Mortality In Male Patients Research Articles

Early and Mid-term Outcomes in Female Patients Undergoing Isolated Conventional Coronary Surgery.

Introduction: Several observational studies comparing outcomes between female and male patients after coronary artery bypass grafting (CABG) have shown that operative mortality rate is higher among female patients than in male patients. However, some conflicting studies report that early mortality among female patients is equivalent to that among male patients. We investigated predictive factors of morbidity, mortality and survival in female patients undergoing isolated conventional CABG. Methods: Between January 2002 and December 2009, 1657 patients underwent isolated conventional CABG in our clinic. 21.8% (n=361) of patients were female and 78.2% (n=1296) males. Results: Advanced age (P<0.0001), hypertension (P<0.0001), diabetes (P<0.0001), and hyperlipidemia (P<0.0001) were the independent predictive factors among female patients. Mean in-hospital mortality rates were 5.8% and 3.2%; for females and males, respectively (P=0.029). Prolonged ventilatory support (P=0.009) and postoperative atrial fibrillation (P=0.049) were the independent predictive factors of in-hospital mortality in female patients. Cardiopulmonary bypass time (P=0.041), prolonged ventilatory support (P<0.0001), and postoperative atrial fibrillation (P=0.031) were the independent predictive factors of in-hospital mortality in male patients. Mean follow-up was 47.51±25.06 months and 48.42±25.21 months among female and male patients (P=0.820). In follow-up, mortality rate was 6.1% (n=22) among female patients and 4.6% (n=60) among male patients (P=0.272). Left internal thoracic artery (LITA) usage (P=0.001) was the independent predictive factor of survival in female patients. Conclusion: In-hospital mortality rate was higher in female patients. Length of ICU and hospital stay, and mid-term survival was similar between female and male patients.

Education Level Is Associated with Mortality in Male Patients Undergoing Maintenance Hemodialysis

Background: Studies of the correlation between education levels and mortality in hemodialysis (HD) patients are rare. The aim of this multi-center study was to investigate the relationship between education levels and 3-year mortality rates in HD patients. Methods: A total of 935 HD patients from 3 HD centers participated in this 3-year prospective observational study. Education levels were categorized as either less than senior high school and above or equal to senior high school. The causes of death and mortality rates were also analyzed for each subgroup. Results: At the end of the 3-year follow-up period, 164 patients had died. In the male group, forward stepwise Cox regression analysis revealed that age, HD duration, hypertension, creatinine level, serum albumin level ≥3.6 g/dl, anuria, Kt/V_urea, and high education level were significant predictive factors for 3-year mortality rates. Conclusion: This prospective observational study demonstrated that education level was associated with mortality in men undergoing HD.

Obesity, Brain Natriuretic Peptide Levels and Mortality in Patients Hospitalized With Heart Failure and Preserved Left Ventricular Systolic Function

BackgroundAn inverse relationship between brain natriuretic peptide (BNP) levels and body mass index (BMI) has been described for patients with left ventricular (LV) systolic dysfunction. In this study, the association of BMI, BNP levels and mortality in patients hospitalized for heart failure with preserved LV systolic function (HFpLVF) was investigated. MethodsOne hundred fifty consecutive patients (98% men) who were hospitalized with HFpLVF and had BNP levels measured on admission were analyzed. Patients were divided into categories of BMI: normal (BMI<25 kg/m2), overweight (BMI 25–29.9 kg/m2) and obese (BMI ≥ 30 kg/m2). Relevant clinical and echocardiographic characteristics and all-cause mortality were obtained through chart review. ResultsBNP levels were significantly lower in obese (median=227 pg/mL) and overweight (median=396 pg/mL) patients compared with those with normal BMI (median=608 pg/mL, P=0.003). Higher BMI predicted BNP levels of <100 pg/mL. Compared with patients with normal BMI, overweight and obese patients had a significantly lower risk of total mortality, even after adjusting for other clinical characteristics, including log-transformed BNP levels, atrial fibrillation, the use of beta-blockers at discharge, age, hemoglobin levels and the presence of pulmonary congestion on admission. Higher BNP levels also independently predicted mortality. ConclusionsAn inverse relationship between BMI and BNP levels exists in patients hospitalized with HFpLVF. Higher BMI is associated with lower mortality, whereas higher BNP levels predict higher mortality in male patients with HFpLVF. These findings should be confirmed in a larger multicenter setting.

Routine early invasive strategy and in-hospital mortality in women with non-ST-elevation myocardial infarction: Results from the Berlin Myocardial Infarction Registry (BMIR)

BackgroundIt is under discussion whether female patients with non-ST-elevation myocardial infarction (NSTEMI) benefit from routine invasive treatment strategy. We accordingly applied our data from the Berlin Myocardial Infarction Registry (BMIR) to analyze the association between early percutaneous coronary intervention (PCI) and hospital mortality in NSTEMI patients. MethodsData prospectively collected in the BMIR between 2004 and 2008 from 2808 patients (m=1820/w=988) directly admitted to hospitals with 24-h PCI facilities were included in the analysis. After adjustment for confounding variables, we compared in-hospital mortality for patients of both sexes with vs. without early PCI. ResultsWomen with NSTEMI were, on average, 7years older than men and demonstrated significantly more comorbidities. A GPIIb/IIIa antagonist was applied in women less often than in men (31.4% vs. 38.4%, p=0.001), and an early PCI was also performed less often in women than in men (64.0% vs. 76.2%, p<0.001). In-hospital mortality was higher in women than in men (5.4% vs. 3.6%, p=0.027). In female patients with NSTEMI, after adjustment for differences in patients' characteristics, hospital mortality did not differ between those treated with early PCI and those managed conservatively (OR: 1.24, 95% CI 0.53–2.91). In contrast, hospital mortality in male patients was lower in those treated with an early PCI (OR: 0.41, 95% CI 0.21–0.78). ConclusionIn our clinical registry, early PCI in female patients with NSTEMI was not associated with lower hospital mortality. Further randomized-controlled trials are needed to better understand which women may benefit from early invasive therapy, and under which conditions such benefits are possible.

Topographical analyses of lung cancer incidence and mortality in Vojvodina

Background: Lung cancer is the leading cancer among men in cancer incidence as well as in cancer death. More recently, unpublished data showed that in women, lung cancer is in the second place in both incidence and mortality in Vojvodina. Methods: Data used for analyses were provided by Cancer Registry of Vojvodina, Oncology Institute of Vojvodina in Sremska Kamenica and from the Bureau of statistics. Descriptive epidemiological method was used. Data were analyzed topographically for two periods of observation, first from 1985 until 1995 and then from 1996 until 2005, separately for male and female population. Results: During the period from 1996-2005, age standardized incidence rate in male patients higher than 140/100,000 was registered in 14 municipalities with the highest incidence of 188.8/100,000. In 40 out of 44 municipalities of Vojvodina, an increase in lung cancer incidence in male patients was registered. Mortality higher than 140/100,000 was registered in 4 municipalities; the highest mortality was 209.9/100,000. In 41 out of 44 municipalities of Vojvodina, an increase in lung cancer mortality in male patients was registered. During the period from 1996-2005, age standardized incidence rate in female patients higher than 20/100,000 was registered in 29 municipalities with the highest incidence of 37.0/100,000. In 39 out of 44 municipalities of Vojvodina, an increase in lung cancer incidence in female patients was registered. Mortality in female patients higher than 20/100,000 was registered in 19 municipalities with the highest mortality of 27.2/100,000. In 33 out of 44 municipalities of Vojvodina, an increase in lung cancer mortality in female patients was registered. Conclusion: Vojvodina is a region with high lung cancer incidence and mortality rates. Incidence and mortality rates in male patients are higher according to topographical distribution than respective incidence in regions and municipalities in countries of the EU, while incidence and mortality rates in female patients are at the similar level as in the EU. In relation to results of the previous studies, we registered an important increase in lung cancer incidence and mortality rates in both male and female patients in the majority of municipalities of Vojvodina.

Three-Year Survival and Stroke Recurrence Rates in Patients With Primary Intracerebral Hemorrhage

There are few studies on the prognosis after primary intracerebral hemorrhages, and they reported big differences in mortality rates. Our aim was to evaluate mortality and stroke recurrence rates in relation to hemorrhage characteristics, demographic and clinical factors, in a large unselected patient cohort. We analyzed consecutive cases of first-ever primary intracerebral hemorrhages from 1993 to 2000 in a prospective stroke register covering the Malmö region, Sweden (population approximately 250 000). Mortality rates during 28 days and 3 years of follow-up and recurrence rates were analyzed. A total of 474 cases were identified (46% women). In patients <75 years of age, 20% of the women and 23% of the men died within 28 days (P=0.38). The corresponding figures in patients >or=75 years were 26% and 41%, respectively (P=0.02). Male sex was an independent risk factor both for 28-day (OR, 1.5; 95% CI, 1.008 to 2.2) and 3-year mortality (OR, 1.7; 95% CI, 1.3 to 2.3). Other independent predictors of death were high age, central and brain stem hemorrhage location, intraventricular hemorrhage, increased volume, and decreased consciousness level. The recurrence rate was 5.1 per 100 person-years, 2.3 per 100 person-years for intracerebral hemorrhage and 2.8 per 100 person-years for cerebral infarction. Only age >65 years was significantly related to recurrent stroke. Women had better survival than men after primary intracerebral hemorrhages. The difference is largely explained by a higher 28-day mortality in male patients >75 years. However, the underlying reasons are yet to be explored.

Angiotensin-converting enzyme 2 A1075G polymorphism is associated with survival in an acute coronary syndromes cohort

Polymorphisms of the angiotensin-converting enzyme 2 (ACE2) gene, which is located on the X chromosome, have been associated with hypertension and left ventricular hypertrophy in previous studies. We tested the hypothesis that the rare allele of an ACE2 gene polymorphism was associated with risk factors for and adverse outcome after acute coronary syndrome (ACS) events. Patients (n = 1,042) were recruited after admission for an ACS event and were genotyped for the A1075G polymorphism of the angiotensin-converting enzyme 2 gene. This genetic marker was tested for association with baseline measurements, echocardiographic measurements, and clinical outcome, over a median 2.19 years follow-up. As the ACE2 gene is X-linked, analyses were performed separately for males and females. Patients were predominantly of European ethnicity (90.1%). The A1075 allele was significantly associated with covariate-adjusted mortality in male patients (hazard ratio 1.95, 95% CI 1.10-3.46, P = .047) but not unadjusted (hazard ratio 1.14, 95% CI 0.736-1.76, P = .56). The G1075 (P < .035) allele was more frequent in patients of Maori compared to European ancestry. E/E', an echocardiographic index of left ventricular diastolic function and filling pressure, was higher in males in the A1075 group (G allele group 10.5 [95% CI 10.0-11.0], A allele group 11.4 [95% CI 10.8-12.1], P = .024). A1075 genotype was significantly associated with male survival in the absence of (mortality: A 12.8%, n = 39; G 29.2%, n = 48; P = .037) but not in the presence of beta-blocker treatment (mortality: A 13.5% n = 273; G 8.2% n = 304, P = nonsignificant). The A1075 allele was associated with covariate-adjusted mortality in male patients.

Increased mortality of male adults with AIDS related to poor compliance to antiretroviral therapy in Malawi

To investigate the effect of gender on mortality of HIV-infected adults receiving antiretroviral therapy (ART) and its possible reasons. A retrospective study to review the records for outcomes of adult cases receiving ART at Mzuzu Central Hospital, Malawi, between July 2004 and December 2006. Over the study period, 2838 adult AIDS patients received ART. Of these, 2029 (71.5%) were alive and still on ART, 376 (13.2%) were dead and 433 (15.3%) were lost to follow-up. Survival analysis with Kaplan-Meier estimator showed significantly higher survival rates among females than males in WHO stage 1, 2 and 3 (both P < 0.0001) and borderline in stage 4 (P = 0.076). The Cox model revealed a death hazard ratio (males vs. females) of 1.70 (95% confidence interval 1.35-2.15) after controlling for WHO clinical stages, body mass index and age. More men than women were lost to follow-up in all occupations except health workers. The most important reasons for a higher mortality in male patients starting ART may relate to their seeking medical care at a more advanced stage of immunodeficiency and poorer compliance with therapy. The issue needs to be addressed in scaling up ART programmes in Africa.

Association of Mortality Risk with High Serum Digoxin Concentrations

Background There are data suggesting a possible association of serum digoxin concentrations (SDC) and risk of mortality in patients treated with digoxin. Objective To determine whether SDCs in the therapeutic range of 1.2 to 2 ng/mL increase the risk of mortality when compared to a lower range of 0.5 to 1.1 ng/mL. Methods Retrospective cohort study to compare the risk of mortality in male patients with SDCs less than 1.2 ng/mL to patients with SDCs of 1.2 to 2 ng/mL. Results A total of 261 male patients were included, 191 (73%) had SDCs in the low range (0.5 to 1.1 ng/mL), and 70 (27%) had SDCs in the high range (at least 1.2 to 2 ng/mL). A high SDC showed a significant increase in risk for mortality with a hazard ratio (HR) of 1.656; 95 % HR confidence interval, 1.153 to 2.38; P = 0.0063. Conclusion Our results showed an increased risk of mortality in the high SDC group (1.2 to 2 ng/mL). This study's findings are consistent with the results of a post hoc evaluation of SDC in male patients in the DIG trial. 1 A prospective trial is warranted to confirm our findings.

Low serum dehydroepiandrosterone sulfate concentration is a predictor for deterioration of urinary albumin excretion in male patients with type 2 diabetes

We recently found that serum dehydroepiandrosterone sulfate (DHEA-S) concentration correlated inversely with the degree of urinary albumin excretion in a cross-sectional study. We therefore performed an observational study to investigate the relationship between serum DHEA-S concentrations and changes in urinary albumin excretion in male patients with type 2 diabetes to answer the question as to whether DHEA is a causal rather than simply coincidental intermediate linking urinary albumin excretion to cardiovascular disease (CVD). The relationship between serum DHEA-S concentration and changes in urinary albumin excretion was investigated in 207 consecutive male patients with type 2 diabetes. Baseline serum DHEA-S concentration and urinary albumin excretion were measured in 2003. After 12 months, urinary albumin excretion was measured and any changes in urinary albumin excretion were calculated. Patients were divided into tertiles according to DHEA-S concentration. Greater changes in urinary albumin excretion were seen in patients with low DHEA-S concentration (29.6 ± 7.6 mg/g creatinine) than in patients with high DHEA-S concentration (5.1 ± 3.6 mg/g creatinine, P = 0.0091). An inverse correlation was observed between serum DHEA-S concentration and changes in urinary albumin excretion ( r = −0.193, P = 0.0052). Multiple regression analysis demonstrated that HbA1c ( β = 0.241, P = 0.0009), and serum DHEA-S concentration ( β = −0.195, P = 0.0054) were independent determinants of changes in urinary albumin excretion. In conclusion, serum DHEA-S concentration was inversely correlated with changes in urinary albumin excretion, which may indicate causality in the increased CVD mortality in male patients with type 2 diabetes and low DHEA-S concentration.

Association Between Urinary Albumin Excretion and Serum Dehydroepiandrosterone Sulfate Concentration in Male Patients With Type 2 Diabetes

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in patients with type 2 diabetes. Both elevated urinary albumin excretion and low serum concentrations of dehydroepiandrosterone (DHEA) are associated with increased CVD mortality. This raises the possibility of DHEA as a causal intermediate linking urinary albumin excretion to CVD. Relationships of urinary albumin excretion to serum DHEA sulfate (DHEA-S) concentration and to major cardiovascular risk factors, including blood pressure, serum lipid concentration, glycemic control (HbA1c), and BMI, were investigated in 357 consecutive men with type 2 diabetes. Serum DHEA-S concentrations were lower in patients with macroalbuminuria (866.5 +/- 523.8 ng/ml, P <0.0001) and in those with microalbuminuria (1,014.4 +/- 525.3 ng/ml, P=0.0006) than in patients with normoalbuminuria (1,232.6 +/- 542.4 ng/ml). Serum DHEA-S concentration correlated inversely with log (urinary albumin excretion) (r=-0.227, P <0.0001). Multiple regression analysis demonstrated that duration of diabetes (beta=0.147, P=0.0075), HbA1c (beta=0.156, P=0.0048), BMI (beta=0.194, P=0.0007), systolic blood pressure (beta=0.195, P=0.0005), and serum DHEA-S concentration (beta=-0.192, P=0.0010) were independent determinants of log (urinary albumin excretion). Serum DHEA-S concentration, which correlated inversely with degree of urinary albumin excretion, may contribute to the link between elevated urinary albumin excretion and higher CVD mortality in male patients with type 2 diabetes.

Health-related quality of life and mortality in male patients with chronic obstructive pulmonary disease.

To assess whether generic and specific health-related quality of life (HRQL) are independently associated with total and specific mortality in patients with chronic obstructive pulmonary disease (COPD), we followed until 1999 a cohort of 321 male patients with COPD, recruited in 1993-1994 at outpatient respiratory clinics. Baseline characteristics recorded under stable clinical conditions included forced spirometry, arterial blood gas tensions, dyspnea scales, 11 comorbid conditions, St. George's Respiratory Questionnaire (SGRQ), and SF-36 Health Survey. Vital status was assessed through reinterviews, the Mortality Register, and clinical records. Subjects who died (106) were older (69.8 versus 62.5 years) (p < 0.001), had lower body mass index (BMI) (25.4 versus 27.1) (p < 0.01), were more impaired in the clinical characteristics studied (%FEV(1), 34.0 versus 51.0) (p < 0.001), and had long-term oxygen therapy more frequently (31% versus 7%) (p < 0.001). Survival was shorter when worse HRQL was reported. SGRQ total and SF-36 physical summary scores were independently associated with total and respiratory mortality in Cox models, including age, FEV(1), and BMI. The total mortality-standardized hazard ratios for both HRQL measures were 1.3, whereas those for FEV(1) were 1.6. HRQL measures provide independent and relevant information on the health status of male patients with COPD. Their use should be considered for a more thorough evaluation and staging of patients with COPD.

Gender differences in survival of 234 patients referred to a psychogeriatric service

To explore the survival characteristics of psychogeriatric patients. Participants and settingAn historical cohort of 234 patients consecutively referred to a specialized psychogeriatric service proximal to a general health service in Perth, Western Australia. Linked health service data were analysed using relative survival analysis and actuarial methods. Relative survival of the cohort after 40 months was significantly lower than the general population of the same age, sex and calendar period (0.78; 95% CI=0.70-0.86). Male patients experienced twice the mortality rate of female patients after adjustment for age (MRR=2.10; 95% CI=1.37-3.20). Age, dementia, mood disorder and ethnicity had no independent effects on mortality in male patients. Female patients with a diagnosis of dementia experienced twice the mortality of female patients without this diagnosis. The distribution of major underlying causes of death was similar in males and females. Gender-specific factors appear to affect survival in psychogeriatric patients. Male patients are younger on average, but experience higher mortality than female patients. Ethnic background does not influence mortality in either male or female patients.

Anxiety, depression, physical fitness, and all-cause mortality in men

The association of low physical fitness with an increased risk of mortality is independent of physiological risk factors, but psychological variables such as anxiety and depression have not been evaluated as possible confounders for all-cause mortality. The purpose of this study was to evaluate the possible confounding effects of anxiety and depression on the relation between physical fitness and mortality in male patients who were given a preventive medical examination between 1977–1986. Physical fitness was measured by maximal exercise treadmill testing. Anxiety and depression were measured by the Clinical Analysis Questionnaire. During follw-up, 83 men died. These cases, aged 19–76 yr, were combined for analyses with 323 randomly selected comparison subjects aged 19–80 yr. The crude odds ratio (95% confidence intervals) for dying in the unfit men was 2.0 (1.1,3.5) compared to the physically fit men. This finding was essentially unchanged after adjustment for anxiety (2.0 (1.1,3.5)), depression (2.1 (1.2,3.8)), or anxiety and depression (2.1 (1.1,3.5)). The increased risk of death in unfit men is not confounded by anxiety or depression. Thus, the higher all-cause death rate in unfit men cannot be explained by higher levels of anxiety or depression.

Cerebral thromboembolism among young women and men in Denmark 1977-1982.

In the period 1977-1982, the Danish National Patient Register recorded 1000 cases of cerebral thromboembolic attacks among women 15-44 years of age, and 971 cases among men of the same age. Cerebral infarction accounted for 70% of cases and transient ischemic attacks (TIA) for the remaining 30%. By analysing this material we found an average age-adjusted incidence rate of cerebral thromboembolism of 14.4/100.000 among men and 15.5/100.000 among women. The incidence rates rose rapidly with increasing age. Women aged 15-34 had significantly higher incidence rates of brain infarction and TIA compared to those of men of the same age. This was reversed in the age group 35-44. The magnitude of the ratio between the female and the male mean incidence rates by increasing age corresponded exactly to the age distribution of the use of oral contraceptives in Denmark. The relative risk for developing cerebral thromboembolism among users of oral contraceptives was estimated to be 3.2-6.5. The mortality in male patients with brain infarction was 3.3% and in females 1.7%. The mean duration of stay in hospital was 8.8 days for TIA and about 26 days for cerebral infarction. Sixteen percent of men and 13.6% of women had hypertension during their stay.

Clinical Study of Patients with Neonatal Respiratory Distress Syndrome

Forty neonate with respiratory distress syndrome were transferred from nursery after birth to the ICU at Severance Hospital, Yonsei Medical Complex between March 1981 to July 1983 and ventilatory support was given with the pressure-cycled ventilator, Babylog I, Bourns BP 200, in ICU. We have analysed the 40 cases according to sex, incidence, symptoms and signs, birth weight and gestation weeks and time to the ventillator support, ICU days and mortality. The results were as follows 1) THe proportion of the patients was 0.7% neonates and the overall mortality was 52.5%. 2) Obstetric and delivery backgrownd were as follows. Ceasarean section, 19 cases; pre-eclampsia, 5 cases; placenta-previa, 5 cases; spontaneous premature rupture of membrane; 4 cases. 3) The percentage and mortality of male patients was 57.5% and 57.1%, higher than famale patients. 4) All the patients showed symptoms and signs within 12 hours after birth. 5) Mortality of those cases born with less than 32 wks gestation was 15%, but above 32 wks the mortality was 35%. 6) The number of babies born with a birth weight below 2,000 grams was 27 and the mortality for them was 70%. 7) The number of cases who had ventilator support begun at 10 hrs, 11∼20 and 21∼30 hours after symproms and signs developed, were 30, 5 and 5. 8) The number of ventlator days less than 4 days duration was 27 cases with a 70% mortality but those above 5 days was 13 cases with 16% mortality. In 1981, the number of patients with ventilator days less than 2 days was 11 case and 2 cases used the ventilator for 7∼8 days. But in 1983 the number of patients with less than 4 ventilator days was 6 cases, and 7 cases used ventilator for more than 5 days. 9) The number of patients with ICU days less 5 days was 23 cases and a mortality of 78% and those of 6∼10 day stay was 6 cases with a mortality of 50%. The number of patients with ICU days above 15 days was 18 and all survived. In 1981, 10 cases stay in the ICU for less than 5 days. Only 2 cases stayed in the ICU for 6∼10 days. In 1983, 6 cases stayed in the ICU for less than 5 days,but 4 cases stayed in the ICU for more than 15 days. 10) Complications were neonatal hyperbilirubinemia, pneumothorax, pneumomediastinum, sepsis, disseminated intravascular coagulopathy, bronchopulmonary dysplasia, and cerebral hemorrhage. From the above results the mortality rate decreased year by year and this is attributed to the early application of ventilator support and adequate intensive care.