The Prognostic Value of the SOFA Score in Patients with COVID-19: A Retrospective, Observational Study

Abstract Background: Patients with Coronavirus disease 2019 (COVID-19) have a high mortality rate, and thus, it is particularly important to predict the severity and prognosis of COVID-19. The Sequential Organ Failure Assessment (SOFA) score has been used to predict the clinical outcomes of patients with multiple organ failure requiring intensive care. Therefore, we retrospectively analyzed the clinical characteristics, risk factors, and relationship between the SOFA score and the prognosis of COVID-19 patients.Methods: Clinical variables were compared between patients with mild and severe COVID-19. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for severe COVID-19. The Cox proportional hazards model was used to analyze risk factors for hospital-related death. Survival analysis was performed by the Kaplan-Meier method, and survival differences were assessed by the log-rank test. Receiver operating characteristic (ROC) curves of the SOFA score in different situations were drawn, and the area under the ROC curve was calculated.Results: The median SOFA score of all patients was 2 (IQR, 1-3). Patients with severe COVID-19 exhibited a significantly higher SOFA score than patients with mild COVID-19 [3 (IQR, 2-4) vs 1 (IQR, 0-1); P<0.001]. The SOFA score increased the risk of severe COVID-19, with an odds ratio of 5.851 (95% CI: 3.044-11.245; P<0.001). The area under the ROC curve (AUC) was used to evaluate the diagnostic accuracy of the SOFA score in predicting severe COVID-19 [cutoff value = 2; AUC = 0.908 (95% CI: 0.857-0.960); sensitivity: 85.20%; specificity: 80.40%] and the risk of death in COVID-19 patients [cutoff value = 5; AUC = 0.995 (95% CI: 0.985-1.000); sensitivity: 100.00%; specificity: 95.40%]. Regarding the 60-day mortality rates of patients in the two groups classified by the optimal cutoff value of the SOFA score (5), patients in the high SOFA score group (SOFA score ≥5) had a significantly greater risk of death than those in the low SOFA score group (SOFA score <5).Conclusion: The SOFA score could be used to evaluate the severity and 60-day mortality of COVID-19. The SOFA score may be an independent risk factor for in-hospital death.

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The prognostic value of the SOFA score in patients with COVID-19: a retrospective, observational study

10.21203/rs.3.rs-76663/v1 ◽

2020 ◽

Author(s):

Zheng Yang ◽

Qinming Hu ◽

Fei Huang ◽

Shouxin Xiong ◽

yi sun

Keyword(s):

Risk Factors ◽

Organ Failure ◽

Roc Curve ◽

Sofa Score ◽

Proportional Hazards Model ◽

Cox Proportional Hazards Model ◽

Rank Test ◽

Hospital Death ◽

Cutoff Value ◽

Risk Of Death

Abstract Background Patients with Coronavirus disease 2019 (COVID-19) have a high mortality rate, and thus, it is particularly important to predict the severity and prognosis of COVID-19. The Sequential Organ Failure Assessment (SOFA) score has been used to predict the clinical outcomes of patients with multiple organ failure requiring intensive care. Therefore, we retrospectively analyzed the clinical characteristics, risk factors, and relationship between the SOFA score and the prognosis of COVID-19 patients. Methods Clinical variables were compared between patients with mild and severe COVID-19. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for severe COVID-19. The Cox proportional hazards model was used to analyze risk factors for hospital-related death. Survival analysis was performed by the Kaplan-Meier method, and survival differences were assessed by the log-rank test. Receiver operating characteristic (ROC) curves of the SOFA score in different situations were drawn, and the area under the ROC curve was calculated. Results The median SOFA score of all patients was 2 (IQR, 1–3). Patients with severe COVID-19 exhibited a significantly higher SOFA score than patients with mild COVID-19 [3 (IQR, 2–4) vs 1 (IQR, 0–1); P < 0.001]. The SOFA score increased the risk of severe COVID-19, with an odds ratio of 5.851 (95% CI: 3.044–11.245; P < 0.001). The area under the ROC curve (AUC) was used to evaluate the diagnostic accuracy of the SOFA score in predicting severe COVID-19 [cutoff value = 2; AUC = 0.908 (95% CI: 0.857–0.960); sensitivity: 85.20%; specificity: 80.40%] and the risk of death in COVID-19 patients [cutoff value = 5; AUC = 0.995 (95% CI: 0.985-1.000); sensitivity: 100.00%; specificity: 95.40%]. Regarding the 60-day mortality rates of patients in the two groups classified by the optimal cutoff value of the SOFA score (5), patients in the high SOFA score group (SOFA score ≥ 5) had a significantly greater risk of death than those in the low SOFA score group (SOFA score < 5). Conclusion The SOFA score could be used to evaluate the severity and 60-day mortality of COVID-19. The SOFA score may be an independent risk factor for in-hospital death.

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Risk factors for mortality in critically ill patients with COVID-19: a multicenter retrospective case-control study

BMC Infectious Diseases ◽

10.1186/s12879-021-06300-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jinghua Gao ◽

Li Zhong ◽

Ming Wu ◽

Jingjing Ji ◽

Zheying Liu ◽

...

Keyword(s):

Risk Factors ◽

Organ Failure ◽

Critically Ill ◽

Sofa Score ◽

Lymphocyte Count ◽

Cox Regression ◽

Survival Curve ◽

Apache Ii ◽

Apache Ii Score ◽

Hospital Death

Abstract Background Coronavirus disease 2019 (COVID-19) has spread around the world, until now, the number of positive and death cases is still increasing. Therefore, it remains important to identify risk factors for death in critically patients. Methods We collected demographic and clinical data on all severe inpatients with COVID-19. We used univariable and multivariable Cox regression methods to determine the independent risk factors related to likelihood of 28-day and 60-day survival, performing survival curve analysis. Results Of 325 patients enrolled in the study, Multi-factor Cox analysis showed increasing odds of in-hospital death associated with basic illness (hazard ratio [HR] 6.455, 95% Confidence Interval [CI] 1.658–25.139, P = 0.007), lymphopenia (HR 0.373, 95% CI 0.148–0.944, P = 0.037), higher Sequential Organ Failure Assessment (SOFA) score on admission (HR 1.171, 95% CI 1.013–1.354, P = 0.033) and being critically ill (HR 0.191, 95% CI 0.053–0.687, P = 0.011). Increasing 28-day and 60-day mortality, declining survival time and more serious inflammation and organ failure were associated with lymphocyte count < 0.8 × 109/L, SOFA score > 3, Acute Physiology and Chronic Health Evaluation II (APACHE II) score > 7, PaO2/FiO2 < 200 mmHg, IL-6 > 120 pg/ml, and CRP > 52 mg/L. Conclusions Being critically ill and lymphocyte count, SOFA score, APACHE II score, PaO2/FiO2, IL-6, and CRP on admission were associated with poor prognosis in COVID-19 patients.

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Ethnicity and other COVID-19 death risk factors in Mexico

Archives of Medical Science ◽

10.5114/aoms.2020.101443 ◽

2020 ◽

Author(s):

Erwin Chiquete ◽

Jesus Alegre-Díaz ◽

Ana Ochoa-Guzmán ◽

Liz Nicole Toapanta-Yanchapaxi ◽

Carlos González-Carballo ◽

...

Keyword(s):

Risk Factors ◽

Proportional Hazards Model ◽

Invasive Mechanical Ventilation ◽

Significant Risk ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Chronic Obstructive ◽

Death Risk ◽

Factors Associated ◽

Risk Of Death

IntroductionPatients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may develop coronavirus disease 2019 (COVID-19). Risk factors associated with death vary among countries with different ethnic backgrounds. We aimed to describe the factors associated with death in Mexicans with confirmed COVID-19.Material and methodsWe analysed the Mexican Ministry of Health’s official database on people tested for SARS-CoV-2 infection by real-time reverse transcriptase–polymerase chain reaction (rtRT-PCR) of nasopharyngeal fluids. Bivariate analyses were performed to select characteristics potentially associated with death, to integrate a Cox-proportional hazards model.ResultsAs of May 18, 2020, a total of 177,133 persons (90,586 men and 86,551 women) in Mexico received rtRT-PCR testing for SARS-CoV-2. There were 5332 deaths among the 51,633 rtRT-PCR-confirmed cases (10.33%, 95% CI: 10.07–10.59%). The median time (interquartile range, IQR) from symptoms onset to death was nine days (5–13 days), and from hospital admission to death 4 days (2–8 days). The analysis by age groups revealed that the significant risk of death started gradually at the age of 40 years. Independent death risk factors were obesity, hypertension, male sex, indigenous ethnicity, diabetes, chronic kidney disease, immunosuppression, chronic obstructive pulmonary disease, age > 40 years, and the need for invasive mechanical ventilation (IMV). Only 1959 (3.8%) cases received IVM, of whom 1893 were admitted to the intensive care unit (96.6% of those who received IMV).ConclusionsIn Mexico, highly prevalent chronic diseases are risk factors for death among persons with COVID-19. Indigenous ethnicity is a poorly studied factor that needs more investigation.

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Risk Factors for Mortality in Critically Ill Patients with COVID-19: A Multicenter Retrospective Case-Control Study

10.21203/rs.3.rs-80661/v1 ◽

2020 ◽

Author(s):

Jinghua Gao ◽

Li Zhong ◽

Ming Wu ◽

Jingjing Ji ◽

Ziyun Shao ◽

...

Keyword(s):

Risk Factors ◽

Organ Failure ◽

Critically Ill ◽

Sofa Score ◽

Lymphocyte Count ◽

Cox Regression ◽

Survival Curve ◽

Apache Ii ◽

Apache Ii Score ◽

Hospital Death

Abstract Background Coronavirus disease 2019 (COVID-19) has spread around the world and caused many deaths, but little is known about the risk factors for death in critically patients. Methods we collected demographic and clinical data on all severe inpatients with COVID-19 .We used univariable and multivariable Cox regression methods to determine the independent risk factors related to likelihood of 28-day and 60-day survival, performing survival curve analysis. Results Of 325 patients enrolled in the study, Multi-factor Cox analysis showed increasing odds of in-hospital death associated with basic illness (hazard ratio [HR] 6.455, 95% Confidence Interval [CI] 1.658–25.139, P = 0.007), lymphopenia (HR 0.373, 95% CI 0.148–0.944, P = 0.037), higher Sequential Organ Failure Assessment (SOFA) score on admission (HR 1.171, 95% CI 1.013–1.354, P = 0.033) and being critically ill (HR 0.191, 95% CI 0.053–0.687, P = 0.011). Increasing 28-day and 60-day mortality, declining survival time and more serious inflammation and organ failure were associated with lymphocyte count ≤ 0.8 × 109/L, SOFA score > 3, Acute Physiology and Chronic Health Evaluation II (APACHE II) score > 7, PaO2/FiO2 ≤ 200 mmHg, IL-6 > 120 pg/ml, and CRP > 52 mg/L. Conclusions Being critically ill and lymphocyte count, SOFA score, APACHE II score, PaO2/FiO2, IL-6, and CRP on admission were associated with poor prognosis in COVID-19 patients.

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Early Risk Factors for Extrapulmonary Organ Injury in Adult COVID-19 Patients

10.21203/rs.3.rs-70751/v1 ◽

2020 ◽

Author(s):

Fang Huang ◽

Wenxia Ma ◽

Jun Jin ◽

Hui Zheng ◽

Yan Ye ◽

...

Keyword(s):

Risk Factors ◽

Logistic Model ◽

Proportional Hazards Model ◽

Clinical Laboratory ◽

Circulatory System ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Organ Injury ◽

Rank Test ◽

D Dimer

Abstract Objective COVID-19 is becoming a global pandemic and often develops extrapulmonary organ injury. However, the risk factors for extrapulmonary organ injury are still unclear. We aim to explore the risk factors for extrapulmonary organ injury for COVID-19 and the association between extrapulmonary organ injury and the prognosis of COVID-19 patients. Methods This is a single-center, retrospective, observational study and total 349 confirmed COVID-19 patients admitted to Tongji Hospital from January 25 to February 25, 2020 were enrolled. We collected demographic, clinical, laboratory and treatment data from electronic medical records. Potential risk factors for extrapulmonary organ injury of COVID-19 patients were analyzed by a multivariable binary logistic model, and multivariable COX proportional hazard regression model was used for survival analysis in the patients with extrapulmonary organ injury. Results Average age of the included patients was 61.73±14.64 years. In the final logistic model, variables including aged 60 or older (OR 1.826, 95% CI 1.060-3.142), ARDS (OR 2.748, 95% CI 1.051-7.185), lymphocytes count lower than 1.1 ×109/L (OR 0.478, 95% CI 0.240-0.949), level of IL-6 greater than 7 pg/ml (OR 1.664, 95% CI 1.005-2.751) and D-Dimer greater than 0.5 μg/ml (OR 2.190, 95% CI 1.176-4.084) were significantly associated with the extrapulmonary organ injury. Kaplan-Meier curve and log-rank test showed that the probabilities of survival for patients with extrapulmonary organ injury were significantly lower than those without extrapulmonary organ injury.between Multivariate COX proportional hazards model showed that only myocardial injury (P=0.000, HR: 5.068, 95% CI: 2.728-9.417) and circulatory system injury (P=0.000, HR: 4.076, 95% CI: 2.216-7.498) were the independent factors associated with COVID-19 patients’ poor prognosis. Conclusion Older age, lymphocytopenia, high level of D-Dimer and IL-6 and the severity of lung injury were the high-risk factors of extrapulmonary organ injury in COVID-19 patients. Myocardial and circulatory system injury were the most important risk factors related to poor outcomes of COVID-19 patients. It may help clinicians to identify extrapulmonary organ injury early and provide relevant management strategy.

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Final analysis results from TITAN: A phase III study of apalutamide (APA) versus placebo (PBO) in patients (pts) with metastatic castration-sensitive prostate cancer (mCSPC) receiving androgen deprivation therapy (ADT).

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.6_suppl.11 ◽

2021 ◽

Vol 39 (6_suppl) ◽

pp. 11-11

Author(s):

Kim N. Chi ◽

Simon Chowdhury ◽

Anders Bjartell ◽

Byung Ha Chung ◽

Andrea Juliana Pereira de Santana Gomes ◽

...

Keyword(s):

Repeated Measures ◽

Proportional Hazards Model ◽

Final Analysis ◽

Cox Proportional Hazards Model ◽

Phase Iii ◽

Rank Test ◽

Mixed Effect ◽

End Points ◽

Risk Of Death

11 Background: TITAN evaluated APA or PBO added to ADT in pts with mCSPC. Pts with high- and low-volume disease, prior docetaxel, prior treatment for localized disease, and prior ADT (≤ 6 mos) were eligible. At the first interim analysis, with 22.7 mos median follow-up, APA significantly improved dual primary end points of overall survival (OS) (hazard ratio [HR] 0.67) and radiographic progression-free survival (rPFS) (HR 0.48) compared with PBO (Chi et al. NEJM. 2019). At that time, OS analysis was first planned interim while rPFS was final. TITAN was unblinded, allowing pts without progression who were still receiving PBO to cross over to APA. Herein, we report the final analysis of efficacy and safety results from TITAN. Methods: 1052 mCSPC pts were randomized 1:1 to receive APA (240 mg QD) or PBO plus ADT. Time-to-event end points were analyzed by Kaplan-Meier method and Cox proportional hazards model. A preplanned sensitivity analysis for OS, accounting for crossover using inverse probability censoring weighted (IPCW) log-rank test, was conducted. No formal statistical retesting was performed; nominal p values were reported without multiplicity adjustment. Change from baseline in Functional Assessment of Cancer Therapy-Prostate (FACT-P) total score was assessed using a mixed-effect repeated-measures model. Results: With 44 mos median follow-up, 405 OS events had occurred. After unblinding, 208 PBO pts (39.5%) crossed over to APA. Median treatment duration was 39.3 mos for the APA group, 20.2 mos for the entire PBO group, and 15.4 mos for the PBO→APA crossover group. OS was superior in the APA group compared with the PBO group despite crossover (Table). 48-mo survival rates were 65% (APA) vs 52% (PBO). Other end points also favored APA vs PBO (Table). Health-related quality of life (HRQoL), per total FACT-P, was maintained in the APA group through the study and was not different from the PBO group. Safety was consistent with previous reports. Conclusions: With close to 4 yrs of follow-up, the final analysis of TITAN demonstrated that in a broad population of pts with mCSPC, APA plus ADT provides an improvement in OS with a 35% reduction in risk of death, which increased to 48% reduction after adjusting for pts who crossed over from PBO to APA. In addition, there was consistent benefit with APA in other end points, including delaying castration resistance, and HRQoL continued to be maintained with an acceptable safety profile. Clinical trial information: NCT02489318. [Table: see text]

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A real-world comparison of multi-modality therapies in locally advanced gastro-esophageal junction (GEJ) cancers.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.96 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 96-96

Author(s):

Haider Samawi ◽

Derek Tilley ◽

Patricia A. Tang ◽

Jennifer L. Spratlin ◽

Richard M. Lee-Ying ◽

...

Keyword(s):

Surgical Resection ◽

Proportional Hazards Model ◽

Locally Advanced ◽

Treatment Selection ◽

Cox Proportional Hazards Model ◽

Rank Test ◽

Routine Practice ◽

Risk Of Death ◽

Increased Risk ◽

The Impact

96 Background: Trials show that addition of systemic therapy and/or radiation to surgery improves survival in GEJ cancers. However, the different regimens have not been directly compared. We examined population-based outcomes of 3 treatments: 1) neoadjuvant carboplatin and paclitaxel plus radiation (CROSS); 2) perioperative epirubicin, cisplatin, and fluoropyrimidine (MAGIC); and 3) cisplatin and fluoropyrimidine with radiation (CisFP). Methods: We reviewed patients diagnosed with GEJ cancer from 2005 to 2015 who received CROSS, MAGIC, or CisFP at 2 tertiary, 4 regional, and 11 community cancer centers in Alberta, Canada. Survival was assessed with Kaplan-Meier curves and compared with the log-rank test. A Cox proportional hazards model was constructed to evaluate the impact of treatment on overall survival (OS). Results: 331 patients were identified. Median age was 63 (IQR 56-69) years and 86% were men. CROSS was used in 217 (65%) cases followed by CisFP in 72 (22%) and MAGIC in 42 (13%). Age, sex, and stage were not associated with treatment selection (all p > 0.05), but a higher proportion of CROSS and CisFP patients had adenocarcinoma (86% and 85%, respectively) compared to MAGIC patients (41%) ( p < 0.01). CROSS and MAGIC correlated with higher surgical resection rates when compared to CisFP (82% vs. 79% vs. 50%, respectively, p < 0.01). Median OS favored CROSS and MAGIC rather than CisFP, but this was not statistically significant (29 vs. 34 vs. 20 months, respectively, p= 0.17). Adjusting for confounders, OS remained similar for MAGIC (HR 0.8, 95%CI 0.5-1.3, p= 0.36) and CisFP (HR 0.7, 95%CI 0.5-1.1, p= 0.10) when compared to CROSS. In addition, age > 65, advanced stage, and lack of surgical resection were associated with increased risk of death (HR 1.5, 95%CI 1.1-2.0, p= 0.02, HR 2.2, 95%CI 1.2-3.9, p< 0.01 and HR 4.1, 95%CI 2.8-5.9, p< 0.01, respectively). Conclusions: OS was similar across all 3 regimens, but outcomes were inferior to those seen in original trials. This observation suggests that GEJ patients in routine practice are different from study participants or that treatment selection may be driven by factors other than trial eligibility criteria.

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The use of a non-biological, bridging, antiprotrusio cage in complex revision hip arthroplasty and periacetabular reconstructive oncologic surgery. Is still today a valid option?: A mid/long-term survival and complications’ analysis

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03929-6 ◽

2021 ◽

Author(s):

Matteo Innocenti ◽

Francesco Muratori ◽

Giacomo Mazzei ◽

Davide Guido ◽

Filippo Frenos ◽

...

Keyword(s):

Proximal Femur ◽

Proportional Hazards Model ◽

Cox Proportional Hazards Model ◽

Harris Hip Score ◽

Acetabular Reconstruction ◽

Reconstruction Method ◽

Term Survival ◽

Primary Tumors ◽

Risk Of Death ◽

Group B

Abstract Introduction Burch–Schneider-like antiprotrusio cages (B-SlAC) still remain helpful implants to bridge severe periacetabular bone losses. The purpose of this study was to evaluate outcomes and estimate both cages’ failures and complication risks in a series of B-SlAC implanted in revision of failed total hip arthroplasties (THA) or after resection of periacetabular primary or secondary bone malignancies. Risk factors enhancing the chance of dislocations and infections were checked. Materials and methods We evaluated 73 patients who received a B-SlAC from January 2008 to January 2018. Group A, 40 oncological cases (22 primary tumors; 18 metastases); Group B, 33 failed THAs. We compared both Kaplan–Meier estimates of risk of failure and complication with the cumulative incidence function, taking account the competing risk of death. Cox proportional hazards model was utilized to identify possible predictors of instability and infection. Harris hip score HHS was used to record clinical outcomes. Results Medium follow-up was 80 months (24–137). Average final HHS was 61 (28–92), with no differences within the two groups (p > 0.05). The probabilities of failure and complications were 57% and 26%, respectively, lower in the oncologic group than in the rTHA group (p =0 .176; risk 0.43) (p = 0.52; risk 0.74). Extended ileo-femoral approach and proximal femur replacement (p =0.02, risk ratio = 3.2; p = 0.04, rr = 2.1) were two significant independent predictors for dislocations, while belonging to group B (p = 0.04, rr = 2.6) was predictable for infections. Conclusion Burch–Schneider-like antiprotrusio cages are a classical non-biological acetabular reconstruction method that surgeons should bear in mind when facing gross periacetabular bone losses, independently of their cause. However, dislocation and infection rates are high. Whenever possible, we suggest preserving the proximal femur in revision THA, and to use a less-invasive postero-lateral approach to reduce dislocation rates in non-oncologic cases.

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Does Vancomycin Resistance Increase Mortality? Clinical Outcomes and Predictive Factors for Mortality in Patients with Enterococcus faecium Infections

Antibiotics ◽

10.3390/antibiotics10020105 ◽

2021 ◽

Vol 10 (2) ◽

pp. 105

Author(s):

Jatapat Hemapanpairoa ◽

Dhitiwat Changpradub ◽

Sudaluck Thunyaharn ◽

Wichai Santimaleeworagun

Keyword(s):

Risk Factors ◽

Clinical Outcomes ◽

Proportional Hazards Model ◽

Significant Risk ◽

Vancomycin Resistance ◽

Cox Proportional Hazards Model ◽

Factors Associated ◽

Joint Infections ◽

Bone And Joint Infections ◽

The Impact

The prevalence of enterococcal infection, especially E. faecium, is increasing, and the issue of the impact of vancomycin resistance on clinical outcomes is controversial. This study aimed to investigate the clinical outcomes of infection caused by E. faecium and determine the risk factors associated with mortality. This retrospective study was performed at the Phramongkutklao Hospital during the period from 2014 to 2018. One hundred and forty-five patients with E. faecium infections were enrolled. The 30-day and 90-day mortality rates of patients infected with vancomycin resistant (VR)-E. faecium vs. vancomycin susceptible (VS)-E. faecium were 57.7% vs. 38.7% and 69.2% vs. 47.1%, respectively. The median length of hospitalization was significantly longer in patients with VR-E. faecium infection. In logistic regression analysis, VR-E. faecium, Sequential Organ Failure Assessment (SOFA) scores, and bone and joint infections were significant risk factors associated with both 30-day and 90-day mortality. Moreover, Cox proportional hazards model showed that VR-E. faecium infection (HR 1.91; 95%CI 1.09–3.37), SOFA scores of 6–9 points (HR 2.69; 95%CI 1.15–6.29), SOFA scores ≥ 10 points (HR 3.71; 95%CI 1.70–8.13), and bone and joint infections (HR 0.08; 95%CI 0.01–0.62) were significant risk factors for mortality. In conclusion, the present study confirmed the impact of VR-E. faecium infection on mortality and hospitalization duration. Thus, the appropriate antibiotic regimen for VR-E. faecium infection, especially for severely ill patients, is an effective strategy for improving treatment outcomes.

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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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