Lower Mortality Risk Research Articles

Association between riboflavin intake and the risk of all-cause mortality of patients with chronic kidney disease: A retrospective cohort study.

Current studies have not clarified the relationship between riboflavin intake and all-cause mortality in patients with chronic kidney disease (CKD). The aim of this study is to investigate whether there is an association between riboflavin intake and the risk of all-cause mortality in patients with CKD. This was a retrospective cohort study with data extracted from the National Health and Nutrition Examination Survey (NHANES). The study was conducted using Cox regression analysis to calculate hazard ratio (HR) and 95% confidence interval (CI) to assess the association between riboflavin intake and risk of all-cause mortality. Subgroup analyses were performed regarding gender, CKD stage, hypertension, hyperlipidemia and cardiovascular disease (CVD). A total of 3750 patients were ultimately included in the analyses. After excluding potential confounders, lower intake of riboflavin was associated with the higher risk of all-cause mortality (Q1: HR = 1.33, 95% CI: 1.05-1.69). The similar association was also found in patients at mild/moderate stage (HR = 1.32, 95% CI: 1.05-1.66), in female (HR = 1.35, 95% CI: 1.01-1.81), with hypertension (HR = 1.37, 95% CI: 1.07-1.75), CVD (HR = 1.48, 95% CI: 1.08-2.03), and dyslipidemia (HR = 1.29, 95% CI: 1.01-1.66). This study found the association between low riboflavin intake and high risk of all-cause mortality, indicating a potential beneficial role of riboflavin in CKD patients.

Left Atrial Plasty in Surgical Treatment of Combined Mitral-Aortic-Tricuspid Valve Diseases Complicated by Left Atrial Dilation

The aim. To study the possibilities of various techniques of the left atrial (LA) plasty in the correction of combined mitral-aortic-tricuspid valve diseases (cMATVD) in the presence of left atrial dilation (LAD). Materials and methods. The analysis included the results of surgical treatment of 360 patients with cMATVD combined with LAD, who were operated on at the National Amosov Institute of Cardiovascular Surgery from January 1, 2006 to January 1, 2023. The main group consisted of 73 patients who underwent cMATVD correction combined with original triangular plasty of LA. The comparison group included 287 patients who underwent only cMATVD correction in the presence of concomitant LAD. Results. Of the 73 operated patients in the main group, 3 died at the hospital stage (mortality rate 4.1%). The dynamics of echocardiographic parameters at the stages of treatment were as follows: left ventricular (LV) end- systolic index (ml/m2): 69.1 ± 12.1 (before surgery), 59.3 ± 8.5 (after surgery), and 48.4 ± 9.5 (long-term period); LV ejection fraction (%): 51.0 ± 5.0 (before surgery), 54.0 ± 5.0 (after surgery), and 56.0 ± 4.0 (long-term period); LA diameter (mm): 64.8 ± 4.1 (before surgery), 50.3 ± 2.1 (after surgery), and 51.2 ± 2.2 (long-term period). Of the 287 operated patients in the comparison group, 9 died (mortality rate 3.1%). The dynamics of echocardiographic parameters at the stages of treatment were as follows: LV end-systolic index (ml/m2): 68.3 ± 11.3 (before surgery), 60.4 ± 9.3 (after surgery), and 52.7 ± 7.2 (remote period); LV ejection fraction (%): 52.0 ± 5.0 (before surgery), 53.0 ± 5.0 (after surgery), and 50.0 ± 4.0 (remote period); LA diameter (mm): 65.5 ± 3.7 (before surgery), 64.1 ± 3.3 (after surgery), and 72.5 ± 2.8 (remote period). In the remote period, thromboembolic complications occurred in 5 (7.7%) patients of the main group (1 severe, 1 mild, and 3 fatal) and 25 (9.3%) patients of the comparison group (10 severe, 6 mild, and 9 fatal). The thromboembolic complications rates indicate the advisability of LA plasty simultaneously with resection of its appendage. Conclusions. In the correction of LAD, all plastic reconstructions of the dilated LA are low-traumatic and effective procedures that lead to a significant improvement in the morphometry of the LA both at the hospital stage and in the remote period. The methods are associated with low risk of hospital mortality, as well as a low level of thromboembolic complications in the remote period. In all methods of LA plasty, its appendage was resected, which also excluded conditions for thrombus formation.

Improved Disease-Specific Survival in Lentigo Maligna Treated with Mohs Surgery over Wide Local Excision: A Retrospective Cohort Analysis.

Lentigo maligna (LM), a subtype of melanoma in situ, typically occurs on sun-damaged skin of the head and neck in older men. Using the SEER database, the aim of this study was to compare disease-specific survival (DSS) outcomes between patients treated with wide local excision (WLE) and Mohs micrographic surgery (MMS), finding – on multivariable analysis – that MMS demonstrated improved 5- and 10-year DSS rates and a lower disease-specific mortality risk than WLE. Our findings highlight a potential DSS benefit of MMS for treating LM, although further research is required to confirm these findings and explore factors influencing treatment choices.

Real-word outcomes for high-risk non-muscle-invasive bladder cancer: screened patients for the BRAVO trial.

To report real-world outcomes for high-risk non-muscle-invasive bladder cancer (HRNMIBC), including bacillus Calmette-Guérin (BCG) and radical cystectomy (RC), as randomised comparisons of these have not been possible. We detail consecutive participants screened for the BRAVO randomised controlled trial comparing RC with BCG (International Standard Randomised Controlled Trial Number [ISRCTN]12509361). Patients were prospectively registered and case-note review used for outcomes. The primary outcome was overall survival. Secondary outcomes included recurrence, progression, metastasis, and bladder cancer-specific survival. A total of 193 patients were screened, including 106 (54.9%) who received BCG, 43 (22.3%) primary RC, 37 (19.2%) 'other' treatment and seven (3.6%) hyperthermic intravesical mitomycin C. All-cause death occurred in 55 (28.5%) patients at median (interquartile range [IQR]) of 29.0 (19.5-42.0) months. In multivariable analysis, overall mortality was more common in older patients (hazard ratio [HR] 2.63, 95% confidence interval [CI] 1.35-5.13; Cox P = 0.004 for age >70 years), those recruited from district hospitals (HR 0.53, 95% CI 0.3-0.95; P = 0.032) and those who did not undergo RC as their first treatment (HR 2.16, 95% CI 1.17-3.99; P = 0.014). In all, 17 (8.8%) patients died from bladder cancer (BC) at median (IQR) of 22.5 (19-36.25) months. In multivariable analysis, BC-specific mortality was more common in older patients (HR 4.87, 95% CI 1.1-21.6; P = 0.037) and those with Tis/T1 disease (HR 2.26, 95% CI 1.23-4.16; P = 0.008) but did not vary with initial treatment. Patients with HRNMIBC are at high-risk of mortality. Those choosing RC as their initial treatment have lower risks of mortality than others, although this may reflect fitness and selection.

Adherence to clinical care standards and mortality after hip fracture surgery in New South Wales, 2015-2018: a retrospective population-based study.

To determine whether adherence to hip fracture clinical care quality indicators influences mortality among people who undergo surgery after hip fracture in New South Wales, both overall and by individual indicator. Retrospective population-based study; analysis of linked Australian and New Zealand Hip Fracture Registry (ANZHFR), hospital admissions, residential aged care, and deaths data. People aged 50 years or older with hip fractures who underwent surgery in 21 New South Wales hospitals participating in the ANZHFR, 1 January 2015 - 31 December 2018. Thirty-day (primary outcome), 120-day, and 365-day mortality (secondary outcomes) by clinical care indicator adherence level (low: none to three of six indicators achieved; moderate: four indicators achieved; high: five or six indicators achieved) and by individual indicator. Registry data were available for 9236 hip fractures in 9058 people aged 50 years or older during 2015-2018; the mean age of patients was 82.8 years (standard deviation, 9.3 years), 5510 patients were women (69.4%). Complete data regarding adherence to clinical care indicators were available for 7951 fractures (86.1%); adherence to these indicators was high for 5135 (64.6%), moderate for 2249 (28.3%), and low for 567 fractures (7.1%). After adjustment for age, sex, comorbidity, admission year, pre-admission walking ability, and residential status, 30-day mortality risk was lower for high (adjusted relative risk [aRR], 0.40; 95% confidence interval [CI], 0.30-0.52) and moderate indicator adherence hip fractures (aRR, 0.61; 95% CI, 0.46-0.82) than for low indicator adherence hip fractures, as was 365-day mortality (high adherence: aRR, 0.59 [95% CI, 0.51-0.68]; moderate adherence: aRR, 0.74 [95% CI, 0.63-0.86]). Orthogeriatric care (365 days: aRR, 0.78; 95% CI, 0.61-0.98) and offering mobilisation by the day after surgery (365 days: aRR, 0.74; 95% CI, 0.67-0.83) were associated with lower mortality risk at each time point. Clinical care for two-thirds of hip fractures attained a high level of adherence to the six quality care indicators, and short and longer term mortality was lower among people who received such care than among those who received low adherence care.

Preventive Aortic Stent Graft Implantation Prior to Thoracic Surgery: Early and Midterm Results

Background: There is a paucity of data concerning the feasibility and value of thoracic aortic stent graft implantation (TEVAR) applications for removing tumors infiltrating the aortic wall. This analysis aimed to demonstrate the feasibility of TEVAR and monitor the perioperative risks of morbidity and mortality. Additionally, a literature review was performed. Methods: A retrospective data analysis was performed on patients who received TEVAR prior to thoracic malignancy resection between January 2010 and April 2024. The primary endpoint was technical success. Results: A total of 15 patients (median age: 67 years; range: 23–75; 66.7% female) received TEVAR prior to thoracic surgery of different tumor entities. In 80% of cases (n = 12), the proximal landing zone was in aortic zone 3. In three cases, the supra-aortic debranching of LSA and/or LCCA via bypass implantation or in situ laser fenestration was necessary. No postoperative endograft-related complications were observed. In eight patients, aortic wall infiltration was confirmed intraoperatively. In total, R0 resection was achieved in seven patients (46.7%). The 30-day mortality rate was 6.7% (n = 1). Technical success was achieved in all patients (100%), while procedural success was achieved in 80% due to incomplete tumor resection in three patients. Conclusions: To the best of our knowledge, this is the largest analysis to date that confirms the results of previous smaller studies. Aortic stent grafting prior to thoracic tumor resection allows for extensive resection while maintaining low morbidity and a low 30-day mortality risk.

Progression from Non-alcoholic Steatohepatitis to Advanced Liver Diseases and Mortality Among Medicare Patients.

Non-alcoholic steatohepatitis (NASH) may progress to more advanced liver disease. This study aimed to characterize NASH progression and mortality in the Medicare population. Patients with NASH in 100% Medicare fee-for-service claims accrued from2015-2021 who were≥66years old at index diagnosis, continuously enrolled for≥12months prior to and≥6months following index (unless death), and had no evidence of other causes of liver disease were included. Diagnosis codes defined severity states: non-cirrhotic NASH, compensated cirrhosis (CC), decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC), and liver transplant (LT). Survival analyses of disease progression and mortality were conducted for each state and by year of progression (Y1-5). Cox proportional hazards models assessed risk factors of worsening disease. Mean age and follow-up were 72.2 and 2.8years in 14,806 unique patients (n=12,990 NASH; 1899 CC; 997 DCC; 209 HCC; 140 LT). Progression rates were highest for patients with CC (11-37% for Y1-5), followed by DCC (3-18%), NASH (3-12%), and HCC (2-4%). Mortality rates were highest for patients with HCC (41-85% for Y1-5), followed by DCC (41-76%), LT (7-33%), CC (6-26%), and NASH (2-12%). Patients with any disease progression had a 5-year mortality rate more than double that of patients without progression (41% vs. 16%). Delayed progression from NASH was associated with lower mortality risk; the 5-year mortality rate was 26% lower for patients with progression in Y2 vs. Y1 (32% vs. 43%) and further decreased for progression in Y3-Y5. Risk factors included age, nursing home use, congestive heart failure, coagulopathy, fluid/electrolyte disorders, and unexplained weight loss. Medicare patients≥66years with NASH experience high risk of disease progression associated with increased mortality rates. Slower disease progression is associated with lower mortality rates, suggesting that therapies that can delay or prevent NASH progression may reduce morbidity and mortality.

Barriers to Type 1 Diabetes Adherence in Adolescents.

Background: Adolescence is a particularly crucial period of physical, emotional, and social development and adaptation, rendering these formative years rather challenging for individuals with chronic conditions like type 1 diabetes (T1D). Despite rapid improvement in diabetes therapies, adolescents with T1D are characterized by poorer adherence to treatment regimens compared with other pediatric age groups. Insufficient adherence is strongly related to low diabetes control, increasing morbidity, and risk for premature mortality. This study aimed to provide a comprehensive overview of adolescents' most common barriers to T1D adherence, stressing the need for a deep and comprehensive understanding of these barriers. The complexity of these barriers is underscored by the diverse factors contributing to poor T1D adherence in adolescents. Methods: A narrative review was conducted, surveying four databases (PubMed, Scopus, EMBASE, and Web of Science) for full-text articles in the English language published up to June 2024. All studies related to barriers to T1D adherence in adolescents were considered. The literature was selected using selection and exclusion criteria and extracted and organized using Mendeley. Exclusion criteria included studies with insufficient data and non-peer-reviewed articles. This review revealed that adolescents face numerous obstacles to T1D adherence related to psychological factors, flux in family dynamics, perceived social pressures, therapy-related factors, transitioning responsibility, risk-taking behaviors, and pubertal changes. Conclusions: Navigating the adaptations to the different aspects of T1D, from treatment to complications and adolescents' personal growth, effectively requires a thorough understanding of the barriers of a treatment regimen that patients at this critical age face.

Abstract C039: Nativity and breast cancer outcomes by breast cancer subtype in the ENCLAVE Study

Abstract Background: Associations of nativity and breast cancer (BC) mortality are mixed in studies using cancer registry data. We examined associations in diverse women with detailed individual-level data on BC treatment and subtype. Methods: The study population included 5,718 Asian (n=722, 71% foreign-born), Hispanic (n=631, 42% foreign-born), and non-Hispanic White (n=4,365, 9% foreign-born) women from the ENCLAVE Study diagnosed with invasive BC from 1996-2013 using pooled, harmonized data from two (of three) cohorts with data on BC subtype. Data on nativity, reproductive and behavioral factors were self-reported from questionnaires; data on disease severity, BC subtype (luminal A, luminal B, Her2 expressing, triple negative breast cancer), treatment, and mortality were obtained from cancer registries and electronic health records. Recurrences were identified by recurrence algorithms and medical record review. We fit Cox proportional hazards regression models to examine associations between self-reported nativity and recurrence, BC-specific mortality, and overall mortality. Covariates included age, sociodemographic factors, disease severity, and treatment, reproductive and behavioral factors. We also examined associations by race, ethnicity, and BC subtype. Results: Compared to US-born women, foreign-born women had lower total mortality (hazard ratio [HR]=0.75, 95% confidence interval [CI]: 0.64-0.89); lower risks were suggested for recurrence (HR=0.85, 95% CI: 0.68-1.06) and breast cancer-specific mortality (HR=0.87, 95% CI: 0.66-1.14). Stratified by BC subtype, foreign- (vs. US-) born women had a lower risk of overall mortality among those with luminal A (HR=0.72, 95% CI: 0.56-0.92) and luminal B (HR=0.66, 95% CI: 0.48-0.91) but not other subtypes. Among women with luminal B BC, these associations reached statistical significance for recurrence (HR=0.65, 95% CI: 0.45-0.94) and BC-specific mortality (HR=0.53, 95% CI: 0.33-0.84). We noted no associations in other BC subtypes though analyses of less common subtypes were underpowered. Associations did not differ by race or ethnicity. Conclusion: Foreign-born women with BC had lower risk of overall mortality than US-born women. Risks of recurrence and BC-specific mortality were lower in foreign-born vs. US-born women among those with the luminal B BC subtype. Associations were not explained by behavioral or reproductive factors. Citation Format: Candyce Kroenke, Rhonda Aoki, Stacey Alexeeff, Scarlett Gomez, Bette Caan, Brittany Morey, Jacqueline Torres, Larry Kushi. Nativity and breast cancer outcomes by breast cancer subtype in the ENCLAVE Study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C039.

Abstract A157: Age-related disparities in survival following colorectal cancer diagnosis in an underserved community in Georgia

Abstract Background: Significantly higher colorectal cancer (CRC) mortality exists in Augusta-Richmond County of Georgia, an area with a large proportion of underserved African Americans. Although age is one of the most important prognostic factors in cancer survival, age disparities in survival following CRC diagnosis have been understudied within geographic areas of Georgia. Thus, we examined overall survival (OS) rates following CRC diagnosis between 18-49, 50-59, 60-69, and 70+ age groups. We also determined whether age-specific differences were associated with OS and examined factors contributing to OS across these four age groups in a cancer center population in Augusta-Richmond County. Methods: A retrospective cohort analysis was performed using 2012-2022 data from the Georgia Cancer Center cancer registry linked with electronic medical records and billing data. OS following CRC diagnosis was the outcome of interest; those who survived until 2023 were censored. Cox proportional hazard regression was used to examine the mentioned associations in different age groups adjusted for sociodemographic characteristics (gender, race, marital status, insurance, county-level poverty), health-related factors (body mass index, smoking status, alcohol use, chronic disease conditions, family history of CRC/cancer), tumor characteristics (tumor grade, stage at diagnosis, primary site), and diagnosis year. Results: Among 839 CRC patients, OS rates were lowest among patients aged 70+ years (52.8%) followed by 60-69 (61.2%), 18-49 (63.7%), and 50-59 (65.2%) years (p <0.001). In the adjusted analysis, CRC patients aged 70+ years had a 2.1-fold increased risk of death due to all causes compared to those aged 18-49 years (HR, 2.1; 95% CI, 1.2-3.7). Regardless of age groups, CRC patients with a late stage at diagnosis were associated with increased risk of all causes of death by 2.0-5.7 times (18-49 year: HR, 4.9; 95% CI,2.7-8.8; 50-59 year: HR, 5.7; 95% CI,3.6-9.0; 60-69 year: HR, 5.3; 95% CI, 3.5-8.0; 70+ year: HR,2.0; 95% CI,1.3-3.0). Among patients aged 60-69 years, those living in poverty areas had an increased risk of all causes of death by 1.8-times (HR, 1.8; 95% CI, 1.2-2.7). However, having private insurance (HR, 0.3; 95% CI,0.2-0.5) was associated with lower risk of mortality by 69% for 50- 59 age group. Conclusion: Patients aged 70+ years reported lower OS rates. Late stage at diagnosis was strongly associated with increased risk of death regardless of age; significantly greater risk was observed at 50-59 age group followed by 60-69, 18-49, and 70+ age groups. In particular, poverty had an negative impact on the risk of death following CRC diagnosis for the 60-69 age group. The high mortality among patients aged 50 and older emphasizes the need for developing strategies for increasing the screening uptake and starting at earlier ages, particularly among the most vulnerable populations. Equally important are strategies to improve access to screening and treatment resources for patients with limited access to healthcare. Citation Format: Meng-Han Tsai, Jorge Cortes, Marlo Vernon, Elinita Pollard, Steven S. Coughlin, Yanbin Dong, Kenneth J. Vega. Age-related disparities in survival following colorectal cancer diagnosis in an underserved community in Georgia [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A157.

Lower mortality risk associated with remdesivir + dexamethasone versus dexamethasone alone for the treatment of patients hospitalized for COVID-19

Abstract Background Treatment guidelines were developed early in the pandemic when much about COVID-19 was unknown. Given the evolution of SARS-CoV-2, real-world data can provide clinicians with updated information. The objective of this analysis was to assess mortality risk in patients hospitalized for COVID-19 during the Omicron period receiving remdesivir+dexamethasone versus dexamethasone alone. Methods A large, multicenter US hospital database was used to identify hospitalized adult patients, with a primary discharge diagnosis of COVID-19 also flagged as “present on admission” treated with remdesivir+dexamethasone or dexamethasone alone from December 2021 to April 2023. Patients were matched 1:1 using propensity score matching and stratified by baseline oxygen requirements. Cox proportional hazards model was used to assess time to 14- and 28-day in-hospital all-cause mortality. Results A total of 33 037 patients were matched, with most patients ≥65 years old (72%), White (78%), and non-Hispanic (84%). Remdesivir+dexamethasone was associated with lower mortality risk versus dexamethasone alone across all baseline oxygen requirements at 14 days (no supplemental oxygen charges: adjusted hazard ratio [95% CI]: 0.79 [0.72-0.87], low flow oxygen: 0.70 [0.64-0.77], high flow oxygen/non-invasive ventilation: 0.69 [0.62-0.76], invasive mechanical ventilation/extracorporeal membrane oxygen (IMV/ECMO): 0.78 [0.64-0.94]), with similar results at 28 days. Conclusions Remdesivir+dexamethasone was associated with a significant reduction in 14- and 28-day mortality compared to dexamethasone alone in patients hospitalized for COVID-19 across all levels of baseline respiratory support, including IMV/ECMO. However, the use of remdesivir+dexamethasone still has low clinical practice uptake. In addition, these data suggest a need to update the existing guidelines.

Examining concordance with the guidelines of the national comprehensive cancer network for the treatment of endometrial cancer in Puerto Rico

BackgroundEndometrial cancer poses a significant health concern in Puerto Rico, where it ranks as the primary gynecological malignancy among women. This study evaluates concordance with the National Comprehensive Cancer Network (NCCN) guidelines for endometrial cancer first treatment in Puerto Rican women and its association with 5-year overall survival. MethodsData on patients with endometrial cancer diagnosed between 2009 and 2015 was obtained from the Puerto Rico Central Cancer Registry, which is linked to the Puerto Rico Health Insurance Linkage database (n = 2114). The association between receiving guideline-concordant first treatment and clinical, socioeconomic, and health system factors was evaluated using logistic regression. The 5-year overall survival was calculated using the Kaplan-Meier method. Cox proportional hazard regression models were used to estimate hazard ratios and 95 % confidence intervals (CIs) for associations between guideline-concordant first treatment and overall survival. ResultsIn our cohort, 53.9 % of patients received guideline-concordant first treatment. Receiving care at a Commission on Cancer-accredited center, being evaluated by a gynecologist-oncologist, and possessing private insurance enhanced the likelihood of receiving guideline-concordant first treatment. In the Cox regression models, receiving guideline-concordant first treatment was associated with a lower mortality risk (HR: 0.72, 95 % CI: 0.59–0.89). ConclusionGuideline-concordant first treatment is a strong predictor of improved survival rates in endometrial cancer. Given that guidelines based on scientific evidence have been demonstrated to enhance patient outcomes, we must understand and promote the factors contributing to their adoption.

The glucocorticoid dose-mortality nexus in pneumonia patients: unveiling the threshold effect.

The impact of glucocorticoid use on mortality risk in pneumonia patients remains unclear. This study aimed to investigate the relationship between the accumulated dose of glucocorticoids (ADG) and secondary pneumonia mortality risk among patients receiving oral or intravenous glucocorticoids. Data from the DRYAD database were analyzed, covering pneumonia patients from six academic hospitals over a 5-year period who had been administered oral or intravenous glucocorticoids. Piecewise linear regression and multivariate regression analysis were utilized to assess the association between ADG and mortality risk in pneumonia patients, while adjusting for potential confounders. Among the 628 pneumonia patients included, the 30-day mortality rate was 23.1% and the 90-day mortality rate was 26.4%. In the high-dose glucocorticoid group (≥24mg/day of methylprednisolone or an equivalent glucocorticoid within 30 days before admission), the 30-day and 90-day mortality rates were 31.2% and 35.9%, respectively. Piecewise linear regression analysis demonstrated a non-linear relationship between ADG and mortality risk in pneumonia patients. Multivariate regression analysis revealed a significantly lower mortality risk in patients receiving an ADG of 20-39g methylprednisolone compared to those receiving lower (<20g) or higher doses (≥40g), after adjusting for potential confounding factors. Additionally, in the high-dose glucocorticoid group, surpassing the inflection point of 20g of methylprednisolone raised the 30-day and 90-day mortality risks (adjusted odds ratio, 95% confidence interval: 1.16, 1.03-1.30 and 1.23, 1.07-1.42, respectively). Notably, this threshold effect was observed exclusively in male patients. This study provides evidence supporting a potential threshold effect between ADG and mortality risk in oral or intravenous glucocorticoid users with secondary pneumonia. Specifically, male patients receiving high-dose glucocorticoids should undergo close monitoring when the ADG of methylprednisolone exceeds 20g, as it may be associated with an elevated risk of mortality.

Application of antithrombotic drugs and risk factor analysis in ICU patients with lower gastrointestinal bleeding from MIMIC-IV

ObjectiveThis study aims to assess the effects of antithrombotic therapy on the outcomes of lower gastrointestinal bleeding (LGIB) in ICU patients, focusing on in-hospital mortality, rebleeding, and length of hospital and ICU stays.MethodThis retrospective observational study utilized the MIMIC-IV 2.2 database, which includes 513 ICU patients with LGIB.ResultThe in-hospital mortality rate was 7.6%, and the rebleeding rate was 11.1%. The average Oakland risk score among the study population was 22.54. Multivariate Cox regression analysis identified the use of antiplatelet drugs as an independent protective factor for in-hospital mortality (HR = 0.37, 95% CI 0.15–0.90, p = 0.029). Patients on anticoagulants experienced significantly longer hospital stays (13.1 ± 12.2 days vs. 17.4 ± 12.6 days, p = 0.031) compared to those not using these drugs. Propensity score matching also supported these findings, indicating that antithrombotic therapy was associated with lower in-hospital mortality and longer hospital stays even after adjusting for factors like age, gender, and primary diagnosis.ConclusionsOur analysis using various statistical methods, including propensity score matching and multivariate regression, confirms that use of antithrombotic drugs in 2.3 days, particularly antiplatelets, are associated with a lower risk of in-hospital mortality. However, they may increase the risk of rebleeding and extend hospital stays in certain subgroups.

Efficacy and safety of calcineurin inhibitors (CNIs) for septic patients in ICU: a cohort study from MIMIC database.

Sepsis is marked by a dysregulated immune response to infection. Calcineurin inhibitors (CNIs), commonly used as immunosuppressants, have unique properties that may help mitigate the overactive immune response in sepsis, potentially leading to better patient outcomes. This study aims to assess whether CNIs improve prognosis in septic patients and to evaluate any associated adverse reactions. We utilized the Medical Information Mart for Intensive Care IV 2.2 (MIMIC-IV 2.2) database to identify septic patients who were treated with CNIs and those who were not. Propensity score matching (PSM) was employed to balance baseline characteristics between the CNI user group and the non-user group. The primary outcome was 28-day mortality, analyzed using the Kaplan-Meier method and Cox proportional hazard regression models to examine the relationship between CNI use and patient survival. From the MIMIC-IV database, 22,517 septic patients were identified. After propensity score matching, a sample of 874 patients was analyzed. The CNI group exhibited a significantly lower 28-day mortality risk compared to the non-user group (HR: 0.26; 95% CI: 0.17, 0.41) in the univariate Cox hazard analysis. Kaplan-Meier survival curves also demonstrated a significantly higher 28- and 365-day survival rate for CNI users compared to non-users (log-rank test p-value = 0.001). No significant association was found between CNI use and an increased risk of new-onset infection (p = 0.144), but an association with mild hypertension (P < 0.001) and liver injury (P < 0.001) was observed. The use of calcineurin inhibitors was associated with reduced short- and long-term mortality in septic patients without an increased incidence of new-onset infections, hyperkalemia, severe hypertension, or acute kidney injury (AKI). However, CNI use may lead to adverse effects, such as liver injury and mild hypertension.

The association between postdiagnosis smoking cessation and survival in advanced non-small cell lung cancer patients in Southern Taiwan: A retrospective cohort study

ABSTRACT Objectives: Smoking is a major lung cancer risk factor. Studies show that smoking after lung cancer diagnosis is associated with an increased risk of developing other cancers and shorter survival. The purpose of this study was to examine the association between postdiagnosis smoking cessation and survival in patients with advanced non-small cell lung cancer (NSCLC). Materials and Methods: A retrospective cohort study was conducted. Data were collected between January 2014 and December 2019 in three hospitals in Southern Taiwan. Patient data were collected from the hospitals’ databases, and the correlation between smoking status and patient survival was analyzed using Kaplan–Meier curves and Cox proportional hazards regression modeling. Results: A total of 681 patients with advanced NSCLC were included in this study. The numbers (percentage) of ex-smokers and current smokers were 334 (49%) and 347 (51%), respectively. More than half of the patients in this study continued to smoke postdiagnosis advanced NSCLC. Furthermore, ex-smokers had lower mortality risk, even though this was not statistically significant (P = 0.212). The results of this study suggest that older than 65 years, men, Eastern Cooperative Oncology Group performance score of 3 and higher, history of chronic disease, receive chemotherapy, and targeted therapy are correlated with and have predictive effects on advanced NSCLC survival. Conclusion: There is no significant difference between postdiagnosis smoking cessation and survival in patients with advanced NSCLC. The reason for this finding may be due to lower survival rates after diagnosis with advanced NSCLC, and the benefits of smoking cessation cannot be seen immediately.

Self-reported physical activity properties and 20-year all-cause and cardiovascular mortality among community-dwelling older adults.

Physical activity was previously associated with decreased mortality. Current guidelines recommend >150min/week or >75min/week of moderate or high-intensity exercise to maintain a healthy lifestyle; however, exercise properties most strongly associated with low mortality among the elderly may still be explored. A total of 1210 community-dwelling older adults, from the third phase (1999-2004) of the Israel Study on Glucose Intolerance, Obesity, and Hypertension, were followed until 2016 and 2019 for cardiovascular and all-cause mortality, respectively. Physical activity properties were recorded and evaluated against all-cause and cardiovascular mortality. Mean age at baseline was 73 ± 7years, with 638 (53%) females, and 585 (48%) reported habitual exercise. When compared to sedentary individuals, multivariable Cox regressions showed a significantly lower risk for all-cause mortality among currently active individuals [hazard ratio (HR) = 0.72, 95% confidence interval (CI): 0.59-0.88, P = .002], those engaging in light-moderate activity (HR = 0.72, 95% CI: 0.57-0.89, P = .003), those with diverse exercise types (HR = 0.59, 95% CI: 0.44-0.80, P = .001), more sessions/week (HR = 0.94, 95% CI: 0.92-0.97, P < .001), those meeting current exercise recommendations (HR = 0.79, 95% CI: 0.58-0.89, P = .03), those who engaged in walking (HR = 0.58, 95% CI: 0.45-0.76, P < .001), and swimming (HR = 0.66, 95% CI: 0.45-0.96, P = .03). Similar HRs were found for cardiovascular mortality, although a somewhat stronger protective association was observed for swimming (HR = 0.48, 95% CI: 0.24-0.95, P = .04) compared to a sedentary lifestyle. The study further supports current exercise guidelines among the elderly. It also underscores the importance of physical activity in older individuals while prioritizing a greater number of sessions/week in addition to the total duration, and highlights specific activity features associated with lower long-term mortality among older adults. Key message • What is already known on this topic - Physical activity was associated with a lower risk for mortality, although the specific properties and the preferred type of exercise among older adults are still debatable. • What this study adds - The study suggests the optimal activity characteristics in older adults while prioritizing activity sessions over time, light-moderate exercise over strenuous activity, diverse activity, and walking and swimming over other activities. • How this study might affect research, practice or policy - Future exercise guidelines should focus on increasing activity sessions throughout the week and not on the cumulative time to maximize the effect on mortality.

Clinical outcomes in type 2 diabetes patients with chronic heart failure treated with metformin: a meta-analysis.

To explore outcomes of metformin (Met) as an antihyperglycemic agent in patients with type 2 diabetes mellitus (T2DM) combined with chronic heart failure (CHF). This article employed a meta-analysis approach to systematically search several databases. Stata 15.1 software was employed for statistical analysis. This meta-analysis encompassed 15 randomized controlled trials, involving 20,595 patients with T2DM and CHF. The results revealed that in comparison to the non-Met group, the Met group exhibited a significantly reduced risk of all-cause mortality (RR = 0.72, 95%CI: 0.60-0.87) and a notably lower risk of cardiovascular mortality (RR = 0.52, 95%CI:0.29-0.92). However, there was no significant difference in the risk of hospitalization due to heart failure (RR = 0.85, 95%CI: 0.70-1.04). Furthermore, the Met group demonstrated significant improvements in NT-proBNP levels compared to the non-Met group (WMD = -132.91, 95%CI: -173.03, -92.79). Regarding the enhancement of Left Ventricular Ejection Fraction and Left Ventricular End-Diastolic Dimension levels, no statistically significant differences were observed between the two groups. In individuals with T2DM and CHF, the use of Met is linked to a decreased likelihood of all-cause mortality and cardiovascular-related mortality. Furthermore, it can enhance cardiac function in CHF patients without elevating the risk of hospitalization due to heart failure, establishing its safety and potential benefits.

In-hospital evolution of secondary mitral regurgitation in acutely decompensated heart failure.

Secondary mitral regurgitation (MR) negatively affects prognosis in acutely decompensated heart failure (ADHF), but can be rapidly sensitive to changes in volume status and medical interventions. We sought to assess the evolution of secondary MR in patients hospitalized for ADHF and its prognostic implications. We retrospectively enrolled 782 patients admitted for ADHF with at least two in-hospital echocardiographic evaluations of MR. We classified MR severity as none-mild or moderate-severe. Based on MR evolution, patients were divided into 'persistent moderate-severe MR', 'improved MR' (from moderate-severe to none-mild) and 'persistent none-mild MR'. Four hundred and forty patients (56%) had moderate-severe MR at first evaluation, of whom 144 (33% of patients with baseline moderate-severe MR) had 'improved MR', while 296 (67%) had 'persistent moderate-severe MR'. Patients with improved MR had better clinical, laboratory and echocardiographic parameters of decongestion at discharge compared with those with persistent moderate-severe MR and showed a higher up-titration of recommended therapies. Left ventricular volume, ejection fraction and serum urea were the predictors of improved MR at multivariable analysis. After adjustment, no differences in 5-years survival (primary outcome) were observed according to baseline MR severity. When patients were stratified according to the in-hospital changes in MR severity, improved MR was associated with lower risk of 5-years mortality, compared with both persistent none-mild MR [hazard ratio (HR) = 0.505, P = 0.032] and persistent moderate-severe MR (HR = 0.556, P = 0.040). The severity of MR frequently improved during hospitalization for ADHF; the extent and the changes in MR severity during the in-hospital stay identified distinct patient phenotypes, and seemed to portend different long-term outcomes, with higher 5-years survival associated with improvement in MR.

Meta-Research in Geriatric Surgery: Improving the Quality of Surgical Evidence for Older Persons in a Multidimensional-Scale Research Field.

The world is facing a significant demographic transition, with a substantial increase in the proportion of older persons, as well as long-lived persons (especially nonagenarians and centenarians). One of the popular beliefs is that old age is synonymous with disease and disability. However, the successful aging hypothesis suggests that those older persons with advanced chronological age who maintain their functional capacity derive from it a delay in biological aging, enhancing the quality of organic aging and regulation. Therefore, regardless of chronological age, even in cases of extreme longevity, those older adults with a successful aging phenotype and favorable functional capacity would be expected to have satisfactory post-surgical recovery with a low risk of morbidity and mortality. Currently, there is a significant gap between the availability of high-certainty surgical evidence that allows for evidence-based interventions applicable to the long-lived population-taking into account the actual conditioning factors of the health phenotype in older persons-and, above all, predictors of satisfactory post-surgical evolution. The application of meta-research to geriatric surgery emerges as a fundamental tool to address this knowledge gap and reveals opportunities and limitations that need to be resolved in the near future to establish evidence-based surgical care for older persons. The aim of this manuscript was to present a real and globally relevant scenario related to surgical care, addressing the longevity, the availability, and the quality of surgical evidence applicable to this population, and also to present variables to consider in analysis and future perspectives in research and meta-research in geriatric surgery.