Mortality after proximal hip fracture in the Singapore population

2005 ◽  
Vol 15 (3) ◽  
pp. 166-170 ◽  
Author(s):  
K.H. Lin ◽  
Y.W. Lim ◽  
Y.J. Wu ◽  
K.S. Lam
Keyword(s):  
Hip Fracture ◽  
Mortality Risk ◽  
Cox Regression ◽  
Regional Hospital ◽  
Age Group ◽  
Risk Of Death ◽  
The Past ◽  
The Mean ◽  
One Year

The aims were to prospectively assess the mortality risk following proximal hip fractures, identify factors predictive of increased mortality and to investigate the time trends in mortality with comparison to previous studies. Prospectively collected data from 68 consecutive patients who had been admitted to a regional hospital from May 2001 to September 2001 were reviewed. The mean age of the patients was 79.3 years old (range, 55–98) and 72.1% females. Patients were followed prospectively to determine the mortality risk associated with hip fracture over a two-year follow-up period. The acute in-hospital mortality rate at six months, one year and two years was 5.9% (4/68), 14.7% (10/68), 20.6% (14/68) and 25% (17/68) respectively. One-year and two-year mortality for those patients who were 80 or older was significantly higher than for other patients and the number of co-morbid illnesses also had significant effect. Cox regression was performed to determine the significant predictors for survival time. It was noted that patients 80 years or older were at higher risk of death compared with those less than 80 years as well as those with higher number of co-morbid illnesses. Our mortality rates have not declined in the past 10 years when compared with previous local studies. We conclude that for this group of patients studied, their mortality at one year and two years could be predicted by their age group and their number of co-morbid illnesses.

scholarly journals Low serum klotho associated with all-cause mortality among a nationally representative sample of American adults

2021 ◽  
Author(s):  
Jacob K Kresovich ◽  
Catherine M Bulka
Keyword(s):  
Physical Activity ◽  
Mortality Risk ◽  
Representative Sample ◽  
Cox Regression ◽  
The United States ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Nationally Representative ◽  
Low Serum

Abstract α-Klotho (klotho) is a protein involved in suppressing oxidative stress and inflammation. In animal models, it is reported to underlie numerous aging phenotypes and longevity. Among a nationally representative sample of adults aged 40 to 79 in the United States, we investigated whether circulating concentrations of klotho is a marker of mortality risk. Serum klotho was measured by ELISA on 10,069 individuals enrolled in the National Health and Nutrition Examination Survey between 2007-2014. Mortality follow-up data based on the National Death Index were available through December 31, 2015. After a mean follow-up of 58 months (range: 1-108), 616 incident deaths occurred. Using survey-weighted Cox regression models adjusted for age, sex and survey cycle, low serum klotho concentration (< 666 pg/mL) was associated with a 31% higher risk of death (compared to klotho concentration > 985 pg/mL, HR: 1.31, 95% CI: 1.00, 1.71, P= 0.05). Associations were consistent for mortality caused by heart disease or cancer. Associations of klotho with all-cause mortality did not appear to differ by most participant characteristics. However, we observed effect modification by physical activity, such that low levels of serum klotho were more strongly associated with mortality among individuals who did not meet recommendation-based physical activity guidelines. Our findings suggest that, among the general population of American adults, circulating levels of klotho may serve as a marker of mortality risk.

scholarly journals The utility of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios and systemic immune-inflammation index in predicting survival in elderly patients who underwent hemiarthroplasty for hip fracture

2021 ◽  
Author(s):  
MEHMET MURAT BALA
Keyword(s):  
Hip Fracture ◽  
Postoperative Mortality ◽  
Predictive Values ◽  
Lymphocyte Ratio ◽  
Risk Of Death ◽  
Increased Risk ◽  
Unit Increase ◽  
The Mean ◽  
Immune Inflammation

Abstract Purpose: To determine the most important and objective preoperative and postoperative predictive values for postoperative mortality in our cohort of patients aged over 60 with hip fracture.Methods: We performed a retrospective analysis of prospectively collected data on patients who had undergone operation for hip fracture between January 2017 and December 2019. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were calculated using biomarker data (neutrophil, lymphocyte, and platelet counts) obtained at admission and on postoperative days 2 and 5.Results: A total of 176 individuals (119 female, 57 male) were included in the study. The mean age of the participants was 81.36 ± 9.22 years. The mortality rate was 8.0% (n=14) at 30 days, 27.3% (n=48) at 6 months, and 36.4% (n=64) at 1 year postoperatively. Considering the 1-year mortality, age, PLR at postoperative day 2, and NLR and SII at postoperative days 2 and 5 were significantly different between the survivors and those who died. Increasing age and higher NLR and SII on postoperative days 2 and 5 were significantly associated with higher risk of death at 1-year follow-up. A 1-year increase in age was associated with a 4.9% increased risk of death at 1-year follow-up (p=0.006). A 1-unit increase in NLR on postoperative day 5 was associated with a 4.3% increased risk of death at 1-year follow-up (p=0.004). Conclusion: It is suggested that SII, PLR, and NLR may constitute the preoperative variables predictive of postoperative mortality risk in orthogeriatric patients admitted to the emergency department for hip fracture and scheduled to undergo hemiarthroplasty.

scholarly journals Is 48 h a critical cut-off point for mortality in geriatric hip fractures?

2020 ◽  
Vol 50 (6) ◽  
pp. 1546-1551
Author(s):  
Ahmet Emre PAKSOY ◽  
Kerim ÖNER ◽  
Ferdi POLAT ◽  
Serhat DURUSOY
Keyword(s):  
Hip Fracture ◽  
Cox Regression ◽  
Independent Effect ◽  
Survival Times ◽  
Notification System ◽  
Cox Regression Analysis ◽  
Geriatric Hip Fracture ◽  
The Mean ◽  
Group 2 ◽  
One Year

Background/aim: In this study, our objective was to evaluate the mortality in geriatric hip fracture patients who were operated within 48 h after admission or after the 48thh. Materials and methods: A total of 194 patients who had undergone surgery for hip fracture between 2016 and 2018 were retrospectively evaluated. Patient information was obtained from the hospital’s database using the ICD codes 81.52, 82.00–82.09, and 82.10. Radiological examination reports were collected from the patient files. Information on mortality was obtained from the Death Notification System of the Turkish Ministry of Health. First-year mortality rates of patients operated within 48 h (Group 1) and those operated at 48–96 h (Group 2) were compared.Results: The mean duration between admission to the hospital and surgical intervention was 33.90 ± 1.95 h (3–96 h). The mean total hospitalization time was 7.29 ± 1.53 days (2–36 days). Of the patients, 62 (32%) died within one year after the operation. The mean survival times for patients operated ≤48 h or >48 h were 8.47 ± 1.90 and 6.57 ± 2.59 months, respectively (Z = 1.074, P = 0.283). There was no significant correlation between survival time and the time delay before the operation (r = –0.103, P = 0.153). Additionally, the Cox regression analysis, including age (years), ASA (grade 3 vs. 2), time to operation (h), and days spent in the ICU, demonstrated no significant independent effect of the time to operation on survival (P = 0.200).Conclusion: Although shortening the time to surgery may have some rationale, we did not find any difference in patients operated before 48 h compared to 48–96 h concerning mortality.

Dementia predicted one-year mortality for patients with first hip fracture

2018 ◽  
Vol 100-B (9) ◽  
pp. 1220-1226 ◽  
Author(s):  
H-C. Chiu ◽  
C-M. Chen ◽  
T-Y. Su ◽  
C-H. Chen ◽  
H-M. Hsieh ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Cox Regression ◽  
Asian Population ◽  
Male Gender ◽  
Research Database ◽  
Risk Of Death ◽  
One Year

Aims We aimed to determine the effect of dementia and Parkinson’s disease on one, three and 12-month mortality following surgery for fracture of the hip in elderly patients from an Asian population. Patients and Methods Using a random sample of patients taken from the Taiwan National Health Insurance Research Database, this retrospective cohort study analyzed the data on 6626 elderly patients who sustained a fracture of the hip between 1997 and 2012 who had ICD-9 codes within the general range of hip fracture (820.xx). We used Cox regression to estimate the risk of death associated with dementia, Parkinson’s disease or both, adjusting for demographic, clinical, treatment, and provider factors. Results Among 6626 hip fracture patients, 10.20% had dementia alone, 5.60% had Parkinson’s disease alone, and 2.67% had both. Corresponding one-year mortality rates were 15.53%, 11.59%, and 15.82%, compared with 9.22% for those without neurological illness. Adjusted hazard ratio for one-year mortality was 1.45 (95% confidence intervals (CI) 1.17 to 1.79) for those with dementia, and 1.57 (95% CI 1.07 to 2.30) with both dementia and Parkinson’s disease versus patients with neither. There was no significant association with death for Parkinson’s disease alone. Age, male gender and comorbidities were also associated with a higher risk of mortality. Conclusion Dementia, with or without Parkinson’s disease, is an independent predictor of mortality following surgery for fractures of the hip. Age, male gender and comorbidities also increase the risk of death. Parkinson’s disease alone has no significant effect. Cite this article: Bone Joint J 2018;100-B:1220–6.

scholarly journals POS0119 RENAL INVOLVEMENT AND NEED OF RENAL REPLACEMENT THERAPY IN ANCA ASSOCIATED VASCULITIS IN A SPANISH SINGLE-CENTER STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 270.2-271
Author(s):  
J. Álvarez Troncoso ◽  
J. C. Santacruz Mancheno ◽  
A. Díez Vidal ◽  
S. Afonso Ramos ◽  
A. Noblejas Mozo ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Granulomatosis With Polyangiitis ◽  
Renal Involvement ◽  
Age At Diagnosis ◽  
Systemic Involvement ◽  
Risk Of Death ◽  
Anca Associated Vasculitis ◽  
The Mean

Background:Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) include granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EPGA). Renal involvement is frequent in AAV and is an important factor for morbidity and mortality.Objectives:The main objective of this study was to analyze the demographic, clinical, histological and therapeutic characteristics of renal involvement in patients with AAV and the risk of renal replacement therapy (RRT) or death.Methods:Retrospective observational study of 56 patients with AAV fulfilling classificatory criteria and renal involvement diagnosed between 1995 and 2020 from a Spanish tertiary centre. We studied the histological involvement (according to the 2010 classification in focal, crescentic, mixed or sclerotic), immunofluorescence (IF) and the treatment received with the risk of RRT or death.Results:We included 56 patients diagnosed with AAV and renal involvement. The mean age was 61.08±4.05 years; 58.9% were women. The mean follow-up time of these patients was 16.14± 8.80 years. Only 57.1% of patients presented systemic involvement.Most frequent non-renal AAV manifestations were lung involvement (39.3%), central nervous system (30.4%), otorhinolaryngology (ORL) (14.3%), skin (8.9%) and cardiac involvement (8.9%). Main immunological findings were ANCA-MPO+ (69.6%), ANCA-PR3+ (23.2%), ANCA-negative (5.4%). Low C3 was found in 19.6% patients. Histologic classification (HC) and need of RRT is described in table 1. Main HC in renal AAV was crescentic, mixed, focal and sclerotic respectively. Eight patients had not biopsy performed. IF was positive for C3 deposits in 20 patients (35.7%). Half of the patients presented <50% normal glomeruli.The treatment of renal involvement in AAV in our cohort was as follows: 83.9% (47) corticosteroids (CS) and cyclophosphamide (of which 40 received intravenous and 7 oral cyclophosphamide; and 12 patients associated plasma exchange (PE) with this treatment), 5.36% CS alone, 2 patients received CS and mycophenolate; 1 CS and rituximab, 1 CS and PE, and 2 patients received no treatment. A total of 13 patients received PE and 18 RRT. The mean time to RRT was 65.44±32.72 months. Relapses were not uncommon, 33.93% of the patients presented ≥1 relapse and 10.71% presented ≥2.Infections were very frequent since they were present in 91.07% of the patients. Other frequent non-immunological complications observed in the follow-up of these patients were thrombosis in 31.14%, cardiovascular events in 28.57% and cancer in 19.64%.Patients with ANCA-PR3+ were younger at diagnosis (p<0.001), were more likely to present cardiac (p=0.045) and ORL involvement (p<0.001). However, neither ANCA-PR3+ nor ANCA-MPO+ were specifically associated with the need of RRT or higher risk of death in our cohort. Use of CS alone for the treatment of renal AAV was associated with higher mortality (p=0.006) but CS and cyclophosphamide with lower mortality (p=0.044). ANCA-negative patients were more likely to receive no treatment. Having <50% normal glomeruli and C3 deposits on IF were associated with an increased need for RRT. Presenting focal disease on HC was protective for the need of RRT. Older age at diagnosis, systemic involvement of AAV and need of RRT was associated with higher mortality.Conclusion:AAVs are complex vasculitides with frequent renal involvement. Increased C3 deposition, non-focal histological forms, and <50% normal glomeruli were related to the need for RRT. In turn, the need for RRT, a later age at diagnosis, and systemic involvement were associated with higher mortality. Holistic and multidisciplinary early management of AAVs in experience centers can help improve renal prognosis and decrease mortality.References:[1]Binda et al. ANCA-associated vasculitis with renal involvement. J Nephrol. 2018 Apr;31(2):197-208.[2]Kronbichler et al. Clinical associations of renal involvement in ANCA-associated vasculitis. Autoimmun Rev. 2020 Apr;19(4):102495.Disclosure of Interests:None declared

Regional cardiac uptake of 99-Tc-DPD is a novel powerful and independent prognostic marker in cardiac ATTR wild type amyloidosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Milani ◽  
G Cavenaghi ◽  
L Obici ◽  
R Mussinelli ◽  
C Klersy ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Cox Regression ◽  
Expectation Maximization Algorithm ◽  
Linear Increase ◽  
Whole Body ◽  
Wall Region ◽  
Cardiac Spect ◽  
Risk Of Death ◽  
Cardiac Wall

Abstract Background Skeletal scintigraphy with bone tracers is a key tool for cardiac ATTR diagnosis. However its prognostic value has not been systematically assessed. Purpose We evaluated the prognostic relevance of a quantitative method to assess regional 99mTc-DPD uptake by SPECT in the heart of ATTRwt patients. Methods All ATTRwt patients (n=229) undergoing clinical assessment and bone scintigraphy at our center (from 2012 to 2019) were enrolled. Theyreceived approximately 700 MBq of 99mTc-DPD. Planar whole body acquisition 10' after the injection followed by cardiac SPECT after 3 hours were performed. SPECT data were reconstructed into 64x64 matrices with an ordered-subset expectation maximization algorithm. For each wall region and for the apex, a circular region of interest (ROI, 20 pixels) was manually drawn and a value equating to the number of counts contained in the ROI was obtained. Partial correlation of ln-transformed ROI and biomarkers was retrieved from a multivariable regression model, while controlling for each cardiac wall region. Multivariable Cox regression was used to assess the prognostic role of lnROI while adjusting for wall region, NT-proBNP, cTnI and eGFR. Hazard ratios and 95% confidence intervals (HR, 95% CI) were computed. The Harrell's c statistic was reported for model discrimination. The interaction of biomarker and regional wall on survival was assessed; also, to account for intra-subject correlation of measures, within subject robust standard errors were computed. Results Median follow-up was 21 months (IQR 11, 40) and 39 (17%) patients died. Median age was 76 years (IQR, 72–80), NT-proBNP 2944 ng/L (IQR, 1815–5319), cTnI 0.095 ng/L (IQR, 0.062–0.144) and eGFR 62 mL/min (IQR, 51–77). ROI did not correlate with any of NT-proBNP, eGFR, age, cTnI or mLVWT (R&lt;1% in all cases). All analyses were adjusted for cardiac wall. At the multivariable Cox regression (Harrell's c=0.75), there was a linear increase in the risk of death associated with lnROI (HR 2.14, P=0.014), which was independent of cardiac wall region, NTproBNP, cTnI and eGFR. Only cTnI maintained a significant prognostic value. The association of lnROI and mortality was not modified by the site of measurement test for interaction with cardiac wall p=0.818). At the predefined subgroup analysis, the risk of death was similar for all walls; we computed the optimal cut-off for 12 months survival at the apex (a region usually lately involved) to 4193 (AUC: 0.68, sensitivity 80%, specificity 68%). At the multivariable Cox regression (Harrell's c 0.76), apex ROI&gt;4193 was an independent predictor of death (HR 3.60, 95% CI 1.45–8.93, p=0.006) and outperformed all the biomarkers tested. Conclusions Quantitative assessment of ROI uptake at cardiac SPECT is a powerful predictor of survival in ATTRwt patients, independent of and outperforming the other known prognostic factors. This observation warrants validation with prolonged follow-up and in independent patient series. Funding Acknowledgement Type of funding source: None

scholarly journals AB0330 HIGH REMISSION RATES IN RA – REAL LIFE DATA FROM BARITICINIB

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1463.2-1464
Author(s):  
S. Bayat ◽  
K. Tascilar ◽  
V. Kaufmann ◽  
A. Kleyer ◽  
D. Simon ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Cox Regression ◽  
Real Life ◽  
Inadequate Response ◽  
Research Support ◽  
Das 28 ◽  
Patient Reported ◽  
One Year

Background:Recent developments of targeted treatments such as targeted synthetic DMARDs (tsDMARDs) increase the chances of a sustained low disease activity (LDA) or remission state for patients suffering rheumatoid arthritis (RA). tsDMARDs such as baricitinib, an oral inhibitor of the Janus Kinases (JAK1/JAK2) was recently approved for the treatment of RA with an inadequate response to conventional (cDMARD) and biological (bDMARD) therapy. (1, 2).Objectives:Aim of this study is to analyze the effect of baricitinb on disease activity (DAS28, LDA) in patients with RA in real life, to analyze drug persistance and associate these effects with various baseline characteristics.Methods:All RA patients were seen in our outpatient clinic. If a patient was switched to a baricitinib due to medical reasons, these patients were included in our prospective, observational study which started in April 2017. Clinical scores (SJC/TJC 76/78), composite scores (DAS28), PROs (HAQ-DI; RAID; FACIT), safety parameters (not reported in this abstract) as well as laboratory biomarkers were collected at each visit every three months. Linear mixed effects models for repeated measurements were used to analyze the time course of disease activity, patient reported outcomes and laboratory results. We estimated the probabilities of continued baricitinib treatment and the probabilities of LDA and remission by DAS-28 as well as Boolean remission up to one year using survival analysis and explored their association with disease characteristics using multivariable Cox regression. All patients gave informed consent. The study is approved by the local ethics.Results:95 patients were included and 85 analyzed with available follow-up data until November 2019. Demographics are shown in table 1. Mean follow-up duration after starting baricitinib was 49.3 (28.9) weeks. 51 patients (60%) were on monotherapy. Baricitinib survival (95%CI) was 82% (73% to 91%) at one year. Cumulative number (%probability, 95%CI) of patients that attained DAS-28 LDA at least once up to one year was 67 (92%, 80% to 97%) and the number of patients attaining DAS-28 and Boolean remission were 31 (50%, 34% to 61%) and 12(20%, 9% to 30%) respectively. Median time to DAS-28 LDA was 16 weeks (Figure 1). Cox regression analyses did not show any sufficiently precise association of remission or LDA with age, gender, seropositivity, disease duration, concomitant DMARD use and number of previous bDMARDs. Increasing number of previous bDMARDs was associated with poor baricitinib survival (HR=1.5, 95%CI 1.1 to 2.2) while this association was not robust to adjustment for baseline disease activity. Favorable changes were observed in tender and swollen joint counts, pain-VAS, patient and physician disease assessment scores, RAID, FACIT and the acute phase response.Conclusion:In this prospective observational study, we observed high rates of LDA and DAS-28 remission and significant improvements in disease activity and patient reported outcome measurements over time.References:[1]Keystone EC, Taylor PC, Drescher E, Schlichting DE, Beattie SD, Berclaz PY, et al. Safety and efficacy of baricitinib at 24 weeks in patients with rheumatoid arthritis who have had an inadequate response to methotrexate. Annals of the rheumatic diseases. 2015 Feb;74(2):333-40.[2]Genovese MC, Kremer J, Zamani O, Ludivico C, Krogulec M, Xie L, et al. Baricitinib in Patients with Refractory Rheumatoid Arthritis. The New England journal of medicine. 2016 Mar 31;374(13):1243-52.Figure 1.Cumulative probability of low disease activity or remission under treatment with baricitinib.Disclosure of Interests:Sara Bayat Speakers bureau: Novartis, Koray Tascilar: None declared, Veronica Kaufmann: None declared, Arnd Kleyer Consultant of: Lilly, Gilead, Novartis,Abbvie, Speakers bureau: Novartis, Lilly, David Simon Grant/research support from: Else Kröner-Memorial Scholarship, Novartis, Consultant of: Novartis, Lilly, Johannes Knitza Grant/research support from: Research Grant: Novartis, Fabian Hartmann: None declared, Susanne Adam: None declared, Axel Hueber Grant/research support from: Novartis, Lilly, Pfizer, EIT Health, EU-IMI, DFG, Universität Erlangen (EFI), Consultant of: Abbvie, BMS, Celgene, Gilead, GSK, Lilly, Novartis, Speakers bureau: GSK, Lilly, Novartis, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB

scholarly journals One Year of the COVID-19 Pandemic in Galicia: A Global View of Age-Group Statistics during Three Waves

2021 ◽  
Vol 18 (10) ◽  
pp. 5104
Author(s):  
Iván Area ◽  
Henrique Lorenzo ◽  
Pedro J. Marcos ◽  
Juan J. Nieto
Keyword(s):  
Intensive Care Unit ◽  
Hospital Admissions ◽  
Age Groups ◽  
Age Group ◽  
Nw Spain ◽  
The Past ◽  
Global View ◽  
Time Period ◽  
Key Variables ◽  
One Year

In this work we look at the past in order to analyze four key variables after one year of the COVID-19 pandemic in Galicia (NW Spain): new infected, hospital admissions, intensive care unit admissions and deceased. The analysis is presented by age group, comparing at each stage the percentage of the corresponding group with its representation in the society. The time period analyzed covers 1 March 2020 to 1 April 2021, and includes the influence of the B.1.1.7 lineage of COVID-19 which in April 2021 was behind 90% of new cases in Galicia. It is numerically shown how the pandemic affects the age groups 80+, 70+ and 60+, and therefore we give information about how the vaccination process could be scheduled and hints at why the pandemic had different effects in different territories.

scholarly journals Mortality in older adults following a fragility fracture: real-world retrospective matched-cohort study in Ontario

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jacques P. Brown ◽  
Jonathan D. Adachi ◽  
Emil Schemitsch ◽  
Jean-Eric Tarride ◽  
Vivien Brown ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Fragility Fracture ◽  
Mortality Risk ◽  
Real World ◽  
First Year ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Fracture Cohort ◽  
One Year

Abstract Background Recent studies are lacking reports on mortality after non-hip fractures in adults aged > 65. Methods This retrospective, matched-cohort study used de-identified health services data from the publicly funded healthcare system in Ontario, Canada, contained in the ICES Data Repository. Patients aged 66 years and older with an index fragility fracture occurring at any osteoporotic site between 2011 and 2015 were identified from acute hospital admissions, emergency and ambulatory care using International Classification of Diseases (ICD)-10 codes and data were analyzed until 2017. Thus, follow-up ranged from 2 years to 6 years. Patients were excluded if they presented with an index fracture occurring at a non-osteoporotic fracture site, their index fracture was associated with a trauma code, or they experienced a previous fracture within 5 years prior to their index fracture. This fracture cohort was matched 1:1 to controls within a non-fracture cohort by date, sex, age, geography and comorbidities. All-cause mortality risk was assessed. Results The survival probability for up to 6 years post-fracture was significantly reduced for the fracture cohort vs matched non-fracture controls (p < 0.0001; n = 101,773 per cohort), with the sharpest decline occurring within the first-year post-fracture. Crude relative risk of mortality (95% confidence interval) within 1-year post-fracture was 2.47 (2.38–2.56) in women and 3.22 (3.06–3.40) in men. In the fracture vs non-fracture cohort, the absolute mortality risk within one year after a fragility fracture occurring at any site was 12.5% vs 5.1% in women and 19.5% vs 6.0% in men. The absolute mortality risk within one year after a fragility fracture occurring at a non-hip vs hip site was 9.4% vs 21.5% in women and 14.4% vs 32.3% in men. Conclusions In this real-world cohort aged > 65 years, a fragility fracture occurring at any site was associated with reduced survival for up to 6 years post-fracture. The greatest reduction in survival occurred within the first-year post-fracture, where mortality risk more than doubled and deaths were observed in 1 in 11 women and 1 in 7 men following a non-hip fracture and in 1 in 5 women and 1 in 3 men following a hip fracture.

scholarly journals POS0141 ACTIVE SCREENING FOR GOUT IDENTIFIES A LARGER CARDIOVASCULAR POPULATION AT HIGH MORTALITY RISK

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 282.2-282
Author(s):  
S. Ruiz-Simón ◽  
I. Calabuig ◽  
M. Gomez-Garberi ◽  
M. Andrés
Keyword(s):  
High Mortality ◽  
Mortality Risk ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Field Studies ◽  
High Mortality Risk ◽  
Active Screening ◽  
Tertiary Centre ◽  
All Cause Mortality

Background:We have recently revealed by active screening that about a third of gout cases in the cardiovascular population is not registered in records [1], highlighting the value of field studies.Objectives:To assess whether gout screening in patients hospitalized for cardiovascular events may also help identify patients at higher risk of mortality after discharge.Methods:A retrospective cohort field study, carried out in 266 patients admitted for cardiovascular events in the Cardiology, Neurology and Vascular Surgery units of a tertiary centre in Spain. The presence of gout was established by records review and face-to-face interview, according to the 2015 ACR/EULAR criteria. The occurrence of mortality during follow-up and its causes were obtained from electronic medical records. The association between gout and subsequent mortality was tested using Cox regression models. Whether covariates affect the gout-associated mortality was also studied.Results:Of 266 patients recruited at baseline, 17 were excluded due to loss to follow-up (>6mo), leaving a final sample of 249 patients (93.6%). Thirty-six cases (14.5% of the sample) were classified as having gout: twenty-three (63.9%) had a previously registered diagnosis, while 13 (36.1%) had not and was established by the interview.After discharge, the mean follow-up was 19.9 months (SD ±8.6), with a mortality incidence of 21.6 deaths per 100 patient-years, 34.2% by cardiovascular causes.Gout significantly increased the risk of subsequent all-cause mortality, with a hazard ratio (HR) of 2.01 (95%CI 1.13 to 3.58). When the analysis was restricted to gout patients with registered diagnosis, the association remained significant (HR 2.89; 95%CI 1.54 to 5.41).The adjusted HR for all-cause mortality associated with gout was 1.86 (95% CI 1.01-3.40). Regarding the causes of death, both cardiovascular and non-cardiovascular were numerically increased.Secondary variables rising the mortality risk in those with gout were age (HR 1.07; 1.01 to 1.13) and coexistent renal disease (HR 4.70; 1.31 to 16.84), while gender, gout characteristics and traditional risk factors showed no impact.Conclusion:Gout was confirmed an independent predictor of subsequent all-cause mortality in patients admitted for cardiovascular events. Active screening for gout allowed identifying a larger population at high mortality risk, which may help tailor optimal management to minimize the cardiovascular impact.References:[1]Calabuig I, et al. Front Med (Lausanne). 2020 Sep 29;7:560.Disclosure of Interests:Silvia Ruiz-Simón: None declared, Irene Calabuig: None declared, Miguel Gomez-Garberi: None declared, Mariano Andrés Speakers bureau: Grunenthal, Menarini, Consultant of: Grunenthal, Grant/research support from: Grunenthal

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