scholarly journals Clues To Mortality Trends And Their Related Factors In IgG4-Related Disease: A Japanese Single-Center Retrospective Study

2021 ◽  
Author(s):  
Hiroyuki Kawahara ◽  
Ichiro Mizushima ◽  
Shunsuke Tsuge ◽  
Seung Shin ◽  
Takahiro Yoshinobu ◽  
...  
Keyword(s):  
Cox Regression ◽  
Organ Involvement ◽  
Regression Analyses ◽  
Mortality Trends ◽  
Related Factors ◽  
Crude Mortality Rate ◽  
Crude Mortality ◽  
Long Term Prognosis

Abstract Background: Few observations on the long-term prognosis have been conducted in immunoglobulin G4-related disease (IgG4-RD) patients with various organ involvement, not limited to autoimmune pancreatitis. Especially, mortality and its related factors in patients with IgG4-RD with various organ involvement are not well known. This study aimed to clarify mortality trends and its related factors in IgG4-RD with various organ involvement.Methods: We retrospectively reviewed the medical records of patients with IgG4-RD at a single center in Japan. We calculated the crude mortality rate and the standardized mortality ratio (SMR) using national Japan mortality statistics and investigated the cause of death. We performed Cox regression analyses to assess mortality-related factors.Results: A total of 179 patients with IgG4-RD were included and the median follow-up from diagnosis was 47 months (IQR 19-96). Ten patients (5.6%) in our cohort died during the follow-up period. The crude mortality rate was 11.1 per 1,000 person-years. According to national Japan mortality statistics, 11.6 age- and sex-matched deaths would have been expected to occur within the follow-up period, resulting in an SMR of 0.86 (95% confidence interval [CI] 0.41-1.59). Univariate Cox regression analyses indicated that the number of affected organs at diagnosis (hazard ratio [HR] 1.45, 95% CI 1.02-2.05), eGFR <45 mL/min/1.73m2 at diagnosis (vs. ≥45, HR 8.48, 95% CI 2.42-29.79), and the presence of malignancy during the clinical course (HR 3.93, 95% CI 1.10-14.02) had a significant impact on the time to death.Conclusions: Our findings suggested that IgG4-RD does not significantly affect long-term patient survival. On the other hand, multi-organ involvement and renal dysfunction as well as malignancy might be associated with higher mortality trends in IgG4-RD. Early detection and appropriate management of risk factors may improve the long-term prognosis of IgG4-RD.

scholarly journals Clues to Mortality Trends and Their Related Factors in IgG4-related Disease: a Japanese Single-center Retrospective Study

2021 ◽  
Author(s):  
Hiroyuki Kawahara ◽  
Ichiro Mizushima ◽  
Shunsuke Tsuge ◽  
Seung Shin ◽  
Takahiro Yoshinobu ◽  
...  
Keyword(s):  
Cox Regression ◽  
Organ Involvement ◽  
Regression Analyses ◽  
Mortality Trends ◽  
Related Factors ◽  
Crude Mortality Rate ◽  
Crude Mortality ◽  
Long Term Prognosis

Abstract Background: Few observations on the long-term prognosis have been conducted in immunoglobulin G4-related disease (IgG4-RD) patients with various organ involvement, not limited to autoimmune pancreatitis. Especially, mortality and its related factors in patients with IgG4-RD with various organ involvement are not well known. This study aimed to clarify mortality trends and its related factors in IgG4-RD with various organ involvement.Methods: We retrospectively reviewed the medical records of patients with IgG4-RD at a single center in Japan. We calculated the crude mortality rate and the standardized mortality ratio (SMR) using national Japan mortality statistics and investigated the cause of death. We performed Cox regression analyses to assess mortality-related factors.Results: A total of 179 patients with IgG4-RD were included and the median follow-up from diagnosis was 47 months (IQR 19-96). Ten patients (5.6%) in our cohort died during the follow-up period. The crude mortality rate was 11.1 per 1,000 person-years. According to national Japan mortality statistics, 11.6 age- and sex-matched deaths would have been expected to occur within the follow-up period, resulting in an SMR of 0.86 (95% confidence interval [CI] 0.41-1.59). Univariate Cox regression analyses indicated that the number of affected organs at diagnosis (hazard ratio [HR] 1.45, 95% CI 1.02-2.05), eGFR <45 mL/min/1.73m2 at diagnosis (vs. ≥45, HR 8.48, 95% CI 2.42-29.79), and the presence of malignancy during the clinical course (HR 3.93, 95% CI 1.10-14.02) had a significant impact on the time to death.Conclusions: Our findings suggested that IgG4-RD does not significantly affect long-term patient survival. On the other hand, multi-organ involvement and renal dysfunction as well as malignancy might be associated with higher mortality trends in IgG4-RD. Early detection and appropriate management of risk factors may improve the long-term prognosis of IgG4-RD.

scholarly journals POS1348 MORTALITY AND ITS RELATED FACTORS IN PATIENTS WITH IGG4-RELATED DISEASE: A JAPANESE SINGLE-CENTER STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 956-957
Author(s):  
I. Mizushima ◽  
H. Kawahara ◽  
T. Yoshinobu ◽  
S. Shin ◽  
R. Hoshiba ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Cox Regression ◽  
Clinical Course ◽  
Regression Analyses ◽  
Related Factors ◽  
Related Disease ◽  
Igg4 Related Disease ◽  
Crude Mortality Rate ◽  
Crude Mortality

Background:In recent years, IgG4-related disease (IgG4-RD) has become a widely recognized disorder. However, mortality and its related factors in this disease are not well known.Objectives:This study aimed to clarify mortality and its related factors in patients with IgG4-RD.Methods:We retrospectively reviewed the medical records of patients with IgG4-RD diagnosed by experts based on fulfillment of the Japanese comprehensive diagnostic criteria and/or the 2019 ACR/EULAR classification criteria for IgG4-RD at a single center in Japan. Using the collected data, we calculated the crude mortality rate and the standardized mortality ratio (SMR) using national Japan mortality statistics and investigated the cause of death. We performed Cox regression analyses to assess mortality-related factors.Results:A total of 179 patients with IgG4-RD were included: 124 were male (69.3%); the median age was 68 years (interquartile range [IQR] 60-75 years); and the median follow-up from diagnosis was 47 months (IQR 17-84). Ten patients (5.6%) in our cohort died during the follow-up period. Five died of malignancy, one of respiratory failure, two of infectious pneumonia, one of sudden cardiac event, and one of suspected aortic aneurysmal rupture. The crude mortality rate was 11.1 per 1,000 person-years. According to national Japan mortality statistics, 11.6 age- and sex-matched deaths were expected to occur within the follow-up period, resulting in a SMR of 0.86 (95% confidence interval [CI] 0.41-1.59). Univariate Cox regression analyses indicated that the number of affected organs at diagnosis (hazard ratio [HR] 1.45, 95% CI 1.02-2.05), serum creatinine levels at diagnosis (HR 1.82, 95% CI 1.06-3.12), and the presence of malignancy during the clinical course (HR 3.93, 95% CI 1.10-14.02) had a significant impact on the time to death, whereas the other factors including age at diagnosis and serum C-reactive protein and IgG4 levels at diagnosis did not.Conclusion:Our findings suggest that the mortality rate of patients with IgG4-RD does not significantly differ from that of the Japanese general population. Multi-organ involvement and renal dysfunction at diagnosis as well as malignancy during the clinical course may be associated with higher mortality. An appropriate clinical evaluation for the early detection of these risk factors is required at first diagnosis and during long-term follow-up.Disclosure of Interests:None declared

Disability pensions in severely disturbed in-patient adolescents

1998 ◽  
Vol 172 (2) ◽  
pp. 159-163 ◽  
Author(s):  
M. Pelkonen ◽  
M. Marttunen ◽  
E. Pulkkinen ◽  
P. Laippala ◽  
J. Lönnqvist ◽  
...  
Keyword(s):  
Psychosocial Functioning ◽  
Disability Pension ◽  
Psychiatric Care ◽  
Critical Time ◽  
Working Capacity ◽  
Short Term ◽  
Related Factors ◽  
Long Term Prognosis

BackgroundKnowledge of working capacity from adolescence until adulthood among severely disturbed in-patients is scarce.MethodIn a follow-up study of 61 adolescent in-patients, we studied associations between being on a disability pension 20 years after hospitalisation, and the patients' psychopathology and treatment-related factors during the hospitalisation and seven-year follow-up.ResultsOf the former in-patients. 27% had not been on a disability pension, 20% had short-term pension periods, and 53% were pensioned. Subjects whose overall psychosocial functioning had improved and who had not utilised in-patient services until the seven-year follow-up, had a better prognosis in terms of working capacity Half of the subjects who had not been on pension during the follow-up had received a diagnosis of conduct disorder at discharge, and half of those pensioned had a psychotic disorder.ConclusionsThe patients' level of psychosocial functioning and capability to work in young adulthood were associated with long-term prognosis in terms of working capacity Adolescence seems to be the critical time for intensive psychiatric care combined with vocational rehabilitation programmes.

scholarly journals Phenotypic frailty and multimorbidity are independent 18-year mortality risk indicators in older men

2021 ◽  
Author(s):  
Timo E. Strandberg ◽  
Linda Lindström ◽  
Satu Jyväkorpi ◽  
Annele Urtamo ◽  
Kaisu H. Pitkälä ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Cox Regression ◽  
Reference Group ◽  
Strong Predictor ◽  
Cognitive Status ◽  
Risk Indicators ◽  
Adl Disability ◽  
Long Term Prognosis

Abstract Purpose Multimorbidity, prefrailty, and frailty are frequent in ageing populations, but their independent relationships to long-term prognosis in home-dwelling older people are not well recognised. Methods In the Helsinki Businessmen Study (HBS) men with high socioeconomic status (born 1919–1934, n = 3490) have been followed-up from midlife. In 2000, multimorbidity (≥ 2 conditions), phenotypic prefrailty and frailty were determined in 1365 home-dwelling men with median age of 73 years). Disability was assessed as a possible confounder. 18-year mortality follow-up was established from registers and Cox regression used for analyses. Results Of the men, 433 (31.7%) were nonfrail and without multimorbidity at baseline (reference group), 500 (36.6%) and 82 (6.0%) men had prefrailty or frailty, respectively, without multimorbidity, 84 (6.2%) men had multimorbidity only, and 201 (14.7%) and 65 (4.8%) men had prefrailty or frailty together with multimorbidity. Only 30 (2.2%) and 86 (6.3%) showed signs of ADL or mobility disability. In the fully adjusted analyses (including ADL disability, mental and cognitive status) of 18-year mortality, frailty without multimorbidity (hazard ratio 1.62, 95% confidence interval 1.13–2.31) was associated with similar mortality risk than multimorbidity without frailty (1.55, 1.17–2.06). The presence of both frailty and multimorbidity indicated a strong mortality risk (2.93, 2.10–4.07). Conclusion Although multimorbidity is generally considered a substantial health problem, our long-term observational study emphasises that phenotypic frailty alone, independently of disability, may be associated with a similar risk, and a combination of multimorbidity and frailty is an especially strong predictor of mortality.

scholarly journals Impact of diabetes mellitus on long-term survival after transcatheter mitral valve edge-to-edge repair

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Geyer ◽  
V H Schmitt ◽  
K Keller ◽  
S Born ◽  
K Bachmann ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Mitral Valve ◽  
Cox Regression ◽  
Regression Analyses ◽  
Term Survival ◽  
Long Term Survival ◽  
Short And Long Term ◽  
Artery Disease

Abstract Introduction Diabetes mellitus (DM) represents a notable risk factor after surgical and interventional procedures but data on the influence of DM on long-term survival after Transcatheter Edge-to-edge Repair (TEER) for Mitral valve Regurgitation (MR) are sparse. Purpose To compare the outcome of patients with and without DM after TEER. Methods Retrospective monocentric assessment of patients after successful treatment of MR by TEER (exclusion of combined forms of transcatheter repair) between 06/2010 and 03/2018. Patients were stratified for DM at baseline and observed regarding mortality during follow-up. Cox regression analyses were performed for survival analyses. Results 627 patients (47.0% females, 88.2% aged ≥70 years) and among these 174 subjects with DM (27.3%) were included with a median follow-up period of 486 days [IQR 157–916 days]). Within the investigation period, 20 patients (3.2%) were lost to follow-up. Patients with DM more often presented severe comorbidities like obesity (27.3% vs. 9.2%, p&lt;0.001), arterial hypertension (91.4% vs. 83.7%, p=0.013), renal insufficiency (63.8% vs. 43.9%, p&lt;0.001), coronary artery disease (77.0% vs. 59.8%, p&lt;0.001) or peripheral artery disease (14.4% vs. 8.4%, p=0.026) and had a higher median logistic Euroscore I (29.4% [20.0/43.0] vs. 25.0% [16.7/36.6], p=0.001) as well as reduced systolic function (LVEF 35% [30/50] vs. 45% [30/55], p&lt;0.001). No statistical differences in short- and long-term survival were detected between patients with and without DM (in-hospital mortality 1.7 vs. 2.6%, p=0.771; at 30-days 5.0 vs. 6.0%, p=0.842, 1-year 28.7 vs. 25.0%, p=0.419, 3-years 49.2 vs. 44.1%, p=0.554, 5-years 69.0 vs. 68.3%, p=0.497). By calculating cox regression analyses, DM was not predictive for a higher mortality, even after adjustment for other risk factors (HR 1-year 1.17 [95% CI 0.80–1.71], p=0.419; HR long-term 1.13 [95% CI 0.86–1.49], p=0.373) in the total cohort, as well as after stratification for the underlying mitral valve pathology (functional MR: 1-year HR 0.99 [95% CI 0.01–1.62], p=0.969, long-term HR 0.903 [95% CI 0.63–1.29, p=0.571; primary MR: 1-year HR 1.48 [95% CI 0.66–3.35, p=0.344, long-term HR1.66 [95% CI 0.89–3.09], p=0.110). Conclusions Even though DM-patients presented with a more vulnerable clinical profile, no relevant differences in short- and long-term mortality after TEER for MR were found. Although being factored in most common risk scores, DM could not be associated with an adverse prognosis after transcatheter therapy of MR. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Retrospective Study on the Survival Rate of Preformed Metal Crowns in Permanent First Molars

2020 ◽  
Vol 47 (2) ◽  
pp. 140-147
Author(s):  
Nayoung Oh ◽  
Soonhyeun Nam ◽  
Jaesik Lee ◽  
Hyunjung Kim
Keyword(s):  
Survival Rate ◽  
Cox Regression ◽  
Regression Analyses ◽  
Preformed Metal Crowns ◽  
Long Term Follow Up ◽  
Permanent Molars ◽  
Restoration Failure ◽  
First Permanent Molars

This study analyzed the longevity of preformed metal crowns (PMCs) in first permanent molars and evaluated factors influencing their survival during a long-term follow-up period. In all, 115 first permanent molars treated with PMCs between June 2008 and June 2018 were retrospectively analyzed. The overall combined success rate for the study group was 84.3%. The 5-year survival rate was 82.8%. Multivariate Cox regression analyses identified distal cavities and mandibular PMC placement as risk factors for restoration failure. Careful placement of PMCs at the final try-in stage augments the longevity of the crown.

P6211Efficacy of comprehensive Managed Care after Acute Myocardial Infarction (MC-AMI) in a long-term follow-up - preliminary experience of a single high-volume center

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Wita ◽  
K Wilkosz ◽  
M Wita ◽  
A Kulach ◽  
M Wybraniec ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Managed Care ◽  
Cardiac Rehabilitation ◽  
Cox Regression ◽  
Icd Implantation ◽  
Cox Regression Analysis ◽  
Long Term Prognosis

Abstract Introduction Despite substantial progress in the medical and interventional treatment of acute myocardial infarction (AMI), a long-term prognosis in MI survivors remains unsatisfactory. The Managed Care in Acute Myocardial Infarction (MC-AMI, KOS-zawal) is the first program of a comprehensive, supervised care for patients with AMI to improve long-term prognosis. It includes acute intervention, complex revascularization, cardiac rehabilitation (CR), outpatient follow-up, and prevention of SCD. Purpose To assess the effect of MC-AMI on major adverse cardiovascular and cerebrovascular events (MACCE) in 12 months follow-up. Methods In this single-center, retrospective observational study we enrolled 1211 patients, out of which 719 consented for participation in MC-AMI and compared them to 1130 subjects in the control group. After propensity score matching two groups of 529 subjects each were compared. Cox regression was performed to assess the effect of MC-AMI on clinical endpoints. Results Primarily, MC-AMI has been proved to reduce MACCE rate by 40% in a 12-month observation. Participants of MC-AMI had a higher adherence to cardiac rehabilitation (98 vs. 14%) higher rate of scheduled revascularisation (coronary artery bypass grafting: 9.8% vs. 4.9%, p<0.001; elective percutaneous coronary intervention: 3.0% vs 2.1%, p<0.05) and ICD implantation (2.8% vs. 0.6%, p<0.05) compared to control. Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with the occurrence MACCE at 12 months (HR=0.500, 95%Cl 0.349–0.718, p<0.001). Besides, older age, diabetes mellitus, hyperlipidemia, prior PAD, previous UA, and lower LVEF were significantly associated with the primary endpoint. 12-month FU - freedom from MACCE Conclusions MC-AMI is the first program of a comprehensive in-hospital and post-discharge care for AMI patients. MC-AMI improves prognosis by increasing the rate of patients undergoing CR, complete revascularization and ICD implantation, thus reducing MACCE rate by 40% in 12 months. Participation in MC-AMI is inversely related to mortality rate, recurrent MI and heart failure related hospitalization during 12 months.

scholarly journals Impact of Admission Hyperglycemia on Heart Failure Events and Mortality in Patients With Takotsubo Syndrome at Long-term Follow-up: Data From the HIGH-GLUCOTAKO Investigators

2021 ◽  
Author(s):  
Pasquale Paolisso ◽  
Luca Bergamaschi ◽  
Pietro Rambaldi ◽  
Gianluca Gatta ◽  
Alberto Foà ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cox Regression ◽  
Takotsubo Syndrome ◽  
Cox Regression Analysis ◽  
Tnf Α ◽  
Long Term Follow Up ◽  
Long Term Prognosis ◽  
Design And Methods

<b>OBJECTIVES</b>: To investigate admission hyperglycemia effects on the sympathetic system and long-term prognosis in Takotsubo syndrome (TTS). <p><b>RESEARCH DESIGN AND METHODS: </b>in TTS hyperglycemics (n=28) vs normoglycemics (n=48) serum norepinephrine and 123I-MIBG cardiac scintigraphy (123I-MIBGcS) were assessed. Heart failure (HF) occurrence and deaths events over 2-years were evaluated.</p> <p><b>RESULTS: </b>At hospitalization, hyperglycemics vs normoglycemics had higher levels of inflammatory markers, BNP and lower left ventricle ejection fraction (LVEF). Glucose values correlated with norepinephrine levels (R<sup>2</sup>=0.39, p=0.001). In 30 TTS patients, 123I-MIBGcS showed lower H/M<sub>late</sub> values<sub> </sub>in the acute phase (p<0.001) and at follow-up (p<0.001) in hyperglycemic patients. Hyperglycemics had a higher rate of HF events (p<0.001) and deaths (p<0.05) after 24-months. At multivariate Cox Regression analysis, hyperglycemia (p=0.008), TNF-α (p=0.001) and norepinephrine (p=0.035) were independent predictors of HF events.</p> <p><b>CONCLUSIONS: </b>TTS hyperglycemic patients exhibit a sympathetic overactivity with a hyperglycemia-mediated pro-inflammatory pathway which could cause a worse prognosis during follow-up.<b><br> </b></p>

Long-Term Clinical Outcome in Elderly Patients Undergoing Mitral Valve Repair

2020 ◽  
Author(s):  
Julia Götte ◽  
Armin Zittermann ◽  
Kavous Hakim-Meibodi ◽  
Masatoshi Hata ◽  
Rene Schramm ◽  
...  
Keyword(s):  
Mitral Valve ◽  
General Population ◽  
Elderly Patients ◽  
Cox Regression ◽  
Functional Class ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Cox Regression Analysis

Abstract Background Long-term data on patients over 75 years undergoing mitral valve (MV) repair are scarce. At our high-volume institution, we, therefore, aimed to evaluate mortality, stroke risk, and reoperation rates in these patients. Methods We investigated clinical outcomes in 372 patients undergoing MV repair with (n = 115) or without (n = 257) tricuspid valve repair. The primary endpoint was the probability of survival up to a maximum follow-up of 9 years. Secondary clinical endpoints were stroke and reoperation of the MV during follow-up. Univariate and multivariable Cox regression analysis was performed to assess independent predictors of mortality. Mortality was also compared with the age- and sex-adjusted general population. Results During a median follow-up period of 37 months (range: 0.1–108 months), 90 patients died. The following parameters were independently associated with mortality: double valve repair (hazard ratio, confidence interval [HR, 95% CI]: 2.15, 1.37–3.36), advanced age (HR: 1.07, CI: 1.01–1.14 per year), diabetes (HR: 1.97, CI: 1.13–3.43), preoperative New York Heart Association (NYHA) functional class (HR: 1.41, CI: 1.01–1.97 per class), and operative creatininemax levels (HR: 1.32, CI: 1.13–1.55 per mg/dL). The risk of stroke in the isolated MV and double valve repair groups at postoperative year 5 was 5.0 and 4.1%, respectively (p = 0.65). The corresponding values for the risk of reoperation were 4.0 and 7.0%, respectively (p = 0.36). Nine-year survival was comparable with the general population (53.2 vs. 53.1%). Conclusion Various independent risk factors for mortality in elderly MV repair patients could be identified, but overall survival rates were similar to those of the general population. Consequently, our data indicates that repairing the MV in elderly patients represents a suitable and safe surgical approach.

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