Risk Factor For All-cause Mortality Research Articles

Associations of fibroblast growth factor 23, vitamin D and parathyroid hormone with 5-year outcomes in a prospective primary care cohort of people with chronic kidney disease stage 3

ObjectivesVitamin D deficiency, elevated fibroblast growth factor 23 (FGF23) and elevated parathyroid hormone (PTH) have each been associated with increased mortality in people with chronic kidney disease (CKD). Previous studies...

Synergistic effects of cognitive impairment on physical disability in all-cause mortality among men aged 80 years and over: Results from longitudinal older veterans study.

ObjectiveWe evaluated effects of the interrelationship between physical disability and cognitive impairment on long-term mortality of men aged 80 years and older living in a retirement community in Taiwan.MethodsThis prospective cohort study enrolled older men aged 80 and older living in a Veterans Care Home. Those with confirmed diagnosis of dementia were excluded. All participants received comprehensive geriatric assessment, including sociodemographic data, Charlson’s Comorbidity Index (CCI), geriatric syndromes, activities of daily living (ADL) using the Barthel index and cognitive function using the Mini-Mental State Examination (MMSE). Subjects were categorized into normal cognitive function, mild cognitive deterioration, and moderate-to-severe cognitive impairment and were further stratified by physical disability status. Kaplan-Meier log-rank test was used for survival analysis. After adjusting for sociodemographic characteristics and geriatric syndromes, Cox proportional hazards model was constructed to examine associations between cognitive function, disability and increased mortality risk.ResultsAmong 305 male subjects aged 85.1 ± 4.1 years, 89 subjects died during follow-up (mean follow-up: 1.87 ± 0.90 years). Kaplan-Meier unadjusted analysis showed reduced survival probability associated with moderate-to-severe cognitive status and physical disability. Mortality risk increased significantly only for physically disabled subjects with simultaneous mild cognitive deterioration (adjusted HR 1.951, 95% CI 1.036–3.673, p = 0.038) or moderate-to-severe cognitive impairment (aHR 2.722, 95% CI 1.430–5.181, p = 0.002) after adjusting for age, BMI, education levels, smoking status, polypharmacy, visual and hearing impairment, urinary incontinence, fall history, depressive symptoms and CCI. Mortality risk was not increased among physically independent subjects with or without cognitive impairment, and physically disabled subjects with intact cognition.ConclusionsPhysical disability is a major risk factor for all-cause mortality among men aged 80 years and older, and risk increased synergistically when cognitive impairment was present. Cognitive impairment alone without physical disability did not increase mortality risk in this population.

La disminución de triyodotironina se asocia con la elevación del péptido natriurético cerebral N-terminal y con la mortalidad en pacientes en diálisis

BackgroundLow thyroid hormone (TH) levels and myocardial damage are common in dialysis patients and are associated with mortality. However, little is known about the role of THs on myocardial damage as has been described in primary thyroid diseases. The aim of this study was to explore the potential relationship between low total triiodothyronine (total T3) and biomarkers of myocardial damage and the effect of their interaction on mortality, to ascertain if cardiovascular damage is the link between low THs and the risk of death in dialysis patients with CKD. Material and methodsTH plasma levels, nutritional markers, inflammation and myocardial damage were studied in 296 patients undergoing peritoneal dialysis or haemodialysis, who were followed up for 16 months to ascertain the association between biochemical variables and mortality. ResultsLow total T3 levels were found in 45% of patients, which was inversely correlated with C-reactive protein (CRP) and NT-proBNP, and directly correlated with albumin and transferrin. Diabetes, CRP and total T3 were risk factors for all-cause mortality, and CRP, NT-proBNP and total T3 for cardiovascular mortality. ConclusionsLow total T3 levels are common in dialysis patients and are associated with inflammation, malnutrition and myocardial damage. The latter may be the link between low THs and all-cause and cardiovascular mortality.

Acute Severe Gastrointestinal Tract Bleeding Is Associated With an Increased Risk of Thromboembolism and Death

We performed a retrospective cohort study of patients with and without gastrointestinal bleeding (GIB) to determine whether GIB increases the risks of thromboembolism and death. We collected data from 522 patients with acute severe GIB and 1044 patients without GIB (control subjects, matched for age, sex, year of diagnosis, history of thromboembolism, and use of antithrombotic drugs) who underwent endoscopy at the National Center for Global Health and Medicine in Japan from January 2009 through December 2014. Hazard ratios of GIB for thromboembolism and mortality risk were estimated, adjusting for confounders. We also compared standardized mortality ratios between the GIB cohort and the age- and sex-matched general population in Japan. During a mean follow up of 23.7 months, thromboembolism was identified in 11.5% of patients with GIB and 2.4% of control subjects (hazard ratio, 5.3; 95% confidence interval, 3.3-8.5; P<.001). Multivariate analysis revealed GIB as a risk factor for all-thromboembolic events, cerebrovascular events, and cardiovascular events. During a mean follow-up of 24.6 months, 15.9% of patients with GIB and 8.6% of control subjects died (hazard ratio, 2.1; 95% confidence interval, 1.6-2.9; P < .001). Multivariate analysis revealed GIB as a risk factor for all-cause mortality. Compared with the general population, patients with GIB were at increased risk of death (standardized mortality ratio, 12.0). In a retrospective analysis of patients undergoing endoscopy in Japan, we identified acute GIB was a significant risk factor for late thromboembolism and death, compared with patients without GIB. GIB also increased risk of death compared with the general population.

Normative Values of Short-Term Heart Rate Variability Parameters in Koreans and Their Clinical Value for the Prediction of Mortality

Heart rate variability (HRV) analysis is an important clinical tool for characterising cardiac autonomic status. We sought to determine the normative values and characteristics of the HRV parameters derived from a short-term study in Koreans and to determine their clinical role in predicting mortality. A total of 1828 consecutive patients (range 20-84 years, men 64.8%) with no serious comorbid conditions were recruited. The RR intervals from 10-minute electrocardiograms were used for computation of the following HRV parameters: conventional time- and frequency-domain measures and nonlinear measures. A greater age-dependence of most conventional parameters, including the low frequency (LF) and high frequency (HF) powers, was observed than that of the Shannon entropy (ShanEn), approximate entropy (ApEn), and sample entropy. Fifty-four patients (14 cardiac deaths) died during a 10-year follow-up period. The LF/HF ratio (odds ratio [OR], 0.876; p=0.025), ShanEn (OR, 0.372; p=0.028), and ApEn (OR, 0.093; p=0.030) were found to be predictors of all-cause mortality in the multivariate regression analysis. Age was also a powerful risk factor for all-cause mortality (OR, 1.141; p<0.001). We presented the normative values and characterised the short-term HRV parameters in Koreans. Among the short-term nonlinear parameters, the ShanEn and ApEn were adjunctive parameters for predicting the all-cause mortality in the general population.

Preoperative Hypoalbuminemia is a Risk Factor for Early and Late Mortality in Patients Undergoing Endovascular Juxtarenal and Thoracoabdominal Aortic Aneurysm Repair

Advances in endovascular aneurysm repair now allow surgeons to treat high-risk patients with complex aortic aneurysms. Stringent selection criteria for repair exist from an anatomic and technical perspective; however, there is a paucity of literature examining frailty in patients being evaluated for fenestrated and branched endovascular aortic repair (FEVAR). As a marker of frailty well supported in the literature, we hypothesized that preoperative hypoalbuminemia would increase risk for short-term mortality after endovascular juxtarenal and thoracoabdominal aortic aneurysm repair. One thousand eighty nine consecutive patients with juxtarenal and thoracoabdominal aortic aneurysms considered high risk for open surgery from a single institution who underwent FEVAR from 2001 to 2014 were included in the study. Risk factors for all-cause mortality were identified via a Cox regression model on time to death. The patients with severe hypoalbuminemia (albumin <2.4g/dL) had significantly increased 30-day mortality (P=0.025, odds ratio [OR]: 4.967 (95% CI: 1.385-17.814, normal versus severe) and 2-year mortality P=0.006, OR: 2.4, 95% CI: 1.05-5.73, normal versus severe), as well as increased 30-day complication rates P=0.026, OR: 1.91, 95% CI: 0.9-4.17, normal versus severe). A univariate analysis for 30-day mortality revealed no significant difference in median age: 75.1 vs. 72.5years (alive at 30 days (Q1, Q3: 69.8, 80.1) versus expired (Q1, Q3: 69.3, 77.8), P=0.24. Patients with hypoalbuminemia have significantly increased mortality risk. Albuminlevel is regulated by nutritional intake and inflammation due to chronic disease, which make it a useful part of a preoperative frailty assessment. Further studies are neededto identify whether optimizing nutrition status will affect albumin levels or decrease mortality.

Factors Contributing to Erythropoietin Hyporesponsiveness Among Hemodialysis Patients: A Cross-Sectional Multicenter Study

Background: Anemia resistant to erythropoietin stimulating agents (ESAs) is a risk factor for all-cause mortality. Determining the etiologies of hyporesponsiveness may help overcome the resistance. We investigated the contributing factors in a population of hemodialysis patients. Methods: In a multicenter cross-sectional study, from January 2015 to May 2015, point-prevalent hemodialysis patients from 22 dialysis centers in Tehran, Iran, were enrolled. Demographic, clinical, and laboratory data and drug history were recorded. ESA hyporesponsiveness index (EHRI) was calculated by dividing weekly ESA dose per kilogram of body weight (IU/Kg/W) by hemoglobin level (g/dL). Patients with EHRI ≥ 16.49 (4th quartile) were compared with those with EHRI < 16.49 with respect to influential factors. Results: A total of 1224 patients were enrolled among whom, 306 (25%) had an EHRI ≥ 16.49 with a mean hemoglobin level of 9.8 ± 1.4 g/dL. There was no age, gender, or dialysis vintage difference within the groups. Iron status, parathormone, CRP, and diabetes were also similar. Hyporesponsive patients had lower body mass index (BMI) and lower serum albumin (P < 0.05). The proportion of patients who were treated with angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) were significantly higher (P < 0.01) in hyporesponsive patients. In multivariate analysis, high doses of Venofer, high Kt/V, and high phosphate level were independently related to the presence of EHRI, and treatment with ACE/ARB was a marginally significant factor for EPO resistance. Conclusions: Apart from the most validated parameters responsible for ESA hyporesponsiveness (e.g. Iron deficiency, dialysis inadequacy, and poorly controlled serum phosphate level), other potential risk factors such as treatment with ACEi/ARB should be evaluated. Discontinuation of these drugs might be a therapeutic strategy to overcome ESA resistance.

Association of serum albumin level and clinical outcomes among heart failure patients receiving cardiac resynchronization therapy

Objective: To assess the relationship between serum albumin level and clinical outcome in heart failure (HF) patients receiving cardiac resynchronization therapy (CRT). Methods: In this retrospective cohort study, 357 consecutive chronic heart failure patients receiving CRT between January 2010 and December 2015 were enrolled and divided into two groups based on pre-CRT serum albumin (albumin≥40 g/L, n=244; albumin<40 g/L, n=113). Clinical outcomes were defined as all-cause mortality (including heart transplantation) and rehospitalization due to worsening HF.Baseline characteristics were compared and all-cause mortality (including heart transplantation) and rehospitalization due to worsening heart failure (HF) were analyzed using Kaplan-Meier curves.Prognostic value of albumin level was evaluated in Cox proportional-hazards regression models. Results: Over a median follow-up time of 21 months, 45 patients (12.6%) died, 4 patients (1.1%) underwent heart transplantation and 100 patients (28.0%) were rehospitalized due to worsening HF. HF patients with pre-CRT albumin<40 g/L were related with worse NYHA function class, lower HDL-C level and ACEI/ARB use compared to HF patients with pre-CRT albumin≥40 g/L. Kaplan-Meier analyses evidenced lower survival rate in HF patients (log-rank test: P=0.000 4, χ(2)=12.60) and higher rehospitalization rate due to worsening HF (log-rank test: P=0.009, χ(2)=6.82) in HF patients with pre-CRT albumin<40 g/L.Multivariate Cox analyses indicated that serum pre-CRT albumin <40 g/L was an independent risk factor for all-cause mortality (HR=2.019, 95%CI 1.125-3.622, P=0.018) and HF rehospitalization (HR=1.517, 95%CI 1.014-2.270, P=0.043). Conclusion: Pre-CRT serum albumin level is associated with the severity of heart failure in CRT recipients.Patients with lower pre-CRT albumin level face increased risk of all-cause mortality and HF rehospitalization in chronic heart failure patients receiving cardiac resynchronization.

Is Type D personality a risk factor for all-cause mortality? A prospective population-based study among 2625 colorectal cancer survivors from the PROFILES registry

ObjectiveOur goal was to examine whether Type D personality and its components, negative affectivity (NA) and social inhibition (SI), were associated with all-cause mortality among colorectal cancer (CRC) patients. MethodsCRC patients diagnosed between 2000 and 2009, as registered in the Dutch population-based Eindhoven Cancer Registry, received a questionnaire on Type D (DS14) on average 5.3years after diagnosis. Survival status (31-12-2013) was obtained from the Central Bureau for Genealogy. We used a Cox proportional hazard model to relate personality to all-cause mortality, while adjusting for demographics, clinical characteristics and cardiovascular disease (CVD). ResultsFifty percent was categorized as the ‘reference group’ (n=1281), 17% as ‘SI only’ (n=421), 12% as ‘NA only’ (n=309), and 21% as ‘Type D’ (n=532). After adjustment, CRC patients in the ‘NA only’ and ‘Type D’ groups showed an increased risk (HR=2.0, 95% CI=1.4–2.8, p<0.01, and HR=1.7, 95% CI=1.3–2.4, p<0.01) for all-cause mortality. This adverse effect of NA was limited to men aged >70. There was an additional adverse effect of SI on all-cause mortality in older men without CVD (HR=2.3, 95% CI=1.2–4.4, p=0.01). Personality was not related to mortality in women. Entering personality continuously, showed an increased risk for NA among older survivors, men and patients with comorbid CVD. Neither SI nor the interaction term was predictive in both the un- and adjusted Cox models. ConclusionOur findings suggest that it is the NA component that drives the adverse effect of psychological distress on survival in CRC patients, which is most prominent among older men.

Association of depression and anxiety before heart transplant with mortality after transplant: a single-center experience

Association of depression and anxiety before heart transplant with mortality after transplant: a single-center experience Flavio Epstein,1 Melissa M Parker,2 Anna Lucero,3 Rakesh Chaudhary,4 Eyun Song,3 Dana Weisshaar1 1Heart Transplant Department, Kaiser Permanente Santa Clara Medical Center, Santa Clara, 2Kaiser Permanente Division of Research, Oakland, 3Department of Graduate Medical Education, 4Department of Internal Medicine, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, USA Objective: The purpose of this study was to evaluate the effects of depression and anxiety before heart transplant on all-cause mortality after heart transplant in a Northern California cohort.Methods: A total of 130 adult patients with heart transplants enrolled at Kaiser Permanente between June 2005 and December 2013 were included in a retrospective chart review. Preoperative depression and anxiety, evidenced by diagnoses, and other risk factors for all-cause mortality were investigated. Statistical methods included Kaplan–Meier survival analysis and Cox proportional hazard regression models.Results: After risk adjustment, patients with preoperative depression and anxiety diagnoses had higher risk of all-cause mortality at 2 years (hazard ratio [HR] =4.2, 95% confidence interval [CI]: 1.1, 15.0, p=0.03) and 3 years (HR=3.7, 95% CI: 1.2, 11.9, p=0.04) following heart transplant than those without depression or anxiety. This finding did not reach statistical significance at 5 years post-heart transplant (HR=2.0, 95% CI: 0.8, 5.3, p=0.14).Conclusion: The findings suggest an association between preoperative depression and anxiety with mortality in heart transplant patients 2 and 3 years post-transplant. Keywords: pre-operative depression, anxiety, survival after heart transplant

Sex-specific Relationship of Serum Uric Acid with All-cause Mortality in Adults with Normal Kidney Function: An Observational Study.

To explain the clinical effect of serum uric acid (SUA) levels as a risk factor for mortality, considering exclusion of kidney function. Participants aged over 40 years who underwent health checkups were recruited. Individuals with estimated glomerular filtrations rates < 60 ml/min/1.73 m2 and who received laboratory study and colonoscopy on the same day were excluded. SUA levels were higher in men than in women (5.7 ± 1.2 mg/dl for men and 4.2 ± 0.9 mg/dl for women, p < 0.001). During 12.3 ± 3.6 years of followup, 1402 deaths occurred among 27,490 participants. About 6.9% of men and 3.1% of women died. The overall mortality rate had a U-shaped association with SUA levels, a U-shaped association in men, and no association in women. There was a significant interaction of sex for the SUA-mortality association (p for interaction = 0.049); therefore, survival analysis was conducted by sex. In men, the lower SUA group had a higher mortality rate after adjustment (SUA ≤ 4.0 mg/dl, adjusted HR 1.413, 95% CI 1.158-1.724, p = 0.001) compared with the reference group (SUA 4.1-6.0 mg/dl). A higher SUA contributed to an insignificant increased mortality in men (> 8.0 mg/dl, adjusted HR 1.140, 95% CI 0.794-1.636, p = 0.479). Women failed to show any significant association between SUA and mortality. This study provided novel evidence that SUA-mortality association differed by sex. We demonstrated that a lower SUA was an independent risk factor for all-cause mortality in men with normal kidney function.

Increased Mortality in Relation to Insomnia and Obstructive Sleep Apnea in Korean Patients Studied with Nocturnal Polysomnography.

To elucidate the links between the two most prevalent sleep disorders, insomnia and obstructive sleep apnea (OSA), and mortality. We studied 4,225 subjects who were referred to the Center for Sleep and Chronobiology, Seoul National University Hospital, from January 1994 to December 2008. We divided the subjects into five groups: mild OSA (5 ≤ AHI < 15), moderate OSA (15 ≤ AHI < 30), severe OSA (AHI ≥ 30), insomnia, and a no-sleep-disorder group consisting of subjects without sleep disorders. Standardized mortality ratio (SMR), hazard ratio, and the survival rates of the five groups were calculated and evaluated. The SMR of all-cause mortality was significantly higher in the severe OSA group than in the general population (1.52, 95% CI 1.23-1.85, p < 0.05). The SMR of cardiovascular mortality increased progressively with the severity of OSA (no-sleep-disorder: 0.09, mild: 0.40, moderate: 0.52, severe: 1.79, p < 0.05). Statistical analyses of the hazard ratios indicated that severe OSA is a risk factor for all-cause mortality (HR 3.50, 95% CI 1.03-11.91, p = 0.045) and cardiovascular mortality (HR 17.16, 95% CI 2.29-128.83, p = 0.006). Cardiovascular mortality was also significantly elevated in the insomnia group (HR 8.11, 95% CI 1.03-63.58, p = 0.046). Severe OSA was associated with increased all-cause mortality and cardiovascular mortality compared to the no-sleep-disorder group. Insomnia was associated with increased cardiovascular mortality compared to the no-sleep-disorder group.

Outcome in biopsy-proven Lupus nephritis: Evaluation of biopsies from the Norwegian Kidney Biopsy Registry.

Objective To evaluate long-term mortality and end-stage renal disease (ESRD) in a cohort of Norwegian patients with biopsy-proven lupus nephritis (LN). Methods Renal biopsies were obtained from 178 patients with LN from 1988 until 2007. Mortality rate and death causes were provided by Statistics Norway and ESRD data were provided by the Norwegian Renal Registry. Risk factors for all-cause mortality were evaluated by Cox regression. Standardized mortality ratio (SMR) was compared to observed deaths in a matched general population sample. Results Mean age was 37.6 (±14.4) years, and median time of follow-up was 8.5 years (0-26.2). Thirty-six patients (20.2%) died during follow-up. The SMR for all-cause mortality was 5.6 (Confidence interval [CI] 3.7-7.5). In an adjusted multivariate analysis proliferative glomerulonephritis (LN class IV) was independently associated with all-cause mortality; hazard ratio (HR) 2.6 (Confidence interval [CI] 1.2-5.7 p = 0.017). Main causes of death were infections (47.2%) and cardiovascular events 8 (22.2%). Thirty-six patients (20.2%) reached ESRD. Conclusions Biopsy-proven LN is associated with increased mortality compared to the general population. LN class IV is associated with all-cause mortality. Infections and cardiovascular events were the most common causes of death. Patients with LN have a high incidence of ESRD.

Impact of diabetes and hypertension on cardiovascular outcomes in patients with coronary artery disease receiving percutaneous coronary intervention

BackgroundPercutaneous coronary intervention (PCI) is a necessary procedure commonly performed for patients with coronary artery disease (CAD). However, the impact of diabetes and hypertension on long-term outcomes of patients after receiving PCI has not yet been determined.MethodsThe data of 1234 patients who received PCI were collected prospectively, and patients were divided into four groups, including patients with and without DM and those with either DM or hypertension alone. Baseline characteristics, risk factors, medications and angiographic findings were compared and determinants of cardiovascular outcomes were analyzed in patients who received PCI.ResultsPatients with DM alone had the highest all-cause mortality (P < 0.001), cardiovascular mortality and myocardial infarctions (MI) (both P < 0.01) compared to the other groups. However, no differences were found between groups in repeat PCI (P = 0.32). Cox proportional hazard model revealed that age, chronic kidney disease (CKD), previous MI and stroke history were risk factors for all-cause mortality (OR: 1.05,1.89, 2.87, and 4.12, respectively), and use of beta-blockers (BB) and statins reduced all-cause mortality (OR: 0.47 and 0.35, respectively). Previous MI and stroke history, P2Y12 inhibitor use, and syntax scores all predicted CV mortality (OR: 4.02, 1.89, 2.87, and 1.04, respectively). Use of angiotensin converting enzyme inhibitors (ACEI), beta-blockers (BB), and statins appeared to reduce risk of CV death (OR: 0.37, 0.33, and 0.32, respectively). Previous MI and syntax scores predicted MI (OR: 3.17 and 1.03, respectively), and statin use reduced risk of MI (OR: 0.43). Smoking and BB use were associated with repeat PCI (OR: 1.48 and 1.56, respectively).ConclusionsAfter PCI, patients with DM alone have higher mortality compared to patients without DM and hypertension, with both DM and hypertension, and with hypertension alone. Comorbid hypertension does not appear to increase risk in DM patients, whereas comorbid DM appears to increase risk in hypertensive patients.Trial registrationREC103-15 IRB of Taichung Tzu-chi Hospital

Elevated fasting glucose and albuminuria may be a marker for all-cause mortality in Indigenous adults in North Queensland - a follow up study, 1998–2006

AimsTo document risk factors of all-cause mortality in a cohort of indigenous Australians from 23 communities of North Queensland during 1998–2006. MethodsAmong 2787 indigenous adults, baseline weight, waist circumference, blood pressure, fasting glucose, lipids, gamma-glutamyl transferase, urine albumin creatinine ratio, smoking, alcohol intake and physical activity were measured in 1998–2000. Deaths were ascertained from State Registry of Deaths, hospitalization and clinical records till 2006. Mortality risk factors were assessed using a Cox proportional-hazards model. ResultsThe standardized all-cause mortality rate was 23.2/1000 person–years (95% CI 20.3–26.3/1000 pys). After adjusting for age, sex, and ethnicity, baseline plasm fasting glucose >=5.5mmol/L was associated with a 50% increased risk of death (HR 1.5, 95% CI 1.2–2.0). Albuminuria was associated with all-cause mortality with a hazards ratio of 1.4 for microalbuminuria (95% CI 1.0–1.9) and 2.6 (95% CI 1.8–3.7) for macroalbuminuria. Gamma-glutamyl transferase >=50IU was associated with an increased risk of all-cause mortality by 40% (95% CI 1.04–1.8). ConclusionsFasting glycaemia, albuminuria, and gamma-glutamyl transferase, may be a marker for all-cause mortality within this cohort.

Urinary 11-Dehydro-Thromboxane B2 and Mortality in Patients With Stable Coronary Artery Disease

Antiplatelet therapy with aspirin has been shown to reduce adverse outcomes in patients with coronary artery disease (CAD). Aspirin irreversibly inhibits platelet cyclooxygenase-1 and attenuates thromboxane A2(TXA2)-mediated platelet aggregation, but there is variable suppression of cyclooxygenase-1. From a cohort of patients with stable CAD, we performed blinded, detailed chart abstraction, and measured urinary 11-dehydro-thromboxane B2 (11dhTxB2), an inactive metabolite of TxA2 from frozen samples. There were 327 men (73%) and 122 women (27%) with a mean age (±SD) of 67 ± 10 and 65 ± 10years, respectively. A positive linear trend for age was observed among tertiles of 11dhTxB2 (ptrend= 0.01). Higher proportions of women (p= 0.001), chronic obstructive pulmonary disease (p trend= 0.0003), and heart failure (p trend= 0.003) were observed in the upper tertile of 11dhTxB2. Sixty-seven patients (14.9%) died over a median follow-up of 1,149days and 87.5% of the deaths were due to cardiovascular causes. Twenty-six nonsurvivors (38.8%) were treated with P2Y12 receptor antagonists versus 161 survivors (42.2%; p= 0.61). By stepwise Cox proportional hazards analysis, we identified that patients in the middle (hazard ratio 7.14; 95% CI 2.46 to 20.68) and upper tertiles (hazard ratio 9.91; 95% CI 3.45 to 28.50) had higher risks for mortality after adjusting for age and co-morbidities. In conclusion, urinary concentration of 11dhTxB2 was a strong independent risk factor for all-cause mortality among patients with stable CAD on aspirin therapy and may be a marker for patients with CAD who require more intensive secondary prevention measures.

Livestock Ownership Among Rural Households and Child Morbidity and Mortality: An Analysis of Demographic Health Survey Data from 30 Sub-Saharan African Countries (2005-2015).

Children living in homes with livestock may have both an increased risk of enteric infections and improved access to food, and therefore improved nutritional status. Few studies, however, have characterized these relationships in tandem. This study investigated the association between child health and household ownership of livestock. A cross-sectional study was performed using data from Demographic and Health Surveys conducted in 30 sub-Saharan African countries with 215,971 rural children under 5 years of age from 2005 to 2015. Logistic regression was performed for each country to estimate the relationship between a log2 increase in the number of livestock owned by the household and three child-health outcomes: 2-week prevalence of diarrhea, stunting, and all-cause mortality. Results for each country were combined using meta-analyses. Most countries (22 of 30) displayed an odds ratio (OR) less than 1 for child stunting associated with livestock (pooled OR = 0.97; 95% confidence interval [CI] = 0.95, 0.99). The results for diarrhea were more even with 14 countries displaying ORs greater than 1 and 10 displaying ORs less than 1. Most countries (22 of 30) displayed an OR greater than 1 for child mortality (pooled OR = 1.04; 95% CI = 1.02, 1.06). All meta-analyses displayed significant heterogeneity by country. Our analysis is consistent with the theory that livestock may have a dual role as protective against stunting, an indicator of chronic malnutrition, and a risk factor for all-cause mortality in children, which may be linked to acute infections. The heterogeneity by country, however, indicates more data are needed on specific household livestock management practices.

The relationship between survival rate and intradialytic blood pressure changes in maintenance hemodialysis patients

Objective: The objective of this study is to investigate the relationship between blood pressure changes and all-cause mortality, and between blood pressure changes and cardiovascular mortality, for maintenance hemodialysis (MHD) patients during dialysis.Methods: Data regarding general condition, biochemical indices, and survival prognosis of MHD patients who were treated at the Shanghai Jiao Tong University School of Medicine-affiliated Renji Hospital from July 2007 to December 2012 were collected, in order to evaluate the relationship between patients’ blood pressure changes during hemodialysis and mortality.Results: Among 364 patients, with an average age of 63.07 ± 13.93 years, an average dialysis vintage of 76.00 (range, 42.25–134.00) months, and a follow-up time of 54.86 ± 19.84 months, there were 85 cases (23.4%) of all-cause death and 46 cases (14.2%) of cardiovascular death. All-cause mortality and cardiovascular mortality were lowest (OR, 0.324 and 0.335; 95% CI, 0.152–0.692 and 0.123–0.911; p value, .004 and .032, respectively) in patients whose systolic blood pressure difference (ΔSBP) before and after dialysis was between 7.09 and 14.25 mmHg. Kaplan–Meier analysis indicated that both all-cause mortality and cardiovascular mortality were markedly increased for patients with ΔSBPless than −0.25 mmHg (p value, .001 and .044, respectively). Cox regression analysis showed that ΔSBP< −0.25 mmHg, hemoglobin concentration, Kt/v and albumin were independent risk factors for all-cause mortality in MHD patients.Conclusions: MHD patients whose blood pressure increased significantly after hemodialysis had a higher risk of dying; ΔSBP, hemoglobin concentration, Kt/v and albumin were independent risk factors for all-cause mortality in MHD patients.

Ankle-Brachial Index as a Predictor of Mortality in Hemodialysis: A 5-Year Cohort Study.

BackgroundAbnormal ankle-brachial index (ABI) has been found to be a strong predictor of mortality in some hemodialysis populations in studies with relatively short periods of follow-up, lower than 2 years.ObjectiveThis study aimed to assess the predictive value of abnormal ABI as a risk factor for death among patients on maintenance hemodialysis after a 5-year follow-up.MethodsA total of 478 patients on hemodialysis for at least 12 months were included in the study. ABI measurement was performed using a mercury column sphygmomanometer and portable Doppler. Patients were divided into 3 groups according to ABI (low: <0.9; normal: 0.9 to 1.3; and high: >1.3) and followed for a 60-month period.ResultsThe prevalence rates of low, normal and high ABI were 26.8%, 64.6% and 8.6%, respectively. The 5-year survival rate was lower in the groups with low ABI (44.1%, P<0.0001) and high ABI (60.8%, P= 0.025) than in the group with normal ABI (71.7%). Cox regression was used to evaluate the association between ABI and mortality, adjusting for potential confounders. Using normal ABI as reference, a low, but not a high ABI was found to be an independent risk factor for all-cause mortality (HR2.57; 95% CI, 1.84-3.57 and HR 1.62; 95% CI, 0.93-2.83, respectively).Conclusionslong-term survival rates of patients with either low or high ABI were lower than the one from those with normal ABI. However, after adjustment for potential confounders, only low ABI persisted as an independent risk factor for all-cause mortality among hemodialysis patients.

D-Dimer: A Novel Predictor of Survival in Patients with Cardiac Light- Chain Amyloidosis

Background: To identify independent risk factors and predictors of survival in patients with cardiac light chain amyloidosis. Methods: This study included 26 patients with cardiac AL amyloidosis who were diagnosed by biopsy between October 2009 and January 2016. All the patients were followed up until August 26th, 2016. Baseline clinical data including clinical symptoms, laboratory data, and echocardiographic findings were recorded. Univariate and multivariate Cox proportional hazard regression analyses were performed to identify risk factors for all-cause mortality. The Kaplan-Meier method and log-rank test were used to compare survival times. Results: In univariate and multivariate analysis, N-terminal pro b-type natriuretic peptide (NT-proBNP) and Ddimer were independent risk factors for all-cause mortality in patients with cardiac AL amyloidosis (P<0.05). The cutoff value of NT-proBNP for 6-month all-cause-mortality was 4509.5 ng/L (sensitivity 73.3%, specificity 77.8%, area under curve (AUC) 67%, 95% confidence interval (CI) 0.442-0.899). The cut-off value of D-dimer for 6-month allcause- mortality was 1.22 mg/L (sensitivity 60%, specificity 90%, AUC 70%, 95% CI: 0.489-0.911). Patients with NTproBNP or D-dimer levels above the cut-off value had a higher all-cause-mortality rate compared to patients below the cut-off value. Conclusion: D-dimer may be an important biomarker of prognosis in cardiac AL amyloidosis patients.