Prognosis of hemodialysis patients with progressive aortic stenosis: a prospective cohort study

Abstract Background Whether progressive mild to moderate aortic stenosis in hemodialysis patients influences their prognosis has not been elucidated. This prospective cohort study explored whether progressive aortic stenosis predicted the rate of cardiac events and mortality in those patients. Methods A total of 283 consecutive hemodialysis patients (no aortic stenosis, 248; progressive aortic stenosis, 35) underwent echocardiography for assessment of aortic stenosis, with a median follow-up period of 4.1 years. Study endpoints were cardiac events, all-cause mortality, and cardiac death. Kaplan–Meier analysis and multivariate Cox proportional hazard analysis were performed to estimate cardiac events, all-cause mortality, and cardiac death. Results Cumulative cardiac event rate, all-cause mortality rate, and the rate of cardiac death at 3-year follow-up were 44.9%, 40.5%, and 26.4% in patients with progressive aortic stenosis and 22.1%, 19.0%, and 7.5% in those without aortic stenosis, respectively. Kaplan–Meier analysis demonstrated the cumulative rates of cardiac events and all-cause mortality. And cardiac death was significantly higher in patients with progressive aortic stenosis than in those without aortic stenosis. Multivariate Cox proportional hazard analysis revealed that progressive aortic stenosis was predictive of cardiac events (adjusted hazard ratio 2.47; 95% confidence interval 1.38–4.39) and cardiac death (adjusted hazard ratio 4.21; 95% confidence interval 2.10–8.46). Age, physical activity, C-reactive protein, and serum albumin levels—but not progressive aortic stenosis—predicted all-cause mortality. Conclusions The rates of cardiac events and cardiac death were higher in hemodialysis patients with progressive aortic stenosis than in those without aortic stenosis. Furthermore, progressive aortic stenosis predicted cardiac events and cardiac death. Compared with those without aortic stenosis, patients with progressive aortic stenosis had higher all-cause mortality, which was related to their comorbidities. Trial registration This study was retrospectively registered with University Hospital Medical Information Network Clinical Trials Registry (registration number, UMIN 000024023) at September 12th, 2016.

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Microalbuminuria After Kidney Transplantation Predicts Cardiovascular Morbidity

Frontiers in Medicine ◽

10.3389/fmed.2021.635847 ◽

2021 ◽

Vol 8 ◽

Author(s):

Dana Bielopolski ◽

Ruth Rahamimov ◽

Boris Zingerman ◽

Avry Chagnac ◽

Limor Azulay-Gitter ◽

...

Keyword(s):

Hazard Analysis ◽

Cardiovascular Morbidity ◽

Urine Collection ◽

Proportional Hazard ◽

Cvd Risk ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Cardiovascular Morbidity And Mortality ◽

Independent Association

Background: Microalbuminuria is a well-characterized marker of kidney malfunction, both in diabetic and non-diabetic populations, and is used as a prognostic marker for cardiovascular morbidity and mortality. A few studies implied that it has the same value in kidney transplanted patients, but the information relies on spot or dipstick urine protein evaluations, rather than the gold standard of timed urine collection.Methods: We revisited a cohort of 286 kidney transplanted patients, several years after completing a meticulously timed urine collection and assessed the prevalence of major cardiovascular adverse events (MACE) in relation to albuminuria.Results: During a median follow up of 8.3 years (IQR 6.4–9.1) 144 outcome events occurred in 101 patients. By Kaplan-Meier analysis microalbuminuria was associated with increased rate of CV outcome or death (p = 0.03), and this was still significant after stratification according to propensity score quartiles (p = 0.048). Time dependent Cox proportional hazard analysis showed independent association between microalbuminuria and CV outcomes 2 years following microalbuminuria detection (HR 1.83, 95% CI 1.07–2.96).Conclusions: Two years after documenting microalbuminuria in kidney transplanted patients, their CVD risk was increased. There is need for primary prevention strategies in this population and future studies should address the topic.

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The temporal relationship between cancer and adult onset anti-transcriptional intermediary factor 1 antibody–positive dermatomyositis

Rheumatology ◽

10.1093/rheumatology/key357 ◽

2018 ◽

Vol 58 (4) ◽

pp. 650-655 ◽

Cited By ~ 26

Author(s):

Alexander Oldroyd ◽

Jamie C Sergeant ◽

Paul New ◽

Neil J McHugh ◽

Zoe Betteridge ◽

...

Keyword(s):

Proportional Hazard ◽

Adult Onset ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Specific Cancer ◽

Associated Malignancy ◽

Cancer Types ◽

The Uk ◽

Screening Approaches

Abstract Objectives To characterize the 10 year relationship between anti-transcriptional intermediary factor 1 antibody (anti-TIF1-Ab) positivity and cancer onset in a large UK-based adult DM cohort. Methods Data from anti-TIF1-Ab-positive/-negative adults with verified diagnoses of DM from the UK Myositis Network register were analysed. Each patient was followed up until they developed cancer. Kaplan–Meier methods and Cox proportional hazard modelling were employed to estimate the cumulative cancer incidence. Results Data from 263 DM cases were analysed, with a total of 3252 person-years and a median 11 years of follow-up; 55 (21%) DM cases were anti-TIF1-Ab positive. After 10 years of follow-up, a higher proportion of anti-TIF1-Ab-positive cases developed cancer compared with anti-TIF1-Ab-negative cases: 38% vs 15% [hazard ratio 3.4 (95% CI 2.2, 5.4)]. All the detected malignancy cases in the anti-TIF1-Ab-positive cohort occurred between 3 years prior to and 2.5 years after DM onset. No cancer cases were detected within the following 7.5 years in this group, whereas cancers were detected during this period in the anti-TIF1-Ab-negative cases. Ovarian cancer was more common in the anti-TIF1-Ab-positive vs -negative cohort: 19% vs 2%, respectively (P < 0.05). No anti-TIF1-Ab-positive case <39 years of age developed cancer, compared with 21 (53%) of those ≥39 years of age. Conclusion Anti-TIF1-Ab-positive-associated malignancy occurs exclusively within the 3 year period on either side of DM onset, the risk being highest in those ≥39 years of age. Cancer types differ according to anti-TIF1-Ab status, and this may warrant specific cancer screening approaches.

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Abstract 201: Gemfibrozil In Combination With Statin Is Associated With Reduction In All Cause Mortality: A Retrospective Cohort Study

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.201 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Sudeep R Aryal ◽

William Newman

Keyword(s):

Coronary Artery ◽

Retrospective Cohort ◽

Bypass Graft ◽

Outcome Variable ◽

Combination Group ◽

Proportional Hazard ◽

Significant Group ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

All Cause Mortality

Objective: Statins and gemfibrozil as individual monotherapy have shown to reduce major cardiovascular events with statins alone reducing all cause mortality. However, it is uncertain whether the combination of statins with gemfibrozil is associated with further reduction in all cause mortality compared to mortality reduction by statins alone. We will examine the hypothesis that combination of gemfibrozil with statin is associated with greater reduction in all cause mortality compared to statin alone. Methods: We performed a retrospective cohort chart review of the VistA database between January 1, 2003 and January 1, 2013 at the Veterans Affairs Healthcare System in Fargo, North Dakota. All veterans greater than or equal to 18 years of age taking either the combination of statin and gemfibrozil or statin alone for a minimum of 12 months were included in the study. The subjects in either group were selected randomly from the pharmacy database, which divided the subjects into statin or combination group. The total sample size was 1800 with 900 subjects in each group. Our primary outcome variable was all cause mortality. The Kaplan Meier Survival curve was drawn for the combination group versus statin alone group. The adjustment for mortality covariates was by the Cox proportional hazard regression. Findings: Statin versus the combination group differed demographically by age (73 ± 11.5 vs 68 ± 11.8), BMI (29.9 ± 50 vs 31.7 ± 5.4), hypertension (72.1% vs 80.9%), diabetes mellitus (33.0% vs 47%), smoking (22% vs 28.2%) and stroke (8.3% vs 5.2%); all P<0.01. The two groups were similar for myocardial infarction, transient ischemic attack, peripheral vascular disease, coronary artery disease, and coronary artery bypass graft outcomes. The all cause mortality difference was 10.2% between statin and the combination group at 10 years (25% vs 14.8%, P<0.0001). The unadjusted Kaplan-Meier analysis over 10 years subsequent to lipid therapy initiation showed a highly significant group difference. Cox proportional hazard adjustment for age, BMI, hypertension, and diabetes revealed persistence of the group difference (P <0.0001). Conclusion: Combination of gemfibrozil with statin is associated with greater reduction in all cause mortality compared to statins alone. Keywords: gemfibrozil, mortality

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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

Public Health and Preventive Medicine Archive ◽

10.24843/phpma.2016.v04.i02.p02 ◽

2016 ◽

pp. 127 ◽

Cited By ~ 1

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.

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Rising Serum Uric Acid Level Is Negatively Associated with Survival in Renal Cell Carcinoma

Cancers ◽

10.3390/cancers11040536 ◽

2019 ◽

Vol 11 (4) ◽

pp. 536 ◽

Cited By ~ 1

Author(s):

Kendrick Yim ◽

Ahmet Bindayi ◽

Rana McKay ◽

Reza Mehrazin ◽

Omer A. Raheem ◽

...

Keyword(s):

De Novo ◽

Hazard Analysis ◽

Stage I ◽

Stage Iii ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

Ckd Stage ◽

All Cause Mortality ◽

Statin Use ◽

Significant Factors

Aim and Background: To investigate the association of serum uric acid (SUA) levels along with statin use in Renal Cell Carcinoma (RCC), as statins may be associated with improved outcomes in RCC and SUA elevation is associated with increased risk of chronic kidney disease (CKD). Methods: Retrospective study of patients undergoing surgery for RCC with preoperative/postoperative SUA levels between 8/2005–8/2018. Analysis was carried out between patients with increased postoperative SUA vs. patients with decreased/stable postoperative SUA. Kaplan-Meier analysis (KMA) calculated overall survival (OS) and recurrence free survival (RFS). Multivariable analysis (MVA) was performed to identify factors associated with increased SUA levels and all-cause mortality. The prognostic significance of variables for OS and RFS was analyzed by cox regression analysis. Results: Decreased/stable SUA levels were noted in 675 (74.6%) and increased SUA levels were noted in 230 (25.4%). A higher proportion of patients with decreased/stable SUA levels took statins (27.9% vs. 18.3%, p = 0.0039). KMA demonstrated improved 5- and 10-year OS (89% vs. 47% and 65% vs. 9%, p < 0.001) and RFS (94% vs. 45% and 93% vs. 34%, p < 0.001), favoring patients with decreased/stable SUA levels. MVA revealed that statin use (Odds ratio (OR) 0.106, p < 0.001), dyslipidemia (OR 2.661, p = 0.004), stage III and IV disease compared to stage I (OR 1.887, p = 0.015 and 10.779, p < 0.001, respectively), and postoperative de novo CKD stage III (OR 5.952, p < 0.001) were predictors for increased postoperative SUA levels. MVA for all-cause mortality showed that increasing BMI (OR 1.085, p = 0.002), increasing ASA score (OR 1.578, p = 0.014), increased SUA levels (OR 4.698, p < 0.001), stage IV disease compared to stage I (OR 7.702, p < 0.001), radical nephrectomy (RN) compared to partial nephrectomy (PN) (OR 1.620, p = 0.019), and de novo CKD stage III (OR 7.068, p < 0.001) were significant factors. Cox proportional hazard analysis for OS revealed that increasing age (HR 1.017, p = 0.004), increasing BMI (Hazard Ratio (HR) 1.099, p < 0.001), increasing SUA (HR 4.708, p < 0.001), stage III and IV compared to stage I (HR 1.537, p = 0.013 and 3.299, p < 0.001), RN vs. PN (HR 1.497, p = 0.029), and de novo CKD stage III (HR 1.684, p < 0.001) were significant factors. Cox proportional hazard analysis for RFS demonstrated that increasing ASA score (HR 1.239, p < 0.001, increasing SUA (HR 9.782, p < 0.001), and stage II, III, and IV disease compared to stage I (HR 2.497, p < 0.001 and 3.195, p < 0.001 and 6.911, p < 0.001) were significant factors. Conclusions: Increasing SUA was associated with poorer outcomes. Decreased SUA levels were associated with statin intake and lower stage disease as well as lack of progression to CKD and anemia. Further investigation is requisite.

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Relationship between social support status and mortality in a community-based population: a prospective observational study (Yamagata study)

10.21203/rs.3.rs-32367/v4 ◽

2020 ◽

Author(s):

Tsutomu Uzuki ◽

Tsuneo Konta ◽

Ritsuko Saito ◽

Ri Sho ◽

Tsukasa Osaki ◽

...

Keyword(s):

Social Support ◽

Social Relationships ◽

Cardiovascular Mortality ◽

Prospective Observational Study ◽

Hazard Analysis ◽

Vital Role ◽

Proportional Hazard ◽

Community Based ◽

Cox Proportional Hazard

Abstract Background: Social support, defined as the exchange of support in social relationships, plays a vital role in maintaining healthy behavior and mitigating the effects of stressors. This study investigated whether functional aspect of social support is related to 5-year mortality in health checkup participants.Methods: This study recruited 16,651 subjects (6,797 males, 9,854 females). Social support was evaluated using five-component questions: Do you have someone 1) whom you can consult when you are in trouble? 2) whom you can consult when your physical condition is not good? 3) who can help you with daily homework? 4) who can take you to hospital when you don't feel well? and 5) who can take care of you when you are ill in bed? The association between the component of social support and all-cause and cardiovascular mortality was examined using Cox proportional hazard analysis.Results: The percentage of subjects without social support components was 7.7%-15.0%. They were more likely to be male, non-elderly, and living alone. During the follow-up period, there were 166 all-cause and 38 cardiovascular deaths. Cox proportional analysis adjusted for confounders showed that only the lack of support for transportation to hospital was significantly associated with all-cause (hazard ratio [HR] 2.01, 95% confidence interval [CI] 1.26-3.05) and cardiovascular mortality (HR 3.30, 95% CI 1.41-6.87). These associations were stronger in males than females.Conclusion: This study showed that the lack of social support for transportation to the hospital was independently associated with all-cause and cardiovascular mortality in a community-based population.

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Relationship between social support status and mortality in a community-based population: a prospective observational study (Yamagata study)

10.21203/rs.3.rs-32367/v3 ◽

2020 ◽

Author(s):

Tsutomu Uzuki ◽

Tsuneo Konta ◽

Ritsuko Saito ◽

Ri Sho ◽

Tsukasa Osaki ◽

...

Keyword(s):

Social Support ◽

Social Relationships ◽

Cardiovascular Mortality ◽

Prospective Observational Study ◽

Hazard Analysis ◽

Vital Role ◽

Proportional Hazard ◽

Community Based ◽

Cox Proportional Hazard

Abstract Background: Social support, defined as the exchange of support in social relationships, plays a vital role in maintaining healthy behavior and mitigating the effects of stressors. This study investigated whether functional aspect of social support is related to 5-year mortality in health checkup participants. Methods: This study recruited 16,651 subjects (6,797 males, 9,854 females). Social support was evaluated using five-component questions: Do you have someone 1) whom you can consult when you are in trouble? 2) whom you can consult when your physical condition is not good? 3) who can help you with daily homework? 4) who can take you to hospital when you don’t feel well? and 5) who can take care of you when you are ill in bed? The association between the component of social support and all-cause and cardiovascular mortality was examined using Cox proportional hazard analysis. Results: The percentage of subjects without social support components was 7.7%-15.0%. They were more likely to be male, non-elderly, and living alone. During the follow-up period, there were 166 all-cause and 38 cardiovascular deaths. Cox proportional analysis adjusted for confounders showed that only the lack of support for transportation to hospital was significantly associated with all-cause (hazard ratio [HR] 2.01, 95% confidence interval [CI] 1.26-3.05) and cardiovascular mortality (HR 3.30, 95% CI 1.41-6.87). These associations were stronger in males than females. Conclusion: This study showed that the lack of social support for transportation to the hospital was independently associated with all-cause and cardiovascular mortality in a community-based population.

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Abstract 1701: Soluble Receptor for Advanced Glycation End Products (RAGE) is a Prognostic Factor for Heart Failure

Circulation ◽

10.1161/circ.116.suppl_16.ii_357-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Yo Koyama ◽

Yasuchika Takeishi ◽

Takeshi Niizeki ◽

Satoshi Suzuki ◽

Tatsuro Kitahara ◽

...

Keyword(s):

Heart Failure ◽

Prognostic Factor ◽

Hazard Analysis ◽

Functional Class ◽

Proportional Hazard ◽

Cardiac Events ◽

Cox Proportional Hazard ◽

Soluble Rage ◽

Glycation End Products ◽

Patients With Heart Failure

Background: It is known that oxidative stress is increased in patients with heart failure. Advanced glycation end products (AGE) are generated nonenzymatically by glycation and oxidation of proteins. We have recently reported that serum level AGE is an independent prognostic factor for heart failure. Receptor for AGE (RAGE) has a secretory isoform of the receptor protein, termed soluble RAGE. In the present study, we measured serum soluble RAGE levels in patients with heart failure. Methods: Serum soluble RAGE level was measured in 160 patients with heart failure and 40 control subjects. Patients were prospectively followed with endpoints of cardiac death or re-hospitalization. Results: Serum soluble RAGE level was increased with advancing NYHA functional class (figure 1 ). We determined the cut-off value of serum soluble RAGE level to predict cardiac events from ROC curve analysis as 1220 pg/ml (sensitivity 0.60, specificity 0.69). As shown in figure 2 , high serum soluble RAGE groups (>1220 pg/ml) had a significantly lower cardiac event-free rate (P = 0.0004) than low serum soluble RAGE groups (≥ 1220 pg/ml). In the univariate Cox proportional hazard analysis, serum soluble RAGE, age, NYHA functional class, creatinine, B-type natriuretic peptide (BNP), left ventricular end-diastolic diameter (LVEDD) were significantly associated with cardiac events. In the multivariate Cox proportional hazard analysis, serum soluble RAGE and plasma BNP were independent risk factors for cardiac events (soluble RAGE: HR 2.22, 95% CI 1.08 - 4.53, P = 0.029; BNP: HR 2.86, 95% CI 1.11 - 7.37, P = 0.029). Conclusions: Serum soluble RAGE level is a novel independent prognostic factor for heart failure.

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Individual testosterone decline and future mortality risk in men

Acta Endocrinologica ◽

10.1530/eje-17-0280 ◽

2018 ◽

Vol 178 (1) ◽

pp. 121-128 ◽

Cited By ~ 6

Author(s):

Stine A Holmboe ◽

Niels E Skakkebæk ◽

Anders Juul ◽

Thomas Scheike ◽

Tina K Jensen ◽

...

Keyword(s):

Mortality Risk ◽

Serum Levels ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

Age Related ◽

National Mortality ◽

All Cause Mortality ◽

Specific Mortality ◽

Cox Proportional Hazard Models

Objective Male aging is characterized by a decline in testosterone (TS) levels with a substantial variability between subjects. However, it is unclear whether differences in age-related changes in TS are associated with general health. We investigated associations between mortality and intra-individual changes in serum levels of total TS, SHBG, free TS and LH during a ten-year period with up to 18 years of registry follow-up. Design 1167 men aged 30–60 years participating in the Danish Monitoring Trends and Determinants of Cardiovascular Disease (MONICA1) study and who had a follow-up examination ten years later (MONICA10) were included. From MONICA10, the men were followed up to 18 years (mean: 15.2 years) based on the information from national mortality registries via their unique personal ID numbers. Methods Cox proportional hazard models were used to investigate the association between intra-individual hormone changes and all-cause, CVD and cancer mortalities. Results A total of 421 men (36.1%) died during the follow-up period. Men with most pronounced decline in total TS (<10th percentile) had a higher all-cause mortality risk compared to men within the 10th to 90th percentile (hazard ratio (HR): 1.60; 95% confidence interval (CI): 1.08–2.36). No consistent associations were seen in cause-specific mortality analyses. Conclusion Our study showed that higher mortality rates were seen among the men who had the most pronounced age-related decline in TS, independent of their baseline TS levels.

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Prognostic Value of Elevated Cardiac Troponin I After Aneurysmal Subarachnoid Hemorrhage

Frontiers in Neurology ◽

10.3389/fneur.2021.677961 ◽

2021 ◽

Vol 12 ◽

Author(s):

Fa Lin ◽

Yu Chen ◽

Qiheng He ◽

Chaofan Zeng ◽

Chaoqi Zhang ◽

...

Keyword(s):

Troponin I ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Rank Test ◽

Cardiac Events ◽

Neurological Outcomes ◽

Log Rank Test ◽

Kaplan Meier ◽

All Cause Mortality

Object: Patients with aneurysmal subarachnoid hemorrhage (aSAH) have an increased incidence of cardiac events and short-term unfavorable neurological outcomes during the acute phase of bleeding. We studied whether troponin I elevation after ictus can predict future major adverse cardiac events (MACEs) and long-term neurological outcomes after 2 years.Methods: Consecutive aSAH patients within 3 days of bleeding were eligible for review from a prospective observational cohort (ClinicalTrials.gov Identifier: NCT04785976). Potential predictors of future MACEs and unfavorable long-term neurological outcomes were calculated by Cox and logistic regression analyses. Additional Kaplan–Meier curves were performed.Results: A total of 213 patients were enrolled with an average follow-up duration of 34.3 months. Individuals were divided into two groups: elevated cTnI group and unelevated cTnI group. By the last available follow-up, 20 patients had died, with an overall all-cause mortality rate of 9.4% and an annual all-cause mortality rate of 3.8%. Patients with elevated cTnI had a significantly higher risk of future MACEs (10.6 vs. 2.1%, p = 0.024, and 95% CI: 1.256–23.875) and unfavorable neurological outcomes at discharge, 3-month, 1-, 2-years, and last follow-up (p = 0.001, p < 0.001, p = 0.001, p < 0.001, and p < 0.001, respectively). In the Cox analysis for future MACE, elevated cTnI was the only independent predictor (HR = 5.980; 95% CI: 1.428–25.407, and p = 0.014). In the multivariable logistic analysis for unfavorable neurological outcomes, peak cTnI was significant (OR = 2.951; 95% CI: 1.376–6.323; p = 0.005). Kaplan–Meier analysis indicated that the elevated cTnI was correlated with future MACE (log-rank test, p = 0.007) and subsequent death (log-rank test, p = 0.004).Conclusion: cTnI elevation after aSAH could predict future MACEs and unfavorable neurological outcomes.

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