Predictor Factor Of Mortality Research Articles

Time-to-Treatment and Its Association With Complications and Mortality Rate in Patients With Acute Myocardial Infarction: A Prospective Cohort Study

IntroductionTime-to-treatment is one of the most important factors affecting the complications and mortality rate in patients with acute myocardial infarction. The purpose of this study was to determine time-to-treatment and its association with complications and mortality rates in patients with acute myocardial infarction in selected hospitals in Zanjan, Iran. MethodsThis prospective cohort study was performed with 200 patients suffering from acute myocardial infarction in selected educational hospitals of Zanjan from June 2016 to March 2017. Parameters including the interval between pain onset and treatment, myocardial infarction complications, in-hospital mortality, and 30-day mortality after the occurrence of myocardial infarction were collected through a special questionnaire and phone calls. The data were analyzed using descriptive statistics and logistic regression models. ResultsThe longest time-to-treatment delay is related to prehospital time (mean, 330.68 [SD=411.55] minutes). Based on the results, the increase in the interval time between onset of pain and treatment (odds ratio: 1.001; 95% confidence interval, 1.000–1.002; P = 0.01), hypertension (odds ratio: 2.96; 95% confidence interval, 1.14–7.68; P = 0.02), and left coronary artery complete occlusion (odds ratio: 2.78; 95% confidence interval, 1.57–4.94; P < 0.001) were mortality predictor factors. Furthermore, the increase in the interval time between onset of pain and treatment (odds ratio: 1.001; 95% confidence interval, 1.000–1.002; P = 0.03), current smoking (odds ratio: 5.53; 95% confidence interval, 1.75–17.43; P = 0.004), and right coronary artery complete occlusion (odds ratio: 5.87; 95% confidence interval, 1.34–25.82; P = 0.02) were highly associated with the occurrence of heart failure. DiscussionHypertension, smoking history, and delay in treatment time were highly associated with the occurrence of heart failure and mortality. Therefore, in Iranian society, education on primary and secondary prevention of myocardial infarction is recommended to reduce patient mortality.

P1533SURVIVAL ANALYSIS OH HAEMODIALYSIS PATIENTS: IMPACTO OF UREMIC TOXINS

Abstract Background and Aims HEMO study showed that β2M level over time was predictive of all-cause mortality in haemodialysis patients (HD). Later studies suggested that protein-bound uremic toxins are associated with mortality in HD patients but with recent contrasting results. Aim of study was to analyse β2M and indoxyl sulfate (IS) as predictor factors of mortality. Method 5 years follow-up of 60 prevalent HD patients of our hospital. Demographic data was described. Baseline midweek pre-dialysis serum β2M was determined by nephelometry and total IS levels by high performance liquid chromatograph connected to a UV detector. We considered high serum β2M group as if was equal or higher than 27,5 mg/L. As to IS, patients were divided into quartiles (1q &amp;lt;9,7 mg/L, 2-3q ≥9.7-26.5mg/L, 4q&amp;gt;26.5 mg/L). Survival curves were assessed using the Kaplan–Meier analysis at 1,2,3 and 5 years in univariate analysis for albumin (≥38 g/L or lower), β2M, and total IS groups, and evaluated by the proportional hazards Cox´s model. P -values &amp;lt;0.05 were considered statistically significant. Results 60 prevalent patients with mean vintage of 46,8 months (range 3-299 months). Mean age was 60±20 years. Males were more prevalent (53,3% vs 46,6%). 35% had diabetes. 51,6% underwent conventional hemodialysis (HD), 48,3% post-dilution haemodiafiltration, with mean convective volume of 23,8±2,8L. Mean eKt/V was 1,67±0,4, mean nPCR was 1±0,27g/kg/day. Only 8,3% of patients had urine volume&amp;gt;500cc/24hours. Mean β2M level was 35,6±1,9mg/L (X±SE) and mean total IS level was 18,9±1,6mg/L. The overall mortality at 5 years was 57%. Albuminemia lower than 38g/L was associated with mortality at 2, 3, and 5-years in univariate analysis (Cox´s F test p=0.03, figure 1). We found no difference in survival rate between patients with high or low serum β2M levels at 3- or 5-years analysis (Cox´s F test p=0.27). At 2 years analysis, patients in the lower β2M group had better survival (Cox´s F test p=0.04, Figure 1). There was no statistically significant association between albumin, β2M, IS level and all-cause mortality on Cox regression multivariate analysis. We observe no statistically significant association between IS levels and all-cause mortality neither on univariate, nor on multivariate analysis. Conclusion β2M &amp;lt; 27,5 mg/l was associated with better survival at 2 years univariate analysis. IS had no statistically significant association with all-cause mortality in our cohort.

Risk Factors for the Development of Complications After Surgical Treatment for Bronchopulmonary Carcinoma

IntroductionThe most suitable treatment in most early-stage lung cancer patients is surgical resection. Despite previously assessing each patient's status being relevant to detect possible complications inherent to surgery, no consensus has been reached on which factors are “high risk” in such patients. Our study aimed to analyze the morbidity and the mortality incidence associated with this surgery in our setting with a multicentre study and to detect risk parameters. MethodsA prospective analysis study with 3307 patients operated for bronchopulmonary carcinoma in 24 hospitals. Study variables were age, TNM, gender, stage, smoking habit, surgery approach, surgical resection, ECOG, neoadjuvant therapy, comorbidity, spirometric values, and intraoperative and postoperative morbidity and mortality. A multivariate logistic regression analysis of the morbidity and mortality predictor factors was done. ResultsWe recorded 34.2% postoperative morbidity and 2.1% postoperative mortality. Gender, myocardial infarction, angina, ECOG ≥1, COPD, DLCO <60%, clinical pathological status, surgical resection and surgery approach were shown as morbidity and mortality predictor factors in lung cancer surgery in our series. ConclusionsThe main variables to consider when assessing the lung cancer patients to undergo surgery are gender, myocardial infarction, angina, ECOG, COPD, DLCO, clinical pathological status, surgical resection and surgery approach.

COVID-19: Lymphocyte Subpopulations Monitoring in Critically Ill Patients

Background: The alteration of lymphocyte subpopulations can help to predict the severity and the prognosis of severe Coronavirus disease 2019 (COVID-19). Our goal was to describe the kinetics of lymphocyte subsets, and their impact on the severity and mortality in critically ill COVID-19 patients. Methods: We collected demographic data, comorbidities, clinical signs on admission, laboratory findings on admission then a follow-up during hospitalization. Lymphocyte subsets including CD3+ T cells, CD4+ T cells, CD8+ T cells, B cells, and natural killer (NK) cells were counted by flow cytometer. Results: On admission, we observed lymphopenia in 57% of cases, decreased CD3+ T cells in 76% of cases, decreased CD4+ T cells in 81% of cases, decreased CD8+ T cells in 62% of cases, decreased B cells in 52% of cases, and decreased natural killer (NK) cells in 33% of cases. After treatment, decreased CD3+ T cells, decreased CD4+ T cells, decreased CD8+ T cells, and decreased natural killer cells were predictor factors of mortality, in the univariable analysis. Conclusion: CD3+ T cells, CD4+ T cells, CD8+ T cells, and natural killer cells were predictor factors of severity, ICU mortality, and also a useful tool for predicting disease progression.

Factores de riesgo para el desarrollo de complicaciones tras tratamiento quirúrgico del carcinoma broncopulmonar

IntroductionThe most suitable treatment in most early-stage lung cancer patients is surgical resection. Despite previously assessing each patient's status being relevant to detect possible complications inherent to surgery, no consensus has been reached on which factors are “high risk” in such patients. Our study aimed to analyse the morbidity and the mortality incidence associated with this surgery in our setting with a multicentre study and to detect risk parameters. MethodsA prospective analysis study with 3,307 patients operated for bronchopulmonary carcinoma in 24 hospitals. Study variables were age, TNM, gender, stage, smoking habit, surgery approach, surgical resection, ECOG, neoadjuvant therapy, comorbidity, spirometric values, and intraoperative and postoperative morbidity and mortality. A multivariate logistic regression analysis of the morbidity and mortality predictor factors was done. ResultsWe recorded 34.2% postoperative morbidity and 2.1% postoperative mortality. Gender, myocardial infarction, angina, ECOG ≥1, COPD, DLCO <60%, clinical pathological status, surgical resection and surgery approach were shown as morbidity and mortality predictor factors in lung cancer surgery in our series. ConclusionsThe main variables to consider when assessing the lung cancer patients to undergo surgery are gender, myocardial infarction, angina, ECOG, COPD, DLCO, clinical pathological status, surgical resection and surgery approach.

Acute‐subacute paracoccidioidomycosis: A paediatric cohort of 141 patients, exploring clinical characteristics, laboratorial analysis and developing a non‐survival predictor

The acute-subacute form of paracoccidioidomycosis (PCM) is a severe systemic mycosis that affects children and adolescents from endemic regions, leading to generalised lymphadenopathy, fever, weight loss, anaemia, eosinophilia, hypoalbuminemia and hypergammaglobulinemia. The objective of this study is to describe the clinical and laboratorial characteristics of acute-subacute PCM, to determine a mortality risk factor and to propose a test for non-survival hazard related to the disease. Children and adolescents diagnosed with PCM, under 15years were included in the study. Their epidemiological, clinical and laboratorial data were obtained from the hospital records. Descriptive analysis, comparison of means, univariate logistic regression, multivariate logistic regression and a ROC curve were performed in order to identify significant information (P<.05). Through a period of 38years, 141 children and adolescents were diagnosed with acute-subacute PCM. The main antifungal agent used for the treatment was sulfamethoxazole-trimethoprim (SMX-TMP). The complication rate was 17%, the relapse rate was 7.8% and the mortality rate was 5.7%. A low albumin dosage was identified as a predictor factor for mortality. The cut-off for serum albumin was 2.18g/dL, above which, the survival rate is 99.1%. Thus, simple clinical and laboratorial examinations may lead to the diagnosis of acute-subacute PCM, and the beginning of the treatment is encouraged even before the isolation of the fungus in biological samples, preventing unfavourable outcomes. Patients with an albumin dosage≤2.18g/dL must receive special attention, preferably hospitalised, during the first four weeks of treatment for presenting an elevated mortality hazard.

Prognosis of heart failure in a tunisan cohort

Inspite of therapeutic progress, chronic heart failure (HF) was associated to poor prognosis due to high mortality, and an important rate of réhospitalisations. The aim of our study was s to describe the epidemiological, clinical, therapeutic and evolutionary characteristics of HF and to release the predictive factors of mortality and rehospitalizations. A prospective study of 110 patients hospitalized for first episode of HF. Data were collected from adut cardioly department of la Rabta hospital, during the period from October 2013 to October 2015. We included patients with reduced left ejection fraction function ≤ 40%. Multivariate analysis was performed, using logistic regression model incorporating in order to determinate predictor factors of mortality and rehospitalisation during HF. The average age was 63.6 ± 11.9 years with sex-ratio of 2.6. Clinically 55% of patients were admitted for left-sided heart failure, The mean ejection fraction was estimated at 33,6 ± 5,8% patients. Dominant etiology was ischemic heart disease (45%). Angiotensin converting enzyme was prescribed in 88% of cases, beta-blockers in (91%) case, spironolactone in 48% of cases, hospital mortality and at 6 months was respectively l4%, and 17%. The rate of re-hospitalization for cardiac decompensation was 35%. In multivariate analysis, diabetes, longitunal global strain,TAPSE and hyperuricemia were independent predictors factors of mortality. Valvular etiology and atrial fibrillation were associated with a high risks for hospitalization. In spite of all the therapeutic advances, the prognosis of the heart failure is still dark, incite to a prevention which consist on an early and effective management of the causal pathology before the deterioration of the left-ventricular function.

Anion gap and base deficit are predictors of mortality in acute pesticide poisoning.

Acute pesticide poisoning has long been a serious problem as a method of suicide worldwide. This poisoning is a highly fatal condition that requires a rapid and precise diagnosis for adequate treatment. However, various studies on mortality predictor factors have been insufficient for whole pesticide treatments. We hypothesized that the initial plasma anion gap (AG) and base deficit (BD) are reliable prognostic factors. A retrospective study analyzed 561 patients with a diagnosis of acute pesticide poisoning between January 1, 2014 and June 30, 2017. The initial AG and BD values were divided into quartiles according to the number of patients. Survival at 30 days from admission was estimated using the Kaplan-Meier survival analysis. Receiver-operator characteristic (ROC) curves were drawn, and the areas under the curve for AG and BD for mortality were calculated. Fifty-eight (10.3%) of 561 patients died within 30 days. The highest AG quartile (>22 mEq/L) was associated with an increased risk of 30-day hospital mortality. Compared to patients with an AG less than 14.7 mEq/L, these patients had a 4.18-fold higher risk of 30-day hospital mortality and the highest BD quartile (>7.9 mEq/L) was associated with an increased risk of 30-day hospital mortality. Compared to patients with a BD less than 1.4 mEq/L, these patients had 2.23-fold higher risk of 30-day hospital mortality. The areas under the ROC for AG and BD curve were 0.699 and 0.744, respectively. Initial high AG and BD values could predict mortality and require precise intensive care.

Comorbidities and mortality in persons with type 1 diabetes: the vantage point of multiple time scales via Bayesian intensity model

Introduction Type 1 diabetes is an incurable autoimmune condition occurring typically before the age of 30 years in which the ability of pancreas to produce insulin in compromised resulting in too high levels of blood sugar. Diabetes often causes other health problems over time. Calendar year and age of diagnosis of type 1 diabetes as well as diabetes duration are considered as important predictor factors for mortality and morbidity in persons with type 1 diabetes. One of the common comorbidities in type 1 diabetes is the chronic kidney disease, which increases the risk for both cardiovascular death and end-stage renal disease (ESRD). ESRD is a life-threatening complication resulting in a poor prognosis for patients. Cardiovascular death and renal failure are therefore competing risks in patents with type 1 diabetes. So far, researchers have focused on the competing risks approach to account for mortality when evaluating the ESRD risk. Our aim is to provide an overall picture on the changes in the progression of type 1 diabetes to ESRD and/or death without ESRD, when studying the risk on multiple time scales simultaneously, and accounting for the interplay of the relevant time scales. Methods This study is based on the cohort formed in the register-based FinDM (Diabetes in Finland) study, in which incident type 1 diabetes patients were identified from the Finnish drug reimbursement register (Social Insurance Institution) and from the Finnish Hospital Discharge Register (National Institute for Health and Welfare). This study focused on those diagnosed with type 1 diabetes between 1972 and 1991 before age of 30 years (n = 11,810). Follow-up data from the date of entitlement until end of 2014 on ESRD (Finnish Registry for Kidney Diseases) and death (Statistics Finland) were obtained through a computerized register linkage. We tracked the individual's risk for ESRD or death without ESRD on the relevant time scales, age, calendar time and diabetes duration, by applying nonparametric Bayesian intensity model. The model allows incorporation of multiple time scales and multiplicative effects of different time scales. We used the informative graphical displays of the hazard, such as 3-dimesional plots and heatmaps, to present and interpret the results. Results After a mean follow-up of 26.7 years, a total of 338,492.8 person-years accumulated and 844 persons (7.1%) developed ESRD, yielding a crude incidence rate of 2.5 per 1000 person-years. Deaths of persons with ESRD (n = 440) comprised almost 19% of all of the 2345 deaths. The crude mortality rate was 5.7 and 86.2 per 1000 person-years among type 1 diabetic patients without and with ESRD, respectively. Estimation of multiplicative effect of the diabetes duration and attended age by means of Bayesian model depicted both time scales as determinants of the risk for ESRD as well as the risk of death without ESRD. After attended age of 20 years, the risk of ESRD increased steeply, reached a plateau around 30 years, and showed a slight decrease after age of 40 years. The risk of ESRD associated with diabetes duration incorporated two levels, the lower one followed by the higher one, with the change point at 15 years. The risk of death without ESRD increased gradually with increasing age, whereas a decrease in risk was seen for increasing diabetes duration in those diagnosed with type 1 after age of 8 years. Calendar time was associated with improved survival of type 1 diabetic patients without ESRD and decreased risk for ESRD. Conclusions Overall prognosis of type 1 diabetes has improved over time. Attended age and duration of diabetes, both important determinants of the morbidity and mortality in patients with type 1 diabetes, have a multiplicative effect. The strongest joint effect of two time scales on the risk of ESRD was seen for those attending 30-40 years after diabetes duration over 15 years.

Ketahanan hidup 2 tahun pasien tuberkulosis resisten obat di RS. Moewardi Surakarta tahun 2010-2014

Two year survival of drug resistant tuberculosis patients in Moewardi hospital in Surakarta in 2010-2014PurposeThe purpose of this study was to determine the two year survival rate and predictor factors of mortality in drug resistant tuberculosis patients during treatment at the Moewardi Hospital in Surakarta.MethodsThis research was a retrospective cohort study of 250 drug resistant tuberculosis patients receiving treatment in the Moewardi Hospital in January 2011-September 2014. Data were analyzed using survival analysis to find factors affecting the 2 year survival. Our variables were demographic factors, disease characteristics and treatment history. We used Cox regression test with 5% significance level.Results2-year survival rates of drug resistant patients was 74.82%. age, the type of patient, HIV status, side effects of medications and culture conversion were significant to survival rate in bivariate analysis. Cox regression test showed that aged ≥ 40 years (HR 3.221; 95% CI 1.037 to 10.001) and have HIV-positive status (HR 18.086; 95% CI 1.958 to 167.073) were related with reduction of two year survival rate in drug resistant tuberculosis patient. ConclusionAge above 40 years old and HIV positive status for drug-resistant tuberculosis patients may accelerate their death. The screening of HIV in drug resistant tuberculosis patients is needed in order to increase two year survival rate of patients during treatment.

Multimorbidity as specific disease combinations, an important predictor factor for mortality in octogenarians: the Octabaix study.

BackgroundThe population is aging and multimorbidity is becoming a common problem in the elderly.ObjectiveTo explore the effect of multimorbidity patterns on mortality for all causes at 3- and 5-year follow-up periods.Materials and methodsA prospective community-based cohort (2009–2014) embedded within a randomized clinical trial was conducted in seven primary health care centers, including 328 subjects aged 85 years at baseline. Sociodemographic variables, sensory status, cardiovascular risk factors, comorbidity, and geriatric tests were analyzed. Multimorbidity patterns were defined as combinations of two or three of 16 specific chronic conditions in the same individual.ResultsOf the total sample, the median and interquartile range value of conditions was 4 (3–5). The individual morbidities significantly associated with death were chronic obstructive pulmonary disease (COPD; hazard ratio [HR]: 2.47; 95% confidence interval [CI]: 1.3; 4.7), atrial fibrillation (AF; HR: 2.41; 95% CI: 1.3; 4.3), and malignancy (HR: 1.9; 95% CI: 1.0; 3.6) at 3-year follow-up; whereas dementia (HR: 2.04; 95% CI: 1.3; 3.2), malignancy (HR: 1.84; 95% CI: 1.2; 2.8), and COPD (HR: 1.77; 95% CI: 1.1; 2.8) were the most associated with mortality at 5-year follow-up, after adjusting using Barthel functional index (BI). The two multimorbidity patterns most associated with death were AF, chronic kidney disease (CKD), and visual impairment (HR: 4.19; 95% CI: 2.2; 8.2) at 3-year follow-up as well as hypertension, CKD, and malignancy (HR: 3.24; 95% CI: 1.8; 5.8) at 5 years, after adjusting using BI.ConclusionMultimorbidity as specific combinations of chronic conditions showed an effect on mortality, which would be higher than the risk attributable to individual morbidities. The most important predicting pattern for mortality was the combination of AF, CKD, and visual impairment after 3 years. These findings suggest that a new approach is required to target multimorbidity in octogenarians.

Transcatheter device closure of postmyocardial infarction ventricular septal defect

BackgroundTranscatheter device closure of postmyocardial infarction ventricular septal defect (PMIVSD) is less invasive than surgical repair. However, its feasibility, timing, outcome, and prognostic factors remain unclear. MethodsThis was a multicenter, retrospective cohort study. Between February 2012 and July 2015, a total of 10 (8 male and 2 female) patients with PMIVSD undergoing attempted device closure were enrolled retrospectively. The procedures were performed under general anesthesia with fluoroscopic and transesophageal echocardiographic guidance. ResultsThe patients enrolled in the study were in the age range 50–85 years (median age of 76.5 years). The interval from infarction to device closure ranged from 6–147 days, with the median of 12 days. A total of 13 devices were implanted in 10 patients. There were five Amplatzer muscular ventricular septal defect occluders, four Amplatzer septal occluders, three Amplatzer PMIVSD occluders and one Amplatzer vascular plug II. Complications included transient ventricular tachycardia in three patients, device embolization in one patient, and tracheal bleeding in one patient. No procedure-related death, stroke, or cardiac tamponade was noted. During follow-up, two patients died of heart failure and two patients died of sepsis. Overall, subjects with age ≥ 80 years, systolic blood pressure ≤ 90 mmHg, and procedure time ≥180 minutes were significant predictor factors for mortality. All patients with the interval of infarction to device closure >12 days survived. ConclusionOur findings indicate that transcatheter device closure of PMIVSD is technically feasible, safe, and effective to reduce the shunt. The crucial prognostic factors were ascertained to be age ≥ 80 years, systolic blood pressure ≤ 90 mmHg, and procedure time ≥180 minutes.

SUN-P143: Calf Circumference as a Predictor Factor of Mortality in Elderly Cancer in Brazil and Portugal

SUN-P143: Calf Circumference as a Predictor Factor of Mortality in Elderly Cancer in Brazil and Portugal

Adrenal hormones as independent predictor factors of mortality during sepsis or septic shock

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

A Risk-Adjusted Retrospective Data Analysis between Younger and Elderly Patients with Acute Coronary Syndromes—Long-Term Prognosis

Purpose: To compare the demographic data and outcomes of younger versus elderly patients with acute coronary syndromes. Methods: This was a retrospective data bank analysis study with 966 patients (268 in the younger group (less than 55 years) and 698 in the elderly group (more than 55 years)). Data were obtained about clinical characteristics, angiography, and medication used at hospital and coronary definitive treatment. The primary endpoint was all cause of in-hospital death and combined events. Comparison between groups was made by Anova and Q-square. Multivariative analysis was determined by logistic regression and was considered significative when p < 0.05. Long-term mortality and combined events were studied using Kaplan- Meyer curves with median follow-up of 11.21 months. Results: The median age in the younger group was 48 years versus 69 years in the elderly group. In the younger group 26% was ST-myocardial infarction versus 18% in the elderly group. About 7% of younger patients were submitted to coronary bypass surgery and 42% to percutaneous coronary angioplasty versus 12% and 25% in elderly group, respectively. Significant difference was observed between the younger versus elderly groups in deaths (1.5% × 7.5%, p = 0.004), combined events (14.9% × 26.3%, p = 0.02) and killip III/IV (3.7% × 8.3%, p = 0.04). Long-term mortality was 3.7% × 10.2%, p = 0.01). Conclusions: In patients with acute coronary syndromes age was an important predictor factor of mortality and complications. Significative differences in outcomes were observed between the two groups in-hospital and long-term follow-up.

Fatores associados à melhora da composição corporal em indivíduos com DPOC após treinamento físico

Introdução A redução da massa magra corpórea (MMC) é um fator independente de mortalidade em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) e a literatura mostra que exercícios físicos aumentam a MMC. Objetivo Identificar fatores associados à melhora da composição corporal em indivíduos com DPOC após treinamento físico de alta intensidade. Métodos 37 pacientes com DPOC (19 H; 66 ± 7 anos; IMC = 27 ± 6 kg/m2; VEF1 = 38 ± 16 %pred) foram avaliados segundo sua composição corporal, função pulmonar, força muscular respiratória e periférica, capacidade funcional de exercício (teste de caminhada dos seis minutos, TC6M), nível de atividade física diária (DynaPort®), sensação subjetiva de dispneia (escala Medical Research Council) e qualidade de vida (Saint George Respiratory Questionnaire). O treinamento conteve exercícios de endurance e força muscular (3 vezes por semana por três meses). Após três meses, os pacientes foram reavaliados. Aqueles que apresentaram incremento de MMC incorporaram à estatística. Resultados No pré-treinamento, a MMC se correlacionou significativamente (p ≤ 0,05) com gasto energético total (r = 0,57), TC6M em %predito (r = 0,46), pressão expiratória máxima (PEmax) (r = 0,57), volume expiratório forçado no primeiro segundo em %predito (r = 0,47), força muscular de quadríceps femoral (r = 0,54), bíceps (r = 0,62) e tríceps braquial (r = 0,63). Contudo, o incremento da MMC após treinamento correlacionou-se significativamente somente com a melhora das escalas MRC (r = 0,4; p = 0,05) e PEmax (r = 0,35; p = 0,04). Conclusão Apesar de a MMC de pacientes com DPOC estar relacionada com a capacidade funcional de exercício, força muscular respiratória e periférica, obstrução pulmonar e gasto energético no pré-tratamento, a melhora da composição corporal está relacionada somente ao incremento da força muscular expiratória e sensação de dispneia após treinamento físico de alta intensidade.

Predictors of mortality in atypical antipsychotic-treated community-dwelling elderly patients with behavioural and psychological symptoms of dementia: a prospective population-based cohort study from Italy

To evaluate the effect of a broad range of covariates on the survival of a real-life long-term follow-up cohort of community-dwelling patients with behavioural and psychological symptoms of dementia who were new users of atypical antipsychotic medications (APMs). This was a prospective cohort study of 1,618 subjects aged ≥65 years with dementia and BPSD ("behavioural and psychological symptoms of dementia") who were new users of atypical APMs and registered in a Dementia Evaluation Unit of Campania Region (Italy) from September 2006 to March 2010. The potential of baseline features to predict mortality was assessed with the Cox proportional hazards model. The average follow-up was 309 days. Of the 1,618 new users of atypical antipsychotics, 9.3 % experienced at least one adverse event, including death (5.1 %), drug therapeutic failure (3.0 %), extrapyramidal symptoms (0.5 %) and stroke (0.2 %). The crude all-cause mortality rate was 6.0 per 100 person-years [95 % confidence interval (CI) 4.8-7.4]; the rate was higher in patients aged >85 years (9.0 per 100 person-years, 95 % CI 6.4-12.7) and among male patients (7.5 per 100 person-years, 95% CI 5.3-10.6). In the multivariate analysis, only age was associated to all-cause mortality [hazard ratio (HR) 1.1; 95 % CI 1.0-1.1 and HR 1.4; 95 % CI: 0.9-2.2, respectively). In contrast, hallucination (HR 0.4; 95 % CI 0.2-0.6) and dosage change (HR 0.4; 95 % CI 0.2-0.78) were significantly associated with a lower risk of all-cause mortality. Among our patient cohort, the mortality rate of patients with BPSD receiving long-term treatment with atypical APMs was lower than that reported in other studies, and only age was found to be significant predictor factor of mortality.

Variables predictoras de mortalidad en pacientes ancianos hospitalizados por insuficiencia cardiaca con fracción de eyección preservada

Background and objectivesThe prevalence of heart failure (HF) increases with age. Even though the mortality of patients≥80years of age with HF and preserved left ventricle ejection fraction (LVEF) is very high, the predictor variables are not well-known. The main goal of this study was to evaluate the mortality predictor factors in this subgroup of the elderly population. Patients and methodsAn observational and prospective study of patients hospitalized due to HF with preserved LVEF has been conducted. The demographic, clinical, functional and analytic factors were evaluated when the patients were admitted with special attention to the co-morbidities. The primary endpoint was the total mortality in the subgroup of patients≥80years of age after a year of follow-up. The predictor variables were studied by means of a multivariate Cox regression model. ResultsFrom a total of 218 patients with an average age of 75.6 (±8.7) years of age, 75 patients (34.4%) were≥80years. The mortality rate of patients≥80 years of age totaled 42.7%, in relation to 26.6% for the lower age group (log-rank<.001). After a multivariate analysis using the Cox regression model in patients≥80, the serum urea levels above the average (hazard ratio [HR] 3.93; 95% confidence interval [95% CI] 1.58-9.75; P=.003), the age (HR 1.17; 95% CI 1.07-1.28; P<.001), the hyponatremia (HR 3.19; 95% CI 1.51-6.74; P=.002) and a lower score on the Barthel index (BI) (HR 1.016; 95% CI 1.002-1.031; P=.034) were independent mortality predictors after an one-year follow-up. ConclusionsSerum urea levels, age, hyponatremia and a low BI score could be proposed as independent mortality predictors in patients≥80 of age hospitalized for HF with preserved LVEF.

Hematomas cerebelosos. Descripción de una cohorte y pronóstico en función de la actitud terapéutica

Spontaneous cerebellar hematomas (CH) represent 5%-10% of intracranial hemorrhaging. We describe the existing cardiovascular risk factors, clinical presentation of CH and its relationship with mortality and the association between the treatment type (conservative medical or neurosurgical treatment) and the subsequent course of the patients. Observational study of patients diagnosed of CH admitted over three years in an Intensive Care Unit of a level III Hospital. Fifty-six consecutive patients diagnosed of CH. VARIABLES OF PRINCIPAL INTEREST: We studied the cardiovascular risk factors, presentation form (with Glasgow Coma Scale- GCS), hematoma size and site, and morbidity-mortality of the patients (with the Glasgow Outcome Scale--GOS). Fisher's exact test, Chi squared, calculation of Spearman's coefficient between certain variables and logistic regression analysis were used. Hematoma size, GCS on admission and presence of hydrocephaly obtained statistical significance. Conservative medical treatment has greater mortality. Patients with GCS < or = 8 and hematoma size > or = 3 cm benefit from surgical treatment. Initial GCS and vermian site are mortality predictor factors. There is no more morbidity due to surgical treatment.

Path analysis on the risk of mortality in very low birth weight infants.

The purpose of this work is to clarify by path analysis which of the predictor factors of mortality in a cohort of 423 singletons VLBW infants born at Beilinson Medical Center during the years 1980-1990 (pre-surfactant era) exert direct or indirect effect on mortality. A direct risk factor was defined as a factor having an immediate effect on the outcome without working through an intermediate variable. By contrast, an indirect risk factor was defined as a factor that does not have a direct effect on the risk of mortality but instead works through an intermediate variable. Evaluation of mortality was done at three points over time (pre-delivery, at birth and post-delivery). In the pre-delivery model, gestational age, appropriateness for gestational age, mother's age and fetal distress work directly on mortality in VLBW infants. At birth, mother's age, birth weight and Apgar score at the fifth minute work directly on the risk of mortality. When the assessment of the risk of death was done post-delivery, mother's age, birth weight, Apgar score at the fifth minute and seizures influence directly on mortality risk, and fetal distress, gestational age and pre-natal induced hypertension (PIH) operate indirectly on the risk of mortality. The methodology we have used can be adopted in other investigations to distinguish and measure the effect of prognostic factors on the risk of an outcome.