Risk Factors For 2-year Mortality Research Articles

Treatment Outcomes in Octogenarians with Chronic Limb-Threatening Ischemia after Infrainguinal Bypass Surgery or Endovascular Therapy

ObjectiveThis study aimed to analyze the clinical outcomes after revascularization for CLTI in patients aged ≥80 years and <80 years. MethodsWe retrospectively analyzed multicenter data of 789 patients who underwent infrainguinal revascularization for CLTI between 2015 and 2021. The endpoints were 2-year overall survival (OS), amputation free survival (AFS), limb salvage (LS), and postoperative complications. ResultsA total of 90 patients aged ≥80 years and 200 patients aged <80 years underwent bypass surgery (BSX), and 205 patients aged ≥80 years and 294 patients aged <80 years underwent endovascular therapy (EVT). Before the propensity score matching (PSM), multivariate analyses showed that age ≥80 years, lower body mass index (BMI) and serum albumin levels, nonambulatory status, and end-stage renal disease were independent risk factors for 2-year mortality in the BSX and EVT groups. After PSM, the 2-year OS was better in the <80 years cohort than in the ≥80 years cohort in both the BSX and EVT groups (P = .018 and P = .035, respectively). There was no difference in the 2-year LS rates between the <80 years and the ≥80 years cohorts in both the BSX and EVT groups (P = .621 and P = .287, respectively). According to the number of risk factors, except for age ≥80 years, there was no difference in the 2-year AFS rates between the <80 years and ≥80 years cohorts for the BSX and EVT groups with 0–1 risk factor (P = .957 and P = .655, respectively). However, the 2-year AFS rate was poor, especially in the ≥80 years cohort in the BSX with 2–4 risk factors (P = .015). The Clavien–Dindo ≥IV complication rates tended to be higher in the ≥80 years cohort than in the <80 years cohort only in the BSX with 2–4 risk factors (P = .056). ConclusionsPatients with CLTI aged ≥80 years had poorer OS than those aged <80. However, there was no difference in LS between the ≥80 years and <80 years cohorts in both the BSX and EVT groups. Although age ≥80 years was associated with poorer OS, patients with 0–1 risk factor may benefit from revascularization, including BSX, because no difference was observed in AFS or Clavien–Dindo ≥IV complications.

Comparison of limb outcomes between bypass surgery and endovascular therapy in dialysis-dependent and -independent patients with chronic limb-threatening ischemia

ObjectiveTo examine limb salvage (LS) and wound healing in dialysis-dependent and -independent patients with chronic limb-threatening ischemia (CLTI) after infrainguinal bypass surgery or endovascular therapy (EVT). MethodsWe retrospectively analyzed the multi-center data of patients who underwent infrainguinal revascularization for CLTI with Wound, Ischemia, and foot Infection (WIfI) stage 2 to 4 between 2015 and 2020. The primary endpoint was LS. The secondary endpoint included wound healing, amputation-free survival (AFS), periprocedural complications, and 2-year survival. Comparison of these outcomes were made after propensity score matching. ResultsWe analyzed 252 dialysis-dependent (318 limbs) and 305 dialysis-independent (354 limbs) patients. Propensity score matching extracted 202 pairs with no significant differences in characteristics. The LS rate in bypass surgery was better than that in EVT in dialysis-dependent patients (P < .001). There was no significant difference in the LS rates between bypass surgery and EVT in dialysis-independent patients (P = .168). The wound healing rate of bypass surgery was better than that of EVT both dialysis-dependent and -independent patients with CLTI. The AFS rate of bypass surgery was better than that of EVT in dialysis-dependent patients (P < .001). There was no significant difference in the AFS rates between bypass surgery and EVT in dialysis-independent patients (P = .099). There was no significant difference in the occurrence of Clavien-Dindo ≥ IV and V between bypass surgery and EVT in dialysis-dependent and -independent patients. Age ≥75 years, serum albumin levels <3.5 g/dL, and non-ambulatory status were risk factors for 2-year mortality in dialysis-dependent patients. The 2-year survival rates in dialysis-dependent patients with risk factors of 0, 1, 2, and 3 were 82.5%, 67.1%, 49.5%, and 10.2%, respectively (P < .001). ConclusionsFor LS and wound healing, bypass surgery was preferred for revascularization in dialysis-dependent patients with WIfI stage 2 to 4. Although dialysis dependency was one of the risk factors for 2-year mortality, dialysis-dependent patients, who have 0 to 1 risk factors, may benefit from bypass surgery, as 2-year survival of >50% is expected.

Impact of early changes in cardiac damage following transcatheter aortic valve implantation.

The staging classification of aortic stenosis (AS) which characterises the extent of cardiac damage has been validated in patients undergoing transcatheter aortic valve implantation (TAVI). Short-term changes in cardiac damage after TAVI and their association with long-term prognosis remain unknown. This study aims to investigate the early evolution of cardiac damage after TAVI and the association of residual cardiac damage with clinical outcomes in TAVI recipients. AS patients undergoing TAVI were consecutively enrolled and classified into five stages of cardiac damage (0-4). Early change in cardiac damage was defined as any change of stage at 30 days (Δcardiac damage between baseline pre-TAVI and 30 days post-TAVI). Within 30 days post-TAVI, the baseline cardiac damage stage had changed in 22.2% of 644 TAVI recipients, accompanied by improvements in the degree of dyspnoea and left ventricular ejection fraction (LVEF). Two-year mortality was associated with residual cardiac damage within 30 days post-TAVI (hazard ratio [HR] 2.97, 95% confidence interval [CI]: 2.07-4.25; p<0.001). Compared to unchanged cardiac damage post-TAVI, further cardiac damage within 30 days was associated with a higher crude risk of 2-year mortality (HR 22.04, 95% CI: 9.87-49.20; p<0.001). Cardiac deterioration within 30 days post-TAVI was an independent risk factor for 2-year mortality (HR 19.564, 95% CI: 8.047-47.565; p<0.001). This investigation provided insight into the early evolution of cardiac damage in TAVI recipients and confirmed the predictive value of both residual and early changes in cardiac damage post-TAVI. Cardiac deterioration within 30 days is associated with poor clinical prognosis.

Risk factors of mortality and second fracture after elderly hip fracture surgery in Shanghai, China.

Hip fracture is one of the leading causes of death and disability in the elderly. We analyzed the risk factors of mortality and second fracture within 2years after hip fracture surgery in elderly Chinese patients. A total of 613 elderly patients after hip fracture surgery were selected, including 181 males and 432 females, and the patients were followed for at least 24months. Information about patients and surgery was collected from medical records. Information on death, secondary fracture, and postoperative activities of daily living (ADL) was obtained by telephone follow-up. Cox regression was performed to identify risk factors associated with mortality and second fracture, measured by hazard ratio (HR). The 1-year and 2-year mortality rates after hip fracture were 13.4% and 20.7%, respectively. The second fracture rate within 2years was 9.5%. Male gender (HR 1.51, P = 0.035), increased age (HR 1.07, P < 0.001), preoperative hypoalbuminemia (HR 1.79, P = 0.004), preoperative pneumonia (HR 2.60, P = 0.005) and poor ADL (P = 0.048) were independent risk factors for 2-year mortality, while high preoperative hemoglobin (HR 0.98, P = 0.002), high preoperative eGFR (HR 0.99, P = 0.031), high preoperative LVEF (HR 0.92, P = 0.048) were protective factors for 2-year mortality. Poor ADL (P = 0.002) was the independent risk factor for second fracture within 2years. The 2-year mortality rate and second fracture rate after hip fracture in elderly remained high, which was related to old age and complications exists. Postoperative rehabilitation and improving ADL were very important to reduce mortality and second fracture.

Evaluation of three nutritional indices as predictors of 2-year mortality and major amputation in patients with chronic limb-threatening ischemia.

The present study aimed to examine which nutritional index, such as the controlling nutritional status (CONUT), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI), is better for predicting prognosis in patients with chronic limb-threatening ischemia (CLTI) following revascularization. We retrospectively analyzed data of patients who underwent revascularization for CLTI between 2008 and 2020. The endpoints were 2-year overall survival and limb salvage. The optimal cutoff values of 2-year overall survival and major amputation were determined by receiver operating characteristic curve analyses. A total of 238 patients with CLTI and 289 limbs were analyzed. The 2-year overall survival rates were 48.9%, 54.6%, and 53.5% in patients with CONUT score ≥4, PNI score <42.6, and GNRI <98.4 compared with 80.0%, 80.0%, and 78.4% in patients with CONUT score <4, PNI score ≥42.6, and GNRI ≥98.4 (p < 0.01). Age, non-ambulatory status, hemodialysis, and nutritional indices were independent risk factors for 2-year mortality in the multivariate analyses. The 2-year limb salvage rates were 70.1%, 82.2%, and 81.9% in patients with CONUT score ≥7, PNI score <41.9, and GNRI <95.3 compared with 92.8%, 98.3%, and 94.2% in patients with CONUT score <7, PNI score ≥41.9, and GNRI ≥95.3 (p < 0.01). Wound, ischemia, and foot infection stage and each nutritional index (CONUT and PNI) were independent risk factors for major amputation in multivariate analyses. The overall survival and limb salvage rates of patients with malnutrition diagnosed by CONUT score were poor compared with those of normal nutrition or malnutrition diagnosed by PNI and/or GNRI scores. The CONUT, PNI, and GNRI scores can predict the 2-year overall survival in patients with CLTI after revascularization. The CONUT and PNI scores were associated with major amputation.

Predictors for long-term mortality in COPD patients requiring non-invasive positive pressure ventilation for the treatment of acute respiratory failure.

IntroductionThe effectiveness of non‐invasive mechanical ventilation (NIV) in the management of COPD patients suffering from acute respiratory failure (ARF) as a consequence of exacerbation of the disease, is well established. However, data on long‐term outcomes and their predictors, including the individual response to NIV, are scarce.ObjectivesTo investigate predictors for short‐ and long‐term mortality in this study population.MethodsA retrospective cohort study was performed including all patients admitted to the Medium Respiratory Care Unit of Maastricht University Medical Center in Maastricht, the Netherlands, with hospitalized exacerbation of COPD (H‐ECOPD) with ARF requiring NIV for the first time between January 2009 and December 2011. An extensive number of potential predictors of outcomes, including the response to NIV, were determined on admission and during hospitalization. Univariate and multivariate logistic regression was used for statistical analysis.ResultsSeventy‐eight consecutive patients with moderate to severe COPD (mean age 71.0 ± 10.7 years; 48.7% males) were included; In‐hospital, 1‐year and 2‐year mortality rates were 14.1%, 43.6% and 56.4%, respectively. Independent risk factors for 2‐year mortality were: advanced age (odds ratio(OR) 1.025; confidence interval (CI) 1.002‐1.049; P = 0.037), prolonged NIV use more than 8 days (OR:1.054;CI:1.006‐1.104; P = 0.027) and no successful response to NIV (OR:2.392;CI:1.297‐4.413; P = 0.005).ConclusionPatients with an H‐ECOPD requiring NIV for the first time, constitute a severely ill patient group with high in‐hospital and 2‐year mortality. This study identified advanced age, NIV use more than 8 days and unsuccessful response to NIV as clinical important independent predictors for long‐term mortality.

Is Chikungunya Virus Infection an Independent Risk Factor for 2-Year Mortality in Older Afro-Caribbean Subjects?

PurposeThe aim of this study was to investigate whether Chikungunya virus infection (CVI) was an independent risk factor for 2-year mortality in Afro-Caribbean subjects aged 65 years or older.Patients and methodsA retrospective cohort study was performed from January 2014 to December 2016 in the University Hospital of Martinique. Subjects aged ≥65 years admitted to the hospital were included. Baseline characteristics and concurrent manifestations at admission were collected. Subjects were followed up by phone for 2 years.ResultsA total of 687 old Afro-Caribbean subjects (80.4±8.0 years) were included: 467 positive for CVI (Chik+) and 220 negative for CVI (Chik-). During the follow-up, 180 (26.2%) died. The proportion of deaths was higher among Chik- (40.9%) than among Chik+ subjects (21.6%) (p<0.0001). By multivariable analysis, when adjusted for age polyarthralgia, neurological troubles, cardiovascular disorders, absence of neutrophilia, thrombocytopenia, hypernatremia, and hospital stay, Chik+ subjects had significantly higher survival rates (HR: 0.58; 95% CI: 0.40–0.85) than Chik- ones.ConclusionWithin the two years following hospital admission of subjects aged ≥65 years or older, Chik+ subjects had significantly higher survival rates than Chik- ones.

Prognostic significance of malnutrition for long-term mortality in community-acquired pneumonia: a propensity score matched analysis.

Background/AimsThe impact of malnutrition on the outcome of hospitalized adults with community-acquired pneumonia (CAP) has not been fully investigated. This study evaluated the prevalence and prognostic significance of malnutrition in a Korean population with CAP.MethodsIn total, 198 patients with CAP from November 2014 to September 2015 were analyzed retrospectively. We assessed the prevalence of malnutrition and the risk factors for 2-year mortality. Furthermore, we divided the patients into two groups: elderly (age ≥ 65 years, n = 131) and non-elderly (age < 65 years, n = 67). Subgroup analyses were performed in the elderly group through propensity score matching.ResultsThe prevalence of malnutrition was 39.4%, and the proportion of patients with malnutrition was significantly higher (53.4% vs. 11.9%, p < 0.001) in the elderly group than in the non-elderly group. In-hospital mortality, 1-year mortality, and 2-year mortality rates were 4.5%, 19.2%, and 26.8%, respectively. Multivariate Cox regression analyses revealed that malnutrition (odds ratio [OR], 2.52; 95% confidence interval [CI], 1.39 to 4.60; p = 0.002) and the Charlson comorbidity index score (OR, 1.30; 95% CI, 1.17 to 1.45; p < 0.001) were associated with 2-year mortality.ConclusionsMalnutrition was common and associated with a poor long-term outcome in patients with CAP, particularly the elderly. A routine nutritional assessment at admission is mandatory as a first step for appropriate nutritional therapy.

Impact of Living Environment on 2-Year Mortality in Elderly Maintenance Hemodialysis Patients

BackgroundStudies on risk factors of mortality in elderly patients with hemodialysis usually focus on comorbidities, nutrition, and inflammation. Discussion on the correlation between living environment and mortality of these patients is limited.MethodsA total of 256 elderly hemodialysis patients participated in this 2-year prospective observational study. The subjects were divided into 2 subgroups based on whether they were living in Taipei Basin (n = 63) or not (n = 193). Demographic, hematological, nutritional, inflammatory, biochemical, and dialysis-related data were obtained for cross-sectional analysis. Causes of death and mortality rates were also analyzed for each subgroup.ResultsPatients in the basin group had a higher incidence of combined protein-energy wasting and inflammation than those in the around basin group. At the end of the 2-year follow-up, 68 patients had died. Univariate binary logistic regression analysis revealed that a very advanced age, basin group, serum albumin levels, serum creatinine levels, non-anuria, and the complications of stroke and CAD were associated with 2-year mortality. Meanwhile, log high-sensitivity C-reactive protein (hs-CRP) levels were not associated with 2-year mortality. Multivariate Cox regression analysis revealed that basin group, serum albumin levels, and the complications of stroke and CAD were significant risk factors for 2-year mortality in these patients.ConclusionThe results of this study indicate that factors such as living in the Taipei Basin with higher air pollutant levels in elderly hemodialysis patients is associated with protein-energy wasting and inflammation, as well as 2-year mortality. These findings suggest that among this population, living environment is as important as comorbidities and nutrition. Furthermore, air pollution should be getting more attention especially in the overcrowding Basin topography.

Associations of depression diagnosis and antidepressant treatment with mortality among young and disabled Medicare beneficiaries with COPD

ObjectiveDepression is prevalent in chronic obstructive pulmonary disease (COPD) patients and a risk factor for COPD exacerbation and death. The objective of this study was to determine the associations of depression diagnosis and antidepressant treatment with mortality among Social Security Disability Insurance (SSDI)-eligible (age <65 years who had permanent physical or mental disabilities) Medicare beneficiaries with COPD. MethodThis retrospective cohort study used a 5% random sample of SSDI-eligible Medicare beneficiaries with COPD in stand-alone Part D plans during 2006–2008 (n=17,320). COPD and depression diagnoses were assessed during 2006. Evidence of antidepressant treatment was measured in 2006–2008. All-cause mortality was measured in 2007–2008. Cox proportional hazards models were used to examine the associations of depression diagnosis with mortality and, among depressed beneficiaries, antidepressant treatment (time dependent) with mortality after controlling for covariates. ResultsMore than one third (37.3%) of SSDI-eligible beneficiaries with COPD had a baseline depression diagnosis; of those, 86.8% had evidence of antidepressant treatment. Baseline depression diagnosis was an independent risk factor for 2-year mortality [hazard ratio (HR)=1.21; 99% confidence interval (CI)=1.07–1.37]. Among depressed beneficiaries, receiving antidepressant treatment was associated with significantly lower mortality (HR=0.55; 99% CI=0.44–0.68). ConclusionProactive antidepressant treatment should be considered as an intervention to reduce mortality for this young and disabled Medicare population.

Ultra-Short-Term Heart Rate Variability for Early Risk Stratification following Acute ST-Elevation Myocardial Infarction

Objectives: To evaluate the prognostic significance of early ultra-short-term heart rate variability (HRV) measurement in patients admitted for ST-elevation myocardial infarction (STEMI). Methods: HRV was calculated retrospectively from the standard admission and discharge 10-second ECG of 196 consecutive patients with STEMI. Reduced HRV was defined as standard deviation of N-N intervals (SDNN) <9.5 (25th percentile). Data regarding all end points were obtained 2 years after discharge for all patients. Results: Patients’ age was 60.9 ± 13 years and 21% were female. Admission SDNN was lower than discharge SDNN (20.2 ± 18 vs. 34.2 ± 31.1, respectively; p = 0.001). Admission and discharge SDNN positively correlated with survival (r = 0.16, p = 0.03 and r = 0.15, p = 0.04, respectively), but were not predictive of other cardiovascular end points. Reduced admission SDNN was associated with increased mortality at 1 and 6 months, and 1 and 2 years after admission, while discharge SDNN was associated only with 1- and 2-year mortality. Using multivariate analysis, adjusted for potential confounders, admission SDNN <9.5 was found to be an independent risk factor for 2-year mortality (odds ratio = 2.9, 95% confidence interval = 1.12–7.56; p = 0.028). Conclusions: Reduced HRV, recorded from admission and discharge ECG, appears to be a significant and independent predictor of all-cause mortality in patients with STEMI.

Predictors of Survival Following Open and Endovascular Repair of Abdominal Aortic Aneurysms

Clinical decision making for asymptomatic abdominal aortic aneurysms (AAAs) weighs risk of aneurysm rupture, treatment hazards, and overall survival expectations. AAA diameter is the primary parameter in assessing rupture risk. Perioperative risk assessment has been extensively studied, and in-hospital mortality has been reduced to less than 8% with higher-risk open repair and less than 3% with endovascular repair. The purpose of this report is to determine risk factors that predict 2-year survival following open and endovascular AAA repair. We studied 334 patients enrolled in a multicenter clinical trial evaluating an endovascular graft in comparison to standard open repair of infrarenal AAA. Demographic, medical history, physical examination, laboratory, anatomic, procedural, and standardized risk score system variables were analyzed in a multivariable Cox proportional hazard model. Overall survival was 89% at 2 years. Heart disease, cancer, and stroke were the most common causes of death, and no deaths were due to AAA rupture. Cox modeling demonstrated that there were several independent predictors for death after AAA repair: smaller body mass index (p=0.005), Society for Vascular Surgery pulmonary risk score >or=1 (p=0.005), history of erectile dysfunction (p=0.008), history of heart valve replacement (p=0.008), lower preoperative platelet count (p=0.012), larger ratio of AAA diameter/proximal neck diameter (p=0.020), and lower ankle-brachial index (p=0.031). Age, gender, and open or endovascular treatment group are not significant independent risk factors for 2-year mortality in this study. Clinical, laboratory, and anatomic factors predict survival after open and endovascular repair of AAAs. With progressive reduction of in-hospital mortality, assessment of patient longevity after AAA repair has become a more important factor in clinical decision making. Use of valid predictors of patient survival will optimize resource utilization and improve overall patient outcomes. Better selection of patients for any method of repair may improve overall utility more than choice of open or endovascular techniques.

Anthropometric measurements of mid-upper arm as a mortality predictor for community-dwelling Japanese elderly: The Nagoya Longitudinal Study of Frail Elderly (NLS-FE)

It remains controversial whether mid-arm anthropometric measurements (MAAMs) are reflected with physical impairment or useful predictors of mortality in the frail elderly. We examined the following hypotheses: (1) MAAMs in frail community-dwelling elderly are lower than those of independent elderly, (2) the lower MAAMs are associated with physical function impairment, and (3) are independent predictors of 2-year mortality. This study was composed of cross-sectional and prospective cohort analyses of 957 community-dwelling elderly. Data included the clients' demographic characteristics, comorbidity, activities of daily living (ADL), and MAAMs at baseline. The mean scores of MAAMs of participants were compared with Japanese Anthropometric Reference Data. Survival analysis of 2-year mortality was conducted using multivariate Cox proportional hazards models. Significantly lower arm muscle area (AMA) and higher triceps skinfold (TSF) levels were observed in most of the age groups of the study participants than those of the standard Japanese population. ADL function was correlated with AMA but not with TSF, both of which were independent risk factors for 2-year mortality in the participants (highest tertile versus lowest, AMA, HR:2.03, 95%CI:1.36-3.02; TSF, HR:1.89, 95%CI:1.30-2.75). AMA and TSF were independent risk factors for 2-year mortality in the community-dwelling frail elderly.