Diagonal earlobe crease and long-term survival after myocardial infarction

Abstract Background The association between the presence of a diagonal earlobe crease (DEC) and coronary artery disease has been prescribed earlier. However, it is unclear whether patients with acute myocardial infarction (AMI) and DEC have a higher risk of dying. Methods Study participants were persons with AMI who were included in the KORA Myocardial Infarction Registry Augsburg from August 2015 to December 2016. After taking pictures of both earlobes, two employees independently assessed the severity of DEC in 4°. For analysis, the expression of the DEC was dichotomized. Information on risk factors, severity and therapy of the AMI was collected by interview and from the medical record. Vital status post AMI was obtained by population registries in 2019. The relationship between DEC and survival time was determined using Cox proportional hazards models. Results Out of 655 participants, 442 (67.5%) showed DEC grade 2/3 and 213 (32.5%) DEC grade 0/1. Median observation period was 3.06 years (5–1577 days). During this period, 26 patients (12.2%) with DEC grade 0/1 and 92 patients (20.8%) with grade 2/3 died (hazard ratio 1.91, 95% confidence interval (CI) 1.23–2.96, p = 0.0037). In the fully adjusted model, patients with DEC grade 2/3 had a 1.48-fold increased risk of death compared to the DEC grade 0/1 patient group (CI 0.94–2.34, p = 0.0897). The fully adjusted model applied for 1-year survival revealed a significant, 2.57-fold hazard ratio of death (CI 1.07–6.17, p = 0.0347) for the patients with DEC grade 2/3. Conclusions Our results indicate that DEC is independently associated with 1-year AMI survival.

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Diagonal Earlobe Crease and Long-Term Survival After Myocardial Infarction

10.21203/rs.3.rs-820579/v1 ◽

2021 ◽

Author(s):

Christian Thilo ◽

Christine Meisinger ◽

Margit Heier ◽

Wolfgang Scheidt ◽

Inge Kirchberger

Keyword(s):

Myocardial Infarction ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Term Survival ◽

Risk Of Death ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

Artery Disease ◽

Adjusted Model

Abstract Background: The association between the presence of a diagonal earlobe crease (DEC) and coronary artery disease (CAD) has been prescribed earlier. However, it is unclear whether patients with acute myocardial infarction (AMI) and DEC have a higher risk of dying. Methods: Study participants were persons with AMI who were included in the KORA Myocardial Infarction Registry Augsburg from August 2015 to December 2016. After taking pictures of both earlobes, two employees independently assessed the severity of DEC in 4 degrees. For analysis, the expression of the DEC was dichotomized. Information on risk factors, severity and therapy of the AMI was collected by interview and from the medical record. Vital status post AMI was obtained by population registries in 2019. The relationship between DEC and survival time was determined using Cox proportional hazards models. Results: Out of 655 participants, 442 (67.5%) showed DEC grade 2/3 and 213 (32.5%) DEC grade 0/1. Median observation period was 3.06 years (5-1577 days). During this period, 26 patients (12.2%) with DEC grade 0/1 and 92 patients (20.8%) with grade 2/3 died (hazard ratio 1.91, 95% confidence interval (CI) 1.23 - 2.96, p = 0.0037). In the fully adjusted model, patients with DEC grade 2/3 had a 1.48-fold increased risk of death compared to the DEC grade 0/1 patient group (CI 0.94 - 2.34, p = 0.0897). The fully adjusted model applied for 1-year survival revealed a significant, 2.57-fold hazard ratio of death (CI 1.07 - 6.17, p = 0.0347) for the patients with DEC grade 2/3.Conclusions: Our results indicate that DEC is independently associated with 1-year AMI survival.

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Abstract P380: Coronary Artery Disease Extent is Predictive of Heart Failure Incidence After Myocardial Infarction

Circulation ◽

10.1161/circ.131.suppl_1.p380 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Yariv Gerber ◽

Susan A Weston ◽

Maurice E Sarano ◽

Sheila M Manemann ◽

Alanna M Chamberlain ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Proportional Hazards ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Disease Extent ◽

Increased Risk ◽

Artery Disease

Background: Little is known about the association between coronary artery disease (CAD) and the risk of heart failure (HF) after myocardial infarction (MI), and whether it differs by reduced (HFrEF) or preserved (HFpEF) ejection fraction (EF) has yet to be determined. Subjects and Methods: Olmsted County, Minnesota residents (n=1,924; mean age, 64 years; 66% male) with first MI diagnosed in 1990-2010 and no prior HF were followed through 2013. Framingham Heart Study criteria were used to define HF, which was further classified according to EF (applying a 50% cutoff). The extent of angiographic CAD was defined at index MI according to the number of major epicardial coronary arteries with ≥50% lumen diameter obstruction. Fine & Gray and Cox proportional hazards regression models were used to assess the association of CAD categories with incidence of HF, and multiple imputation methodology was applied to account for the 19% with missing EF data. Results: During a mean (SD) follow-up of 6.7 (5.9) years, 594 patients developed HF. Adjusted for age and sex, with death considered a competing risk, the cumulative incidence rates of HF among patients with 1- (n=581), 2- (n=622), and 3-vessel disease (n=721) were 11.2%, 14.6% and 20.5% at 30 days; and 18.1%, 22.3% and 29.4% at 5 years after MI, respectively. The increased risk of HF with greater number of occluded vessels was only modestly attenuated after further adjustment for patient and MI characteristics, and did not differ materially by EF (Table). Conclusions: The extent of angiographic CAD expressed by the number of diseased vessels is independently associated with HF incidence after MI. The association is evident promptly after MI and applies to both HFrEF and HFpEF.

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Distinct eGFR trajectories are associated with risk of myocardial infarction in people with diabetes or pre-diabetes

10.21203/rs.3.rs-25392/v1 ◽

2020 ◽

Author(s):

Yingting Zuo ◽

Anxin Wang ◽

Shuohua Chen ◽

Xue Tian ◽

Shouling Wu ◽

...

Keyword(s):

Myocardial Infarction ◽

Proportional Hazards ◽

Exposure Period ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

Increased Risk ◽

And Control ◽

Incident Cases

Abstract Background The relationship between estimated glomerular filtration rate (eGFR) trajectories and myocardial infarction (MI) remains unclear in people with diabetes or prediabetes. We aimed to identify common eGFR trajectories in people with diabetes or prediabetes and to examine their association with MI risk. Methods The data of this analysis was derived from the Kailuan study, which was a prospective community-based cohort study. The eGFR trajectories of 24,723 participants from year 2006 to 2012 were generated by latent mixture modeling. Incident cases of MI occurred during 2012 to 2017, confirmed by review of medical records. Cox proportional hazards models were used to calculate hazard ratios (HR) and their 95% confidence intervals (CIs) for the subsequent risk of MI of different eGFR trajectories. Results We identified 5 distinct eGFR trajectories, and named them as low-stable (9.4%), moderate-stable (31.4%), moderate-increasing (29.5%), high-decreasing (13.9%) and high-stable (15.8%) according to their range and pattern. During a mean follow-up of 4.61 years, there were a total of 235 incident MI. Although, the high-decreasing group had similar eGFR levels with the moderate-stable group at last exposure period, the risk was much higher (adjusted HR, 3.43; 95%CI, 1.56–7.54 versus adjusted HR, 2.82; 95%CI, 1.34–5.95). Notably, the moderate-increasing group had reached to the normal range, still had a significantly increased risk (adjusted HR, 2.55; 95%CI, 1.21–5.39). Conclusions eGFR trajectories were associated with MI risk in people with diabetes or prediabetes. Emphasis should be placed on early and long-term detection and control of eGFR decreases to further reduce MI risk.

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Early hemoglobin decline and survival prognosis in epoetin alfa studies

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.9625 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 9625-9625

Author(s):

J. A. Berlin ◽

P. J. Bowers ◽

S. Rao ◽

S. Sun ◽

K. Liu ◽

...

Keyword(s):

Proportional Hazards ◽

Cox Proportional Hazards ◽

Time Dependent ◽

Epoetin Alfa ◽

Survival Prognosis ◽

Proportional Hazards Models ◽

Risk Of Death ◽

Cox Proportional Hazards Models ◽

Level Data ◽

Increased Risk

9625 Background: When cancer patients (pts) with chemotherapy-induced anemia (CIA) respond to erythropoietic-stimulating agents (ESA), hemoglobin (Hb) typically increases within 4–8 weeks. This exploratory analysis examined whether mortality differs depending on Hb response after 4 or 8 weeks of epoetin alfa (EPO) treatment or depending on transfusion. Methods: Pt-level data were analyzed from 31 randomized studies (7,215 pts) of epoetin alfa vs non-EPO (15 studies) or placebo (16 studies) in pts with CIA. A landmark analysis was used; Hb change was set at a specific time (4 and 8 weeks) and subsequent survival was examined separately for EPO and placebo. Pts were categorized as “Hb increased” (>0.5 g/dL), “Hb decreased” (>0.5 g/dL), or “Hb stable” (within ±0.5 g/dL) compared to baseline. Hb stable was compared to other Hb change categories with Cox proportional hazards models, stratified by study and adjusted for potential confounders. Results: The hazard ratio (HR) for Hb decreased versus Hb stable at 4 weeks was 1.44 for EPO (95% CI: 1.04, 1.99), indicating worse survival for pts with a decline in Hb. This association was weaker for placebo (HR: 1.12; 95% CI: 0.74, 1.67). Increased risk with declining Hb in EPO-treated pts was most pronounced in studies that maintained Hb ≥12 g/dL or treated pts for >12–16 weeks (1,876 pts). Patterns were similar using the 8-week landmark. In both EPO-treated and placebo pts, transfusion increased the rate of on-study death ∼3.5 fold (treating transfusion as a time-dependent variable). Conclusions: These exploratory findings suggest that both decreased Hb after 4 or 8 weeks of EPO treatment and transfusion are associated with increased risk of death. In spite of adjustment for other prognostic factors, it is likely that this association reflects poorer underlying prognosis of pts whose Hb fails to respond. ESAs should be discontinued in the absence of a Hb response. [Table: see text]

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Biomarkers Associated with Death After Initiating Treatment for Tuberculosis and HIV in Patients with Very Low CD4 Cells

Pathogens and Immunity ◽

10.20411/pai.v3i1.235 ◽

2018 ◽

Vol 3 (1) ◽

pp. 46 ◽

Cited By ~ 1

Author(s):

Fred Richard Sattler ◽

Daniel Chelliah ◽

Xingye Wu ◽

Alejandro Sanchez ◽

Michelle A. Kendall ◽

...

Keyword(s):

Proportional Hazards ◽

Cox Proportional Hazards ◽

C Reactive Protein ◽

Retrospective Case ◽

Reactive Protein ◽

Risk Of Death ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

Treatment Naïve ◽

Low Bmi

Background: The risk of short-term death for treatment naive patients dually infected with Mycobacterium tuberculosis and HIV may be reduced by early anti-retroviral therapy. Of those dying, mechanisms responsible for fatal outcomes are unclear. We hypothesized that greater malnutrition and/or inflammation when initiating treatment are associated with an increased risk for death.Methods: We utilized a retrospective case-cohort design among participants of the ACTG A5221 study who had baseline CD4 < 50 cells/mm3. The case-cohort sample consisted of 51 randomly selected participants, whose stored plasma was tested for C-reactive protein, cytokines, chemokines, and nutritional markers. Cox proportional hazards models were used to assess the association of nutritional, inflammatory, and immunomodulatory markers for survival.Results: The case-cohort sample was similar to the 282 participants within the parent cohort with CD4 < 50 cells/mm3. In the case cohort, 7 (14%) had BMI < 16.5 (kg/m2) and 17 (33%) had BMI 16.5-18.5(kg/m2). Risk of death was increased per 1 IQR width higher of log10 transformed level of C-reactive protein (adjusted hazard ratio (aHR) = 3.42 [95% CI = 1.33-8.80],P = 0.011), interferon gamma (aHR = 2.46 [CI = 1.02-5.90], P = 0.044), MCP-3 (3.67 [CI = 1.08-12.42], P = 0.037), and with IL-15 (aHR = 2.75 [CI = 1.08-6.98], P = 0.033) and IL-17 (aHR = 3.99 [CI = -1.06-15.07], P = 0.041). BMI, albumin, hemoglobin, and leptin levels were not associated with risk of death.Conclusions: Unlike patients only infected with M. tuberculosis for whom malnutrition and low BMI increase the risk of death, this relationship was not evident in our dually infected patients. Risk of death was associated with significant increases in markers of global inflammation along with soluble biomarkers of innate and adaptive immunity.

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Large Body Mass Index does not Predict Short-Term Survival in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080202200205 ◽

2002 ◽

Vol 22 (2) ◽

pp. 191-196 ◽

Cited By ~ 62

Author(s):

Nabeel Aslam ◽

Judith Bernardini ◽

Linda Fried ◽

Beth Piraino

Keyword(s):

Body Mass Index ◽

Peritoneal Dialysis ◽

Body Mass ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Dialysis Patients ◽

Term Survival ◽

Technique Survival ◽

Risk Of Death ◽

Increased Risk

♦ Objective Higher than normal body mass index (BMI) is associated with an increased risk of death in the general population. We examined the effect of higher than normal BMI on patient and technique survival in peritoneal dialysis patients (PD), controlling for comorbidity, initial albumin, dialysate-to-plasma ratio of creatinine (D/PCr), and initial urea clearance (Kt/V). ♦ Design Registry database. ♦ Settings Four dialysis centers. ♦ Patients Incident PD patients. ♦ Methods All data were collected prospectively. Demographics, BMI, serum albumin, D/PCr, and comorbidity using the Charlson Comorbidity Index (CCI) were determined at the start of PD. 104 patients with a high BMI (> 27) were matched to a control group of 104 patients with normal BMI (20 – 27) for age, gender, presence of diabetes, and CCI. Patient and technique survival were compared using Cox proportional hazards model. ♦ Main Outcome Measures Patient and technique survival. ♦ Results The groups were of similar age (56.1 vs 56.7 years), sex (60% males in both groups), race (Caucasian 80% vs 86%), presence of diabetes (40% vs 37%), CCI score (5.4 in both groups), initial albumin (3.6 vs 3.5 g/dL), and D/PCr (0.65 in both groups). Kaplan–Meier survival analysis showed similar 2-year patient survival between large BMI (> 27) and control (20 – 27) groups (76.6% vs 76.1%). Two-year technique survival was also similar between the two groups (59.7% vs 66.8%). With Cox proportional hazards analysis, BMI was not a predictor of patient mortality or technique survival when controlling for initial albumin, D/PCr, and initial Kt/V. ♦ Conclusions We conclude that a BMI above normal is not associated with any increased or decreased risk of death in patients on PD for 2 years.

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Clinicopathological Characteristics and Survival Outcomes for Pneumonectomy: a Population-Based Study

10.21203/rs.3.rs-51841/v1 ◽

2020 ◽

Author(s):

Linlin Wang ◽

Lihui Ge ◽

Yongyu Liu ◽

Yi Ren

Keyword(s):

Prognostic Factors ◽

Prognostic Factor ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Forest Plot ◽

Seer Database ◽

Term Survival ◽

Risk Of Death ◽

Increased Risk

Abstract Background: Prognostic factors in pneumonectomy (PN) are not yet fully defined. This study is to analyze and evaluate long-term survival after PN for non-small cell lung cancer (NSCLC). Methods: We obtained data from the Surveillance, Epidemiology, and End Results (SEER) database for patients who underwent PN between 2004 and 2015. In order to reduce bias and imbalance, propensity score matching (PSM) analysis was performed. We used Kaplan-Meier curves to estimate overall survival (OS), performed univariate and multivariate Cox proportional hazards regression analyses to identify independent prognostic factors for OS, and applied the Cox proportional hazards model to create a forest plot. Results: A total of 1557 PN patients from the SEER database were included. The patients were grouped according to the side of PN. Before matching, OS was worse after right PN (hazard ratio [HR]: 1.303; 95% confidence interval [CI] 1.133-1.498; P<0.001), but survival difference between groups was not significant after matching (HR: 1.061; 95% CI 0.912-1.235; P=0.443). Regression analysis revealed that age, grade, N-stage, radiotherapy, and chemotherapy were independent predictors of OS (P<0.05). Chemotherapy was associated with improved OS (HR: 0.709; 95% CI 0.609-0.825; P<0.001), but radiotherapy was associated with increased risk of death in OS (HR: 1.268; 95% CI 1.061-1.561; P=0.009). On the forest plot, patients with primary overlapping lesions had better OS (HR: 0.684; 95% CI 0.497-0.941; P=0.020) in left, vs right, PN; patients diagnosis during 2004 to 2007 had lower OS (HR: 0.576; 95% CI 0.346-0.960; P=0.034) for left PN vs right PN.Conclusions: Laterality was not a significant prognostic factor for long-term survival after PN for NSCLC. Chemotherapy was a significant independent predictor of improved OS, while radiotherapy appeared to be a negative prognostic factor with increased risk of death in OS.

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Resting Heartbeat Complexity Predicts All‐Cause and Cardiorespiratory Mortality in Middle‐ to Older‐Aged Adults From the UK Biobank

Journal of the American Heart Association ◽

10.1161/jaha.120.018483 ◽

2021 ◽

Vol 10 (3) ◽

Author(s):

Lei Gao ◽

Arlen Gaba ◽

Longchang Cui ◽

Hui‐Wen Yang ◽

Richa Saxena ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Rate ◽

Proportional Hazards ◽

Large Population ◽

Cox Proportional Hazards ◽

Uk Biobank ◽

Cardiovascular Risks ◽

Prior Myocardial Infarction ◽

Risk Of Death ◽

Cox Proportional Hazards Models

Background Spontaneous heart rate fluctuations contain rich information related to health and illness in terms of physiological complexity, an accepted indicator of plasticity and adaptability. However, it is challenging to make inferences on complexity from shorter, more practical epochs of data. Distribution entropy (DistEn) is a recently introduced complexity measure that is designed specifically for shorter duration heartbeat recordings. We hypothesized that reduced DistEn predicted increased mortality in a large population cohort. Method and Results The prognostic value of DistEn was examined in 7631 middle‐older–aged UK Biobank participants who had 2‐minute resting ECGs conducted (mean age, 59.5 years; 60.4% women). During a median follow‐up period of 7.8 years, 451 (5.9%) participants died. In Cox proportional hazards models with adjustment for demographics, lifestyle factors, physical activity, cardiovascular risks, and comorbidities, for each 1‐SD decrease in DistEn, the risk increased by 36%, 56%, and 73% for all‐cause, cardiovascular, and respiratory disease–related mortality, respectively. These effect sizes were equivalent to the risk of death from being >5 years older, having been a former smoker, or having diabetes mellitus. Lower DistEn was most predictive of death in those <55 years with a prior myocardial infarction, representing an additional 56% risk for mortality compared with older participants without prior myocardial infarction. These observations remained after controlling for traditional mortality predictors, resting heart rate, and heart rate variability. Conclusions Resting heartbeat complexity from short, resting ECGs was independently associated with mortality in middle‐ to older‐aged adults. These risks appear most pronounced in middle‐aged participants with prior MI, and may uniquely contribute to mortality risk screening.

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Survival analysis in primary progressive apraxia of speech and agrammatic aphasia

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000919 ◽

2020 ◽

pp. 10.1212/CPJ.0000000000000919

Author(s):

Jennifer L. Whitwell ◽

Peter Martin ◽

Joseph R. Duffy ◽

Heather M. Clark ◽

Rene L. Utianski ◽

...

Keyword(s):

Proportional Hazards ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Apraxia Of Speech ◽

Primary Progressive ◽

Risk Of Death ◽

Baseline Visit ◽

Cox Proportional Hazards Models ◽

Point Increase ◽

Agrammatic Aphasia

ABSTRACTObjective:To compare survival among patients with different combinations of apraxia of speech (AOS) and agrammatic aphasia, including those with isolated AOS (primary progressive apraxia of speech, PPAOS), both AOS and agrammatic aphasia (AOS+PAA) and isolated agrammatic aphasia (progressive agrammatic aphasia, PAA).Methods:One-hundred-and-nine patients were recruited who had any combination of AOS and agrammatic aphasia (42 PPAOS, 56 AOS+PAA and 11 PAA) and were followed longitudinally, with 57 patients having since died. Cox proportional hazards models were used to quantify the relative risk of death across diagnoses. Adjusted survival curves are presented based on this model. We also assessed the influence of AOS and aphasia severity on survival.Results:PPAOS had the longest survival (median survival of 5.97 years from baseline visit), followed by PAA (5.26 years) and then AOS+PAA (4.33 years). AOS+PAA had a greater risk of death than PPAOS, with a hazard ratio of 3.01 (Lower/upper CI= 1.66/5.46, p<0.001). Risk of death did not differ between PAA and the other groups. All results accounted for age and time from onset to baseline visit. AOS severity, independent of syndromic diagnosis, was associated with greater risk of death, with a hazard ratio of 1.35 for a one-point increase in severity. Aphasia severity was not associated with risk of death.Conclusions:Individuals with PPAOS have better survival and reduced risk of death compared to AOS+PAA individuals. This finding will help improve prognostic estimates for these patients and supports the value of distinguishing PPAOS from AOS+PAA.

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Low Intracellular Water, Overhydration, and Mortality in Hemodialysis Patients

Journal of Clinical Medicine ◽

10.3390/jcm9113616 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3616

Author(s):

Carolina Gracia-Iguacel ◽

Emilio González-Parra ◽

Ignacio Mahillo ◽

Alberto Ortiz

Keyword(s):

Proportional Hazards ◽

Hemodialysis Patients ◽

Cox Proportional Hazards ◽

Intracellular Water ◽

C Reactive Protein ◽

Reactive Protein ◽

Risk Of Death ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

Over Time

Background: In hemodialysis patients, extracellular water (ECW) overload predicts all-cause and cardiovascular mortality. The primary aim of the present study was to analyze changes in post-dialysis (i.e., following removal of excess ECW) ECW, intracellular water (ICW), and the overhydration (OH) parameter over time. Additionally, the association of these parameters with mortality was explored. Patients and methods: Prospective study of prevalent hemodialysis patients (n = 124) followed for a median of 20 (interquartile range (IQR) 8–31) months. In three visits, inflammation (C-reactive protein) and post-dialysis fluid status (bioimpedance, BIS) were assessed. Results: During follow-up, the overhydration (OH) parameter increased (−0.696 ± 1.6 vs. 0.268 ± 1.7 L; p = 0.007) at the expense of a decrease in intracellular water (ICW) (19.90 ± 4.5 vs. 18.72 ± 4.1 24 L; p = 0.006) with a non-significant numerical increase in ECW/ICW ratio (0.795 ± 0.129 vs. 0.850 ± 0.143; p = 0.055). Baseline ICW positively correlated with muscle mass and energy intake and negatively with C-reactive protein and it was lower in those who died than in survivors (15.09 ± 2.36 vs. 18.87 ± 4.52 L; p = 0.004). In Kaplan–Meier analysis, patients with low baseline ICW (≤17 L) and high ECW/ICW ratio (≥0.84) were at an increased risk of death. Baseline ICW was also associated with the risk of death in adjusted Cox proportional hazards models (HR 0.62 (0.40–0.98) p = 0.04). Conclusions: In hemodialysis patients, the post-dialysis OH parameter increased over time while ICW decreased, without changes in ECW. Low baseline post-dialysis ICW correlated with muscle wasting and inflammation and was an independent risk factor for mortality.

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