scholarly journals Monocyte and neutrophil levels are potentially linked to progression to IPF for patients with indeterminate UIP CT pattern

2021 ◽  
Vol 8 (1) ◽  
pp. e000899
Author(s):  
Andrew Achaiah ◽  
Amila Rathnapala ◽  
Andrea Pereira ◽  
Harriet Bothwell ◽  
Kritica Dwivedi ◽  
...  
Keyword(s):  
Usual Interstitial Pneumonia ◽  
Potential Contribution ◽  
Proportional Hazard ◽  
Limited Data ◽  
Disease Evolution ◽  
Patient Demographics ◽  
Cox Proportional Hazard ◽  
Potential Factors ◽  
Fibrotic Lung Disease

RationaleIdiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease with poor prognosis. Identifying patients early may allow intervention which could limit progression. The ‘indeterminate for usual interstitial pneumonia’ (iUIP) CT pattern, defined in the 2018 IPF guidelines, could be a precursor to IPF but there is limited data on how patients with iUIP progress over time.ObjectiveTo evaluate the radiological progression of iUIP and explore factors linked to progression to IPF.MethodsWe performed a retrospective analysis of a lung fibrosis clinic cohort (n=230) seen between 2013 and 2017. Cases with iUIP were identified; first ever CTs for each patient found and categorised as 'non-progressor' or 'progressors' (the latter defined as increase in extent of disease or to 'definite' or 'probable' UIP CT pattern) during their follow-up. Lung function trends, haematological data and patient demographics were examined to explore disease evolution and potential contribution to progression.Results48 cases with iUIP CT pattern were identified. Of these, 32 had follow-up CT scans, of which 23 demonstrated progression. 17 patients in this cohort were diagnosed with IPF over a mean (SD) period of 3.9 (±1.9) years. Monocyte (HR: 23, 95% CI: 1.6 to 340, p=0.03) and neutrophil levels (HR: 1.8, 95% CI: 1.3 to 2.3, p<0.001), obtained around the time of initial CT, were associated with progression to IPF using Cox proportional hazard modelling.Conclusion53% of our evaluable patients with iUIP progressed to IPF over a mean of 4 years. Monocyte and neutrophil levels at initial CT were significantly associated with progression in disease. These data provide a single-centre analysis of the evolution of patients with iUIP CT pattern, and first signal for potential factors associated with progression to IPF.

scholarly journals Monocytes and neutrophil levels are potentially linked to progression to IPF for patients with indeterminate UIP CT pattern.

2021 ◽  
Author(s):  
Andrew Achaiah ◽  
Amilla Rathnapala ◽  
Andrea Periera ◽  
Harriet Bothwell ◽  
Kritica Dwivedi ◽  
...  
Keyword(s):  
Potential Contribution ◽  
Proportional Hazard ◽  
Limited Data ◽  
Disease Evolution ◽  
Patient Demographics ◽  
Cox Proportional Hazard ◽  
Potential Factors ◽  
Fibrotic Lung Disease ◽  
Extent Of Disease

Rationale: Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease with poor prognosis. Identifying patients early may allow intervention which could limit progression. The indeterminate for UIP (iUIP) CT pattern, defined in the 2018 IPF guidelines, could be a precursor to IPF but there is limited data on how patients with iUIP progress over time. Objective: To evaluate the radiological progression of iUIP and explore factors linked to progression to IPF. Methods: We performed a retrospective analysis of a lung fibrosis clinic cohort (n=230) seen between 2013-2017. Cases with iUIP were identified; first ever CTs for each patient found and categorised as non-progressor or progressors (the latter defined as increase in extent of disease or to definite or probable UIP CT pattern) during their follow up. Lung function trends, haematological data and patient demographics were examined to explore disease evolution and potential contribution to progression. Results: 48 cases with iUIP CT pattern were identified. Of these, 32 had follow up CT scans, of which 23 demonstrated progression. 17 patients in this cohort were diagnosed with IPF over a mean (S.D.) period of 3.9 (1.9) years. Monocyte [HR 23, CI 1.6-340, p=0.03] and neutrophil levels [HR 1.8, CI 1.3-2.3, p<0.001] obtained around the time of initial CT, were associated with progression to IPF using Cox proportional hazard modelling. Conclusion: 53% of our evaluable iUIP patients progressed to IPF over a mean of four years. Monocyte and neutrophil levels at initial CT were significantly associated with progression in disease. These data provide a single-centre analysis of the evolution of patients with iUIP CT pattern, and first signal for potential factors associated with progression to IPF.

scholarly journals Low serum parathyroid hormone is a risk factor for peritonitis episodes in incident peritoneal dialysis patients: a retrospective study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yuqi Yang ◽  
Jingjing Da ◽  
Yi Jiang ◽  
Jing Yuan ◽  
Yan Zha
Keyword(s):  
Risk Factor ◽  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Proportional Hazard ◽  
Serum Parathyroid Hormone ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Regression ◽  
Gram Negative Organisms ◽  
Serum Pth

Abstract Background Serum parathyroid hormone (PTH) levels have been reported to be associated with infectious mortality in peritoneal dialysis (PD) patients. Peritonitis is the most common and fatal infectious complication, resulting in technique failure, hospital admission and mortality. Whether PTH is associated with peritonitis episodes remains unclear. Methods We examined the association of PTH levels and peritonitis incidence in a 7-year cohort of 270 incident PD patients who were maintained on dialysis between January 2012 and December 2018 using Cox proportional hazard regression analyses. Patients were categorized into three groups by serum PTH levels as follows: low-PTH group, PTH < 150 pg/mL; middle-PTH group, PTH 150-300 pg/mL; high-PTH group, PTH > 300 pg/mL. Results During a median follow-up of 29.5 (interquartile range 16–49) months, the incidence rate of peritonitis was 0.10 episodes per patient-year. Gram-positive organisms were the most common causative microorganisms (36.2%), and higher percentage of Gram-negative organisms was noted in patients with low PTH levels. Low PTH levels were associated with older age, higher eGFR, higher hemoglobin, calcium levels and lower phosphate, alkaline phosphatase levels. After multivariate adjustment, lower PTH levels were identified as an independent risk factor for peritonitis episodes [hazard ratio 1.643, 95% confidence interval 1.014–2.663, P = 0.044]. Conclusions Low PTH levels are independently associated with peritonitis in incident PD patients.

scholarly journals Lower Risk for Dementia Following Adult Tetanus, Diphtheria and Pertussis (Tdap) Vaccination

2021 ◽  
Author(s):  
Jeffrey F Scherrer ◽  
Joanne Salas ◽  
Timothy L Wiemken ◽  
Christine Jacobs ◽  
John E Morley ◽  
...  
Keyword(s):  
Lower Risk ◽  
Protective Effects ◽  
Proportional Hazard ◽  
Veterans Health ◽  
Cox Proportional Hazard ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Nonspecific Effects ◽  
Reduce Risk

Abstract Background Adult vaccinations may reduce risk for dementia. However it has not been established whether tetanus, diphtheria, pertussis (Tdap) vaccination is associated with incident dementia. Methods Hypotheses were tested in a Veterans Health Affairs (VHA) cohort and replicated in a MarketScan medical claims cohort. Patients were ≥65 years of age and free of dementia for 2 years prior to index date. Patients either had or did not have a Tdap vaccination by the start of either of two index periods (2011 or 2012). Follow-up continued through 2018. Controls had no Tdap vaccination for the duration of follow-up. Confounding was controlled using entropy balancing. Competing risk (VHA) and Cox proportional hazard (MarketScan) models estimated the association between Tdap vaccination and incident dementia in all patients and in age sub-groups (65-69, 70-74, ≥75 years of age). Results VHA patients were, on average, 75.6 (SD±7.5) years of age, 4% female, and 91.2% were white race. MarketScan patients were 69.8 (SD±5.6) years of age, on average and 65.4% were female. After controlling for confounding, patients with, compared to without Tdap vaccination, had a significantly lower risk for dementia in both cohorts (VHA: HR=0.58; 95%CI:0.54 - 0.63 and MarketScan: HR=0.58; 95%CI:0.48 - 0.70). Conclusions Tdap vaccination was associated with a 42% lower dementia risk in two cohorts with different clinical and sociodemographic characteristics. Several vaccine types are linked to decreased dementia risk, suggesting that these associations are due to nonspecific effects on inflammation rather than vaccine-induced pathogen-specific protective effects.

Manual occupations with high all-cause mortality: The contribution of socioeconomic and occupational characteristics

2020 ◽  
pp. 140349482096065
Author(s):  
Hanna Rinne ◽  
Mikko Laaksonen
Keyword(s):  
High Mortality ◽  
Excess Mortality ◽  
Proportional Hazard ◽  
Individual Level ◽  
Cox Proportional Hazard ◽  
Occupational Characteristics ◽  
Study Population ◽  
Cox Proportional Hazard Regression ◽  
Year 2000

Aims: Most high mortality-risk occupations are manual occupations. We examined to what extent high mortality of such occupations could be explained by education, income, unemployment or industry and whether there were differences in these effects among different manual occupations. Methods: We used longitudinal individual-level register-based data, the study population consisting of employees aged 30–64 at the end of the year 2000 with the follow-up period 2001–2015. We used Cox proportional hazard regression models in 31 male and 11 female occupations with high mortality. Results: There were considerable differences between manual occupations in how much adjusting for education, income, unemployment and industry explained the excess mortality. The variation was especially large among men: controlling for these variables explained over 50% of the excess mortality in 23 occupations. However, in some occupations the excess mortality even increased in relation to unadjusted mortality. Among women, these variables explained a varying proportion of the excess mortality in every occupation. After adjustment of all variables, mortality was no more statistically significantly higher than average in 14 occupations among men and 2 occupations among women. Conclusions: The high mortality in manual occupations was mainly explained by education, income, unemployment and industry. However, the degree of explanation varied widely between occupations, and considerable variation in mortality existed between manual occupations after controlling for these variables. More research is needed on other determinants of mortality in specific high-risk occupations.

scholarly journals The temporal relationship between cancer and adult onset anti-transcriptional intermediary factor 1 antibody–positive dermatomyositis

Rheumatology ◽  
2018 ◽  
Vol 58 (4) ◽  
pp. 650-655 ◽  
Author(s):  
Alexander Oldroyd ◽  
Jamie C Sergeant ◽  
Paul New ◽  
Neil J McHugh ◽  
Zoe Betteridge ◽  
...  
Keyword(s):  
Proportional Hazard ◽  
Adult Onset ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Specific Cancer ◽  
Associated Malignancy ◽  
Cancer Types ◽  
The Uk ◽  
Screening Approaches

Abstract Objectives To characterize the 10 year relationship between anti-transcriptional intermediary factor 1 antibody (anti-TIF1-Ab) positivity and cancer onset in a large UK-based adult DM cohort. Methods Data from anti-TIF1-Ab-positive/-negative adults with verified diagnoses of DM from the UK Myositis Network register were analysed. Each patient was followed up until they developed cancer. Kaplan–Meier methods and Cox proportional hazard modelling were employed to estimate the cumulative cancer incidence. Results Data from 263 DM cases were analysed, with a total of 3252 person-years and a median 11 years of follow-up; 55 (21%) DM cases were anti-TIF1-Ab positive. After 10 years of follow-up, a higher proportion of anti-TIF1-Ab-positive cases developed cancer compared with anti-TIF1-Ab-negative cases: 38% vs 15% [hazard ratio 3.4 (95% CI 2.2, 5.4)]. All the detected malignancy cases in the anti-TIF1-Ab-positive cohort occurred between 3 years prior to and 2.5 years after DM onset. No cancer cases were detected within the following 7.5 years in this group, whereas cancers were detected during this period in the anti-TIF1-Ab-negative cases. Ovarian cancer was more common in the anti-TIF1-Ab-positive vs -negative cohort: 19% vs 2%, respectively (P < 0.05). No anti-TIF1-Ab-positive case <39 years of age developed cancer, compared with 21 (53%) of those ≥39 years of age. Conclusion Anti-TIF1-Ab-positive-associated malignancy occurs exclusively within the 3 year period on either side of DM onset, the risk being highest in those ≥39 years of age. Cancer types differ according to anti-TIF1-Ab status, and this may warrant specific cancer screening approaches.

scholarly journals Microalbuminuria After Kidney Transplantation Predicts Cardiovascular Morbidity

2021 ◽  
Vol 8 ◽  
Author(s):  
Dana Bielopolski ◽  
Ruth Rahamimov ◽  
Boris Zingerman ◽  
Avry Chagnac ◽  
Limor Azulay-Gitter ◽  
...  
Keyword(s):  
Hazard Analysis ◽  
Cardiovascular Morbidity ◽  
Urine Collection ◽  
Proportional Hazard ◽  
Cvd Risk ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Cardiovascular Morbidity And Mortality ◽  
Independent Association

Background: Microalbuminuria is a well-characterized marker of kidney malfunction, both in diabetic and non-diabetic populations, and is used as a prognostic marker for cardiovascular morbidity and mortality. A few studies implied that it has the same value in kidney transplanted patients, but the information relies on spot or dipstick urine protein evaluations, rather than the gold standard of timed urine collection.Methods: We revisited a cohort of 286 kidney transplanted patients, several years after completing a meticulously timed urine collection and assessed the prevalence of major cardiovascular adverse events (MACE) in relation to albuminuria.Results: During a median follow up of 8.3 years (IQR 6.4–9.1) 144 outcome events occurred in 101 patients. By Kaplan-Meier analysis microalbuminuria was associated with increased rate of CV outcome or death (p = 0.03), and this was still significant after stratification according to propensity score quartiles (p = 0.048). Time dependent Cox proportional hazard analysis showed independent association between microalbuminuria and CV outcomes 2 years following microalbuminuria detection (HR 1.83, 95% CI 1.07–2.96).Conclusions: Two years after documenting microalbuminuria in kidney transplanted patients, their CVD risk was increased. There is need for primary prevention strategies in this population and future studies should address the topic.

scholarly journals Potato consumption and risk of pancreatic cancer in the HELGA cohort

2018 ◽  
Vol 119 (12) ◽  
pp. 1408-1415
Author(s):  
Lene A. Åsli ◽  
Tonje Braaten ◽  
Anja Olsen ◽  
Anne Tjønneland ◽  
Kim Overvad ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Registries ◽  
Glycaemic Index ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Models ◽  
The Mean ◽  
Potato Consumption ◽  
Adjusted Model

AbstractPotatoes have been a staple food in many countries throughout the years. Potatoes have a high glycaemic index (GI) score, and high GI has been associated with several chronic diseases and cancers. Still, the research on potatoes and health is scarce and contradictive, and we identified no prospective studies that had investigated the association between potatoes as a single food and the risk of pancreatic cancer. The aim of this study was to prospectively investigate the association between potato consumption and pancreatic cancer among 114 240 men and women in the prospective HELGA cohort, using Cox proportional hazard models. Information on diet (validated FFQ’s), lifestyle and health was collected by means of a questionnaire, and 221 pancreatic cancer cases were identified through cancer registries. The mean follow-up time was 11·4 (95 % CI 0·3, 16·9) years. High consumption of potatoes showed a non-significantly higher risk of pancreatic cancer in the adjusted model (hazard ratio (HR) 1·44; 95 % CI 0·93, 2·22,Pfor trend0·030) when comparing the highestv.the lowest quartile of potato consumption. In the sex-specific analyses, significant associations were found for females (HR 2·00; 95 % CI 1·07, 3·72,Pfor trend0·020), but not for males (HR 1·01; 95 % CI 0·56, 1·84,Pfor trend0·34). In addition, we explored the associations by spline regression, and the absence of dose–response effects was confirmed. In this study, high potato consumption was not consistently associated with a higher risk of pancreatic cancer. Further studies with larger populations are needed to explore the possible sex difference.

Abstract 4355: Functional Status Is More Strongly Associated with Mortality in Cardiac Amyloid Compared to Echocardiographic Parameters

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Bethany A Austin ◽  
Brendan Duffy ◽  
Rene Rodriguez ◽  
Carmela Tan ◽  
Randall C Starling ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Cardiac Amyloidosis ◽  
Nyha Class ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Proportional Hazard ◽  
Term Survival ◽  
Cox Proportional Hazard ◽  
Lv Mass

Cardiac amyloidosis (CA) is generally associated with a poor prognosis and significantly increased mortality. We sought to identify predictors of longer-term survival in patients with EMB documented CA. Forty-five consecutive EMB documented CA patients were studied from 1/98 –12/03. Age, gender, NYHA class, medications, presence of light chain amyloid and ECG voltage were recorded. Baseline left ventricular ejection fraction (LVEF), deceleration time (DT), diastology, LV mass, interventricular septal (IVS) thickness and myocardial performance index (MPI) [(isovolumic contraction time + isovolumic relaxation time)/ejection time] were recorded. Length of follow-up and all-cause mortality were recorded. Mean age was 66 ±10 years with 34 (76 %) men. NYHA class > 2 and low voltage on ECG [S (V1) + R (V5) ≤12] were noted in 26 (58 %) and 12 (27 %) patients, respectively. Mean LVEF, IVS thickness and LV mass were 46 % ±13, 1.7 cm ±0.42 and 303 grams ±114, respectively. DT <150 msec and MPI > 0.6 were found in 19 (42 %) and 15 (33 %) patients, respectively. At median follow-up of 1.7 years, there were 25 (56%) deaths. On univariate Kaplan-Meier survival analysis, NYHA class > 2, DT <150 msec and lack of beta-blocker use were associated with increased mortality (log-rank statistic p-values <0.001, <0.05 and 0.01, respectively). Cox Proportional Hazard Survival Analysis is shown in the table . In patients with EMB-documented CA, s urvival is more strongly associated with NYHA functional class compared to ECG and echocardiographic variables, including DT and MPI. Evaluation of advanced imaging techniques such as cardiac magnetic resonance in predicting prognosis in these patients is warranted. Table: Cox Proportional Hazard Analysis of Various Clinical, Electrocardiographic and Echocardiographic Predictors of Mortality in Patients with Biopsy Proven Cardiac Amyloidosis

scholarly journals Farming tasks and the development of rheumatoid arthritis in the agricultural health study

2019 ◽  
pp. oemed-2018-105361 ◽  
Author(s):  
Christine G Parks ◽  
Armando Meyer ◽  
Laura E Beane Freeman ◽  
Jonathan Hofmann ◽  
Dale P Sandler
Keyword(s):  
Rheumatoid Arthritis ◽  
Self Report ◽  
Health Study ◽  
Proportional Hazard ◽  
Agricultural Health ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Cox Proportional Hazard Models ◽  
Agricultural Health Study

ObjectivesFarming has been associated with rheumatoid arthritis (RA). Some studies have evaluated the effects of pesticides, but other agricultural exposures may also affect immune response.MethodsWe investigated non-pesticide agricultural exposures in relation to RA in licensed pesticide applicators (n=27 175, mostly male farmers) and their spouses (n=22 231) in the Agricultural Health Study (AHS) cohort (1993–1997) who completed at least one follow-up survey through 2015. Incident RA cases (n=229 applicators and 249 spouses) were identified based on self-report confirmed by use of disease-modifying antirheumatic drugs or medical records. Hazard Ratios (HRs) and 95% Confidence Intervals (CIs) were estimated by Cox proportional hazard models adjusting for applicator status, state, smoking, education and specific pesticide use, allowing estimates to vary by median age when hazards assumptions were not met.ResultsOverall, RA was associated with regularly applying chemical fertilisers (HR=1.50; 95% CI 1.11 to 2.02), using non-gasoline solvents (HR=1.40; 95% CI 1.09 to 1.80), and painting (HR=1.26; 95% CI 1.00 to 1.59). In older applicators (>62 years), RA was associated with driving combines (HR=2.46; 95% CI 1.05 to 5.78) and milking cows (HR=2.56; 95% CI 1.01 to 6.53). In younger participants (≤62 years), RA was inversely associated with raising animals as well as crops (HR=0.68; 95% CI 0.51 to 0.89 vs crops only). Associations with specific crops varied by age: some (eg, hay) were inversely associated with RA in younger participants, while others (eg, alfalfa) were associated with RA in older participants.ConclusionThese findings suggest several agricultural tasks and exposures may contribute to development of RA.

Predictors of Loss To Follow Up and Mortality Among Children ?12 Years Receiving Anti Retroviral Therapy during the First Year at a Referral Hospital in Bali

2016 ◽  
pp. 127 ◽  
Author(s):  
S. Juergens ◽  
A.A.S. Sawitri ◽  
I.W.G. Artawan Eka Putra ◽  
Tuti Parwati Merati
Keyword(s):  
Clinical Characteristics ◽  
Demographic Characteristics ◽  
First Year ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Loss To Follow Up ◽  
Cox Proportional Hazard ◽  
Kaplan Meier

Background and purpose: Many HIV-infected children in Bali have started antiretroviral therapy (ART), but loss to follow up (LTFU) is a continuing concern, and the issue of childhood adherence is more complex compared to adults.Methods: This was a retrospective study among cohort of 138 HIV+ children on ART in Sanglah General Hospital, Denpasar, Bali from January 2010 to December 2015. Kaplan-Meier analysis was used to describe incidence and median time to LTFU/mortality and Cox Proportional Hazard Model was used to identify predictors. Variables which were analysed were socio-demographic characteristics, birth history, care giver and clinical condition of the children.Results: Mean age when starting ARV therapy was 3.21 years. About 25% experienced LTFU/death by 9.1 month resulting in an incidence rate of 3.28 per 100 child month. The higher the WHO stage, the higher the risk for LTFU/mortality along with low body weight (AHR=0.90; 95%CI: 0.82-0.99).Conclusion: Clinical characteristics were found as predictors for LTFU/mortality among children on ART.

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