Baseline Predictors Of Mortality Research Articles

Impact of eGFR slope upon mortality in a real world heart failure cohort

Abstract Background Heart failure (HF) frequently causes an imbalance in heart and kidney functions, and the prognosis of heart and kidney disease can worsen one another. In addition to the prognostic role of chronic kidney disease (CKD), dynamic changes in renal function have been recognized to portend a poor prognosis in HF patients. Purpose This study aimed to investigate the prevalence of impaired renal function at HF diagnosis and its association with short and long-term outcomes in a real-world cohort of HF patients. In addition, we assessed how dynamic changes in renal function after HF diagnosis might predict HF prognosis. Methods Using a natural language processing algorithm, clinical data of patients with at least one diagnosis of HF (index event) were retrospectively collected. Patients for which the most recent estimated glomerular filtration rate (eGFR) value prior to the index date was ≤ 60 mL/min/1.73m2 and/or had a documented medical history of CKD (including dialysis) were considered as having CKD. A linear mixed effects model was used to show the longitudinal eGFR trajectories during the follow-up period (after index). A Cox proportional hazard model was used to analyse the association between baseline variables and mortality. Finally, joint modelling was used to combine the linear mixed eGFR sub-model with the survival sub-model, to estimate the effect of the current eGFR value and the eGFR slope of the year prior on mortality. Results The study population consisted of 1992 patients with a mean (±SD) age of 74.8 ± 11.7 years and 58% males. In total, 17% had HF with preserved ejection fraction (HFpEF, n = 339) and 70% (n = 1156) presented CKD at the index event. The median follow-up time was 3.16 years and 13% (n = 198) of the patients were deceased after two years. The group of 2-year survivors had significantly lower proportion of CKD at index (55 vs 76%, p < 0.001). The calculated mean yearly decrease of the eGFR value was 4.2 mL/min/1.73m². The multivariate Cox PH model identified age, CVA, diastolic blood pressure, HDL, and log10proBNP as baseline predictors of mortality. Joint modelling showed that a 10 mL/min/1.73m2 lower current eGFR value amongst patients was associated with an increased mortality hazard of 1.30 ± 0.06 (p < 0.001). Additionally, a decrease of 10 mL/min/1.73m2 in eGFR during the year prior indicated an increased mortality hazard of 1.87 ± 0.19 (p < 0.001). Conclusion In a real-world cohort of HF patients, the prevalence of CKD is high and CKD is an independent predictor of mortality. The current eGFR value and the year prior’s eGFR slope adds additional prognostic information and helps to better fine tune the individual mortality hazard. Based on the findings of this analysis, patients with worse prognosis might benefit from a closer and more vigilant follow-up.

Drivers of mortality in patients with chronic coronary disease in the low-dose colchicine 2 trial

BackgroundLow-dose colchicine significantly reduces the risk of cardiovascular events in patients with chronic coronary disease. An increase of non-cardiovascular death raised concerns about its safety. This study reports cause-specific mortality and baseline predictors of mortality in the Low-Dose Colchicine 2 (LoDoCo2) trial. MethodsPatients with chronic coronary disease were randomly allocated to colchicine 0.5 mg once daily or placebo on a background of optimal medical therapy. Cause-specific mortality data were analysed, stratified by treatment status. Multivariate analyses were performed to examine the predictors of mortality as well as cardiovascular and non-cardiovascular death. ResultsAfter a median 28.6 months follow-up, 133 out of 5522 participants (2.4%) died. Forty-five deaths were cardiovascular (colchicine versus placebo: 20 [0.7%] versus 25 [0.9%], HR, 0.80; 95% CI, 0.44–1.44), while eighty-eight deaths were non-cardiovascular (53 [1.9%] versus 35 [1.3%]; HR, 1.51; 95% CI, 0.99–2.31). Forty-eight deaths were due to cancer (26 [0.9%] versus 22 [0.8%]), thirteen end-stage pulmonary disease (9 [0.3%] versus 4 [0.1%]), eight infection (4 [0.1%] versus 4 [0.1%]), five dementia (4 [0.1%] versus 1 [0.0%]) and five related multiple organ failure (3 [0.1%] versus 2 [0.1%]). Multivariable analysis demonstrated age > 65 years was the only independent baseline characteristic associated with non-cardiovascular death (HR, 3.65; 95% CI, 2.06–6.47). ConclusionsDuring the LoDoCo2 trial, assignment to colchicine was not associated with an adverse effect on any specific causes of death. Most deaths were related to non-cardiovascular causes, underscoring the importance of comorbidities as drivers of all-cause mortality in patients with chronic coronary disease.

Thrombectomy for Comatose Patients with Basilar Artery Occlusion : AMulticenter Study.

Acute ischemic stroke (AIS) secondary to abasilar artery occlusion (BAO) carries apoor prognosis, especially in cases of severe symptoms, such as coma at presentation. Despite alack of evidence, mechanical thrombectomy (MT) is often performed as the procedural risks are felt to be minimal compared to the natural history. We sought to evaluate MT efficacy and safety in comatose BAO patients. We performed aretrospective analysis of amulticenter prospective cohort of consecutive AIS patients with BAO who underwent MT. We compared baseline characteristics between comatose and noncomatose BAO patients, as well as clinical outcomes (modified Rankin scale, mRS 0-3 at 3months). Using amultivariate logistic regression, we examined the population of comatose patients for baseline predictive factors of mortality. We included 269patients, 72 (27%) comatose and 197 (73%) non-comatose. Despite similar recanalization rates between comatose and non-comatose patients (83% vs. 90% p = 0.221), comatose patient long-term outcomes were dramatically worse (11% mRS 0-3 vs. 54%, p < 0.0001) and mortality was higher (64% vs. 34%, p < 0.0001). Baseline predictors of mortality at 3months among comatose BAO patients after multivariate analysis were the following: male sex (odds ratio, OR 31.20, 2.57-378.52, p = 0.007), older age (OR 1.13, 1.04-1.24, p = 0.007) and higher serum glucose levels (OR 1.54, 1.07-2.21, p = 0.019). Thrombectomy is technically effective for BAO patients presenting with coma; however, the long-term favorable outcome remains poor. Male sex, old age and hyperglycemia were predictors of mortality in these patients.

Late Presentation With HIV in Africa: Phenotypes, Risk, and Risk Stratification in the REALITY Trial.

BackgroundSeverely immunocompromised human immunodeficiency virus (HIV)–infected individuals have high mortality shortly after starting antiretroviral therapy (ART). We investigated predictors of early mortality and “late presenter” phenotypes.MethodsThe Reduction of EArly MortaLITY (REALITY) trial enrolled ART-naive adults and children ≥5 years of age with CD4 counts <100 cells/µL initiating ART in Uganda, Zimbabwe, Malawi, and Kenya. Baseline predictors of mortality through 48 weeks were identified using Cox regression with backwards elimination (exit P > .1).ResultsAmong 1711 included participants, 203 (12%) died. Mortality was independently higher with older age; lower CD4 count, albumin, hemoglobin, and grip strength; presence of World Health Organization stage 3/4 weight loss, fever, or vomiting; and problems with mobility or self-care at baseline (all P < .04). Receiving enhanced antimicrobial prophylaxis independently reduced mortality (P = .02). Of five late-presenter phenotypes, Group 1 (n = 355) had highest mortality (25%; median CD4 count, 28 cells/µL), with high symptom burden, weight loss, poor mobility, and low albumin and hemoglobin. Group 2 (n = 394; 11% mortality; 43 cells/µL) also had weight loss, with high white cell, platelet, and neutrophil counts suggesting underlying inflammation/infection. Group 3 (n = 218; 10% mortality) had low CD4 counts (27 cells/µL), but low symptom burden and maintained fat mass. The remaining groups had 4%–6% mortality.ConclusionsClinical and laboratory features identified groups with highest mortality following ART initiation. A screening tool could identify patients with low CD4 counts for prioritizing same-day ART initiation, enhanced prophylaxis, and intensive follow-up.Clinical Trials RegistrationISRCTN43622374.

Baseline Predictors of Mortality among Predominantly Rural-Dwelling End-Stage Renal Disease Patients on Chronic Dialysis Therapies in Limpopo, South Africa.

BackgroundDialysis therapy for end-stage renal disease (ESRD) continues to be the readily available renal replacement option in developing countries. While the impact of rural/remote dwelling on mortality among dialysis patients in developed countries is known, it remains to be defined in sub-Saharan Africa.MethodsA single-center database of end-stage renal disease patients on chronic dialysis therapies treated between 2007 and 2014 at the Polokwane Kidney and Dialysis Centre (PKDC) of the Pietersburg Provincial Hospital, Limpopo South Africa, was retrospectively reviewed. All-cause, cardiovascular, and infection-related mortalities were assessed and associated baseline predictors determined.ResultsOf the 340 patients reviewed, 52.1% were male, 92.9% were black Africans, 1.8% were positive for the human immunodeficiency virus (HIV), and 87.5% were rural dwellers. The average distance travelled to the dialysis centre was 112.3 ± 73.4 Km while 67.6% of patients lived in formal housing. Estimated glomerular filtration rate (eGFR) at dialysis initiation was 7.1 ± 3.7 mls/min while hemodialysis (HD) was the predominant modality offered (57.1%). Ninety-two (92) deaths were recorded over the duration of follow-up with the majority (34.8%) of deaths arising from infection-related causes. Continuous ambulatory peritoneal dialysis (CAPD) was a significant predictor of all-cause mortality (HR: 1.62, CI: 1.07–2.46) and infection-related mortality (HR: 2.27, CI: 1.13–4.60). On multivariable cox regression, CAPD remained a significant predictor of all-cause mortality (HR: 2.00, CI: 1.29–3.10) while the risk of death among CAPD patients was also significantly modified by diabetes mellitus (DM) status (HR: 4.99, CI: 2.13–11.71).ConclusionCAPD among predominantly rural dwelling patients in the Limpopo province of South Africa is associated with an increased risk of death from all-causes and infection-related causes.

Baseline Predictors of Mortality in Patients with Relapsed or Refractory Acute Myeloid Leukemia Treated with Vosaroxin Plus Cytarabine or Placebo Plus Cytarabine in the Phase 3 VALOR Study

Baseline Predictors of Mortality in Patients with Relapsed or Refractory Acute Myeloid Leukemia Treated with Vosaroxin Plus Cytarabine or Placebo Plus Cytarabine in the Phase 3 VALOR Study

Nutritional Status and Other Baseline Predictors of Mortality among HIV-Infected Children Initiating Antiretroviral Therapy in Tanzania.

We assembled a prospective cohort of 3144 children less than 15 years of age initiating antiretroviral therapy (ART) in Dar es Salaam, Tanzania. The relationships of nutritional status and other baseline characteristics in relation to mortality were examined using Cox proportional hazards model. Compared with children with weight for age (WAZ) > -1, those with WAZ ≤ -2 to < -3 had a nearly double risk of death (relative risk [RR], 1.85; 95% confidence interval [CI], 1.10-3.11), and among those with WAZ ≤ -3, the risk more than tripled (RR, 3.36; 95% CI, 2.12-5.32). Other baseline risk factors for overall mortality included severe anemia (P < .001), severe immune suppression (P = .02), history of tuberculosis (P = .01), opportunistic infections (P < .001), living in the poorest district (P < .001), and advanced World Health Organization stage (P = .003). To sustain the obtained benefit of ART in this setting, interventions to improve nutritional status may be used as an adjunct to ART.

Mortality and its determinants among patients infected with HIV-1 on antiretroviral therapy in a referral centre in Yaounde, Cameroon: a retrospective cohort study

ObjectivesMortality has declined in people with HIV infection, subsequent to the improved access to antiretroviral therapy (ART). We assessed the incidence and determinants of mortality among patients with HIV-1 infection...

All-cause mortality in criminal justice clients with substance use problems—A prospective follow-up study

BackgroundMortality in previously incarcerated individuals is known to be elevated, with high proportions of drug-related deaths. However, there is less documentation of whether specific substance use patterns and other clinical characteristics predict increased mortality in the group. MethodsThis is a follow-up study of mortality and causes of death in ex-prisoners with substance use problems prior to incarceration (N=4081), who were followed during an average of 3.6 years from release from prison until death or until data were censored. Baseline predictors of mortality, derived from interviews with Addiction Severity Index (ASI) in prison, were studied in a Cox regression analysis. ResultsDuring follow-up, 166 subjects (4.1%) died. Standardized mortality ratios were 7.0 (3.6–12.2) for females and 7.7 (5.6–9.0) for males. In 84% of cases, deaths were unnatural or due to substance-related disease. Most common causes of death were accidental poisoning (27%), transport accidents (13%), poisoning/injury with undetermined intent (12%), and suicide (10%). Death was positively predicted by heroin use, overdose, and age, and negatively predicted by a history of depression. ConclusionsA vast majority of deaths after release from prison in individuals with substance use are due to violent or substance-related causes. Significant predictors identified were mainly related to patterns of drug use, and need to be addressed upon incarceration as risk factors of death. The findings have implications for referral and treatment upon release from prison.

Baseline predictors of survival in metastatic colorectal cancer.

e14105 Background: Patients with non-resectable metastatic colorectal cancer can survive several years with palliative chemotherapy and newer biological agents. However, survival varies greatly within this group. The aim of the present study was to identify baseline predictors of overall mortality in an unselected cohort of patients with metastatic colorectal cancer. Methods: Clinical information was collected from patient files in consecutive patients treated with palliative chemotherapy from August 2007 until June 2011. The primary outcome was overall survival. Cox regression analysis was used to examine the effect of predictive variables on time to outcome. The variables analysed were: Gender, age, performance status, primary tumor site (colon or rectum), status of primary tumor (resected or un-resected), metachronous metastases, more than two metastatic sites, liver-only metastases, and low albumin. Results: We included 314 patients (Median age 64.5 IQ (57-70) years, 194 (61.8%) male). Median follow-up for survival was 471 days IQ (257-708). One-year survival was 79%, CI (74-84%). Median overall survival was 676 days, CI (577-750). Following baseline variables were independent predictors of all-cause mortality: Primary tumor site colon HR: 1.49, CI (1.03-2.16), p=0.036, un-resected primary tumor HR 2.92, CI (1.85-4.62), p&lt;0.001, metachronous metastases HR 1.72, CI (1.06-2.79), p=0.027 and more than two metastatic sites HR 3.46, CI (1.71-6.99), p=0.001. Both Performance status and low albumin were statistically significant in the univariate analysis, but not in the multivariate analysis. Conclusions: In daily clinical practice, baseline predictors of mortality in metastatic colorectal cancer were colon as the primary tumor site, un-resected primary tumor, metachronous metastases, and more than two metastatic sites.

High mortality from cardiovascular disease and analysis of risk factors in Indian and Melanesian Fijians.

In recent years, developing populations such as the Pacific island nation of Fiji, have seen decreases in infectious diseases and increasing frequency of cardiovascular diseases (CVD), diabetes and cancer. However, cohort studies of mortality in these populations are scarce. Here we report 11-year all-cause and cause-specific mortality rates and risk factors for total, CVD and coronary heart disease (CHD) for indigenous Melanesian and Asian Indian people of Fiji. Following a baseline risk factor survey in 1980, mortality surveillance continue until 1991 in a representative cohort of 1325 Melanesians and 1221 Indians from urban and rural areas of Fiji. Date and cause of death were recorded and total, CVD and CHD mortality rates calculated. Baseline predictors of mortality were assessed using Cox regression. Total mortality rates in Melanesians were 15.9 and 9.2/1000 person-years, and in Indians were 13.5 and 6.8/1000 person-years, in men and women respectively. Death due to CHD was more common in men than women, and in Indian than Melanesian men, although total CVD deaths were more common in Melanesian men. Deaths due to CHD were more common in the urban than the rural area. After adjusting for other risk factors Indian ethnicity was associated with a significantly reduced risk of total and CVD mortality in men, and total mortality in women. Age and systolic blood pressure were consistently and independently associated with mortality from all causes, as well as CVD and CHD (except in Indian women). In men associations were also identified for total cholesterol with CVD and CHD mortality in Melanesians, and 2-hour plasma glucose with total and CVD mortality in Indians. In women, 2-hour glucose was important for total, CVD and CHD mortality in both ethnic groups as was smoking in Indians. Obesity had inconsistent associations with mortality. Cardiovascular disease is now responsible for a large proportion of total mortality in both Indian and Melanesian Fijians. The major risk factors identified in Fijians are similar to those observed in developed populations.

Events in the cardiac arrhythmia suppression trial: Baseline predictors of mortality in placebo-treated patients

Patients randomized to placebo in the encainide and flecainide arms of the Cardiac Arrhythmia Suppression Trial (CAST) have been found to have a relatively low 1-year mortality rate of 3.9% in comparison with previous studies of patients in the postmyocardial infarction period. To determine the comparability of CAST with previous studies, baseline variables were examined in the 743 patients randomized to placebo in the flecainide and encainide arms of CAST. Twenty-three baseline characteristics were correlated with major outcome events: arrhythmic death (16 events), total mortality (26 events) and congestive heart failure (51 events).On multivariate analysis the risk of new or worsening congestive heart failure was significantly associated with diuretic use, diabetes, high New York Heart Association functional class, age, prolonged QRS duration and low ejection fraction. The risk of arrhythmic death or resuscitated cardiac arrest was significantly associated with an index Q wave myocardial infarction, history of heart failure, use of digitalis, diabetes and prolonged QRS duration. Total mortality or resuscitated cardiac arrest was significantly associated with an index Q wave myocardial infarction, diabetes, ST segment depression, high functional class, prolonged QRS duration and low ejection fraction.The variables at baseline associated with mortality from all causes or arrhythmic death or resuscitated cardiac arrest and heart failure in the CAST placebo-treated patients are similar to those identified in previous postmyocardial infarction studies. Thus, the observation of increased mortality in CAST associated with the administration of encainide and flecainide for suppression of ventricular premature depolarizations is probably applicable to any comparably defined group of patients in the postmyocardial infarction period.