Risk Of 1-year All-cause Mortality Research Articles

Age-specific mortality trends in heart failure over 25 years: a retrospective Danish nationwide cohort study

Despite advances in heart failure care reducing mortality in clinical trials, it remains unclear whether real-life cohorts have had similar improvements in life expectancy across the age spectrum. We aimed to investigate how mortality trends changed in patients with heart failure over the past 25 years, stratified by age groups. Using Danish nationwide registries, we identified patients with new-onset heart failure aged 18-95 years. The 5-year all-cause mortality risk and the absolute risk difference of mortality between patients with heart failure and age-matched and sex-matched heart failure-free controls were assessed using Kaplan-Meier estimates and multivariable Cox regression models. Mortality trends were analysed across five calendar periods (1996-2000, 2001-05, 2006-10, 2011-15, and 2016-20) and three age groups (<65 years, 65-79 years, and ≥80 years). 194 997 patients with heart failure were included. Mortality significantly decreased from 1996-2000 (66% [95% CI 65·5-66·4]) to 2016-20 (43% [42·1-43·4]), with similar results shown in all age groups (<65 years: 35% [33·9-36·1] to 15% [14·6-16·3]; 65-79 years: 64% [63·1-64·5] to 39% [37·6-39·6]; and ≥80 years: 84% [83·1-84·3] to 73% [71·7-73·9]). Adjusted mortality rates supported these associations. The absolute risk difference declined notably in younger age groups (<65 years: 29·9% [28·8-31·0] to 12·7% [12·0-13·4] and 65-79 years: 41·1% [40·3-41·9] to 25·1% [24·4-25·8]), remaining relatively stable in those aged 80 years or older (30·6% [29·9-31·3] to 28% [27·2-28·8]). Over 25 years, there has been a consistent decrease in mortality among patients with heart failure across age groups, albeit less prominently in patients aged 80 years or older. Further insight is needed to identify effective strategies for improving disease burden in older patients with heart failure. None. For the Danish translation of the abstract see Supplementary Materials section.

Perioperative Transfusion and Mortality for Cardiovascular Surgery: A Cohort Study Based on Population in Republic of Korea.

Objective:This study aimed to evaluate the rate of transfusion for cardiovascular surgeries between 2010 and 2019 in Republic of Korea and the association between blood transfusion and postoperative mortality. Methods: Data were extracted from the National Health Insurance Service database in Republic of Korea. This study includes adult patients who underwent cardiovascular surgery between 1 January 2010 and 31 December 2019. The endpoints were in-hospital mortality and the 1-year all-cause mortality. Results: The analysis included 62,794 cases, with transfusions used in 88.8% of cases. Multivariable logistic regression revealed that older age, comorbidities, hospital admission through the emergency room, aortic procedures (versus coronary artery bypass grafting), cardiopulmonary bypass, repeat procedures, and supportive therapies during the intensive care (extracorporeal membrane oxygenation and mechanical ventilation) were risk factors for blood transfusion. Female sex was associated with a lower risk of transfusion. Perioperative blood transfusion was associated with a 6.87-fold increased risk of in-hospital mortality (odds ratio [OR]: 6.87, 95% confidence interval [CI]: 3.95, 11.93; p < 0.001) and a 3.20-fold increased risk of 1-year all-cause mortality (OR: 3.35, 95% CI: 2.75, 3.93; p < 0.001). Conclusions: Blood transfusion is used at a high rate in cardiovascular surgeries, and it was associated with increases in the risk of in-hospital and 1-year all-cause mortality. However, these correlations should be viewed with caution as emergent phenomena rather than causative. Understanding factors associated with the need for blood transfusion can assist surgeons in predicting the outcomes of cardiovascular surgery and in tailoring procedures as needed to optimize outcomes.

Comparison of mortality and amputation after lower extremity bypass versus peripheral vascular intervention in patients with chronic limb-threatening ischemia and comorbid chronic kidney disease

ObjectiveComorbid chronic kidney disease (CKD) is associated with worse outcomes for patients with chronic limb-threatening ischemia (CLTI). However, comparative effectiveness data are limited for lower extremity bypass (LEB) vs peripheral vascular intervention (PVI) in patients with CLTI and CKD. We aimed to evaluate (1) 30-day all-cause mortality and amputation and (2) 5-year all-cause mortality and amputation for LEB vs PVI in patients with comorbid CKD. MethodsIndividuals who underwent LEB and PVI were queried from the Vascular Quality Initiative with Medicare claims-linked outcomes data. Propensity scores were calculated using 13 variables, and a 1:1 matching method was used. The mortality risk at 30 days and 5 years in LEB vs PVI by CKD was assessed using Kaplan-Meier and Cox proportional hazards models, with interaction terms added for CKD. For amputation, cumulative incidence functions and Fine-Gray models were used to account for the competing risk of death, with interaction terms for CKD added. ResultsOf 4084 patients (2042 per group), the mean age was 71.0 ± 10.8 years, and 69.0% were male. Irrespective of CKD status, 30-day mortality (hazard ratio [HR]: 0.94, 95% confidence interval [CI]: 0.63-1.42, P = .78) was similar for LEB vs PVI, but LEB was associated with a lower risk of 30-day amputation (sub-HR [sHR]: 0.66, 95% CI: 0.44-0.97, P = .04). CKD status, however, did not modify these results. Similarly, LEB vs PVI was associated with a lower risk of 5-year mortality (HR: 0.79, 95% CI: 0.71-0.88, P < .001) but no difference in 5-year amputation (sHR: 1.03, 95% CI: 0.89-1.20, P = .67). CKD status did not modify these results. ConclusionsRegardless of CKD status, patients had a lower risk of 5-year all-cause mortality and 30-day amputation with LEB vs PVI. Results may help inform preference-sensitive treatment decisions on LEB vs PVI for patients with CLTI and CKD, who may commonly be deemed too high risk for surgery.

Handgrip strength and mortality in a cohort of kidney failure patients: Comparative analysis of different normalization methods

BackgroundReduced handgrip strength (HGS) is associated with adverse clinical outcomes. We analyzed and compared associations of HGS with mortality risk in dialysis patients, using different normalization methods of HGS. MethodsHGS and clinical and laboratory parameters were measured in cohort of 446 incident dialysis patients (median age 56 years, 62% males). The area under the receiver-operating characteristic curve (AUC) was used to compare different normalization methods of HGS as predictors of mortality: absolute HGS in kg or HGS normalized to height, weight, or body mass index, or to HGS of a reference population (HGS%). Multivariate linear regression analysis was used to assess HGS predictors. Competing risk regression analysis was used to evaluate 5-year all-cause mortality risk. Differences in survival time between HGS% tertiles were quantitated by analyzing the restricted mean survival time. ResultsAUC for HGS% was higher than AUCs for absolute or normalized HGS values. Compared to the high HGS% tertile, low HGS% (sub-hazard ratio, sHR, 2.36 [95% confidence interval, CI, 1.19 - 3.70]) and middle HGS% (sHR 1.79 [95% CI 1.12 - 2.74]) tertiles were independently associated with higher all-cause mortality and those with high HGS% tertile survived on average 7.95 [95% CI, 3.61 - 12.28] months and 18.99 [95% CI, 14.42 - 23.57] months longer compared with middle and low HGS% tertile, respectively. ConclusionHGS% was a strong predictor of all-cause mortality risk in incident dialysis patients and a better discriminator of survival than absolute HGS or HGS normalized to body size dimensions.

Development and validation of a risk score nomogram model to predict the risk of 5-year all-cause mortality in diabetic patients with hypertension: A study based on NHANES data

BackgroundThe present study aimed to develop and validate a prediction nomogram model for 5-year all-cause mortality in diabetic patients with hypertension. MethodsData were extracted from the National Health and Nutrition Examination Survey (NHANES). A total of 3291 diabetic patients with hypertension in the NHANES cycles for 1999–2014 were selected and randomly assigned at a ratio of 8:2 to the training cohort (n = 2633) and validation cohort (n = 658). Multivariable Cox regression was conducted to establish a visual nomogram model for predicting the risk of 5-year all-cause mortality. Receiver operating characteristic curves and C-indexes were used to evaluate the discriminant ability of the prediction nomogram model for all-cause mortality. Survival curves were created using the Kaplan–Meier method and compared by the log-rank test. ResultsThe nomogram model included eight independent predictors: age, sex, education status, marital status, smoking, serum albumin, blood urea nitrogen, and previous cardiovascular disease. The C-indexes for the model in the training and validation cohorts were 0.76 (95% confidence interval: 0.73–0.79, p < 0.001) and 0.75 (95% confidence interval: 0.69–0.81, p < 0.001), respectively. The calibration curves indicated that the model had satisfactory consistency in the two cohorts. The risk of all-cause mortality gradually increased as the tertiles of the nomogram model score increased (log-rank test, p < 0.001). ConclusionThe newly developed nomogram model, a readily useable and efficient tool to predict the risk of 5-year all-cause mortality in diabetic patients with hypertension, provides a novel risk stratification method for individualized intervention.

Triglyceride-glucose index and triglyceride to high-density lipoprotein cholesterol ratio predict the prognosis in patients with type B aortic dissection receiving thoracic endovascular aortic repair.

The triglyceride-glucose (TyG) index and triglyceride to high-density lipoprotein cholesterol (TG/HDL-c) ratio are both reliable surrogate indicator of insulin resistance and have been shown to be valuable in predicting various cardiovascular diseases. However, few studies have explored its association with the prognosis of type B aortic dissection (TBAD) patients receiving thoracic endovascular aortic repair (TEVAR). A total of 1,425 consecutive patients who underwent TEVAR were included. Data from 935 patients were analyzed in the study. The endpoint was defined as 30-day and 1-year aortic-related adverse events (ARAEs), all-cause mortality, and major adverse cardiovascular and cerebrovascular events (MACCEs). There were 935 patients included during a mean follow-up time of 2.8 years. After adjusting for multiple confounding factors, continuous TG/HDL-c [hazard ratio (HR) =1.07; 95% confidence interval (CI): 1.00-1.15; P=0.041] was independently associated with 1-year all-cause mortality. Both a high (Quintile 5: TG/HDL-c ratio ≥4.11) (HR =4.84; 95% CI: 1.55-15.13; P=0.007) and low TG/HDL-c ratio (Quintile 1: TG/HDL-c ratio <1.44) (HR =4.67; 95% CI: 1.46-14.94; P=0.001) were still independent risk factors for 1-year all-cause mortality. Elevated baseline TG/HDL-c ratio and TG/HDL-c ≥4.11 were significantly related to a higher risk of 1-year all-cause mortality among TBAD patients undergoing TEVAR. At the same time, the low TG/HDL-c ratio was also independently associated with 1-year all-cause mortality. Special attention should be paid to TBAD patients with a higher or an overly low TG/HDL-c ratio.

Predicting the risk of mortality and rehospitalization in heart failure patients: A retrospective cohort study by machine learning approach.

Heart failure (HF) is a global problem, affecting more than 26 million people worldwide. This study evaluated the performance of 10 machine learning (ML) algorithms and chose the best algorithm to predict mortality and readmission of HFpatients by using The Fasa Registry on Systolic HF (FaRSH) database. ML algorithms may better identify patients at increased risk of HF readmission or death with demographic and clinical data. Through comprehensive evaluation, the best-performing model was used for prediction. Finally, all the trained models were applied to the test data, which included 20% of the total data. For the final evaluation and comparison of the models, five metrics were used: accuracy, F1-score, sensitivity, specificity and Area Under Curve (AUC). Ten ML algorithms were evaluated. The CatBoost (CAT) algorithm uses a series of decision tree models to create a nonlinear model, and this CAT algorithm performed the best of the 10 models studied. According to the three final outcomes from this study, which involved 2488 participants, 366 (14.7%) of the patients were readmitted to the hospital, 97 (3.9%) of the patients died within 1 month of the follow-up, and 342 (13.7%) of the patients died within 1 year of the follow-up. The most significant variables to predict the events were length of stay in the hospital, hemoglobin level, and family history of MI. The ML-based risk stratification tool was able to assess the risk of 5-year all-cause mortality and readmission in patients with HF. ML could provide an explicit explanation of individualized risk prediction and give physicians an intuitive understanding of the influence of critical features in the model.

Unveiling the Hidden Burden: Estimating All-Cause Mortality Risk in Older Individuals with Type 2 Diabetes.

The mortality rate among older persons with diabetes has been steadily increasing, resulting in significant health and economic burdens on both society and individuals. The objective of this study is to develop and validate a predictive nomogram for estimating the 5-year all-cause mortality risk in older persons with T2D (T2D). We obtained data from the National Health and Nutrition Survey (NHANES). A random 7 : 3 split was made between the training and validation sets. By linking the national mortality index up until December 31, 2019, we ensured a minimum of 5 years of follow-up to assess all-cause mortality. A nomogram was developed in the training cohort using a logistic regression model as well as a least absolute shrinkage and selection operator (LASSO) regression model for predicting the 5-year risk of all-cause mortality. Finally, the prediction performance of the nomogram is evaluated using several validation methods. We constructed a comprehensive prediction model based on the results of multivariate analysis and LASSO binomial regression. These models were then validated using data from the validation cohort. The final model includes four independent predictors: age, gender, estimated glomerular filtration rate, and white blood cell count. The C-index values for the training and validation cohorts were 0.748 and 0.762, respectively. The calibration curve demonstrates satisfactory consistency between the two cohorts. The newly developed nomogram proves to be a valuable tool in accurately predicting the 5-year all-cause mortality risk among older persons with diabetes, providing crucial information for tailored interventions.

Opioid Prescription and Long-Term Survival Outcomes in Adults: A Nationwide Cohort Study in Korea.

We aimed to investigate the association between short- and long-term opioid use and long-term mortality in Korea. In this population-based retrospective cohort study, data were obtained from the National Health Insurance Service of South Korea. The study included all adult individuals who were prescribed opioids in 2016. The control group comprised adults not prescribed opioids in 2016 selected using a 1:1 stratified random sampling technique. Participants were categorized into three groups: non-user, opioid 1-89 days user (short-term), and opioid ≥ 90 days user (long-term) groups. The primary endpoint in this study was 5-year all-cause mortality, evaluated from January 1, 2017 to December 31, 2021. In total, 4,556,606 adults were included in this study. Of these, 2,070,039 were prescribed opioids at least once. Specifically, 1,592,883 adult individuals were prescribed opioids for 1-89 days, while 477,156 adults were prescribed opioid for ≥ 90 days. In the multivariable Cox regression modelling, the opioid user group had a 28% (hazard ratio [HR], 1.28; 95% confidence interval [95% CI], 1.26-1.29; P < 0.001) higher risk of 5-year all-cause mortality than had the non-user group. Moreover, the opioid 1-89 days and opioid ≥ 90 days user groups had 15% (HR, 1.15; 95% CI, 1.14-1.17; P < 0.001) and 49% (HR, 1.49; 95% CI, 1.47-1.51; P < 0.001) higher risks of 5-year all-cause mortality than had the non-user group, respectively. Both short and long-term opioid prescriptions were associated with increased long-term mortality among the Korean adult population.

Early arteriovenous fistula failure associated with mortality and major adverse cardiovascular events in patients undergoing incident hemodialysis.

Arteriovenous fistula (AVF) patency is important for patients undergoing hemodialysis. The association between early AVF failure and the prognosis, including all-cause mortality and major adverse cardiovascular events (MACE), has not been fully investigated. The present study was performed to investigate the association between early AVF failure and 3-year mortality, cardiovascular disease (CVD) mortality, and MACE. We analyzed 358 patients who started hemodialysis in our institution from October 2008 to February 2020. We defined early AVF failure as cases requiring percutaneous transluminal angioplasty or reoperation within 1 year after AVF surgery. The patients were divided into two groups according to the presence or absence of early AVF failure, and the prognosis of each group was examined. The association between early AVF failure and outcomes (3-year all-cause mortality, CVD mortality, and MACE) was determined using Cox proportional hazards regression analysis. During the 3-year follow-up, 75 (20.9%) patients died (cardiovascular death: n = 39) and 145 patients developed MACE. According to the multivariable analysis, the early AVF failure group had a significantly higher risk of 3-year all-cause mortality (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.09-1.83; p = 0.009), CVD mortality (HR, 1.54; 95% CI, 1.29-2.08; p < 0.001), and MACE (HR, 1.68; 95% CI, 1.25-2.26; p < 0.001). When the patients were stratified by age, early AVF failure was associated with 3-year all-cause mortality in all groups except for the younger group (<65 years of age). Early AVF failure was associated with an increased risk of 3-year all-cause mortality, CVD mortality, and MACE.

Cardiac troponin is a strong prognostic biomarker for patients admitted with heart failure

Abstract Background Cardiac troponin T (cTnT) and I (cTnI) are strong prognostic biomarkers in several diseases and play a key role in risk stratification of patients admitted with cardiac disease. Though viewed as equals, there are substantial differences in the biology and frequency of elevations among non-cardiac illnesses between cTnT and cTnI. A recent study of all comers with a measurement of cTn showed that the risk of mortality was highest for patients with low grade elevations of cTn, while high concentrations were associated with a paradoxical decrease in the risk. We aimed to investigate whether this pattern exists among patients with heart failure. Purpose To compare the prognostic ability of cTnT and cTnI among patients admitted with heart failure. Methods This nationwide cohort study includes patients admitted with heart failure who had cTn measurements from 2009-2022 using one of five different cTn assays: Roche high-sensitivity cTnT (hs-cTnT), Abbott Alinity high sensitivity cTnI (hs-cTnI), Siemens Vista Hs-cTnI, Siemens Atellica hs-cTnI and Beckman-Coulter hs-cTnI. We selected the peak concentration of cTn on admission and grouped patients into those with measurements of cTnI and those with cTnT. The primary outcome was all-cause mortality. We divided the peak cTn concentrations into groups based on the bands of concentrations of cTn from &amp;lt;1 times the 99th percentile, 1-2, 2-5, 5-100 and &amp;gt;100 times the 99th percentile and compared cumulative mortality using Kaplan-Meier analysis and the risk of mortality for each group using logistic regression for the 30-day mortality. Results A total of 9,344 patients were included in this study with a median age of 75 years (65-83) and 5,613 (60%) were males. Of these, 2,874 (31%) had a history of heart failure and 2,349 (25%) had a history of ischemic heart disease. When grouping for type of cTn used, there were more patients treated using hs-cTnT (n = 7,131 76%) than hs-cTnI (n = 2,213, 24%). The median age of patients treated who had a measurement of cTnI was slightly higher; 77 years (IQR 67-84) vs cTnT 74 years (64-83) p&amp;lt;0.001. Of the 9,344 patients, 1,096 (12%) died within 30 days of admission. Figure 1 shows the absolute risk of 1-year all-cause mortality for each band of cTn concentration for (panel A) hs-cTnI and (panel B) hs-cTnT. This showed an increase in the risk of mortality for patients up to 2-5 times the 99th percentile for cTnI and 5-100 times the 99th percentile for cTnT. Figure 2 shows the risk of 30-day mortality for patients for each concentration of cTn. There was a much higher risk of mortality associated with elevation of cTnT than cTnI for all bands of concentration. Conclusion Though both cTnI and cTnT are strong prognostic markers of mortality among patients admitted with heart failure, cTnT seemed to be the strongest prognostic marker. The risk of mortality increased with concentration of cTnT up to very high concentrations of &amp;gt;5 times the 99th percentile.Figure 1Figure 2

Treatments associated with all-cause mortality among children with primary brain and central nervous system tumors: a retrospective cohort study from the SEER database.

Evidence on treatment modalities and survival in childhood primary brain and central nervous system (CNS) tumors remains contradictory, with previous studies often lacking sufficient patient cohort sizes to assess the differences in histological subtypes. This cohort study based on a large population investigated the effects of various treatments on the mortality of patients with different histological types of primary brain and CNS tumors from the Surveillance, Epidemiology, and End Results (SEER) database. Data of demography, primary tumor site, histology, tumor grade and treatments from all pediatric patients with primary brain and CNS tumors were extracted in this retrospective cohort. The outcomes were overall, 1-, 5-, and 10-year all-cause mortality. Multivariate Cox proportional hazards models were to explore the associations of treatment with overall, 1-, 5-, and 10-year all-cause mortality, with hazard ratios (HRs) and 95% confidence intervals (CIs). Totally 10,994 children were included, with the mean age at diagnosis of 7.3 years, and the median follow-up time of 5.0 years. Of which, 2,003 (18.2%) were diffuse astrocytoma, 3,188 (29.0%) were embryonal tumors, and 3,691 (33.5%) were malignant glioma. Then 4,333 (39.41%) children died during the follow-up. For diffuse astrocytomas and malignant gliomas, patients who received all other treatments were associated with overall, 1-, 5- and 10-year all-cause mortality compared to those only received resection. Embryonal tumors patients receiving resection with radiation only and those receiving resection with both chemotherapy and radiation were associated with lower odds of overall, 1-, 5- and 10-year all-cause mortality compared to patients who only received resection. For ependymal tumors, no surgery/only biopsy with chemotherapy, resection with chemotherapy only, resection with both chemotherapy and radiation, and other treatments had increased risks of overall all-cause mortality compared with resection. The risk of 1-year all-cause mortality increased in ependymal tumors with treatment involving resection and radiation. However, resection with both chemotherapy and radiation was not significantly associated with the 1- nor 5-year all-cause mortality. Resection may be recommended for children with diffuse astrocytoma, ependymal tumors, and malignant glioma, while resection with radiotherapy or chemoradiation may be recommended for children with embryonal tumors.

Association of atrial fibrillation with survival in patients with low-flow low-gradient aortic stenosis with preserved ejection fraction undergoing TAVI.

There is limited evidence on the prognostic significance of atrial fibrillation (AF) in patients with low flow, low gradient aortic stenosis with preserved ejection fraction (LFLG-pEF AS). We aimed to evaluate the recovery of stroke volume after transcatheter aortic valve implantation (TAVI) and clinical outcomes in patients with LFLG-pEF AS stratified by presence or absence of AF. In a prospective TAVI registry, patients with preserved left ventricular ejection fraction (LVEF≥50%) were stratified according to flow-gradient status and presence of AF. Among 2259 TAVI patients with preserved LVEF between August 2007 and June 2021, 765 had high-gradient AS (HG AS) and 444 had LFLG-pEF AS. AF was observed in 199 patients with HG AS (26.0%) and 190 patients with LFLG-pEF AS (42.8%). At 1 year, SVi was significantly improved in LFLG-pEF AS patients without AF, while SVi remained low in patients with AF (from 25.9±8.5mL/m2 to 37.2±9.9mL/m2 and from 26.8±5.1mL/m2 to 26.1±9.1mL/m2, respectively). LFLG-pEF AS patients with AF had an increased risk of 1-year all-cause mortality compared with those without AF (HRadjusted 2.57; 95% CI 1.44-4.59). LFLG-pEF AS patients without AF had similar mortality compared with HG AS patients without AF (HRadjusted 0.85; 95% CI 0.49-1.46). Patients with LFLG-pEF AS and AF experienced no relevant recovery of stroke volume after TAVI, but a more than two-fold increased risk of death compared to patients with HG AS or LFLG-pEF AS without AF. Clinical Trial Registration: https://www.clinicaltrials.gov. NCT01368250.

Ability of the DANCAMI to predict the risk ischemic stroke and mortality in patients with atrial fibrillation/flutter

ObjectivesComparison of the danish comorbidity index for acute myocardial infarction (DANCAMI), the charlson comorbidity index (CCI), the elixhauser comorbidity index (ECI), and the CHA2DS2-VASc score to predict ischemic stroke, cardiovascular mortality, and all-cause mortality after atrial fibrillation/flutter. Materials and MethodsA population-based cohort study of all Danish patients with incident atrial fibrillation/flutter during 2000–2020 (n=361,901). C-Statistics were used to evaluate the discriminatory performance for predicting 1 and 5-year risks of the outcomes for a baseline model (including age and sex) +/- the individual indices. ResultsFor the DANCAMI, the 5-year risk did not increase with comorbidity burden for ischemic stroke (5.9% for low vs. 5.6% for severe) but did increase for cardiovascular mortality (10% for low vs. 16% for severe) and all-cause mortality (33% for low vs. 61% for severe). C-Statistics for predicting 5-year ischemic stroke risk were similar for all models (0.64). C-Statistics for predicting 5-year cardiovascular mortality risk were also similar for the baseline (0.76), the DANCAMI (0.77), the CCI (0.76), the ECI (0.76), and the CHA2DS2-VASc (0.76) models. C-Statistics for predicting 5-year all-cause mortality risk were lower for the baseline (0.71) and the CHA2DS2-VASc (0.71) models than for the DANCAMI (0.75), the CCI (0.74), and the ECI (0.74) models. The 1-year C-Statistics were comparable. ConclusionThe DANCAMI predicted ischemic stroke and cardiovascular mortality risks similar to the CCI, the ECI, and the CHA2DS2-VASc. The DANCAMI predicted all-cause mortality risk similar to the CCI and the ECI, but better than the baseline and the CHA2DS2-VASc.

The prognostic nutritional index predicts all-cause mortality in critically ill patients with acute myocardial infarction

BackgroundMalnutrition is common in patients with acute myocardial infarction (AMI) and is associated with a poor prognosis. The prognostic value of the prognostic nutritional index (PNI) in patients with AMI remains controversial. We aimed to explore the relationship between PNI and all-cause mortality in critically ill patients with AMI and evaluate the incremental prognostic value of PNI to commonly used prognostic assessment tools.MethodsThe Medical Information Mart for Intensive Care-IV (MIMIC-IV) database was used to conduct a retrospective cohort analysis on 1180 critically ill patients with AMI. The primary endpoints were defined as 6-month and 1-year all-cause mortality. Cox regression analysis was used to investigate the relationship between admission PNI and all-cause mortality. The effect of adding PNI to sequential organ failure assessment (SOFA) score, or charlson comorbidity index (CCI) on its discriminative ability was assessed using C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).ResultsMultivariate cox regression analysis demonstrated that the low PNI was regarded as an independent predictor of 1-year all-cause mortality in AMI patients admitted to ICU (adjusted Hazard Ratio: 95% CI = 1.75 (1.22–2.49)). The ROC test showed that admission PNI had a moderate predictive ability to predict all-cause mortality of critically ill patients with AMI. Furthermore, the net reclassification and integrated discrimination of the CCI alone model improved significantly with PNI. [C-statistic increased from 0.669 to 0.752, p < 0.001; NRI = 0.698, p < 0.001; IDI = 0.073, p < 0.001]. When PNI was added to the SOFA score, the C-statistic significantly improved from 0.770 to 0.805 (p < 0.001), and the NRI and IDI were estimated at 0.573 (p < 0.001) and 0.041 (p < 0.001), respectively.ConclusionPNI could be a novel predictor for identifying patients at high risk of 1-year all-cause mortality in critically ill patients with AMI. The addition of PNI to the SOFA score or CCI may be useful for very early risk stratification.

D-DIMER AS AN ASSOCIATED FACTOR FOR LONG-TERM MORTALITY IN PATIENTS WITH ACUTE SEVERE HYPERTENSION

Objective: D-dimer, which serve as a marker of thrombotic events, was associated with poor outcome in various cardiovascular disease. However, there are no study on its prognostic implication in acute severe hypertension. This study aimed to investigate the association between D-dimer and long-term mortality in patients with acute severe hypertension visiting the emergency department. Design and method: This observational study included patients with acute severe hypertension who visited emergency department between 2016 and 2019. Acute severe hypertension was defined as systolic blood pressure &gt; = 180 mmHg or diastolic blood pressure &gt; = 100 mmHg. Among the 10219 patient, 4203 patients who performed assay for D-dimer were analyzed. Patients were categorized into tertiles according to D-dimer levels upon admission to the emergency department. Results: Among the 4203 patients with acute severe hypertension, 3.2% in the first (lowest) tertile, 17.7% in the second tertile, and 44.8% in the third (highest) tertile of D-dimer died up to 3-years. After adjusting for confounding variables, third tertile of D-dimer group (hazard ratio 8.105; 95% confidence interval, 5.799–11.327) and second tertile of D-dimer group (hazard ratio 3.234; 95% confidence interval, 2.298–4.550) showed significantly higher risk of 3-year all-cause mortality than first tertile of D-dimer group. Conclusions: D-dimer may be a useful marker for identifying high-risk group at risk of mortality in patients with acute severe hypertension visiting emergency department.

Use of 5α-reductase inhibitors and survival of oesophageal and gastric cancer in a nationwide Swedish cohort study

Background We hypothesised that the use of the anti-androgenic drug 5α-reductase inhibitors (5-ARIs) improves survival in patients with oesophago-gastric cancer. Methods This nationwide Swedish population-based cohort study included men who underwent surgery for oesophageal or gastric cancer between 2006-2015, with follow-up until the end of 2020. Multivariable Cox regression estimated hazard ratios (HR) for associations between 5-ARIs use and 5-year all-cause mortality (main outcome) and 5-year disease-specific mortality (secondary outcome). The HR was adjusted for age, comorbidity, education, calendar year, neoadjuvant chemo(radio)therapy, tumour stage, and resection margin status. Results Among 1769 patients with oesophago-gastric cancer, 64 (3.6%) were users of 5-ARIs. Compared to non-users, users of 5-ARIs were not at any decreased risk of 5-year all-cause mortality (adjusted HR 1.13, 95% CI 0.79-1.63) or 5-year disease-specific mortality (adjusted HR 1.10, 95% CI 0.79-1.52). Use of 5-ARIs was not associated with any decreased risk of 5-year all-cause mortality in subgroup analyses stratified by categories of age, comorbidity, tumour stage, or tumour subtype (oesophageal or cardia adenocarcinoma, non-cardia gastric adenocarcinoma, or oesophageal squamous cell carcinoma). Conclusion This study did not support the hypothesis of improved survival among users of 5-ARIs after curatively intended treatment for oesophago-gastric cancer.

Lifestyle factors and long-term survival in patients with chronic non-cancer pain: a nationwide cohort study in South Korea.

This study aimed to investigate the association of modifiable lifestyle factors with long-term survival outcomes in patients with chronic non-cancer pain (CNCP) in South Korea. This population-based cohort study used data from the National Health Insurance Service database in South Korea. We considered three lifestyle factors from the standard health examination (smoking status, alcohol consumption, and physical activity). A total of 1,298,314 patients with CNCP were analyzed; moreover, the 5-year all-cause mortality rate was 3.3% (42,875 patients). In the multivariable Cox regression model, in the previous-smoker and current-smoker groups, it was 5% (hazard ratio [HR]:1.05, 95% confidence interval [CI]:1.02-1.08; P = 0.003) and 65% (HR: 1.65, 95% CI: 1.60-1.69; P < 0.001) higher, respectively, than that in the never-smoker group. The 5-year all-cause mortality was 19% (HR: 1.19, 95% CI: 1.14-1.24; P < 0.001) higher in the heavy-alcohol-consumption group than in the non-alcohol-consumption group. Compared with those without mild physical activity, patients who engaged in mild physical activity for 1-3 (HR: 0.89, 95% CI: 0.87-0.92; P < 0.001), 4-5 (HR: 0.88, 95% CI: 0.86-0.91; P < 0.001), and 6-7 (HR: 0.90, 95% CI: 0.88-0.93; P < 0.001) days per week exhibited a significantly decreased 5-year all-cause mortality. The association between moderate/intensive physical activity and 5-year all-cause mortality yielded similar results. Lifestyle factors, including previous/current smoking, heavy alcohol consumption, and physical activity, were associated with a higher 5-year all-cause mortality risk among patients with CNCP in South Korea.

J-shaped association of free triiodothyronine to free thyroxine ratio with 5-year mortality among patients with chronic kidney disease: a prospective cohort study.

To investigate the association of free triiodothyronine to free thyroxine (FT3/FT4) ratio with 5-year mortality in patients with chronic kidney disease (CKD) using data from the National Health and Nutrition Examination Survey (NHANES) through 2001-2002 and 2007-2012. Two thousand four hundred twenty-four patients with CKD stage 1-5 were included. Patients' baseline characteristics were collected. Cox proportional hazards models were used to investigate the association of FT3/FT4 ratio with 5-year all-cause and cardiovascular mortality. Subgroup analysis was performed. Within 5years of follow-up duration, 425 (17.53%) deaths were recorded, and 154 patients died from cardiovascular disease. A J-shaped association between FT3/FT4 ratio and 5-year mortality was observed. After fully adjustment, the elevated FT3/FT4 ratio was significantly associated with a decreased 5-year all-cause mortality risk (HR: 0.79, 95% CI 0.63-0.99) among patients with CKD stage 1-5 when FT3/FT4 ratio < 4.71, and is significantly associated with an increased 5-year all-cause mortality risk in CKD patients with advanced CKD stages or low UACR when FT3/FT4 ratio ≥ 4.71 (HR: 2.74, 95% CI 1.20-6.29; HR: 3.09, 95% CI 1.12-8.57, respectively). The elevated FT3/FT4 ratio also showed a J-shaped association with the 5-year cardiovascular mortality which disappears after fully adjustment. The FT3/FT4 ratio is closely associated with 5-year mortality risk among patients with CKD, indicating a potential role of FT3/FT4 ratio as a biomarker for mortality prediction in CKD patients.

NT-proBNP trajectory after transcatheter aortic valve replacement and its association with 5-year clinical outcomes.

There are only limited reports on the trends of NT-proBNP after transcatheter aortic valve replacement (TAVR) in aortic stenosis (AS) and even fewer report on the prognostic value of the NT-proBNP trajectory following TAVR. This study aims to investigate short-term NT-proBNP trajectory following TAVR and explore its association with clinical outcomes in TAVR recipients. Aortic stenosis patients undergoing TAVR were included if they had NT-proBNP levels recorded at baseline, prior to discharge, and within 30 days after TAVR. We used latent class trajectory models to identify NT-proBNP trajectories based on their trends over time. Three distinct NT-proBNP trajectories were identified from 798 TAVR recipients, which were named class 1 (N = 661), class 2 (N = 102), and class 3 (N = 35). Compared to those with trajectory class 1, patients with trajectory class 2 had a more than 2.3-fold risk of 5-year all-cause death and 3.4-fold risk of cardiac death, while patients with trajectory class 3 had a more than 6.6-fold risk of all-cause death and 8.8-fold risk of cardiac death. By contrast, the groups had no differences in 5-year hospitalization rates. In multivariable analyses, the risk of 5-year all-cause mortality was significantly higher in patients with trajectory class 2 (HR 1.90, 95% CI 1.03-3.52, P = 0.04) and class 3 (HR 5.70, 95% CI 2.45-13.23, P < 0.01). Our findings implied different short-term evolution of NT-proBNP levels in TAVR recipients and its prognostic value for AS patients following TAVR. NT-proBNP trajectory may have further prognostic value, in addition to its baseline level. This may aid clinicians with regards to patient selection and risk prediction in TAVR recipients.