The Association Between Serum Liver Enzymes And Cancer Mortality

Kaplan Meier ◽

Increased Risk ◽

Abstract BACKGROUND & AIMS: Interpreting levels of liver enzymes is often challenging because they may be influenced by metabolic processes beyond the liver. Given their pathophysiologic roles in inflammation and oxidative stress, higher levels of these enzymes may be associated with increased risk of mortality. However, studies have found inconsistent results. Thus, we examined the association of liver enzymes levels with cancer mortality in the general U.S. adult population. METHODS: We used the US National Health and Nutrition Examination Survey from 1999 to 2016. Kaplan-Meier survival curve comparisons were examined across quartiles of liver enzymes. Cox proportional hazards models were built to examine the relationship between cancer mortality and liver enzymes quartiles without and with adjustment for potential confounding factors. RESULTS: During the 338,882 person-years follow-up, 1059 participants had cancer-related deaths. There was a nonlinear U-shaped relationship between serum alanine and aspartate aminotransferase (ALT and AST) levels and cancer mortality. There was no relationship between cancer mortality and gamma glutamyltransferase (GGT), however, each 10 IU/L increase in GGT after median was associated with 1% higher mortality risk (HR=1.01; 95% CI=1.00, 1.02; P=0.001). Only subjects with high levels of alkaline phosphatase (ALP) had higher cancer mortality (HR=1.63; 95CI=1.30, 2.05; P<0.001 and HR=1.52; 95%CI=1.20, 1.94; P=0.001 respectively).CONCLUSIONS: Only the lowest and highest serum ALT and AST levels are associated with increased cancer mortality. For ALP, the relationship is present at higher levels. The association with GGT was not robust to different analyses. The mechanisms underlying the observed relationships need further exploration.

Prospective Study of Serum Uric Acid Levels and First Stroke Events in Chinese Adults With Hypertension

Frontiers in Physiology ◽

10.3389/fphys.2021.807420 ◽

2021 ◽

Vol 12 ◽

Author(s):

Feng Hu ◽

Longlong Hu ◽

Rihua Yu ◽

Fengyu Han ◽

Wei Zhou ◽

...

Keyword(s):

Uric Acid ◽

Serum Uric Acid ◽

Proportional Hazards ◽

Survival Curve ◽

Chinese Adults ◽

Stroke Event ◽

Kaplan Meier ◽

Objectives: We investigated the association between serum uric acid (SUA) levels and the risk of the first stroke in Chinese adults with hypertension.Methods: A total of 11, 841 hypertensive patients were selected from the Chinese Hypertension Registry for analysis. The relationship between SUA levels and first stroke was determined using multivariable Cox proportional hazards regression, smoothing curve fitting, and Kaplan–Meier survival curve analysis.Results: During a median follow-up of 614 days, 99 cases of the first stroke were occurred. Cox proportional hazards models indicated that SUA levels were not significantly associated with the first stroke event [adjusted-hazard ratio (HR) per SD increase: 0.98, 95% CI 0.76–1.26, P = 0.889]. In comparison to the group without hyperuricemia (HUA), there were no significantly higher risks of first stroke events (adjusted-HR: 1.22, 95% CI 0.79–1.90, P = 0.373) in the population with HUA. However, in the population less than 60 years old, subjects with HUA had a significantly higher risk of the first stroke than the population without HUA (adjusted-HR: 4.89, 95% CI 1.36–17.63, P = 0.015). In subjects older than 60 years, we did not find a significant relationship between HUA and first stroke (adjusted-HR: 0.97, 95% CI 0.60–1.56, P = 0.886). Survival analysis further confirmed this discrepancy (log-rank P = 0.013 or 0.899 for non-aging or aging group).Conclusion: No significant evidence in the present study indicated that increased SUA levels were associated with the risk of first stroke in the Chinese adults with hypertension. Age played an interactive role in the relationship between HUA and the first stroke event.

The Dose-Response Relationship between The triglyceride-glucose index and Risk of Diabetes Mellitus Using Publicly Available Data: A Longitudinal Study in Chinese Obesity adult population

10.21203/rs.3.rs-786426/v1 ◽

2021 ◽

Author(s):

jiacheng he

Keyword(s):

Diabetes Mellitus ◽

Proportional Hazards ◽

Adult Population ◽

Continuous Variable ◽

Study Data ◽

Tyg Index ◽

Triglyceride Glucose Index ◽

Increased Risk

Abstract BackgroundTriglyceride-glucose index (TyG index) is associated with type 2 diabetes mellitus (T2DM), but research on this relationship is limited in Obesity population. The purpose of this study was to evaluate the correlation between TyG index and the risk of incident T2DM in Chinese Obesity adult population.Methods80,919 participants with BMI≥ 24 were selected from a prospective cohort study data which was collected between 2010 and 2016 across 32 sites and 11 cities in China.The risk of incident T2DM according to TyG index was estimated using multivariable Cox proportional hazards models and a two-piece wise linear regression model was developed to find out the threshold effect.The formula for TyG index was expressed as ln[fasting triglyceride leve (mg/dL)× fasting plasma glucose level(mg/dL)/2].ResultsAfter follow-up, 3008 ( 3.7%) patients developed T2DM. After adjusting for potential confounders, as a continuous variable, TyG index was associated with an increased risk of incident T2DM (adjusted hazard ratio (aHR), 3.81; 95% confidence interval (95% CI), 3.56-4.09.Further analysis revealed a positive curvilinear association between TyG index and incident T2DM, with a saturation effect predicted at 9.328. When the TyG index was less than 9.328, the risk of incident T2DM increased significantly[HR 4.778 (4.149,5.462), P< 0.001], while the risk became gentle when beyond 9.328[HR 2.61 (2.123,3.209), P< 0.001]. Subgroup analyses showed that the association between TyG index and incident T2DM stably existed in different subgroups.ConclusionsTyG index was a significant predictor of subsequent risk of incident T2DM in Chinese Obesity adult population. An increase in TyG index of one unit increased the risk of developing T2DM by 3.81-fold.

Association of Urinary Cadmium with Cancer Mortality Is Influenced by Zinc Intake in Follow-up Study of NHANES 1988–1994 and 1999–2004 (P18-026-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz039.p18-026-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Kijoon Kim ◽

Melissa Melough ◽

Junichi Sakaki ◽

Hwayoung Noh ◽

Sung Koo ◽

...

Keyword(s):

Cancer Mortality ◽

Proportional Hazards ◽

Adult Population ◽

Positive Association ◽

Toxic Heavy Metal ◽

All Cause Mortality ◽

Risk Of Cancer

Abstract Objectives Exposure to cadmium (Cd), a toxic heavy metal, increases risk of numerous chronic diseases and overall mortality. However, little work has been conducted to examine the effect of Zn intake on the association between Cd burden and mortality. The aim of this study was to examine whether the association between urinary Cd concentration and all-cause and disease specific mortality differs by Zn intake level among a representative sample of the US adult population. Methods A total of 15,642 US adults aged 30 years and older in the National Health and Nutrition Examination Survey 1988–1994 and 1999–2004 were followed up through December 31, 2011. Participants’ Zn intake was assessed through 24-hour dietary recalls. The main outcomes included mortality from cardiovascular disease (CVD), cancer, and all causes. Using Cox proportional hazards models, hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for quartiles of urinary Cd, quartiles of dietary Zn, and for quartiles of urinary Cd stratified by level of dietary Zn. Results Of 5367 total deaths that occurred over a mean follow-up of 15 years, 1194 were attributed to cancer and 1677 were attributed to CVD. After adjustment for potential confounders, positive relationships were observed between urinary Cd and all-cause mortality (HR for highest vs. lowest quartile (Q4 vs. Q1): 1.38; 95% CI: 1.14–1.68; P-trend < 0.0001) and cancer mortality (HR for Q4 vs. Q1: 1.54; 95% CI: 1.05–2.27; P-trend < 0.005), but not CVD mortality (HR for Q4 vs. Q1: 1.22; 95% CI: 0.95–1.57; P-trend = 0.0502). Negative associations were observed between dietary Zn and all-cause mortality (HR for Q4 vs. Q1: 0.88; 95% CI: 0.75–1.02; P-trend < 0.05) and cancer mortality (HR for Q4 vs. Q1: 0.82; 95% CI: 0.65–1.03, P-trend < 0.05). Among the lowest tertile of Zn consumers, there was a clear positive association between urinary Cd and cancer mortality (HR for Q4 vs. Q1: 1.79; 95% CI: 1.07–3.01), however, among the highest Zn consumers, this association was somewhat diminished (HR for Q4 vs. Q1: 1.66; 95% CI: 0.80–3.41). Conclusions These findings support existing evidence that Cd burden is associated with greater mortality, and also demonstrate that greater Zn consumption is associated with reduced risk of cancer death related to Cd. Funding Sources This study received no financial support.

Racial Disparities in Delivery Gestational Age among Twin Pregnancies

American Journal of Perinatology ◽

10.1055/s-0037-1603764 ◽

2017 ◽

Vol 34 (11) ◽

pp. 1065-1071

Author(s):

Catherine Vladutiu ◽

Tracy Manuck ◽

Jacqueline Grant

Keyword(s):

Gestational Age ◽

Proportional Hazards ◽

Secondary Analysis ◽

Neonatal Morbidity ◽

Kaplan Meier ◽

Hazard Ratios ◽

Increased Risk ◽

Hydroxyprogesterone Caproate

Objective This study aims to estimate the association between maternal race and delivery gestational age among women with twin gestations. Study Design Secondary analysis of a prospective, randomized control trial of 17-α hydroxyprogesterone caproate versus placebo for preterm birth (PTB) prevention in twin gestations. Non-Hispanic (NH) black and whites were included. Demographic and antenatal characteristics were compared. The primary outcome was delivery gestational age. Secondary outcomes included a composite of major neonatal morbidity. Kaplan–Meier curves estimated survival probabilities for delivery gestational age by race. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI). Results A total of 535 women with twin gestations were included; 150 were NH black. NH blacks delivered earlier than NH whites (33.6 ± 4.8 weeks vs. 35.1 ± 3.5 weeks, p < 0.001). Differences in delivery gestational age between NH blacks and whites were consistent across gestation. In adjusted analyses, NH black race (HR: 1.24, 95% CI: 1.02–1.51), prior PTB (HR: 1.59, 95% CI: 1.15–2.19), and cerclage (HR: 3.90, 95% CI: 2.00–7.60) were associated with an increased risk of earlier delivery. Major neonatal morbidity was higher for NH blacks compared with NH whites (12.7 vs. 7.0%, p = 0.036). Conclusion NH blacks with twin gestations have an increased risk of early delivery and neonatal morbidity compared with NH whites.

Faster Transport Status and Mortality in Anuric Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Blood Purification ◽

10.1159/000433416 ◽

2015 ◽

Vol 40 (2) ◽

pp. 160-166 ◽

Cited By ~ 2

Author(s):

Liping Xiong ◽

Li Fan ◽

Qingdong Xu ◽

Qian Zhou ◽

Huiyan Li ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Proportional Hazards ◽

Increased Risk ◽

All Cause Mortality ◽

History Of ◽

Background: There are limited data regarding the relationship between transport status and mortality in anuric continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: According to the dialysate to plasma creatinine ratio (D/P Cr), 292 anuric CAPD patients were stratified to faster (D/P Cr ≥0.65) and slower transport groups (D/P Cr <0.65). The Cox proportional hazards models were used to evaluate the association of transport status with mortality. Results: During a median follow-up of 22.1 months, 24% patients died, 61.4% of them due to cardiovascular disease (CVD). Anuric patients with faster transport were associated with an increased risk of all-cause mortality (HR (95% CI) = 2.16 (1.09-4.26)), but not cardiovascular mortality, after adjustment for confounders. Faster transporters with pre-existing CVD had a greater risk for death compared to those without any history of CVD. Conclusion: Faster transporters were independently associated with high all-cause mortality in anuric CAPD patients. This association was strengthened in patients with pre-existing CVD.

Impact of Extended and Restricted Antibiotic Deescalation on Mortality

Antibiotics ◽

10.3390/antibiotics11010022 ◽

2021 ◽

Vol 11 (1) ◽

pp. 22

Author(s):

Hwei Lin Teh ◽

Sarimah Abdullah ◽

Anis Kausar Ghazali ◽

Rahela Ambaras Khan ◽

Anitha Ramadas ◽

...

Keyword(s):

Proportional Hazards ◽

Survival Curve ◽

Survival Rates ◽

Pressure Sore ◽

Kaplan Meier ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

The Impact

Background: More data are needed about the safety of antibiotic de-escalation in specific clinical situations as a strategy to reduce exposure to broad-spectrum antibiotics. This study aims to compare the survival curve of patient de-escalated (early or late) against those not de-escalated on antibiotics, to determine the association of patient related, clinical related, and pressure sore/device related characteristics on all-cause 30-day mortality and determine the impact of early and late antibiotic de-escalation on 30-day all-cause mortality. Methods: This is a retrospective cohort study on patients in medical ward Hospital Kuala Lumpur, admitted between January 2016 and June 2019. A Kaplan–Meier survival curve and Fleming–Harrington test were used to compare the overall survival rates between early, late, and those not de-escalated on antibiotics while multivariable Cox proportional hazards regression was used to determine prognostic factors associated with mortality and the impact of de-escalation on 30-day all-cause mortality. Results: Overall mortality rates were not significantly different when patients were not de-escalated on extended or restricted antibiotics, compared to those de-escalated early or later (p = 0.760). Variables associated with 30-day all-cause mortality were a Sequential Organ Function Assessment (SOFA) score on the day of antimicrobial stewardship (AMS) intervention and Charlson’s comorbidity score (CCS). After controlling for confounders, early and late antibiotics were not associated with an increased risk of mortality. Conclusion: The results of this study reinforce that restricted or extended antibiotic de-escalation in patients does not significantly affect 30-day all-cause mortality compared to continuation with extended and restricted antibiotics.

Abstract 2321: CXCL5 Genotype is Associated with Mortality after Acute Coronary Syndromes

Circulation ◽

10.1161/circ.116.suppl_16.ii_507-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Amber L Beitelshees ◽

Issam Zineh ◽

Sharon Cresci ◽

Jun Wu ◽

Matthew R Minton ◽

...

Keyword(s):

Acute Coronary Syndromes ◽

Proportional Hazards ◽

Coronary Revascularization ◽

Recessive Model ◽

Entire Cohort ◽

Kaplan Meier ◽

Increased Risk ◽

Coronary Syndromes

BACKGROUND: Epithelial neutrophil activating peptide (ENA-78) is a chemokine implicated in many inflammatory processes and may be involved in cardiovascular disease. We have previously found the −156 G>C variant in the ENA-78 gene ( CXCL5 ) to be associated with elevated plasma ENA-78 concentrations and production from cultured leukocytes. Since leukocytes, including neutrophils, are involved in acute cardiovascular events, we hypothesized that the CXCL5 −156 G>C variant would be associated with worse event-free survival after acute coronary syndromes (ACS). METHODS: A prospective cohort of ACS patients (n=704) with 3-year follow-up was assessed and CXCL5 was genotyped by Taqman. Cox proportional hazards models adjusting for age, race, sex, diabetes, heart failure, ACS type, coronary revascularization, and genotype were constructed in the entire cohort and separately by race. Kaplan Meier curves were estimated. RESULTS: The −156C allele frequency was 0.17, 0.12, and 0.43 in the overall cohort, whites, and blacks, respectively. The −156C allele was associated with an increased risk mortality according to a recessive model of inheritance in the overall cohort (HR 2.8, 95% CI 1.4 –5.9) [Figure ], and in the white (HR 3.7, 95% CI 1.3–11.1) and black (HR 2.6, 95% CI 0.90 –7.3) subgroups. CONCLUSIONS: CXCL5 −156 C/C genotype was associated with 2.8-fold higher mortality relative to other genotypes in ACS patients. The magnitude of risk was similar in both white and black patients. Taken with previous findings, CXCL5 genotype may represent a novel risk-stratification biomarker in ACS.

Age at onset and familial risk for major depression in a Swedish national twin sample

Psychological Medicine ◽

10.1017/s0033291705005714 ◽

2005 ◽

Vol 35 (11) ◽

pp. 1573-1579 ◽

Cited By ~ 46

Author(s):

KENNETH S. KENDLER ◽

MARGARET GATZ ◽

CHARLES O. GARDNER ◽

NANCY L. PEDERSEN

Keyword(s):

Major Depression ◽

Proportional Hazards ◽

Age At Onset ◽

Familial Risk ◽

Increased Risk ◽

History Of ◽

Background. In many biomedical disorders, early age at onset (AAO) is an index of high liability to illness which is manifest by an increased risk of illness in relatives. Most but not all prior studies report such a pattern for major depression (MD).Method. Lifetime MD and AAO were assessed at personal interview using modified DSM-III-R criteria in 13864 twin pairs, including 4229 onsets of MD, from the Swedish National Twin Registry. Analyses were conducted using Cox proportional hazards models.Results. Controlling for year of birth, gender, zygosity, co-twin history of MD and the interaction of zygosity and co-twin history, the best-fit model showed a significant main effect and a quadratic effect of AAO of MD in the co-twin on the log hazard ratio for MD in the index twin. When examined together, these effects predicted that from the ages of 15 to ~35 years, AAO of MD is moderately negatively related to risk of illness in relatives. However, past age 35, the function flattens out, with little change of risk in relatives with further increases of AAO. Even when the co-twin had a late AAO, the risk in the index twin substantially exceeded that seen when the co-twin had no history of MD.Conclusion. In this large sample, AAO is a meaningful, albeit modest, index of familial liability to MD. The relationship is nonlinear and results largely from an increased liability in individuals with an early AAO. These results should be interpreted in the context of the limitations of long-term recall.

Factors that contribute to urban–rural gradients in risk of schizophrenia: Comparing Danish and Western Australian registers

Australian & New Zealand Journal of Psychiatry ◽

10.1177/00048674211009615 ◽

2021 ◽

pp. 000486742110096

Author(s):

Oleguer Plana-Ripoll ◽

Patsy Di Prinzio ◽

John J McGrath ◽

Preben B Mortensen ◽

Vera A Morgan

Keyword(s):

Confidence Interval ◽

Western Australia ◽

Urban Areas ◽

Proportional Hazards ◽

Hazard Ratio ◽

Indigenous Status ◽

Increased Risk ◽

The Relationship ◽

Western Australian

Introduction: An association between schizophrenia and urbanicity has long been observed, with studies in many countries, including several from Denmark, reporting that individuals born/raised in densely populated urban settings have an increased risk of developing schizophrenia compared to those born/raised in rural settings. However, these findings have not been replicated in all studies. In particular, a Western Australian study showed a gradient in the opposite direction which disappeared after adjustment for covariates. Given the different findings for Denmark and Western Australia, our aim was to investigate the relationship between schizophrenia and urbanicity in these two regions to determine which factors may be influencing the relationship. Methods: We used population-based cohorts of children born alive between 1980 and 2001 in Western Australia ( N = 428,784) and Denmark ( N = 1,357,874). Children were categorised according to the level of urbanicity of their mother’s residence at time of birth and followed-up through to 30 June 2015. Linkage to State-based registers provided information on schizophrenia diagnosis and a range of covariates. Rates of being diagnosed with schizophrenia for each category of urbanicity were estimated using Cox proportional hazards models adjusted for covariates. Results: During follow-up, 1618 (0.4%) children in Western Australia and 11,875 (0.9%) children in Denmark were diagnosed with schizophrenia. In Western Australia, those born in the most remote areas did not experience lower rates of schizophrenia than those born in the most urban areas (hazard ratio = 1.02 [95% confidence interval: 0.81, 1.29]), unlike their Danish counterparts (hazard ratio = 0.62 [95% confidence interval: 0.58, 0.66]). However, when the Western Australian cohort was restricted to children of non-Aboriginal Indigenous status, results were consistent with Danish findings (hazard ratio = 0.46 [95% confidence interval: 0.29, 0.72]). Discussion: Our study highlights the potential for disadvantaged subgroups to mask the contribution of urban-related risk factors to risk of schizophrenia and the importance of stratified analysis in such cases.

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 Model ◽

Differentiation Factor ◽

Hazards Model ◽

Increased Risk ◽

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.