scholarly journals All-cause mortality risk in aged femoral intertrochanteric fracture patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xin-ping Li ◽  
Ping Zhang ◽  
Shi-wen Zhu ◽  
Ming-hui Yang ◽  
Xin-bao Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intertrochanteric Fracture ◽  
Osteoporosis Treatment ◽  
Management Model ◽  
Mineral Density ◽  
All Cause Mortality ◽  
Femoral Intertrochanteric Fracture ◽  
Fracture History ◽  
The Dead ◽  
The Impact

Abstract Introduction The 1-year mortality rate after femoral intertrochanteric fracture is higher than that of femoral neck fracture, which also belongs to hip fracture (Cui et al. in Arch Osteoporos 14(1):55, 2019). With the application of the concept of co-management model of orthopedics and geriatrics, the short-term and long-term mortality of all types of hip fractures has decreased (Van Heghe et al. in Calcif Tissue Int, 2021, https://doi.org/10.1007/s00223-021-00913-5). However, the mortality of Chinese femoral intertrochanteric fracture patients under this model has not been reported in the literatures. Aim This paper aims to study the risk factors of postoperative all-cause mortality in aged patients with femoral intertrochanteric fracture under the co-management model of orthopedics and geriatrics. Materials and methods This is a single-center prospective cohort study based on the real world, under the co-management of orthopedics and geriatrics, 363 patients aged ≥ 65 years with femoral intertrochanteric fracture were enrolled and followed up for 2–3 years; 52 patients were lost to follow up. Age, gender, body mass index (BMI), history of comorbidities, hip Bone Mineral Density (BMD), fracture history, 25(OH)D level, hemoglobin level, anti-osteoporosis treatment were risk factors to be tested. Kaplan–Meier survival curves and multivariate Cox proportional hazards models were constructed to analyze the impact of factors on all-cause mortality. Results (1) Most of the dead patients were older (the mean age was 83.4 years, compared with 79.8 years for surviving patients), with more complications and without anti-osteoporosis medication; gender, pre-fracture history, BMI, total hip BMD, hemoglobin, 25(OH)D had no difference between the dead and the living patients. (2) Elderly patients with Intertrochanteric fracture can benefit from the early treatment of Zoledronic Acid (within 3 days after the operation). Conclusion Under the co-management of orthopedics and geriatrics, to Chinese patients with Femoral Intertrochanteric fracture, Doctors should pay more attention to their age and chronic disease, and give anti-osteoporosis treatment if allowed.

scholarly journals Femoral Intertrochanteric Fracture and All-Cause Mortality Risk in Aged Osteoporosis Patients

2021 ◽  
Author(s):  
Xinping Li ◽  
ping zhang ◽  
shiwen zhu ◽  
Ming-hui Yang ◽  
xinbao wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intertrochanteric Fracture ◽  
Osteoporosis Treatment ◽  
Cox Proportional Hazards ◽  
Chinese Patients ◽  
Mineral Density ◽  
All Cause Mortality ◽  
Femoral Intertrochanteric Fracture ◽  
Fracture History ◽  
The Dead

Abstract Introduction：Clinicians pay attention to the risk factors of all-cause mortality after hip fracture, and expect to make intervention and choice. With the progress of diagnosis and treatment mode and technology, the composition and influence degree of risk factors changed in some extent. Materials and methods：This is a single-center prospective cohort study based on the real world, under the co management of orthopedics and geriatrics, 363 patients aged ≥65 years with femoral intertrochanteric fracture were enrolled and were followed up for 2-3 years; 52 patients were lost to follow up. Age, genders, body mass index (BMI), history of comorbidities, hip Bone Mineral Density (BMD), fracture history, 25(OH)D level, hemoglobin level, anti osteoporosis treatment were risk factors to be tested. Kaplan-Meier survival curves and multivariate Cox proportional hazards models were constructed to the analyzed impact of factors on all-cause mortality.Results (1) Most of the dead patients were older, with more complications and without anti osteoporosis medication; gender, pre-fracture history, BMI, total hip BMD, hemoglobin, 25(OH)D had no difference between the dead and the living patients. (2) Elderly patients with Intertrochanteric fracture can benefit from the early treatment of Zoledronic Acid (≤3days). Conclusions: Under the co management of orthopedics and geriatrics, to Chinese patients with Femoral Intertrochanteric fracture, Doctors should pay more attention to their age and chronic diseases, and give anti osteoporosis treatment if allowed.

scholarly journals Calcium and phosphate levels after kidney transplantation and long-term patient and allograft survival

2020 ◽  
Author(s):  
Julio Chevarria ◽  
Donal J Sexton ◽  
Susan L Murray ◽  
Chaudhry E Adeel ◽  
Patrick O’Kelly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Transplant ◽  
Graft Failure ◽  
Graft Function ◽  
Renal Transplant Recipients ◽  
Post Transplant ◽  
All Cause Mortality ◽  
Transplant Function ◽  
The Republic ◽  
The Impact

Abstract Background Non-traditional cardiovascular risk factors, including calcium and phosphate derangement, may play a role in mortality in renal transplant. The data regarding this effect are conflicting. Our aim was to assess the impact of calcium and phosphate derangements in the first 90 days post-transplant on allograft and recipient outcomes. Methods We performed a retrospective cohort review of all-adult, first renal transplants in the Republic of Ireland between 1999 and 2015. We divided patients into tertiles based on serum phosphate and calcium levels post-transplant. We assessed their effect on death-censored graft survival and all-cause mortality. We used Stata for statistical analysis and did survival analysis and spline curves to assess the association. Results We included 1525 renal transplant recipients. Of the total, 86.3% had hypophosphataemia and 36.1% hypercalcaemia. Patients in the lowest phosphate tertile were younger, more likely female, had lower weight, more time on dialysis, received a kidney from a younger donor, had less delayed graft function and better transplant function compared with other tertiles. Patients in the highest calcium tertile were younger, more likely male, had higher body mass index, more time on dialysis and better transplant function. Adjusting for differences between groups, we were unable to show any difference in death-censored graft failure [phosphate = 1.14, 95% confidence interval (CI) 0.92–1.41; calcium = 0.98, 95% CI 0.80–1.20] or all-cause mortality (phosphate = 1.10, 95% CI 0.91–1.32; calcium = 0.96, 95% CI 0.81–1.13) based on tertiles of calcium or phosphate in the initial 90 days. Conclusions Hypophosphataemia and hypercalcaemia are common occurrences post-kidney transplant. We have identified different risk factors for these metabolic derangements. The calcium and phosphate levels exhibit no independent association with death-censored graft failure and mortality.

scholarly journals A Droplet Digital PCR Assay for Smoking Predicts All-Cause Mortality

2018 ◽  
Vol 47 (4) ◽  
pp. 220-229 ◽  
Author(s):  
Allan M. Andersen ◽  
Philip T. Ryan ◽  
Fredrick X. Gibbons ◽  
Ronald L. Simons ◽  
Jeffrey D. Long ◽  
...  
Keyword(s):  
Risk Factors ◽  
Polymerase Chain Reaction ◽  
Longitudinal Study ◽  
Clinical Risk Factors ◽  
Chain Reaction ◽  
Clinical Risk ◽  
Epigenetic Biomarkers ◽  
All Cause Mortality ◽  
Polymerase Chain ◽  
The Impact

Objectives.—Determine whether an epigenetic assay for smoking predicts all-cause mortality in adults participating in a longitudinal study of Iowa adoptees. Background.—Improved biomarkers for smoking are needed given its large public health impact and significant limitations of both self-report and current biomarkers, such as cotinine in detecting smoking. In the past 5 years, multiple epigenome-wide association studies of smoking have identified loci suitable for translation as epigenetic biomarkers for smoking, in particular the CpG cg05575921. Digital polymerase chain reaction methods hold promise for the development of this and other epigenetic biomarkers. Methods.—Participants in the Iowa Adoption Studies were interviewed regarding their smoking habits. DNA was prepared from whole blood and bisulfite-converted for methylation analysis and digital droplet polymerase chain reaction assay of methylation at cg05575921 was performed. National Death Index records were requested for 584 study participants, resulting in 24 complete matches, 210 partial matches and 350 non-matching records. Complete matches were coded as deceased while the remainder were coded as alive (ie, censored). In total, methylation data and vital status information were available for a total of N = 193 subjects, including 15 deceased and 178 non-deceased. Cox regression was used to examine the ability of cg05575921 methylation as a continuous value to predict the timing of mortality with and without the inclusion of age, sex, race, BMI, marital status, educational status, socioeconomic status, cardiovascular risk factors, and a history of cancer as covariates. Results.—Methylation at cg05575921 predicted the hazard of mortality as the sole predictor and after accounting for major demographic and clinical risk factors. The fitted model showed the hazard ratio increased by 3.5% for every 1% decrease in methylation. Conclusions.—Decreased methylation at cg05575921, an emerging epigenetic biomarker for smoking, was associated with early mortality in a longitudinal study of adults after accounting for the impact of major demographic and clinical risk factors for all-cause mortality. This approach may be useful in clinical research or actuarial assessments.

scholarly journals Interpretable machine learning prediction of all-cause mortality

2021 ◽  
Author(s):  
Wei Qiu ◽  
Hugh Chen ◽  
Ayse Berceste Dincer ◽  
Su-In Lee
Keyword(s):  
Machine Learning ◽  
Risk Factors ◽  
Prediction Accuracy ◽  
Linear Models ◽  
Age Groups ◽  
Mortality Prediction ◽  
Linear Relationships ◽  
All Cause Mortality ◽  
Non Linear ◽  
The Impact

AbstractExplainable artificial intelligence provides an opportunity to improve prediction accuracy over standard linear models using “black box” machine learning (ML) models while still revealing insights into a complex outcome such as all-cause mortality. We propose the IMPACT (Interpretable Machine learning Prediction of All-Cause morTality) framework that implements and explains complex, non-linear ML models in epidemiological research, by combining a tree ensemble mortality prediction model and an explainability method. We use 133 variables from NHANES 1999–2014 datasets (number of samples: n = 47, 261) to predict all-cause mortality. To explain our model, we extract local (i.e., per-sample) explanations to verify well-studied mortality risk factors, and make new discoveries. We present major factors for predicting x-year mortality (x = 1, 3, 5) across different age groups and their individualized impact on mortality prediction. Moreover, we highlight interactions between risk factors associated with mortality prediction, which leads to findings that linear models do not reveal. We demonstrate that compared with traditional linear models, tree-based models have unique strengths such as: (1) improving prediction power, (2) making no distribution assumptions, (3) capturing non-linear relationships and important thresholds, (4) identifying feature interactions, and (5) detecting different non-linear relationships between models. Given the popularity of complex ML models in prognostic research, combining these models with explainability methods has implications for further applications of ML in medical fields. To our knowledge, this is the first study that combines complex ML models and state-of-the-art feature attributions to explain mortality prediction, which enables us to achieve higher prediction accuracy and gain new insights into the effect of risk factors on mortality.

scholarly journals Endostatin Is an Independent Risk Factor of Graft Loss after Kidney Transplant

2020 ◽  
Vol 51 (5) ◽  
pp. 373-380
Author(s):  
Chang Chu ◽  
Ahmed A. Hasan ◽  
Mohamed M.S. Gaballa ◽  
Shufei Zeng ◽  
Yingquan Xiong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Transplant ◽  
Cox Regression ◽  
Graft Loss ◽  
Kidney Graft ◽  
Operating Characteristics ◽  
Baseline Serum ◽  
Collagen Xviii ◽  
All Cause Mortality ◽  
The Impact

Background: Endostatin is a 20-kDa C-terminal fragment of collagen XVIII, known for its ability to inhibit the proliferation of capillary endothelial cells. Previous studies suggested that circulating endostatin independently predicts incident chronic kidney disease. However, the impact of endostatin on graft loss level in kidney transplant recipients (KTRs) remains unknown. Methods: We conducted a prospective observational cohort study in 574 maintenance KTRs. Patients were followed for kidney graft loss and all-cause mortality during a median follow-up of 48 months. Serum-, and urine-samples and clinical data were collected at baseline. Serum Endostatin concentration was analyzed by an ELISA. Results: Among 574 patients, 37 patients had graft loss and 62 patients died. For graft loss, the optimal cut-off value based on receiver operating characteristics analysis (area under the curve 0.79, 95% CI 0.71–0.86, p < 0.001) of endostatin was 147.3 pmol/L. Kaplan-Meier curves revealed that higher serum endostatin concentrations positively correlated with graft loss (p < 0.001). Multivariable Cox regression analyses showed that baseline endostatin concentrations were significantly associated with graft loss after adjusting for graft loss risk factors (adjusted hazard ratio [HR] 8.34; 95% CI 2.19–31.72; p = 0.002). The adjusted HRs for classical graft loss risk factors such as baseline estimated glomerular filtration rate and urinary protein excretion were lower (1.91 and 5.44, respectively). In contrast to graft loss, baseline endostatin concentrations were not associated with all-cause mortality. Conclusion: Increased serum endostatin at baseline is independently associated with the risk of graft loss in KTRs.

scholarly journals AB0620 MODIFICATION OF THE DECISION OF THE ANTI-OSTEOPOROSIS TREATMENT AFTER PERFORMING THE VFA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1344.2-1344
Author(s):  
H. Tantaoui ◽  
K. Nassar ◽  
S. Janani
Keyword(s):  
Bone Mineral Density ◽  
Vertebral Fracture ◽  
Bone Mineral ◽  
Clinical Data ◽  
Osteoporosis Treatment ◽  
Vertebral Fracture Assessment ◽  
Therapeutic Decision ◽  
Mineral Density ◽  
Osteoporosis Therapy ◽  
The Impact

Background:Spinal fractures are the most common of all osteoporotic fractures. Its diagnosis is essential, because the discovery of a vertebral fracture testifies the gravity of osteoporosis and modifies the therapeutic intervention threshold by justifying a specific anti-osteoporosis treatment. The evolution of densitometers now makes it possible to take a true X-ray image using software called “Vertebral Fracture Assessment” or VFA.Objectives:To assess the impact of VFA results on therapeutic decision-making after measuring bone mineral density.Methods:We conducted a retrospective and descriptive study in the rheumatology department.We included all patient followed at the consultation for bone pathologies, in whom a measurement of bone mineral density and a supplementation of VFA were performed. Clinical data, BMD, VFA and the therapeutic decision by anti-osteoporosis treatment before and after VFA were collected.Results:Sixty-one patients were included. The mean age was 62.8 years [38 - 85 years]. Sex ratio (female / male) was 19.3. At BMD level, patients with osteoporosis and osteopenia were 49% and 51% respectively. VFA objectified at least one spinal fracture in 64% of patients. Prior to VFA, anti-osteoporosis therapy was indicated to 49% of patients, based on clinical data and BMD. After performing VFA, the prescription of anti-osteoporosis therapy was indicated to 80% of patients.Conclusion:Patients who had no indication for osteoporosis treatment based on BMD data, VFA was able to modify their therapeutic treatment by detecting vertebral fractures in patients who had back pain.Disclosure of Interests:None declared.

scholarly journals Assessment of the Relationship Between Bone Mineral Density and Fracture Risk Factors in the Family Doctor Practice

2021 ◽  
pp. 64-67
Author(s):  
Yevheniia Luk’ianets
Keyword(s):  
Risk Factors ◽  
Bone Mineral Density ◽  
Early Detection ◽  
Bone Mineral ◽  
Family Doctor ◽  
Social Consequences ◽  
Mineral Density ◽  
The Impact ◽  
The Relationship ◽  
Average Body

Osteoporosis is the fourth most common after cardiovascular, cancer and endocrine diseases. According to WHO experts, due to the aging population and the impact of negative environmental factors, the incidence of osteoporosis will increase further. The objective: determining the relationship between ultrasound densitometry data on the heel cyst and the risk of fractures in older women from different regions of the country. Materials and methods. The study was based on a survey of women in major cities of Ukraine – Kyiv, Kharkiv, Odessa. 116 women aged 40 to 79 years were included. The average age of the subjects was 56±9,62 years, the average body weight was 74,5±12,9 kg, height 163,1±5,62 cm, the average body mass index (BMI) was 28±4,90. Normal (BMI) 20–24,9 had 35 women (30,2%), rates of preobesity and clinical obesity were in 81 surveyed women (69,8%). All subjects were divided into 4 groups by age: 40–49 years, 50–59 years, 60–69 years, 70–79 years. Results. Decrease in bone mineral density was found in 59,5% of examined women, of which osteopenia was in 57%, osteoporosis in 2,5% of women, the norm in 40,5% of women. The number of women with low BMD increased with age. Analyzing the risk factors in women after 40 years revealed a high incidence of hypertension 40,5%, the frequency of previous fractures in the anamnesis was 22,% of respondents, fractures of the femur and other fractures in parents noted 33,6% of women, a decrease in growth by 3 cm during life occurred in 13,7%, early menopause (up to 45 years) in 16,3% of women. Physical activity less than 30 minutes a day was noted by 27,5%. The risk of FRAX and Q-fracture fractures is significantly correlated with densitometry. Conclusions. Early detection of osteoporosis risk factors in the practice of a family doctor will help prevent an epidemic of this disease in our country and will prevent negative medical and social consequences. All of the above should be considered for planning preventive measures for osteoporosis and its complications, as well as for subsequent diagnostic steps for early detection of the disease.

scholarly journals Burden of osteoporosis in Vietnam: An analysis of population risk

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252592
Author(s):  
Duy K. Hoang ◽  
Minh C. Doan ◽  
Linh D. Mai ◽  
Thao P. Ho-Le ◽  
Lan T. Ho-Pham
Keyword(s):  
Hip Fracture ◽  
Lumbar Spine ◽  
Femoral Neck ◽  
Osteoporosis Treatment ◽  
Mineral Density ◽  
Thai Population ◽  
Recommended Treatment ◽  
Prior Fracture ◽  
The Us ◽  
Fracture History

Purpose To estimate the proportion of men and women aged 50 years and older who would be classified as "high risk" for fracture and eligible for anti-fracture treatment. Methods The study involved 1421 women and 652 men aged 50 years and older, who were recruited from the general population in Ho Chi Minh City, Vietnam. Fracture history was ascertained from each individual. Bone mineral density (BMD) was measured at the lumbar spine and femoral neck by DXA (Hologic Horizon). The diagnosis of osteoporosis was based on the T-scores ≤ -2.50 derived from either femoral neck or lumbar spine BMD. The 10-year risks of major fractureand hip fracture were estimated from FRAX version for Thai population. The criteria for recommended treatment were based on the US National Osteoporosis Foundation (NOF). Results The average age of women and men was ~60 yr (SD 7.8). Approximately 11% (n = 152) of women and 14% (n = 92) of men had a prior fracture. The prevalence of osteoporosis was 27% (n = 381; 95% CI, 25 to 29%) in women and 13% (n = 87; 95% CI, 11 to 16%) in men. Only 1% (n = 11) of women and 0.1% (n = 1) of men had 10-year risk of major fracture ≥ 20%. However, 23% (n = 327) of women and 9.5% (n = 62) of men had 10-year risk of hip fracture ≥ 3%. Using the NOF recommended criteria, 49% (n = 702; 95% CI, 47 to 52%) of women and 35% (n = 228; 95% CI, 31 to 39%) of men would be eligible for therapy. Conclusion Almost half of women and just over one-third of men aged 50 years and older in Vietnam meet the NOF criteria for osteoporosis treatment. This finding can help develop guidelines for osteoporosis treatment in Vietnam.

scholarly journals Risk Factors Analysis of Bone Mineral Density Based on Lasso and Quantile Regression in America during 2015–2018

2021 ◽  
Vol 19 (1) ◽  
pp. 355
Author(s):  
Chao Sun ◽  
Boya Zhu ◽  
Sirong Zhu ◽  
Longjiang Zhang ◽  
Xiaoan Du ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heavy Metals ◽  
Bone Mineral Density ◽  
Alcohol Use ◽  
Quantile Regression ◽  
Bone Mineral ◽  
Robust Regression ◽  
Lasso Regression ◽  
Mineral Density ◽  
The Impact

This study aimed to explore the risk factors of bone mineral density (BMD) in American residents and further analyse the extent of effects, to provide preventive guidance for maintenance of bone health. A cross-sectional study analysis was carried out in this study, of which data validity was identified and ethics approval was exempted based on the National Health and Nutrition Examination Survey (NHANES) database. Candidates’ demographics, physical examination, laboratory indicators and part of questionnaire information were collected and merged from NHANES in 2015–2016 and 2017–2018. The least absolute shrinkage selection operator (lasso) was used to select initial variables with “glmnet” package of R, quantile regression model to analyze influence factors of BMD and their effects in different sites with “qreg” code in Stata. Among 2937 candidates, 17 covariates were selected by lasso regression (λ = 0.00032) in left arm BMD, with 16 covariates in left leg BMD (λ = 0.00052) and 14 covariates in total BMD (λ = 0.00065). Quantile regression results displayed several factors with different coefficients in separate sites and quantiles: gender, age, educational status, race, high-density lipoprotein (HDL), total cholesterol (TC), lead, manganese, ethyl mercury, smoking, alcohol use and body mass index (BMI) (p < 0.05). We constructed robust regression models to conclude that some demographic characteristics, nutritional factors (especially lipid levels, heavy metals) and unhealthy behaviors affected BMD in varying degrees. Gender and race differences, Low-fat food intake and low exposure to heavy metals (mostly lead, manganese and mercury) should be considered by both clinical doctors and people. There is still no consensus on the impact of smoking and alcohol use on bone mineral density in our study.

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