WED 167 Socioeconomic status and progression of disability in ms

2018 ◽  
Vol 89 (10) ◽  
pp. A21.1-A21
Author(s):  
Katharine Harding ◽  
Elaine Kingwell ◽  
Mark Wardle ◽  
Feng Zhu ◽  
Neil Robertson ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Proportional Hazards ◽  
Meta Analysis ◽  
Age At Onset ◽  
Cox Proportional Hazards ◽  
Proportional Hazards Regression ◽  
Working Correlation ◽  
Long Term Prognosis ◽  
Generalised Estimating Equations

There is evidence that socioeconomic status (SES) is associated with multiple sclerosis (MS) incidence; however it is less clear whether there is also an association with long-term prognosis.3113 patients were selected from the MS registries of British Columbia, Canada (n=2069), and Cardiff, Wales (n=1044). SES, based on neighbourhood-level average income, was measured at onset of MS. Cox proportional hazards regression was used to analyse the association of SES with time to sustained and confirmed EDSS 6.0 and EDSS 4.0. The association between SES and EDSS scores was assessed longitudinally by a linear regression model fitted using generalised estimating equations (GEE) with an exchangeable working correlation structure. All models were adjusted for age at onset, sex, year of onset, initial course and DMT. The cohorts were analysed individually and results combined using meta-analysis.SES was associated with hazard of reaching EDSS 6.0 (adjusted hazard ratio [aHR]=0.90, 95% CI 0.89–0.91), and 4.0 (aHR=0.93, 0.88–0.98). GEE modelling confirmed association of SES with EDSS (β=−0.13, [−0.18- −0.08], p<0.001). We found evidence that lower SES is associated with poorer outcomes. Reasons for this are complex but may include lifestyle or comorbidity. Our findings are relevant for planning and development of MS services.

scholarly journals Adjusted Comparison of Outcomes between Patients from CARTITUDE-1 versus Multiple Myeloma Patients with Prior Exposure to PI, Imid and Anti-CD-38 from a German Registry

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 5996
Author(s):  
Maximilian Merz ◽  
Hartmut Goldschmidt ◽  
Parameswaran Hari ◽  
Mounzer Agha ◽  
Joris Diels ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Average Treatment Effect ◽  
T Cell Therapy ◽  
Intention To Treat ◽  
Proportional Hazards Regression ◽  
Overlap Population ◽  
German Registry

Ciltacabtagene autoleucel (cilta-cel) is a Chimeric antigen receptor T-cell therapy with the potential for long-term disease control in heavily pre-treated patients with relapsed/refractory multiple myeloma (RRMM). As cilta-cel was assessed in the single-arm CARTITUDE-1 clinical trial, we used an external cohort of patients from the Therapie Monitor registry fulfilling the CARTITUDE-1 inclusion criteria to evaluate the effectiveness of cilta-cel for overall survival (OS) and time to next treatment (TTNT) vs. real-world clinical practice. Individual patient data allowed us to adjust the comparisons between both cohorts, using the inverse probability of treatment weighting (IPW; average treatment effect in the treated population (ATT) and overlap population (ATO) weights) and multivariable Cox proportional hazards regression. Outcomes were compared in intention-to-treat (HR, IPW-ATT: TTNT: 0.13 (95% CI: 0.07, 0.24); OS: 0.14 (95% CI: 0.07, 0.25); IPW-ATO: TTNT: 0.24 (95% CI: 0.12, 0.49); OS: 0.26 (95% CI: 0.13, 0.54)) and modified intention-to-treat (HR, IPW-ATT: TTNT: 0.24 (95% CI: 0.09, 0.67); OS: 0.26 (95% CI: 0.08, 0.84); IPW-ATO: TTNT: 0.26 (95% CI: 0.11, 0.59); OS: 0.31 (95% CI: 0.12, 0.79)) populations. All the comparisons were statistically significant in favor of cilta-cel. These results highlight cilta-cel’s potential as a novel, effective treatment to address unmet needs in patients with RRMM.

scholarly journals Prognostic value of the ALBI grade among patients with single hepatocellular carcinoma without macrovascular invasion

2020 ◽  
Author(s):  
Heng Zou ◽  
Wenhao Chen ◽  
Huan Wang ◽  
Li Xiong ◽  
Yu Wen ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Tumor Size ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Grading System ◽  
Term Survival ◽  
Proportional Hazards Regression ◽  
Disease Outcomes ◽  
Single Tumor

Abstract Overview and objective: Although evidence for the application of albumin–bilirubin (ALBI) grading system to assess liver function in hepatocellular carcinoma (HCC) is available, less is known whether it can be applied to determine the prognosis of single HCC with different tumor sizes. This study aimed to address this gap.Methods: Here, we enrolled patients who underwent hepatectomy due to single HCC from the year 2010 to 2014. Analyses were performed to test the potential of ALBI grading system to monitor the long-term survival of single HCC subjects with varying tumor sizes.Results: Overall, 265 participants were recruited. The overall survival (OS) among patients whose tumors were ≤ 7 cm was remarkably higher compared to those whose tumors were > 7 cm. The Cox proportional hazards regression model identified the tumor differentiation grade, ALBI grade, and maximum tumor size as key determinants of the OS. The ALBI grade could stratify the patients who had a single tumor ≤ 7 cm into two distinct groups with different prognoses. The OS between ALBI grades 1 and 2 was comparable for patients who had a single tumor > 7 cm.Conclusions: We show that ALBI grading system can predict disease outcomes of single HCC patients with tumor size ≤ 7 cm. However, the ALBI grade may not predict capability the prognosis of patients with single tumor > 7 cm.

scholarly journals Association Between Positive Cultures During Admission and 1-Year Mortality in Patients With Cancer Receiving Perioperative Intensive Care

2018 ◽  
Vol 25 (1) ◽  
pp. 107327481879416 ◽  
Author(s):  
Hsiu-Yin Chiang ◽  
Tung-Han Wu ◽  
Chiann-Yi Hsu ◽  
Wen-Cheng Chao
Keyword(s):  
Intensive Care ◽  
Urinary Tract ◽  
Soft Tissue ◽  
Respiratory Tract ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Patients With Cancer ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression

The number of patients with cancer being admitted to intensive care units (ICUs) is increasing worldwide, and these patients are vulnerable to infection. This study aimed to address the long-term impact of positive cultures during admission on 1-year mortality among patients with cancer who received perioperative intensive care. This retrospective cohort study enrolled adult patients with cancer who were admitted to ICUs and received surgery during 2011 to 2016 at a tertiary hospital in central Taiwan. Cancer-related data were retrieved from the cancer registry, and data during ICU admissions were obtained from the electronic medical records. We compared the survival curves between patients with and without positive clinical cultures using log-rank test and used a multivariable Cox proportional hazards regression model to evaluate the influence of positive clinical cultures on 1-year mortality. A total of 638 patients were included for analyses, and 37.9% of them had positive cultures during the index admission. In-hospital mortality was 9.1%, while 1-year mortality was 21.0%. Compared with patients who survived, patients who died were significantly more likely to have positive cultures (59.7% vs 32.1%), to have a higher Acute Physiology and Chronic Health Evaluation II scores (median 21.8 vs 19.0), and to receive mechanical ventilation (86.6% vs 77.4%). Survival analysis found that positive cultures of blood, the respiratory tract, the urinary tract, or the skin and soft tissue were associated with an increased 1-year mortality. Multivariable Cox proportional hazards regression analysis found that positive cultures of blood, the respiratory tract, the urinary tract, or the skin and soft tissue (hazard ratio: 1.621; 95% confidence interval: 1.087-2.419) were significantly associated with 62.1% increased hazards of death within 1 year after the ICU admission. A positive culture during admission was associated with a worsened long-term survival among patients with cancer who received perioperative intensive care. Further studies are needed to confirm this association.

Socioeconomic status and disability progression in multiple sclerosis

Neurology ◽  
2019 ◽  
Vol 92 (13) ◽  
pp. e1497-e1506 ◽  
Author(s):  
Katharine E. Harding ◽  
Mark Wardle ◽  
Robert Carruthers ◽  
Neil Robertson ◽  
Feng Zhu ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Socioeconomic Status ◽  
Drug Exposure ◽  
Proportional Hazards ◽  
Meta Analysis ◽  
Random Effect ◽  
Cox Proportional Hazards ◽  
Disability Progression ◽  
Cox Proportional Hazards Models ◽  
Neighborhood Level

ObjectiveTo examine the association between socioeconomic status (SES) and disability outcomes and progression in multiple sclerosis (MS).MethodsHealth administrative and MS clinical data were linked for 2 cohorts of patients with MS in British Columbia (Canada) and South East Wales (UK). SES was measured at MS symptom onset (±3 years) based on neighborhood-level average income. The association between SES at MS onset and sustained and confirmed Expanded Disability Status Scale (EDSS) 6.0 and 4.0 and onset of secondary progression of MS (SPMS) were assessed using Cox proportional hazards models. EDSS scores were also examined via linear regression, using generalized estimating equations (GEE) with an exchangeable working correlation. Models were adjusted for onset age, sex, initial disease course, and disease-modifying drug exposure. Random effect models (meta-analysis) were used to combine results from the 2 cohorts.ResultsA total of 3,113 patients with MS were included (2,069 from Canada; 1,044 from Wales). A higher SES was associated with a lower hazard of reaching EDSS 6.0 (adjusted hazard ratio [aHR] 0.90, 95% confidence interval [CI] 0.89–0.91), EDSS 4.0 (aHR 0.93, 0.88–0.98), and SPMS (aHR 0.94, 0.88–0.99). The direction of findings was similar when all EDSS scores were included (GEE: β = −0.13, −0.18 to −0.08).ConclusionsLower neighborhood-level SES was associated with a higher risk of disability progression. Reasons for this association are likely to be complex but could include factors amenable to modification, such as lifestyle or comorbidity. Our findings are relevant for planning and development of MS services.

scholarly journals T83. SUBSTANCE-INDUCED PSYCHOSIS LINKED TO BOTH INFECTIONS AND SCHIZOPHRENIA

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S263-S263
Author(s):  
Carsten Hjorthøj ◽  
Marie Starzer ◽  
Michael Benros ◽  
Merete Nordentoft
Keyword(s):  
Bipolar Disorder ◽  
Proportional Hazards ◽  
Strong Support ◽  
Cox Proportional Hazards ◽  
Schizophrenia Spectrum Disorders ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
Kaplan Meier ◽  
Long Term Prognosis ◽  
Time Varying Covariates

Abstract Background Substance-induced psychosis is an under-researched phenomenon, and little is known about its etiology (other than exposure to substances) and long-term prognosis. In this presentation, we aim to present results from two recent studies, one of which was recently published and the other is currently in the process of being analyzed. The first study investigates rates and predictors of conversion from substance-induced psychosis; the second study investigates the association between severe infections and substance-induced psychosis, including the contribution of infections on conversion to schizophrenia. Methods Both studies utilized the nationwide Danish registers. In study 1, we included all people diagnosed with substance-induced psychosis from 1994 to 2014 (n=6,788). These were followed using the Kaplan-Meier method and Cox proportional hazards regression to estimate rates and predictors of conversion to schizophrenia or bipolar disorder. In study 2, we included the entire Danish population born since 1981 (n=2,256,779). These were followed in Cox proportional hazards regression models, linking hospital-requiring infections as time-varying covariates to development of substance-induced psychosis. In further analyses, we followed those who had developed substance-induced psychosis to determine whether infections would influence the risk of converting to schizophrenia. Results Study 1: Overall, 32.2% (95% CI 29.7–34.9) of patients with a substance-induced psychosis converted to either bipolar or schizophrenia-spectrum disorders. The highest conversion rate was found for cannabis-induced psychosis, with 47.4% (95% CI 42.7–52.3) converting to either schizophrenia or bipolar disorder. Young age was associated with a higher risk of converting to schizophrenia. Self-harm was significantly linked to a higher risk of converting to both schizophrenia and bipolar disorder. Study 2: Infections increased the risk of substance-induced psychosis (HR=1.30, 95% CI 1.22–1.39) in the fully adjusted model. Hepatitis was the infection most strongly associated with substance-induced psychosis, at HR=3.42 (95% CI 2.47–4.74). Different sites of infections showed associations with different types of substance-induced psychosis. Finally, hepatitis increased the risk of conversion to schizophrenia with HR=1.87 (95% CI 1.07–3.26). Discussion Substance-induced psychosis is strongly associated with the development of severe mental illness, and a long follow-up period is needed to identify the majority of cases. Infections appear to play a role in the etiology of substance-induced psychosis which is very similar to the role infections play in the etiology of schizophrenia. This lends strong support to the existence of an immune-related component to psychosis in general, and not just to schizophrenia.

Long-Term Exposure to Ambient Hydrocarbons Increases Dementia Risk in People Aged 50 Years and above in Taiwan

2020 ◽  
Vol 16 (14) ◽  
pp. 1276-1289
Author(s):  
Han-Wei Zhang ◽  
Victor C. Kok ◽  
Shu-Chun Chuang ◽  
Chun-Hung Tseng ◽  
Chin-Teng Lin ◽  
...  
Keyword(s):  
Air Pollutants ◽  
Proportional Hazards ◽  
The Elderly ◽  
Cox Proportional Hazards ◽  
Proportional Hazards Regression ◽  
Hazard Ratios ◽  
Dementia Risk ◽  
Disease Exposure ◽  
Total Hydrocarbons

Background: Alzheimer’s disease, the most common cause of dementia among the elderly, is a progressive and irreversible neurodegenerative disease. Exposure to air pollutants is known to have adverse effects on human health, however, little is known about hydrocarbons in the air that can trigger a dementia event. Objective: We aimed to investigate whether long-term exposure to airborne hydrocarbons increases the risk of developing dementia. Method: The present cohort study included 178,085 people aged 50 years and older in Taiwan. Cox proportional hazards regression analysis was used to fit the multiple pollutant models for two targeted pollutants, including total hydrocarbons and non-methane hydrocarbons, and estimated the risk of dementia. Results: Before controlling for multiple pollutants, hazard ratios with 95% confidence intervals for the overall population were 7.63 (7.28-7.99, p <0.001) at a 0.51-ppm increases in total hydrocarbons, and 2.94 (2.82-3.05, p <0.001) at a 0.32-ppm increases in non-methane hydrocarbons. The highest adjusted hazard ratios for different multiple-pollutant models of each targeted pollutant were statistically significant (p <0.001) for all patients: 11.52 (10.86-12.24) for total hydrocarbons and 9.73 (9.18-10.32) for non-methane hydrocarbons. Conclusion: Our findings suggest that total hydrocarbons and non-methane hydrocarbons may be contributing to dementia development.

Long-Term Case-Fatality Rate of Nontuberculous Mycobacterial Disease in People Living with HIV

2021 ◽  
Author(s):  
Jingjing Hu ◽  
Ling Gu ◽  
Yueming Shao ◽  
Renfang Zhang ◽  
Tangkai Qi ◽  
...  
Keyword(s):  
Case Fatality Rate ◽  
Proportional Hazards ◽  
Case Fatality ◽  
Cox Proportional Hazards ◽  
People Living With Hiv ◽  
Fatality Rate ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
Living With Hiv

Abstract Background Few data are available regarding the long-term case-fatality rate (CFR) among people living with HIV (PLWH) with nontuberculous mycobacteria (NTM) disease. Objectives To analyze the long-term CFR in patients with NTM disease and to identify risk factors for their death. Methods A retrospective cohort study of 379 cases of microbiologically confirmed NTM disease in PLWH was conducted during January 1, 2012 to December 31, 2020 in Shanghai, China. We used Kaplan-Meier survival analysis and log-rank test to compare long-term CFR in patients with disseminated NTM (DNTM) and localized NTM disease. Univariate Cox proportional hazards regression analysis and stepwise Cox proportional hazards regression model were used to estimate the predictors of long-term CFR. Results The cohort was follow-up for a median of 26 months. The total CFR was 15.7% by one year and increased to 22.6% at 5 years after the diagnosis of NTM disease. The 5-year CFR of PLWH with DNTM was significantly higher than that of localized NTM (26.7% vs. 19.6% for DNTM and localized NTM disease, respectively). Older age (hazard ratio [HR] = 1.04, 95% confidence interval [CI]: 1.02-1.06, P < 0.001), comorbidity (HR = 2.05, 95% CI: 1.21-3.49, P < 0.01), DNTM (HR = 2.08, 95% CI: 1.17-3.68, P < 0.05), and HIV viral load (HR = 1.32, 95% CI: 1.12-1.55, P < 0.001) were all independent risk factors of long-term CFR. In the subgroup analysis, time to culture positivity was negatively correlated with CFR in patients with DNTM (HR = 0.90, 95% CI: 0.82-0.98, P < 0.05). Conclusions NTM was associated with significantly high long-term CFR in PLWH. Further approaches to prevent NTM disease in PLWH are urgently needed.

scholarly journals THE PROGNOSTIC SIGNIFICANCE OF CD3+, CD68+, CD20+ INTERSTITIAL CELLS IN PATIENTS WITH KIDNEY ALLOGRAFT GLOMERULITIS

2018 ◽  
Vol 22 (6) ◽  
pp. 47-55
Author(s):  
V. A. Dobronravov ◽  
A. O. Mukhametdinova ◽  
M. S. Khrabrova ◽  
A. Nabokow ◽  
H. -J. Gröne ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Cox Proportional Hazards ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Long Term Prognosis ◽  
The Impact ◽  
The Relationship

THE OBJECTIVEof the study was to assess the impact of the count of interstitial CD3+, CD68+ and CD20+ cells on long-term prognosis of renal allograft (RA).PATIENTS AND METHODS.86 RA recipients with biopsy-proven according to the Banff 2013- 2017 criteria glomerulitis were enrolled in this retrospective study. The patients were subdivided into the following groups: 1) isolated glomerulitis with negative donor-specific antibodies (DSA) at the biopsy (n=53); 2) glomerulitis with positive DSA (n=22); 3) glomerulitis with undetermined DSA (n=11). Quantitative assay of interstitial positive cells was performed after immunohistochemical staining for CD68+, CD3+, CD20+. The Kaplan-Meier method and Cox proportional hazards regression model were used for the analysis of the relationship between interstitial CD3+, CD68+, CD20+ cells and risk of RA loss.RESULTS.CD68+ and CD3+ cells prevailed in interstitium in RA glomerulitis. CD20+ infiltrates were found in 60% of cases. CD20+ cells tended to form infiltrates, in 9 cases these infiltrates reached large sizes (≥ 50 CD20+ lymphocytes) and formed nodular structures. There was no difference in the count of interstitial CD3+ and CD68+ cells and in the presence of CD20+ infiltrates between DSA subgroups. Interstitial CD68+ ≥ 5 cells per field of view (FOV) (x400) and CD3+ ≥ 8 cells per FOV (x400), as well as the presence of large CD20+ infiltrates were associated with a lower RA survival (plog-rank < 0,05). Interstitial CD68+ (≥ 5 cells/FOV), CD3 + (≥ 8 cells/FOV) and the presence of large CD20+ interstitial infiltrates were independently associated with the risk of RA loss in the multivariable Cox regression analysis adjusted for DSA, cold and warm ischemia time (p < 0.05). CONCLUSION. Grade of interstitial infiltration by CD68+, CD3+ and CD20+ cells in RA glomerulitis could be independent predictor of RA loss.

The long-term prognosis of pneumomediastinum associated with dermatomyositis: a two-centre retrospective cohort study

Rheumatology ◽  
2020 ◽  
Author(s):  
Can Li ◽  
Mei’e Liang ◽  
Hui Jiang ◽  
Jiuliang Zhao ◽  
Chanyuan Wu ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Term Survival ◽  
Long Term Survival ◽  
Hazards Model ◽  
Long Term Prognosis

Abstract Objectives Pneumomediastinum (PnM) is a rare but life-threatening complication of DM. The present study aims to characterize the long-term prognosis and prognostic factors of DM-associated PnM. Methods Inpatients with DM-associated PnM were retrospectively enrolled from two tertiary referral centres for rheumatic disease. The enrolled patients were divided into survivors or non-survivors. Information about the demographics, clinical manifestations, CT scan features, laboratory findings and outcomes were collected from their medical records. A least absolute shrinkage and selection operator regularized Cox regression model was used to select the most relevant factors. Prognosis was analysed using a Kaplan–Meier curve. A Cox proportional hazards model was used to identify independent predictive factors for long-term survival. Results A total of 62 patients (26 women) with DM-associated PnM were enrolled. The mean age was 44.3 years (s.d. 11.7). The median follow-up duration was 17 days (quartiles 7, 266.5). Thirty-five patients died during follow-up. The survival rates were 75.4% at 1 week, 46.2% at 3 months and 41.9% at 1 year. The Cox proportional hazards model identified the development of fever [hazard ratio (HR) 3.23 (95% CI 1.25, 8.35), P = 0.02] and a decrease in the number of lymphocytes [HR 2.19 (95% CI 1.10, 4.39), P = 0.03] as independent risk factors for death. Conclusion The results suggest poor overall survival among patients with DM-associated PnM. Survival during the first 3 months is crucial for long-term survival. Meanwhile, the development of fever and a decrease in the number of lymphocytes were associated with long-term mortality. Early recognition and prompt treatment of this high-risk group of DM patients is therefore important.

scholarly journals Vasoactive Biomarkers Associated With Long-Term Incidence of Symptomatic Peripheral Arterial Disease and Mortality

Angiology ◽  
2021 ◽  
pp. 000331972098773
Author(s):  
Ardwan Dakhel ◽  
Gunnar Engström ◽  
Olle Melander ◽  
Stefan Acosta ◽  
Shahab Fatemi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Peripheral Arterial Disease ◽  
Proportional Hazards ◽  
Arterial Disease ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression ◽  
Peripheral Arterial

We evaluated if plasma biomarkers can predict incident peripheral arterial disease (PAD) and mortality in a longitudinal cohort study. Men (n = 3618) and women (n = 1542) were included in the Malmö Preventive Project and underwent analysis of: C-terminal endothelin-1 (CT-proET-1), N-Terminal prosomatostatin (NT-proSST), midregional proatrial natriuretic peptide (MR-proANP), procalcitonin (PCT), and copeptin. Participants were followed up for incident PAD and mortality until December 31, 2016. Median follow-up was 11.2 years (interquartile range 9.4-12.2). Cumulative incidence of PAD was 4.3% (221/5160), 4.5% in men (164/3618) and 3.7% in women (57/1542; P = .174). In an adjusted Cox proportional hazards regression model, higher CT-proET-1 (hazard ratio [HR] 1.8; 95% confidence interval [CI] 1.4-2.3), NT-proSST (HR 1.5; 95% CI 1.2-2.0), and MR-proANP (HR 1.7; 95% CI 1.3-2.3) were independently associated with incident PAD, and higher CT-proET-1 (HR 1.3; 95% CI 1.2-1.5), NT-proSST (HR 1.2; 95% CI 1.1-1.3), MR-proANP (HR 1.4; 95% CI 1.3-1.6), PCT (HR 1.1; 95% CI 1.0-1.2), and copeptin (HR 1.2; 95% CI 1.1-1.4) were independently associated with mortality. Increased levels of CT-proET-1, NT-proSST, and MR-proANP were independently associated with incident PAD, whereas all the vasoactive biomarkers were independently associated with mortality during follow-up.

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