relating garlic consumption to all-cause mortality. Among 92,505 person-years of follow-up from baseline to September 1, 2014, 22,321 participants died. Participants who often (≥5 times/week) or occasionally (1–4 times/week) consumed garlic survived longer than those who rarely (less than once/week) consumed it (p < 0.001). Participants who consumed garlic occasionally or often had a lower risk for mortality than those who rarely consumed garlic at baseline; the adjusted HRs for mortality were 0.92(0.89–0.94) and 0.89(0.85–0.92), respectively. The inverse associations between garlic consumption and all-cause mortality were robust in sensitivity analyses and subgroup analyses. In this study, habitual consumption of garlic was associated with a lower all-cause mortality risk; this advocates further investigation into garlic consumption for promoting longevity.

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Impact of Retinopathy and Systemic Vascular Comorbidities on All-Cause Mortality

Frontiers in Endocrinology ◽

10.3389/fendo.2021.750017 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zhuoting Zhu ◽

Xianwen Shang ◽

Wei Wang ◽

Jason Ha ◽

Yifan Chen ◽

...

Keyword(s):

Proportional Hazards ◽

Vascular Risk Factor ◽

Cox Proportional Hazards ◽

Hypertension Status ◽

Term Survival ◽

Time To Death ◽

Health And Nutrition ◽

Cox Proportional Hazards Models ◽

All Cause Mortality ◽

The Impact

PurposeTo assess the impact of retinopathy and systemic vascular comorbidities on the all-cause mortality in a representative U.S. sample.MethodsA total of 5703 participants (≥40 years old) from the 2005-2008 National Health and Nutrition Examination Survey. The Early Treatment Diabetic Retinopathy Study grading scale was used to evaluate the retinopathy status. Systemic vascular comorbidities included diabetes mellitus (DM), high blood pressure (HBP), chronic kidney disease (CKD) and cardiovascular disease (CVD). Time to death was calculated as the time from baseline to either the date of death or censoring (December 31st, 2015), whichever came first. Risks of mortality were estimated using Cox proportional hazards models after adjusting for confounders and vascular comorbidities.ResultsAfter a median follow-up of 8.33 years (IQR: 7.50-9.67 years), there were 949 (11.8%) deaths from all causes. After adjusting for confounders, the presence of retinopathy predicted higher all-cause mortality (hazard ratio (HR), 1.41; 95% confidence interval (CI), 1.08-1.83). The all-cause mortality among participants with both retinopathy and systemic vascular comorbidities including DM (HR, 1.72; 95% CI, 1.21-2.43), HBP (HR, 1.47; 95% CI, 1.03-2.10), CKD (HR, 1.73; 95% CI, 1.26-2.39) and CVD (HR, 1.92; 95% CI, 1.21-3.04) was significantly higher than that among those without either condition. When stratified by diabetic or hypertension status, the co-occurrence of retinopathy and CKD or CVD further increased the all-cause mortality compared to those without either condition.ConclusionsThe co-occurrence of retinopathy and systemic vascular conditions predicted a further increase in the risk of mortality. More extensive vascular risk factor assessment and management are needed to detect the burden of vascular pathologies and improve long-term survival in individuals with retinopathy.

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Cardiac biomarkers and long-term outcomes of exacerbations of COPD: a long-term follow-up of two cohorts

ERJ Open Research ◽

10.1183/23120541.00531-2020 ◽

2020 ◽

pp. 00531-2020

Author(s):

E. Shafuddin ◽

S.M. Fairweather ◽

C.L. Chang ◽

C. Tuffery ◽

R.J. Hancox

Keyword(s):

Proportional Hazards ◽

Troponin T ◽

Cox Proportional Hazards ◽

Cardiac Biomarkers ◽

Chronic Obstructive ◽

Copd Exacerbation ◽

Long Term Outcomes ◽

Term Survival ◽

Copd Exacerbations

BackgroundChronic obstructive pulmonary disease (COPD) patients often have cardiac comorbidities. Cardiac involvement at the time of a COPD exacerbation is associated with a high short-term mortality, but whether this influences long-term outcomes is unknown. We explored whether biomarkers of cardiac dysfunction at the time of a COPD exacerbation predict long term outcomes.MethodsTwo prospective cohorts of patients admitted to Waikato hospital for exacerbations of COPD were recruited during 2006–2007 and 2012–2013. N-terminal proBNP (NT-proBNP) and troponin T were measured on admission and were used to indicate cardiac stretch and myocardial injury respectively. Five-year survival after discharge and subsequent admissions for cardiac disease and COPD exacerbations were analysed using Kaplan-Meier and Cox proportional hazards tests.ResultsThe overall 5-year mortality was 61%. Patients with high NT-proBNP on admission had higher mortality than those with normal cardiac biomarkers (adjusted Hazard Ratio (aHR) 1.76, 95% CI 1.18–2.62). High NT-proBNP was also associated with a higher risk of future cardiac admissions (aHR 1.75 95% CI 1.2–2.55). Troponin T levels were not associated with long-term survival (aHR 0.86 95 CI 0.40–1.83) or future cardiac admissions (aHR 0.74, 95% CI 0.34–1.57). Neither biomarker predicted future COPD exacerbations.ConclusionThe long-term prognosis following a hospitalisation for an exacerbation of COPD is poor with less than half of patients surviving for 5 years. Elevated NT-proBNP at the time of a COPD exacerbation is associated with higher long-term mortality and a greater likelihood of future cardiac admissions, but not future COPD exacerbations.

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Impact of Extended and Restricted Antibiotic Deescalation on Mortality

Antibiotics ◽

10.3390/antibiotics11010022 ◽

2021 ◽

Vol 11 (1) ◽

pp. 22

Author(s):

Hwei Lin Teh ◽

Sarimah Abdullah ◽

Anis Kausar Ghazali ◽

Rahela Ambaras Khan ◽

Anitha Ramadas ◽

...

Keyword(s):

Proportional Hazards ◽

Survival Curve ◽

Survival Rates ◽

Pressure Sore ◽

Cox Proportional Hazards ◽

Kaplan Meier ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

The Impact

Background: More data are needed about the safety of antibiotic de-escalation in specific clinical situations as a strategy to reduce exposure to broad-spectrum antibiotics. This study aims to compare the survival curve of patient de-escalated (early or late) against those not de-escalated on antibiotics, to determine the association of patient related, clinical related, and pressure sore/device related characteristics on all-cause 30-day mortality and determine the impact of early and late antibiotic de-escalation on 30-day all-cause mortality. Methods: This is a retrospective cohort study on patients in medical ward Hospital Kuala Lumpur, admitted between January 2016 and June 2019. A Kaplan–Meier survival curve and Fleming–Harrington test were used to compare the overall survival rates between early, late, and those not de-escalated on antibiotics while multivariable Cox proportional hazards regression was used to determine prognostic factors associated with mortality and the impact of de-escalation on 30-day all-cause mortality. Results: Overall mortality rates were not significantly different when patients were not de-escalated on extended or restricted antibiotics, compared to those de-escalated early or later (p = 0.760). Variables associated with 30-day all-cause mortality were a Sequential Organ Function Assessment (SOFA) score on the day of antimicrobial stewardship (AMS) intervention and Charlson’s comorbidity score (CCS). After controlling for confounders, early and late antibiotics were not associated with an increased risk of mortality. Conclusion: The results of this study reinforce that restricted or extended antibiotic de-escalation in patients does not significantly affect 30-day all-cause mortality compared to continuation with extended and restricted antibiotics.

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Predictors of mortality in chronic pulmonary aspergillosis

European Respiratory Journal ◽

10.1183/13993003.01062-2016 ◽

2016 ◽

Vol 49 (2) ◽

pp. 1601062 ◽

Cited By ~ 51

Author(s):

David Lowes ◽

Khaled Al-Shair ◽

Pippa J. Newton ◽

Julie Morris ◽

Chris Harris ◽

...

Keyword(s):

Proportional Hazards ◽

Mycobacterial Infection ◽

Cox Proportional Hazards ◽

Chronic Obstructive ◽

Pulmonary Aspergillosis ◽

Obstructive Pulmonary Disease ◽

Kaplan Meier ◽

St George's Respiratory Questionnaire ◽

Chronic Pulmonary Aspergillosis ◽

The Impact

Chronic pulmonary aspergillosis (CPA) is a chronic progressive infection that destroys lung tissue in non-immunocompromised patients. Contemporary series suggest 50–85% 5-year mortality, with few prognostic factors identified.A cohort of 387 CPA patients referred to the UK's National Aspergillosis Centre from 1992 to June 2012 was studied until June 2015. The impact of objective and subjective variables including age, sex, previous pulmonary conditions, dyspnoea score, quality of life, serum albumin and C-reactive protein and radiological appearances were assessed using Kaplan–Meier curves, log rank tests and Cox proportional hazards modelling. In samples of patients, retrospective review of time from likely onset of CPA to referral and cause of death were also investigated.Survival was 86%, 62% and 47% at 1, 5 and 10 years, respectively. Increased mortality was associated with nontuberculous mycobacterial infection (hazard ratio 2.07, 95% CI 1.22–3.52; p<0.001) and chronic obstructive pulmonary disease (1.57, 1.05–2.36; p=0.029) as well as higher age (1.053, 1.03–1.07 per year; p<0.001), lower albumin (0.92, 0.87–0.96 per g·L−1), lower activity (1.021, 1.01–1.03 per point increase in St George's Respiratory Questionnaire activity domain; p<0.001) and having one, and especially, bilateral aspergillomas (p<0.001).Several factors impact on mortality of CPA, and can be evaluated as tools to assess CPA prognosis.

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Serum Potassium Levels and Mortality in Hemodialysis Patients: A Retrospective Cohort Study

American Journal of Nephrology ◽

10.1159/000448341 ◽

2016 ◽

Vol 44 (3) ◽

pp. 179-186 ◽

Cited By ~ 25

Author(s):

Akeem A. Yusuf ◽

Yan Hu ◽

Bhupinder Singh ◽

José A. Menoyo ◽

James B. Wetmore

Keyword(s):

Serum Potassium ◽

Potassium Level ◽

Proportional Hazards ◽

Serum Potassium Level ◽

Short Interval ◽

Hemodialysis Patients ◽

Cox Proportional Hazards ◽

Maintenance Hemodialysis ◽

All Cause Mortality ◽

The Impact

Background: Hyperkalemia is common in patients receiving maintenance hemodialysis. However, few studies have examined the association between serum potassium level and mortality. Methods: This study used annual cohorts of hemodialysis patients during 2007-2010. To determine hyperkalemia prevalence, monthly hyperkalemia was defined as serum potassium level ≥5.5 mEq/l; prevalence was calculated as a ratio of hyperkalemia episodes to follow-up time, reported separately by long and short interdialytic interval. To determine the impact of hyperkalemia on mortality, patients in the 2010 cohort were followed from first potassium measurement until death or a censoring event; hyperkalemia was defined, sequentially, by potassium levels 5.5-6.0 mEq/l at 0.1 mEq/l intervals. Time-dependent Cox proportional hazards modeling was used to estimate the association between hyperkalemia and mortality. Results: The 4 annual cohorts ranged from 28,774 to 36,888 patients. Mean age was approximately 63 years, about 56% were men, 51% were white and 44% had end-stage renal disease caused by diabetes. Hyperkalemia prevalence was consistently estimated at 16.3-16.8 events per 100 patient-months. Prevalence on the day after the long interdialytic interval was 2.0-2.4 times as high as on the day after the short interval. Hyperkalemia, when defined as serum potassium ≥5.7 mEq/l, was associated with all-cause mortality (adjusted hazards ratio (AHR) 1.13, 95% CI 1.01-1.28, p = 0.037, vs. <5.7 mEq/l) after adjustment. AHRs increased progressively as the hyperkalemia threshold increased, reaching 1.37 (95% CI 1.16-1.62, p < 0.0001) for ≥6.0 mEq/l. Conclusions: The long interdialytic interval was associated with increased likelihood of hyperkalemia. Hyperkalemia was associated with all-cause mortality beginning at serum potassium ≥5.7 mEq/l; mortality risk estimates increased ordinally through ≥6.0 mEq/l, suggesting a threshold at which serum potassium becomes substantially more dangerous.

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Effect of Leptin Therapy on Survival in Generalized and Partial Lipodystrophy: A Matched Cohort Analysis

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab216 ◽

2021 ◽

Author(s):

Keziah Cook ◽

Omer Ali ◽

Baris Akinci ◽

Maria Cristina Foss de Freitas ◽

Renan Magalhães Montenegro ◽

...

Keyword(s):

Mortality Risk ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cohort Analysis ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Sensitivity Analyses ◽

Naive Patient ◽

Partial Lipodystrophy ◽

The Impact

Abstract Context Data quantifying the impact of metreleptin therapy on survival in nonHIVrelated generalized lipodystrophy (GL) and partial lipodystrophy (PL) are unavailable. Objective This study aimed to estimate the treatment effect of metreleptin on survival in patients with GL and PL. Design/Setting/Patients Demographic and clinical characteristics were used to match metreleptin-treated and metreleptin-naïve patients with GL and PL. Differences in mortality risk were estimated between matched cohorts of metreleptin-treated and metreleptin-naïve patient cohorts using Cox proportional hazard models. Sensitivity analyses assessed the impact of study assumptions and robustness of results. Outcome Measures This study assessed time to mortality and risk of mortality. Results The analysis evaluated 103 metreleptin-naïve patients with characteristics matched to 103 metreleptin-treated patients at treatment initiation. Even after matching, some metabolic and organ abnormalities were more prevalent in the metreleptin-treated cohort due to bias toward treating more severely affected patients. A Cox proportional hazards model associated metreleptin therapy with an estimated 65% decrease in mortality risk (HR 0.348, 95% CI: 0.134-0.900; P = 0.029) even though the actual number of events were relatively small. Results were robust across a broad range of alternate methodological assumptions. Kaplan-Meier estimates of time to mortality for the metreleptin-treated and the matched metreleptin-naïve cohorts were comparable. Conclusions Metreleptin therapy was associated with a reduction in mortality risk in patients with lipodystrophy syndromes despite greater disease severity in treated patients, supporting the view that metreleptin can have a positive disease-modifying impact. Confirmatory studies in additional real-world and clinical datasets are warranted.

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Endothelial and leukocyte-derived microvesicles and cardiovascular risk after stroke—PROSCIS-B

Neurology ◽

10.1212/wnl.0000000000011223 ◽

2020 ◽

pp. 10.1212/WNL.0000000000011223

Author(s):

Shufan Huo ◽

Nicolle Kränkel ◽

Alexander Heinrich Nave ◽

Pia Sophie Sperber ◽

Jessica Lee Rohmann ◽

...

Keyword(s):

Myocardial Infarction ◽

Proportional Hazards ◽

Recurrent Stroke ◽

Cox Proportional Hazards ◽

Blood Levels ◽

Stroke Patients ◽

Link Type ◽

All Cause Mortality ◽

The Impact

ObjectiveTo determine the role of circulating microvesicles (MV) on long-term cardiovascular outcomes after stroke, we measured them in first-ever stroke patients with a three-year follow-up.MethodsIn the PROSpective Cohort with Incident Stroke Berlin (PROSCIS-B), patients with first-ever ischemic stroke were followed for 3 years. The primary combined endpoint consisted of recurrent stroke, myocardial infarction, and all-cause mortality. Citrate-blood levels of endothelial MV (EMV), leukocyte-derived MV (LMV), monocytic MV (MMV), and platelet-derived MV (PMV) were measured using flow cytometry. Kaplan-Meier curves and adjusted Cox proportional hazards models were used to estimate the effect of MV levels on the combined endpoint.ResultsFive hundred seventy-one patients were recruited (median age 69 years; 39% female; median NIHSS 2, interquartile range 1–4) and 95 endpoints occurred. Patients with levels of EMV [adjusted hazard ratio (HR) = 2.5, 95% confidence interval (CI) 1.2–4.9] or LMV (HR = 3.1, 95% CI 1.4–6.8) in the highest quartile were more likely to experience an event than participants with lower levels using the lowest quartile as reference category. The association was less pronounced for PMV (HR = 1.7, 95% CI 0.9–3.2) and absent for MMV (HR = 1.1, 95% CI 0.6–1.8).ConclusionHigh levels of EMV and LMV after stroke were associated with worse cardiovascular outcome within 3 years. These results reinforce that endothelial dysfunction and vascular inflammation affect the long-term prognosis after stroke. EMV and LMV might play a role in risk prediction for stroke patients.Study registrationclinicaltrials.gov/ct2/show/NCT01363856. UID: NCT01363856.Classification of evidenceThis study provides Class II evidence of the impact of MV levels on subsequent stroke, myocardial infarction or all-cause mortality in survivors of mild stroke.

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