Abstract P017: Serum N-Carboxymethyl-Lysine and Risk of Mortality in Older Adults

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Mary Lou Biggs ◽  
David Benkeser ◽  
Joachim Ix ◽  
Jorge Kizer ◽  
Luc Djousse ◽  
...  
Keyword(s):  
Renal Failure ◽  
Mortality Risk ◽  
Community Dwelling ◽  
Cardiovascular Health Study ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Organ Systems ◽  
Increased Risk ◽  
Carboxymethyl Lysine ◽  
The Mean

Advanced glycation end products (AGEs) are compounds formed by the non-enzymatic glycation of proteins, lipids, and nucleic acids, and are thought to play a role in the pathogenesis of diseases across multiple organ systems. Carboxymethyl-lysine (CML) is a dominant AGE found in tissue proteins and in the circulation, and a commonly used AGE biomarker. Only a few epidemiological studies have evaluated the association between circulating CML and mortality risk, and none have evaluated the association between CML and cause-specific non-CVD mortality. We measured CML by ELISA on serum specimens collected from 3,373 Cardiovascular Health Study participants in 1996. Participants were followed for death through 2010, and cause of death was classified using death certificates, medical records, and proxy interview. We used Cox regression to estimate the relative risk of total and cause-specific mortality associated with circulating CML, adjusting for confounders (Models 1 & 2) and estimated glomerular filtration rate (eGFR) as a potential mediator (Model 3). We tested whether sex or diabetes modified the association between CML and mortality. The mean age among participants was 78 years and 60% were women. The mean CML level among participants was 629 ng/mL. Over median follow-up of 10 years, 2,322 deaths occurred (73.4 per 1,000 person-years). After adjustment for confounders (Models 1 & 2), CML was associated with an increased risk of death from CVD, dementia, infection, fracture/trauma, and renal failure (Table). Aside from renal failure, adjustment for eGFR attenuated the HR estimates modestly. There was no evidence for effect modification of the association of CML and all-cause mortality risk by sex or diabetes. In a cohort of community-dwelling older individuals, elevated circulating CML was associated with increased risk of mortality from cardiovascular causes, dementia, infection, fracture/trauma, and renal failure. A portion of the increased risk may be mediated through decreased renal function.

scholarly journals 416 - Risk of Mortality Associated with Antipsychotics in Alzheimer's Disease

2020 ◽  
Vol 32 (S1) ◽  
pp. 132-132
Author(s):  
Liliana P. Ferreira ◽  
Núria Santos ◽  
Nuno Fernandes ◽  
Carla Ferreira
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Adverse Events ◽  
Mortality Risk ◽  
Antipsychotic Treatment ◽  
Serious Adverse Events ◽  
Risk Of Death ◽  
Mesh Terms ◽  
Risk Of Mortality ◽  
Increased Risk

Objectives: Alzheimer's disease (AD) is the most common cause of dementia and it is associated with increased mortality. The use of antipsychotics is common among the elderly, especially in those with dementia. Evidence suggests an increased risk of mortality associated with antipsychotic use. Despite the short-term benefit of antipsychotic treatment to reduce the behavioral and psychological symptoms of dementia, it increases the risk of mortality in patients with AD. Our aim is to discuss the findings from the literature about risk of mortality associated with the use of antipsychotics in AD.Methods: We searched Internet databases indexed at MEDLINE using following MeSH terms: "Antipsychotic Agents" AND "Alzheimer Disease" OR "Dementia" AND "Mortality" and selected articles published in the last 5 years.Results: Antipsychotics are widely used in the pharmacological treatment of agitation and aggression in elderly patients with AD, but their benefit is limited. Serious adverse events associated with antipsychotics include increased risk of death. The risk of mortality is associated with both typical and atypical antipsychotics. Antipsychotic polypharmacy is associated with a higher mortality risk than monotherapy and should be avoided. The mortality risk increases after the first few days of treatment, gradually reducing but continues to increase after two years of treatment. Haloperidol is associated with a higher mortality risk and quetiapine with a lower risk than risperidone.Conclusions: If the use of antipsychotics is considered necessary, the lowest effective dose should be chosen and the duration should be limited because the mortality risk remains high with long-term use. The risk / benefit should be considered when choosing the antipsychotic. Further studies on the efficacy and risk of adverse events with antipsychotics are needed for a better choice of treatment and adequate monitoring with risk reduction.

Circulating Ceramides and Sphingomyelins and Risk of Mortality: The Cardiovascular Health Study

2021 ◽  
Author(s):  
Amanda M Fretts ◽  
Paul N Jensen ◽  
Andrew N Hoofnagle ◽  
Barbara McKnight ◽  
Colleen M Sitlani ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Fatty Acid ◽  
Cardiovascular Health ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
High Concentrations ◽  
Long Chain

Abstract Background Recent studies suggest that associations of ceramides (Cer) and sphingomyelins (SM) with health outcomes differ according to the fatty acid acylated to the sphingoid backbone. The purpose of this study was to assess associations of Cer and SM species with mortality. Methods The study population included participants from the Cardiovascular Health Study (CHS), a community-based cohort of adults aged ≥65 years who were followed from 1992–2015 (n = 4612). Associations of plasma Cer and SM species carrying long-chain (i.e., 16:0) and very-long-chain (i.e., 20:0, 22:0, 24:0) saturated fatty acids with mortality were assessed using Cox proportional hazards models. Results During a median follow-up of 10.2 years, 4099 deaths occurred. High concentrations of Cer and SM carrying fatty acid 16:0 were each associated with an increased risk of mortality. Conversely, high concentrations of several ceramide and sphingomyelin species carrying longer fatty acids were each associated with a decreased risk of mortality. The hazard ratios for total mortality per 2-fold difference in each Cer and SM species were: 1.89 (95% CI), 1.65–2.17 for Cer-16, 0.79 (95% CI, 0.70–0.88) for Cer-22, 0.74 (95% CI, 0.65–0.84) for Cer-24, 2.51 (95% CI, 2.01–3.14) for SM-16, 0.68 (95% CI, 0.58–0.79) for SM-20, 0.57 (95% CI, 0.49–0.67) for SM-22, and 0.66 (0.57–0.75) for SM-24. We found no association of Cer-20 with risk of death. Conclusions Associations of Cer and SM with the risk of death differ according to the length of their acylated saturated fatty acid. Future studies are needed to explore mechanisms underlying these relationships.

scholarly journals Loneliness, health and mortality

2017 ◽  
Vol 28 (2) ◽  
pp. 234-239 ◽  
Author(s):  
J. Henriksen ◽  
E. R. Larsen ◽  
C. Mattisson ◽  
N. W. Andersson
Keyword(s):  
Mortality Risk ◽  
Structured Interviews ◽  
Community Based ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Relative Risk Of Death ◽  
The Relationship ◽  
Health And Mortality

Aims.Literature suggests an association between loneliness and mortality for both males and females. Yet, the linkage of loneliness to mortality is not thoroughly examined, and need to be replicated with a long follow-up time. This study assessed the association between loneliness and mortality, including associations to gender, in 1363 adult swedes.Methods.This community-based prospective cohort study from the Swedish Lundby Study included 1363 individuals of whom 296 individuals (21.7%) were identified as lonely with use of semi-structured interviews in 1997. The cohort was followed until 2011 and survival analyses were used to estimate the relative risk of death.Results.Death occurred with an incidence rate of 2.63 per 100 person-years and 2.09 per 100 person-years for lonely and non-lonely individuals, respectively. In crude analysis, loneliness was associated with a significant increased mortality risk of 27% compared with non-lonely individuals [hazard ratio (HR) 1.27; 95% CI 1.01–1.60]. Unadjusted, lonely females had a significant increased risk (HR 1.76; 95% CI 1.31–2.34) and adjusted insignificant increased mortality risk of 27% (HR 1.27; 95% CI 0.92–1.74), compared with non-lonely females. Lonely males were found to have an adjusted significant decreased risk of mortality (HR 0.50; 95% CI 0.32–0.80), compared with non-lonely males.Conclusions.Findings suggest an association between loneliness and increased risk of mortality and that gender differences may exist, which have not been previously reported. If replicated, our results indicate that loneliness may have differential physical implications in some subgroups. Future studies are needed to further investigate the influence of gender on the relationship.

scholarly journals Effect of Antipyretic Therapy on Mortality in Critically Ill Patients with Sepsis Receiving Mechanical Ventilation Treatment

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Sheng Ye ◽  
Dan Xu ◽  
Chenmei Zhang ◽  
Mengyao Li ◽  
Yanyi Zhang
Keyword(s):  
Mechanical Ventilation ◽  
Regression Model ◽  
Critically Ill ◽  
Mortality Risk ◽  
Critically Ill Patients ◽  
Risk Of Death ◽  
External Cooling ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Significant Difference

Purpose. The study aimed to investigate the effectiveness of antipyretic therapy on mortality in critically ill patients with sepsis requiring mechanical ventilation. Methods. In this study, we employed the multiparameter intelligent monitoring in intensive care II (MIMIC-II) database (version 2.6). All patients meeting the criteria for sepsis and also receiving mechanical ventilation treatment were included for analysis, all of whom suffer from fever or hyperthermia. Logistic regression model and R language (R version 3.2.3 2015-12-10) were used to explore the association of antipyretic therapy and mortality risk in critically ill patients with sepsis receiving mechanical ventilation treatment. Results. A total of 8,711 patients with mechanical ventilator were included in our analysis, and 1523 patients died. We did not find any significant difference in the proportion of patients receiving antipyretic medication between survivors and nonsurvivors (7.9% versus 7.4%, p=0.49). External cooling was associated with increased risk of death (13.5% versus 9.5%, p<0.001). In our regression model, antipyretic therapy was positively associated with mortality risk (odds ratio [OR]: 1.41, 95% CI: 1.20–1.66, p<0.001). Conclusions. The use of antipyretic therapy is associated with increased risk of mortality in septic ICU patients requiring mechanical ventilation. External cooling may even be deleterious.

scholarly journals Renal Function and Death in Older Women: Which eGFR Formula Should We Use?

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Muna T. Canales ◽  
Terri Blackwell ◽  
Areef Ishani ◽  
Brent C. Taylor ◽  
Allyson Hart ◽  
...  
Keyword(s):  
Older Women ◽  
Cardiovascular Death ◽  
Community Dwelling ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Discriminant Ability ◽  
A Prospective Study ◽  
Egfr Equation

Background. The Berlin Initiative Study (BIS) eGFR equations were developed specifically for aged populations, but their predictive validity compared to standard formulae is unknown in older women.Methods. In a prospective study of 1289 community-dwelling older women (mean age 79.5 years), we compared the performance of the BIS1 SCr-based equation to the CKD-EPIcrand the BIS2 SCr- and Scysc-based equation to the CKD-EPIcr,cyscto predict cardiovascular and all-cause mortality.Results. Prevalence of specific eGFR category (i.e., ≥75, 60–74, 45–59, and <45) according to eGFR equation was 12.3%, 38.4%, 37.3%, and 12.0% for BIS1; 48.3%, 27.8%, 16.2%, and 7.8% for CKD-EPIcr; 14.1%, 38.6%, 37.6%, and 9.6% for BIS2; and 33.5%, 33.4%, 22.0%, and 11.1% for CKD-EPIcr,cysc, respectively. Over9±4years, 667 (51.8%) women died. For each equation, women with eGFR <45 were at increased risk of mortality compared to eGFR ≥75 [adjusted HR (95% CI): BIS1, 1.5 (1.1–2.0); CKD-EPIcr, 1.7 (1.3–2.2); BIS2, 2.0 (1.4–2.8); CKD-EPIcr,cysc, 1.8 (1.4–2.3);p-trend <0.01]. Net reclassification analyses found no material difference in discriminant ability between the BIS and CKD-EPI equations. Results were similar for cardiovascular death.Conclusions. Compared to CKD-EPI, BIS equations identified a greater proportion of older women as having CKD but performed similarly to predict mortality risk. Thus, the BIS equations should not replace CKD-EPI equations to predict risk of death in older women.

Abstract 13533: Acute Post-operative Renal Failure and Mortality Risk Following Norwood Surgical Palliation: A Secondary Analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial Public Use Database

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Reid C Chamberlain ◽  
Nicholas D Andersen ◽  
Andrew W McCrary ◽  
Christoph P Hornik ◽  
Kevin D Hill
Keyword(s):  
Risk Factors ◽  
Renal Failure ◽  
Right Ventricle ◽  
Mortality Risk ◽  
Single Ventricle ◽  
Risk Of Death ◽  
Increased Risk ◽  
Public Data ◽  
Delayed Sternal Closure ◽  
One Year

Introduction: The Single Ventricle Reconstruction (SVR) trial randomized neonates with a single morphologic right ventricle undergoing Norwood to a modified Blalock-Taussig shunt (mBTS) or a right ventricle-to-pulmonary artery shunt at 15 centers. The trial demonstrated increased risk of death or heart transplant at one-year post-Norwood in subjects randomized to a mBTS. Using SVR public data, we evaluated incidence and risk factors for post-op renal failure after Norwood, and evaluated the relationship between renal failure, shunt type and one-year post-Norwood mortality. Methods: Post-op renal failure was defined a-priori as a 3-fold rise in creatinine from baseline, or dialysis use within 7 days of Norwood. We used multivariate logistic regression to evaluate risk factors for post-op renal failure and Cox hazard regression to determine the association between post-op renal failure and one-year post-Norwood mortality. Results: Overall 46/544 (8.4%) SVR trial subjects developed post-op renal failure, the majority (32/46, 69.6%) by post-op day 3. In multivariate analysis, risk factors for post-op renal failure included receipt of a mBTS (aOR 3.3, p=0.02), center volume <15 cases/year (aOR 2.7, p=0.005), presence of ≥ 2 pre-op complications (aOR 4.0, p<0.001), low birth weight (aOR 3.2, p=0.002), post-op heart block (aOR 8.5, p=0.001), and delayed sternal closure (aOR 5.3, p=0.026). Renal failure was an independent risk factor for one-year post-Norwood mortality (aHR 1.9, CI 1.1-3.2, p=0.019). When renal failure and shunt type were included as model covariates, there was interaction (p=0.049) with renal failure attenuating the mortality risk associated with receipt of a mBTS (p=0.24), Figure. Conclusions: In the SVR trial, post-op renal failure was relatively common but with modifiable risk factors including receipt of a mBTS. Our findings suggest that post-op renal failure accounts for some of the increased mortality risk associated with the mBTS.

Increased mortality risk among offspring of mothers with postnatal depression: a nationwide population-based study in Taiwan

2011 ◽  
Vol 41 (11) ◽  
pp. 2287-2296 ◽  
Author(s):  
Y.-H. Chen ◽  
S.-Y. Tsai ◽  
H.-C. Lin
Keyword(s):  
Preschool Children ◽  
Mortality Risk ◽  
Postnatal Depression ◽  
Population Based ◽  
Research Database ◽  
Population Based Study ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Comparison Cohort

BackgroundThere is compelling evidence that children of mothers with postnatal depression (PD) experience poor developmental outcomes. However, no studies have specifically ascertained the risk of mortality for offspring during preschool years, the most catastrophic outcome in the vulnerable period. This nationwide population-based study aimed to investigate whether maternal depression in the first year after giving birth was associated with increased mortality risk among their preschool children aged up to 5 years.MethodThree nationwide population-based datasets [the National Health Insurance Research Database (NHIRD), birth certificate registry and death certificate registry] were linked in this study. A total of 10 236 offspring of mothers with PD were recruited, together with a comparison cohort of 81 888 births matched with the affected women in terms of maternal age and year of delivery. Each child was traced for 5 years from delivery between 2001 and 2003 until the end of 2008 to determine mortality during preschool years.ResultsDuring preschool years, 98 (0.96%) deaths were identified among the offspring of mothers with PD and 470 (0.57%) children in the comparison cohort died. For children up to 5 years old, exposure to maternal PD was independently associated with a 1.47-fold [95% confidence interval (CI) 1.16–1.87] increased mortality risk, after adjusting for family income, urbanization level and the characteristics of mother, father and infant. The risk of death by unnatural causes was even higher (about 2.23 times the risk, 95% CI 1.34–3.70) among exposed offspring.ConclusionsPD places preschool children at significantly increased risk of mortality, especially from unnatural causes of death.

scholarly journals The Joint Effects of Loneliness and Depression on Mortality: Does Gender Matter?

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 323-323
Author(s):  
Ted Kheng Siang Ng ◽  
Abhijit Visaria ◽  
Angelique W M Chan ◽  
Kheng Siang Ted Ng
Keyword(s):  
Los Angeles ◽  
Mortality Risk ◽  
Proportional Hazards ◽  
Depression Scale ◽  
Well Being ◽  
Joint Effect ◽  
Epidemiologic Studies ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Increased Risk

Abstract Loneliness and depression are both associated with an increased risk of all-cause mortality among older adults. However, the evidence on the joint effect of loneliness and depression is scarce. Furthermore, previous research has rarely examined the modifying effects of gender. We investigated these questions using the Panel on Health and Aging of Singaporean Elderly, a nationally-representative cohort study of community-dwelling older Singaporean adults aged 60 and above, conducted in 2009 with two follow-up waves in 2011 and 2015 (N=4536). We operationalized six groups based on three categories of loneliness measured using the 3-item University of California, Los Angeles (UCLA) loneliness scale: always lonely, sometimes lonely, and never lonely; Two categories of depressive symptom scores were measured using the 11-item Center for Epidemiologic Studies Depression Scale (CES-D) scale: depressed and not depressed. Cox proportional hazards models were employed to estimate the mortality risks for each group, with an extensive set of covariates. Due to significant differences in the prevalence of loneliness and depression in different genders, we conducted gender-stratified analyses. Compared to being not depressed and never lonely, women who were depressed and sometimes lonely and who were not depressed but always lonely had a higher mortality risk. Men who were not depressed but sometimes lonely had a higher mortality risk. We conclude that loneliness appears to be the predominant construct in conferring excess mortality risk. Health policies and interventions addressing the factors common and unique to each gender may improve psychological well-being at older ages, thereby extending the lifespan.

scholarly journals Sudden death in patients with sleep apnea: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Emily S. Heilbrunn ◽  
Paddy Ssentongo ◽  
Vernon M. Chinchilli ◽  
Anna E. Ssentongo
Keyword(s):  
Sleep Apnea ◽  
Sudden Death ◽  
Cardiovascular Mortality ◽  
Meta Analysis ◽  
Cardiac Mortality ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
All Cause Mortality

AbstractBackgroundOver 1 billion individuals across the globe experience some form of sleep apnea, and this number is steadily rising. Obstructive sleep apnea (OSA) can negatively influence one’s quality of life and potentially increase the risk of mortality. However, this association between OSA and mortality has not been comprehensively and thoroughly explored. This meta-analysis was conducted to conclusively estimate the risk of death for all-cause mortality and cardiovascular mortality in OSA patients.Study Design4,613 articles from databases including PUBMED, OVID & Joana Briggs, and SCOPUS were comprehensively assessed by two reviewers (AES & ESH) for inclusion criteria. 28 total articles were included, with 22 of them being used for quantitative analysis. Pooled effects of all-cause mortality, cardiac mortality, and sudden death were calculated by utilizing the metaprop function in R Statistical Software and the random-effects model with appropriate 95% confidence intervals.ResultsAnalysis on 42,032 individuals revealed that those with OSA were twice as likely to die from cardiac mortality compared to those without sleep apnea (HR= 1.94, 95%CI 1.39-2.70). Likewise, individuals with OSA were 1.7 times as likely to die from all-cause sudden death compared to individuals without sleep apnea (HR= 1.74, 95%CI 1.40-2.10). There was a significant dose response relationship between severity of sleep apnea and incidence risk of death, where those with severe sleep apnea wereConclusionsIndividuals with obstructive sleep apnea are at an increased risk for all-cause mortality and cardiac mortality. Further research related to appropriate interventions and treatments are necessary in order to reduce this risk and optimize survival in this population.Key MessagesWhat is the key question?Are individuals with sleep apnea at an increased risk for cardiovascular mortality and sudden death?What is the bottom Line?Sleep apnea is associated with an increased risk of cardiovascular mortality and sudden death, with a dose response relationship, where those with severe sleep apnea are at the highest risk of mortality.Why read on?This is the first systematic review and meta-analyses to synthesize and quantify the risk of mortality in those with sleep apnea, highlighting important directions for future research.Prospero Registration IDCRD42020164941

scholarly journals Predictors of mortality in adult patients with dengue: a study from South India

2018 ◽  
Vol 6 (5) ◽  
pp. 1605 ◽  
Author(s):  
Vasudeva Acharya ◽  
Mohammed Fahad Khan ◽  
Srinivas Kosuru ◽  
Sneha Mallya
Keyword(s):  
Renal Failure ◽  
Prothrombin Time ◽  
Tertiary Care ◽  
P Value ◽  
Bleeding Tendency ◽  
Care Hospital ◽  
Laboratory Parameters ◽  
Prolonged Prothrombin Time ◽  
Risk Of Death ◽  
Increased Risk

Background: Dengue is one of the important causes of acute febrile illnesses in India. Dengue can be a fatal disease, however there are no reliable markers which can predict mortality among these patients.Methods: A prospective cross sectional study was done in patients who were admitted to a tertiary care hospital with features of dengue fever. A total of 364 patients with IgM dengue serology positive were included in the study. Relevant clinical and laboratory parameters were collected from all patients. Association between clinico-laboratory parameters with mortality was studied using appropriate statistical methods.Results: Among the 364 patients recruited in this study, 14 (3.85%) patients died. Mortality among patients with age group 18-40 years was 2.04%, in patients aged above 40 years was 7.56%. Mortality among patients with hypotension was 42.42% (14 out of 33), bleeding manifestations was 15.38% (8/52), platelets <20,000/mm3 was 10.41% (10/96), ALT >200 was 13.04% (6/46), AST>200 was 12.34% (10/81), prolonged prothrombin time was 60%(12/20), renal failure was 28%(14/50), encephalopathy was 31.57% (6/19), multi organ dysfunction syndrome(MODS) was 43.33% (13/30), acute respiratory distress syndrome (ARDS) was 45.45% (5/11), pleural effusion was 7.5% (6/80).Conclusions: The overall mortality in the present study was 3.85%. Following variables were associated with increased risk of death among the dengue patients: Age >40 years, presence of hypotension, platelets <20000 cells/mm3, ALT>200U/L, AST>200U/L, prolonged prothrombin time, presence of renal failure, encephalopathy, MODS, ARDS and bleeding tendency (p value <0.05). Early identification of factors associated with mortality can help to make appropriate decision on care required.

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