Survival analysis of elderly patients in Intensive Care Units

Abstract Objective: Conduct a survival analysis of elderly patients hospitalized in an intensive care unit (ICU), identifying the predictors of mortality among this age group. Methods: A retrospective cohort study was performed with data from the medical records of 457 elderly patients hospitalized in an ICU located in the city of Natal in Brazil. Survival functions were estimated using the Kaplan-Meier estimator, and the Log-rank test was used for comparisons. In addition, a multiple Cox proportional hazards model was constructed to identify the independent effects of the predictors of survival. Results: It was found that the survival of elderly ICU patients declined due to factors such as increased hospitalization time, advancing years, unmarried (including common-law-marriage) status, the presence of shock, pneumonia, septicaemia, fractures, a reduced state of consciousness, hospitalization for clinical reasons, being bedridden prior to hospitalization, fever, bradycardia, hypotension, cardiac arrest and the need for mechanical ventilation. The multiple Cox proportional hazards model revealed that variables such as shock, longevity, bradycardia, fractures, fever, hospitalization in the public healthcare system and admission for clinical reasons remained significant as predictors of reduced survival in intensive care units. Conclusions: The survival rates of elderly persons in an ICU in the city of Natal in Brazil were affected by demographic and clinical predictors, and those related to the type of hospitalization and the health care network. This shows that any initiative aimed at increasing the survival of elderly ICU patients must look at individual and social issues and factors related to the health care network.

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Characteristics and Survival of Intensive Care Unit Patients with Coronavirus Disease in Osaka, Japan: A Retrospective Observational Study

Journal of Clinical Medicine ◽

10.3390/jcm10112477 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2477

Author(s):

Ling Zha ◽

Tomotaka Sobue ◽

Taro Takeuchi ◽

Kenta Tanaka ◽

Yusuke Katayama ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Multivariable Model ◽

Icu Patients ◽

Hazards Model ◽

Osaka Prefecture

The epidemiological and clinical characteristics, treatments, and outcomes of patients with coronavirus disease 2019 (COVID-19) who are admitted to the intensive care unit (ICU) have not been adequately evaluated in Japan. We analyzed the registry data of 205 patients with COVID-19 admitted to the ICU between February and November 2020, in Osaka Prefecture, Japan. A Cox proportional hazards model was used to assess the association between epidemiological factors and mortality among ICU patients. Of the 205 ICU patients, 161 (78.5%) were men and 149 (72.7%) were older than 60 years. A total of 117 patients (57.1%) had comorbidities. The most common symptoms at diagnosis were mild (n = 131, 63.9%). A total of 187 patients (91.2%) received mechanical ventilation, and 32 patients (15.6%) required extracorporeal membrane oxygenation. Patients were followed up for a median of 25 days after ICU admission. A total of 147 patients (71.7%) were alive at discharge, and 58 patients (28.3%) died. The hazard ratio for mortality among patients aged >80 years was 6.02 (95% confidence interval: 2.10−17.25) in the multivariable model, which was higher than that among those aged ≤59 years. These results are useful for recognizing the clinical course of this infection in ICU patients.

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A promising predictor of mortality— A cohort study (Preprint)

10.2196/preprints.28633 ◽

2021 ◽

Author(s):

Ji Ha Ling

Keyword(s):

Intensive Care ◽

Poor Prognosis ◽

Medical Information ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Hazards Model ◽

Clinical Biomarker ◽

Secondary Result

UNSTRUCTURED Severe inflammation leads to poor prognosis for intensive care unit hospitalized patients. The is a biomarker used to monitor inflammation and immune response, which can predict poor prognosis of various diseases. However, it is unclear whether NLR is associated with all-cause mortality in ICU patients. This study investigated the correlation between MLR and ICU results. Extract clinical data from Medical Information Mart for Intensive Care III (MIMIC-III) database, which contains health data of more than 50,000 patients. The main result was 30-day mortality, and the secondary result was 90-day mortality. Use the Cox proportional hazards model to reveal the association between MLR and results. Multivariable analyses were used to control for confounders. NLR is a promising clinical biomarker, which can be used as a available predictor of ICU mortality.

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Colorectal Cancer Surgery in Patients Older than 80 Years of Age: Experience at One Nonteaching Hospital in Japan

The American Surgeon ◽

10.1177/000313481107701132 ◽

2011 ◽

Vol 77 (11) ◽

pp. 1454-1459 ◽

Cited By ~ 2

Author(s):

Hiromichi Maeda ◽

Takehiro Okabayashi ◽

Kengo Ichikawa ◽

Jyunichi Miyazaki ◽

Kazuhiro Hanazaki ◽

...

Keyword(s):

Colorectal Cancer ◽

Elderly Patients ◽

Surgical Resection ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Colorectal Cancer Surgery ◽

Nonteaching Hospital ◽

Hazards Model

The safety and efficacy of surgical treatment for colorectal cancer in patients older than 80 years of age are seldom assessed. The aim of the present study was to compare short- and long-term outcomes after surgery between younger and elderly patients at a single nonteaching hospital. In all, 342 consecutive patients who underwent surgical resection for invasive primary colorectal cancer between April 1999 and April 2007 were included in the study. Patients were divided into two groups according to their age at the time of surgery, those younger than 79 years of age (n = 283) and those older than 80 years of age (n = 59). A greater proportion of elderly patients had concurrent disease before surgery, right-sided colon cancer, and postoperative complications. Cox proportional hazards model (multivariate analysis) identified three independent risk factors for a poor outcome after surgery (excluding death by other causes): 1) the presence of preoperative symptoms; 2) noncurative resection for colorectal cancer; and 3) the presence of lymph node metastases. Age older than 80 years was not a risk factor for a poor postoperative prognosis. At our nonteaching hospital, surgical resection appears to be a safe and beneficial treatment option for elderly patients (older than 80 years of age) who have colorectal cancer.

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Predictors of mortality among intensive care unit patients coinfected with tuberculosis and HIV

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562017000000316 ◽

2018 ◽

Vol 44 (2) ◽

pp. 118-124 ◽

Cited By ~ 5

Author(s):

Marcia Danielle Ferreira ◽

Cynthia Pessoa das Neves ◽

Alexandra Brito de Souza ◽

Francisco Beraldi-Magalhães ◽

Giovanni Battista Migliori ◽

...

Keyword(s):

Proportional Hazards ◽

Proportional Hazards Model ◽

Invasive Mechanical Ventilation ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Hazards Model ◽

Hiv Coinfection ◽

Admission Data ◽

Laboratory Variables ◽

The City

ABSTRACT Objective: To identify factors predictive of mortality in patients admitted to the ICU with tuberculosis (TB)/HIV coinfection in the Manaus, Amazon Region. Methods: This was a retrospective cohort study of TB/HIV coinfected patients over 18 years of age who were admitted to an ICU in the city of Manaus, Brazil, between January of 2011 and December of 2014. Sociodemographic, clinical, and laboratory variables were assessed. To identify factors predictive of mortality, we employed a Cox proportional hazards model. Results: During the study period, 120 patients with TB/HIV coinfection were admitted to the ICU. The mean age was 37.0 ± 11.7 years. Of the 120 patients evaluated, 94 (78.3%) died and 62 (66.0%) of those deaths having occurred within the first week after admission. Data on invasive mechanical ventilation (IMV) and ARDS were available for 86 and 67 patients, respectively Of those 86, 75 (87.2%) underwent IMV, and, of those 67, 48 (71.6%) presented with ARDS. The factors found to be independently associated with mortality were IMV (p = 0.002), hypoalbuminemia (p = 0.013), and CD4 count < 200 cells/mm3 (p = 0.002). Conclusions: A high early mortality rate was observed among TB/HIV coinfected ICU patients. The factors predictive of mortality in this population were IMV, hypoalbuminemia, and severe immunosuppression.

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A Time-Trend Survival Analysis of Elderly Resectable Pancreatic Cancer Patients

10.21203/rs.3.rs-218149/v1 ◽

2021 ◽

Author(s):

Rui Jing ◽

Yuru Shang ◽

Bing Li ◽

Xiaodong Bai ◽

Guangrui Shao

Keyword(s):

Pancreatic Cancer ◽

Elderly Patients ◽

Cancer Patients ◽

Time Trend ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Young Patients ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Hazards Model

Abstract Background: The time-trend in the survival of elderly pancreatic cancer patients was still unclear. Thus, the aim of this study was to compare the survival benefit of young and elderly pancreatic cancer patients by a time-trend analysis. Methods: From 2004-2013, we obtained 5,341 of young patients (< 80 years) and 569 elderly patients (≥ 80 years) from the Surveillance, Epidemiology, and End Results (SEER) database, and the overall survival of these patients were analyzed by Kaplan-Meier estimator. The independent factors which could predict the survival of patients were determined by cox proportional hazards model.Results: We observed that the median overall survival of the young patients in 2004-2008 cohort was significantly (P < 0.001) increased when compared to that in the 2009-2013 cohort. However, we did not observe the survival benefit for the elderly patients. The Cox proportional hazards model demonstrated that the tumor size, lymph node ratio, grade, and AJCC TNM stage were independent factors of survival. Conclusions: This study demonstrated that compared to 2004-2008, the survival of elderly patients in 2009-2013 was not significantly improved. Thus, the clinicians still need to administer more care to elderly patients.

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Association Between Base Excess and Mortality Among Patients in ICU With Acute Kidney Injury

Frontiers in Medicine ◽

10.3389/fmed.2021.779627 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yi Cheng ◽

You Zhang ◽

Boxiang Tu ◽

Yingyi Qin ◽

Xin Cheng ◽

...

Keyword(s):

Acute Kidney Injury ◽

Intensive Care ◽

Medical Information ◽

Proportional Hazards ◽

Base Excess ◽

Proportional Hazards Model ◽

Kidney Injury ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Icu Patients

Objective: This study aimed to explore the association between base excess (BE) and the risk of 30-day mortality among patients with acute kidney injury (AKI) in the intensive care unit (ICU).Methods: This retrospective study included patients with AKI from the Medical Information Mart for Intensive Care (MIMIC)-IV database. We used a multivariate Cox proportional-hazards model to obtain the hazard ratio (HR) for the risk of 30-day mortality among patients with AKI. Furthermore, we utilized a Cox proportional-hazard model with restricted cubic splines (RCS) to explore the potential non-linear associations.Results: Among the 14,238 ICU patients with AKI, BE showed a U-shaped relationship with risk of 30-day mortality for patients with AKI, and higher or lower BE values could increase the risk. Compared with normal base excess (−3~3 mEq/L), patients in different groups (BE ≤ −9 mEq/L, −9 mEq/L < BE ≤ −3 mEq/L, 3 mEq/L < BE ≤ 9 mEq/L, and BE > 9 mEq/L) had different HRs for mortality: 1.57 (1.40, 1.76), 1.26 (1.14, 1.39), 0.97 (0.83, 1.12), 1.53 (1.17, 2.02), respectively. The RCS analyses also showed a U-shaped curve between BE and the 30-day mortality risk.Conclusion: Our results suggest that higher and lower BE in patients with AKI would increase the risk of 30-day mortality. BE measured at administration could be a critical prognostic indicator for ICU patients with AKI and provide guidance for clinicians.

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Risk factors associated with major adverse cardiac and cerebrovascular events following percutaneous coronary intervention: a 10-year follow-up comparing random survival forest and Cox proportional-hazards model

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01834-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maryam Farhadian ◽

Sahar Dehdar Karsidani ◽

Azadeh Mozayanimonfared ◽

Hossein Mahjub

Keyword(s):

Proportional Hazards ◽

Proportional Hazards Model ◽

Coronary Intervention ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Hazards Model ◽

Cerebrovascular Events ◽

Long Term Follow Up ◽

Stent Length

Abstract Background Due to the limited number of studies with long term follow-up of patients undergoing Percutaneous Coronary Intervention (PCI), we investigated the occurrence of Major Adverse Cardiac and Cerebrovascular Events (MACCE) during 10 years of follow-up after coronary angioplasty using Random Survival Forest (RSF) and Cox proportional hazards models. Methods The current retrospective cohort study was performed on 220 patients (69 women and 151 men) undergoing coronary angioplasty from March 2009 to March 2012 in Farchshian Medical Center in Hamadan city, Iran. Survival time (month) as the response variable was considered from the date of angioplasty to the main endpoint or the end of the follow-up period (September 2019). To identify the factors influencing the occurrence of MACCE, the performance of Cox and RSF models were investigated in terms of C index, Integrated Brier Score (IBS) and prediction error criteria. Results Ninety-six patients (43.7%) experienced MACCE by the end of the follow-up period, and the median survival time was estimated to be 98 months. Survival decreased from 99% during the first year to 39% at 10 years' follow-up. By applying the Cox model, the predictors were identified as follows: age (HR = 1.03, 95% CI 1.01–1.05), diabetes (HR = 2.17, 95% CI 1.29–3.66), smoking (HR = 2.41, 95% CI 1.46–3.98), and stent length (HR = 1.74, 95% CI 1.11–2.75). The predictive performance was slightly better by the RSF model (IBS of 0.124 vs. 0.135, C index of 0.648 vs. 0.626 and out-of-bag error rate of 0.352 vs. 0.374 for RSF). In addition to age, diabetes, smoking, and stent length, RSF also included coronary artery disease (acute or chronic) and hyperlipidemia as the most important variables. Conclusion Machine-learning prediction models such as RSF showed better performance than the Cox proportional hazards model for the prediction of MACCE during long-term follow-up after PCI.

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Elevated plasma growth and differentiation factor 15 predicts incident anemia in older adults aged 60 years and older

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa324 ◽

2020 ◽

Author(s):

Yuko Yamaguchi ◽

Marta Zampino ◽

Toshiko Tanaka ◽

Stefania Bandinelli ◽

Yusuke Osawa ◽

...

Keyword(s):

Older Adults ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Differentiation Factor ◽

Hazards Model ◽

Increased Risk ◽

The Relationship

Abstract Background Anemia is common in older adults and associated with greater morbidity and mortality. The causes of anemia in older adults have not been completely characterized. Although elevated circulating growth and differentiation factor 15 (GDF-15) has been associated with anemia in older adults, it is not known whether elevated GDF-15 predicts the development of anemia. Methods We examined the relationship between plasma GDF-15 concentrations at baseline in 708 non-anemic adults, aged 60 years and older, with incident anemia during 15 years of follow-up among participants in the Invecchiare in Chianti (InCHIANTI) Study. Results During follow-up, 179 (25.3%) participants developed anemia. The proportion of participants who developed anemia from the lowest to highest quartile of plasma GDF-15 was 12.9%, 20.1%, 21.2%, and 45.8%, respectively. Adults in the highest quartile of plasma GDF-15 had an increased risk of developing anemia (Hazards Ratio 1.15, 95% Confidence Interval 1.09, 1.21, P<.0001) compared to those in the lower three quartiles in a multivariable Cox proportional hazards model adjusting for age, sex, serum iron, soluble transferrin receptor, ferritin, vitamin B12, congestive heart failure, diabetes mellitus, and cancer. Conclusions Circulating GDF-15 is an independent predictor for the development of anemia in older adults.

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Dementia Adjudication Triggers Associated With Increased Mortality for Older Australians: Evidence From ASPREE

Innovation in Aging ◽

10.1093/geroni/igaa057.523 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 161-161

Author(s):

Jane Banaszak-Holl ◽

Xiaoping Lin ◽

Jing Xie ◽

Stephanie Ward ◽

Henry Brodaty ◽

...

Keyword(s):

Proportional Hazards ◽

Proportional Hazards Model ◽

The Elderly ◽

Cox Proportional Hazards ◽

Service Planning ◽

Cox Proportional Hazards Model ◽

Cognitive Test ◽

Risk Of Death ◽

Hazards Model ◽

Using Data

Abstract Research Aims: This study seeks to understand whether those with dementia experience higher risk of death, using data from the ASPREE (ASPirin in Reducing Events in the Elderly) clinical trial study. Methods: ASPREE was a primary intervention trial of low-dose aspirin among healthy older people. The Australian cohort included 16,703 dementia-free participants aged 70 years and over at enrolment. Participants were triggered for dementia adjudication if cognitive test results were poorer than expected, self-reporting dementia diagnosis or memory problems, or dementia medications were detected. Incidental dementia was adjudicated by an international adjudication committee using the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) criteria and results of a neuropsychological battery and functional measures with medical record substantiation. Statistical analyses used a cox proportional hazards model. Results: As previously reported, 1052 participants (5.5%) died during a median of 4.7 years of follow-up and 964 participants had a dementia trigger, of whom, 575 (60%) were adjucated as having dementia. Preliminary analyses has shown that the mortality rate was higher among participants with a dementia trigger, regardless of dementia adjudication outcome, than those without (15% vs 5%, Χ2 = 205, p <.001). Conclusion: This study will provide important analyses of differences in the hazard ratio for mortality and causes of death among people with and without cognitive impairment and has important implications on service planning.

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Evaluation of Changes on World Stock Exchanges in Connection with the SARS-CoV-2 Pandemic. Survival Analysis Methods

Risks ◽

10.3390/risks9070121 ◽

2021 ◽

Vol 9 (7) ◽

pp. 121

Author(s):

Beata Bieszk-Stolorz ◽

Krzysztof Dmytrów

Keyword(s):

Survival Analysis ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Stock Exchange ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Stock Exchanges ◽

Analysis Methods ◽

Hazards Model ◽

Kaplan Meier

The aim of our research was to compare the intensity of decline and then increase in the value of basic stock indices during the SARS-CoV-2 coronavirus pandemic in 2020. The survival analysis methods used to assess the risk of decline and chance of rise of the indices were: Kaplan–Meier estimator, logit model, and the Cox proportional hazards model. We observed the highest intensity of decline in the European stock exchanges, followed by the American and Asian plus Australian ones (after the fourth and eighth week since the peak). The highest risk of decline was in America, then in Europe, followed by Asia and Australia. The lowest risk was in Africa. The intensity of increase was the highest in the fourth and eleventh week since the minimal value had been reached. The highest odds of increase were in the American stock exchanges, followed by the European and Asian (including Australia and Oceania), and the lowest in the African ones. The odds and intensity of increase in the stock exchange indices varied from continent to continent. The increase was faster than the initial decline.

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