scholarly journals The natriuretic peptide MR-proANP predicts all-cause mortality and adverse outcome in community patients: a 10-year follow-up study

2017 ◽  
Vol 55 (9) ◽  
Author(s):  
Jonas Odermatt ◽  
Lara Hersberger ◽  
Rebekka Bolliger ◽  
Lena Graedel ◽  
Mirjam Christ-Crain ◽  
...  
Keyword(s):  
Natriuretic Peptide ◽  
Cox Regression ◽  
Adverse Outcome ◽  
Characteristic Curve ◽  
Physiological Role ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Blood Levels ◽  
All Cause Mortality

AbstractBackground:The precursor peptide of atrial natriuretic peptide (MR-proANP) has a physiological role in fluid homeostasis and is associated with mortality and adverse clinical outcomes in heart failure patients. Little is known about the prognostic potential of this peptide for long-term mortality prediction in community-dwelling patients. We evaluated associations of MR-proANP levels with 10-year all-cause mortality in patients visiting their general practitioner for a respiratory tract infection.Methods:In this post-hoc analysis including 359 patients (78.5%) of the original trial, we calculated cox regression models and area under the receiver operating characteristic curve (AUC) to assess associations of MR-proANP blood levels with mortality and adverse outcome including death, pulmonary embolism, and major adverse cardiac or cerebrovascular events.Results:After a median follow-up of 10.0 years, 9.8% of included patients died. Median admission MR-proANP levels were significantly elevated in non-survivors compared to survivors (80.5 pmol/L, IQR 58.6–126.0; vs. 45.6 pmol/L, IQR 34.2–68.3; p<0.001) and associated with 10-year all-cause mortality (age-adjusted HR 2.0 [95% CI 1.3–3.1, p=0.002]; AUC 0.79). Results were similar for day 7 blood levels and also for the prediction of other adverse outcomes.Conclusions:Increased MR-proANP levels were associated with 10-year all-cause mortality and adverse clinical outcome in a sample of community-dwelling patients. If diagnosis-specific cut-offs are confirmed in future studies, this marker may help to direct preventive measures in primary care.

scholarly journals Copeptin predicts 10-year all-cause mortality in community patients: a 10-year prospective cohort study

2016 ◽  
Vol 54 (10) ◽  
Author(s):  
Jonas Odermatt ◽  
Rebekka Bolliger ◽  
Lara Hersberger ◽  
Manuel Ottiger ◽  
Mirjam Christ-Crain ◽  
...  
Keyword(s):  
Respiratory Infection ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Hospital Setting ◽  
Acute Care Hospital ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Care Hospital ◽  
All Cause Mortality

AbstractBackground:Copeptin, the C-terminal part of the arginine vasopressin (AVP) precursor peptide, is secreted in response to stress and correlates with adverse clinical outcomes in the acute-care hospital setting. There are no comprehensive data regarding its prognostic value in the community. We evaluated associations of copeptin levels with 10-year mortality in patients visiting their general practitioner (GP) for a respiratory infection included in a previous trial.Methods:This is a post hoc analysis including data from 359 patients included in the PARTI trial. Copeptin was measured in batch-analysis on admission and after 7 days. We calculated Cox regression models and area under the receiver operating characteristic curve (AUC) to assess an association of copeptin with mortality and adverse outcome. Follow-up data were collected by GP, patient and relative tracing through phone interviews 10 years after trial inclusion.Results:After a median follow-up of 10.0 years, mortality was 9.8%. Median admission copeptin levels (pmol/L) were significantly elevated in non-survivors compared to survivors (13.8, IQR 5.9–27.8; vs. 6.3 IQR 4.1–11.5; p<0.001). Admission copeptin levels were associated with 10-year all-cause mortality [age-adjusted hazard ratio 1.7 (95% CI, 1.2–2.5); p<0.001, AUC 0.68]. Results were similar for discharge copeptin levels. Copeptin also predicted adverse outcomes defined as death, pulmonary embolism and major adverse cardiac and cerebrovascular events.Conclusions:In a sample of community-dwelling patients visiting their GP for a respiratory infection, copeptin levels were associated with 10-year all-cause mortality. In conjunction with traditional risk factors, this marker may help to better direct preventive measures in this population.

scholarly journals Direct comparison of BNP and NT-proBNP for mortality prediction in patients with acute dyspnea

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Wussler ◽  
M Belkin ◽  
I Strebel ◽  
N Kozhuharov ◽  
N Sabti ◽  
...  
Keyword(s):  
Natriuretic Peptide ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Mortality Prediction ◽  
Percentage Change ◽  
Diagnostic Study ◽  
Acute Dyspnea ◽  
Prognostic Accuracy ◽  
Cox Proportional Hazard Models

Abstract Background It is unclear whether BNP or NT-proBNP, their admission or discharge measurement or percentage change during hospitalization are preferable for mortality prediction in patients with acute dyspnea. Purpose To directly compare BNP and NT-proBNP regarding their potential in mortality prediction in patients with acute dyspnea and in patients with dyspnea due to AHF. Methods In a prospective multicenter diagnostic study the presence of AHF was centrally adjudicated by two independent cardiologists among patients presenting with acute dyspnea. The levels of BNP and NT-proBNP were measured at presentation and discharge. Patients were stratified according to their natriuretic peptide response (responders vs. non-responders: natriuretic peptide decrease ≥25% vs. &lt;25% before discharge). Prognostic accuracy for 720-day mortality was quantified using the area under the receiver-operating-characteristic curve (AUC). Cox proportional hazard models were constructed to identify significant predictors for 720-day mortality. Results Among 1156 patients presenting with acute dyspnea, 353 (30.5%) died within 720 days of follow-up. Prognostic accuracy for death at 720 days was significantly higher for discharge compared to admission measurements for BNP (AUC 0.750 vs. 0.711, p&lt;0.001) and NT-proBNP (AUC 0.769 vs. 0.720, p&lt;0.001). When directly comparing discharge measurements, NT-proBNP levels exhibited a significantly higher accuracy (p=0.013). 632 (54.6%) and 600 (51.9%) patients were BNP and NT-proBNP non-responders, respectively. Among BNP and NT-proBNP non-responders 202 (32%) and 207 (34.5%) patients died within 720 days of follow-up. After adjusting for common covariates NTproBNP response was the strongest predictor for 720-day mortality in a Cox regression model (Hazard ratio for NT-proBNP non-responders: 2.096 (95% CI 1.550–2.835), p&lt;0.001). Results were confirmed in a sensitivity analysis of 687 (59.4%) patients with adjudicated AHF. Conclusion Percentage change of NT-proBNP during hospitalization seems to be the strongest predictor for long-term mortality in patients with acute dyspnea in general and in those with dyspnea due to AHF in particular. ROC curve for direct comparison Funding Acknowledgement Type of funding source: None

scholarly journals Association of Soluble Klotho Level with Adverse Outcomes in Patients on Maintenance Hemodialysis

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Li-xia Yu ◽  
Qi-feng Liu ◽  
Jian-hua Feng ◽  
Sha-sha Li ◽  
Xiao-xia Gu ◽  
...  
Keyword(s):  
Cox Regression ◽  
Adverse Outcomes ◽  
Maintenance Hemodialysis ◽  
Strongly Correlated ◽  
Independent Predictive Factor ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Potential Association ◽  
All Cause Mortality

Background. The predictive value of soluble Klotho (sKlotho) for adverse outcomes in patients on maintenance hemodialysis (MHD) is controversial. In this study, we aimed to clarify the potential association of sKlotho levels with adverse outcomes in this patient population. Materials. A total of 211 patients on MHD were identified and stratified according to the median sKlotho level. Patients were followed up for adverse outcomes including cardiovascular (CV) morbidity and all-cause mortality. Results. During the 36-month follow-up, 75 patients [51 CV events (including 16 CV deaths) and 40 deaths] experienced adverse outcomes. After stratification according to median sKlotho level, patients with a lower sKlotho level had a greater risk of CV events (38.2% vs. 19.5%, p = 0.006 ), all-cause mortality (28.4% vs. 11.6%, p = 0.003 ), and combined adverse outcomes (51.0% vs. 24.2%, p < 0.001 ). Similar observations were made from analyses using Kaplan-Meier survival curves. Cox regression analysis showed that a low sKlotho level was strongly correlated with CV morbidity [1.942 (1.030–3.661), p = 0.040 )], all-cause mortality [2.073 (1.023–4.203), p = 0.043 ], and combined adverse outcomes [1.818 (1.092–3.026), p = 0.021 ] in fully adjusted models. Conclusions. The sKlotho level was an independent predictive factor of adverse outcomes including CV morbidity and mortality in patients on MHD.

scholarly journals All-cause mortality over a three-year period among community-dwelling older adults in Southern Brazil

2021 ◽  
Vol 24 ◽  
Author(s):  
Ana Clara Ledezma Greiner de Souza ◽  
Caroline Cardozo Bortolotto ◽  
Andréa Dâmaso Bertoldi ◽  
Elaine Tomasi ◽  
Flávio Fernando Demarco ◽  
...  
Keyword(s):  
Older Adults ◽  
Cox Regression ◽  
Early Death ◽  
Community Dwelling ◽  
Epidemiological Surveillance ◽  
Daily Life Activities ◽  
All Cause Mortality ◽  
Community Dwelling Older Adults

ABSTRACT: Objective: To evaluate all-cause mortality in approximately three years of follow-up and related sociodemographic, behavioral and health factors in community-dwelling older adults in Pelotas, RS. Methods: This was a longitudinal observational study that included 1,451 older adults (≥ 60 years) who were interviewed in 2014. Information on mortality was collected from their households in 2016–2017 and confirmed with the Epidemiological Surveillance department of the city and by documents from family members. Associations between mortality and independent variables were assessed by crude and multiple Cox regression, with hazard ratio with respective 95% confidence intervals (95%CI). Results: Almost 10% (n = 145) of the participants died during an average of 2.5 years of follow-up, with a higher frequency of deaths among males (12.9%), ?80 years (25.2%), widowhood (15.0%), no education (13.8%) and who did not work (10.5%). Factors associated with higher mortality were: being a male (HR = 2.8; 95%CI 1.9 – 4.2), age ?80 years (HR = 3.9; 95%CI 2.4 – 6.2), widowhood (HR = 2.2; 95%CI 1.4 – 3.7), physical inactivity (HR = 2.3; 95%CI 1.1 – 4..6), current smoking (HR = 2.1; 95%CI 1.2 – 3.6), hospitalizations in the previous year (HR = 2.0; 95%CI 1.2 – 3.2), depressive symptoms (HR = 2.0; 95%CI 1.2 – 3,4) and dependence for two or more daily life activities (HR = 3.1; 95%CI 1,7 – 5.7). Conclusion: The identification of factors that increased the risk of early death makes it possible to improve public policies aimed at controlling the modifiable risk factors that can lead to aging with a better quality of life.

scholarly journals Effect of Exercising with Others on Incident Functional Disability and All-Cause Mortality in Community-Dwelling Older Adults: A Five-Year Follow-Up Survey

2020 ◽  
Vol 17 (12) ◽  
pp. 4329 ◽  
Author(s):  
Yuya Fujii ◽  
Keisuke Fujii ◽  
Takashi Jindo ◽  
Naruki Kitano ◽  
Jaehoon Seol ◽  
...  
Keyword(s):  
Older Adults ◽  
Functional Disability ◽  
Cox Regression ◽  
Mail Survey ◽  
Exercise Group ◽  
Community Dwelling ◽  
Cox Regression Analysis ◽  
Exercise Habits ◽  
All Cause Mortality

We clarified the effect of exercising with others on the risks of incident functional disability and all-cause mortality among community-dwelling adults. We used an inventory mail survey with a five-year follow-up for 1520 independently living older adults (mean age: 73.4 ± 6.3 years) in Kasama City, Japan. Subjects responded to a self-reported questionnaire in June 2014. Exercise habits and the presence of exercise partners were assessed. Subjects were classified into three groups: Non-exercise, exercising alone, and exercising with others. Follow-up information and date of incident functional disability and death during the five-year follow-up were collected from the database. To compare the association between exercise habits and functional disability and mortality, Cox regression analysis was conducted. Compared with the non-exercise group, exercising with others had significantly lower hazard ratios (HRs) for functional disability (0.59, 95% confidence interval (CI) 0.40–0.88) and mortality (0.40, 95% CI 0.24–0.66) in the covariate models. Compared with exercising alone, exercising with others decreased the HRs for incident functional disability (0.53, 95% CI: 0.36–0.80) and mortality (0.50, 95% CI 0.29–0.85) rates in the unadjusted model; these associations were not significant in the covariate models. Exercising with others can contribute to functional disability prevention and longevity.

scholarly journals Fear of falling and all-cause mortality among young-old community-dwelling adults: a 6-year prospective study

2021 ◽  
Author(s):  
Giulia Belloni ◽  
Christophe Büla ◽  
Brigitte Santos-Eggimann ◽  
Yves Henchoz ◽  
Sarah Fustinoni ◽  
...  
Keyword(s):  
Cox Regression ◽  
Fear Of Falling ◽  
Community Dwelling ◽  
Activity Restriction ◽  
Personalized Care ◽  
Hazard Ratios ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Young Old

AbstractThis study investigated whether fear of falling (FOF) measured by two different instruments, the Falls Efficacy Scale-International (FES-I) and the single question on FOF and activity restriction (SQ-FAR), is associated with mortality at 6-year follow-up. Participants (n = 1359, 58.6% women) were community-dwelling persons enrolled in the Lausanne cohort 65 + , aged 66 to 71 years at baseline. Covariables assessed at baseline included demographic, cognitive, affective, functional and health status, while date of death was obtained from the office in charge for population registration. Unadjusted Kaplan Meyer curves were performed to show the survival probability for all-cause mortality according to the degree of FOF reported with FES-I and SQ-FAR, respectively. Bivariable and multivariable Cox regression analyses were performed to assess hazard ratios, using time-in-study as the time scale variable and adjusting for variables significantly associated in bivariable analyses. During the 6-year follow-up, 102 (7.5%) participants died. Reporting the highest level of fear at FES-I (crude HR 3.86, 95% CI 2.37–6.29, P < .001) or “FOF with activity restriction” with SQ-FAR (crude HR 2.42, 95% CI 1.44-4.09, P = .001) were both associated with increased hazard of death but these associations did not remain significant once adjusting for gender, cognitive, affective and functional status. As a conclusion, although high FOF and related activity restriction, assessed with FES-I and SQ-FAR, identifies young-old community-dwelling people at increased risk of 6-year mortality, this association disappears when adjusting for potential confounders. As a marker of negative health outcomes, FOF should be screened for in order to provide personalized care and reduce subsequent risks.

scholarly journals Plasma N-terminal pro-brain natriuretic peptide level as a marker of adverse outcome in patients with co-existing diabetes, chronic kidney disease and heart failure

2020 ◽  
Vol 10 (3) ◽  
pp. e20-e20
Author(s):  
Amin Roshdy Soliman ◽  
Rabab Mahmoud Ahmed ◽  
Ahmad Yousry ◽  
Tarek Samy Abdelaziz ◽  
Abdel Hakem Selem
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Natriuretic Peptide ◽  
Adverse Outcome ◽  
Serum Levels ◽  
Adverse Outcomes ◽  
Patients With Diabetes ◽  
Time Of Admission

Introduction: N-terminal pro–B-type natriuretic peptide (NT-proBNP) is a novel marker of cardiac disease and heart failure; both are in patients with diabetes and chronic kidney disease. Objectives: This study aimed to investigate the NT-proBNP and adverse outcome in patients with diabetes complicated by chronic kidney disease (CKD). Patients and Methods: We measured the serum levels of NT-proBNP. The association of this novel marker with re-hospitalization and mortality rate were prospectively compared among the studied groups. Results: Among 120 patients, baseline NT-proBNP at the time of admission was significantly elevated in patients with CKD (P= 0.001). Levels of NT-proBNP were significantly elevated in patients with diabetes and CKD than those with CKD alone (P= 0.04) at the end of follow-up. Higher proBNP levels significantly correlated with decreased glomerular filtration rate (GFR) and higher serum creatinine levels (P= 0.03, P< 0.001, respectively). In addition, increased mortality was noticed in those patients. Conclusion: NT-proBNP levels have prognostic implication in the setting of CKD, diabetes mellitus and heart failure. Adverse outcomes are; a higher rate of need for dialysis, re-hospitalization and increased mortality which are correlated with levels of NT-proBNP.

scholarly journals Prognostic Value of Emerging Neurohormones in Chronic Heart Failure during Optimization of Heart Failure–Specific Therapy

2010 ◽  
Vol 56 (1) ◽  
pp. 121-126 ◽  
Author(s):  
Stephanie Neuhold ◽  
Martin Huelsmann ◽  
Guido Strunk ◽  
Joachim Struck ◽  
Christopher Adlbrecht ◽  
...  
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Primary Endpoint ◽  
Cox Regression ◽  
Specific Therapy ◽  
Cox Regression Analysis ◽  
Endothelin 1 ◽  
All Cause Mortality ◽  
Serial Measurements

Abstract Background: Serial measurements of neurohormones have been shown to improve prognostication in the setting of acute heart failure (HF) or chronic HF without therapeutic intervention. We investigated the prognostic role of serial measurements of emerging neurohormones and BNP in a cohort of chronic HF patients undergoing increases in HF-specific therapy. Methods: In this prospective study we included 181 patients with chronic systolic HF after an episode of hospitalization for worsening HF. Subsequently, HF therapy was gradually increased in the outpatient setting until optimized. We measured copeptin, midregional proadrenomedullin, C-terminal endothelin-1 precursor fragment, midregional proatrial natriuretic peptide, and B-type natriuretic peptide before and after optimization of HF therapy. The primary endpoint was all-cause mortality at 24 months. Results: Angiotensin-converting enzyme/angiotensin receptor blocker and β-blockers were increased significantly during the 3-month titration period (P &lt; 0.0001 for both). In a stepwise Cox regression analysis adjusted for age, sex, glomerular filtration rate, diabetes mellitus, and ischemic HF, baseline and follow-up neurohormone concentrations were predictors of the primary endpoint as follows (baseline hazard ratios): copeptin 1.92, 95% CI 1.233–3.007, P = 0.004; midregional proadrenomedullin 2.79, 95% CI 1.297–5.995, P = 0.009; midregional proatrial natriuretic peptide 2.05, 95% CI 1.136–3.686, P = 0.017; C-terminal endothelin-1 precursor fragment 2.24, 95% CI 1.133–4.425, P = 0.025; B-type natriuretic peptide 1.46, 95% CI 1.039–2.050, P = 0.029. Conclusions: In pharmacologically unstable chronic HF patients, baseline values and follow-up measures of copeptin, midregional proadrenomedullin, C-terminal endothelin-1 precursor fragment, midregional proatrial natriuretic peptide, and B-type natriuretic peptide were equally predictive of all-cause mortality. Relative change of neurohormone values was noncontributory.

Abstract 13613: Combination of Atrial Fibrillation and Frailty: Association With All-cause Mortality in Older Veterans

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Marlena Fernandez ◽  
Marie Pitteloud ◽  
Angelica Torres ◽  
Sergio Ruiz ◽  
Victor Cevallos ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cox Regression ◽  
Frailty Index ◽  
Community Dwelling ◽  
Sensory Loss ◽  
All Cause Mortality ◽  
Physiological Reserve ◽  
Icd Codes ◽  
The Impact

Background: Atrial fibrillation (AF), the commonest arrhythmia among older adults, is associated with increased mortality. Frailty constitutes a state of vulnerability to stressors resulting from multisystemic loss of physiological reserve. The study aim was to determine whether concurrent frailty and AF increases all-cause mortality in older Veterans. Methods: Retrospective cohort study of community-dwelling Veterans 60 years and older identified as having baseline AF (ICD codes) or frailty through a 30-item VA Frailty Index (VA-FI). The VA-FI was generated as a proportion of morbidity, function, sensory loss, cognition/mood and other variables. The VA-FI categorized Veterans into non-frail (robust FI≤.10, prefrail FI=>.10,<.21) and frail (FI≥.21). The combination resulted in 4 groups: Neither AF nor frailty (NoAF-F), atrial fibrillation (AF), frailty (F), and AF and frailty (AF-F). At the end of follow-up, data on mortality was aggregated and adjusted for age, gender, race, ethnicity, marital status, and BMI, the association of concurrent AF and/or frailty with all-cause mortality was determined using a Cox regression model including testing for interaction effects. Results: A total of 16391 Veterans were included, mean age 72.06 (SD=9.23) years 74.2% White, 86.7% non-Hispanic, and 97.9% male. There were 1534 (9.4%) Veterans with AF and the proportion of robust, pre-frail and frail patients was 44.3% (n=7255), 37.2% (n=6095) and 18.6% (n=3041) respectively. The 4 resulting groups were NoAF-F (12357, 75.4%), AF (993, 6.1%), F (2500, 15.3%) and AF-F (541, 3.3%). Over a median follow-up of 2025 days (IQR=245) 3917 deaths occurred. As compared with NoAF-F, AF-F, F and AF in that order had higher all-cause mortality, adjusted hazard ratio (HR)=3.24 (95%CI:2.88-3.66), p<.0005; HR=2.06 (95%CI:1.90-2.22), p<.0005; and HR=1.47 (95%CI:1.31-1.64), p<.0005 respectively. When frailty and AF were considered jointly they did not interact. Conclusions: The combination of AF and frailty at baseline represents the group with highest risk for all-cause mortality in older Veterans. Further studies may be needed to assess the impact on mortality of clinical interventions targeting both conditions.

Prognostic Value of Serial Brain Natriuretic Peptide Measurements in Patients with Acute Myocardial Infarction

Cardiology ◽  
2015 ◽  
Vol 131 (2) ◽  
pp. 116-121 ◽  
Author(s):  
Antonio E.P. Pesaro ◽  
Marcelo Katz ◽  
Adriano Caixeta ◽  
Márcia R. Makdisse ◽  
Alessandra G. Correia ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Natriuretic Peptide ◽  
Prognostic Value ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Adverse Outcomes ◽  
Hospital Death ◽  
Hospital Variation

Objectives: Elevated B-type natriuretic peptide (BNP) levels following acute myocardial infarction (AMI) are associated with adverse outcomes. The role of serial BNP monitoring after AMI has been poorly investigated. We aimed to evaluate the prognostic value of in-hospital serial BNP measurements in AMI patients. Methods: Patients with AMI (n = 1,924) were retrospectively evaluated. We selected patients with at least 2 in-hospital BNP measurements. The association between in-hospital mortality and BNP measurements (earliest, highest follow-up and the variation between measurements) were tested in multivariate models. Results: Serial BNP levels were determined in 176 patients. Compared to the rest of the population, these patients were older and had higher mortality rates. In the adjusted models, only the highest follow-up BNP remained associated with in-hospital death (odds ratio 1.06; 95% confidence interval, CI, 1.01-1.15; p = 0.014). Receiver-operating characteristic curve analysis demonstrated that the highest follow-up BNP was the best predictor of in-hospital death (area under the curve = 0.75; 95% CI 0.64-0.86). Conclusions: Serial BNP monitoring was performed in a high-risk subgroup of AMI patients. The highest follow-up BNP was a better predictor of short-term death than the baseline and in-hospital variation values. In AMI patients, a later in-hospital BNP assessment may be more useful than an early measurement.

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