Mortality in Patients with Pituitary Disease

Pituitary disease is associated with increased mortality predominantly due to vascular disease. Control of cortisol secretion and GH hypersecretion (and cardiovascular risk factor reduction) is key in the reduction of mortality in patients with Cushing’s disease and acromegaly, retrospectively. For patients with acromegaly, the role of IGF-I is less clear-cut. Confounding pituitary hormone deficiencies such as gonadotropins and particularly ACTH deficiency (with higher doses of hydrocortisone replacement) may have a detrimental effect on outcome in patients with pituitary disease. Pituitary radiotherapy is a further factor that has been associated with increased mortality (particularly cerebrovascular). Although standardized mortality ratios in pituitary disease are falling due to improved treatment, mortality for many conditions are still elevated above that of the general population, and therefore further measures are needed. Craniopharyngioma patients have a particularly increased risk of mortality as a result of the tumor itself and treatment to control tumor growth; this is a key area for future research in order to optimize the outcome for these patients.

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Neuroprotective agents in critical illness

10.1093/med/9780199600830.003.0048 ◽

2016 ◽

Author(s):

Jerrold L. Perrott ◽

Steven C. Reynolds

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Future Research ◽

Secondary Injury ◽

Aneurysmal Subarachnoid Haemorrhage ◽

Neuroprotective Agents ◽

Important Goal ◽

Risk Of Mortality ◽

Increased Risk ◽

Neuroprotective Strategies

The prevention and reduction of secondary injury following primary CNS insult is an important goal in critically-ill patients. Numerous pharmacological therapies have been studied as potential neuroprotective agents with few translating from research to clinical benefit. These are nimodipine and statins in aneurysmal subarachnoid haemorrhage and phenytoin in traumatic brain injury. Additionally, in traumatic brain injury, clinical studies have identified that corticosteroids and albumin colloid resuscitation are associated with increased risk of mortality, and as such should be avoided. Future research into new pharmacological neuroprotective strategies is warranted.

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Competing causes of death in patients with neuroendocrine tumor.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e23009 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e23009-e23009

Author(s):

Soon Khai Low ◽

Bao Long Hoang Trong ◽

Nourelhoda Sami Bahaie ◽

Dimitrios Giannis ◽

Gehad Mohamed Tawfik ◽

...

Keyword(s):

Causes Of Death ◽

Heart Diseases ◽

Unknown Primary ◽

Relative Risks ◽

Time Period ◽

Risk Of Mortality ◽

Increased Risk ◽

Standardized Mortality Ratios ◽

Competing Causes ◽

Using Data

e23009 Background: Increasing survival of patients with neuroendocrine tumors (NETs) may be associated with higher risk of mortality due to causes other than the primary NET, namely the competing causes of death (CCD). Therefore, our study focused on comprehensively investigating the magnitude of the CCD on the overall NET mortality and the associated demographic, clinicopathologic and treatment factors using data from the Surveillance, Epidemiology, and End Results (SEER) database. Methods: Patients with histologically confirmed primary NET diagnosed from 1973 through 2015 were identified using the SEER-9 registries for subsequent data collection and analysis. CCD were stratified and analyzed using standardized mortality ratios (SMRs) as measures of the relative risks of mortality for NET patients in comparison to the general population in the US adjusted by age, sex and race over the same time period. Competing risk regression analysis was performed using Fine and Gray multivariate regression model. Results: A total of 29,981 NET patients were included, 5481 (42.5%) of which deceased due to CCD. Overall SMR attributed to CCD was 2.50 [95% Confidence interval (CI): 2.43–2.56]. The SMR of non-cancer CCD was 2.65 (95% CI:2.58–2.73) and that of SPN was 1.91 (95% CI:1.79–2.04). Heart diseases and other cardiovascular diseases accounted for approximately half of all non-cancer CCD. SPN mortality accounted for 16.1% of CCD, with lung and bronchus cancer being the most prevalent. Stratification by the year of diagnosis revealed a drastic rise in CCD was observed in the last decade between 2005 and 2015, during which the SMR peaked. Advanced age, black race, small intestinal and gastric NETs, and cancer-directed surgery were significantly associated with an increased risk of CCD (p<0.001). Interestingly, female sex, pancreatic NETs, recto-anal NETs, NETs of unknown primary site, race other than white and black, distant and regional spread, chemotherapy and radiotherapy were significantly associated with a decrease in the incidence of CCD. Conclusions: CCD play an increasingly significant role in NET mortality in recent years, especially for those with higher risk of CCD. Further prospective studies are needed to evaluate the association of NETs with these CCD.

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Population-Based Study on the All-Cause and Cause-Specific Risks of Mortality among Long-Term Opioid Analgesics Users without Cancer in Taiwan

Healthcare ◽

10.3390/healthcare9111402 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1402

Author(s):

Po-Feng Lee ◽

Chung-Yi Li ◽

Yen-Chin Liu ◽

Chang-Ta Chiu ◽

Wen-Hsuan Hou

Keyword(s):

General Population ◽

Opioid Analgesics ◽

Population Based ◽

Opioid Use ◽

Data Set ◽

Risk Of Mortality ◽

Increased Risk ◽

Underlying Causes ◽

Standardized Mortality Ratios

(1) Background: The prevalence of opioid use in Taiwan increased by 41% between 2002 and 2014. However, little is known regarding the risk of mortality among long-term opioid analgesics users who do not have cancer. This study investigated this mortality risk with an emphasis on the calendar year and patients’ age and sex. (2) Methods: This retrospective cohort study included 12,990 adult individuals without cancer who were long-term users of opioid analgesics and were randomly selected from the data set of Taiwan’s National Health Insurance program from 2000 to 2012. They were then followed up through 2013. Information on the underlying causes of death was retrieved from the Taiwan Death Registry. Age, sex, and calendar year-standardized mortality ratios (SMRs) of all-cause and cause-specific mortality were calculated with reference to those of the general population. (3) Results: With up to 14 years of follow-up, 558 individuals had all-cause mortality in 48,020 person-years (cumulative mortality: 4.3%, mortality rate: 11.62 per 1000 person-years). Compared with the general population, the all-cause SMR of 4.30 (95% confidence interval (95% CI): 3.95–4.66) was significantly higher: it was higher in men than in women, declined with calendar year and age, and was significantly higher for both natural (4.15, 95% CI: 3.78–4.53) and unnatural (5.04, 95% CI: 3.88–6.45) causes. (4) Conclusions: Long-term opioid analgesics use among individuals without cancer in Taiwan was associated with a significantly increased risk of mortality. The notably increased mortality in younger adults warrants attention. Strategies to reduce long-term opioid analgesics use, especially their overuse or misuse, are in an urgent need.

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Survival in Restless Legs Syndrome: An 11-Year Surveillance, Community-Based Population Study

Neuroepidemiology ◽

10.1159/000508855 ◽

2020 ◽

Vol 54 (5) ◽

pp. 375-382

Author(s):

Esther Cubo ◽

Carla Collazo Riobo ◽

Cesar Gallego-Nieto ◽

Miren Elizari-Roncal ◽

Teresa Barroso-Pérez ◽

...

Keyword(s):

Regression Analysis ◽

General Population ◽

Restless Legs Syndrome ◽

Cox Regression ◽

Cox Regression Analysis ◽

Restless Legs ◽

Risk Of Mortality ◽

Increased Risk ◽

Standardized Mortality Ratios

Background: A growing body of evidence relates restless legs syndrome (RLS) to an increased risk of mortality attributable to both cerebrovascular and cardiovascular events. The aim was to investigate survival in patients with RLS. Methods: This was an observational, retrospective longitudinal study of a cohort of patients followed up for 11 years. RLS was diagnosed by a physician using the International RLS Study Group criteria. Mortality was analyzed using age-standardized mortality ratios (SMR: observed/expected deaths) and Cox regression analysis. Results: Vital status was studied in a cohort of 232 patients: 181 women (78%), 96 with RLS (41.4%) with a mean age at baseline of 49.8 ± 15.0 years and a mean RLS duration of 14.1 ± 1.9 years, and 136 non-RLS (58.6%) with a mean age of 51.3 ± 14.9 years. This RLS cohort was followed up for a period of 10.4 ± 2.0 years. As of September 2019, 17 (7.3%) patients died (6 with RLS, 6.3%), and the most frequent cause was oncological (66.7%). A total of 944 person-years of observations were available for survival analysis. RLS was not associated with increased mortality in adjusted Cox regression analysis (HR = 1.12, 95% CI: 0.40–3.15), and survival was similar to that expected for the general population (SMR = 0.61, 95% CI: 0.27–1.36). Conclusions: RLS seems not to be associated with increased mortality compared to the general population. Still, studies with prospective data collection with large samples are needed to study the long-term mortality risk factors in RLS cohorts.

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How active are we? Levels of routine physical activity in children and adults

Proceedings of The Nutrition Society ◽

10.1079/pns2003291 ◽

2003 ◽

Vol 62 (3) ◽

pp. 681-701 ◽

Cited By ~ 79

Author(s):

M. B. E. Livingstone ◽

P. J. Robson ◽

J. M. W. Wallace ◽

M. C. McKinley

Keyword(s):

Physical Activity ◽

Activity Patterns ◽

Age Groups ◽

Moderate Intensity ◽

Future Research ◽

Extensive Literature ◽

Activity Levels ◽

Moderate Intensity Exercise ◽

Clear Cut ◽

Increased Risk

The accurate measurement of physical activity is fraught with problems in adults, but more especially in children because they have more complex and multi-dimensional activity patterns. In addition, the results of different studies are often difficult to interpret and compare, because of the diversity of methodological approaches, differences in data analysis and reporting, and the adoption of varying definitions of what constitutes an appropriate level of activity. Furthermore, inactivity is seldom quantified directly. Although there exists an extensive literature documenting the health benefits of regular physical activity in adults, activity-health relationships in children are not clear-cut. Current recommendations reinforce the concept of health-related activity, accumulating 30 min moderate-intensity exercise on at least 5 d/week (adults) and 1 h moderate-intensity exercise/d (children). Evidence suggests a high prevalence of inactivity in adults, but whether or not inactivity is increasing cannot be assessed currently. Similarly, no definite conclusions are justified about either the levels of physical activity of children, or whether these are sufficient to maintain and promote health. Data to support the belief that activity levels in childhood track into adulthood are weak. Inactivity is associated with an increased risk of weight gain and obesity, but causality remains to be established. In children there is strong evidence to demonstrate a dose-response relationship between the prevalence and incidence of obesity and time spent viewing television. Future research should focus on refining methodology for physical activity assessment to make it more sensitive to the different dimensions and contexts of activity in different age-groups.

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The Management of Diabetic Patients with Heart Failure

International Cardiovascular Forum Journal ◽

10.17987/icfj.v10i0.449 ◽

2017 ◽

Vol 10 ◽

Cited By ~ 3

Author(s):

Giuseppe Rosano ◽

Petar Seferovic

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Therapeutic Agents ◽

Diabetic Patients ◽

Developing Heart ◽

Risk Of Mortality ◽

Increased Risk ◽

Patients With Heart Failure ◽

Patients With Diabetes ◽

Reduction Of Mortality

Patients with diabetes mellitus have an increased risk of developing heart failure and diabetes mellitus is highly prevalent amongst patients with heart failure, especially those with HFpEF. Diabetic patients with heart failure have an increased mortality and an increased risk of hospitalisations and the use of certain anti- diabetic agents increase the risk of mortality and hospitalisation in heart failure. Conversely, newer therapeutic agents have shown a significant reduction of mortality, morbidity and risk of developing heart failure in diabetic patients with proven cardiovascular disease. This highly important area is reviewed in this paper.

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1507: Acute Urinary Retention is Associated with an Increased Risk of Mortality

The Journal of Urology ◽

10.1016/s0022-5347(18)31708-7 ◽

2007 ◽

Vol 177 (4S) ◽

pp. 497-497

Author(s):

James Armitage ◽

Nokuthaba Sibanda ◽

Paul Cathcart ◽

Mark Emberton ◽

Jan Van Der Meulen

Keyword(s):

Urinary Retention ◽

Acute Urinary Retention ◽

Risk Of Mortality ◽

Increased Risk

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A Silenced Population

Crisis ◽

10.1027/0227-5910/a000470 ◽

2017 ◽

Vol 38 (6) ◽

pp. 433-442 ◽

Cited By ~ 1

Author(s):

Kim Gryglewicz ◽

Melanie Bozzay ◽

Brittany Arthur-Jordon ◽

Gabriela D. Romero ◽

Melissa Witmeier ◽

...

Keyword(s):

At Risk ◽

Depressive Symptomatology ◽

The United States ◽

Future Research ◽

At Risk Youth ◽

Peer Relationship ◽

Student Records ◽

Cross Sectional ◽

Increased Risk ◽

Method Student

Abstract. Background: Given challenges that exceed the normal developmental requirements of adolescence, deaf and hard-of-hearing (DHH) youth are believed to be at elevated risk for engaging in suicide-related behavior (SRB). Unfortunately, little is known about the mechanisms that put these youth potentially at risk. Aims: To determine whether peer relationship difficulties are related to increased risk of SRB in DHH youth. Method: Student records (n = 74) were retrieved from an accredited educational center for deaf and blind students in the United States. Results: Peer relationship difficulties were found to be significantly associated with engagement in SRB but not when accounting for depressive symptomatology. Limitations: The restricted sample limits generalizability. Conclusions regarding risk causation cannot be made due to the cross-sectional nature of the study. Conclusion: These results suggest the need for future research that examines the mechanisms of the relationship between peer relationship difficulties, depression, and suicide risk in DHH youth and potential preventive interventions to ameliorate the risks for these at-risk youth.

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Association Between Potentially Inappropriate Medications and 30-Day Post–Hospital Discharge Outcomes in US Veterans

Annals of Pharmacotherapy ◽

10.1177/10600280211032072 ◽

2021 ◽

pp. 106002802110320

Author(s):

Heather G. Allore ◽

Danijela Gnjidic ◽

Melissa Skanderson ◽

Ling Han

Keyword(s):

Hospital Discharge ◽

Adverse Drug Events ◽

Primary Care Clinic ◽

Care Utilization ◽

Potentially Inappropriate Medications ◽

Care Hospital ◽

Care Clinic ◽

Risk Of Mortality ◽

Increased Risk ◽

Reduced Risk

Background Potentially inappropriate medication (PIMs) use is common in older inpatients and it may lead to increased risk of adverse drug events. Objectives To examine prevalence of PIMs at hospital discharge and its contribution to health care utilization and mortality within 30-days of hospital discharge. Methods This was a prospective cohort of 117 570 veterans aged ≥65 years and hospitalized in 2013. PIMs at discharge were categorized into central nervous system acting (CNS) and non-CNS. Outcomes within 30-days of hospital discharge were: (1) time to first acute care hospital readmission, and all-cause mortality, (2) an emergency room visit, and (3) ≥3 primary care clinic visits. Results The cohort’s mean age was 74.3 years (SD 8.1), with 51.3% exposed to CNS and 62.8% to non-CNS PIMs. Use of CNS and non-CNS PIMs, respectively, was associated with a reduced risk of readmission, with an adjusted hazard ratio (aHR) of 0.93 (95% CI = 0.89-0.96) for ≥2 (vs 0) CNS PIMs and an aHR of 0.85 (95% CI = 0.82-0.88) for ≥2 (vs 0) non-CNS PIMs. Use of CNS PIMs (≥2 vs 0) was associated with increased risk of mortality (aHR = 1.37 [95% CI = 1.25-1.51]), whereas non-CNS PIMs use was associated with a reduced risk of mortality (aHR = 0.75 [95% CI = 0.69-0.82]). Conclusion and Relevance PIMs were highly common in this veteran cohort, and the association with outcomes differed by PIMs. Thus, it is important to consider whether PIMs are CNS acting to optimize short-term posthospitalization outcomes.

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Age is just a number: Is frailty being ignored in vascular access planning for dialysis?

The Journal of Vascular Access ◽

10.1177/1129729821989902 ◽

2021 ◽

pp. 112972982198990

Author(s):

Kulli Kuningas ◽

Nicholas Inston

Keyword(s):

Decision Making ◽

Kidney Disease ◽

Vascular Access ◽

Clinical Condition ◽

The Elderly ◽

Dialysis Access ◽

Adverse Health Outcomes ◽

Risk Of Mortality ◽

Increased Risk ◽

First Choice

Current international guidelines advocate fistula creation as first choice for vascular access in haemodialysis patients, however, there have been suggestions that in certain groups of patients, in particular the elderly, a more tailored approach is needed. The prevalence of more senior individuals receiving renal replacement therapy has increased in recent years and therefore including patient age in decision making regarding choice of vascular access for dialysis has gained more relevance. However, it seems that age is being used as a surrogate for overall clinical condition and it can be proposed that frailty may be a better basis to considering when advising and counselling patients with regard to vascular access for dialysis. Frailty is a clinical condition in which the person is in a vulnerable state with reduced functional capacity and has a higher risk of adverse health outcomes when exposed to stress inducing events. Prevalence of frailty increases with age and has been associated with an increased risk of mortality, hospitalisation, disability and falls. Chronic kidney disease is associated with premature ageing and therefore patients with kidney disease are prone to be frailer irrespective of age and the risk increases further with declining kidney function. Limited data exists on the relationship between frailty and vascular access, but it appears that frailty may have an association with poorer outcomes from vascular access. However, further research is warranted. Due to complexity in decision making in dialysis access, frailty assessment could be a key element in providing patient-centred approach in planning and maintaining vascular access for dialysis.

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