Mortality Curves Research Articles

Impact of the Malnutrition on Mortality in Patients With Osteoporosis: A Cohort Study From NHANES 2005-2010.

BackgroundOsteoporosis is the most common metabolic bone disease. Recent studies have shown that malnutrition can promote the development of osteoporosis. However, the incidence of malnutrition in patients with osteoporosis and the relationship between malnutrition and all-cause mortality has not been adequately studied. Therefore, our study investigated the relationship between malnutrition and all-cause mortality in patients with osteoporosis.MethodsWe analyzed data on 7,700 adults ≥20 years of age during National Health and Nutrition Examination Survey (NHANES) 2005-2010. Each patient was assigned to one of three groups: normal nutritional status, mild malnutrition, and moderate to severe malnutrition. Survival curves and univariate and multivariable cox regressions based on the NHANES recommended weights were used to assess the association between malnutrition status and mortality. Moreover, cox proportional hazards regression analyses were performed on the matched pairs.ResultsOverall, 7,700 eligible individuals with osteoporosis were included in the final analysis, and the mean age was 52.0 ± 0.4 years. From the Kaplan–Meier curves for long-term all-cause mortality of malnutrition, worsening malnutrition status was associated with higher incidence of all-cause mortality. In the fully adjusted models, the adjusted hazard ratio (aHR) was 1.54 [95% confidence interval (CI), 1.02–2.31, p = 0.039] at mild malnutrition status and 2.70 (95%CI, 1.95–3.74, p < 0.001) at moderate to severe malnutrition status. The cox model after matching indicated that malnutrition was still a high mortality risk than no malnutrition (aHR = 2.23, 95% CI, 1.66–3.01, p < 0.001).ConclusionsPoor malnutrition status, common in osteoporotic patients, is strongly associated with a risk for all-cause mortality comparable to that seen with normal nutritional status. These findings highlight the importance of risk stratification for nutritional status in osteoporotic patients and the implementation of strategies that is now available to help prevent malnutrition in these patients.

Adherence to Hormonal Therapy in Breast Cancer Patients in Saudi Arabia: A Single-Center Study

Breast cancer is one of the most common types of cancer in women. Approximately three-quarters of all breast cancer patients have estrogen and/or progesterone receptor positivity. As a result, the majority of patients receive hormonal treatment for between five and 10 years. Long-term use of hormonal therapy reduces the recurrence rate and the risk of death. In Saudi patients, adherence to hormonal therapy is not adequately assessed. The primary objective of this study is to determine the clinical outcomes associated with hormonal therapy adherence in breast cancer patients.This is a retrospective cohort study of patients who received adjuvant hormonal therapy for hormone-receptor-positive breast cancer. Patients were included if they had received at least two prescription refills following their breast cancer diagnosis. The primary outcome measure was mortality and disease progression in relation to hormonal therapy adherence. Progression of disease is defined as local recurrence or radiographic evidence of metastatic disease. The secondary outcome measure was the study population's adherence to hormonal therapy. The proportion of days covered during hormonal therapy was used to assess adherence (PDC). PDC was calculated as the number of days in the prescription period divided by the total number of days in the prescription period. Patients are considered adherent if their PDC value is greater than 0.8. The mortality and disease progression curves were generated using the Kaplan-Meier method. The proportion of patients adhering to hormonal therapy was determined using descriptive analysis. The IRB granted approval. A total of 121 patients were included in the study from the 380 patients screened. Tamoxifen, letrozole, and anastrozole were administered to 58%, 27%, and 14% of patients, respectively. The median age was 53 years. Women who were postmenopausal constituted 52.3% of the study population. The majority of patients were in Stages II and I (56.2% and 16.53%, respectively). The majority of the tumors were Grade II (58.68 %). Adherence was not associated with disease progression (HR, 0.66; 95% CI, 0.25-1.72) or mortality (HR, 1.391; 95 percent CI, 0.33-5.82). Disease progression and mortality were not found to be significantly associated with hormonal therapy adherence in this study. A larger study is required to confirm the findings of our study.

Changes in Long-term Mortality in Patients with Myocardial Infarction History According to the LIS Luberetskiy registry

Aim. The aim of the research was to study the dynamics of distant cases of the disease that underwent AMI in 2005-2007 (LIS registry) and in 2014 and 2018 (LIS-3 registry), discharged from the same hospital of the Lyubertsy District Hospital (LDH).Material and methods. The study was conducted on the basis of two registries - a retrospective-prospective register LIS (Lyubertsy investigation of death), which was conducted in the Lyubertsy district of the Moscow region, all cases of check-ups in the AMI hospital for a 3-year period (2005- 2007) and the prospective register LIS-3 (11/01/2013 – to the present), which included patients admitted to the cardiology department of the Lyubertsy District Hospital No. 2 with the correct diagnosis of Acute coronary syndrome with and without ST segment elevation. With patients discharged from the hospital, a telephone contact was established no earlier than 1 year after discharge to clarify the life status, and in case of death – to find out its causes. Search for patients who did not answer the phone call, was using by the study of the archive of the polyclinic, with database statistics. Longterm cases of the LIS were compared with LIS-3 registers, clinical demographic characteristics and risk indicators in patients in the LIS and LIS-3 registers were also compared, differences in drug therapy before the onset of AMI and after discharge from the hospital register between LIS and LIS3 were analyzed.Results. Out of 327 patients, the registry included 104 (31.8%) patients discharged in 2014 and 223 (68.2%) in 2018. When comparing the longterm mortality curves of the LIS and LOS-3 registers, a significant difference was noted. The LIS-3 study revealed more frequent referrals for antiplatelet agents (20% vs 16%), statins (11.6% vs 2.0%). Less commonly, diuretics began to be prescribed at the prehospital level. After discharge from the hospital in the LIS-3 registry, a decrease compared to the LIS registry, more frequent prescription of antiplatelet agents (97.5% vs 85.0%), anticoagulants (1.1% vs 0%), statins (96.5% vs 67.0%), beta-blockers (93.3% vs 81.0%). Less commonly, diuretics are prescribed at discharge from the hospital.Conclusion. The present study of the LIS-3 registry showed a significant decrease in the incidence of those who had AMI, which occurred 15-20 years after the LIS registry was conducted.

Evaluation and Application of Ultra-Low-Resolution Pressure Reactivity Index in Moderate or Severe Traumatic Brain Injury.

The pressure reactivity index (PRx) has emerged as a surrogate method for the continuous bedside estimation of cerebral autoregulation and a predictor of unfavorable outcome after traumatic brain injury (TBI). However, calculation of PRx require continuous high-resolution monitoring currently limited to specialized intensive care units. The aim of this study was to evaluate a new index, the ultra-low-frequency PRx (UL-PRx) sampled at ∼0.0033 Hz at ∼5 minutes periods, and to investigate its association with outcome. Demographic data, admission Glasgow coma scale, in-hospital mortality and Glasgow outcome scale extended at 12 months were extracted from electronic records. The filtering and preparation of time series of intracranial pressure (ICP), mean arterial pressure and cerebral perfusion pressure (CPP), and calculation of the indices (UL-PRx, Δ-optimal CPP), were performed in MATLAB using an in-house algorithm. A total of 164 TBI patients were included in the study; in-hospital and 12-month mortality was 29.3% and 38.4%, respectively, and 64% of patients had poor neurological outcome at 12 months. On univariate analysis, ICP, CPP, UL-PRx, and ΔCPPopt were associated with 12-month mortality. After adjusting for age, Glasgow coma scale, ICP and CPP, mean UL-PRx and UL-PRx thresholds of 0 and +0.25 remained associated with 12-month mortality. Similar findings were obtained for in-hospital mortality. For mean UL-PRx, the area under the receiver operating characteristic curves for in-hospital and 12-month mortality were 0.78 (95% confidence interval [CI]: 0.69-0.87; P <0.001) and 0.70 (95% CI: 0.61-0.79; P <0.001), respectively, and 0.65 (95% CI: 0.57-0.74; P =0.001) for 12-month neurological outcome. Our findings indicate that ultra-low-frequency sampling might provide sufficient resolution to derive information about the state of cerebrovascular autoregulation and prediction of 12-month outcome in TBI patients.

MO313: Haematological Ratios as Risk Factor for Acute Kidney Injury in Patients Suspected of an Infection at the Emergency Department

Abstract BACKGROUND AND AIMS Evidence exists that inflammation plays an important role in the pathogenesis of acute kidney injury (AKI) in sepsis patients. Haematological ratios can be used to measure systemic and silent inflammation. Therefore, we investigated what haematological ratios could be identified as risk factors to predict AKI &amp;lt; 30 days in patients suspected of infection at the emergency department (ED). METHOD Data from the SPACE-cohort (SePsis in the Acutely ill patients in the ED) were used. This cohort consists of all patients ≥ 18 years, that present at the ED of the UMC Utrecht for the internal medicine with suspicion of infection. AKI was defined based on the KDIGO criteria. Haematological markers were determined with the Abbott Cell-DYN Sapphire haematology analyser. In total, 7 haematological ratios were included. A Cox regression was performed after the ratios were divided into tertiles. Consequently, Kaplan–Meier curves for 30-day mortality were constructed for the significant predictors from the Cox analysis. RESULTS In univariate Cox regression, neutrophil-to-lymphocyte ratio (NLR), segmented neutrophil-to-monocyte ratio (SeMo) and neutrophil-to-lymphocyte-and-platelet ratio (NLPR) were all significant risk factors for the occurrence of AKI &amp;lt; 30 days after ED presentation (Fig. 1). After correction for multiple confounders, NLR, SeMo and NLPR remained significant. There were significant differences in survival for all these three ratios (Fig. 2). CONCLUSION In this study, we show that several haematological ratios are risk factors for AKI and mortality in patients suspected of infection at the ED. Using these risk factors in prediction models might enable ED physicians to treat AKI in an early phase and prevent any short- and long-term complications. A limitation of this study is the retrospective character. Because of this, not all patients in the cohort had follow-up creatinine levels, and the occurrence of AKI could not be determined in these patients.

External validation of the simple NULL-PLEASE clinical score in predicting outcomes of out-of-hospital cardiac arrest in the Danish population - a nationwide register-based study

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation The Danish Foundation TrygFonden Background Clinical decision-making in patients with out-of-hospital cardiac arrest (OHCA) admitted to the hospital is challenging, and multiple scoring systems have been developed to predict survival. The NULL-PLEASE score (Nonshockable rhythm, Unwitnessed arrest, Long no-flow or Long low-flow period, blood pH &amp;lt;7.2, Lactate &amp;gt;7.0 mmol/L, End-stage renal disease on dialysis, Age ≥85 years, Still resuscitation, and Extracardiac cause) may be able to identify patients with OHCA who are unlikely to survive; however, this score system have not previously been tested in a nationwide setting. Purpose The aim of this study was to validate the NULL-PLEASE clinical score to identify patients with OHCA in the Danish population who are unlikely to survive. Methods We retrospectively validated the predictive ability of the NULL-PLEASE score, using Danish nationwide registry data from 2001-2015. We identified OHCA survivors who had return of spontaneous circulation (ROSC) or ongoing cardiopulmonary resuscitation at hospital arrival and all NULL-PLEASE score parameters available. The primary outcome was 1-day mortality, and the secondary outcome was 30-day mortality. Outcomes were estimated using multivariable logistic regression with a NULL-PLEASE score of zero as reference. Results A total of 868 patients with all NULL-PLEASE score parameters available was included in the analysis. Overall, 1-day mortality was 33%, and 30-day mortality was 62%. A NULL-PLEASE score &amp;gt;0 (assessed as a continuous variable) was associated with significantly increased 1-day mortality (odds ratio (OR): 1.62, 95% confidence interval (CI): 1.51-1.74) as well as significantly increased 30-day mortality (OR: 1.80, 95% CI: 1.66-1.96). Figures 1 and 2 show the ROC curves of NULL-PLEASE and 1-day mortality and 30-day mortality, respectively. Area under the curve (AUC) for 1-day mortality was 0.81, and AUC for 30-day mortality was 0.83. Assessed categorically, a NULL-PLEASE score ≥5 was associated with a particularly high OR for mortality: 1-day mortality (OR: 7.46, 95% CI: 5.42-10.27), and 30-day mortality (OR: 10.596, 95% CI: 7.32-15.33). Conclusions In a large nationwide OHCA-cohort, we found that a NULL-PLEASE score &amp;gt;0 was associated with higher 1-day mortality as well as higher 30-day mortality.

Comparisons between short-peptide formula and intact-protein formula for early enteral nutrition initiation in patients with acute gastrointestinal injury: a single-center retrospective cohort study.

BackgroundEarly enteral nutrition (EN) in critically ill patients is important and most of them have suffered acute gastrointestinal injury (AGI). In this study, we investigated the influence of short-peptide EN formula and intact-protein EN formula on the prognosis of patients with AGI grades I–II to provide some guidance.MethodsA retrospective cohort study was performed. The primary outcomes were the percentage of EN calories (25 kcal/kg/d) and protein (1.2 g/kg/d) on the 3rd and 7th days of intensive care unit (ICU) admission, EN percent elevation in calories and protein on days 3–7, and the incidence of gastric retention and diarrhea after EN administration. Secondary outcomes included ICU and 28-day mortality, length of ICU stay, total hospitalization cost, and ventilator-free days. Univariate and multivariate Cox regression analysis was used to identify factors associated with gastric retention and diarrhea. And we used Kaplan-Meier survival curves to compare 28-day mortality rates between the two groups.ResultsThere were no statistically significant differences in ICU and 28-day mortality, ICU length of stay, total hospitalization cost, or ventilator-free days in the short-peptide formula group compared with the intact-protein formula group. Kaplan-Meier survival curves of 28-day mortality also showed no statistically significant difference. The EN percent elevation in calories and protein on days 3–7 in the short-peptide formula group was significantly higher than the intact-protein formula group (48% vs. 38%, P=0.03 and 37% vs. 38%, P=0.04, respectively). For gastrointestinal (GI) adverse events, the incidence of gastric retention (15.5% vs. 29.8%, P=0.03) and diarrhea (8.5% vs. 19.8%, P=0.04) were lower in the short-peptide group. In the multivariate-adjusted model, the use of short-peptide formula was the only independent variable of reduction in gastric retention and diarrhea [HR =0.469 (95% CI: 0.239–0.922), P=0.028; and HR =0.394 (95% CI: 0.161–0.965), P=0.041, respectively].ConclusionsShort-peptide formula is more easily tolerated by patients in the acute phase of AGI and can quickly achieve nutritional goals by EN provision, making it the preferred formula for the initiation of EN in the acute phase of AGI.

Joint Modeling of Multivariate Longitudinal Depressive Symptoms and Survival with Application to an Aging Study

Objective The primary aim in this study was to use a joint analysis approach to examine the association between longitudinal depressive symptoms and survival in Mexican Americans.&#x0D; Methods: The separate Cox regression and joint modeling were applied to data from the Hispanic Established Population for Epidemiological Study of the Elderly (HEPESE). Depressive symptoms were measured by the Center of Epidemiological Studies Depression Scale (CES-D). The trajectories of CES-D, modeled by random effect, were used as independent variables to fit the mortality curve adjusted by other variables including demographics and physical functioning.&#x0D; Results: The separate Cox regression couldn’t identify association between depressive symptoms and survival. The joint analysis indicated that the slope of CES-D score was not associated with mortality in older Mexican-Americans, however the intercept had negative effects on mortality.&#x0D; Conclusion: There was significant association between baseline depression symptoms and mortality, while no association with slope in older Mexican Americans

Impact of Prognostic Nutrition Index on the Waitlist Mortality of Lung Transplantation

<h3>Purpose</h3> Preoperative nutritional status affects surgical complications and prognoses postoperatively. The prognostic nutrition index (PNI) is a nutritional and inflammatory index recently regarded as a new preoperative prognostic score in the field of lung transplantation (LTx). However, no studies have reported the correlation between PNI and waitlist mortality for LTx. Thus, this study aimed to investigate the impact of PNI as a prognostic parameter of mortality on the waiting list for LTx. <h3>Methods</h3> A retrospective review was conducted on the data of 132 patients who were registered for LTx in our department between January 2013 and June 2020. Patients who registered for re-transplantation and those with insufficient data at the time of registration were excluded. Patients who finally received LTx were analyzed as censored data. The overall survival was evaluated using the Kaplan-Meier method for preoperative factors including PNI. Discriminative abilities of continuous variable factors were evaluated using a receiver operating characteristic (ROC) curve for overall mortality. <h3>Results</h3> The median follow-up period and age of patients on the waiting list were 16.3 months and 46 (range, 19-60) years, respectively. Sixty-six (52%) patients were male, and 52 (41%) had a smoking history. The largest number of indications for LTx was idiopathic interstitial pneumonias (n = 44, 35%). The cut-off value, calculated by the ROC curve, of the PNI for the waitlist mortality was 45.8. The low PNI group had a significantly worse prognosis (<i>p</i> = 0.0005). Multivariate analysis demonstrated that idiopathic interstitial pneumonia as an indication for LTx (<i>p</i> = 0.00002), PNI (<i>p</i> = 0.0005), lung allocation score (LAS) (<i>p</i> = 0.0009), and age (<i>p</i> = 0.012) were independent prognostic factors for waitlist mortality. In addition, PNI was significantly correlated with LAS (r = -0.22, <i>p</i> = 0.014). <h3>Conclusion</h3> PNI can be an independent prognostic parameter in registered candidates for LTx.

Survival After Lung Transplantation is Conditional to Bronchial Complications

<h3>Purpose</h3> Bronchial complications (BC) following lung transplant have a significant impact on morbidity and mortality. The published incidence of bronchial complications varies between 2 and 18%. This study was undertaken to analyse our experience with BC following lung transplantation in first 300 patients at our unit. <h3>Methods</h3> A retrospective analysis of our first 300 lung transplant recipients from 1993 to 2019 was undertaken with regards to BC. Recipient and donor-specific risk factors were analysed. Patients were divided into two groups: Group A, with and Group B, without BC. A <i>p</i> value of < 0.05 was considered statistically significant with statistical analysis performed using SAS v9.4. Graft salvage was achieved in a small subset of patients. <h3>Results</h3> 47 patients (15.6%) developed BC. On univariate analysis, recipient risk factors predictive of bronchial complications were male sex, age, a diagnosis of cystic fibrosis and Alpha 1 antitrypsin deficiency, respiratory colonisation and prolonged post-operative ventilation. Male donors posed higher risk. However, on stepwise multivariate logistic regression analysis, only recipient male gender, recipient age, and prolonged ventilation were significant. The median follow-up was 6.2 years. The survival rates were 93.4%, 87.4%, 83.2%, and 53.8% at 30 days, 90 days, 1 year, and 5 years respectively. The median survival varied, was 3.9 years (Group A) and 6.2 years (Group B).The 30 day, 90-day, 1-year and 5-year actuarial survival rates were significantly lower for recipients with bronchial complications. Patients with BC had twice the mortality within one year. BC contributed to early mortality and similar long term survival curves for those with and without BC. <h3>Conclusion</h3> Development of major bronchial complications is one of the important factors in determining morbidity and survival following lung transplantation. However, the conditional survival following three months after surgery is similar and early intervention may prolong survival.

Excess mortality in Israel associated with COVID-19 in 2020-2021 by age group and with estimates based on daily mortality patterns in 2000-2019.

BackgroundWe aimed to build a basic daily mortality curve in Israel based on 20-year data accounting for long-term and annual trends, influenza-like illness (ILI) and climate factors among others, and to use the basic curve to estimate excess mortality during 65 weeks of the COVID-19 pandemic in 2020–2021 stratified by age groups.MethodsUsing daily mortality counts for the period 1 January 2000 to 31 December 2019, weekly ILI counts, daily climate and yearly population sizes, we fitted a quasi-Poisson model that included other temporal covariates (a smooth yearly trend, season, day of week) to define a basic mortality curve. Excess mortality was calculated as the difference between the observed and expected deaths on a weekly and periodic level. Analyses were stratified by age group.ResultsBetween 23 March 2020 and 28 March 2021, a total of 51 361 deaths were reported in Israel, which was 12% higher than the expected number for the same period (expected 45 756 deaths; 95% prediction interval, 45 325–46 188; excess deaths, 5605). In the same period, the number of COVID-19 deaths was 6135 (12% of all observed deaths), 9.5% larger than the estimated excess mortality. Stratification by age group yielded a heterogeneous age-dependent pattern. Whereas in ages 90+ years (11% excess), 100% of excess mortality was attributed to COVID-19, in ages 70–79 years there was a greater excess (21%) with only 82% attributed to COVID-19. In ages 60–69 and 20–59 years, excess mortality was 14% and 10%, respectively, and the number of COVID-19 deaths was higher than the excess mortality. In ages 0–19 years, we found 19% fewer deaths than expected.ConclusionThe findings of an age-dependent pattern of excess mortality may be related to indirect pathways in mortality risk, specifically in ages <80 years, and to the implementation of the lockdown policies, specifically in ages 0–19 years with lower deaths than expected.

Machine-Learning-Based Functional Time Series Forecasting: Application to Age-Specific Mortality Rates

We propose a functional time series method to obtain accurate multi-step-ahead forecasts for age-specific mortality rates. The dynamic functional principal component analysis method is used to decompose the mortality curves into dynamic functional principal components and their associated principal component scores. Machine-learning-based multi-step-ahead forecasting strategies, which automatically learn the underlying structure of the data, are used to obtain the future realization of the principal component scores. The forecasted mortality curves are obtained by combining the dynamic functional principal components and forecasted principal component scores. The point and interval forecast accuracy of the proposed method is evaluated using six age-specific mortality datasets and compared favorably with four existing functional time series methods.

Development of an Electronic Frailty Index for Hospitalized Older Adults in Sweden.

Frailty assessment in the Swedish health system relies on the Clinical Frailty Scale (CFS), but it requires training, in-person evaluation, and is often missing in medical records. We aimed to develop an electronic frailty index (eFI) from routinely collected electronic health records (EHRs) and assess its association with adverse outcomes in hospitalized older adults. EHRs were extracted for 18 225 patients with unplanned admissions between 1 March 2020 and 17 June 2021 from 9 geriatric clinics in Stockholm, Sweden. A 48-item eFI was constructed using diagnostic codes, functioning and other health indicators, and laboratory data. The CFS, Hospital Frailty Risk Score, and Charlson Comorbidity Index were used for comparative assessment of the eFI. We modeled in-hospital mortality and 30-day readmission using logistic regression; 30-day and 6-month mortality using Cox regression; and length of stay using linear regression. Thirteen thousand one hundred and eighty-eight patients were included in analyses (mean age 83.1 years). A 0.03 increment in the eFI was associated with higher risks of in-hospital (odds ratio: 1.65; 95% confidence interval: 1.54-1.78), 30-day (hazard ratio [HR]: 1.43; 1.38-1.48), and 6-month mortality (HR: 1.34; 1.31-1.37) adjusted for age and sex. Of the frailty and comorbidity measures, the eFI had the highest area under receiver operating characteristic curve for in-hospital mortality of 0.813. Higher eFI was associated with longer length of stay, but had a rather poor discrimination for 30-day readmission. An EHR-based eFI has robust associations with adverse outcomes, suggesting that it can be used in risk stratification in hospitalized older adults.

MELD-XI score predict no-reflow phenomenon and short-term mortality in patient with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

IntroductionNo-reflow phenomenon (NRP) is one of the complications that mostly occur during percutaneous coronary intervention (PCI). In this study, we comprehensively examined the relationship between the model for end-stage liver disease-XI (MELD-XI) score and NRP. Moreover, we discussed whether the MELD-XI score could be considered as an accurate risk assessment score of patients with ST-segment elevation myocardial infarction (STEMI) who are candidates for PCI.MethodsThis retrospective study involved 693 patients with acute STEMI and who underwent an emergency PCI. They were divided into a normal reflow group or a no-reflow group on the basis of the flow rate of post-interventional thrombolysis in myocardial infarction. Univariate, multivariate logistic regression, and Cox regression analyses were performed to identify the independent predictors of NRP in both groups. Receiver operator characteristic (ROC) curves and Kaplan–Meier curves were plotted to estimate the predictive values of the MELD-XI score.ResultsMELD-XI score was found to be an independent indicator of NRP (odds ratio: 1.247, 95% CI: 1.144–1.360, P < 0.001). Multivariate Cox regression analysis also revealed that the MELD-XI score is an independent prognostic factor for 30-day all-cause mortality (hazard ratio: 1.155, 95% CI: 1.077–1.239, P < 0.001). Moreover, according to the ROC curves, the cutoff value of the MELD-XI score to predict NRP was 9.47 (area under ROC curve: 0.739, P < 0.001). The Kaplan–Meier curves for 30-day all-cause mortality revealed lower survival rate in the group with a MELD-XI score of > 9.78 (P < 0.001).ConclusionThe MELD-XI score can be used to predict NRP and the 30-day prognosis in patients with STEMI who are candidates for primary PCI. It could be adopted as an inexpensive and a readily available tool for risk stratification.

Prognostic value of National Early Warning Scores (NEWS2) and component physiology in hospitalised patients with COVID-19: a multicentre study

BackgroundNational Early Warning Scores (NEWS2) are used to detect all-cause deterioration. While studies have looked at NEWS2, the use of virtual consultation and remote monitoring of patients with COVID-19 mean...

Variability of Mortality: Additional Information on Mortality and Morbidity Curves under Normal and Pathological Conditions [Commentary on the Article by A. G. Malygin "Programmed Risks of Death in Male Patients with Diabetes" Published in Biochemistry (Moscow), vol. 86, pp. 1553-1562 (2021)

Analysis of demographic data indicates uneven distribution of mortality within a year, month, and even week time period. This is of great practical importance for the operation of medical institutions, including intensive care units, and makes it possible to calculate economic and labor requirements of medical institutions. All the above is especially relevant during the era of the COVID-19 pandemic. Malygin showed the presence of one to two fluctuations per week in the mortality of male patients with type 2 diabetes. The height of the peaks of such fluctuations is determined, as expected, by the regular parameter indicating their position on the axis of lifespan and random parameter reflecting adverse effects of external environmental factors on the body, as well as the extent of the periodically occurring sharp decrease in the nonspecific resistance. This article discusses results of recent research in the field of small (semi-weekly, weekly, monthly, and seasonal) fluctuations of mortality. Based on a large array of accumulated data, it can be concluded that the decrease in seasonal variability of mortality accompanies an increase in the life expectancy. Studying characteristics of mortality fluctuations makes it possible to move from investigating the impact of biorhythms (Master Clock) on the development of acute and chronic phenoptotic processes directly to studying the patterns of mortality rhythms themselves (rhythms of phenoptosis).

Identification of Independent Patterns of COVID-19 Mortality in Brazil by a Functional QR Decomposition

The subset selection problem of linear algebra is applied to identify independent patterns of COVID-19 evolution within Brazil. The data consist of a set of mortality curves in states of Brazil. A subset of the most independent curves is selected by using a functional version of the QR matrix decomposition technique with column pivoting. The selected subset is used next as a basis to represent the remaining curves filtering out any data redundancy. For each independent curve, an associated epidemiological region of influence is defined. The results show two main independent curves with a similar two-peak pattern and a 50-day shift between the patterns. Two main epidemiological regions are next identified: one encompassing most of the country from the center and northeast states to the south, an another one containing the Amazonian region at the northwest.

Abstract P3-14-02: Racial/ethnic differences in the benefit of adjuvant chemotherapy for breast cancer patients with an intermediate risk 21-gene recurrence score

Abstract Background: The Oncotype 21-gene Recurrence Score (RS) is the most commonly ordered genomic biomarker used to inform decisions on adjuvant chemotherapy for patients with estrogen receptor (ER)-positive, HER2-negative early breast cancer. Representation of racial/ethnic minority patients in the population used to develop the assay was poor, with only 5% of study participants identified as Black. This raises concern about the accuracy of the RS in underrepresented populations. In earlier work (Hoskins et al, JAMA Oncology 2021), we showed that the RS has less prognostic accuracy in Black compared with non-Hispanic White (NHW) women. This finding is concerning in light of persistent racial disparities in breast cancer mortality. Here we examine the predictive accuracy of the RS according to race/ethnicity for identifying patients with ER+, axillary node-negative breast cancer who benefit from adjuvant chemotherapy.Methods: We conducted a large, population-based retrospective cohort study of women 18+ years diagnosed with ER+, axillary node-negative breast cancer from 2004 to 2010 using Surveillance, Epidemiology and End Results Oncotype DX Database (2004-2015). This analysis included women with a minimum of 7 yrs follow-up and an RS of 11-25, since this is the group with the most uncertainty regarding the benefit of chemotherapy. Demographic and clinical characteristics were collected from cancer registry data. Propensity score weighted Cox models determined the association between chemotherapy use and breast cancer death. Age, insurance status, tumor grade, tumor size, progesterone receptor status, and RS were included as predictors of the propensity score. Associations between chemotherapy use and breast cancer death were determined using overall, race/ethnicity, and age stratum-specific hazard ratios (HR) and 95% confidence intervals (CI). Results: The analysis included 22,693 NHW, 5,657 Black, and 3,348 Hispanic women. The overall result is consistent with the prospective TAILORx trial, showing greater benefit from chemotherapy in women under age 50. There is a greater reduction in the hazard of breast cancer death associated with chemotherapy use for Black (HR 0.31, 95% CI, 0.15, 0.66) and Hispanic (HR 0.07, 95% CI, 0.02, 0.31) compared with NHW women under age 50 (HR 0.43, 95% CI,0.32, 0.59). In models combining Black and NHW patients, an interaction term for race*chemotherapy was significant (p=0.022), indicating a differential association between chemotherapy use and breast cancer death according to race/ethnicity. Visual comparison of breast cancer mortality curves that plot 7-year breast cancer death rate as a function of the continuous RS, stratified by chemotherapy administration (yes/no), shows that the curves begin to diverge at a lower RS for Black (RS 17) compared with NHW women (RS 24). Conclusions: This observational study found that Black women under age 50 with ER+, axillary node-negative breast cancer and an RS of 11-25 derive significantly more benefit from adjuvant chemotherapy than NHW women. National practice guidelines do not recommend routine use of adjuvant chemotherapy for patients in this risk category, indicating that many Black patients may be undertreated. Results need to be confirmed in prospective studies, but they suggest that RS cut-offs used to recommend adjuvant chemotherapy may need to be modified for racial/ethnic minority women. Hazard of Breast Cancer Death (95% Confidence Interval)Race/EthnicityChemotherapyAll AgesAge &amp;lt; 50Age 50+OverallYes0.71 (0.63, 0.81)0.32 (0.25, 0.41)1.01 (0.87, 1.18)NoRefRefRefNHWYes0.73 (0.62,0.84)0.43 (0.32, 0.59)0.87 (0.74, 1.04)NoRefRefRefBlackYes0.83 (0.60, 1.16)0.31 (0.15, 0.66)1.26 (0.84, 1.89)NoRefRefRefHispanicYes0.33 (0.20, 0.57)0.07 (0.02, 0.31)0.61 (0.33, 1.12)NoRefRefRef Citation Format: Hsiao- Ching Huang, Gregory S. Calip, Jennifer Weiss, Yael Simons, V.K. Gadi, Oana C. Danciu, Garth H. Rauscher, Kent F. Hoskins. Racial/ethnic differences in the benefit of adjuvant chemotherapy for breast cancer patients with an intermediate risk 21-gene recurrence score [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-14-02.

Spatiotemporal Characteristics and Patterns of the COVID-19 Pandemic in China: An Empirical Study Based on 413 Cities or Regions.

The global economy was stagnant and even regressed since the outbreak of COVID-19. Exploring the spatiotemporal characteristics and patterns of COVID-19 pandemic spread may contribute to more scientific and effective pandemic prevention and control. This paper attempts to investigate the spatiotemporal characteristics in cumulative confirmed COVID-19 cases, mortality, and cure rate in 413 Chinese cities or regions using the data officially disclosed by the government. The results showed that: (1) The pandemic development can be divided into five stages: early stage (sustained growth), early mid-stage (accelerated growth), mid-stage (rapid growth), late mid-stage (slow growth), and late-stage (stable disappearance); (2) the cumulative number of confirmed COVID-19 cases remained constant in Wuhan, whilst the mortality tended to rise faster from the early stage to the late-stage and the cure rate moved from the southeast to the northwest; (3) the three indicators mentioned above showed significant and positive spatial correlation. Moran’s I curve demonstrated an inverted “V” trend in cumulative confirmed COVID-19 cases; the mortality curve was generally flat; the cure rate curve tended to rise. There are apparent differences in the local spatial autocorrelation pattern of the three primary indicators.

Crossing Birthweight-Specific Mortality Curves: How a Puzzling Clinical Observation Led to an Important Advance in Epidemiologic Methods.

Clinicians have long noted that although African-American neonates were more likely than white neonates to weigh <2500 grams at birth (low birthweight), among low birthweight infants African-Americans were more likely than whites to survive. However when born at normal weight, African-American infants were substantially less likely to survive. The observation generated much physiological speculation, and several clever mathematical manipulations were devised to "uncross the mortality curves." With the development and dissemination of Directed Acyclic Graphs in the early 2000s, methodologists focused on perinatal epidemiology showed graphically, in an early use of Directed Acyclic Graphs, that birthweight was a "collider", and that controlling for birthweight, whether by regression, stratification or restriction, introduced confounding of the race-mortality association by all unmeasured common causes of birthweight and mortality. These investigations showed that the crossing curves could be explained as an artifact of a conceptually flawed analysis. These results have applicability beyond perinatal epidemiology, including to the "obesity paradox."