Rituximab-Induced Hypogammaglobulinemia and Infections in AQP4 and MOG Antibody–Associated Diseases

ObjectiveTo determine the potential association between infections and rituximab (RTX)-induced hypogammaglobulinemia among patients with CNS inflammatory diseases.MethodsWe included in a prospective observational study all consecutive adults with aquaporin 4 (AQP4) or myelin oligodendrocyte glycoprotein (MOG) antibody–positive disorders treated with RTX. Dosing schedule was adapted to memory B-cell measurement.ResultsWe included 48 patients (mean age 47 [SD: 14] years; 77% females; 31 AQP4 positive and 17 MOG positive). The median follow-up was 3.6 years (range: 0.9–8.1 years). The median number of RTX infusions was 8 (range: 2–14). The median dosing interval was 6 months (range: 1.7–13.7 months). Sixty-seven symptomatic infections (SIs) were observed in 26 of 48 (54%) patients, including 13 severe infections in 9 (19%). Urinary and lower respiratory tract infections were the most frequent, representing 42% and 21% of SI. At RTX onset, the immunoglobulin G (IgG) level was abnormal in 3 of 48 (6%) patients. After RTX, 15 (31%), 11 (23%), 3 (6%), and 0 of 48 patients showed sustained IgG level <7, <6, <4, and <2 g/L, respectively. On multivariate Cox proportional hazards analysis, the main variables explaining the risk of SI were the presence of urinary tract dysfunction (hazard ratio [HR] = 34, 95% CI 4–262, p < 0.001), the dosing intervals (HR = 0.98, 95% CI 0.97–0.99, p < 0.001), and the interaction between IgG level and urinary tract dysfunction (HR = 0.67, 95% CI 0.53–0.85, p < 0.005). IgG level <6 g/L during RTX was associated with male sex (HR = 4, 95% CI 1.4–11.4, p < 0.01) and previous immunosuppression (HR = 3.4, 95% CI 1.2–10, p < 0.05).ConclusionsRTX used as maintenance therapy in CNS inflammatory diseases is frequently associated with reduced IgG level and increases the infection risk of the most vulnerable patients.

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Pre-diagnostic Circulating Concentrations of Fat-soluble Vitamins and Risk of Glioma in Three Cohort Studies

10.21203/rs.3.rs-110462/v1 ◽

2020 ◽

Author(s):

Yiyang Yue ◽

Jordan Creed ◽

David Cote ◽

Meir Stampfer ◽

Molin Wang ◽

...

Keyword(s):

Proportional Hazards ◽

Conditional Logistic Regression ◽

Plasma Concentrations ◽

Cox Proportional Hazards ◽

Health Study ◽

Hydroxyvitamin D ◽

Potential Association ◽

25 Hydroxyvitamin D ◽

Glioma Risk ◽

Fat Soluble Vitamins

Abstract Few prospective studies have evaluated the relation between fat-soluble vitamins and glioma risk. Using three cohorts—UK Biobank (UKB), Nurses’ Health Study (NHS), and Health Professionals Follow-Up Study (HPFS), we investigated associations of pre-diagnostic concentrations of fat-soluble vitamins D, A, and E with incident glioma. In 346,785 participants (444 cases) in UKB, associations with vitamin D (25-hydroxyvitamin D [25(OH)D]) were evaluated by Cox proportional hazards regression. In NHS (52 cases, 104 controls) and HPFS (32 cases, 64 controls), associations with 25(OH)D, vitamin A (retinol), and vitamin E (α- and γ-tocopherol) were assessed using conditional logistic regression. Our results suggested plasma concentrations of 25(OH)D and retinol were not associated with glioma risk. Comparing the highest to lowest tertile, the multivariable hazard ratio (MVHR) for 25(OH)D was 0.87 (95% confidence interval [CI]: 0.68-1.11) in UKB and the multivariable risk ratio (MVRR) was 1.08 (95%CI: 0.55-2.09) in NHS and HPFS. In NHS and HPFS, the MVRR for the same comparison for retinol was 1.16 (95%CI: 0.56-2.38). Nonsignificant associations were observed for α-tocopherol (MVRRtertile3vs1=0.61, 95%CI: 0.29-1.32) and γ-tocopherol (MVRR tertile3vs1=1.30, 95%CI: 0.63-2.69) that became stronger in 4-year lagged analyses. Further investigation is warranted on a potential association between α- and γ-tocopherol and glioma risk.

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Obesity and risk of infections: results from men and women in the Swedish National March Cohort

International Journal of Epidemiology ◽

10.1093/ije/dyz129 ◽

2019 ◽

Cited By ~ 1

Author(s):

Francesca Ghilotti ◽

Rino Bellocco ◽

Weimin Ye ◽

Hans-Olov Adami ◽

Ylva Trolle Lagerros

Keyword(s):

Proportional Hazards ◽

Cox Model ◽

Normal Weight ◽

Cox Proportional Hazards ◽

Event Analysis ◽

Obese Women ◽

Cox Models ◽

Increased Risk ◽

Repeated Events ◽

Tract Infections

Abstract Background Previous studies have shown an association between body mass index (BMI) and infections, but the literature on type-specific community acquired infections is still limited. Methods We included 39 163 Swedish adults who completed a questionnaire in September 1997 and were followed through record-linkages until December 2016. Information on BMI was self-reported and infections were identified from the Swedish National Patient Register using International Classification of Diseases (ICD), Tenth Revision (ICD-10) codes. We fitted multivariable Cox proportional hazards models for time-to-first-event analysis, and we used extensions of the standard Cox model when repeated events were included. Results During a 19-year follow-up 32% of the subjects had at least one infection requiring health care contact, leading to a total of 27 675 events. We found an increased incidence of any infection in obese women [hazard ratio (HR) = 1.22; 95% confidence interval (CI) = 1.12; 1.33] and obese men (HR = 1.25; 95% CI = 1.09; 1.43) compared with normal weight subjects. For specific infections, higher incidences were observed for skin infections in both genders (HR = 1.76; 95% CI = 1.47; 2.12 for obese females and HR = 1.74; 95% CI = 1.33; 2.28 for obese males) and gastrointestinal tract infections (HR = 1.44; 95% CI = 1.19; 1.75), urinary tract infections (HR = 1.30; 95% CI = 1.08; 1.55) and sepsis (HR = 2.09; 95% CI = 1.46; 2.99) in obese females. When accounting for repeated events, estimates similar to the aforementioned ones were found. Conclusions Obesity was associated with an increased risk of infections in both genders. Results from multiple-failure survival analysis were consistent with those from classic Cox models.

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Circulating Inflammatory and Hemostatic Biomarkers are Associated with All-Cause Death and Cancer Death in a Population of Community-Dwelling Japanese: The Tanushimaru Study

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s17065 ◽

2014 ◽

Vol 8s3 ◽

pp. CMC.S17065

Author(s):

Mika Enomoto ◽

Hisashi Adachi ◽

Ako Fukami ◽

Ayako Yoshimura ◽

Aya Obuchi ◽

...

Keyword(s):

Cardiovascular Diseases ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Inflammatory Diseases ◽

Cox Proportional Hazards ◽

Predictive Markers ◽

Community Dwelling ◽

Cox Proportional Hazards Model ◽

Cancer Death ◽

Hazards Model

Background In patients with cardiovascular diseases, inflammatory and hemostatic biomarkers are significant indicators of prognosis. We investigated whether circulating inflammatory and hemostatic biomarkers were predictive markers for all-cause death and cancer death in a population of community-dwelling Japanese. Methods We studied 1,920 healthy Japanese adults who underwent health examinations in 1999. Those who reported a history of inflammatory diseases and malignancy on a baseline questionnaire were excluded. Inflammatory and hemostatic biomarkers were measured in the remaining 1,862 participants, who were followed up periodically for 10 years. Multivariate proportional hazards regression analysis was used to estimate all-cause and cancer mortality. Results A total of 258 participants died during follow-up: 87 from cancer, 38 from cerebro-cardiovascular diseases, and 133 from other diseases. Mean C-reactive protein (CRP) levels at baseline were significantly higher in decedents than in survivors. Mean von Willebrand factor (vWF) levels at baseline were significantly higher in decedents than in survivors. The Cox proportional hazards model after adjustments for age and sex showed that CRP (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.06-1.51) and vWF (HR, 1.01; 95% CI, 1.00-1.01) were independent predictors of all-cause death. CRP (HR, 1.40; 95% CI, 1.06-1.86) and vWF (HR, 1.01; 95% CI, 1.00-1.02) were also independent predictive markers for cancer death. Conclusions Serum CRP and vWF were predictors of all-cause death and cancer death in the population of community dwelling Japanese.

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The role of extensive lymphadenectomy in stage I ovarian cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.5069 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 5069-5069

Author(s):

E. G. Munro ◽

N. Karnik Lee ◽

M. K. Cheung ◽

K. Osann ◽

A. Husain ◽

...

Keyword(s):

Ovarian Cancer ◽

Proportional Hazards ◽

Clear Cell ◽

Median Number ◽

Cox Proportional Hazards ◽

Stage I ◽

Extensive Lymphadenectomy ◽

Stage Ib ◽

Primary Surgery ◽

Stage Ia

5069 Background: To determine if extent of lymphadenectomy affects the survival of women with stage I ovarian cancer. Methods: Demographic and clinico-pathologic information were obtained from the Surveillance, Epidemiology and End Results Program from 1988–2001 and analyzed using Kaplan-Meier methods and Cox proportional hazards regression. Results: Of the 6,686 women diagnosed with stage I ovarian cancer, 4,092 (61.2%) had stage IA, 392 (5.9%) had stage IB, 1,840 (27.5%) had stage IC, and 362 (5.4%) had unspecified stage I disease. The median age was 53 (range: 1–99). 5,625 (84.1%) were White, 388 (5.8%) Black, 488 (7.3%) Asian, and 185 (2.8%) were Other. All patients underwent primary surgery; of which, 3,824 women had no nodes, 1,533 had <10 nodes, and 1,329 had ≥10 nodes resected. Of the patients who underwent a lymphadenectomy, the median number of nodes resected was 9 (range: 1–84). The extent of lymphadenectomy (0, <10, and ≥10 nodes) increased the survival of patients with stage IC disease from 72.8%, 86.7%, to 90.1% (p < 0.0001), but not in those with stage IA (p = 0.07) or stage IB (p = 0.04) disease. In patients with non-clear cell epithelial carcinoma, the extent of lymphadenectomy was associated with improved 5-year disease-specific survivals of 85.6%, 93.3%, and 93.5%, respectively (p < 0.0001). However, the benefit associated with an extensive lymphadenectomy was not evident in clear cell (p = 0.09), sarcoma (p = 0.33), germ cell (p = 0.55), or sex cord stromal tumors of the ovary (p = 0.99). Similarly, patients with grade 3 disease had an improved survival associated with the extent of lymph node resection, 74.4%, 87.5%, to 90.5% (p < 0.0001), but not in those with grade 1 (p = 0.18) or grade 2 (p = 0.27) disease. In multivariate analysis, a more extensive lymphadenectomy remained significant as an independent prognostic factor for improved survival after adjusting for all other independent prognostic factors including age, surgery, histology, stage, and grade. Conclusions: Our findings suggest that the extent of lymphadenectomy was associated with an improvement in the survival of women with stage IC ovarian cancer. No significant financial relationships to disclose.

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Graded prognostic assessment index for melanoma with brain metastases (MBM).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.9086 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 9086-9086 ◽

Cited By ~ 1

Author(s):

Kwabena Osei-Boateng ◽

Vyshak Alva Venur ◽

Saurabh Dahiya ◽

Lingling Du ◽

Rohan Garje ◽

...

Keyword(s):

Brain Metastases ◽

Proportional Hazards ◽

Cleveland Clinic ◽

Prognostic Index ◽

Whole Brain Radiotherapy ◽

Median Number ◽

Cox Proportional Hazards ◽

Karnofsky Performance Scale ◽

Prognostic Assessment ◽

Graded Prognostic Assessment

9086 Background: The Graded Prognostic Assessment (GPA) is a commonly used prognostic index in patients with brain metastases (BM). GPA for melanoma consists of Karnofsky Performance Scale (KPS) and the number of BM present. The purpose of this study was to evaluate the utility of GPA index in a contemporary cohort of patients (pts) with MBM at a single institution to predict Overall Survival (OS). Methods: With IRB approval, the Cleveland Clinic Brain Tumor and Neuro-Oncology Center’s database was used to identify pts with MBM treated between 2000-2012. The primary endpoint was OS from diagnosis of MBM. Cox proportional hazards models were used for data analysis. Stepwise variable selection was used to identify independent prognostic factors. Results: 90 MBM (51 females) median age 57 years (range 24-87) were included for analysis. The median number of BM was 2 (range, 1-11). KPS was 90-100(52%), 70-80 (43%) and <70 (6%). Extracranial metastases was present in 75 patients (83%). Initial treatment included Stereotactic Radiosurgery (SRS) (49%), Whole Brain Radiotherapy (WBRT) (8%), WBRT + SRS (22%), WBRT + Surgery (S)(14%) and SRS + (S) (7%). Median OS was 7.8 months (95% C.I. 6.8-10.1). GPA was prognostic for OS ( p=0.01), however this was because pts with scores of 4 had worse outcomes (median 5.1months) than the other 3 groups, which had similar OS (median 9.0-12.8 months). In addition, number of BM was not associated with OS (p=0.19). In contrast, KPS (p=0.02), Liver (p=0.04) and hemorrhagic metastasis (p=0.02) were independently prognostic for OS. These factors can be used to derive a new prognostic index with 3 groups: Unfavorable, Intermediate and Favorable (see Table). Conclusions: GPA was prognostic for OS in pts with MBM, however separation of the groups was not clear. A new prognostic index consisting of KPS, liver and hemorrhagic metastases is proposed for MBM. [Table: see text]

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High-dose interleukin-2 (HD IL-2) in the treatment of advanced melanoma: The University of Pittsburgh experience.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.9075 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 9075-9075

Author(s):

Diwakar Davar ◽

Melissa Saul ◽

Ahmad A. Tarhini ◽

An Tran ◽

Kerry Trent ◽

...

Keyword(s):

Proportional Hazards ◽

Interleukin 2 ◽

Complete Response ◽

Median Number ◽

Cox Proportional Hazards ◽

Advanced Melanoma ◽

High Dose ◽

Severe Toxicity ◽

University Of Pittsburgh ◽

Radiological Data

9075 Background: IL-2 is a T-cell growth factor tested in a variety of regimens for advanced melanoma (MEL) and renal cell carcinoma (RCC). High-dose IL-2 (600,000-720,000 IU/kg administered intravenously every 8 hours for up to 14 consecutive doses) was approved by FDA for advanced MEL and RCC in 1998 based upon the durability of responses observed. Early studies of HD IL-2 reported overall (OR) and complete response (CR) rates of 16% and 8% respectively. Severe toxicity limited use to specialized centers with standardized protocols, either intensive care (ICU) or oncology specialty settings. The U Pittsburgh has treated 1022 patients with IL-2 at any dosage and we here present outcomes of 550 MEL pts treated with HD IL-2 in an oncology specialty non-ICU setting. Methods: Clinical and radiological data were collected on all pts treated with IL-2 using the UPCI Cancer Registry and Medical Archival System (MARS). Pharmacy records were reviewed for dosing details. The influence of baseline characteristics on treatment outcomes was assessed using Cox proportional hazards analysis. Results: A total of 848 pts received HD IL-2, of which 298 pts had RCC while 550 had MEL. Detailed pharmacy dosing records were reviewed from 176 pts treated over the past 12 years (2000-2012) who received a total of 3738 cycles. Of 165 pts evaluable for response, OR was documented in 24 pts (14.8%) and CR in 5 pts (3.0%). Median overall survival (OS) was 10.0 mos for all patients and 21.5 mos for responders (CR+PR). Median number of doses per cycle was 7. Toxicity was consistent with prior reports. HD IL-2 required ICU transfers in 5% and 1 death was attributed to HD IL-2. Pts with higher baseline lactate dehydrogenase (LDH) had poorer OS (p < 0.05). Conclusions: In this large and uniformly treated series of recent patients treated with IL-2 OR/CR rates with HD IL-2 are 14.8% and 3.0% respectively. Higher LDH is associated with poorer outcome. Biomarkers of response are currently being evaluated in banked clinical specimens collected from patients under the SPORE in Skin Cancer (P50 CA121973).

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Association Between Positive Cultures During Admission and 1-Year Mortality in Patients With Cancer Receiving Perioperative Intensive Care

Cancer Control ◽

10.1177/1073274818794162 ◽

2018 ◽

Vol 25 (1) ◽

pp. 107327481879416 ◽

Cited By ~ 1

Author(s):

Hsiu-Yin Chiang ◽

Tung-Han Wu ◽

Chiann-Yi Hsu ◽

Wen-Cheng Chao

Keyword(s):

Intensive Care ◽

Urinary Tract ◽

Soft Tissue ◽

Respiratory Tract ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Patients With Cancer ◽

Cox Proportional Hazards Regression ◽

Proportional Hazards Regression

The number of patients with cancer being admitted to intensive care units (ICUs) is increasing worldwide, and these patients are vulnerable to infection. This study aimed to address the long-term impact of positive cultures during admission on 1-year mortality among patients with cancer who received perioperative intensive care. This retrospective cohort study enrolled adult patients with cancer who were admitted to ICUs and received surgery during 2011 to 2016 at a tertiary hospital in central Taiwan. Cancer-related data were retrieved from the cancer registry, and data during ICU admissions were obtained from the electronic medical records. We compared the survival curves between patients with and without positive clinical cultures using log-rank test and used a multivariable Cox proportional hazards regression model to evaluate the influence of positive clinical cultures on 1-year mortality. A total of 638 patients were included for analyses, and 37.9% of them had positive cultures during the index admission. In-hospital mortality was 9.1%, while 1-year mortality was 21.0%. Compared with patients who survived, patients who died were significantly more likely to have positive cultures (59.7% vs 32.1%), to have a higher Acute Physiology and Chronic Health Evaluation II scores (median 21.8 vs 19.0), and to receive mechanical ventilation (86.6% vs 77.4%). Survival analysis found that positive cultures of blood, the respiratory tract, the urinary tract, or the skin and soft tissue were associated with an increased 1-year mortality. Multivariable Cox proportional hazards regression analysis found that positive cultures of blood, the respiratory tract, the urinary tract, or the skin and soft tissue (hazard ratio: 1.621; 95% confidence interval: 1.087-2.419) were significantly associated with 62.1% increased hazards of death within 1 year after the ICU admission. A positive culture during admission was associated with a worsened long-term survival among patients with cancer who received perioperative intensive care. Further studies are needed to confirm this association.

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Outcomes of patients (pts) with metastatic renal cell carcinoma (mRCC) treated with pazopanib after progression on other targeted therapies (TT): Updated results.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.367 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 367-367

Author(s):

Marc Ryan Matrana ◽

Cihan Duran ◽

Aditya Shetty ◽

Lianchun Xiao ◽

Bradley J. Atkinson ◽

...

Keyword(s):

Proportional Hazards ◽

Kinase Inhibitor ◽

Clear Cell ◽

Progression Free Survival ◽

Median Number ◽

Cox Proportional Hazards ◽

Clinical Activity ◽

Pancreatic Metastases ◽

Cox Proportional Hazards Models ◽

Treatment Naïve

367 Background: Pazopanib is an multi-tyrosine kinase inhibitor shown to prolong progression-free survival (PFS) compared to placebo in treatment-naive and cytokine-refractory mRCC. Outcomes and safety on its use after TT are limited. Methods: We retrospectively reviewed records of consecutive pts with mRCC who were treated with pazopanib between November 2009-November 2011 after having progressive disease (PD) with other TT. Radiographic response was assessed by a blinded radiologist using RECIST v1.1 criteria. PFS and overall survival (OS) were estimated by the Kaplan-Meier method. Hazard ratios (HR) were estimated by fitting univariable and multivariable Cox proportional hazards models to evaluate the association of PFS with patient co-variates. Results: 112 pts (median age 63 years, 67% male, 83% clear cell) met inclusion criteria. Median number of previous TT was 2 (range 1-5). 85 events (PD or death) occurred. 14 pts (12.5%) had a partial response. Median PFS was 5.7 months (95% CI: 4.3-8.9 months). PFS was significantly associated with male gender (HR=0.55; 95% CI: 0.34-0.87; p=0.011), clear-cell histology (HR=0.42; 95% CI: 0.24-0.74; p=0.0031), number of metastatic sites (HR= 1.26; 95% CI: 1.05-1.52; p=0.0123), pancreatic metastases (HR=0.40; 95% CI: 0.18-0.85;p=0.0185), Karnofsky PS< 80 (HR=2.07; 95% CI: 1.22-3.48; p=0.0062), and elevated LDH (HR=1.63; 95% CI: 1.03-2.573; p=0.035). Median OS was 16.9 months (95% CI: 10.3–21.9). 26% of pts were still receiving pazopanib at the time of analysis. 51% discontinued pazopanib due to PD and 12% died of PD on treatment. 11% discontinued pazopanib due to adverse events (AEs). There were no treatment related deaths. Common AEs included fatigue (43%), increase LFTs (34%), diarrhea (28%), nausea/vomiting (14%), anorexia (14%), hypertension exacerbation (12%), and hypothyroidism (11%). 89% of AEs were grade 1/2. Conclusions: Pazopanib demonstrated meaningful clinical activity in heavily pretreated pts with mRCC following PD with other TT. AEs were mild/moderate and manageable.

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Butyrylcholinesterase Levels on Admission Predict Severity and 12-Month Mortality in Hospitalized AIDS Patients

Mediators of Inflammation ◽

10.1155/2018/5201652 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 3

Author(s):

Lijun Xu ◽

Biao Zhu ◽

Ying Huang ◽

Zongxing Yang ◽

Jia Sun ◽

...

Keyword(s):

Proportional Hazards ◽

Proportional Hazards Model ◽

Inflammatory Diseases ◽

Serum Levels ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Cd4 Count ◽

Aids Patients ◽

Hazards Model ◽

Immunodeficiency Syndrome

Background. Butyrylcholinesterase (BChE) is synthesized mainly in the liver and an important marker in many infectious/inflammatory diseases, but its role in acquired immunodeficiency syndrome (AIDS) patients is not clear. We wished to ascertain if BChE level is associated with the progression/prognosis of AIDS patients.Methods. BChE levels (in U/L) were measured in 505 patients; <4500 was defined as “low” and ≥4500 as “normal.” Associations between BChE level and CD4 count, WHO stage, body mass index (BMI), C-reactive protein (CRP) level, and duration of hospitalization were assessed. Kaplan–Meier curves and Cox proportional hazards model were used to assess associations between low BChE levels and mortality, after adjustment for age, CD4 count, WHO stage, and laboratory parameters.Results. A total of 129 patients (25.5%) had a lower BChE level. BChE was closely associated with CD4 count, WHO stage, CRP level, and BMI (allP<0.001). Eighty-four patients (16.6%) died in the first year of follow-up. One-year survival was 64.5 ± 4.5% for patients with low BChE and 87.6 ± 1.8% for those with normal BChE (log-rank,P<0.001). After adjustment for sex, age, BMI, WHO stage, and CD4 count, as well as serum levels of hemoglobin, sodium, and albumin, the hazard ratio was 1.8 (95% confidence interval, 1.0–3.2) for patients with a low BChE compared with those with a normal BChE (P=0.035).Conclusion. BChE level is associated with HIV/AIDS severity and is an independent risk factor for increased mortality in AIDS patients.

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Demographics and Clinical Features of Postresuscitation Comorbidities in Long-Term Survivors of Out-of-Hospital Cardiac Arrest: A National Follow-Up Study

BioMed Research International ◽

10.1155/2017/9259182 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Chih-Pei Su ◽

Jr-Hau Wu ◽

Mei-Chueh Yang ◽

Ching-Hui Liao ◽

Hsiu-Ying Hsu ◽

...

Keyword(s):

Heart Failure ◽

Cardiac Arrest ◽

Proportional Hazards ◽

Patient Characteristics ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Models ◽

Tract Infections ◽

Hospital Cardiac Arrest ◽

New Onset

The outcome of patients suffering from out-of-hospital cardiac arrest (OHCA) is very poor, and postresuscitation comorbidities increase long-term mortality. This study aims to analyze new-onset postresuscitation comorbidities in patients who survived from OHCA for over one year. The Taiwan National Health Insurance (NHI) Database was used in this study. Study and comparison groups were created to analyze the risk of suffering from new-onset postresuscitation comorbidities from 2011 to 2012 (until December 31, 2013). The study group included 1,346 long-term OHCA survivors; the comparison group consisted of 4,038 matched non-OHCA patients. Demographics, patient characteristics, and risk of suffering comorbidities (using Cox proportional hazards models) were analyzed. We found that urinary tract infections (n=225, 16.72%), pneumonia (n=206, 15.30%), septicemia (n=184, 13.67%), heart failure (n=111, 8.25%) gastrointestinal hemorrhage (n=108, 8.02%), epilepsy or recurrent seizures (n=98, 7.28%), and chronic kidney disease (n=62, 4.61%) were the most common comorbidities. Furthermore, OHCA survivors were at much higher risk (than comparison patients) of experiencing epilepsy or recurrent seizures (HR = 20.83; 95% CI: 12.24–35.43), septicemia (HR = 8.98; 95% CI: 6.84–11.79), pneumonia (HR = 5.82; 95% CI: 4.66–7.26), and heart failure (HR = 4.88; 95% CI: 3.65–6.53). Most importantly, most comorbidities occurred within the first half year after OHCA.

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