Increased INR Values Predict Accelerating Deterioration and High Short-Term Mortality Among Patients Hospitalized With Cirrhosis or Advanced Fibrosis

Background and Objective: An increase in the international normalized ratio (INR) is associated with increased mortality in patients with cirrhosis and other chronic liver diseases, while little is known about the quantitative relationship. This study aimed to investigate the quantitative relationship between the INR and short-term prognosis among patients hospitalized with cirrhosis or advanced fibrosis and to evaluate the role of the INR as a risk factor for short-term liver transplant (LT)-free mortality in these patients.Patients and Methods: This study prospectively analyzed multicenter cohorts established by the Chinese Acute-on-Chronic Liver Failure (CATCH-LIFE) study. Cox regression was used to describe the relationship between the INR and independent risk factors for short-term LT-free mortality. Forest plots were used in the subgroup analysis. Generalized additive models (GAMs) and splines were used to illustrate the quantitative curve relationship between the INR and the outcome and inflection point on the curve.Results: A total of 2,567 patients with cirrhosis and 924 patients with advanced fibrosis were included in the study. The 90-day LT-free mortality of patients with cirrhosis and advanced fibrosis was 16.7% (428/2,567) and 7.5% (69/924), respectively. In the multivariable Cox regression analysis, the increase in the INR was independently associated with the risk of 90-day LT-free mortality both in patients with cirrhosis (HR, 1.06; 95% CI, 1.04–1.07, p < 0.001) and in patients with advanced fibrosis (HR, 1.09; 95% CI, 1.06–1.12, p < 0.001). An INR of 1.6/1.7 was found to be the starting point of coagulation dysfunction with a rapid increase in mortality in patients with cirrhosis or in patients with advanced fibrosis, respectively. A 28-day LT-free mortality of 15% was associated with an INR value of 2.1 in both cirrhosis and advanced fibrosis patients.Conclusions: This study was the first to quantitatively describe the relationship between the INR and short-term LT-free mortality in patients with cirrhosis or advanced fibrosis. The starting points of INR indicating the rapid increase in mortality and the unified cutoff value of coagulation failure in cirrhosis and advanced fibrosis, will help clinicians accurately recognize early disease deterioration.

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Relationship Between Creatinine and Body Weight Ratio and Diabetes Mellitus in a Chinese Cohort Study

10.21203/rs.3.rs-360026/v1 ◽

2021 ◽

Author(s):

Xinyu Wang ◽

Zhuangsen Chen ◽

Fan Yang ◽

Xiaohan Ding ◽

Changchun Cao ◽

...

Keyword(s):

Body Weight ◽

Missing Values ◽

Proportional Hazards ◽

Cox Regression ◽

Weight Ratio ◽

Cox Proportional Hazards ◽

Additive Models ◽

Cox Regression Analysis ◽

Non Linear ◽

The Relationship

Abstract Background: Research on the relationship between Creatinine to Body Weight Ratios (Cre/BW ratios) and the prevalence of diabetes is still lacking. The aim of this study was to investigate the potential association between Cre/BW ratios and incident of diabetes in Chinese adults.Methods: This retrospective study was conducted in 199,526 patients from Rich Healthcare Group in China from 2010 to 2016. The participants were divided into quartiles of the Cre/BW ratios. Multivariate multiple imputation and dummy variables were used to handle missing values. Cox proportional-hazards regression was used to investigate the association of Cre/BW and diabetes. Generalized additive models(GAM) were used to identify non-linear relationships.Results: Of all participants,after handling missing values and adjustment for potential confounders, the multivariate Cox regression analysis results showed that Cre/BW ratios was inversely associated with diabetes risk( HR: 0.268; 95% CI:0.229 to 0.314, P < 0.00001).For men, the hazard ratios(HRs) of incident diabetes was 0.255(95%CI: 0.212-0.307);and for women HR= 0.297 (95%CI: 0.218-0.406).Moreover, sensitivity analysis confirmed the stability of the results. Furthermore, GAM revealed a saturation effect on the independent association between Cre/BW and incident of diabetes.Conclusions: This study demonstrated that increased Cre/BW is negatively correlated with incident of diabetes in Chinese for the first time. And we found that the relationship between Cre/BW and incident of diabetes was non-linear.

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D-dimer daily continuous tendency predicts the short-term prognosis for COVID-19 independently: A retrospective study from Northeast China

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-201071 ◽

2021 ◽

pp. 1-9

Author(s):

Yinting Xing ◽

Wei Yang ◽

Yingyu Jin ◽

Chao Wang ◽

Xiuru Guan

Keyword(s):

Cox Regression ◽

Short Term ◽

Cox Regression Analysis ◽

Prognosis Group ◽

The Difference ◽

Group B ◽

The Relationship ◽

Worse Prognosis ◽

D Dimer

BACKGROUND AND OBJECTIVE: To study whether D-dimer daily continuous tendency could predict the short-term prognosis of COVID-19. PATIENTS AND METHODES: According to the short-term prognosis, 81 COVID-19 patients were divided into two groups, one of worse prognosis (Group W) and the other of better prognosis (Group B). The slope of D-dimer linear regression during hospitalization (SLOPE) was calculated as an indicator of D-dimer daily continuous tendency. The SLOPE difference between Group W and Group B was compared. The difference between the discharge results and the 3-month follow-up results was also compared. COX regression analysis was used to analyze the relationship between SLOPE and short-term prognosis of COVID-19. RESULTS: There were 16 patients in Group W and 65 patients in Group B. Group W had more critical proportion (p < 0.0001), indicating that the symptoms of its patients were more severe during hospitalization. ARDS, the most visible cause of worse prognosis, accounted for up to 68.75%, and many symptoms merged and resulted in worse prognosis. The D-dimer levels of Group W not only were significantly higher (p < 0.0001), but also showed an increasing trend. In addition, the D-dimer levels at discharge were significantly higher than those at follow-up (p = 0.0261), and the mean difference was as high as 0.7474. SLOPE significantly correlated with the short-term prognosis of COVID-19 independently (RR: 1.687, 95% CI: 1.345–2.116, P < 0.0001). The worst prognosis occurred most likely during the first month after COVID-19 diagnosis. CONCLUSION: Our study found that D-dimer daily continuous tendency independently correlates with worse prognosis and can be used as an independent predictor of the short-term prognosis for COVID-19.

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Possible unrecognised liver injury is associated with mortality in critically ill COVID-19 patients

Therapeutic Advances in Gastroenterology ◽

10.1177/17562848211023410 ◽

2021 ◽

Vol 14 ◽

pp. 175628482110234

Author(s):

Mario Romero-Cristóbal ◽

Ana Clemente-Sánchez ◽

Patricia Piñeiro ◽

Jamil Cedeño ◽

Laura Rayón ◽

...

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Liver Injury ◽

Chronic Liver Disease ◽

Critically Ill ◽

Cox Regression ◽

Chronic Liver ◽

Cox Regression Analysis ◽

Risk Of Death ◽

The Impact

Background: Coronavirus disease (COVID-19) with acute respiratory distress syndrome is a life-threatening condition. A previous diagnosis of chronic liver disease is associated with poorer outcomes. Nevertheless, the impact of silent liver injury has not been investigated. We aimed to explore the association of pre-admission liver fibrosis indices with the prognosis of critically ill COVID-19 patients. Methods: The work presented was an observational study in 214 patients with COVID-19 consecutively admitted to the intensive care unit (ICU). Pre-admission liver fibrosis indices were calculated. In-hospital mortality and predictive factors were explored with Kaplan–Meier and Cox regression analysis. Results: The mean age was 59.58 (13.79) years; 16 patients (7.48%) had previously recognised chronic liver disease. Up to 78.84% of patients according to Forns, and 45.76% according to FIB-4, had more than minimal fibrosis. Fibrosis indices were higher in non-survivors [Forns: 6.04 (1.42) versus 4.99 (1.58), p < 0.001; FIB-4: 1.77 (1.17) versus 1.41 (0.91), p = 0.020)], but no differences were found in liver biochemistry parameters. Patients with any degree of fibrosis either by Forns or FIB-4 had a higher mortality, which increased according to the severity of fibrosis ( p < 0.05 for both indexes). Both Forns [HR 1.41 (1.11–1.81); p = 0.006] and FIB-4 [HR 1.31 (0.99–1.72); p = 0.051] were independently related to survival after adjusting for the Charlson comorbidity index, APACHE II, and ferritin. Conclusion: Unrecognised liver fibrosis, assessed by serological tests prior to admission, is independently associated with a higher risk of death in patients with severe COVID-19 admitted to the ICU.

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Short term survival of critically ill COVID-19 Egyptian patients on assisted ventilation treated by either Dexamethasone or Tocilizumab

Scientific Reports ◽

10.1038/s41598-021-88086-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Alaa Rashad ◽

Sherif Mousa ◽

Hanaa Nafady-Hego ◽

Asmaa Nafady ◽

Hamed Elgendy

Keyword(s):

Critically Ill ◽

Cox Regression ◽

Ferritin Level ◽

Short Term ◽

Term Survival ◽

Cox Regression Analysis ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Dexamethasone Group ◽

Short Term Survival

AbstractTocilizumab (TCZ) and Dexamethasone are used for the treatment of critically ill COVID-19 patients. We compared the short-term survival of critically ill COVID-19 patients treated with either TCZ or Dexamethasone. 109 critically ill COVID-19 patients randomly assigned to either TCZ therapy (46 patients) or pulse Dexamethasone therapy (63 patients). Age, sex, neutrophil/ lymphocyte ratio, D-dimer, ferritin level, and CT chest pattern were comparable between groups. Kaplan–Meier survival analysis showed better survival in Dexamethasone group compared with TCZ (P = 0.002), patients didn’t need vasopressor at admission (P < 0.0001), patients on non-invasive ventilation compared to patients on mechanical ventilation (P<0.0001 ), and in patients with ground glass pattern in CT chest (P<0.0001 ) compared with those who have consolidation. Cox regression analysis showed that, TCZ therapy (HR = 2.162, 95% CI, 1.144–4.087, P <0.0001) compared with Dexamethasone group, higher neutrophil/Lymphocyte ratio (HR = 2.40, CI, 1.351–4.185, P = 0.003), lower PaO2/FiO2, 2 days after treatment, (HR = 1.147, 95% CI, 1.002–1.624, P < 0.0001) independently predicted higher probability of mortality. Dexamethasone showed better survival in severe COVID-19 compared to TCZ. Considering the risk factors mentioned here is crucial when dealing with severe COVID-19 cases.Clinical trial registration No clinicalTrials.gov: Nal protocol approved by Hospital Authorities, for data collection and for participation in CT04519385 (19/08/2020).

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Short-term outcomes associated with temozolomide or PCV chemotherapy for 1p/19q-codeleted WHO grade 3 oligodendrogliomas: a national evaluation

Neuro-Oncology Practice ◽

10.1093/nop/npac004 ◽

2022 ◽

Author(s):

Nayan Lamba ◽

Malia McAvoy ◽

Vasileios K Kavouridis ◽

Timothy R Smith ◽

Mehdi Touat ◽

...

Keyword(s):

Cox Regression ◽

Extent Of Resection ◽

First Line ◽

Short Term ◽

Who Grade ◽

Cox Regression Analysis ◽

Significant Difference ◽

Pcv Chemotherapy ◽

Grade 3 ◽

National Analysis

Abstract Background The optimal chemotherapy regimen between temozolomide and procarbazine, lomustine, and vincristine (PCV) remains uncertain for W.H.O. grade 3 oligodendroglioma (Olig3) patients. We therefore investigated this question using national data. Methods Patients diagnosed with radiotherapy-treated 1p/19q-codeleted Olig3 between 2010-2018 were identified from the National Cancer Database. The OS associated with first-line single-agent temozolomide vs. multi-agent PCV was estimated by Kaplan-Meier techniques and evaluated by multivariable Cox regression. Results 1,596 radiotherapy-treated 1p/19q-codeleted Olig3 patients were identified: 88.6% (n=1,414) treated with temozolomide and 11.4% (n=182) with PCV (from 5.4% in 2010 to 12.0% in 2018) in the first-line setting. The median follow-up was 35.5 months (interquartile range [IQR] 20.7-60.6 months) with 63.3% of patients alive at time of analysis. There was a significant difference in unadjusted OS between temozolomide (5yr-OS 58.9%, 95%CI: 55.6-62.0) and PCV (5yr-OS 65.1%, 95%CI: 54.8-73.5; p=0.04). However, a significant OS difference between temozolomide and PCV was not observed in the Cox regression analysis adjusted by age and extent of resection (PCV vs. temozolomide HR 0.81, 95%CI: 0.59-1.11, p=0.18). PCV was more frequently used for younger Olig3s, but otherwise was not associated with patient’s insurance status or care setting. Conclusions In a national analysis of Olig3s, first-line PCV chemotherapy was associated with a slightly improved unadjusted short-term OS compared to temozolomide; but not following adjustment by patient age and extent of resection. There has been an increase in PCV utilization since 2010. These findings provide preliminary data while we await the definitive results from the CODEL trial.

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Short-term outcomes associated with temozolomide vs. PCV chemotherapy for 1p/19q-codeleted WHO grade III anaplastic oligodendrogliomas: a national evaluation

10.1101/2020.03.29.20046805 ◽

2020 ◽

Author(s):

Nayan Lamba ◽

Malia McAvoy ◽

Vasileios K. Kavouridis ◽

Timothy R. Smith ◽

Mehdi Touat ◽

...

Keyword(s):

Cox Regression ◽

Long Term Results ◽

National Database ◽

Newly Diagnosed ◽

First Line ◽

Short Term ◽

Who Grade ◽

Cox Regression Analysis ◽

Pcv Chemotherapy ◽

Grade Iii

AbstractPURPOSEThe optimal chemotherapy regimen between temozolomide (TMZ) and procarbazine, lomustine, and vincristine (PCV) remains uncertain for newly-diagnosed anaplastic oligodendroglioma (AO). We therefore addressed this question using a national database.METHODSPatients newly-diagnosed with 1p/19q-codeleted W.H.O. grade III AO between 2010-2016 were identified from the National Cancer Database. Predictors of receiving first-line single-agent TMZ vs. multi-agent PCV were assessed by multivariable logistic regression. Overall survival (OS) was estimated by Kaplan-Meier techniques and evaluated by multivariable Cox regression.RESULTS1,360 AO patients were identified: 74.5% (n=1,013) treated with TMZ, 9.6% (n=131) with PCV, and 15.9% (n=216) with no chemotherapy in the first-line setting. In multivariable logistic analysis, PCV utilization increased from 2010 to 2016 (OR=1.38/year, 95%CI: 1.22-1.56, p<0.001) and was less commonly utilized in privately insured patients (OR=0.38 vs. uninsured, 95%CI: 0.15-0.97, p=0.04). In survival analyses (33.1% reached endpoint), there was no difference in unadjusted OS between TMZ (5yr-OS 60.1%, 95%CI: 55.9-64.1) and PCV (5yr-OS 61.1%, 95%CI: 45.6-73.5; p=0.42). There remained no OS difference between TMZ and PCV in the 75.9% (n=1,032) of AO patients that also received radiotherapy (p=0.51), in the Cox regression analysis adjusted by age, extent of resection, and radiotherapy (TMZ vs. PCV HR=1.31, 95%CI: 0.83-2.08, p=0.24), and in subgroup analyses that incorporate KPS or MGMT status.CONCLUSIONSIn a national database of AOs managed in the ‘real-world’ setting, there is no difference in the short-term mortality between first-line TMZ and PCV chemotherapy. These findings provide preliminary data while we await the long-term results from the CODEL trial.

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Identification and Validation of a Glycolysis Related Metabolic Reprogramming Gene Signature for Predicting Survival in Colon Cancer Patients

10.21203/rs.3.rs-916034/v1 ◽

2021 ◽

Author(s):

Gang Liu ◽

Xiaowang WU ◽

Jian Chen

Keyword(s):

Colon Cancer ◽

Prediction Model ◽

Cox Regression ◽

Malignant Tumors ◽

Gene Signature ◽

Metabolic Reprogramming ◽

Risk Scores ◽

Cox Regression Analysis ◽

Prognosis Model ◽

The Relationship

Abstract Background Colon cancer (CC) is one of the most common gastrointestinal malignant tumors with high mortality rate. Because of malignancy and easily metastasis feather, and limited treatments, the prognosis of CC remains poor. Glycolysis is a metabolic process of glucose in anoxic environments which is an important way to provide energy for tumor. The role of glycolysis in CC largely remains unknown and is necessary to be explored. Method In our study, we analyzed glycolysis related genes expression in CC, patients gene expression and corresponding clinical data were downloaded from GEO dataset, glycolysis related genes sets were collected from Msigdb. Through COX regression analysis, prognosis model based on glycolysis-related genes was established. The efficacy of gene model was tested by Survival analysis, ROC analysis and PCA analysis. Furthermore, the relationship between risk scores and clinical characteristic was researched. Results Our findings identified 13 glycolysis related genes (NUP107, SEC13, ALDH7A1, ALG1, CHPF, FAM162A, FBP2, GALK1, IDH1, TGFA, VLDLR, XYLT2 and OGDHL) consisted prognostic prediction model with relative high accuracy. The relationship between prediction model and clinical feathers were specifically studied, results showed age > 65years, TNM III-IV, T3-4, N1-3, M1 and high-risk score were independent prognostic risk factors with poorer prognosis. Finally, model genes were significantly expressed and EMT were activated in CC patients. Conclusion This study provided a new aspect to advance our understanding in the potential mechanism of glycolysis in CC.

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Abstract 2128: Predictive Value of Short-term Deceleration Capacity

Circulation ◽

10.1161/circ.118.suppl_18.s_671-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Georg Schmidt ◽

Axel Bauer ◽

Petra Barthel ◽

Alexander Müller

Keyword(s):

High Resolution ◽

Cox Regression ◽

Strong Predictor ◽

Short Term ◽

Cox Regression Analysis ◽

Deceleration Capacity ◽

Clinical Covariates ◽

History Of ◽

Acute Mi ◽

Holter Recordings

Background: Deceleration Capacity (DC) derived from 24-hour Holter recordings is a strong predictor of mortality in patients after acute myocardial infarction (MI). This prospective cohort study investigates the predictive power of DC derived from short-term recordings. Methods: 938 survivors of acute MI (age ≤80 years, sinus rhythm) were included. Within one week after index infarction, 30-min high resolution ECGs (1600Hz, supine position and resting conditions) as well as 24h-Holter recordings were performed. Short-term DC (DCs) and long-term DC (DCl) were calculated according to the previously published technology. Primary endpoint was death from any cause at two years. Multivariate Cox-regression analyses were adjusted for LVEF ≤30% and clinical covariates. Results: During the 2-year follow-up, 36 patients (3.8%) died. Both, DCs and DCl were strong predictors of death with areas under the receiver-operator characteristics curves of 76.3% and 77.8%, respectively (p<0.0001). DCs was significantly correlated with DCl (r=0.7, p<0.0001). After adjustment for LVEF, presence of diabetes mellitus, advanced age and history of a previous MI, DCs (≤2.5ms) remained a highly significant predictor of death (Table ). Conclusion: DC derived from high-resolution short-term ECGs is a strong and significant predictor of death in post-infarction patients. Multivariate Cox regression analysis for Prediction of 2y-Mortality

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Abstract P254: Daytime Napping is Associated With Incident Stroke in Community

Circulation ◽

10.1161/circ.141.suppl_1.p254 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Xuting Jin ◽

Bin Yan ◽

Ruohan Li ◽

Ya Gao ◽

Jingjing Zhang ◽

...

Keyword(s):

Regression Analysis ◽

Cox Regression ◽

Life Quality ◽

Health Study ◽

Sleep Habits ◽

Community Based ◽

Cox Regression Analysis ◽

Increased Risk ◽

Registration Number ◽

The Relationship

Introduction: There are conflicting reports regarding whether daytime napping is a risk factor for cardiovascular events. The purpose of this study was to investigate the relationship between daytime napping and incident stroke within a community-based cohort study. Hypothesis: We assessed the hypothesis that the duration and the frequency of daytime napping may be associated with incident stroke. Methods: Participants without previous stroke were enrolled in the present prospective study from the Sleep Heart Health Study (registration number, NCT00005275). Daytime napping were assessed with a self-reported Sleep Habits Questionnaire. Duration of daytime napping was divided into the following categories: no naps, 0-30 min, 31-60 min, or >60 min. Frequency of naps were categorised as: no naps, 1-2 times/week, 3-4 times/week, 5-6 times/week, or daily. After combining nap duration and frequency, participants were further divided into groups with regular long naps (≥5 times per week and >30 min), regular short naps (≥5 times per week and ≤30 min), irregular naps or no naps. Subsequently, participants were followed up until the first stroke occurred between the date of the completed questionnaire and the final censoring date. Cox regression analysis was used to estimate the relationship between daytime napping and incident stroke. Results: The present study enrolled 4757 participants, of which 220 participants (4.6%) experienced incident stroke during an average follow-up of 10.6 years. There was a higher rate of stroke among participants taking longer and more frequent naps than others. Multivariate Cox regression analysis indicated that, when compared with participants with no naps, those with a nap duration of ≥60 min or of 31-60 min had a higher risk of stroke (HR, 2.182; 95% CI, 1.443-3.301; HR, 1.594; 95% CI, 1.003-2.531, respectively). Moreover, there was an increased risk of stroke among participants taking daily daytime naps (HR, 1.563; 95% CI, 1.059-2.307) or napping 5-6 times per week (HR, 1.548; 95% CI, 1.026-2.335) than those with no naps. And after combining nap duration and frequency, regular long naps and regular short naps were also associated with higher risk of incident stroke (HR, 1.903; 95% CI, 1.182-3.065; HR, 1.451; 95% CI, 1.010-2.084, respectively). Conclusions: In conclusion, daytime napping of long duration and high frequency may increase the risk of incident stroke in community. Modification of sleep habits may improve the life quality among those elderly community-based population.

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Prognostic Significance of Fragmented QRS in Patients with Hypertrophic Cardiomyopathy

Cardiology ◽

10.1159/000471845 ◽

2017 ◽

Vol 138 (1) ◽

pp. 26-33 ◽

Cited By ~ 3

Author(s):

Xili Lu ◽

Wei Wang ◽

Ling Zhu ◽

Yilu Wang ◽

Kai Sun ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Clinical Outcomes ◽

Cox Regression ◽

Prognostic Significance ◽

Cox Regression Analysis ◽

Fragmented Qrs ◽

All Cause Mortality ◽

The Relationship ◽

Cvd Mortality

Objectives: The relationship between a fragmented QRS (fQRS) and clinical outcomes in patients with hypertrophic cardiomyopathy (HCM) remains unclear. This study aimed to investigate the prognostic significance of fQRS in patients with HCM. Methods: Between 2000 and 2012, 326 unrelated patients with HCM (72% male with a mean age of 52 years) were included and were divided into 2 groups: those with fQRS and those without fQRS. Results: A total of 105/326(32.2%) patients with HCM presented with fQRS at enrollment. During a follow-up of 5.3 ± 2.4 years, 33 patients died, 30 of cardiovascular disease (CVD). Cox regression analysis revealed that fQRS predicted a higher risk of all-cause mortality (adjusted hazard ratio [HR] 2.24; 95% confidence interval [CI] 1.08-4.64; p = 0.030) and CVD mortality (adjusted HR 2.68; 95% CI 1.22-5.91; p = 0.014). Our study also showed that fQRS increased the risk of heart failure-related death (adjusted HR 3.75; 95% CI 1.24-11.30; p = 0.019). Conclusions: Our results indicate that fQRS is associated with adverse clinical outcomes in patients with HCM.

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