Determinants of Mortality among Adult HIV-Infected Patients on Antiretroviral Therapy in a Rural Hospital in Southeastern Nigeria: A 5-Year Cohort Study

Background. Study examined the determinants of mortality among adult HIV patients in a rural, tertiary hospital in southeastern Nigeria, comparing mortality among various ART regimens.Methods. Retrospective cohort study of 1069 patients on ART between August 2008 and October 2013. Baseline CD4 counts, age, gender, and ART regimen were considered in this study. Kaplan-Meier method was used to estimate survival and Cox proportional hazards models to identify multivariate predictors of mortality. Median follow-up period was 24 months (IQR 6–45).Results. 78 (7.3%) patients died with 15.6% lost to followup. Significant independent predictors of mortality include age (>45), sex (male > female), baseline CD4 stage (<200), and ART combination. Adjusted mortality hazard was 3 times higher among patients with CD4 count <200 cells/μL than those with counts >500 (95% CI 1.69–13.59). Patients on Truvada-based first-line regimens were 88% more likely to die than those on Combivir-based first line (95% CI 1.05–3.36), especially those with CD4 count <200 cells/μL.Conclusion. Study showed lower mortality than most studies in Nigeria and Africa, with mortality higher among males and patients with CD4 count <200. Further studies are recommended to further compare treatment outcomes between Combivir- and Truvada-based regimens in resource-limited settings using clinical indicators.

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Prevalence and Prognostic Value of Heart Failure Stages: An Elderly Inpatient Based Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.639453 ◽

2021 ◽

Vol 8 ◽

Author(s):

Pei-Pei Zheng ◽

Si-Min Yao ◽

Di Guo ◽

Ling-ling Cui ◽

Guo-Bin Miao ◽

...

Keyword(s):

Heart Failure ◽

Cohort Study ◽

Prognostic Value ◽

Proportional Hazards ◽

Regression Tree ◽

Cox Proportional Hazards ◽

Hospitalized Patients ◽

Classification And Regression Tree ◽

Major Adverse Cardiovascular Events ◽

Cox Proportional Hazards Models

Background: The prevalence and prognostic value of heart failure (HF) stages among elderly hospitalized patients is unclear.Methods: We conducted a prospective, observational, multi-center, cohort study, including hospitalized patients with the sample size of 1,068; patients were age 65 years or more, able to cooperate with the assessment and to complete the echocardiogram. Two cardiologists classified all participants in various HF stages according to 2013 ACC/AHA HF staging guidelines. The outcome was rate of 1-year major adverse cardiovascular events (MACE). The Kaplan–Meier method and Cox proportional hazards models were used for survival analyses. Survival classification and regression tree analysis were used to determine the optimal cutoff of N-terminal pro-brain natriuretic peptide (NT-proBNP) to predict MACE.Results: Participants' mean age was 75.3 ± 6.88 years. Of them, 4.7% were healthy and without HF risk factors, 21.0% were stage A, 58.7% were stage B, and 15.6% were stage C/D. HF stages were associated with worsening 1-year survival without MACE (log-rank χ2 = 69.62, P < 0.001). Deterioration from stage B to C/D was related to significant increases in HR (3.636, 95% CI, 2.174–6.098, P < 0.001). Patients with NT-proBNP levels over 280.45 pg/mL in stage B (HR 2; 95% CI 1.112–3.597; P = 0.021) and 11,111.5 pg/ml in stage C/D (HR 2.603, 95% CI 1.014–6.682; P = 0.047) experienced a high incidence of MACE adjusted for age, sex, and glomerular filtration rate.Conclusions : HF stage B, rather than stage A, was most common in elderly inpatients. NT-proBNP may help predict MACE in stage B.Trial Registration: ChiCTR1800017204; 07/18/2018.

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Risk of depressive disorders after tobacco smoking cessation: a retrospective cohort study in Fukuoka, Japan

BMJ Open ◽

10.1136/bmjopen-2018-025124 ◽

2019 ◽

Vol 9 (3) ◽

pp. e025124 ◽

Cited By ~ 1

Author(s):

Takako Fujita ◽

Akira Babazono ◽

Yumi Harano ◽

Peng Jiang

Keyword(s):

Smoking Cessation ◽

Cohort Study ◽

Survival Analysis ◽

Retrospective Cohort ◽

Depressive Disorders ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Proportional Hazards Models ◽

Cox Proportional Hazards Models ◽

Significant Difference

ObjectiveWe sought to examine the effect of smoking cessation on subsequent development of depressive disorders.DesignThis was a retrospective cohort study.MethodsWe used administrative claim and health check data from fiscal years 2010 to 2014, obtained from the largest health insurance association in Fukuoka, Japan. Study participants were between 30 and 69 years old. The end-point outcome was incidence of depressive disorders. Survival analysis and Cox proportional hazards models were conducted. The evaluated potential confounders were sex, age, standard monthly income and psychiatric medical history.ResultsThe final number of participants was 87 255, with 7841 in the smoking cessation group and 79 414 in the smoking group. The result of survival analysis showed no significant difference in depressive disorders between the two groups. The results of Cox proportional hazards models showed no significant difference by multivariate analysis between participants, including users of smoking cessation medication (HR 1.04, 95% Cl 0.89 to 1.22) and excluding medication use (HR 0.97, 95% Cl 0.82 to 1.15).ConclusionsThe present study showed that there were no significant differences with respect to having depressive disorders between smoking cessation and smoking groups. We also showed that smoking cessation was not related to incidence of depressive disorders among participants, including and excluding users of smoking cessation medication, after adjusting for potential confounders. Although the results have some limitations because of the nature of the study design, our findings will provide helpful information to smokers, health professionals and policy makers for improving smoking cessation.

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A cohort study of dietary fibre intake and menarche

Public Health Nutrition ◽

10.1079/phn2002261 ◽

2002 ◽

Vol 5 (2) ◽

pp. 353-360 ◽

Cited By ~ 40

Author(s):

Malcolm M Koo ◽

Thomas E Rohan ◽

Meera Jain ◽

John R McLaughlin ◽

Paul N Corey

Keyword(s):

Cohort Study ◽

Dietary Intake ◽

Dietary Fibre ◽

Lower Risk ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Age At Menarche ◽

Relative Hazard ◽

Component Level ◽

Cox Proportional Hazards Models

AbstractObjective:To evaluate the influence of dietary fibre on menarche in a cohort of pre-menarcheal girls.Design:Prospective cohort study.Setting:Ontario, Canada.Subjects:Free-living pre-menarcheal girls (n = 637), 6 to 14 years of age.Methodology:Information on dietary intake, physical activity and date of menarche was collected at baseline and was updated annually by self-administered questionnaires for three years. Cox proportional hazards models were used to evaluate the association between dietary fibre and menarche, adjusting for age at entry to the study and potential confounders.Results:A higher intake of energy-adjusted dietary fibre was associated with a lower risk of (i.e. a later age at) menarche (relative hazard 0.54, 95% confidence interval (CI) 0.31–0.94 for highest vs. lowest quartile, P for trend = 0.027). At the fibre component level, a higher intake of energy-adjusted cellulose was associated with a lower risk of menarche (relative hazard 0.45, 95% CI 0.26–0.76, P for trend = 0.009).Conclusions:The findings are consistent with the hypothesis that pre-menarcheal dietary intake can influence menarche.

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U-Shaped Association of Serum Uric Acid With All-Cause and Cause-Specific Mortality in US Adults: A Cohort Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgz068 ◽

2019 ◽

Vol 105 (3) ◽

pp. e597-e609 ◽

Cited By ~ 1

Author(s):

Lihua Hu ◽

Guiping Hu ◽

Benjamin Ping Xu ◽

Lingjuan Zhu ◽

Wei Zhou ◽

...

Keyword(s):

Uric Acid ◽

Cohort Study ◽

Serum Uric Acid ◽

Inflection Point ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Proportional Hazards Models ◽

Cox Proportional Hazards Models ◽

Specific Mortality ◽

The Relationship

Abstract Background In addition to the controversy regarding the association of hyperuricemia with mortality, uncertainty also remains regarding the association between low serum uric acid (SUA) and mortality. We aimed to assess the relationship between SUA and all-cause and cause-specific mortality. Methods This cohort study included 9118 US adults from the National Health and Nutrition Examination Survey (1999-2002). Multivariable Cox proportional hazards models were used to evaluate the relationship between SUA and mortality. Our analysis included the use of a generalized additive model and smooth curve fitting (penalized spline method), and 2-piecewise Cox proportional hazards models, to address the nonlinearity between SUA and mortality. Results During a median follow-up of 5.83 years, 448 all-cause deaths occurred, with 100 cardiovascular disease (CVD) deaths, 118 cancer deaths, and 37 respiratory disease deaths. Compared with the reference group, there was an increased risk of all-cause, CVD, cancer, and respiratory disease mortality for participants in the first and third tertiles of SUA. We further found a nonlinear and U-shaped association between SUA and mortality. The inflection point for the curve was found at a SUA level of 5.7 mg/dL. The hazard ratios (95% confidence intervals) for all-cause mortality were 0.80 (0.65-0.97) and 1.24 (1.10-1.40) to the left and right of the inflection point, respectively. This U-shaped association was observed in both sexes; the inflection point for SUA was 6 mg/dL in males and 4 mg/dL in females. Conclusion Both low and high SUA levels were associated with increased all-cause and cause-specific mortality, supporting a U-shaped association between SUA and mortality.

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Differences in survival for metastatic colorectal cancer patients by lines of therapy received.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e14016 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e14016-e14016

Author(s):

Brian S. Seal ◽

Benjamin Chastek ◽

Mahesh Kulakodlu ◽

Satish Valluri

Keyword(s):

Proportional Hazards ◽

Survival Rates ◽

Patient Characteristics ◽

Cox Proportional Hazards ◽

Research Database ◽

First Line ◽

Cox Proportional Hazards Models ◽

Stage 4 ◽

Similar Survival ◽

The Impact

e14016 Background: Improvements in survival for advanced-stage CRC patients who receive chemotherapy have been reported. We compared survival rates for patients with 3+ vs. <3 lines of therapy. Methods: Adult patients with a diagnosis of CRC between 01/01/05 and 05/31/10 were identified from the Impact Intelligence Oncology Management (IIOM) registry. Patients with either stage 4 CRC at original diagnosis or development of metastasis were included. Registry data included original stage and date of diagnosis. Linked healthcare claims from the Life Sciences Research Database, a large US health insurance database affiliated with OptumInsight, were used to identify lines of therapy after metastases and patient characteristics. Death data were obtained from the Social Security Administration’s master death file. Patients were categorized by number of lines of therapy received (0, 1, 2, 3+) and original stage at diagnosis (0-2, 3, 4, unknown). Survival following metastases was evaluated using Cox proportional hazards models controlling for lines of therapy received, stage, and other patient characteristics. Results: 598 patients, followed for a mean of 653 days after becoming metastatic, were included. Mean unadjusted length of follow-up was lowest among patients who received no chemotherapy (516 days) or only 1 line (511 days), and increased to 627 days for those with 2 lines and 930 days for those with 3+ lines. However, multivariate analysis indicated that patients with 3+ lines had comparable survival vs. those with 0 (HR=0.79), 1 (HR=1.59), or 2 (HR=1.15) lines of therapy (p>0.05 for all comparisons). Compared to patients who presented with stage 4 CRC, those who progressed from stage 0-2 (HR=1.22), stage 3 (HR=0.83), or unknown stage (HR=1.18) had similar survival after metastases (p>0.05 for all comparisons). After excluding 94 patients who didn’t receive chemotherapy, patients treated with an oxaliplatin-based regimen (HR=1.28; p=0.24) in first line had similar survival compared to patients treated with an irinotecan-based or anti-EGFR regimen in first line. Conclusions: Lines of therapy received and initial stage were not associated with survival after development of metastases.

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Depression as a risk factor for the development of rheumatoid arthritis: a population-based cohort study

RMD Open ◽

10.1136/rmdopen-2018-000670 ◽

2018 ◽

Vol 4 (2) ◽

pp. e000670 ◽

Cited By ~ 12

Author(s):

Isabelle A Vallerand ◽

Ryan T Lewinson ◽

Alexandra D Frolkis ◽

Mark W Lowerison ◽

Gilaad G Kaplan ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Cohort Study ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Future Research ◽

Health Improvement ◽

Proportional Hazards Models ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

Antidepressant Use

ObjectivesMajor depressive disorder (MDD) is associated with increased levels of systemic proinflammatory cytokines, including tumour necrosis factor alpha. As these cytokines are pathogenic in autoimmune diseases such as rheumatoid arthritis (RA), our aim was to explore on a population-level whether MDD increases the risk of developing RA.MethodsA retrospective cohort study was conducted using The Health Improvement Network (THIN) database (from 1986 to 2012). Observation time was recorded for both the MDD and referent cohorts until patients developed RA or were censored. Cox proportional hazards models were used to determine the risk of developing RA among patients with MDD, accounting for age, sex, medical comorbidities, smoking, body mass index and antidepressant use.ResultsA cohort of 403 932 patients with MDD and a referent cohort of 5 339 399 patients without MDD were identified in THIN. Cox proportional hazards models revealed a 31% increased risk of developing RA among those with MDD in an unadjusted model (HR=1.31, 95% CI 1.25 to 1.36, p<0.0001). When adjusting for all covariates, the risk remained significantly increased among those with MDD (HR=1.38, 95% CI 1.31 to 1.46, p<0.0001). Antidepressant use demonstrated a confounding effect that was protective on the association between MDD and RA.ConclusionMDD increased the risk of developing RA by 38%, and antidepressants may decrease this risk in these patients. Future research is necessary to confirm the underlying mechanism of MDD on the pathogenesis of RA.

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Predictors of 10-year hospital use in a community-dwelling population of Brazilian elderly: the Bambuí cohort study of aging

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2011001500003 ◽

2011 ◽

Vol 27 (suppl 3) ◽

pp. s336-s344 ◽

Cited By ~ 6

Author(s):

James Macinko ◽

Vitor Camargos ◽

Josélia O. A. Firmo ◽

Maria Fernanda Lima-Costa

Keyword(s):

Cohort Study ◽

Chronic Conditions ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Proportional Hazards Models ◽

Cox Proportional Hazards Models ◽

Male Sex

We use data from a population-based cohort of elderly Brazilians to assess predictors of hospitalizations during ten years of follow-up. Participants were 1,448 persons aged 60 years and over at baseline (1997). The outcome was self-reported number of hospitalizations per year. Slightly more than a fifth (23%) experienced no hospitalizations during the 10 year follow-up. About 30% had 1-2 events, 31% had between 3 and 7 events, and about 18% had 8 or more events during this time. Results of multivariable hurdle and Cox proportional hazards models showed that the risk of hospitalization was positively associated with male sex, increased age, chronic conditions, and visits to the doctors in the previous 12 months. Underweight was a predictor of any hospitalization, while obesity was an inconsistent predictor of hospitalization.

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Safety of the Methotrexate-leflunomide Combination in Rheumatoid Arthritis: Results of a Multicentric, Registry-based, Cohort Study (Biobadabrasil)

The Journal of Rheumatology ◽

10.3899/jrheum.201248 ◽

2021 ◽

pp. jrheum.201248

Author(s):

Markus Bredemeier ◽

Roberto Ranza ◽

Adriana Maria Kakehasi ◽

Aline Ranzolin ◽

Inês Guimarães da Silveira ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Cohort Study ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Serious Adverse Events ◽

Cox Proportional Hazards Models ◽

Advanced Therapies ◽

Serious Infections ◽

Cox Analysis ◽

Lower Hazard

Objective To evaluate the safety of the methotrexate (MTX)-leflunomide (LEF) combination in rheumatoid arthritis (RA), comparing it with other therapeutic schemes involving conventional synthetic (cs-) and biologic (b-) disease modifying anti-rheumatic drugs (DMARDs) or JAK inhibitors (JAKi). Methods RA patients starting the first treatment course with a csDMARD (without previous use of biologic or JAKi) or first bDMARD/JAKi were followed-up in a registry-based, multicentric cohort study in Brazil (BiobadaBrasil). The primary outcome was the incidence of serious adverse events (SAEs); secondary outcomes included serious infections. Multivariate Cox proportional hazards models and propensity score matched analysis (PSMA) were used for statistical comparisons. Results In total, 1671 patients (5349 patient-years [PY]) were enrolled; 452 patients (1537 PY) received MTX plus LEF. The overall incidence of SAEs was 5.6/100 PY. The hazard of SAEs for MTX plus LEF was not higher than for MTX or LEF (adjusted hazard ratio: 1.00, 95% CI, 0.76 to 1.31, P=0.984). The MTX-LEF combo presented a lower hazard of SAEs (0.56, 0.36 to 0.88, P=0.011) and infectious SAEs (0.48, 0.25 to 0.94, P=0.031) than bDMARDs/JAKi with MTX or LEF. MTX plus LEF presented lower hazard of SAEs than MTX plus SSZ (0.33, 0.16 to 0.65, P=0.002). Analysis using PSMA confirmed the results obtained with traditional multivariate Cox analysis. Conclusion In our study, MTX plus LEF presented a relatively good overall safety profile in comparison to MTX plus SSZ and schemes involving advanced therapies in RA.

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Association of frailty with mortality in older inpatients with Covid-19: a cohort study

Age and Ageing ◽

10.1093/ageing/afaa184 ◽

2020 ◽

Vol 49 (6) ◽

pp. 915-922 ◽

Cited By ~ 7

Author(s):

Darren Aw ◽

Lauren Woodrow ◽

Giulia Ogliari ◽

Rowan Harwood

Keyword(s):

Cohort Study ◽

Mortality Risk ◽

Proportional Hazards ◽

Illness Severity ◽

Cox Proportional Hazards ◽

Acute Illness ◽

Clinical Frailty Scale ◽

Cox Proportional Hazards Models ◽

All Cause Mortality ◽

Older Inpatients

Abstract Background COVID-19 has disproportionately affected older people. Objective The objective of this paper to investigate whether frailty is associated with all-cause mortality in older hospital inpatients, with COVID-19. Design Cohort study. Setting Secondary care acute hospital. Participants Participants included are 677 consecutive inpatients aged 65 years and over. Methods Cox proportional hazards models were used to examine the association of frailty with mortality. Frailty was assessed at baseline, according to the Clinical Frailty Scale (CFS), where higher categories indicate worse frailty. Analyses were adjusted for age, sex, deprivation, ethnicity, previous admissions and acute illness severity. Results Six hundred and sixty-four patients were classified according to CFS. Two hundred and seventy-one died, during a mean follow-up of 34.3 days. Worse frailty at baseline was associated with increased mortality risk, even after full adjustment (P = 0.004). Patients with CFS 4 and CFS 5 had non-significant increased mortality risks, compared to those with CFS 1–3. Patients with CFS 6 had a 2.13-fold (95% CI 1.34–3.38) and those with CFS 7–9 had a 1.79-fold (95% CI 1.12–2.88) increased mortality risk, compared to those with CFS 1–3 (P = 0.001 and 0.016, respectively). Older age, male sex and acute illness severity were also associated with increased mortality risk. Conclusions Frailty is associated with all-cause mortality risk in older inpatients with COVID-19.

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Mortality Related to Coagulase-Negative Staphylococcal Bacteremia in Febrile Neutropenia: A Cohort Study

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2014/702621 ◽

2014 ◽

Vol 25 (1) ◽

pp. e14-e17 ◽

Cited By ~ 13

Author(s):

Regis G Rosa ◽

Rodrigo P dos Santos ◽

Luciano Z Goldani

Keyword(s):

Cohort Study ◽

Febrile Neutropenia ◽

Proportional Hazards ◽

Bloodstream Infections ◽

Tertiary Hospital ◽

Cox Proportional Hazards ◽

Adult Patients ◽

Lower Mortality ◽

Coagulase Negative Staphylococci ◽

Patients With Cancer

BACKGROUND: Coagulase-negative staphylococci (CoNS) are currently the most common isolates recovered from the blood of patients with cancer and febrile neutropenia (FN).OBJECTIVES:To assess the mortality associated with bloodstream infections (BSIs) caused by CoNS in cancer patients with FN.METHODS: A prospective cohort study was conducted in a single tertiary hospital from October 2009 to August 2011. Follow-ups were performed on all of the adult patients who were admitted to the hematology ward with cancer and FN. Bacteremia caused by CoNS was defined as two positive results of two independent cultures. Twenty-eight days after the onset of FN, the mortality rates of the patients with BSIs caused by CoNS were compared with those of patients with BSIs caused by other pathogens.RESULTS: A total of 169 subjects were evaluated. During the study period, 78 patients with BSIs were documented. Twenty-three BSIs (29.4%) were a result of CoNS. CoNS-induced bacteremia resulted in lower 28-day mortality compared with bacteremia caused by other pathogens (4.3% versus 32.7%; log-rank P=0.009). In a Cox proportional hazards regression analysis, BSIs caused by CoNS were independently associated with lower mortality (HR 0.09 [95% CI 0.01 to 0.74]).CONCLUSIONS:In adult patients with cancer and FN, BSIs caused by CoNS were associated with lower mortality compared with BSIs caused by other pathogens.

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