scholarly journals The association between BMI and 90-day mortality in patients with and without diabetes seeking care at the emergency department

2021 ◽  
Vol 126 (1) ◽  
Author(s):  
Per Wändell ◽  
Axel C. Carlsson ◽  
Anders Larsson ◽  
Olle Melander ◽  
Torgny Wessman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Missing Values ◽  
Cox Regression ◽  
Bonferroni Correction ◽  
Short Term ◽  
Mortality Risks ◽  
Increased Risk ◽  
The Impact ◽  
Long Term Mortality

Background: The impact of body mass index (BMI) on mortality varies with age and disease states. The aim of this research study was to analyse the associations between BMI categories and short- and long-term mortality in patients with or without diabetes seeking care at the emergency department (ED) with acute dyspnoea. Population and methods: Patients aged ≥18 years at ED during daytime on weekdays from March 2013 to July 2018 were included. Participants were triaged according to the Medical Emergency Triage and Treatment System-Adult score (METTS-A), and blood samples were collected. Totally, 1,710 patients were enrolled, with missing values in 113, leaving 1,597 patients, 291 with diabetes and 1,306 without diabetes. The association between BMI and short-term (90-day) and long-term (mean follow-up time 2.1 years) mortality was estimated by Cox regression with normal BMI (18.5–24.9) as referent category, with adjustment for age, sex, METTS-A scoring, glomerular filtration rate, smoking habits and cardiovascular comorbidity in a fully adjusted model. The Bonferroni correction was also used. Results: Regarding long-term mortality, patients with diabetes and BMI category ≥30 kg/m2 had a fully adjusted Hazard Ratio (HR) of 0.40 (95% confidence interval [CI]: 0.23–0.69), significant after the Bonferroni correction. Amongst patients without diabetes, those with underweight had an increased risk but only of borderline significance, whilst risks in those with overweight or obesity did not differ from reference. Regarding short-term mortality, risks did not differ from reference amongst patients with or without diabetes. Conclusions: We found divergent long-term mortality risks in patients with and without diabetes, with lower risk in obese patients (BMI ≥ 30 kg/m2) with diabetes, but no increased risk for patients without diabetes and overweight (BMI: 25–29.9 kg/m2) and obesity.

scholarly journals Role of diuretics on long-term mortality may differ in volume status in patients with acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Kawai ◽  
D Nakatani ◽  
T Yamada ◽  
T Watanabe ◽  
T Morita ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Propensity Score ◽  
Plasma Volume ◽  
Cox Regression ◽  
Volume Status ◽  
Increased Risk ◽  
Long Term Mortality

Abstract Background Diuretics has been reported to have a potential for an activation of the renin-angiotensin-aldosterone system and the sympathetic nervous system, leading to a possibility of poor clinical outcome in patients with cardiovascular disease. However, few data are available on clinical impact of diuretics on long-term outcome in patients with acute myocardial infarction (AMI) based on plasma volume status. Methods To address the issue, a total of 3,416 survived patients with AMI who were registered to a large database of the Osaka Acute Coronary Insufficiency Study (OACIS) were studied. Plasma volume status was assessed with the estimated plasma volume status (ePVS) that was calculated at discharge as follows: actual PV = (1 − hematocrit) × [a + (b × body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c × body weight (c=39 in males and c=40 in females), and ePVS = [(actual PV − ideal PV)/ideal PV] × 100 (%). Multivariable Cox regression analysis and propensity score matching were performed to account for imbalances in covariates. The endpoint was all-cause of death (ACD) within 5 years. Results During a median follow-up period of 855±656 days, 193 patients had ACD. In whole population, there was no significant difference in long-term mortality risk between patients with and without diuretics in both multivariate cox regression model and propensity score matching population. When patients were divided into 2 groups according to ePVS with a median value of 4.2%, 46 and 147 patients had ACD in groups with low ePVS and high ePVS, respectively. Multivariate Cox analysis showed that use of diuretics was independently associated with an increased risk of ACD in low ePVS group, (HR: 2.63, 95% confidence interval [CI]: 1.22–5.63, p=0.01), but not in high ePVS group (HR: 0.70, 95% CI: 0.44–1.10, p=0.12). These observations were consistent in the propensity-score matched cohorts; the 5-year mortality rate was significantly higher in patients with diuretics than those without among low ePVS group (4.7% vs 1.7%, p=0.041), but not among high ePVS group (8.0% vs 10.3%, p=0.247). Conclusion Prescription of diuretics at discharge was associated with increased risk of 5-year mortality in patients with AMI without PV expansion, but not with PV expansion. The role of diuretics on long-term mortality may differ in plasma volume status. Therefore, prescription of diuretics after AMI may be considered based on plasma volume status. Funding Acknowledgement Type of funding source: None

scholarly journals The Impact of a Long-Term Rivastigmine and Donepezil Treatment on All-Cause Mortality in Patients With Alzheimer’s Disease

2018 ◽  
Vol 33 (6) ◽  
pp. 385-393 ◽  
Author(s):  
Jakub Kazmierski ◽  
Chaido Messini-Zachou ◽  
Mara Gkioka ◽  
Magda Tsolaki
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cox Regression ◽  
Symptomatic Treatment ◽  
Risk Of Death ◽  
Increased Risk ◽  
Functional Assessments ◽  
The Impact

Cholinesterase inhibitors (ChEIs) are the mainstays of symptomatic treatment of Alzheimer’s disease (AD); however, their efficacy is limited, and their use was associated with deaths in some groups of patients. The aim of the current study was to assess the impact of the long-term use of ChEIs on mortality in patients with AD. This observational, longitudinal study included 1171 adult patients with a diagnosis of AD treated with donepezil or rivastigmine. Each patient was observed for 24 months or until death. The cognitive and functional assessments, the use of ChEIs, memantine, antipsychotics, antidepressants, and anxiolytics were recorded. The total number of deaths at the end of the observational period was 99 (8.45%). The patients who had received rivastigmine treatment were at an increased risk of death in the follow-up period. The higher risk of death in the rivastigmine group remained significant in multivariate Cox regression models.

Association of adrenal hormone metabolites and mortality over a 6-year follow-up in COPD patients with acute exacerbation

2018 ◽  
Vol 56 (4) ◽  
pp. 669-680 ◽  
Author(s):  
Seline Zurfluh ◽  
Manuela Nickler ◽  
Manuel Ottiger ◽  
Christian Steuer ◽  
Alexander Kutz ◽  
...  
Keyword(s):  
Cox Regression ◽  
Time Dependent ◽  
Chronic Obstructive ◽  
Short Term ◽  
Therapeutic Implications ◽  
Adrenal Hormone ◽  
Copd Patients ◽  
Short And Long Term ◽  
Long Term Mortality

Abstract Background: The release of hormones from the adrenal gland is vital in acute and chronic illnesses such as chronic obstructive pulmonary disease (COPD) involving recurrent exacerbations. Using a metabolomic approach, we aim to investigate associations of different adrenal hormone metabolites with short- and long-term mortality in COPD patients. Methods: We prospectively followed 172 COPD patients (median age 75 years, 62% male) from a previous Swiss multicenter trial. At baseline, we measured levels of a comprehensive spectrum of adrenal hormone metabolites, including glucocorticoid, mineralocorticoid and androgen hormones by liquid chromatography coupled with tandem mass spectrometry (MS). We calculated Cox regression models adjusted for gender, age, comorbidities and previous corticosteroid therapy. Results: Mortality was 6.4% after 30 days and increased to 61.6% after 6 years. Higher initial androgen hormones predicted lower long-term mortality with significant results for dehydroepiandrosterone (DHEA) [adjusted hazard ratio (HR), 0.82; 95% confidence interval (CI), 0.70–0.98; p=0.026] and dehydroepiandrosterone sulfate (DHEA-S) (adjusted HR, 0.68; 95% CI, 0.50–0.91; p=0.009). An activation of stress hormones (particularly cortisol and cortisone) showed a time-dependent effect with higher levels pointing towards higher mortality at short term, but lower mortality at long term. Activation of the mineralocorticoid axis tended to be associated with increased short-term mortality (adjusted HR of aldosterone, 2.76; 95% CI, 0.79–9.65; p=0.111). Conclusions: Independent of age, gender, corticosteroid exposure and exacerbation type, adrenal hormones are associated with mortality at short and long term in patients with COPD exacerbation with different time-dependent effects of glucocorticoids, androgens and mineralocorticoids. A better physiopathological understanding of the causality of these effects may have therapeutic implications.

scholarly journals Association of Early and Late Contrast-Associated Acute Kidney Injury and Long-Term Mortality in Patients Undergoing Coronary Angiography

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Zhubin Lun ◽  
Jin Liu ◽  
Liwei Liu ◽  
Jingjing Liang ◽  
Guanzhong Chen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Coronary Angiography ◽  
Cox Regression ◽  
Late Phase ◽  
Kidney Injury ◽  
Rank Test ◽  
Preoperative Serum ◽  
Increased Risk ◽  
Long Term Mortality

Background. Contrast-associated acute kidney injury (CA-AKI) is a common complication in patients undergoing coronary angiography (CAG). However, few studies demonstrate the association between the prognosis and developed CA-AKI in the different periods after the operation. Methods. We retrospectively enrolled 3206 patients with preoperative serum creatinine (Scr) and at least twice SCr measurement after CAG. CA-AKI was defined as an increase ≥50% or ≥0.3 mg/dL from baseline in the 72 hours after the procedure. Early CA-AKI was defined as having the first increase in SCr within the early phase (<24 hours), and late CA-AKI was defined as an increase in SCr that occurred for the first time in the late phase (24–72 hours). The first endpoint of this study was long-term all-cause mortality. Kaplan–Meier analysis was used to count the cumulative mortality, and the log-rank test was used to assess differences between curves. Univariate and multivariate cox regression analyses were performed to assess whether patients who developed different type CA-AKI were at increased risk of long-term mortality. Results. The number of deaths in the 3 groups was 407 for normal (12.7%), 106 for early CA-AKI (32.7%) and 57 for late CA-AKI (17.7%), during a median follow-up period of 3.95 years. After adjusting for important clinical variables, early CA-AKI (HR = 1.33, 95% CI: 1.02–1.74, P = 0.038 ) was significantly associated with mortality, while late CA-AKI (HR = 0.92, 95% CI: 0.65–1.31, P = 0.633 ) was not. The same results were found in patients with coronary artery disease, chronic kidney disease, diabetes mellitus, and percutaneous coronary intervention. Conclusions. Early increases in Scr, i.e., early CA-AKI, have better predictive value for long-term mortality. Therefore, in clinical practice, physicians should pay more attention to patients with early renal injury related to long-term prognosis and give active treatment.

scholarly journals The impact of cognitive dysfunction on mid- and long-term mortality after vascular surgery

2020 ◽  
Author(s):  
Andras Szabo ◽  
Nikoletta Czobor ◽  
Adam Nagy ◽  
Krisztina Toth ◽  
Csaba Eke ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Cognitive Dysfunction ◽  
Cox Regression ◽  
Mmse Score ◽  
Life Quality ◽  
Relative Risks ◽  
The Difference ◽  
The Impact ◽  
Long Term Mortality

Abstract Background: In the last decades prior studies noted the importance of frailty which is a frequently used term in perioperative risk evaluation. We investigated frailty syndrome as the psychological and socioeconomic elements of the human being. The aim of this study was assessing the importance of these factors for mortality after vascular surgery.Methods: In our prospective, observational study (ClinicalTrials.gov Identifier: NCT02224222) we examined 164 patients who underwent an elective vascular surgery between 2014 and 2017. At the point of admission they filled out a questionnaire, in this way the patients’ cognitive functions, depression and anxiety, social support and self-reported life quality were mapped. We used Cox regression and Kaplan-Meier method for relative risk calculation and survival analyses. Propensity score matching was performed to analyze the difference between patient and control, nation-wide population cohort. Effects of psychosocial factors on long term mortality were defined as primary outcome. Results: The patients mean age were 67.05 years (SD: 9.49 years). One out of four patients had some kind of cognitive impairment measured by Mini Mental State Examination with modified, more sensitive cut-off values. In univariate Cox regression higher MMSE score was associated decreased risk for all-cause mortality (OR: 0.883, 95% CI: 0.802-0.973, p=0.012). After clusters were created according to MMSE score relative risks were calculated. Even mild cognitive dysfunction could increase risk for long term mortality (AHR: 1.634, 95% CI: 1.118-2.368, p=0.009).Conclusion: Even mild cognitive dysfunction measured by the MMSE preoperatively could be an important risk factor for mortality after vascular surgery.

scholarly journals Association between red blood cell distribution width and long-term mortality in acute respiratory failure patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Wei Zhang ◽  
Yadan Wang ◽  
Jun Wang ◽  
Shaochun Wang
Keyword(s):  
Regression Analysis ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Cox Regression ◽  
Cell Distribution ◽  
Distribution Width ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
Long Term Mortality

AbstractThe red cell distribution width (RDW) has been reported to be positively correlated with short-term mortality of pulmonary disease in adults. However, it is not clear whether RDW was associated with the long-term prognosis for acute respiratory failure (ARF). Thus, an analysis was conducted to evaluate the association between RDW and 3-year mortality of patients by the Cox regression analysis, generalized additives models, subgroup analysis and Kaplan–Meier analysis. A total of 2999 patients who were first admitted to hospital with ARF were extracted from the Medical Information Mart for Intensive Care III database (MIMIC-III). The Cox regression analysis showed that the high RDW was associated with 3-year mortality (HR 1.10, 95% CI 1.07, 1.12, P < 0.0001) after adjusting for age, gender, ethnicity and even co-morbid conditions. The ROC curve illustrated the AUC of RDW was 0.651 (95% CI 0.631, 0.670) for prediction of 3-year mortality. Therefore, there is an association between the RDW and survival time of 3 years follow-up, particularly a high RDW on admission was associated with an increased risk of long-term mortality in patients with ARF. RDW may provide an alternative indicator to predict the prognosis and disease progression and more it is easy to get.

scholarly journals 80 The impact of sex and physical performance on long-term mortality in older patients with myocardial infarction

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Elisabetta Tonet ◽  
Albert Ariza-solé ◽  
Matteo Serenelli ◽  
Francesc Formiga ◽  
Sanchis Juan ◽  
...  
Keyword(s):  
Physical Performance ◽  
Prognostic Role ◽  
Risk Of Death ◽  
Coronary Syndrome ◽  
Female Sex ◽  
Increased Risk ◽  
The Impact ◽  
Long Term Mortality

Abstract Aims To investigate the prognostic role of sex and physical performance on long-term mortality in older adults hospitalized for acute coronary syndrome (ACS). Methods and results The analysis is based on older (≥70 years) ACS patients included in the FRASER, HULK, and LONGEVO SCA prospective studies. Physical performance was assessed with the Short Physical Performance Battery (SPPB). The primary outcome was all-cause mortality. The study included 1388 patients, 441 (32%) were women. At presentation, women were older and more compromised than men. After a median follow-up of 998 (730–1168) days, all-cause death occurred in 334 (24.1%) patients. At univariate analysis, female sex was related to increased risk of death. After adjustments for confounding factors, female sex was no longer associated with mortality. Women showed poor physical performance compared with men (P &lt; 0.001). SPPB values emerged as independent predictor of death. Including clinical features and SPPB in the multivariable model, we observed a paradigm shift in the prognostic role of female sex that becomes a protective factor (HR: 0.73, 95% CI: 0.56–0.96). Sex and physical performance showed a significant interaction (P = 0.03). For lower SPPB values (poor physical performance), sex-related changes in mortality were not recorded, while in patients with higher SPPB values (preserved physical performance), female sex was associated with better survival. Conclusions Two key findings emerged from the present real-life cohort of older ACS patients: (i) physical performance strongly influences long-term mortality and (ii) women with preserved physical performance have a better outcome compared to men.

scholarly journals CT-assessed sarcopenia is a predictive factor for both long-term and short-term outcomes in gastrointestinal oncology patients: a systematic review and meta-analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Huaiying Su ◽  
Junxian Ruan ◽  
Tianfeng Chen ◽  
Enyi Lin ◽  
Lijing Shi
Keyword(s):  
Risk Factor ◽  
Cochrane Library ◽  
Short Term ◽  
Skeletal Muscle Index ◽  
Major Complications ◽  
Oncological Patients ◽  
Increased Risk ◽  
The Impact ◽  
Disease Free

Abstract Background The impact of sarcopenia on the outcome of gastrointestinal (GI) oncological patients is still controversial. We aim to discuss the prevalence of sarcopenia and its relation to the oncological outcome. Methods Embase, Medline, PubMed, and the Cochrane library were systematically searched for related keywords. Studies using CT to assess sarcopenia and evaluate its relationship with the outcome of GI oncological patients were included. Long-term outcomes, including overall survival and disease-free survival, were compared by hazard ratios (HRs) with 95% confidence intervals (CIs). Short-term outcomes, including total complications and major complications (Clavien-Dindo ≥IIIa) after curable surgery, were compared by the risk ratio (RR) and 95% CI. Results A total of 70 studies including 21,875 patients were included in our study. The median incidence of sarcopenia was 34.7% (range from 2.1 to 83.3%). A total of 88.4% of studies used skeletal muscle index (SMI) in the third lumbar level on CT to define sarcopenia, and a total of 19 cut-offs were used to define sarcopenia. An increasing trend was found in the prevalence of sarcopenia when the cut-off of SMI increased (β = 0.22, 95% CI = 0.12–0.33, p < 0.001). The preoperative incidence of sarcopenia was associated both with an increased risk of overall mortality (HR = 1.602, 95% CI = 1.369–1.873, P < 0.001) and with disease-free mortality (HR = 1.461, 95% CI = 1.297–1.646, P < 0.001). Moreover, preoperative sarcopenia was a risk factor for both total complications (RR = 1.188, 95% CI = 1.083–1.303, P < 0.001) and major complications (RR = 1.228, 95% CI = 1.042–1.448, P = 0.014). Conclusion The prevalence of sarcopenia depends mostly on the diagnostic cut-off points of different criteria. Preoperative sarcopenia is a risk factor for both long-term and short-term outcomes.

scholarly journals The Impact of New-onset Atrial Fibrillation on Short-term and Long-term Mortality of Critically ill Patients with Candidemia

2021 ◽  
Author(s):  
zengli xiao ◽  
Qi Wang ◽  
Xuebin Li ◽  
Youzhong An
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Short Term ◽  
The Impact ◽  
Onset Atrial Fibrillation ◽  
Long Term Mortality ◽  
New Onset

Abstract Background Both new-onset atrial fibrillation (NOAF) and candidemia occurred frequently in critically ill patients, which are associated with poor outcomes. But, the association between NOAF and critically ill patients with candidemia is still uncertain. This study is try to identify the impact of NOAF on short-term and long-term mortality of critically ill patients with candidemia. Methods We retrospectively identified NOAF in all patients with candidemia admitted to a non-cardiac intensive care unit (ICU) from January 2011 to March 2018 in a teaching hospital. We categorized these patients into 3 groups (NOAF, Prior AF, No AF) and compared clinical information between groups. Risk factors for these patients’ short-term and long-term mortality were also analyzed. Results Ninety-two patients with candidemia were identified from 2011 to 2018. Among these patients, 26 (28.3%) developed NOAF during their hospital stay. The multivariable logistic regression analysis indicated that stroke, anemia, Sequential Organ Failure Assessment (SOFA) score and NOAF were independent risk factors for in-hospital mortality and NOAF was also the independent risk factor for 1 year mortality. Conclusions There was a high incidence of NOAF in critically ill patients with candidemia, which was associated with in-hospital mortality and 1 year mortality after hospital discharge. Further multicenter studies should be conducted to help confirm this relationship and to find effective interventions that reduce short-term and long-term mortality.

scholarly journals De-Ritis Ratio Improves Long-Term Risk Prediction after Acute Myocardial Infarction

2018 ◽  
Vol 7 (12) ◽  
pp. 474 ◽  
Author(s):  
Matthias Steininger ◽  
Max-Paul Winter ◽  
Thomas Reiberger ◽  
Lorenz Koller ◽  
Feras El-Hamid ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cox Regression ◽  
Independent Predictor ◽  
Troponin T ◽  
Hazard Analysis ◽  
Entire Study ◽  
The Impact ◽  
Long Term Mortality

Background: Recent evidence suggested levels of aspartate aminotransferase (AST), alanine transaminase (ALT), and AST/ALT ratio (De-Ritis ratio) were associated with a worse outcome after acute myocardial infarction (AMI). However, their value for predicting long-term prognosis remained unknown. Therefore, we investigated the prognostic potential of transaminases on patient outcome after AMI from a long-term perspective. Methods: Data of a large AMI registry including 1355 consecutive patients were analyzed. The Cox regression hazard analysis was used to assess the impact of transaminases and the De-Ritis ratio on long-term mortality. Results: The median De-Ritis ratio for the entire study population was 1.5 (interquartile range [IQR]: 1.0–2.6). After a median follow-up time of 8.6 years, we found that AST (crude hazard ratio (HR) of 1.19 per 1-SD [95% confidence interval (CI): 1 .09–1.32; p < 0.001]) and De-Ritis ratio (crude HR of 1.31 per 1-SD [95% CI: 1.18–1.44; p < 0.001]), but not ALT (p = 0.827), were significantly associated with long-term mortality after AMI. After adjustment for confounders independently, the De-Ritis ratio remained a strong and independent predictor for long-term mortality in the multivariate model with an adjusted HR of 1.23 per 1-SD (95% CI: 1.07–1.42; p = 0.004). Moreover, the De-Ritis ratio added prognostic value beyond N-terminal pro-B-Type Natriuretic Peptide, Troponin T, and Creatine Kinase. Conclusion: The De-Ritis ratio is a strong and independent predictor for long-term mortality after AMI. As a readily available biomarker in clinical routine, it might be used to identify patients at risk for fatal cardiovascular events and help to optimize secondary prevention strategies after AMI.

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