scholarly journals Extra-Hepatic Comorbidity Burden Significantly Increases 90-day Mortality in Patients with Cirrhosis and High Model for Endstage Liver Disease

2020 ◽  
Author(s):  
Scott Coppel ◽  
Karan Mathur ◽  
Burcin Ekser ◽  
Kavish R Patidar ◽  
Eric Orman ◽  
...  
Keyword(s):  
Liver Disease ◽  
Risk Analysis ◽  
Competing Risk ◽  
Ageing Population ◽  
Competing Risk Analysis ◽  
Comorbidity Burden ◽  
Short Term Mortality ◽  
Cox Proportional Hazard Regression ◽  
Overall Mortality

Abstract BackgroundWe examined how extra-hepatic comorbidity burden impacts mortality in patients with cirrhosis referred for liver transplantation (LT).MethodsAdults with cirrhosis evaluated for their first LT in 2012 were followed through their clinical course with last follow up in 2019. Extra-hepatic comorbidity burden was measured using the Charlson Comorbidity Index (CCI). The endpoints were 90-day transplant free survival (Cox-Proportional Hazard regression), and overall mortality (competing risk analysis).ResultsThe study included 340 patients, mean age 56±11, 63% male and MELD-Na 17.2±6.6. The CCI was 0 (no comorbidities) in 44%, 1-2 in 44% and >2 (highest decile) in 12%, with no differences based on gender but higher CCI in patients with fatty and cryptogenic liver disease. Thirty-three (10%) of 332 patients not receiving LT within 90 days died. Beyond MELD-Na, the CCI was independently associated with 90-day mortality (hazard ratio (HR), 1.32 (95% confidence interval (CI) 1.02–1.72). Ninety-day mortality was specifically increased with higher CCI category and MELD ≥ 18 (12% (CCI=0), 22% (CCI=1-2) and 33% (CCI>2), (p=0.002)) but not MELD-Na ≤17. At last follow-up, 69 patients were alive, 100 underwent LT and 171 died without LT. CCI was associated with increased overall mortality in the competing risk analysis (Sub-HR 1.24, 95%CI 1.1-1.4 ).ConclusionsExtra-hepatic comorbidity burden significantly impacts short-term mortality in patients with cirrhosis and high MELD-Na. This has implications in determining urgency of LT and mortality models in cirrhosis and LT waitlisting, especially with an ageing population with increasing prevalence of fatty liver disease.

scholarly journals Extra-Hepatic Comorbidity Burden Significantly Increases 90-day Mortality in Patients with Cirrhosis and High Model for Endstage Liver Disease

2020 ◽  
Author(s):  
Scott Coppel ◽  
Karan Mathur ◽  
Burcin Ekser ◽  
Kavish R Patidar ◽  
Eric Orman ◽  
...  
Keyword(s):  
Liver Disease ◽  
Risk Analysis ◽  
Competing Risk ◽  
Ageing Population ◽  
Competing Risk Analysis ◽  
Comorbidity Burden ◽  
Short Term Mortality ◽  
Cox Proportional Hazard Regression ◽  
Overall Mortality

Abstract Background & aims We examined how extra-hepatic comorbidity burden impacts mortality in patients with cirrhosis referred for liver transplantation (LT). Methods Adults with cirrhosis evaluated for their first LT in 2012 were followed through their clinical course with last follow up in 2019. Extra-hepatic comorbidity burden was measured using the Charlson Comorbidity Index (CCI). The endpoints were 90-day transplant free survival ( Cox-Proportional Hazard regression), and overall mortality (competing risk analysis). Results The study included 340 patients, mean age 56 ± 11, 63% male and MELD-Na 17.2 ± 6.6. The CCI was 0 (no comorbidities) in 44%, 1–2 in 44% and > 2 (highest decile) in 12%, with no differences based on gender but higher CCI in patients with fatty and cryptogenic liver disease. Thirty-three (10%) of 332 patients not receiving LT within 90 days died. Beyond MELD-Na, the CCI was independently associated with 90-day mortality (hazard ratio (HR), 1.32 (95% confidence interval (CI) 1.02–1.72). Ninety-day mortality was specifically increased with higher CCI category and MELD ≥ 18 (12% (CCI = 0), 22% (CCI = 1–2) and 33% (CCI > 2), (p = 0.002)) but not MELD-Na ≤ 17. At last follow-up, 69 patients were alive, 100 underwent LT and 171 died without LT. CCI was associated with increased overall mortality in the competing risk analysis (Sub-HR 1.24, 95%CI 1.1–1.4 ). Conclusions Extra-hepatic comorbidity burden significantly impacts short-term mortality in patients with cirrhosis and high MELD-Na. This has implications in determining urgency of LT and mortality models in cirrhosis and LT waitlisting, especially with an ageing population with increasing prevalence of fatty liver disease.

scholarly journals Extra-hepatic comorbidity burden significantly increases 90-day mortality in patients with cirrhosis and high model for endstage liver disease

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Scott Coppel ◽  
Karan Mathur ◽  
Burcin Ekser ◽  
Kavish R. Patidar ◽  
Eric Orman ◽  
...  
Keyword(s):  
Liver Disease ◽  
Risk Analysis ◽  
Competing Risk ◽  
Ageing Population ◽  
Competing Risk Analysis ◽  
Comorbidity Burden ◽  
Short Term Mortality ◽  
Cox Proportional Hazard Regression ◽  
Overall Mortality

Abstract Background We examined how extra-hepatic comorbidity burden impacts mortality in patients with cirrhosis referred for liver transplantation (LT). Methods Adults with cirrhosis evaluated for their first LT in 2012 were followed through their clinical course with last follow up in 2019. Extra-hepatic comorbidity burden was measured using the Charlson Comorbidity Index (CCI). The endpoints were 90-day transplant free survival (Cox-Proportional Hazard regression), and overall mortality (competing risk analysis). Results The study included 340 patients, mean age 56 ± 11, 63% male and MELD-Na 17.2 ± 6.6. The CCI was 0 (no comorbidities) in 44%, 1–2 in 44% and > 2 (highest decile) in 12%, with no differences based on gender but higher CCI in patients with fatty and cryptogenic liver disease. Thirty-three (10%) of 332 patients not receiving LT within 90 days died. Beyond MELD-Na, the CCI was independently associated with 90-day mortality (hazard ratio (HR), 1.32 (95% confidence interval (CI) 1.02–1.72). Ninety-day mortality was specifically increased with higher CCI category and MELD ≥18 (12% (CCI = 0), 22% (CCI = 1–2) and 33% (CCI > 2), (p = 0.002)) but not MELD-Na ≤17. At last follow-up, 69 patients were alive, 100 underwent LT and 171 died without LT. CCI was associated with increased overall mortality in the competing risk analysis (Sub-HR 1.24, 95%CI 1.1–1.4). Conclusions Extra-hepatic comorbidity burden significantly impacts short-term mortality in patients with cirrhosis and high MELD-Na. This has implications in determining urgency of LT and mortality models in cirrhosis and LT waitlisting, especially with an ageing population with increasing prevalence of fatty liver disease.

scholarly journals Mortality on the UNOS Waitlist for Patients with Autoimmune Liver Disease

2020 ◽  
Vol 9 (2) ◽  
pp. 319
Author(s):  
Jaspreet S. Suri ◽  
Christopher J. Danford ◽  
Vilas Patwardhan ◽  
Alan Bonder
Keyword(s):  
Liver Disease ◽  
Risk Analysis ◽  
Liver Transplant ◽  
Autoimmune Hepatitis ◽  
Competing Risk ◽  
Clinical Deterioration ◽  
Primary Biliary Cholangitis ◽  
Competing Risk Analysis ◽  
Subdistribution Hazard ◽  
Similar Risk

Background: Outcomes on the liver transplant waitlist can vary by etiology. Our aim is to investigate differences in waitlist mortality of autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) using the United Network for Organ Sharing (UNOS) database. Methods: We identified patients who were listed for liver transplantation from 1987 to 2016 with a primary diagnosis of AIH, PBC, or PSC. We excluded patients with overlap syndromes, acute hepatic necrosis, missing data, and those who were children. The primary outcome was death or removal from the waitlist due to clinical deterioration. We compared waitlist survival using competing risk analysis. Results: Between 1987 and 2016, there were 7412 patients listed for liver transplant due to AIH, 8119 for PBC, and 10,901 for PSC. Patients with AIH were younger, more likely to be diabetic, and had higher listing model for end-stage liver disease (MELD) scores compared to PBC and PSC patients. Patients with PBC and AIH were more likely to be removed from the waitlist due to death or clinical deterioration. On competing risk analysis, AIH patients had a similar risk of being removed from the waitlist compared to those with PBC (subdistribution hazard ratio (SHR) 0.94, 95% CI 0.85–1.03) and higher risk of removal compared to those with PSC (SHR 0.8, 95% CI 0.72 to 0.89). Conclusion: Autoimmune hepatitis carries a similar risk of waitlist removal to PBC and a higher risk than PSC. The etiology of this disparity is not entirely clear and deserves further investigation.

scholarly journals Risk Factors of Mortality from All Asbestos-Related Diseases: A Competing Risk Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Rafael Abós-Herràndiz ◽  
Teresa Rodriguez-Blanco ◽  
Isabel Garcia-Allas ◽  
Isabel-Magdalena Rosell-Murphy ◽  
Constança Albertí-Casas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Analysis ◽  
Incidence Rate ◽  
Hazard Analysis ◽  
Competing Risk ◽  
Competing Risk Analysis ◽  
Subdistribution Hazard ◽  
Related Disease ◽  
Asbestos Related Disease

Background. The mortality from all malignant and nonmalignant asbestos-related diseases remains unknown. The authors assessed the incidence and risk factors for all asbestos-related deaths. Methods. The sample included 544 patients from an asbestos-exposed community in the area of Barcelona (Spain), between Jan 1, 1970, and Dec 31, 2006. Competing risk regression through a subdistribution hazard analysis was used to estimate risk factors for the outcomes. Results. Asbestos-related deaths were observed in 167 (30.7%) patients and 57.5% of these deaths were caused by some type of mesothelioma. The incidence rate after diagnosis was 3,600 per 100,000 person-years. In 7.5% of patients death was non-asbestos-related, while pleural and peritoneal mesothelioma were identified in 87 (16.0%) and 18 (3.3%) patients, respectively. Conclusions. Age, sex, household exposure, cumulative nonmalignant asbestos-related disease, and single malignant pathology were identified as risk factors for asbestos-related death. These findings suggest the need to develop a preventive approach to the community and to improve the clinical follow-up process of these patients.

scholarly journals Association Between Digoxin Use and Cancer Incidence: A Propensity Score-Matched Cohort Study With Competing Risk Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Chi-Jung Tai ◽  
Yi-Hsin Yang ◽  
Tzyy-Guey Tseng ◽  
Fang-Rong Chang ◽  
Hui-Chun Wang
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Risk Analysis ◽  
Cancer Prevention ◽  
Cancer Incidence ◽  
Competing Risk ◽  
Research Database ◽  
Competing Risk Analysis ◽  
Β Blocker

Background: Previous studies neglected death as a critical competing risk while estimating the cancer risk for digoxin users. Therefore, the current study aims to assess the effectiveness of digoxin on cancer prevention by competing risk analysis.Methods: We performed a population-based retrospective cohort study using the Taiwan National Health Insurance Research database between 1998 and 2010. After one-to-one propensity score-matching from 36,160 patients with defined criteria, we enrolled 758 patients both in digoxin and β-blocker group for further analysis.Results: The results showed that the digoxin group had higher all-cause mortality than the β-blocker group in the 4- year (10.4 vs. 4.9%) and 8 years (13.6 vs. 7.0%) follow-up. The subdistribution HR of cancer incidence in the digoxin group compared to the β-blocker group was 1.99 (95% confidence interval [CI]: 1.22–3.01) and 1.46 (95% CI: 1.01–2.15) in the 4 years and 8 years follow-up, respectively.Conclusions: The result of our study showed the usage of digoxin has no benefit in cancer prevention compared with β-blocker. The possibility of β-blocker as a new drug candidate for cancer prevention needs further clinical evaluation. The current study also emphasized the necessity of competing risk analysis applying to similar clinical researches.

Updated survival analysis of JBR.10: A randomized phase III trial of vinorelbine/cisplatin versus observation in completely resected stage IB and II non-small cell lung cancer (NSCLC)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 7501-7501 ◽  
Author(s):  
M. D. Vincent ◽  
C. Butts ◽  
L. Seymour ◽  
K. Ding ◽  
B. Graham ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Survival Analysis ◽  
Risk Analysis ◽  
Competing Risk ◽  
Phase Iii ◽  
Competing Risk Analysis ◽  
Risk Of Death ◽  
Stage Ib ◽  
Resected Stage

7501 Background: JBR.10 was one of a number of phase III trials that established adjuvant cisplatin based chemotherapy as a recommended treatment in completely resected NSCLC . Long-term follow-up of these trials is important to document persistent benefit and potential late toxicities of adjuvant therapy. We report the updated survival data for JBR.10 with more than 9 years median follow up. Methods: Patients with completely resected stage IB (T2N0) or II (T1–2N1) NSCLC were randomized to receive 4 cycles of vinorelbine/cisplatin or observation.. Kaplan-Meier curves were generated for overall (OS) and disease specific survival (DSS). Log-rank test was used to compare survival distribution and to test cause specific hazard. For the competing risk analysis, the Gray test was used to test the difference in cause specific incidences. All efficacy analyses were done on an ITT basis. Results: 482 patients were randomized. Data cut-off for this update was July 2008. Median follow-up is 9.3 years (3.2–13.8 y). 12 patients were lost to follow up, a median 4.9 years from randomization (1.5–12 years). 271 deaths have occurred, 73% due to lung cancer or its treatment. Survival analysis continues to show a benefit for chemotherapy: HR .78 (CI .61-.99, p=.04). The benefit appears to be confined to N1 patients: median OS 6.8 y versus 3.6 y, HR .68 (CI .5-.92, p=.01). N0 patients did not appear to benefit: HR 1.03 (CI .7–1.52, p=.87). Chemotherapy significantly prolonged DSS, HR.73 (CI .55-.97, p=.03) Competing risk analysis showed observation to be associated with significantly higher risk of death from lung cancer (p=.02) with no difference in incidences of death from other causes between arms (p=.62). Conclusions: Prolonged follow-up of patients in the JBR.10 trial continues to show a benefit in survival for adjuvant chemotherapy. This benefit appears to be confined to N1 patients. There was no increase in death from other causes in the chemotherapy arm. [Table: see text]

scholarly journals Primary hemiarthroplasty after unstable trochanteric fracture in elderly patients: mortality, readmission and reoperation

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Tzu-Chieh Lin ◽  
Pin-Wen Wang ◽  
Chun-Teng Lin ◽  
Yu-Jun Chang ◽  
Ying-Ju Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Analysis ◽  
Cumulative Incidence ◽  
Trochanteric Fracture ◽  
Older Age ◽  
Competing Risk ◽  
Competing Risk Analysis ◽  
Long Term Outcomes

Abstract Background Most unstable trochanteric fractures are treated with internal fixation and often with high complication rates. Hemiarthroplasty might be an alternative method in difficult condition, especially in unstable comminuted fracture in fragile bone. However, few have investigated the long-term outcomes after hemiarthroplasty for unstable trochanteric fracture. We conducted a population-based retrospective cohort study of trochanteric fracture after primary hemiarthroplasty using competing risk analysis on their long-term outcomes, including mortality, readmission and reoperation. Methods We studied a total of 2798 patients over 60 years old, with a mean age of 79 years, of which 68% are females and 67.23% have at least one comorbidity. They underwent a hemiarthroplasty for unstable trochanteric fracture during the period between January 1, 2000 and December 31, 2010 and were follow-up until the end of 2012, or death. Survival analysis and Cox model were used to characterize mortality. Competing risk analysis and Fine and Gray model were used to estimate the cumulative incidences of the first readmission and the first reoperation. Results The follow-up mortality rate for 1-year was 17.94%; 2-year, 29.76%; 5-year, 56.8%; and 10-year, 83.38%. The cumulative incidence of the first readmission was 16.4% for 1-year and 22.44% for 3-year. The cumulative incidence of the first reoperation was 13.87% for 1-year, 18.11% for 2-year, 25.79% for 5-year, and 38.24% for 10-year. Male gender, older age, higher Charlson Comorbidity Index (CCI) and lower insured amount were all risk factors for the overall mortality. Older age and higher CCI were risk factors for the first readmission. Older age was a protective factor for reoperation, which is likely due to the competing death. Conclusions The mortality and revision rates after hemiarthroplasty for unstable trochanteric fracture are acceptable as a salvage procedure for this fragile sub-population.

scholarly journals Antihypertensive Drug Use and the Risk of Ovarian Cancer Death among Finnish Ovarian Cancer Patients—A Nationwide Cohort Study

Cancers ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 2087
Author(s):  
Eerik E. E. Santala ◽  
Miia Artama ◽  
Eero Pukkala ◽  
Kala Visvanathan ◽  
Synnöve Staff ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Drug Use ◽  
Risk Analysis ◽  
Ace Inhibitors ◽  
Population Based ◽  
Competing Risk ◽  
Competing Risk Analysis ◽  
Time Period ◽  
Morbidity Risk

Ovarian cancer (OC) has a poor prognosis. Hypertension may be a prognostic factor for OC, but it is unclear whether antihypertensive (anti-HT) drug use of modifies OC prognosis. We performed a population-based analysis assessing the effect of anti-HT drug use on OC mortality. A cohort of 12,122 women identified from the Finnish Cancer Registry with OC in 1995–2013 was combined with information on their anti-HT drug use during the same time period. Use of each anti-HT drug was analysed as a time-dependent variable. Analyses were run for five, ten and full follow-up (19-year) mortality with cardiovascular morbidity risk evaluated in competing risk analysis. No anti-HT drug group was associated with OC survival within five years after OC diagnosis. At ten years, a dose-dependent association was observed between pre-diagnostic ACE-inhibitor use and improved OC survival. With full follow-up, post-diagnostic high-intensity use associated with reduced OC death risk for multiple anti-HT drug groups. In competing risk analysis, only the post-diagnostic use of ACE-inhibitors associated with increased OC survival. Anti-HT drugs were not associated with survival benefits within five years after OC diagnosis. ACE-inhibitors may confer survival benefits in women with OC, but further confirmatory studies are needed.

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