Endotoxemia is Associated with Better Clinical Outcome in Incident Chinese Peritoneal Dialysis Patients: A Prospective Cohort Study

2010 ◽  
Vol 30 (2) ◽  
pp. 178-186 ◽  
Author(s):  
Cheuk-Chun Szeto ◽  
Bonnie Ching-Ha Kwan ◽  
Kai-Ming Chow ◽  
Ka-Bik Lai ◽  
Wing-Fai Pang ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Rank Test ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Dialysis Patients ◽  
Technique Survival ◽  
Cox Proportional Hazard ◽  
Log Rank Test ◽  
All Cause Mortality

BackgroundEndotoxemia is common in peritoneal dialysis (PD) patients; circulating lipopolysaccharide (LPS) level is related to the degree of systemic inflammation and atherosclerosis. We examine whether baseline plasma LPS level represents a prognostic marker in new PD patients.MethodsWe studied 158 new Chinese PD patients (80 males). Baseline plasma LPS level at initiation of PD was measured. Patients were stratified into quartiles according to plasma LPS level: quartile I, <0.45 EU/mL; II, 0.45 – <0.70 EU/mL; III, 0.70 – <0.95 EU/mL; and IV, ≥0.95 EU/mL. The patients were then prospectively followed for the development of cardiovascular events. All-cause mortality and duration of hospitalization were also recorded.ResultsAverage age was 55.6 ± 14.7 years; average endotoxin concentration was 0.70 ± 0.30 EU/mL; average follow-up was 55.5 ± 36.9 months. At 60 months, event-free survival was 41.0%, 52.5%, 65.0%, and 61.5% for LPS level quartiles I, II, III, and IV, respectively (log rank test p = 0.066). By multivariate analysis with the Cox proportional hazard model to adjust for confounders, plasma LPS level had no independent effect. At 60 months, technique survival was 20.5%, 20.0%, 32.5%, and 51.3% for LPS level quartiles I, II, III, and IV, respectively (log rank test p = 0.0009). By Cox proportional hazard model, each higher quartile of LPS conferred 28.6% protection (95% confidence interval 15.6% – 40.3%, p = 0.0002) from developing technique failure. A higher plasma LPS level had a lower all-cause mortality (unadjusted hazard ratio 0.486, p = 0.046) and cardiovascular mortality (unadjusted hazard ratio 0.251, p = 0.025), but the result became insignificant after adjusting for potential confounders.ConclusionA higher baseline plasma LPS level is an independent predictor of better technique survival in new Chinese PD patients, with an insignificant trend of fewer cardiovascular events. The observation seems to conform to the phenomenon of reverse epidemiology for other traditional cardiovascular risk factors in dialysis patients but the exact reason for this paradoxical phenomenon requires further investigation.

scholarly journals A prospective cohort study on effects of gemigliptin on cardiovascular outcomes in patients with type 2 diabetes (OPTIMUS study)

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Eun Heui Kim ◽  
Sang Soo Kim ◽  
Dong Jun Kim ◽  
Young Sik Choi ◽  
Chang Won Lee ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Events ◽  
Primary Outcome ◽  
Cardiovascular Death ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
All Cause Mortality

Abstract This study was performed to evaluate the long-term cardiovascular safety of gemigliptin in patients with type 2 diabetes mellitus (T2DM). After screening, eligible patients with T2DM were enrolled, received gemigliptin, and were followed up for a median of 2.50 years. The primary outcome was a composite of confirmed cardiovascular death, nonfatal myocardial infarction, or nonfatal ischemic stroke (3-point major adverse cardiovascular event [MACE]). The key secondary outcomes were incidence of all-cause mortality and any other cardiovascular events. A total of 5179 patients were included in the study and 5113 were treated with gemigliptin. Overall, the primary outcome occurred in 26 patients within 12 months (estimated incidence by Cox proportional hazard model 0.49%, 95% CI 0.29–0.69%) and in 54 patients within 54 months (estimated incidence from Cox proportional hazard model 1.35%, 95% CI 0.92–1.77%). During the study period, the incidence rates of each component of the primary composite outcome were 0.04% (0.2 events per 1000 person-years) for cardiovascular death, 0.51% (2.2 events per 1000 person-years) for nonfatal myocardial infarction, and 0.61% (2.5 events per 1000 person-years) for nonfatal ischemic stroke. The incidence of all-cause mortality was 0.82% (3.2 events per 1000 person-years) and the incidences of other cardiovascular events were all less than 0.3%. In conclusion, T2DM patients who received gemigliptin exhibited a low incidence of the primary composite MACE and all-cause mortality. Therefore, the use of gemigliptin is expected to be safe without an increase in cardiovascular risk. Trial registration: The study was registered at ClinicalTrials.gov (identifier: NCT02290301).

Association of inflammation and clinical outcomes (CO) in metastatic renal cell carcinoma (mRCC) patients (pts) treated with cabozantinib (cabo).

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 612-612
Author(s):  
Dylan J Martini ◽  
Julie M. Shabto ◽  
Yuan Liu ◽  
Bradley Curtis Carthon ◽  
Alexandra Speak ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Progression Free Survival ◽  
Rank Test ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Clinical Progression ◽  
Free Survival ◽  
Cox Proportional Hazard ◽  
Log Rank Test

612 Background: Ratios of neutrophils, monocytes, and platelets to lymphocytes (NLR, MLR, and PLR) are associated with poor CO in cancer pts. We investigated the association of NLR, MLR, and PLR and CO in mRCC pts treated with cabo. Methods: We performed a retrospective study of 65 mRCC pts treated with cabo at Winship Cancer Institute from 2016-2018. Overall survival (OS) and progression free survival (PFS) were calculated from first dose to date of death and radiographic or clinical progression, respectively. NLR, MLR, and PLR were obtained at baseline (BL) and 6 (±2) weeks (6W) after cabo initiation. Optimal cut (OC) was determined searching all cuts and testing them by bias adjusted log rank test to associate with PFS. Multivariate analysis (MVA) was performed using Cox proportional hazard model. Results: The medians were: 2.8 (NLR), 0.4 (MLR), and 176.7 (PLR). Increased NLR, MLR, and PLR were significantly associated with worse CO (Table). Conclusions: High NLR, MLR, and PLR may be poor prognostic factors in mRCC pts treated with cabo. Larger studies are needed to validate the results of this study. [Table: see text]

scholarly journals SMOKING STATUS AFFECTING SURVIVAL OF ADENOCARCINOMA LUNG CANCER PATIENTS IN KUALA LUMPUR, MALAYSIA

2017 ◽  
Vol 10 (9) ◽  
pp. 312
Author(s):  
Nida Sajid Ali Bangash ◽  
Natasha Hashim ◽  
Nahlah Elkudssiah Ismail
Keyword(s):  
Lung Cancer ◽  
Prognostic Significance ◽  
Hazard Model ◽  
Rank Test ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Kuala Lumpur ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
Survival Difference

  Objective: Adenocarcinoma (AC) of the lung is now the most common histologic type of non-small cell lung cancer (NSCLC) worldwide since the past 20 years. This study was conducted to investigate survival difference among smoker and non-smoker lung AC patients.Methods: A retrospective observational study was conducted for 81 advanced NSCLC adult Malaysian patients in Radiotherapy and Oncology Clinic at Hospital Kuala Lumpur, Malaysia. A total of adult 30 Malaysian smokers and 51 non-smokers with lung AC were included. Ex-smokers were not included in the study. Demographic and clinical data were collected and described. For survival analysis, Kaplan–Meier test and log-rank test were used to calculate overall survival (OS) and analyse the difference in the survival curve. Cox proportional hazard model was used to identify prognostic significance of smoking status.Results: Non-smokers showed a significant association with female gender and Stage IV NSCLC. The median OS was higher for non-smokers (493 days) as compared to smokers (230 days). The Cox proportional hazard model showed higher hazard ratio for smokers.Conclusion: Non-smoking is an independent positive prognostic factor in lung AC.

scholarly journals Neonatal, Infant and Under-Five Mortality: an Application of Cox Proportional Hazard Model to Bdhs Data

2018 ◽  
Vol 44 (1) ◽  
pp. 7-14
Author(s):  
Shahnaz Nilima ◽  
Rebeka Sultana ◽  
Shahjadi Ireen
Keyword(s):  
Maternal Education ◽  
Hazard Model ◽  
Rank Test ◽  
Bivariate Analysis ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Under Five ◽  
Cox Proportional Hazard ◽  
Size At Birth

This study utilizes data derived from the Bangladesh demographic and health survey (BDHS), 2014 to identify the determinants of neonatal, infant and under-five mortality in Bangladesh. Log-rank test has been used for bivariate analysis. Regression analysis has been performed by applying Cox proportional hazard model to the data. It has been found from the analysis that maternal education, region, exposure to NGO activities are significant determinants of under-five and infant mortality whereas region, gender of child, child’s size at birth play significant role in reducing neonatal mortality in Bangladesh. The findings of the study suggest that policymakers should give priority on maternal education, region, and child’s size at birth as well as exposure to NGO activities to reduce neonatal, infant and under-five mortality in Bangladesh. Asiat. Soc. Bangladesh, Sci. 44(1): 7-14, June 2018

PREDICTIVE ABILITY OF SEVEN DOMAINS OF THE KIHON CHECKLIST FOR INCIDENT DEPENDENCY AND MORTALITY

2019 ◽  
pp. 1-3
Author(s):  
S. Satake ◽  
H. Shimokata ◽  
K. Senda ◽  
I. Kondo6 ◽  
H. Arai ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Predictive Ability ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
Structured Questionnaire

The Kihon Checklist (KCL) is a structured questionnaire consisting of 7 domains to assess seniors’ function in daily living. The aim of this study was to examine which domains of the KCL can predict incident dependency and mortality. The municipality sent a KCL questionnaire to independent seniors in Higashi-ura Town and collected the answers of the 5542 seniors who provided complete answers. Their incident dependency and mortality were followed-up for 2.5 years. A Cox proportional hazard model indicated that meeting any of the criteria in instrumental activities of daily living, physical, nutrition, and mood domains significantly predicted the risk of dependency, whereas meeting any of the criteria in physical, nutrition and socialization domains significantly predicted the risk of mortality. Category assessment by the KCL could be useful to predict incident dependency and all-cause mortality.

Peritoneal Dialysis Clearance can Replace Residual Renal Function

2001 ◽  
Vol 21 (3) ◽  
pp. 263-268 ◽  
Author(s):  
Nabeel Aslam ◽  
Judith Bernardini ◽  
Linda Fried ◽  
Beth Piraino
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Residual Renal Function ◽  
First Year ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Dialysis Patients ◽  
Technique Survival ◽  
Cox Proportional Hazard ◽  
One Year

Objective There is controversy whether increasing peritoneal clearance effectively substitutes for declining residual renal function. We studied the impact of renal and peritoneal clearances on outcome, controlling for comorbidity. Design Registry database. Settings Four dialysis centers. Patients Incident peritoneal dialysis patients. Methods Data were collected prospectively on 90 incident patients between 1991 and 1999. At the end of their first year on peritoneal dialysis, patients were divided into groups based on the first year's clearance results: group 1 ( n = 62) had weekly Kt/V greater than or equal to 2.0 and creatinine clearance (CCr/1.73 m2) greater than or equal to 60 L throughout the first year; group 2 ( n = 28) fell below these targets due to loss of residual renal function and then reached targets due to prescription change. Main Outcome Measures Patient and technique survival. Results Both groups were similar in baseline characteristics except age (57 years vs 49 years, p = 0.02) and initial albumin (34.4 g/L vs 37.5 g/L, p = 0.001). One-year patient survival after grouping was similar in both groups (86.3% vs 80.9%, p = 0.72). Cox proportional hazard model, controlling for comorbidity, did not show “group” to be a significant predictor of outcome ( p = 0.96). One-year technique survival after grouping was similar in both groups (77.3% vs 83.2%, log rank p = 0.89). For technique failure, Cox proportional hazard model showed peritonitis ( p = 0.004) to be the only significant predictor of worse outcome. Conclusions Peritoneal dialysis patients with improved clearances due to prescription changes had survival comparable to patients who never fell below target. This suggests that loss of residual renal function may be replaced by increasing peritoneal dialysis clearance. A large multicenter trial to study this important question further is needed.

Immediate Postoperative Coagulopathy Predicts the Long-term Survival of Traumatic Brain Injury Patients: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Wenxing Cui ◽  
Tian Li ◽  
Yingwu Shi ◽  
Chen Yang ◽  
Shunnan Ge ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rank Test ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Term Survival ◽  
Long Term Survival ◽  
Cox Proportional Hazard ◽  
Log Rank Test

Abstract Objective: To assess the association between immediate postoperative coagulopathy and the long-term survival of traumatic brain injury (TBI) patients undergoing surgery, as well as to explore predisposing risk factors of immediate postoperative coagulopathy.Methods: This retrospective study included 352 TBI patients from January 1, 2015, to April 25, 2019. The log-rank test and a Cox proportional hazard model were conducted to assess the relationship between immediate postoperative coagulopathy and the long-term survival of TBI patients. Furthermore, a multivariate logistic regression model was performed to identify the underlying risk factors for postoperative coagulopathy.Results: Of the 352 patients analyzed, the median age was 50 (41,60) years, and 82 (23%) patients were female. By May 26, 2019, 117 (33.24%) patients had died, 195 (55.40%) had survived, and 40 (11.36%) had been lost to follow-up. The median follow-up time was 773 days. In the log-rank test, immediate postoperative coagulopathy was significantly associated with the survival of TBI patients (P = 0.002). A Cox proportional hazard model identified immediate postoperative coagulopathy (HR, 1.471; 95% CI, 1.011-2.141; P = 0.044) as an independent risk factor for survival following TBI. According to multivariate logistic regression analysis, abnormal ALT and RBC at admission, intraoperative infusion of crystalloid solution > 2900 mL, infusion of colloidal solution > 1100 mL and intraoperative bleeding > 950 mL were identified as independent risk factors for immediate postoperative coagulopathy.Conclusions: Those who suffered from immediate postoperative coagulopathy due to TBI were at higher risk of poor prognosis than those who did not.

scholarly journals A Study of Factors Affecting the Length of Hospital Stay of COVID-19 Patients by Cox-Proportional Hazard Model in a South Indian Tertiary Care Hospital

2021 ◽  
Vol 12 ◽  
pp. 215013272110002
Author(s):  
Gayathri Thiruvengadam ◽  
Marappa Lakshmi ◽  
Ravanan Ramanujam
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Hazard Model ◽  
Cox Proportional Hazard Model ◽  
Care Hospital ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
South Indian

Background: The objective of the study was to identify the factors that alter the length of hospital stay of COVID-19 patients so we have an estimate of the duration of hospitalization of patients. To achieve this, we used a time to event analysis to arrive at factors that could alter the length of hospital stay, aiding in planning additional beds for any future rise in cases. Methods: Information about COVID-19 patients was collected between June and August 2020. The response variable was the time from admission to discharge of patients. Cox proportional hazard model was used to identify the factors that were associated with the length of hospital stay. Results: A total of 730 COVID-19 patients were included, of which 675 (92.5%) recovered and 55 (7.5%) were considered to be right-censored, that is, the patient died or was discharged against medical advice. The median length of hospital stay of COVID-19 patients who were hospitalized was found to be 7 days by the Kaplan Meier curve. The covariates that prolonged the length of hospital stay were found to be abnormalities in oxygen saturation (HR = 0.446, P < .001), neutrophil-lymphocyte ratio (HR = 0.742, P = .003), levels of D-dimer (HR = 0.60, P = .002), lactate dehydrogenase (HR = 0.717, P = .002), and ferritin (HR = 0.763, P = .037). Also, patients who had more than 2 chronic diseases had a significantly longer length of stay (HR = 0.586, P = .008) compared to those with no comorbidities. Conclusion: Factors that are associated with prolonged length of hospital stay of patients need to be considered in planning bed strength on a contingency basis.

scholarly journals POS1329 A COHORT STUDY ON THE RISK OF DEVELOPING OBSTRUCTIVE SLEEP APNEA, TEMPOROMANDIBULAR JOINT DISORDERS AND CRANIOFACIAL DEFORMITIES IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 947.1-947
Author(s):  
K. S. K. MA ◽  
L. T. Wang
Keyword(s):  
Obstructive Sleep Apnea ◽  
Cohort Study ◽  
Juvenile Idiopathic Arthritis ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
Obstructive Sleep ◽  
Subgroup Analyses ◽  
Underlying Mechanisms

Background:Juvenile Idiopathic Arthritis (JIA), an autoimmune disease, has been proposed to be comorbid with obstructive sleep apnea (OSA).Objectives:We aimed at identifying the relationship between JIA and OSA.Methods:We performed a cohort study including JIA and OSA patients from 1999 to 2013. A total of 2791 patients diagnosed with OSA after JIA onset were recruited, which 11,164 eligible individuals without JIA history were selected as matched-controls. A Cox proportional hazard model was developed to estimate the risk of OSA in JIA patients. A cumulative probability model was adopted to assess the time-dependent effect of JIA on OSA development, implying the casual link of the association. To identify whether JIA patients have higher risks for developing temporomandibular joint (TMJ) disorders, craniofacial anomalies and deformities than non-JIA individuals, subgroup analyses was conducted. Finally, Ingenuity Systems Pathway Analysis (IPA) was conducted to identify underlying mechanisms of the above disease correlation among peripheral blood mononuclear cells (PBMCs) from rheumatic factor (RF)-positive and RF-negative JIA patients, and subcutaneous fat tissues from OSA patients, using p-value visualization for RNA-seq analyses.Results:The Cox proportional hazard model showed that JIA patients were more likely to have OSA than non-JIA individuals (adjusted hazard ratio =1.949, 95% CI =1.264–3.005). The incidence of developing OSA was particularly high among patients who developed JIA aged 18-30 years old (aHR= 2.034, 95% CI=1.305-3.169) and males (aHR=1.82, 95% CI=1.121-2.954). The risk of developing OSA increased within 0-36 months (aHR = 2.216, 95% CI = 1.001 – 4.907) and over 60 months (aHR = 2.558, 95% CI = 1.346 – 4.860) of follow-up duration after JIA onset. Subgroup analyses showed that JIA patients were more likely to have TMJ disorders (relative risk = 2.047, 95% CI = 1.446-2.898) and to receive treatment for craniofacial deformities (RR = 1.722, 95% CI = 1.38-2.148) than non-JIA controls. IPA analyses suggested that the underlying mechanisms involved activation of antigen presentation pathway followed by antigen presentation to CD4+ and CD8+ T lymphocytes, as well as B cell development.Conclusion:Our findings identified high risks of developing OSA, TMJ disorders, and craniofacial deformities following JIA onset, which the underlying mechanisms may involve both cellular and humoral immunity.Disclosure of Interests:None declared

scholarly journals Proton pump inhibitor is a risk factor for recurrence of common bile duct stones after endoscopic sphincterotomy – propensity score matching analysis

2017 ◽  
Vol 05 (04) ◽  
pp. E291-E296
Author(s):  
Nobuhiko Fukuba ◽  
Shunji Ishihara ◽  
Hiroki Sonoyama ◽  
Noritsugu Yamashita ◽  
Masahito Aimi ◽  
...  
Keyword(s):  
Bile Duct ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Common Bile Duct Stones ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Bile Duct Stones ◽  
Proportional Hazard Model ◽  
Propensity Score Matching Analysis ◽  
Cox Proportional Hazard

Abstract Background and study aims Recurrence of common bile duct stones (CBDS) in patients treated with endoscopic sphincterotomy (ES) can lead to deterioration in their quality of life. Although the pathology and related factors are unclear, we speculated that proton pump inhibiter (PPI) administration increases the risk of CBDS recurrence by altering the bacterial mixture in the bile duct. Patients and methods The primary endpoint of this retrospective study was recurrence-free period. Several independent variables considered to have a relationship with CBDS recurrence including PPI use were analyzed using a COX proportional hazard model, with potential risk factors then evaluated by propensity score matching analysis. Results A total of 219 patients were analyzed, with CBDS recurrence found in 44. Analysis of variables using a COX proportional hazard model demonstrated that use of PPIs and ursodeoxycholic acid (UDCA), as well as the presence of periampullary diverticula (PD) each had a hazard ratio (HR) value greater than 1 (HR 2.2, P = 0.007; HR 2.0, P = 0.02; HR 1.9, P = 0.07; respectively). Furthermore, propensity score matching analysis revealed that the mean recurrence-free period in the oral PPI cohort was significantly shorter as compared with the non-PPI cohort (1613 vs. 2587 days, P = 0.014). In contrast, neither UDCA administration nor PD presence was found to be a significant factor in that analysis (1557 vs. 1654 days, P = 0.508; 1169 vs. 2011 days, P = 0.121; respectively). Conclusion Our results showed that oral PPI administration is a risk factor for CBDS recurrence in patients who undergo ES.

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