scholarly journals Prognostic relevance of elevated plasma osmolality on admission in acute decompensated heart failure with preserved ejection fraction: insights from PURSUIT-HFpEF registry

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Akito Nakagawa ◽  
Yoshio Yasumura ◽  
Chikako Yoshida ◽  
Takahiro Okumura ◽  
Jun Tateishi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Plasma Osmolality ◽  
Adverse Outcomes ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Preserved Ejection Fraction ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
Kaplan Meier

Abstract Background Complicated pathophysiology makes it difficult to identify the prognosis of heart failure with preserved ejection fraction (HFpEF). While plasma osmolality has been reported to have prognostic importance, mainly in heart failure with reduced ejection fraction (HFrEF), its prognostic meaning for HFpEF has not been elucidated. Methods We prospectively studied 960 patients in PURSUIT-HFpEF, a multicenter observational study of acute decompensated HFpEF inpatients. We divided patients into three groups according to the quantile values of plasma osmolality on admission. During a follow-up averaging 366 days, we examined the primary composite endpoint of cardiac mortality or heart failure re-admission using Kaplan–Meier curve analysis and Cox proportional hazard testing. Results 216 (22.5%) patients reached the primary endpoint. Kaplan–Meier curve analysis revealed that the highest quantile of plasma osmolality on admission (higher than 300.3 mOsm/kg) was significantly associated with adverse outcomes (Log-rank P = 0.0095). Univariable analysis in the Cox proportional hazard model also revealed significantly higher rates of adverse outcomes in the higher plasma osmolality on admission (hazard ratio [HR] 7.29; 95% confidence interval [CI] 2.25–23.92, P = 0.0009). Multivariable analysis in the Cox proportional hazard model also showed that higher plasma osmolality on admission was significantly associated with adverse outcomes (HR 5.47; 95% CI 1.46–21.56, P = 0.0113) independently from other confounding factors such as age, gender, comorbid of atrial fibrillation, hypertension history, diabetes, anemia, malnutrition, E/e′, and N-terminal pro-B-type natriuretic peptide elevation. Conclusions Higher plasma osmolality on admission was prognostically important for acute decompensated HFpEF inpatients.

scholarly journals Prognostic Relevance of Elevated Plasma Osmolality on Admission in Acute Decompensated Heart Failure With Preserved Ejection Fraction: Insights From PURSUIT-HFpEF Registry

2020 ◽  
Author(s):  
Akito Nakagawa ◽  
Yoshio Yasumura ◽  
Chikako Yoshida ◽  
Takahiro Okumura ◽  
Jun Tateishi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Plasma Osmolality ◽  
Adverse Outcomes ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Preserved Ejection Fraction ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
Kaplan Meier

Abstract BackgroundComplicated pathophysiology makes it difficult to identify the prognosis of heart failure with preserved ejection fraction (HFpEF). While plasma osmolality has been reported to have prognostic importance, mainly in heart failure with reduced ejection fraction (HFrEF), its prognostic meaning for HFpEF has not been elucidated. MethodsWe prospectively studied 960 patients in PURSUIT-HFpEF, a multicenter observational study of acute decompensated HFpEF inpatients. We divided patients into three groups according to the quantile values of plasma osmolality on admission. During a follow-up averaging 366 days, we examined the primary composite endpoint of cardiac mortality or heart failure re-admission using Kaplan-Meier curve analysis and Cox proportional hazard testing. Results216 (22.5%) patients reached the primary endpoint. Kaplan-Meier curve analysis revealed that the highest quantile of plasma osmolality on admission (higher than 300.3 mOsm/kg) was significantly associated with adverse outcomes (Log-rank P = 0.0095). Univariable analysis in the Cox proportional hazard model also revealed significantly higher rates of adverse outcomes in the higher plasma osmolality on admission (hazard ratio [HR] 7.29; 95% confidence interval [CI] 2.25–23.92, P = 0.0009). Multivariable analysis in the Cox proportional hazard model also showed that higher plasma osmolality on admission was significantly associated with adverse outcomes (HR 4.70; 95% CI 1.33–17.35, P = 0.0160) independently from other confounding factors such as age, gender, comorbid of atrial fibrillation, hypertension history, diabetes, malnutrition, and N-terminal pro-B-type natriuretic peptide elevation. ConclusionsHigher plasma osmolality on admission was prognostically important for acute decompensated HFpEF inpatients.

scholarly journals Introduction of Two-Dose Mumps-Containing Vaccine into Routine Immunization Schedule in Quzhou, China, Using Cox-Proportional Hazard Model

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Zhiying Yin ◽  
Canjie Zheng ◽  
Quanjun Fang ◽  
Xiaoying Gong ◽  
Guoping Cao ◽  
...  
Keyword(s):  
Hazard Model ◽  
Routine Immunization ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Immunization Schedule ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Routine Immunization Schedule ◽  
Different Doses

Mumps is a vaccine-preventable disease caused by the mumps virus, but the incidence of mumps has increased among the children who were vaccinated with one-dose measles-mumps-rubella (MMR) in recent years. In this study, we analyzed the influence of different doses of mumps-containing vaccine (MuCV) against mumps using Cox-proportional hazard model. We collected 909 mumps cases of children who were born from 2006 to 2010 and vaccinated with different doses of MuCV in Quzhou during 2006-2018, which were all clinically diagnosed. Kaplan-Meier survival methods and Cox-proportional hazard model were used to estimate the hazard probabilities. Kaplan–Meier curves showed that the cumulative hazard of male and female has no difference; lower hazards were detected among those who were vaccinated with two-dose MuCV, born in 2006, and infected after supplementary immunization activities (SIA). Cox-proportional hazard regression suggested that onset after SIA, born in 2006, and vaccinated with two-dose MuCV were protective factors against infection even after adjusting for potential confounding effects. Our study showed that it was necessary to revise the diagnostic criteria of mumps and identify RT-PCR as the standard for mumps diagnosis in China. We suggested that routine immunization schedule should introduce two doses of MMR and prevaccination screening should be performed before booster immunization in vaccinated populations.

Abstract 16571: The Potential Impact of Expanding Cardiac Rehabilitation Coverage in Heart Failure: Insights From Get With the Guidelines Heart Failure

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jacob P Kelly ◽  
Brad G Hammill ◽  
Jacob A Doll ◽  
G. Michael Felker ◽  
Paul A Heidenreich ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Adverse Outcomes ◽  
P Value ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Cox Proportional Hazard Models ◽  
Expanded Criteria ◽  
Get With The Guidelines

Background: In February 2014, coverage for cardiac rehabilitation (CR) was expanded by Centers for Medicare & Medicaid to include patients with chronic symptomatic heart failure (HF) on optimal medical therapy with ejection fraction <35%. Thus, we sought to characterize the patient population newly eligible for CR based on the expanded criteria and their associated outcomes. Methods: We analyzed the Get With The Guidelines-HF registry linked to Medicare claims data from 2008-2012 to assess three groups of patients age 65 or older: previously eligible (due to prior MI, CABG, stable angina, heart valve surgery, or PCI in the previous 12 months), newly eligible, and ineligible for CR. Ineligible patients met neither criteria. Incidence rate was calculated with Kaplan-Meier estimates and Cox proportional hazard models were used to determine the association of events. Results: Among 51,665 HF patients discharged alive, 27.2% (n=14,053) were newly eligible and 14.5% were previously eligible for CR (n=7477). Newly eligible patients were more likely to be black, have atrial fibrillation and EF < 35%, while having fewer previous hospitalizations than patients previously eligible for CR. Newly eligible and ineligible patients had similar risk for 1-year mortality compared with those previously eligible (adjusted Hazard Ratio [HR] 0.95, 95% Confidence Interval [CI] 0.88-1.02, p-value=0.13 and [HR] 1.05, 95% [CI] 0.98-1.13, p-value=0.17, respectively). However, newly eligible and ineligible patients had lower risk for 1-year readmission compared with those previously eligible (adjusted [HR] 0.89, 95% [CI] 0.85-0.93, p-value<0.001 and [HR] 0.94, 95% [CI] 0.90- 0.98, p-value<0.001). Conclusions: The extension of coverage for cardiac rehabilitation has tripled the potentially eligible HF population. As these newly eligible patients are at high risk for adverse outcomes, cardiac rehabilitation should be considered.

scholarly journals The productive lifetime of sows on two farms from the aspect of reasons for culling

2015 ◽  
Vol 15 (3) ◽  
pp. 747-758 ◽  
Author(s):  
Peter Balogh ◽  
Wojciech Kapelański ◽  
Hanna Jankowiak ◽  
Lajos Nagy ◽  
Sandor Kovacs ◽  
...  
Keyword(s):  
Old Age ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Large White ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Breeding Farms ◽  
On Farm

Abstract The aim of this study was to compare the characteristics of the productive lifetime (PLT) of sows kept on two farms, from the aspect of reasons for culling. The study was based on data from animals from two breeding farms in Hungary, using the data of 3493 crossbred Dutch Large White and Dutch Landrace sows (DLW × DL) between their first farrowing until the time of culling (2006 and 2012). For six years, the annual culling rate for both farms averaged 45%. The most frequent reasons for removal on both farms were reproductive problems (40%, 51%), leg problems (29%, 23%) and mortality (19%, 15%). There was a significant difference between the distributions of reasons for culling on the two farms (χ2=41.7, P≤0.001). The distributions of reasons for culling differed in three periods of sow breeding (Farm A: χ2=264.7, P≤0.001; Farm B: χ2=511.1, P≤0.001). The percentage of main removal reasons decreased, whereas the frequency of culling due to age increased. Using survival analysis (Kaplan-Meier method and Cox proportional hazard model), significant differences were identified between the PLT of sows culled due to reproductive problems (P≤0.001), leg problems (P≤0.001) and old age (P≤0.001). Reproductive problems (HR: 1.34, P≤0.001) and leg problems (HR: 1.39, P≤0.001) were higher and culling due to old age (HR: 0.44, P≤0.001) was lower on Farm A compared to Farm B. There were no significant differences between the two farms in terms of mortality (HR: 0.99, P=0.923). Overall, the results can be useful for breeders of crossbred (DLW × DL) sow populations in more accurately defining their culling systems.

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

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

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

scholarly journals Relationship among Activities of Daily Living, Nutritional Status, and 90 Day Readmission in Elderly Patients with Heart Failure

2019 ◽  
Vol 16 (24) ◽  
pp. 5068
Author(s):  
Masahiro Kitamura ◽  
Kazuhiro P. Izawa ◽  
Masakazu Yaekura ◽  
Yumi Mimura ◽  
Yuichi Ikeda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nutritional Status ◽  
Activities Of Daily Living ◽  
Hospital Readmission ◽  
Daily Living ◽  
Hazard Model ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard

Purpose: This investigation aimed to examine the relationship among activities of daily living (ADL), nutritional status and 90-day hospital readmission in elderly heart failure (HF) patients. Methods: Participants were selected from 634 HF patients consecutively hospitalized at one institution. We investigated patient characteristics, ADL (motor and cognitive items of Functional Independence Measure (FIM)) and nutritional status (Geriatric Nutritional Risk Index (GNRI)). Data were analyzed using unpaired t-test, χ2 test, Cox proportional hazard model, and Kaplan-Meier method. Results: The 169 participants that met inclusion criteria were divided into two groups based on hospital readmission within 90 days of discharge. Body mass index (BMI) (p = 0.03), hemoglobin (p = 0.047), GNRI (p = 0.02) and motor-FIM (p = 0.007) were significantly different between the readmission (n = 31) and non-readmission (n = 138) groups. After Cox proportional hazard model analysis, GNRI (HR: 0.96; p = 0.048) and motor-FIM (HR: 0.97; p = 0.03) scores remained statistically significant. Participants were then classified into four groups based on a previous study’s cut-off values of prognosis for GNRI and motor-FIM. Readmission avoidance rate was significantly lower (p = 0.002) in the group with GNRI <92 and motor FIM <75. Conclusions: This study showed that motor-FIM and GNRI scores for hospitalized elderly HF patients were predictors of readmission within 90 days of discharge.

scholarly journals Preoperative Lymphocyte-To-Monocyte Ratio as a Prognostic Predictor of Long-term Mortality Among Cardiac Surgery Patients: A Propensity Score Matching Analysis Based on a 4-year Follow-up Cohort

2020 ◽  
Author(s):  
Zhuoming Zhou ◽  
Mengya Liang ◽  
Suiqing Huang ◽  
Rennan Weng ◽  
Jian Hou ◽  
...  
Keyword(s):  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Survival Curves ◽  
Entire Cohort ◽  
Lymphocyte To Monocyte Ratio ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Long Term Mortality

Abstract BackgroundCardiac surgery is associated with a specific inflammatory response. The lymphocyte-to-monocyte ratio (LMR) has been shown to be related to the prognosis of many cardiovascular diseases. We aimed to evaluate the prognostic value of the preoperative LMR in patients who underwent cardiac surgery.MethodsClinical data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC)-III database. The optimum cutoff value of the LMR for 4-year mortality was determined by X-tile software. The Cox proportional hazard model was applied for the identification of independent prognostic factors of 4-year mortality. Survival curves were estimated using the Kaplan-Meier method, and receiver operating characteristic (ROC) curves were constructed. The 1:1 propensity score matching (PSM) method was performed to balance the influence of selection bias and potential confounding factors.ResultsA total of 1701 patients were included. The X‐tile software indicated that the optimum cutoff value of the LMR for 4-year mortality was 3.58. After PSM, 489 pairs of score-matched patients were generated. The Cox proportional hazard model showed that patients with an LMR < 3.58 had a significantly higher 4-year mortality than patients with an LMR ≥ 3.58 in the entire cohort (HR = 1.925, 95%CI: 1.509-2.456, p < 0.001) and the PSM subset (HR = 1.568, 95%CI: 1.2-2.05, p = 0.001). The Kaplan-Meier survival curves showed that patients with an LMR < 3.58 had a significantly lower 4-year survival rate in the entire cohort (71.7% vs. 88.5%, P < 0.001) and the PSM subset (73.2% vs. 81.4%, P = 0.002).ConclusionsA lower LMR (< 3.58) was associated with a higher risk of 4-year mortality and can potentially predict the long-term mortality of cardiac surgery patients.

scholarly journals Reinfection hazard of hand-foot-mouth disease in Wuhan, China, using Cox-proportional hazard model

2018 ◽  
Vol 146 (10) ◽  
pp. 1337-1342
Author(s):  
Y. Peng ◽  
B. Yu ◽  
D. G. Kong ◽  
Y. Y. Zhao ◽  
P. Wang ◽  
...  
Keyword(s):  
Urban Areas ◽  
Group Living ◽  
Hazard Model ◽  
Mouth Disease ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Hand Foot Mouth Disease

AbstractHand-foot-mouth disease (HFMD) is an acute infectious disease caused by serotypes of the enterovirus (EV) family. HFMD reinfection occurs commonly in lack of cross-protection between different EV serotypes. In this study, we investigated the hazards of HFMD reinfection using Cox-proportional hazard model. Retrospective data of 95 209 HFMD cases in Wuhan during 2008–2015 was used. Kaplan–Meier survival methods and Cox-proportional hazard model were used to estimate the hazard probabilities. Of the all HFMD cases, about 2% experienced reinfection (1842/95 209). Kaplan–Meier curves revealed the reinfection risk sharply increased before 40 months from first infection. Higher hazards of reinfection were detected among those who were males, aged 3 years and below, scattered children, belonging to urban areas and first infected with coxsackievirus (CV)-A16 compared with their respective counterparts. Cox-proportional hazard model suggested that gender, age, group, living area and serotypes of first infection had significant effect on reinfection even after adjusting for potential confounding effects of other selected factors considered in the study. These results indicate that boys aged 3 years and below, especially those living in urban areas and first infected with CV-A16 are more prone to reinfection. Interventions should be imposed on these high-risk populations.

scholarly journals Father’s social and economic position has strongest impact on age at menarche in girls from Central India

2019 ◽  
Vol 82 (4) ◽  
pp. 357-371
Author(s):  
Magdalena Kosińska ◽  
Grażyna Liczbińska ◽  
Rajesh K. Gautam ◽  
Pragya Dubey ◽  
Ajay Kumar Ahirwar ◽  
...  
Keyword(s):  
Central India ◽  
Age At Menarche ◽  
Economic Factors ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
The Impact ◽  
Socio Economic Factors

Abstract We assessed the impact of socio-economic factors on age at menarche among the adolescent female population from the state of Madhya Pradesh, Central India. Records such as date of birth, chronological age, caste affiliation, size of place of residence, parents’ level of education and occupation, number of siblings, body height and weight, and age at menarche were collected for 330 students of A Central University, Sagar. The impact of socio-economic factors on age at menarche was analysed using analysis of variance. To establish the probability of menarche occurrence at a given age, time-to-event analysis was carried out using Kaplan-Meier curves and the log-rank test for curve comparison. The association between probability of attaining menarche and the independent variables was investigated using Cox proportional-hazard model. ANOVA and the Kaplan-Meier curves showed statistically significant differences in age at menarche according to size of the place of residence, number of siblings, parental level of education, father’s occupation and females’ BMI. The Cox proportional hazard model revealed that father’s occupation was the strongest factor affecting age at menarche among all SES characteristics under study. Irrespective of rapid economic progress over the past few decades, Indian society is still patriarchal with societal male dominance. This translates into participation of fewer women in the paid workforce and labour market, their lower wage rates and smaller contribution to the household budget compared to their male counterparts.

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