Cox Proportional Risk Model Research Articles

Association between life's essential 8 score and 5-year all-cause and cardiovascular mortality in people with prediabetes: based on a cohort study

Abstract Background The Life's Essential 8 (LE8) score, which evaluates cardiovascular health (CVH) status, is linked to premature mortality in individuals with diabetes. However, the relationship between LE8 score and the risk of all-cause and cardiovascular mortality in individuals with prediabetes remains unclearly. Purpose This study aims to investigate the association between LE8 score and both all-cause and cardiovascular mortality among prediabetic patients within the United States population. Methods Our retrospective cohort study was based on the National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2016. We selected prediabetic patients with blood glucose levels between normal and type 2 diabetes range from this database. The CVH status of these patients was categorized into low group (0-49), medium group (50-79), and high group (80-100) based on the LE8 score, which was assessed on a scale of 0 to 100. We constructed a multivariable Cox proportional hazards model to explore the relationship between LE8 score and mortality, and used restricted cubic spline curves to assess their non-linear correlation. Additionally, we conducted stratified analyses by age, gender, BMI, comorbid hypertension, and ASCVD in different populations to investigate the association between LE8 score and mortality. Results This study enrolled a total of 4,912 individuals with prediabetes (577 with low LE8 scores, 3,549 with medium LE8 scores, and 786 with high LE8 scores). Compared to the other groups, prediabetic patients with high LE8 scores exhibited younger age, lower BMI levels, a smaller proportion of Non-Hispanic Black individuals, higher education levels, and fewer clinical comorbidities. After adjusting for covariates using Cox proportional regression risk models, we observed that a low LE8 score was significantly associated with an increased rate of cardiovascular mortality (HR 4.13; 95% CI = 1.16-14.72) and all-cause mortality (HR 3.42; 95% CI = 1.73-6.74) in prediabetic patients. Restricted cubic splines demonstrated a linear trend between high LE8 scores and decreased risks of all-cause and cardiovascular mortality (P>0.05). Stratified analysis indicated that compared to the group with high LE8 scores, the group with low LE8 scores had a significantly higher risk of death within subgroups defined by age (≥65), gender, BMI<30, presence of hypertension, and absence of ASCVD. Conclusions In the American population, as the LE8 score increases, the risk of all-cause and cardiovascular mortality decreases for individuals with prediabetes over a 5-year period. Maintaining an ideal LE8 score will provide long-term benefits for individuals with prediabetes.Cox proportional regression modelRestricted cubic spline curves

Clinical characteristics and prognostic analysis of adult patients hospitalized with acute myocarditis

Objective: To analyze the clinical characteristics of patients hospitalized with acute myocarditis and explore the relevant factors affecting the prognosis. Methods: This study was a retrospective cohort study. Patients with acute myocarditis hospitalized in the Second Affiliated Hospital of Harbin Medical University from March 2010 to October 2022 were included and divided into severe myocarditis group and non-severe myocarditis group according to clinical diagnosis results, retrospectively. Basic clinical features were collected and followed up in both groups. The primary endpoint was cardiac death and the secondary endpoint was cardiac re-hospitalization. According to the clinical outcome, Kaplan-Meier survival curve was drawn and assessed via log-rank P test. Cox proportional risk model was established to analyze the related factors affecting the prognosis of patients with acute myocarditis. Results: A total of 235 patients with acute myocarditis were included, including 138 males (58.7%), aged (34±16) years, 102 patients (43.4%) in the severe myocarditis group and 133 patients (56.6%) in the non-severe myocarditis group. Compared with the non-severe myocarditis group, the severe myocarditis group was older and had more clinical symptoms of dyspnea, edema, and syncope. At a follow-up of 3.8 (2.8, 4.8) years, cumulative cardiac mortality and cardiac readmissions in patients with acute myocarditis were 4.2% and 9.6%, respectively. Among them, patients with severe myocarditis had a higher risk of cardiac death and cardiac readmission than those without severe myocarditis (9.3% vs. 1.0%, log-rank P=0.004; 13.4% vs. 4.2%, log-rank P=0.021). Multivariate Cox analysis showed that the independent risk factor for cardiac death in patients with acute myocarditis was elevated serum creatinine level at baseline (HR=1.016, 95%CI: 1.003-1.028, P=0.013). Independent risk factors for cardiogenic readmission were increased left ventricular end-diastolic diameter on admission (HR=1.108, 95%CI: 1.035-1.187, P=0.003) and ventricular tachycardia or fibrillation during hospitalization (HR=6.563, 95%CI: 2.138-20.142, P=0.001). Conclusions: The patients with acute myocarditis had more clinical symptoms of dyspnea, edema, and syncope. Elevated serum creatinine level on admission was an independent risk factor for cardiac death in patients with acute myocarditis; increased end-left ventricular diameter on admission and ventricular tachycardia or fibrillation during hospitalization were independently associated with cardiac rehospitalization.

Association between preoperative advanced lung cancer inflammation index and recurrence of hepatocellular carcinoma after curative resection.

The association between the advanced lung cancer inflammation index (ALI) and the recurrence of hepatocellular carcinoma (HCC) in patients treated with curative resection and its predictive value remains unclear. To assess the association between preoperative ALI and the recurrence of HCC in patients treated with surgical resection. This retrospective study analyzed patients with HCC treated with surgical resection at The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University (Huai'an, China) from 2019 to 2021. The advanced lung cancer inflammation index was calculated as (BMI × ALB/NLR), where BMI = body mass index, ALB = serum albumin and NLR = neutrophil-lymphocyte ratio. Univariate and multivariable Cox proportional risk models were performed to evaluate the association between the ALI and recurrence of HCC patients treated with surgical resection. Subgroup analyses were conducted based on age, sex, performance status (PS), cirrhosis, pathological staging, tumor grading, tumor size, and number of tumors. Among the 295 HCC patients treated with surgical resection, 180 patients (61.02%) had recurrences, with the mean follow-up being 462 (187, 730) days. Patients with higher ALI scores were significantly less likely to have a recurrence of HCC after surgical resection (hazard ratio (HR): 0.59, 95% confidence interval (95% CI): 0.42-0.83, p = 0.003). Based on subgroup analyses, HCC patients undergoing surgical resection with higher ALI scores were associated with recurrence in those ≥60 years of age, with tumors ≥5 cm, and in patients with single tumors and ≥2 tumors. This study confirms the association between ALI and the reduced risk of recurrence in HCC patients treated with surgical resection.

Relationship between metabolically healthy overweight/obesity and risk of type 2 diabetes in different ethnicity: a prospective cohort study in southwest China

BackgroundTo estimate and compare the association between metabolically healthy overweight/obesity (MHO) and the risk of type 2 diabetes (T2DM) among different ethnic groups in southwest China, while also exploring possible ethnic differences.MethodsThis is a prospective cohort study of 6,820 participants in Southwest China. MHO was defined as body mass index (BMI) ≥ 24 kg/m2 and the presence of ≤ 1 component of metabolic syndrome. Cox proportional risk models were utilized to analyze the association between MHO and the risk of T2DM.ResultsThe median follow-up time was 6.58 years, during which 708 new cases of T2DM were diagnosed. In the total population, after adjusting for confounding factors, MHO was found to increase the risk of T2DM compared to metabolically healthy normal weight (MHNW) individuals (HR = 1.49, 95% CI: 1.15–1.93). Subgroup analysis by ethnicity revealed that, MHO increased the risk of T2DM in the Han population (HR = 1.64, 95% CI: 1.21–2.23), however, the difference was not statistically significant in the ethnic minority population.The results of sensitivity analysis further supported the robustness of these findings. Meanwhile, stratified by sex, age, and urban/rural, it was found that ethnic differences in the association between MHO and T2DM still existed, however, it is important to note that the association between MHO and T2DM was not statistically significant in the Han population subgroup aged ≥ 45 years (p > 0.05).ConclusionMHO was associated with an increased risk of T2DM compared to MHNW, and there are ethnic differences. Future interventions need to be strengthened for Han Chinese key populations to reduce the risk of T2DM.

Associations of metabolic syndrome with cognitive function and dementia risk: Evidence from the UK Biobank cohort.

To investigate the associations of metabolic syndrome (MetS) with cognitive function, dementia and its subtypes. Based on the participants recruited by UK Biobank, this study aims to investigate the associations of MetS with cognitive function, dementia and its subtypes. Generalized estimating equations, Cox proportional risk models, and multiple linear regression models were respectively used to assess associations between MetS and dementia-related outcomes. Among the 363,231 participants, 95,713 had MetS at baseline. The results showed that MetS was significantly associated with cognitive function related to fluid intelligence and prospective memory at follow-up. Among participants aged ≥60 years, MetS was correlated with elevated risk of all-cause dementia, particularly vascular dementia (VaD) [hazard ratio 1.115 (95% confidence interval: 1.047, 1.187), hazard ratio 1.393 (95% confidence interval: 1.233, 1.575), respectively]. With increasing MetS components, the risk of all-cause dementia and VaD tended to be elevated. MetS has also been associated with dementia-related structural changes in the brain, including alterations in overall brain volume, white matter volume, grey matter volume and white matter integrity. MetS was associated with poorer cognitive performance and might increase the risk of all-cause dementia as well as VaD, but the effect on Alzheimer's disease was not significant. Holistic control of the MetS may benefit the prevention and control of cognitive impairment and dementia.

Intervention of traditional Chinese patent medicine based on syndrome differentiation in female patients after percutaneous coronary intervention due to acute coronary syndrome: a nationwide multicenter prospective cohort study

Objective: To evaluate the efficacy and safety of discriminative application of Chinese patent medicines in female patients after percutaneous coronary intervention (PCI) due to acute coronary syndrome (ACS). Methods: The study population was from the Chinese Patent Medicine (CPM) trial. CPM trial was a multicenter prospective cohort study, which enrolled patients from 40 centers in mainland China between February 2012 and December 2015, with the discriminative use of Chinese patent medicines as the exposure factor. Female patients with ACS after PCI who completed 36-month follow-up were included in this analysis, and were divided into a conventional treatment group (using conventional western medicine recommended by the guidelines) and a group with the discriminative use of proprietary Chinese medicines (on the basis of conventional western medicine treatment, discriminative use of Qishen Yiqi dropping pills for Qi deficiency and blood stasis syndrome, Guanxin Danshen dropping pills for blood stasis syndrome, and Danlou tablets for phlegm and blood stasis syndrome combined with the conventional western medicine). The primary endpoint event was a composite endpoint event including cardiovascular death, nonfatal myocardial infarction, and emergency revascularization surgery. Secondary endpoint events were composite endpoint events including readmission for ACS, heart failure, stroke, and other thrombotic events. Adverse events were collected. Cox proportional risk model was used to assess the effect of discriminatory application of Chinese patent medicine on endpoint events, and sensitivity analysis was performed by comparing the results with propensity score matching analysis. Results: A total of 748 female ACS post-PCI patients were included in the analysis, aged (63.2±8.3) years. There were 370 patients in the group of discriminative application of Chinese patent medicines and 378 patients in the conventional treatment group. There were 37 cases (10.0%) and 58 cases (15.3%) of primary endpoint events in the discriminatory application of Chinese patent medicines group and the conventional treatment group, respectively. Cox analysis showed that the risk of primary endpoint in the discriminatory application of Chinese patent medicines group was lower than that in the conventional treatment group after adjusting for confounding factors (adjusted HR=0.62, 95%CI 0.40-0.96, P=0.031). There were 38 (10.3%) and 57 (15.1%) cases of secondary endpoint events in the two groups, respectively. Cox regression analysis showed that the risk of secondary endpoint events in the discriminatory application of Chinese patent medicine group was lower than that in the conventional treatment group after adjusting for confounders (adjusted HR=0.56, 95%CI 0.37-0.87, P=0.001). The results of propensity score matching analysis also showed that Chinese patent medicines based on discriminatory application could reduce the risk of primary endpoint (HR=0.62,95%CI 0.40-0.97,P=0.033) and second endpoint (HR=0.56, 95%CI 0.37-0.87,P=0.009) significantly. There was no significant difference in adverse events between the two groups (12.4% (46/370) vs. 10.3% (39/378), P=0.362). Conclusion: On the basis of conventional western medicine treatment, discriminatory application of Chinese patent medicines can reduce the risk of endpoints in female patients after PCI due to ACS without significant adverse effects.

Effect of radiation after surgery on the prognosis of children with Wilms tumor

Background To explore the association between radiation after surgery and the 5-year overall survival (OS) and 5-year cancer-specific survival (CSS) in patients with Wilms tumor. Methods In this cohort study, 1564 participants were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The univariate and multivariable COX proportional risk model as well as competitive risk model were used to explore the covariates associated with 5-year OS and 5-year CSS of patients with Wilms tumor and the correlation between radiation after surgery and 5-year OS or 5-year CSS of patients with Wilms tumor, respectively. The Kaplan-Meier curves of participants were plotted. Results The median follow-up was 126.00 (84.00, 178.00) months. Patients receiving surgery had higher 5-year survival probability than those not receiving surgery, while participants receiving radiation after surgery showed poor 5-year survival than those not. After adjusting for covariates including age and SEER stage, increased risk of 5-year overall mortality in patients with Wilms tumor [hazard ratio (HR) = 1.62, 95% confidence interval (CI): 1.10–2.41). After the adjustment for confounding factors including age, SEER stage and ethnicity, increased risk of 5-year cancer-specific mortality of patients with Wilms tumor was observed in those receiving radiation after surgery (HR = 1.77, 95%CI: 1.13–2.79). Conclusion Radiation after surgery was associated with poor prognosis of patients with Wilms tumor, which indicated that the clinicians should assess whether the patient was suitable for using radiation after surgery.

Body roundness index and the risk of hypertension: a prospective cohort study in Southwest China

BackgroundBody roundness index (BRI) is an anthropometric measure related to obesity, combining waist circumference (WC) and height to more accurately reflect body fat. This study aims to investigate the relationship between BRI and the risk of hypertension using data from a prospective cohort study in Southwest China.MethodsData for the study were derived from Guizhou Population Health Cohort Study (GPHCS), established in 2010. A total of 9,280 participants (aged 18 to 95 years, mean 41.53 ± 14.15 years) from 48 townships across 12 districts/counties were surveyed at baseline through multistage stratified random cluster sampling. Cox proportional risk models were employed to analyze the association between BRI and the risk of hypertension, estimating hazard ratios (HRs) and 95% confidence intervals (CIs) after adjusting for confounding factors. The relationship between BRI and the onset time of hypertension was analyzed using the time failure acceleration model.ResultsOver a median follow-up period of 6.64 years, 1,157 participants were diagnosed with hypertension. After adjusting for confounding variables, each unit increase in BRI was associated with a 17% increase in hypertension risk (HR = 1.17, 95% CI: 1.11, 1.24, P for trend < 0.001). Compared to participants in the first quartile (Q1) of BRI, the risk of hypertension for those in the third quartile (Q3) and fourth quartile (Q4) was 1.31 (95% CI: 1.10, 1.56) and 1.53 (95% CI: 1.28, 1.84), respectively. Each unit increase in BRI advanced the onset of hypertension by 0.26 years (95% CI: 0.16, 0.35).ConclusionThis study indicates that BRI has a positive association with hypertension and can accelerate the onset of hypertension in the Chinese population. It is suggested that reducing BRI by controlling abdominal fat may be one of the effective measure to prevent hypertension.

Association of benzodiazepine and Z-hypnotic use with cardiovascular disease risk: insights from a prospective study of 10 million people in China.

To assess the association between Benzodiazepines (BZDs) or Z-hypnotic use and cardiovascular diseases (CVD) incidence in residents in Beijing, China. We included 2,415,573 individuals with a prescription record for BZDs or Z-hypnotics in the Beijing Medical Claim Data for Employees database during 2010-2017, and 8,794,356 non-users with other prescriptions for the same period. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional risk models for 712,850 exposed and 712,850 unexposed participants who were matched 1:1 by propensity score. BZDs or Z-hypnotics users had a higher risk of CVD than non-users, with an HR of 1.11 (95% CI: 1.10, 1.13). Compared with non-users, those who used them for less than 3 months had the lowest risk of CVD, and those for more than 5 years had the highest risk, with HRs of 0.50 (0.48, 0.51) and 1.78 (1.72, 1.83), respectively. The risk of CVD was relatively low in those who used only one of the long-acting BZDs, short-acting BZDs, or Z-hypnotics compared to unexposed individuals. Individuals exposed to all three types of drugs had the highest risk, 2.33 (2.22, 2.44) times that of non-users. Users below the median dose had a lower risk of CVD compared to non-users, whereas users exceeding the median dose had an increased risk. BZD or Z-hypnotic use in general was nominally associated with an elevated risk of CVD. However, for short-term, single-type, and low-to-moderate-dose users, not only did this elevated risk disappear, but drug use also demonstrated a protective effect.

Life's Essential 8, genetic susceptibility, and risk of incident pancreatic cancer: A prospective cohort study.

The association between the American Heart Association (AHA) Life's Essential 8 (LE8) and the risk of pancreatic cancer (PC) remains unclear. Our goal was to assess the relationships between LE8, genetic susceptibility, and PC risk. This cohort consisted of 234,102 participants from the UK Biobank. The components of LE8 include diet, nicotine exposure, sleep, physical activity, blood glucose, body mass index, blood lipids, and blood pressure. LE8 is classified into three categories: low cardiovascular health (CVH), moderate CVH, and high CVH. Measurements were made using Cox proportional risk models to estimate impact of associations between LE8, genetic susceptibility, and incidence of PC in participants. Compared to participants with low LE8 scores, those with moderate and high LE8 scores had a 53% (HR, 0.47; 95% CI, 0.39-0.57) and 70% (HR, 0.30; 95% CI, 0.22-0.41) lower risk of developing PC, respectively. Interestingly, among individuals with high genetic risk, high LE8 scores were associated with greater benefits (HR, 0.24; 95% CI, 0.15-0.40), whereas the protective effect was weaker among those with low genetic risk (HR, 0.40; 95% CI, 0.21-0.75). Participants with a high LE8 score and a low polygenic risk score (PRS) had the lowest risk of PC (HR, 0.19; 95% CI: 0.11-0.33). Furthermore, we observed a significant additive interaction between LE8 and PRS. A higher LE8 score is associated with a lower risk of PC, especially for participants with a high PRS. These findings have important implications for participants most genetically predisposed to PC and for targeted strategies for PC prevention.

Eight-year total, cognitive-affective, and somatic depressive symptoms trajectories and risks of cardiac events

In this study, we analyzed pooled data from two prospective population-based cohorts—the Health Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA)—to explore the association between trajectories of depressive symptoms and the risk of cardiac events. Depressive symptoms were assessed using the 8-item CES-D scale and categorized into somatic and cognitive-affective subtypes. Trajectories were tracked for four surveys from baseline. Heart disease was identified based on self-reported physician-diagnosed conditions. Hazard ratios and 95% confidence intervals were calculated with Cox proportional risk models that adjusted for potential confounders. In total, 17,787 subjects (59.7% female, median age 63 years) were enrolled at baseline. During a 10-year follow-up, 2409 cases of heart disease were identified. Participants with fluctuating (HR = 1.13, 95% CI: 1.06–1.20), increasing (HR = 1.43, 95% CI: 1.25–1.64), and consistently high (HR = 1.64, 95% CI: 1.45–1.84) depressive symptom trajectories exhibited an increased risk of heart disease compared to those with consistently low depressive symptoms, while a decreasing (HR = 1.07, 95% CI: 0.96–1.19) depressive symptom trajectory did not significantly affect the risk of heart disease. Moreover, the association between heart disease and somatic depressive symptoms was found to be stronger than with cognitive-affective symptoms. These findings suggest a significant link between depressive symptom trajectories and heart disease, with particular emphasis on stronger associations with somatic symptoms. It is recommended that the identification and management of depressive symptoms be incorporated into heart disease prevention strategies.

Delirium Mediated the Association Between a History of Falls and Short-Term Mortality Risk in Critically Ill Ischemic Stroke Patients.

Patients with ischemic stroke have an increased propensity to fall, resulting in significant physical and psychological distress. This study examined the association between falls in the 3 months prior to intensive care unit (ICU) admission and mortality within 28 days among 2950 adult ICU patients diagnosed with ischemic stroke from 2008 to 2019, focusing on the potential mediating role of delirium. The primary outcomes were short-term mortality (28, 60, and 90 days) and the risk of delirium. Each patient was followed for at least 1 year. Delirium was primarily assessed using the Confusion Assessment Method for the ICU and by reviewing nursing notes. Group differences between patients with and without a history of falls were compared using the Wilcoxon rank-sum test or the chi-squared test. Cox proportional risk or logistic regression models were used to explore the association between fall history and outcomes, and causal mediation analysis was performed. Results showed that patients with a recent fall history had a significantly increased risk of 28-day (hazard ratio [HR]: 1.62, 95% confidence interval [CI]: 1.35-1.94), 60-day (HR: 1.67, 95% CI: 1.42-1.98), and 90-day mortality (HR: 1.66, 95% CI: 1.41-1.95), as well as an increased risk of delirium (odds ratio: 2.00, 95% CI: 1.66-2.42). Delirium significantly mediated the association between fall history and 28-day mortality (total effect: HR: 1.77, 95% CI: 1.45-2.16; natural indirect effect: HR: 1.12, 95% CI: 1.05-1.21; proportion mediated: 24.6%). These findings suggest that ischemic stroke patients with a recent fall have an increased risk of short-term mortality, partly mediated by delirium. Strategies aimed at preventing delirium may potentially improve prognosis in this patient population.

Resistant hypertension and the risk of major adverse cardiac and cerebrovascular events in outpatients

Objective: To investigate the prevalence and associated risk of cardiovascular event of resistant hypertension in treated outpatients. Methods: This study was a nationwide multi-center prospective cohort study. The participants were treated outpatients enrolled in the China Nationwide Ambulatory and Home Blood Pressure Registry study of 42 hospitals in 19 provinces across the country from August 2009 to October 2017. Apparent resistant hypertension was defined as uncontrolled office blood pressure (≥140/90 mmHg, 1 mmHg=0.133 kPa) in spite of the use of three antihypertensive drugs or controlled office blood pressure (<140/90 mmHg) with four antihypertensive drugs or more. Subjects diagnosed with uncontrolled office blood pressure were further subdivided as pseudo-resistant hypertension and true resistant hypertension based on 24 h ambulatory blood pressure monitoring. The primary endpoint was fatal and non-fatal cardiovascular and cerebrovascular events, which was a composite endpoint consisting of cardiovascular and cerebrovascular death, ischemic and hemorrhagic stroke, myocardial infarction, coronary artery revascularization, unstable angina, heart failure, and coronary artery stenosis≥50% confirmed by coronary angiography. Secondary outcomes included fatal and non-fatal stroke or cardiac events. Patients with controlled office blood pressure after taking only 1 or 2 antihypertensive drugs were included as control. Kaplan-Meier survival curves, log-rank test, and Cox proportional risk model were used to evaluate the risk of apparent refractory hypertension in relation to cardiovascular and cerebrovascular prognosis. Results: A total of 2 782 treated hypertensive patients, aged (58.1±12.3) years were enrolled, including 1 403 (50.4%) men. The prevalence of apparent and true resistant hypertension was 15.1% (420/2 782) and 10.5% (293/2 782), respectively. Among patients with apparent resistant hypertension, during a median of 5 years follow-up, the cumulative incidence rate was 28.2, 11.2 and 19.1 per 1 000 person-years for fatal and non-fatal cardiovascular events (n=58), stroke (n=24) and cardiac events (n=40), respectively. The Kaplan-Meier curve and log-rank test showed that those patients with true resistant hypertension, had the highest cumulative incidence rate of fatal and non-fatal cardiovascular events, stroke, and cardiac events. Multivariable Cox regression analyses showed that true resistant hypertension was associated with a significantly higher risk of fatal and non-fatal cardiovascular events (HR=1.73, 95%CI 1.17-2.56, P=0.006) and stroke (HR=2.81, 95%CI 1.53-5.17, P=0.001). Conclusion: Resistant hypertension, especially true resistant hypertension, is associated with a higher risk of fatal and non-fatal cardiac and cerebrovascular events.

Relationship of the trajectory of the triglyceride-glucose index with heart failure: the Kailuan study

BackgroundA high triglyceride-glucose index (TyG) is associated with a higher risk of incident heart failure. However, the effects of longitudinal patterns of TyG index on the risk of heart failure remain to be characterized. Therefore, in the present study, we aimed to characterize the relationship between the trajectory of TyG index and the risk of heart failure.MethodsWe performed a prospective study of 56,149 participants in the Kailuan study who attended three consecutive surveys in 2006–2007, 2008–2009, and 2010–2011 and had no history of heart failure or cancer before the third wave survey (2010–2011). The TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2], and we used latent mixture modeling to characterize the trajectory of the TyG index over the period 2006–2010. Additionally, Cox proportional risk models were used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for incident heart failure for the various TyG index trajectory groups.ResultsFrom 2006 to 2010, four different TyG trajectories were identified: low-stable (n = 13,554; range, 7.98–8.07), moderate low-stable (n = 29,435; range, 8.60–8.65), moderate high-stable (n = 11,262; range, 9.31–9.30), and elevated-stable (n = 1,898; range, 10.04–10.25). A total of 1,312 new heart failure events occurred during a median follow-up period of 10.04 years. After adjustment for potential confounders, the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident heart failure for the elevated-stable, moderate high-stable, and moderate low-stable groups were 1.55 (1.15, 2.08), 1.32 (1.08, 1.60), and 1.17 (0.99, 1.37), respectively, compared to the low-stable group.ConclusionsHigher TyG index trajectories were associated with a higher risk of heart failure. This suggests that monitoring TyG index trajectory may help identify individuals at high risk for heart failure and highlights the importance of early control of blood glucose and lipids for the prevention of heart failure.

Dietary antioxidant and inflammatory potential in asthmatic patients and its association with all-cause mortality

BackgroundThe occurrence and progression of asthma can be influenced by the components in food. Our study aims to determine whether dietary antioxidant and inflammatory potential are associated with the risk of mortality in asthma patients.MethodsParticipants from the 2001–2018 National Health and Nutrition Examination Survey (NHANES) aged 20 years and older with a diagnosis of asthma were included. Mortality status was obtained according to death certificate records from the National Death Index. The antioxidant and inflammatory potential of the diet was assessed using two widely used and dependable indices, Composite Dietary Antioxidant Index (CDAI) and Dietary Inflammatory Index (DII). Restricted cubic spline (RCS) regression was used to analyze the non-linear relationship between the two indexes and mortality. Multivariable Cox proportional risk models were used to estimate hazard ratio and 95% confidence intervals for mortality. Finally, the relationship between CDAI and DII was analyzed.ResultsA total of 4698 NHANES participants represented 23.2 million non-institutionalized residents of the US were enrolled in our study. Patients with higher CDAI or lower DII exhibited longer survival times. RCS regression showed a linear relationship of CDAI or DII with mortality. In the Cox regression, both crude and adjusted models demonstrated that higher CDAI or lower DII was linked to a reduced risk of all-cause mortality. Similar associations were found in subgroup analysis. Finally, a negative relationship was found between CDAI and DII.ConclusionReducing pro-inflammatory or increasing antioxidant diets could reduce all-cause mortality among adult asthma patients.

Detailed pathological characteristics and survival prognosis of patients with penile cancer from a high-capacity tertiary referral centre over a 20-year period.

120 Background: Penile cancer is a rare cancer that affects 0.1-1 per 100,000 men in developed countries. However, data on this cancer in developing countries, particularly in Asian populations, are lacking. A retrospective study is needed to determine the characteristics of penile cancer patients, tumor-related treatments, and prognosis. The objective of our study was to present statistical results that are applicable to an Asian population under the most recent staging system. Additionally, we aimed to report on the pathological characteristics and prognosis of a large sample of patients with penile cancer who underwent long-term follow-up with the standard extent of radical dissection. Methods: This study retrospectively analyzed clinical and pathological data from 1017 patients who were diagnosed with penile cancer at Sun Yat-sen University Cancer Center between October 2001 and October 2023. The primary study endpoint was overall survival (OS), and the secondary endpoint was progression-free survival (PFS). Survival curves were plotted using the Kaplan‒Meier method, and differences were compared using the log-rank test. Univariate and multivariate Cox proportional risk models were used to analyze the factors associated with tumor survival. Results: The average follow-up time was 50 months (range: 0.6-232.8 months). The 5- and 10-year OS rates were 67.3% and 62.7%, respectively, and the 5- and 10-year PFS rates were 63.9% and 61.1%, respectively. After excluding 127 Tx patients and 23 TIS stage patients, the 10-year OS rates of pTa stage (29 patients), pT1 (305 patients), pT2 stage (217 patients), pT3 stage (271 patients), and pT4 stage (45 patients) patients were 96.3%, 80.1%, 61.7%, 55.4%, and 14.2%, respectively. A total of 690 patients underwent standard lymph node dissection. The 10-year OS rates of pN0 (376 patients), pN1 (111 patients), pN2 (78 patients), and pN3 (125 patients) patients were 92.7%, 62.5%, 48.1% and 31.3%, respectively. The results of the multifactorial analysis revealed that T stage (T4 stage versus Ta-T1 stage: HR=2.38, 95% CI: 1.00~5.66, P=0.05), pathological grade (G3~4 grade versus G1~2 grade: HR=1.63, 95% CI: 1.05~2.53, P=0.027), N stage (pN+ versus pN0: HR=14.11, 95% CI: 7.83~25.43, P&lt;0.001), and white blood cell count (WBC&gt;8.5: HR=1.71, 95% CI: 1.17~2.51, P=0.006) were independent prognostic factors in penile cancer patients. Conclusions: Patients with penile cancer had better long-term OS after standard lymph node dissection. The adverse factors were T stage, pathological grade, extent of lymph node metastasis, and preoperative WBC count. Identifying high-risk patients through preoperative evaluation can improve long-term survival rates. Radical lymph node dissection in the early stage has more curative value, and adjuvant therapy should be provided in patients with advanced-stage disease after surgery.

Risk and mediation analyses of hemoglobin glycation index and survival prognosis in patients with sepsis.

An increasing number of studies have reported the close relation of the hemoglobin glycation index (HGI) with metabolism, inflammation, and disease prognosis. However, the prognostic relationship between the HGI and patients with sepsis remains unclear. Thus, this study aimed to analyze the association between the HGI and all-cause mortality in patients with sepsis using data from the MIMIC-IV database. In this study, 2605 patients with sepsis were retrospectively analyzed. The linear regression equation was established by incorporating glycated hemoglobin (HbA1c) and fasting plasma glucose levels. Subsequently, the HGI was calculated based on the difference between the predicted and observed HbA1c levels. Furthermore, the HGI was divided into the following three groups using X-tile software: Q1 (HGI ≤ - 0.50%), Q2 (- 0.49% ≤ HGI ≤ 1.18%), and Q3 (HGI ≥ 1.19%). Kaplan-Meier survival curves were further plotted to analyze the differences in 28-day and 365-day mortality among patients with sepsis patients in these HGI groups. Multivariate corrected Cox proportional risk model and restricted cubic spline (RCS) were used. Lastly, mediation analysis was performed to assess the factors through which HGI affects sepsis prognosis. This study included 2605 patients with sepsis, and the 28-day and 365-day mortality rates were 19.7% and 38.9%, respectively. The Q3 group had the highest mortality risk at 28days (HR = 2.55, 95% CI: 1.89-3.44, p < 0.001) and 365days (HR = 1.59, 95% CI: 1.29-1.97, p < 0.001). In the fully adjusted multivariate Cox proportional hazards model, patients in the Q3 group still displayed the highest mortality rates at 28days (HR = 2.02, 95% CI: 1.45-2.80, p < 0.001) and 365days (HR = 1.28, 95% CI: 1.08-1.56, p < 0.001). The RCS analysis revealed that HGI was positively associated with adverse clinical outcomes. Finally, the mediation effect analysis demonstrated that the HGI might influence patient survival prognosis via multiple indicators related to the SOFA and SAPS II scores. There was a significant association between HGI and all-cause mortality in patients with sepsis, and patients with higher HGI values had a higher risk of death. Therefore, HGI can be used as a potential indicator to assess the prognostic risk of death in patients with sepsis.

Novel Classification of Cardiovascular Disease Subtypes Reveals Associations Between Mortality and Polyunsaturated Fatty Acids: Insights from the United Kingdom Biobank Study

BackgroundTraditional association studies of cardiovascular disease (CVD) categorizations and polyunsaturated fatty acids (PUFAs) yielded conflicting findings. We propose a novel classification system based on fundamental characteristics of cardiovascular patients, such as age, body mass index, waist–hip ratio, to more accurately assess the impact of PUFAs (plasma measures) such as omega (ω)-3 (n–3) and ω-6 on mortality in cardiovascular patients. MethodsPrincipal component analysis and k-means clustering were used to determine the CVD subtype. Variables included age, body mass index, waist–hip ratio, diastolic blood pressure, systolic blood pressure, total cholesterol, total triglycerides, high-density lipoprotein-cholesterol, apolipoprotein B:apolipoprotein A1, glycated hemoglobin, creatinine, albumin, C-reactive protein, white blood cell count, platelet count, and hemoglobin concentration. The association of PUFAs with all-cause, cardiovascular, and ischemic heart disease (IHD) mortality in patients with CVD was prospectively evaluated using restricted cubic splines and Cox proportional risk models. ResultsAmong the 35,096 participants, 3,786 fatalities occurred. Three distinct CVD subtypes were identified, with cluster 3 characterized by older age, male gender, and low high-density lipoprotein-cholesterol, having the highest risk of mortality. Clusters 2 and 3 had the highest DHA and ω-6/ω-3 ratios, respectively, compared with Cluster 1. The protective effects of total PUFAs, ω-3, and DHA were mainly reflected in all-cause mortality and were more significant in clusters 2 and 3. Furthermore, the ω-6/ω-3 ratio of the highest quartile increased risk of all-cause [Q3: hazard ratio (HR): 1.14, 95% confidence interval [CI]: 1.00, 1.29; Q4: HR: 1.41, 95% CI: 1.24, 1.61], CVD (Q4: HR: 1.36, 95% CI: 1.07, 1.75), and IHD mortality (Q4: HR: 1.17, 95% CI: 1.12, 2.03) in cluster 3 compared with the first quartile. ConclusionsOur findings highlight the heterogeneity of associations observed for the same type of PUFAs across distinct clusters. This association may be elucidated by the intricate interplay of various factors, encompassing inflammation, lipid metabolism, and cardiovascular health.

Relationship between creatinine–cystatin C ratio and all-cause mortality in hospitalized patients with COVID-19: A prospective study in China

BackgroundThis study was conducted to investigate whether baseline creatinine–cystatin C ratio is associated with all-cause mortality in adult Chinese patients hospitalized with coronavirus disease 2019. MethodsThis study included 933 patients with coronavirus disease 2019 who were admitted to The Affiliated Hospital of Guangdong Medical University between December 2022 and March 2023. All-cause mortality was determined by telephone follow-up after 28 days. Multivariate Cox proportional risk models were used to investigate the relationship between baseline creatinine–cystatin C ratio and all-cause mortality. Restricted cubic spline and two-piecewise Cox proportional hazards risk models were used to identify non-linear correlations. ResultsOf the 933 patients, 128 died during the 28 days follow-up. The restricted cubic spline analysis of hospitalized patients with coronavirus disease 2019 revealed an L-shaped association between baseline creatinine–cystatin C ratio and all-cause mortality, with a threshold creatinine–cystatin C ratio of ≤0.93 predicting all-cause mortality. Specifically, a baseline creatinine–cystatin C ratio below this threshold value was negatively correlated with mortality (hazard ratio 0.12, 95 % confidence interval 0.03–0.48), but a creatinine–cystatin C ratio >0.93 was not correlated with mortality (hazard ratio 1.29, 95 % confidence interval 0.65–2.55). ConclusionsIn Chinese adult patients hospitalized with coronavirus disease 2019, an L-shaped relationship was observed between the baseline creatinine–cystatin C ratio and all-cause mortality.

Immunohistochemistry identifies E-cadherin, N-cadherin and focal adhesion kinase (FAK) as predictors of stage I non-small cell lung carcinoma spread through the air spaces (STAS), and the combinations as prognostic factors.

Spread through air spaces (STAS) is one of the multiple modes of lung cancer dissemination, yet its molecular and clinicopathological characterization remains poorly studied. This study aimed to investigate the effect of adhesion molecule expression levels on the incidence of STAS and postoperative recurrence in stage I lung cancer patients undergoing radical resection. E-cadherin, P-cadherin, N-cadherin, focal adhesion kinase (FAK), epithelial cell adhesion molecule (EpCAM), neural cell adhesion molecule 1 (NCAM1), vascular cell adhesion molecule 1 (VCAM1), intercellular cell adhesion molecule-1 (ICAM-1) were analyzed retrospectively using immunohistochemistry in patients undergoing radical resection for stage I non-small cell lung cancer (NSCLC). Patients were categorized into four groups based on adhesion molecule expression levels: "low/low", "high/low", "low/high", and "high/high", and the group with the lowest recurrence-free probability (RFP) was defined as high risk. Associations between those adhesion molecules' expression levels and STAS were determined by using the Chi-squared test and logistic regression model. RFP was analyzed by using the log-rank test and Cox proportional risk model. As of January 1, 2024, 12 of 60 patients undergoing radical resection for stage I lung carcinoma had a disease recurrence. All 60 patients' tissue specimens were retrospectively analyzed, and there were no significant differences between patients with STAS-positive (n=30) and STAS-negative (n=30) in baseline clinicopathologic features, except for histological growth patterns. We found that low expression of E-cadherin, high expression of N-cadherin and FAK, and males were independent predictors of higher incidence of STAS. Multivariate Cox analysis showed that tumors with low E-cadherin/high N-cadherin, low E-cadherin/high FAK, and high N-cadherin/high FAK expression were important predictors of recurrence in patients with stage I lung carcinoma. In addition, females and high N-cadherin/high FAK were associated with a high risk of recurrence in patients with STAS. E-cadherin, N-cadherin, and FAK are predictors of STAS occurrence in stage I NSCLC, and their combinations are prognostic factors. The discovery of these molecular markers provides clinicians with a reliable means that may help in the early identification of individuals with a higher risk of recurrence in lung cancer patients, targeting personalized treatment plans such as aggressive adjuvant therapy or closer follow-up.