PREDICTOR BIOMARKERS OF NONELECTIVE HOSPITAL READMISSION AND MORTALITY IN MALNOURISHED HOSPITALIZED OLDER ADULTS

Background: 90-day mortality and rehospitalizations are important hospital quality metrics. Biomarkers that predict these outcomes among malnourished hospitalized patients could identify those at risk and help direct care plans. Objectives: To identify biomarkers that predict 90-day (primary) and 30-day (secondary) mortality or nonelective rehospitalization. Design and Participants: An analysis of the ability of biomarkers to predict 90- and 30-day mortality and rehospitalization among malnourished hospitalized patients. Setting: 52 blood biomarkers were measured in 193 participants in NOURISH, a randomized trial that determined the effects of a nutritional supplement on 90-day readmission and death in patients >65 years. Composite outcomes were defined as readmission or death over 90-days or 30-days. Univariate Cox Proportional Hazards models were used to select best predictors of outcomes. Markers with the strongest association were included in multivariate stepwise regression. Final model of hospital readmission or death was derived using stepwise selection. Measurements: Nutritional, inflammatory, hormonal and muscle biomarkers. Results: Mean age was 76 years, 51% were men. In univariate models, 10 biomarkers were significantly associated with 90-day outcomes and 4 biomarkers with 30-day outcomes. In multivariate stepwise selection, glutamate, hydroxyproline, tau-methylhistidine levels, and sex were associated with death and readmission within 90-days. In stepwise selection, age-adjusted model that included sex and these 3 amino-acids demonstrated moderate discriminating ability over 90-days (C-statistic 0.68 (95%CI 0.61, 0.75); age-adjusted model that included sex, hydroxyproline and Charlson Comorbidity Index was predictive of 30-day outcomes (C-statistic 0.76 (95%CI 0.68, 0.85). Conclusions: Baseline glutamate, hydroxyproline, and tau-methylhistidine levels, along with sex and age, predict risk of 90-day mortality and nonelective readmission in malnourished hospitalized older patients. This biomarker set should be further validated in prospective studies and could be useful in prognostication of malnourished hospitalized patients and guiding in-hospital care.

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Prevalence and Prognostic Value of Heart Failure Stages: An Elderly Inpatient Based Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.639453 ◽

2021 ◽

Vol 8 ◽

Author(s):

Pei-Pei Zheng ◽

Si-Min Yao ◽

Di Guo ◽

Ling-ling Cui ◽

Guo-Bin Miao ◽

...

Keyword(s):

Heart Failure ◽

Cohort Study ◽

Prognostic Value ◽

Proportional Hazards ◽

Regression Tree ◽

Cox Proportional Hazards ◽

Hospitalized Patients ◽

Classification And Regression Tree ◽

Major Adverse Cardiovascular Events ◽

Cox Proportional Hazards Models

Background: The prevalence and prognostic value of heart failure (HF) stages among elderly hospitalized patients is unclear.Methods: We conducted a prospective, observational, multi-center, cohort study, including hospitalized patients with the sample size of 1,068; patients were age 65 years or more, able to cooperate with the assessment and to complete the echocardiogram. Two cardiologists classified all participants in various HF stages according to 2013 ACC/AHA HF staging guidelines. The outcome was rate of 1-year major adverse cardiovascular events (MACE). The Kaplan–Meier method and Cox proportional hazards models were used for survival analyses. Survival classification and regression tree analysis were used to determine the optimal cutoff of N-terminal pro-brain natriuretic peptide (NT-proBNP) to predict MACE.Results: Participants' mean age was 75.3 ± 6.88 years. Of them, 4.7% were healthy and without HF risk factors, 21.0% were stage A, 58.7% were stage B, and 15.6% were stage C/D. HF stages were associated with worsening 1-year survival without MACE (log-rank χ2 = 69.62, P < 0.001). Deterioration from stage B to C/D was related to significant increases in HR (3.636, 95% CI, 2.174–6.098, P < 0.001). Patients with NT-proBNP levels over 280.45 pg/mL in stage B (HR 2; 95% CI 1.112–3.597; P = 0.021) and 11,111.5 pg/ml in stage C/D (HR 2.603, 95% CI 1.014–6.682; P = 0.047) experienced a high incidence of MACE adjusted for age, sex, and glomerular filtration rate.Conclusions : HF stage B, rather than stage A, was most common in elderly inpatients. NT-proBNP may help predict MACE in stage B.Trial Registration: ChiCTR1800017204; 07/18/2018.

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Prognostic Factors for Event-Free Survival in Pediatric Patients with Hepatoblastoma Based on the 2017 PRETEXT and CHIC-HS Systems

Cancers ◽

10.3390/cancers11091387 ◽

2019 ◽

Vol 11 (9) ◽

pp. 1387 ◽

Cited By ~ 2

Author(s):

Hee Mang Yoon ◽

Jisun Hwang ◽

Kyung Won Kim ◽

Jung-Man Namgoong ◽

Dae Yeon Kim ◽

...

Keyword(s):

Pediatric Patients ◽

Proportional Hazards ◽

Hazard Analysis ◽

Staging System ◽

Cox Proportional Hazards ◽

Event Free Survival ◽

Free Survival ◽

Tertiary Referral Center ◽

C Statistic ◽

Pre Treatment

This study aimed to evaluate the prognostic value of variables used in the 2017 PRE-Treatment EXTent of tumor (PRETEXT) system and the Children’s Hepatic tumors International Collaboration-Hepatoblastoma Stratification (CHIC-HS) system in pediatric patients with hepatoblastoma. A retrospective analysis of data from the pediatric hepatoblastoma registry of a tertiary referral center was conducted to evaluate the clinical and imaging variables (annotation factors) of the PRETEXT staging system. The primary outcome was event-free survival (EFS). Data from 84 patients (mean age: 2.9 ± 3.5 years) identified between 1998 and 2017 were included. Univariable Cox proportional hazards analysis revealed that PRETEXT annotation factors P (portal vein involvement), F (multifocality of tumor), and M (distant metastasis) showed a significant negative association with EFS. Multivariable Cox proportional hazard analysis showed that factor F was the strongest predictor (HR (hazard ratio), 2.908; 95% CI (confidence interval), 1.061–7.972; p = 0.038), whereas factor M showed borderline significance (HR, 2.416; 95% CI, 0.918–6.354; p = 0.074). The prediction model based on F and M (F + M) showed good performance to predict EFS (C-statistic, 0.734; 95% CI, 0.612–0.854). In conclusion, the PRETEXT annotation factor F was the strongest predictor of EFS, and the F + M model showed good performance to predict EFS in pediatric patients with hepatoblastoma.

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Statins use and COVID-19 outcomes in hospitalized patients

PLoS ONE ◽

10.1371/journal.pone.0256899 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0256899

Author(s):

Samuel K. Ayeh ◽

Enoch J. Abbey ◽

Banda A. A. Khalifa ◽

Richard D. Nudotor ◽

Albert Danso Osei ◽

...

Keyword(s):

Treatment Effect ◽

Proportional Hazards ◽

Respiratory Infections ◽

Invasive Mechanical Ventilation ◽

Cox Proportional Hazards ◽

Average Treatment Effect ◽

Hospitalized Patients ◽

Average Treatment ◽

Increased Risk ◽

Statin Use

Background There is an urgent need for novel therapeutic strategies for reversing COVID-19-related lung inflammation. Recent evidence has demonstrated that the cholesterol-lowering agents, statins, are associated with reduced mortality in patients with various respiratory infections. We sought to investigate the relationship between statin use and COVID-19 disease severity in hospitalized patients. Methods A retrospective analysis of COVID-19 patients admitted to the Johns Hopkins Medical Institutions between March 1, 2020 and June 30, 2020 was performed. The outcomes of interest were mortality and severe COVID-19 infection, as defined by prolonged hospital stay (≥ 7 days) and/ or invasive mechanical ventilation. Logistic regression, Cox proportional hazards regression and propensity score matching were used to obtain both univariable and multivariable associations between covariates and outcomes in addition to the average treatment effect of statin use. Results Of the 4,447 patients who met our inclusion criteria, 594 (13.4%) patients were exposed to statins on admission, of which 340 (57.2%) were male. The mean age was higher in statin users compared to non-users [64.9 ± 13.4 vs. 45.5 ± 16.6 years, p <0.001]. The average treatment effect of statin use on COVID-19-related mortality was RR = 1.00 (95% CI: 0.99–1.01, p = 0.928), while its effect on severe COVID-19 infection was RR = 1.18 (95% CI: 1.11–1.27, p <0.001). Conclusion Statin use was not associated with altered mortality, but with an 18% increased risk of severe COVID-19 infection.

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Title: Risk factors for severe disease in patients admitted with COVID-19 to a hospital in London, England: a retrospective cohort study

10.1101/2020.09.24.20200337 ◽

2020 ◽

Author(s):

Jack W Goodall ◽

Thomas A N Reed ◽

Maddalena Ardissino ◽

Paul Bassett ◽

Ashley M Whittington ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Proportional Hazards ◽

Severe Disease ◽

Cox Proportional Hazards ◽

Hospitalized Patients ◽

Reactive Protein ◽

Global Pandemic ◽

Northwick Park Hospital ◽

Observational Cohort

COVID-19 has caused a major global pandemic and necessitated unprecedented public health restrictions in almost every country. Understanding risk factors for severe disease in hospitalized patients is critical as the pandemic progresses. This observational cohort study aimed to characterize the independent associations between the clinical outcomes of hospitalized patients and their demographics, comorbidities, blood tests and bedside observations. All patients admitted to Northwick Park Hospital, London, United Kingdom between 12 March and 15 April 2020 with COVID-19 were retrospectively identified. The primary outcome was death. Associations were explored using Cox proportional hazards modelling. The study included 981 patients. The mortality rate was 36.0%. Age (adjusted hazard ratio (aHR) 1.53), respiratory disease (aHR 1.37), immunosuppression (aHR 2.23), respiratory rate (aHR 1.28), hypoxia (aHR 1.36), Glasgow Coma Score <15 (aHR 1.92), urea (aHR 2.67), alkaline phosphatase (aHR 2.53), C-reactive protein (aHR 1.15), lactate (aHR 2.67), platelet count (aHR 0.77) and infiltrates on chest radiograph (aHR 1.89) were all associated with mortality. These important data will aid clinical risk stratification and provide direction for further research.

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Abstract 13093: Clinical Features and Prognosis of Acute Cardiac Injury in Hospitalized Patients With Covid-19: A Retrospective Cohort Study

Circulation ◽

10.1161/circ.142.suppl_3.13093 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Mingxing XIE ◽

Li Zhang ◽

yanting zhang ◽

Wei Sun ◽

CHUN WU ◽

...

Keyword(s):

Hospital Mortality ◽

Proportional Hazards ◽

Troponin I ◽

Clinical Laboratory ◽

Invasive Mechanical Ventilation ◽

Cardiac Injury ◽

High Sensitivity ◽

Final Analysis ◽

Cox Proportional Hazards ◽

Hospitalized Patients

Aims: The fatalities case due to coronavirus disease 2019 (COVID-19) is escalating. However, information on critical complications in hospitalized patients of COVID-19 is scant. We aimed to explore the prevalence of acute cardiac injury and its association with in-hospital mortality in COVID-19 patients. Methods: This retrospective study analyzed COVID-19 patients in Union Hospital (Wuhan, China) from Jan 24 to March 18, 2020. Clinical outcomes (discharge, or death) were monitored to April 9, 2020, the latest date of follow-up. Demographic, clinical, laboratory, echocardiographic data, treatment and prognosis were analyzed. Results: A total of 235 COVID-19 patients were included in the final analysis. Their median age was 66 years (interquartile range 57 - 73), and 131 (55.7%) were men. 98 (41.7%) patients were diagnosed with acute cardiac injury, of whom 60 (61.2%) died. There were more comorbidities in those who with acute cardiac injury than those without. A higher proportion of patients with acute cardiac injury received glucocorticoid therapy (68.0% vs 37.0%; P < 0.001), immunoglobulin (53.1% vs 30.1%; P < 0.001) and invasive mechanical ventilation (40.8% vs 6.6%; P < 0.001) than those without. The percentage of patients who were admitted to intensive care unit (39.8 % vs 8.0%; P < 0.001) or died during hospitalization (61.2% vs 8.0%, P < 0.001) were also higher in those with acute cardiac injury. Plasma high-sensitivity troponin I level correlated significantly with plasma interleukin -6, procalcitonin and C-reactive protein levels in COVID-19 patients. Echocardiography showed that cardiac function was attenuated in acute cardiac injury patients. Multivariable Cox proportional hazards regression analysis showed acute cardiac injury was an independent risk factor for higher in-hospital mortality in COVID-19 patients (HR, 3.393; 95% CI, 1.647- 6.987, P <0.001). Conclusions: Acute cardiac injury is a common condition and may be related to inflammatory response in COVID-19 patients. In addition, our study highlights an association between acute cardiac injury and a higher risk of in-hospital mortality. It is suggested that clinicians should be alert to acute cardiac injury in COVID-19 patients and take prompt treatments to improve outcomes.

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Sociodemographic Differences in Care Plans and Time to Treatment Among Children Being Considered for Adenotonsillectomy

Otolaryngology ◽

10.1177/01945998211064233 ◽

2021 ◽

pp. 019459982110642

Author(s):

Maria E. Knaus ◽

Swapna Koppera ◽

Meredith N. Lind ◽

Jennifer N. Cooper

Keyword(s):

Proportional Hazards ◽

Metropolitan Areas ◽

Sociodemographic Factors ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Medication Therapy ◽

Care Plans ◽

Sociodemographic Differences ◽

Obstructive Sleep ◽

Nonmetropolitan Areas

Objective To assess sociodemographic differences in care plans and time to evaluation or treatment after otolaryngologic consultation among children with obstructive sleep-disordered breathing (oSDB). Study Design Retrospective cohort study. Setting Single tertiary children’s hospital. Methods We included children aged 2 to 9 years with oSDB seen from June to December 2018 as new otolaryngology clinic patients. Logistic regression was used to examine whether sociodemographic factors were associated with having adenotonsillectomy or polysomnography planned at the end of the visit. Kaplan-Meier analyses and Cox proportional hazards models were used to compare times to these events. Results An overall 1020 children were included, of whom 65% were White and 18% were Black. Approximately 77% were metropolitan residents, 52% were publicly insured, and 88% of caregivers spoke primarily English. Treatment plans included adenotonsillectomy for 62% of patients, polysomnography for 15%, and new medication therapy for 13%. In multivariable analyses, there were no significant differences by child race/ethnicity, metropolitan/nonmetropolitan residence, type of health insurance, or caregiver primary language in the likelihood of having adenotonsillectomy or polysomnography planned. Among children for whom adenotonsillectomy was planned, children from metropolitan areas had greater times to surgery than children from nonmetropolitan areas (hazard ratio, 0.81 [95% CI, 0.66-0.99]; P = .04). This was explained by a difference between Black children from metropolitan areas and White children from nonmetropolitan areas (hazard ratio, 0.65 [95% CI, 0.49-0.86]; P = .003); there were no racial/ethnic differences in time to surgery among metropolitan-residing children ( P = .09). Conclusions After initial otolaryngology consultation, children with oSDB from metropolitan areas have longer times to adenotonsillectomy than those from nonmetropolitan areas.

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Association of Rehabilitation Intensity for Stroke and Risk of Hospital Readmission

Physical Therapy ◽

10.2522/ptj.20140610 ◽

2015 ◽

Vol 95 (12) ◽

pp. 1660-1667 ◽

Cited By ~ 23

Author(s):

A. Williams Andrews ◽

Dongmei Li ◽

Janet K. Freburger

Keyword(s):

Confidence Interval ◽

Acute Care ◽

Hospital Readmission ◽

Proportional Hazards ◽

Cohort Analysis ◽

Hospital Readmissions ◽

Illness Severity ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Increased Risk

Background Little is known about the use of rehabilitation in the acute care setting and its impact on hospital readmissions. Objective The objective of this study was to examine the association between the intensity of rehabilitation services received during the acute care stay for stroke and the risk of 30-day and 90-day hospital readmission. Design A retrospective cohort analysis of all acute care hospitals in Arkansas and Florida was conducted. Methods Patients (N=64,065) who were admitted for an incident stroke in 2009 or 2010 were included. Rehabilitation intensity was categorized as none, low, medium-low, medium-high, or high based on the sum and distribution of physical therapy, occupational therapy, and speech therapy charges within each hospital. Cox proportional hazards regression was used to estimate hazard ratios, controlling for demographic characteristics, illness severity, comorbidities, hospital variables, and state. Results Relative to participants who received the lowest intensity therapy, those who received higher-intensity therapy had a decreased risk of 30-day readmission. The risk was lowest for the highest-intensity group (hazard ratio=0.86; 95% confidence interval=0.79, 0.93). Individuals who received no therapy were at an increased risk of hospital readmission relative to those who received low-intensity therapy (hazard ratio=1.30; 95% confidence interval=1.22, 1.40). The findings were similar, but with smaller effects, for 90-day readmission. Furthermore, patients who received higher-intensity therapy had more comorbidities and greater illness severity relative to those who received lower-intensity therapy. Limitations The results of the study are limited in scope and generalizability. Also, the study may not have adequately accounted for all potentially important covariates. Conclusions Receipt of and intensity of rehabilitation therapy in the acute care of stroke is associated with a decreased risk of hospital readmission.

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Association of Kidney Function With 30-Day and 1-Year Poststroke Mortality and Hospital Readmission

Stroke ◽

10.1161/strokeaha.118.022011 ◽

2018 ◽

Vol 49 (12) ◽

pp. 2896-2903 ◽

Cited By ~ 5

Author(s):

Nada El Husseini ◽

Gregg C. Fonarow ◽

Eric E. Smith ◽

Christine Ju ◽

Shubin Sheng ◽

...

Keyword(s):

Ischemic Stroke ◽

Kidney Function ◽

Hospital Readmission ◽

Proportional Hazards ◽

Hospital Readmissions ◽

Cox Proportional Hazards ◽

Fee For Service ◽

Hospital Readmission Rates ◽

Cox Proportional Hazards Models ◽

Relevant Variables

Background and Purpose— Kidney dysfunction is common among patients hospitalized for ischemic stroke. Understanding the association of kidney disease with poststroke outcomes is important to properly adjust for case mix in outcome studies, payment models and risk-standardized hospital readmission rates. Methods— In this cohort study of fee-for-service Medicare patients admitted with ischemic stroke to 1579 Get With The Guidelines-Stroke participating hospitals between 2009 and 2014, adjusted multivariable Cox proportional hazards models were used to determine the independent associations of estimated glomerular filtration rate (eGFR) and dialysis status with 30-day and 1-year postdischarge mortality and rehospitalizations. Results— Of 204 652 patients discharged alive (median age [25th–75th percentile] 80 years [73.0–86.0], 57.6% women, 79.8% white), 48.8% had an eGFR ≥60, 26.5% an eGFR 45 to 59, 16.3% an eGFR 30 to 44, 5.1% an eGFR 15 to 29, 0.6% an eGFR <15 without dialysis, and 2.8% were receiving dialysis. Compared with eGFR ≥60, and after adjusting for relevant variables, eGFR <45 was associated with increased 30-day mortality with the risk highest among those with eGFR <15 without dialysis (hazard ratio [HR], 2.09; 95% CI, 1.66–2.63). An eGFR <60 was associated with increased 1-year poststroke mortality that was highest among patients on dialysis (HR, 2.65; 95% CI, 2.49–2.81). Dialysis was also associated with the highest 30-day and 1-year rehospitalization rates (HR, 2.10; 95% CI, 1.95–2.26 and HR, 2.55; 95% CI, 2.44–2.66, respectively) and 30-day and 1-year composite of mortality and rehospitalization (HR, 2.04; 95% CI, 1.90–2.18 and HR, 2.46; 95% CI, 2.36–2.56, respectively). Conclusions— Within the first year after index hospitalization for ischemic stroke, eGFR and dialysis status on admission are associated with poststroke mortality and hospital readmissions. Kidney function should be included in risk-stratification models for poststroke outcomes.

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P6360Prognostic value of polypharmacy in patients with heart failure

European Heart Journal ◽

10.1093/eurheartj/ehz746.0956 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Fujita ◽

K Takabayashi ◽

K Iwatsu ◽

K Matsumura ◽

T Ikeda ◽

...

Keyword(s):

Heart Failure ◽

Hospital Readmission ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Medication Schedule ◽

Significant Difference ◽

Patients With Heart Failure ◽

Clinical Background ◽

The Impact

Abstract Background Polypharmacy creates an increased patient's burden by drug-drug interactions and poor adherence. However, there are very few studies available evaluating the association of polypharmacy with hospital readmission in patients with heart failure (HF). Purpose The aim of this study was to investigate the impact of polypharmacy on hospital readmission for HF. Methods We enrolled 1253 patients who were hospitalized with acute heart failure (AHF) or acute exacerbation of chronic heart failure in the Kitakawachi Clinical Background and Outcome of Heart Failure Registry (KICKOFF Registry) from April 2015 to July 2018 (age 78.1±11.5 years, male 51.4%). Our Registry is a prospective multicenter community-based cohort study of HF patients in Japan. The inclusion criteria for the registry was a diagnosis of HF during hospitalization according to the Framingham criteria, and there were no exclusion criteria. From data at discharge, we collected data on clinical characteristics, medication schedule, and social backgrounds. We defined polypharmacy as the use of seven or more medications. The primary end point was HF rehospitalization within 1 year after discharge. Cox proportional hazards regression analysis was used to describe the association between polypharmacy and 1-year HF rehospitalization, controlling for potential confounding factors. Results In this study, the prevalence of polypharmacy was 59.7% of all patients. Patients with polypharmacy were more likely to have comorbidities such as hypertension, dyslipidemia, diabetes, chronic kidney disease, coronary artery disease and dementia. They also had lower EF (50.9±0.64 vs 53.6±0.80, p<0.01), compared to patients without polypharmacy. There was no significant difference in age, gender and BMI, compared to patients without polypharmacy. During the follow-up period, a total of 278 patients (24.9%) were readmitted for HF. In Kaplan-Meier analyses, hospital readmission for HF during 1-year follow-up was significantly higher in patients with polypharmacy (p<0.01) (figure). After adjusting for gender, age, EF, and the other co-morbidities, polypharmacy was independently associated with higher risk of rehospitalization for HF (hazard ratio 1.28, 95% confidence interval, 1.07–1.52, p<0.01). Conclusion Polypharmacy is an independent predictor of hospital readmission for HF. Our study suggests the need for developing an effective strategy to choose the appropriate drugs in patients with HF. Acknowledgement/Funding Nakajima Steel Pipe

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γ-Glutamyl Transferase Is Associated with Mortality Outcomes Independently of Fatty Liver

Clinical Chemistry ◽

10.1373/clinchem.2015.240424 ◽

2015 ◽

Vol 61 (9) ◽

pp. 1173-1181 ◽

Cited By ~ 13

Author(s):

Ki-Chul Sung ◽

Seungho Ryu ◽

Bum-Soo Kim ◽

Eun Sun Cheong ◽

Dong-il Park ◽

...

Keyword(s):

Fatty Liver ◽

Cancer Mortality ◽

Proportional Hazards ◽

High Serum ◽

Cox Proportional Hazards ◽

Liver Fat ◽

Increased Risk ◽

Glutamyl Transferase ◽

Adjusted Model ◽

Cvd Mortality

Abstract BACKGROUND High serum enzyme activity levels of γ-glutamyl transferase (GGT) are associated with increased risk of mortality, but whether this is mediated by fatty liver, as a common cause of high GGT levels, is uncertain. Our aim was to test whether GGT levels are associated with all-cause, cancer, and cardiovascular (CVD) mortality, independently of fatty liver. METHODS In an occupational cohort (n = 278 419), causes of death (International Statistical Classification of Diseases and Related Health Problems, 10th revision) were recorded over 7 years. Liver function tests and liver fat [measured by ultrasonographic standard criteria or fatty liver index (FLI)] were assessed at baseline. We used Cox proportional hazards models to estimate adjusted hazard ratios (HRs) and 95% CIs of all-cause, cancer, and CVD mortality for GGT quartiles (with lowest GGT quartile as reference). RESULTS There were 136, 167, 265, and 342 deaths across increasing GGT quartiles. After adjusting for liver fat (by ultrasound diagnosis) in the fully adjusted model, all-cause and cancer mortality were increased in the highest GGT quartile [HR 1.50 (95% CI 1.15–1.96) and 1.57 (1.05–2.35), respectively]. For CVD mortality, the hazard was attenuated: HR 1.35 (95% CI 0.72–2.56). After adjusting for FLI in the fully adjusted model, HRs for all-cause, cancer, and CVD mortality were 1.46 (0.72–2.56), 2.03 (1.02–4.03), and 1.16 (0.41,3.24), respectively. CONCLUSIONS There were similar hazards for all-cause and cancer mortality and attenuated hazards for CVD mortality for people in the highest GGT quartile, adjusting for fatty liver assessed by either ultrasound or FLI.

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